0:00

Hi everybody Cheryl

0:02

Atkinson here. I hope

0:04

you enjoy this special

0:06

from the archives edition

0:09

of Full Measure After Hours.

0:11

Hi everybody Cheryl

0:14

Atkinson here. Welcome to

0:16

another edition of Full

0:18

Measure After Hours. Today,

0:20

what's behind the long

0:22

wait times to see

0:24

the doctor? I'll

0:28

bet a whole lot of you

0:30

listening have experienced what we're talking

0:32

about today, excruciatingly long wait times

0:35

to see the doctor for maybe

0:37

a basic checkup, maybe to establish

0:39

a new doctor, or even for

0:42

important surgery. What exactly is going

0:44

on? After Obamacare, we were promised

0:47

everything with our health care system

0:49

would be better. And while it's

0:51

true that more people now have

0:54

insurance coverage as a result, America's

0:56

total health bill has

0:58

skyrocketed. We are paying more in

1:01

premiums, but also through invisible

1:03

costs, such as taxpayers paying

1:05

for all the people getting

1:08

subsidized on insurance. Yes, some

1:10

of them are paying a reduced amount,

1:12

but we're all picking up the

1:14

slack. We also have to pay

1:16

more for Medicare and Medicaid, that's

1:19

insurance for the poor and

1:21

the elderly. It may seem like things

1:23

are somewhat affordable in the moment because

1:25

when you pay out of pocket that

1:27

amount may not seem too bad, but

1:29

we're getting hit in a way that's

1:31

bigger than ever when you're talking about

1:33

total costs that we're covering in other

1:36

ways. And in the meantime, with

1:38

more people having insurance and us

1:40

paying more than ever, people are getting

1:42

sicker and sicker with all kinds

1:44

of chronic disorders, more people are trying

1:46

to see the doctor and finding

1:48

they can't get a timely appointment.

1:50

It's reached crisis proportions in

1:53

some cities. Here are a few

1:55

stats, according to surveys. The average

1:57

wait time for new patient appointments

1:59

and... 2004, way back then it

2:01

was widely considered unacceptably long. It

2:04

was just over four weeks. But

2:06

by 2022, the last date they have

2:08

figures for this, the weight had grown

2:10

a full week longer. Now, the average

2:12

weight for a new patient appointment had

2:14

grown to five weeks and a day,

2:16

or 26 days. But that's hardly the

2:18

worst of it. For a heart check

2:20

up with a cardiologist,

2:22

hope nothing's wrong with you, because

2:24

you could find yourself waiting as

2:26

long as... four and a half

2:29

to five months in Washington DC

2:31

and Houston, Texas, you could wait about

2:33

five and a half months in Seattle,

2:35

Washington, same in Miami, Florida, and

2:37

Atlanta, Georgia, and you might be

2:40

waiting nine and a half months

2:42

in New York City for a

2:44

heart checkup with a cardiologist.

2:46

In Atlanta, Georgia, the longest

2:48

wait time for a basic

2:50

women's gyological exam jumped from

2:52

about 2.3 months in 2004 to

2:55

nearly eight months in 2022. Hope you're

2:57

not suffering anything serious when

2:59

you're waiting for that

3:01

gynecological exam. In Portland, Oregon,

3:03

to check for possible skin cancer

3:06

with a dermatologist, the longest wait

3:08

time went up from about 2.3

3:10

months back in 2004 to 10 months

3:13

in 2022. And in San Diego, California,

3:15

just try to get an appointment

3:17

with an orthopedic surgeon for a

3:19

knee injury. You're going to be

3:21

in pain for a long time.

