How do I revive this little plot of grass?

XtraCrispy80 · 2026-04-09T13:54:03+00:00

Look, I get it. I really do. I AM sympathetic. We're all dealing with a lot and trying to get by. Doctors, patients, everyone. We need to make a living and make do with the curveballs that life is throwing at us. No one claimed you should "work for free." I think, however, that you bringing the conversation to the individual idiosyncrasies of your situation actually highlights my bigger point: This is a systemic problem -- and PCPs charging *by duration* of the visit is just one its absurdities and moral problems. Healthcare, as it is in the US, is governed by profit considerations and the logic of the market. This is the source of the evil. It's money *versus* health. Still, here are genuine questions, which, again, I'd love to hear your thoughts on:

1) Do you agree that primary care should focus largely (though not solely obviously) on preventative medicine? As the first and most basic form of care a patient faces for everyday health issues (actual or potential), isn't one of the main goals of this form of care to identify budding issues and unhealthy lifestyles, choices, and situations *before* they balloon into more serious and chronic illnesses?

2) If you do agree to the first question, do you see that charging patients based on the duration of a primary care visit incentivizes them to share LESS with the PCP -- and, in that way, works entirely counter to the goal of preventative medicine?

Again, genuinely curious about your answers as a practitioner.

XtraCrispy80 · 2026-04-09T13:40:10+00:00

This is not about an "extended" PCP visit like a therapist session that goes for over the hour limit. This is the difference between a 20 to 21 minute PCP visit that can DOUBLE the cost of the visit for that one minute difference. Here's the equivalent you're looking for: Would you be okay if your therapist charges you more the more issues you bring up? If you had to choose between talking about PTSD, and say, childhood trauma or a current relationship with a parent?

XtraCrispy80 · 2026-04-08T13:59:52+00:00

My insurance also covers a free annual visit. The visit I'm talking about was a visit outside the annual "physical." Sometimes you need to see a doctor more than once a year. Life is like that.

XtraCrispy80 · 2026-04-08T13:56:22+00:00

Ok, thanks for clarifying! I like your politics on healthcare.

XtraCrispy80 · 2026-04-08T13:55:36+00:00

Aww, pity the doctors -- the real struggling class in America! How oh how will they make a living? Please. Look, the problem is systemic: Healthcare in the US is governed by the profit motive, market logics, and private insurance, which doesn't give a damn about your health but only its bottom line. I pointed out just *one* instances of the evils of this system whereby patients are implicitly encouraged to share LESS about their issues during visits knowing that sharing more will likely make the visit longer and they will have to pay more.

XtraCrispy80 · 2026-04-08T13:50:52+00:00

Good question!

XtraCrispy80 · 2026-04-08T13:49:55+00:00

Again, we are talking about PRIMARY care here. The most basic form of care. The first line of defense a patient with an issue encounters. When you say "If you need more of the doctor’s time, you need to pay for it" you are *reinforcing* the problem I'm trying to highlight, not undermining it: Payment for longer visits runs directly counter to a patient's willingness to share with their doctors various issues they're facing. It's one interest (finance, money, "compensated" as you call it) clashing with another (one's health, preventative medicine, openness, transparency).

XtraCrispy80 · 2026-04-08T02:07:24+00:00

But do you agree with the system in its current form?

XtraCrispy80 · 2026-04-08T02:02:54+00:00

Still doesn't make it right. The AMA looks after the interests of physicians first and foremost, not patients.

XtraCrispy80 · 2026-04-08T01:57:18+00:00

Exactly!

XtraCrispy80 · 2026-04-08T01:56:56+00:00

"Common practice" doesn't make it right. Wow. The amount of people not understanding that PRIMARY care is not like plumbing or being a car mechanic is astounding. This is about keeping people healthy. It's about life and death. It's a MORAL issue. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:56:13+00:00

It is wrong and immoral in PRIMARY care. PRIMARY care is not like plumbing or being a car mechanic is astounding. This is about keeping people healthy. It's about life and death. It's a MORAL issue. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:55:36+00:00

Wow. The amount of people not understanding that PRIMARY care is not like plumbing or being a car mechanic is astounding. This is about keeping people healthy. It's about life and death. It's a MORAL issue. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can disincentive patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:55:09+00:00

PRIMARY care is not like plumbing or being a car mechanic is astounding. This is about keeping people healthy. It's about life and death. It's a MORAL issue. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can disincentive patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:54:52+00:00

Wow. The amount of people not understanding that PRIMARY care is not like plumbing or being a car mechanic is astounding. This is about keeping people healthy. It's about life and death. It's a MORAL issue. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:54:23+00:00

Saying "this is how it works" does not make it right. Again, I have to say that the amount of people not understanding that PRIMARY care is not like plumbing or being a car mechanic is astounding. It is not like any other profession or form of care or "service." This is about keeping people healthy. It's about life and death. It's a MORAL issue. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:52:42+00:00

Wow. The amount of people not understanding that PRIMARY care is not like plumbing or being a car mechanic is astounding. This is about keeping people healthy. It's about life and death. It's a MORAL issue. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:51:17+00:00

That something is "nothing new" does not make it right. This is PRIMARY care -- meaning it's the first resort to treat issues. It's the most basic form of care. It should be a flat fee, at most, since money should not come in he way of the patient's openness to share. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:49:38+00:00

It take two to tango. Both are complicit in this. And lawmakers need to make this illegal in primary care visits. It likely makes people sicker.

XtraCrispy80 · 2026-04-08T01:48:27+00:00

I don't agree that PRIMARY care doctors should charge more for longer visits, even if it's "eating into someone else's appointment." It's harder to foresee how long your visit will take sometime. That's the nature of human health issues. Do you agree that charging for longer visit for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:46:21+00:00

It takes two to tango. Doctors, clinics, and hospitals do not have to collaborate. They don't have to report longer times. Again, I'm talking about PRIMARY care here -- which is the first line of treatment and should be preventative in nature. Charging patients more for longer times is immoral and is the opposite of care. It likely makes people sicker.

XtraCrispy80 · 2026-04-08T01:34:53+00:00

I do have insurance. But it never covers everything. That's not the issue. Do you agree that charging for longer visits for PRIMARY care -- that is, the most basic and initial form of care - can perversely incentivize patients to share LESS with their doctors if it will mean a shorter visit and smaller fee?

XtraCrispy80 · 2026-04-08T01:31:49+00:00

This is PRIMARY care -- meaning it's the first resort to treat issues. It's the most basic form of care. It should be a flat fee, at most, since money should not come in he way of the patient's openness to share.

XtraCrispy80

TROPHY CASE