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Five Reasons Online Review Sites for Doctors Stink

Written by Suzanne Berman MD

The Internet provides plenty of opportunities for consumers to rate the quality of professional services they receive. A quick search can help you find recommended plumbers in your area, or suggest that you steer away from a certain roofing contractor.

Similarly, there are lots of online physician rating websites that offer the same service to consumers: check and see which doctors in your area are recommended by other patients.

I’ve watched the mushrooming of these “rate-the-doctor” websites with interest. While they provide an opportunity for patients to provide feedback to doctors and other patients, some elements could use improvement.

1 – They’re anonymous

Who is writing the reviews? While most come from true patients, there’s nothing to limit one single patient from sending 8 reviews about the same experience. For that matter, who’s to say good reviews aren’t from the doctor, trying to boost her image?

Physicians who are also small business owners (like me) from time to time terminate poor-performing employees. After a firing, does a spike in negative reviews of our practice reflect coincidence, or an ex-employee trying to retaliate anonymously– especially if the review contains “insider information” that our average patient wouldn’t be aware of?

2 – It’s not clear the patient is really a patient

When I read travel reviews online, I’m struck by how many reviews come from people who admit in their review that they didn’t actually stay at the hotel or eat at the restaurant. The review will read something like “I wanted to stay at this hotel because I’ve read so much about it, but when I clicked on the Reservations tab, I was shocked at the room rates. I couldn’t believe this hotel would charge so much for so little.

“They will never get my business!”

While the consumer is giving feedback to the hotel (“I think the market won’t sustain your prices”), this one-star comment hardly addresses what most travelers want feedback on (cleanliness of the rooms, friendliness of the staff, quality of the restaurant), since anyone can look up the prices for rooms.

Similarly, anonymous patient reviews don’t distinguish between a patient who came once, a long-term patient, and a prospective patient who has never been seen.

The latter’s comments are usually about a perceived access barrier to care, like: “I was new to town and needed a pediatrician. My son had terrible ear pain so I called to see if anyone could phone him in some antibiotics before the weekend. They were so rude and refused to help me out. I will never go there.”

Since I never had an opportunity to meet the family myself, never established a physician/patient relationship, and certainly never had an opportunity to explain, I don’t really consider this a review from a patient – but it’s in there with the rest of them.

3 – There’s no way to respond.

Some consumer rating websites, like Trip Advisor, allow the hotel or restaurant to respond or comment to a particular review. Many doctor rating websites don’t have a similar feature.

I don’t have an opportunity to apologize, or set the record straight, or offer to make my patient’s bad experience right. The patient can vent, surely, but I’d rather to try to reconcile the relationship.

4 – Patient privacy is protected.

Even if I can figure out who wrote a particular negative review, I can’t respond specifically in public with patient-specific information. Let’s say a mother posts a comment that I misdiagnosed her child’s ear infection: “even though Dr. Berman said Caleb’s ears looked great — later, when I took him to the ER, they said his ear was terrible.”

I review the child’s record: indeed, I examined the child in my office, who had clear ears. The child indeed went to the ER for worsening ear pain — five days later.

To me, this doesn’t speak to misdiagnosis as much as it does a common medical problem of kids: good ears sometimes go bad. I’d like to post something to clarify this online – to take the opportunity to educate families that ear exams can change over a period of days – but I can’t.

Simply, if I post any public health information about Caleb on the Internet, I’ve violated patient privacy laws (HIPAA). I can try to contact Caleb’s mother privately to make this same point, but she may or may not see fit to alter her online statement.

5 – Even the “neutral” information can be wrong.

“Rate-the-doctor” websites usually contain some basic demographic information, like the physician’s address, board certification status, age, gender, and so on. This information is often out-of-date, if not completely erroneous.

I’m amused to sometimes find that, according to some websites, I’m not board certified or that I practice at an address I haven’t worked at in seven years. Again, there’s often no mechanism for me, as the actual physician, to contact the site administrator to ask that my information be corrected.

So patients who come to these websites to get information about physicians may read bad information even before they look at the reviews.

Once it’s on the Internet, it’s there forever.

Our office periodically reviews our online reviews. A while ago we found one from a dissatisfied patient, rating us 2 stars out of 5, and concluding, “If there’s another place to take your kids, you should probably take them there, and not to this office.” The review was dated about 9 months prior to our discovering it.

The mother had left enough personally-identifiable information in the review for us to figure out who had posted it. Interestingly, in the 9 months since she felt dissatisfied with us, she was continuing to bring her son to us, and in fact had had a newborn daughter, whom she was bringing to our office for care.

We were puzzled that, if she were that displeased with our office, she hadn’t followed her own advice and transferred care to another practice. The next time she was in the office, we gently asked her about her review.

At first she looked blank; she’d completely forgotten she’d posted it! Finally she said, “Oh – that. Yes, I was dissatisfied with your office a couple of times, but since then I’ve kept coming, and now I’m much happier to be a patient here.”

We’re happy that she’s now more comfortable with us. Unfortunately, her review is still on the Internet, forever, and possibly no longer able to be amended.

Doctors are starting to fight back, and it’s not pretty.

While patients have the right to post opinions on the Internet, doctors who feel an opinion crosses the line have sued for defamation, slander and lost income. Doctors who respond in this way have drawn a lot of media attention – and many of them have a sudden increase in negative reviews posted.

This suggests that many of the newer respondents perhaps aren’t patients at all, but rather many readers are angry that a doctor would try to sue a patient for expressing her opinion. As far as a doctor trying to enhance her online reputation, it doesn’t seem to be a very effective method.