3:23

In 2004, you could find yourself

3:25

waiting about... 1.6 months, but in

3:27

2022, that wait time skyrocketed to

3:29

more than 11 months. Imagine waiting

3:32

about a year to get an

3:34

appointment with an orthopedic surgeon for

3:36

a knee injury. In today's podcast,

3:38

we're going to get some insight

3:40

into all of that. With a

3:43

physician and professor at Harvard Medical

3:45

School, he also takes care of

3:47

patients at the Beth Israel

3:49

Deaconess Medical Center. He is

3:52

Dr. Ativ Morotra. He studied this

3:54

issue and has some great insight into

3:56

what's happening to our health care system

3:58

and maybe what we... could do about

4:01

it. Here's Dr. Marotra. I

4:03

mean I think that the US health

4:05

care system is going through a lot

4:07

of change right now and I think

4:09

that the patients unfortunately are suffering

4:11

from that and some of those

4:14

changes are positive. We're really seeing

4:16

how technology can be used to

4:18

really transform how people get care

4:20

and we're Before it was always

4:22

this theoretical idea in the future,

4:24

but now most Americans through telemedicine

4:26

and portals and other things are

4:29

actually seeing that, that their day-to-day

4:31

experience getting care is changing. But

4:33

at the same time, we're also

4:35

seeing some trends that are really

4:37

disturbing in terms of consolidation in

4:39

the health care system, private equity,

4:41

buying hospitals and practices, and I

4:43

think people don't feel like they're

4:45

getting the same care that they

4:47

used to. And I think that's

4:50

a source of understandably great frustration

4:52

for the average American and also

4:54

the wait time thing we're about to talk about.

4:56

What is that you have looked at

4:58

and studied? Yeah, most of my

5:00

work has been on the digital

5:02

health transformation in the United States

5:04

and both what's happening, what are

5:06

the new ways that people are

5:09

getting care, what has been the

5:11

impact of that in terms of

5:13

quality, spending, access to care, who's

5:15

actually receiving this new form of

5:17

health care? I feel like it's almost

5:19

a time from the past to be

5:22

able to... say, hey, I needed to see

5:24

my doctor and got in to see him

5:26

today or the next day or on a

5:28

timely basis. So many people are saying they're

5:31

having trouble getting basic appointments or even to

5:33

see specialists. That's a whole new ball game.

5:35

Yeah, and I think you touched, you

5:37

hit upon a really important issue. Both

5:39

seeing your regular doctor, your primary care

5:41

doctor, Americans increasingly are having difficulty getting

5:44

in in a timely manner today, tomorrow,

5:46

as well as specialty weight times. Those

5:48

have gone up quite a bit over

5:50

the last decade or so. And so

5:52

what you're describing from, and I hear

5:54

from my friends and family also, why

5:57

does it take so long to get

5:59

to see? to see a doctor or

6:01

schedule an appointment. Not all that long

6:03

ago, we heard stories about this in

6:05

other countries. We would say, oh, the

6:07

Canadians are coming here for health care

6:09

because they have to wait so long

6:11

to see a doctor. They have to

6:13

wait months and months or a year

6:15

for a surgery. It now feels like

6:17

we're approaching something like that. Can you say

6:19

why this is happening or explain some

6:22

of the factors behind it? Yeah,

6:24

so first I think you're correct.

6:26

And when people have done surveys

6:28

of... people in different industrialized nations.

