WARNING: This is a pretty long rant. I have decided to participate in a wellness program at a hospital within the system that I work for. Side note, I run twice a week during my lunch break in the gym of the hospital I work for in addition to other activities after work. What really got me interested in the program at the other hospital is that they offer a customized fitness plan based on your goals, a body fat analysis, and few other perks. Great! So I contacted the program to find that they require a written letter from the doctor stating that you are healthy enough to participate in exercise, easy enough right? Well here’s where I start to get angry. Last Thursday I contacted my GP to request a note and I was told that I needed to make an appointment. I explained that I had my last annual exam in December and my endo and opthemologist have both faxed the results of all my visits to him as normal so there has been no change. The doctor maintains that something may have changed in the 5 months that he saw me last and I must come in. So I called back a little angry and said I wanted to speak to the doctor himself, knowing that he would not come to the phone. I then asked her so you want me to take time out of my work day to 1) sit in your waiting room for 10 minutes, 2) sit in the exam room for 5 minutes, 3) see the doctor for a minute and a half? All so he can say that its ok. I told them that it was ridiculous and I was not coming in so they could make money off of my insurance. I then called my endo who responded three days later by saying the letter is ready did I want to pick it up or have her mail it. Needless to say I’m looking for a new GP.

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I have had this experience as well. As angry as it makes me (and it really does make me angry!) I sort of understand the position the GPs are in. First, yes, they want to make some money off your insurance. But believe it or not, GPs are not rolling money. In fact, this is the exact reason that so few medical students want to go into general practice - they don't make enough to cover the basic expenses of running a practice, paying admin staff, and paying their medical malpractice insurance. Believe it or not, many GPs really aren't making that much money (it's the specialists who earn the big bucks).

Second, because malpractice lawsuits are so commonplace, most doctors operate in a constant CYA mode. They order tests and schedule visits not because it's always in the best interest of the patient, but so they can demonstrate in a malpractice case that they did everything properly. If the doctor had given you that note without seeing you and then you up and had a heart attack while participating in that program, well, you could have had grounds to sue the doctor who said you were healthy enough to participate. And don't think the lawyers wouldn't be following your ambulance to the hospital to make sure you knew you could sue!

Unfortunately, what you describe is the sad reality of our medical system here in the U.S. Your endo is maybe slightly less concerned about malpractice and because he/she is a specialist, is not as concerned about paying the bills, because he/she gets reimbursed at a higher rate than does your GP.

Believe me, I feel your frustration because I've had the exact thing happen to me so many times. But I know that there is a whole other side to the equation and it's just as frustrating for them.

Different doctors will have different approaches to this sort of thing. I would actually expect most doctors to make you pay for a visit when you ask them to write a letter rendering their opinion. What becomes more touchy is when you ask for an administrative thing, like filling a prescription. Many doctors want you to visit them in order to satisfy a request for a prescription refill. When you already see your doctor on a regular basis, having to do this seems out of line. My current endo (who I see quarterly) will provide refills without requiring a visit. Unfortunately, as MyBustedPancreas notes, doctors are paid a fee for the services they provide, not for how well they take care of you.

ps. A note from your endo is probably sufficient to approve you for exercise.

I can somewhat see that point, still don't like it and will still be looking for a new GP. Then again after a month of being at the doctor's office every week (pump training, eye exams, ect.) I was at my breaking point. I'm also tired of having to leave work for a flipping doctor's appointment I like to use my lunch hours and time off for more pleasant things. I'm lobbying for after 5 hours then maybe I wouldn't be so annoyed. I'm actually annoyed that there wasn't just a consent form, but that's another issue entirely I exercise all the time without a doctor's note always have, if I fall out in my living room from Zumba or in the park running, oh well that's on me.

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