January 24, 2018

First visit with a Reproductive Endocrinologist Part 2. The paperwork

Not ready to get professional fertility help? Many times, the uncertainty of what to expect during the initial visit to a RE makes some people hesitant about taking that first step. So to help you out, here’s a typical example of the progression of events.

Let’s picture that you want to be pregnant and have been trying for almost a year. With your job and all your other obligations, you just haven’t seen any opportunity to take action on this just yet. Besides, you and your husband are healthy and can clearly picture it happening naturally, right? Occasionally, during random moments of browsing the internet, you see some flashes of information that makes you inspired to take action, but then the motivation fades and you are back to your busy life. Over the next year, the pages on your calendar cascade down month after month, and still nothing has happened. Now it’s been two years, so you stare at your phone and eventually pick it up and call.

The voice on the other line is pleasant and you are told about the office policies, the initial consultation fee and you are given a choice of times. You and your husband decide to take the leap and book an appointment.

You arrive at the unfamiliar office and are warmly greeted with a smile, but you are immediately taken aback by the pile of forms to fill out and sign.

The first is a demographic sheet asking for your contact information, so we can facilitate reaching you, especially in an emergency. Besides the personal data, you are also asked for any insurance information that is needed. So this has practical value and you don’t mind filling it out.

The next form you will have to read and sign is the HIPAA agreement. You will have to bear with me while I gripe, but this is another reason why we should hope and pray that government-run universal healthcare never becomes a reality. Sure, everyone agrees that privacy is important, but it should not be the way it is, where physicians are made to be so terrified of a perceived infraction that we are all forced to take drastic measures. Anything that takes up our undue attention will distract from the pool of attention resources we can devote to more meaningful things, such as patient care. So we had to pay attorneys to draw up legal documents for our patients to sign. You see, while the government mandates us to abide by the rules, they don’t provide any acceptable standard documents that we can use, so we have to expend major time and energy each time there is a HIPAA revision. Also, we used to have a convenient sign-in sheet. But now we had to hide it. Technically, we also can’t risk saying hi to anybody by their name if it can be heard by anybody else in the waiting room. Basically, we walk on eggshells for something that was never a significant problem even before HIPAA. And yet, ironically, now with HIPAA, it still doesn’t prevent those news stories of people leaking celebrity medical information to the press. OK, thanks for listening. Let’s go on.

The next piece of paper is the Arbitration Agreement outlining that any disputes will be addressed by a legal professional and not by a random jury of medically unsophisticated people.  This document benefits us by protecting us from lawsuit abuse in many ways. It sets up a fair system and it also weeds out the litigious fringe problem patients who jack up the costs for everyone.  There have been a handful of people who refuse to sign the form and therefore, refuse to be our patient. One such person went on to see another doctor whom she wound up suing for something silly. She also sued her landlord for mold and sued her employer and this one store she went to. (I later found these cases listed on the internet). With an arbitration agreement, while we can still be sued if we do something wrong, it’s less likely that someone is going to file an nuisance suit against us just to exploit and intimidate us. And actually, it also benefits the patient. How? Well, in almost 13 years of practice, I have yet to be named in a lawsuit, so that helps keep our malpractice costs low. Don’t underestimate the significance of this. Due to arbitration and legal protections (MICRA) against lawsuit abuse, OB/Gyn’s in Orange County CA pay about 50K each year in malpractice costs. In contrast, OB/Gyn’s in Long Island NY pay 168K and those in Dade County FL pay 203K per year. You can probably already guess that these costs will get passed down to the patient somehow. I believe it also gives good doctors an incentive to avoid those places, thereby depriving the people in those regions of more good doctors from which to choose.

So after all this gruelingly painful paperwork, you will finally get to meet with the doctor, which we’ll discuss next post.