6:30

It is what we're describing, the

6:32

average American in terms of getting

6:34

into their regular doctor in a

6:36

timely manner, has about the same

6:38

difficulty as in other industrialized nations

6:40

or in some cases it's worse

6:42

here in the United States. So

6:44

I think just to echo what

6:46

you're saying. I mean in terms

6:48

of what's driving this. There's obviously

6:51

at its heart a supply demand

6:53

issue with the supply of physicians

6:55

the United States has been about

6:57

per capita has been stagnant or

6:59

gone up just a little bit

7:01

but the demand for health care

7:04

has gone up Some of that is

7:06

because our population is aging and an

7:08

older adult needs more health care on

7:10

average than a younger adult or a

7:13

child Another aspect of this is

7:15

the we in the United States have

7:17

made a big push to expanding insurance

7:19

And so now when you have insurance,

7:21

you can go get care. So that

7:24

means more Americans can actually go and

7:26

get care, which is good, but that

7:28

increases demand. And also maybe something

7:30

that people don't recognize as much

7:32

as the style of health care

7:34

has changed. And what I mean

7:36

by that is what we would

7:38

have previously just had your primary

7:41

care doctor handle, increasingly we have

7:43

a specialist handle. One study found

7:45

that if over a decade, the

7:47

fraction of primary care appointments where

7:49

the primary care doctor referred to

7:51

a specialist more than doubled. Well,

7:54

that means a large amount of

7:56

demand out there in terms of

7:58

more specialty needs. And that again,

8:01

as some of it is driven by

8:03

the complexity of health care. It's getting,

8:05

there's so much to know and how

8:07

can the average primary care doctor know

8:10

all the nuances under many conditions. And

8:12

I also think that's on the patient

8:14

side, where previously they might have

8:16

been okay having their primary care

8:18

doctor handle a problem, but now

8:21

there's an expectation, no, no, I'm

8:23

going to go see a specialist

8:25

for that problem. And so that's

8:27

also driving that increased demand for

8:29

that. you know, largely contributing to

8:31

the problem we're describing. From

8:34

the patient's viewpoint, do you

8:36

have any stats or has

8:38

someone collected facts over time that

8:40

shows how long waits for a typical

8:42

appointment used to be compared to what

8:44

we're facing today? Yeah, there are some

8:47

numbers. Merritt Hawkins, for example, does a

8:49

secret shopper study every couple years and

8:51

what they're describing and then they do

8:53

that in different markets in the United

8:55

States for some... you know, I have

8:58

a knee problem, I got a rash,

9:00

I got to go in. And what

9:02

they're documenting in those secret shopper studies

9:04

is a substantial increase if I remember

9:07

exactly. It's about a 35% increase in

9:09

the wait time to get an appointment

9:11

in the United States. Another trend I've

9:13

noticed and I've heard from other people

9:15

as well, they're places that won't even

9:18

take appointments. They're so booked out

9:20

into the future and I know Mayo Clinic

9:22

have this issue because we called to try

9:24

to get an appointment for something and they

9:26

said not only Can we not get you

9:29

now? We can't put you on the

9:31

waiting list and don't even call in

9:33

six months because that's too soon.

