Medicare Won’t Pay Fees for Services Next Year

There is something to that. And I know time is precious in a medical practice. Still, the art of salesmanship is part of every job. Although your guy didn't need to convince you of his competence, I can tell you that I would have felt more favorably toward my doctor if he had silently made a mental diagnosis in 2 seconds, and then spent 3-4 minutes "carefully examining" me. That might convince me that he cared. The level of service would have been the same for me in either case, but he would have "sold" me on his service. That used to count for something.

FWIW, my field is not medicine, but I learned long ago that if I fix a problem in 5 minutes, no one is happy. They will usually instantly reject that solution because "it can't be right". So I never solve anything in 5 minutes. I gauge an amount of time and then I present a solution in a way that convinces my boss that I put in a thorough effort and applied decades of expertise to a challenging problem. That makes him respect me.

It's the way the world works.

I’m not exonerating the medical profession here, either. There is also the self-serving motive to order more tests because of potential liability (thank you, legal profession). Doc’s sort of between the proverbial rock and a hard place. He wants to do a more thorough work up for that patient’s benefit, and his own security, but financial and time constraints won’t let him. Personally, when all is said and done, I, and pretty much all the docs that I know, opt for the history and physical exam to arrive at a initial working diagnosis. The more complete the history and more thorough the physical exam, the more accurate that initial working diagnosis (that’s where your “skin cancer screening test would be included). Completeness and thoroughness take time, but a benefit of spending more time with the patient is that you get to know him/her better, and as such you can treat him/her better. The down-side of that is you make less money, so your practice has to be smaller and slower (and you make less money). Oh, and any tests ordered after arriving at an initial diagnosis should be directed at confirming the diagnosis and as such I should have a pretty good idea what the test results will be before I order the test. If the tests don’t confirm the diagnosis, I will re-interview/re-examine the patient and modify the diagnosis accordingly. If things still don’t add up, I will likely consult with a specialist in the area of concern. I explain my thinking to the patient as I go along. Obviously this takes time to talk, but the patient and I get to know each other better, with regards to their care. Not much money in this approach, I’ll admit. BTW, I don’t do insurance of any kind. Cash only. Initial and basic visit costs a fixed amount. Extra time=extra charge, etc. Oh, and I don’t carry malpractice insurance. (Much cheaper that way besides, I don’t have much of anything lawyers would want.)

I had breast cancer so wound up with specialists for everything. I have found that I get better care using specialists. I use my GP for normal stuff but specialists for everything else. Wish I had done it many years ago.
I have:
GP
Oncologist
Dermatologist
gastroenterologist
Cardiologist
And a surgeon.
They are all great and I wouldn’t trade one of them.

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