9:35

That's sort of like it starts

9:37

to feel like crisis proportions in terms

9:39

of when do we know we've

9:41

reached something that someone takes some

9:43

kind of action to take care of

9:46

or try to fix? Yeah. And I think that

9:48

is, you know, where I hear it most is

9:50

a person moves to a new town. They need

9:52

to get a new primary care doc and they

9:54

start calling around. And so many of the primary

9:57

care practices say we're close to new patients. And

9:59

that is it. source of enormous frustration

10:01

and then you go to your

10:03

insurance book and you look at the

10:05

different primary care doctors listed but many

10:07

of them are full and I think

10:10

that really highlights you know the difficulty

10:12

here. But I also want to bring

10:14

up another complexity why it's not just

10:16

about the supply of physicians because if

10:18

that was the case then we would

10:20

go around the country and in areas

10:22

of the country where there are a

10:24

lot more physicians per capita. For example,

10:26

where I live in Boston, Massachusetts,

10:28

or New York City, or Florida,

10:30

where we have more doctors per

10:33

capita, we would expect in those

10:35

areas of the country, it would

10:37

be pretty easy to get into

10:39

a doctor, and in other areas of

10:41

the country, that have fewer physicians, it

10:43

would be much harder. And that's

10:45

not what we see. We see

10:47

across the country, even in those

10:49

areas that have more physicians per capita,

10:51

we see more, you know. terrible

10:53

wait times, again, for example, where

10:55

I live in Boston. So I think

10:58

it also, I just wanted to emphasize

11:00

that point, and one of the other

11:03

complexities here is style, and that

11:05

different regions of the country have

11:07

different propensity to make a

11:09

referral or how they practice. For

11:11

example, if I'm a cardiologist, how

11:13

often do I have my patients come

11:15

back? that's going to vary from doctor

11:17

to doctor and from region of the

11:19

region of the country to another region

11:21

of the country. So I think I

11:23

just wanted to bring that up because it

11:25

just getting more doctors in the market

11:28

will help, but we also have to

11:30

address this difference in style and how

11:32

medicine is practiced in different parts of

11:34

the country because that also plays a

11:36

role in the wait times that patients

11:38

are suffering from. Who teaches doctors the

11:40

style? I mean, I'm sure some of it

11:43

is developed through their own practice and experience,

11:45

but there must be something, if this is

11:47

kind of happening across the country with

11:49

a lot of doctors, where is this

11:51

coming from that maybe they're bringing the

11:53

same patients back more often or the

11:55

patients need to come back more often

11:57

and there's not room for new patients?

12:00

I mean, I think this is a bit

12:02

of a dirty secret. There is no, in

12:04

medical school, there's never a lecture

12:07

on when you have a patient with

12:09

high blood pressure, how often do you

12:11

bring them back? You develop a style

12:14

or a sort of practice pattern by

12:16

where you trained. So you see when you're

12:18

in residency, for example, you see that

12:20

your preceptor says bring them back in

12:23

a month or three months and then

12:25

you adopt that style and slightly adjust

12:27

it as you go on into practice.

12:29

So I think that plays a substantial

12:32

role in there. And I think there

12:34

has been one way to potentially improve

12:36

specialty access and some health systems are

12:38

trying this as saying to their specialty

12:41

physicians. You've been seeing this patient once

12:43

a year for the last five years.

12:45

everything's pretty stable, send them back

12:47

to the primary care doc, and

12:49

that'll open up a new slot for

12:52

a new patient. So addressing that style,

12:54

sort of pushing back, because as a

12:56

doctor it's very, and I understand

12:58

it, that when I see a patient, I'll see

13:00

you back next year, Cheryl. And,

13:02

but maybe sometimes it's better to

13:04

say, you're doing really well. If

13:06

there's an issue, call me. but I

13:08

don't need to see you. And trying to

13:11

make that more, I take care of the

13:13

problem and then they move back to the

13:15

primary care doc. And that's another interesting way

13:17

that people are trying to increase specialty access.

13:19

Now, if you don't have thoughts on this,

13:22

no problem, but my dad who's a doctor

13:24

called it the diagnostic pipeline, and some of

13:26

this is insurance driven, and some of it

13:29

is just driven by technology that we have

13:31

available, that people go to the doctor now,

13:33

and they're, even if there's nothing seriously

13:35

wrong with them. Maybe they're put

13:38

through a battery of tests

13:40

that require follow-ups and new

13:42

appointments and appointments to do

13:44

technological things to check this

13:46

or that. Do you think that's a factor

13:48

in this? I think you really touched upon

13:51

a really important point that when

13:53

you, it seems so natural to

13:55

get a test and in modern

13:57

medicine tests such as laboratory tests,

13:59

x-ray. CT scans, MRIs, all the things

14:01

we have available to us, play such

14:04

a valuable role. But one of the things

14:06

that we don't think a lot about

14:08

and maybe don't focus as much as

14:10

we should in the in medicine is

14:12

the cascade event effect of those tests. So

14:14

you get one test, it's a little

14:16

abnormal, for example, just give you an

14:19

example to take it to an extreme.

14:21

A person comes to me and some

14:23

doctors will do a yearly urinalysis. Well,

14:25

maybe the protein level is a little

14:27

high. Maybe I'll do a follow-up test

14:29

and just see what's going on. Oh,

14:31

the protein level is a little bit

14:34

higher. I'm going to do a CT

14:36

scan of looking at what's going on

14:38

in the kidneys. Maybe there's something a

14:40

little funny going on in those kidneys.

14:42

Maybe I need to do a biopsy

14:44

of that. That's an example of that

14:47

cascade where there were a lot

14:49

of appointments there. that used

14:51

up valuable physician resources, as well as

14:53

in the end didn't really help the

14:55

patient. So being more judicious in our

14:57

testing because of that cascade effect is

14:59

a really important issue. And I don't

15:02

think it gets the attention that we

15:04

really need to. There has been more

15:06

and more research on that cascade effect,

15:08

but it's something that we really need

15:10

to consider. Now I do want to

15:12

emphasize these tests are very valuable in

15:15

some cases. It's just being a bit

15:17

more judicious in when it's really important

15:19

to get that test. and maybe not

15:21

overusing those tests because of

15:24

the issue we're describing. I

15:26

take your point about the aging

15:28

of America and people living

15:31

longer and needing more care.

15:33

It also seems to me just

15:35

anecdotally that young

15:37

people are sicker now. There's

15:39

a lot of chronic illnesses,

15:42

whether we're talking about, you know,

15:44

bowel disorders, crones,

15:46

juvenile diabetes. the

15:48

allergies, that sort of thing. So have you looked

15:50

at it? Do you know of anyone

15:52

who's looked at the impact that not

15:54

just older people are having on seeing

15:56

the doctors more often, but are we

15:58

sicker as a society? than we used

16:01

to be? I think the place that

16:03

there's been the most attention

16:05

to that is in the

16:07

area of mental illness where

16:09

year over year more and

16:11

more patients are seeking mental

16:13

health treatment and that has

16:15

been a real positive. We

16:18

have really decreased the stigma

16:20

about saying I have depression

16:22

or I have anxiety or

16:24

whatever other mental disorder is

16:26

that there is and that

16:28

has... I think in a

16:30

very positive change in our

16:32

society. On the other hand,

16:34

because on average an adult in the

16:36

United States is more likely

16:38

to go get care, that has

16:40

put a tremendous amount of strain

16:42

on our mental health specialty. clinicians

16:44

and more maybe more than almost

16:46

any other area in particular in

16:48

the pandemic. We've heard so many

16:50

people struggling, their children are struggling,

16:53

their loved ones are struggling, and

16:55

they just can't get in to

16:57

see somebody. And I think that

16:59

is reflective of some of the

17:01

societal changes we've seen in the

17:03

mental health area. Whose job do you see

17:05

it as being the fix, sort of putting

17:08

their finger on the pulse of all

17:10

this and trying to implement some kind

17:12

of solution? There

17:15

are in terms of solutions for

17:17

this problem. I think there are a

17:19

bunch of them that we could people,

17:21

there's going to be no one single

17:23

fix on this issue. And some of

17:26

it is going to be on the

17:28

health care system, individual,

17:30

doctor's offices, health systems

17:32

to implement changes. And some of

17:35

it is going to be larger

17:37

policy issues. And I'll kind of

17:39

touch upon a couple of those.

17:41

And we can on the. clinician

17:43

side there's an interesting

17:45

paradox which is let's say

17:48

I've used the example of a

17:50

cardiologist and it's a very

17:52

valuable resource it's taking months for

17:54

people to come in but on the

17:56

other hand when you go to the

17:59

their average day, many of those

18:01

appointments don't go filled because of

18:03

no shows because people schedule

18:05

appointments months and months ahead

18:08

of time and for a variety

18:10

of reasons, life happens, they

18:12

forget and they don't cancel the

18:14

appointment and so you have

18:16

this really paradoxical situation where some

18:18

of those resources are not

18:20

used effectively. So one of

18:23

the things that some health systems are

18:25

trying to do, and I encourage more

18:27

to do so, is how do you

18:29

improve the scheduling system, reminders, and how

18:31

people make those appointments so that we

18:33

can better take advantage of that, and

18:35

so we don't have so many free

18:38

slots going unused. In some doctors, what

18:40

they'll do is double book or triple

18:42

book, just because they assume some people

18:44

don't show up, but then when everyone

18:46

shows up, then people wait, and it's

18:48

a very frustrating situation. Another

18:50

aspect of this which is that I've

18:53

been really intrigued with is a thing

18:55

called e-consults. And what that means is

18:57

that so many times when you go to

18:59

a primary care doc and say there's a

19:02

rash, and the doctor's not sure exactly what's

19:04

going on, right now they would say to

19:06

you, why don't you, I'll make a

19:08

referral to a dermatologist and you'll

19:10

go see the dermatologist. But a

19:12

bunch of health systems around the

19:14

country are implementing a thing called

19:17

e-consult. They say to the primary

19:19

care doc, look, Go to the computer,

19:21

take a photo of what's going on

19:23

with the rash, tell me a little

19:26

bit about what's going on, and a

19:28

dermatologist will look at that within 24

19:30

hours and get back to the primary

19:32

care doc. And sometimes they'll

19:34

say, oh, this is what's going on, just

19:36

do X. And you're fine. And the

19:39

patient never ended up having to

19:41

go see the dermatologist. So the

19:43

patient saves a lot of time and the

19:45

patient gets the care that they need in

19:48

a timely manner. And they're finding with those

19:50

kinds of systems that they can reduce the

19:52

number of specialty referrals by about

19:54

a quarter and therefore improve wait time.

19:56

So another way that people can actually

19:59

get the care... that they need. Another

20:01

thing that I'm really excited about is

20:03

telemedicine and portals. I don't know a

20:05

patient portal is just I think what

20:07

most people have in the country where

20:09

they can go to their doctor and

20:11

just ask them a question right away

20:13

and get an answer really heavily quickly

20:15

as opposed to waiting for a couple

20:17

of months if you're already plugged into

20:19

the practice. during the pandemic, more and

20:22

more people are really taking advantage of

20:24

that. That's a really efficient way for

20:26

people to get the care they need,

20:28

at least for some things, where they

20:30

don't need a visit, to actually get

20:32

questions answered. So those are some examples

20:34

on the health system side that I

20:36

think are really, really important. And just,

20:38

I can go in more, but yeah,

20:41

about how they can improve the process

20:43

and therefore decrease the wait time and

20:45

use this resource more efficiently. I mean,

20:47

the frustrating thing from my standpoint

20:49

is it relies on nobody in

20:52

particular to kind of realize and

20:54

implement changes in a way that doesn't

20:56

seem to be organized by

20:58

the American Medical Association, whoever

21:01

might organize it. What about policy?

21:03

You mentioned maybe some policy things that

21:05

could be done. Do you mean by

21:07

federal government or by medical

21:09

groups doing policies? So I think

21:11

first I want to emphasize you

21:13

made a really valuable point. The U.S.

21:16

We don't do a lot of top-down

21:18

policy. We have a very,

21:20

each health system, each doctor's

21:22

office is implementing these changes

21:24

and there's no one saying

21:26

you've got to do something

21:28

in terms of making change.

21:30

I do think there are a

21:32

couple places where policy could have

21:35

a very valuable role. The first

21:37

is in terms of residency slots.

21:39

One of the reasons that I

21:41

told you at its heart is

21:43

a bit of a supply problem.

21:45

We haven't really increased the number

21:47

of specialists per capita relative to

21:49

demand. And we've kept that relatively

21:52

tightly restricted and limited the

21:54

number of international medical grads

21:56

who can come and do

21:58

or into our training. programs as

22:00

well as limited the number

22:02

of medical schools. We could, as

22:04

a nation, decide that we

22:06

want to train more physicians. It's

22:08

not going to fix the

22:10

problem tomorrow. It's going to be

22:12

a long timeline because it

22:14

takes a while to train doctors.

22:16

But that is one area

22:18

that we could emphasize a way

22:20

to improve this problem. Another

22:22

way is to put pressure on

22:24

individual health systems to improve

22:26

specialty wait time. There

22:28

was a recent congressional hearing just last

22:30

week where they were talking about one

22:32

of the things we're trying to do

22:35

in the U .S. health care system

22:37

is not just pay doctors for providing

22:39

care, but actually on the quality of

22:41

care they provide. And one of the

22:43

ways that we could put pressure on

22:45

health systems is that when we pay

22:47

a health system, you would get paid

22:49

more or less depending on your specialty

22:51

wait time. So a health system that

22:53

has very poor specialty wait time would

22:55

hit their bottom line. And the idea

22:57

would be is that this would force

22:59

those health systems to put more resources

23:01

and tackle this problem as opposed to

23:03

maybe ignoring it if they don't prioritize

23:05

it. So those are two examples of

23:07

policies that we could address. And from

23:09

a patient standpoint, is there anything you

23:11

can recommend a patient can do if

23:13

they're facing a long wait time, maybe

23:15

they're new to an area and they

23:17

really need to get in to see

23:20

a primary or a specialist? What advice

23:22

do you have? I

23:24

wish there was an easy answer

23:26

and I've certainly had lots of

23:28

friends and family. A lot of

23:30

it is unfortunately people calling and

23:32

asking around and pulling favors, which

23:35

is not a very useful piece

23:37

of advice. My only other thought

23:39

is that increasingly for some issues,

23:41

you don't need to go to

23:43

a doctor in town. So embracing

23:45

some of these new care options,

23:47

which allow you to see a

23:50

doctor anywhere in the country when

23:52

it's feasible. For example, in particular,

23:54

we talked about mental health treatment.

23:56

There are a number of different

23:58

options that are available to people.

24:00

people of telemedicine for mental health,

24:03

and that increases the pool of

24:05

people they can go to, and

24:07

research has shown that for conditions

24:09

like anxiety and depression, those treatment

24:11

options can be just as good

24:13

as seeing someone in person in

24:15

your local area. So those are

24:18

two considerations. I'm not sure they're,

24:20

but in particular the first one,

24:22

it's tough. I

24:24

mean, would you recommend something practical, and I

24:26

don't know if you would. Should

24:29

they try to leave a message if they can't

24:31

reach somebody and say, when there's no

24:33

appointments, if

24:35

you have a cancellation

24:37

call me, or if

24:40

this is more, not an ER emergency, but

24:42

this is urgent, can you work me

24:44

in? Like, is it a matter to

24:46

do anything like that? Yeah,

24:48

I certainly can't hurt.

24:50

I guess when your comment

24:52

really makes me frustrated,

24:54

because that's exactly what the clinic

24:56

should tell the patient, right? Because I

24:59

told you already that unfortunately, often

25:01

there's no shows, and there

25:03

are a bunch of people who want to get

25:05

in more quickly. It's not rocket science to

25:07

tell the patient, hey, we have a waiting list,

25:09

sometimes people no show the day before will

25:11

pull you in right away. But I don't know

25:13

why health systems and practices don't do that more.

25:15

It's not that complicated, and it would really

25:17

help people in some cases when they need to

25:19

get in more urgently. It's not going to

25:21

fix the problem, but it'll just be a partial,

25:23

at least a little bit of a help

25:25

in terms of improving things. I

25:31

hope you enjoyed today's podcast, and that if you

25:33

did, you will leave a great review and share

25:35

it with your friends. To see the

25:37

actual story on full measure, you

25:39

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25:42

To find a list of stations and

25:44

times, go to SherylAxon .com and click

25:46

the Store tab. Or you can

25:48

just watch it live when

25:50

it feeds on Sunday, March 3rd

25:52

at fullmeasure .news online at about

25:54

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25:56

That's when the feed starts, and

25:58

then it's posted. at Full Measured Dot

26:01

News thereafter, so you can watch replays right

26:03

now or any time. If you like the

26:05

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26:07

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26:11

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26:13

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26:15

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26:17

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26:19

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26:21

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