So what’s better?

Our office collects anonymous periodic surveys of our patients to learn how we’re doing and how we can improve. We ask patients to rate us on timeliness, friendliness, professionalism, and so on while they’re in the office as part of a visit.

This assures us that the reviews are being completed by actual patients, and that they’re being completed at the time of the visit, while impressions are still fresh.

Because we design the survey, we can make it specific as needed to help us identify problem areas: for example, rather than asking if “staff” are rude or friendly, we can ask for separate feedback on receptionists, nurses, doctors, billing staff, etc.

We’ve started sharing the results of our surveys with our patients, and we’re going to post future results on our practice website as well.

While our patients are free to comment about their experiences on rate-the-doctor websites, we believe posting results of our surveys will provide an equivalent service, and will be a more complete representation of our patients’ impressions of our practice.

Suzanne Berman is a practicing general pediatrician in rural Tennessee.

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4

I’m Not Sure I Support Your Decision to Homeschool

Written by Suzanne Berman, MD, FAAP

My dear friends Matt and Jill are homeschooling their four children, and they’re doing an awesome job of it. Matt, no stranger to education (he has two master’s degrees) is a great communicator and very involved in his kids’ lives.

Jill is smart, sweet, and a model of organization; the “master whiteboard” in her kitchen reflects an orderliness worthy of a military quartermaster. Their kids are well-behaved, smart, curious, and articulate, just like their mom and dad. And the more time they spend with their parents, the more their parents’ character, values, and personality will be instilled in their kids. What’s not to like about homeschooling?

In the ‘80s and ‘90s, homeschooling pioneers fought for the right to direct their children’s educations. And they got good results, too. The original predictions of warped, antisocial children didn’t seem to pan out, and the early generations of homeschooled kids turned out as well-educated (if not better) than the average public schoolchild.

But I’m starting to see some disturbing trends in homeschooling: less Matt and Jill, and more child neglect and perjury.

Not too long ago, an 11-year-old boy came to my office for a well-child check, accompanied by his mom. “How’s school going?” I asked, as I a do always do. “Oh, I’m homeschooled,” he replied. “Tell me about that,” I continued, “what you like to learn about most?”

“Well,” he said, thoughtfully, “we usually do it on the computer. But we haven’t really done any school for a long time, so mostly I watch TV with my dad.” The boy and his two school-aged siblings had been pulled out of school one year prior because dad disagreed with the school’s assessment that the son was not performing at grade level.

The boy reported watching six hours of TV per day most days, with another two-to-three hours of computer game time per day. He might get in thirty minutes of the school program per day. Mom (and later Dad) separately reported that the boy’s self-assessment of school hours was correct.

“We’ve just been so busy with life,” they admitted, “we just haven’t gotten around to doing much school this year.” However, I didn’t see many hopeful indicators that things would change soon; mom works long hours at her job; dad is too disabled to work. When I checked in with them later, the boy couldn’t remember doing any appreciable school work in over six months.

Another mother came in with her 17-year-old daughter, 12 year old daughter, and 7 year old son. Mom reported that her three children are homeschooled; however, she is a single parent and is working 2 jobs to make ends meet.

Mother reports that her kids enjoy staying home. “We have it worked out,” mother explained, “so that while I’m at work, the oldest does her work on the computer. Then she can help the other two with their assignments.”

I gently asked the mother if being responsible for their schooling wasn’t overwhelming, given her work hours as a single parent. “No,” she said, “I don’t have to get them off on the school bus in the morning, so that saves me a lot of time.”

Similarly, a twelve-year-old told me this week that her “homeschooling” for the past three months has consisted of reading a novel — plus cleaning the house and keeping an eye on her fellow foster sibs so her foster parents can work. Other subjects? “No,” she said thoughtfully, “I really haven’t done any math or social studies or anything like that.”

Another mother came in with her twin 7-year-old daughters. The girls had matted hair and body odor. Mother, who had trouble keeping her eyes open during the visit, had lost custody of the twins when they were three years old for about a year; details were sketchy, but the Department of Children’s Services had been involved for a time.

“We’re doing great now, and I’m homeschooling them,” mother stated proudly, if sleepily. “They know all their shapes and letters, and we’re working on their colors and numbers.”

Families don’t have to be accountable to me for their school choice, but they need to be accountable to someone.

The homeschool umbrella (either a private school or local school district) at least nominally asks for attendance records and progress reports.

Even informal homeschool co-ops, which exist in many communities, help parents share best practices with each other. But the families that give me the most concern seem to have a lot of self-imposed isolation: the children don’t participate in music groups or sports teams, and the family doesn’t participate in community activities or attend worship services.

In extreme (and fortunately rare) cases, this can have heartbreaking consequences society expressed its disgust in the failure of child protective services workers to identify this perilous situation, but if someone from outside his family read Christian’s anguished “school essays,” might the outcome have been different?

There’s plenty not to like about public schools and private schools, and families in America certainly have the right to opt to home educate their children.

But public and private schools at least have requirements for transparency and accountability – in fact, that’s usually how we know which schools are winners and which aren’t.

Families like Matt and Jill, who still make up many of the homeschooling families I see professionally, occasionally express annoyance at required record keeping; they’re motivated to do it right even without oversight.

But when homeschooling families don’t appear to take their education responsibility seriously, and there are no consequences from their umbrella, who will hold them accountable?

Suzanne Berman is a practicing general pediatrician in rural Tennessee. Her study of Medicaid access was supported by a grant from the American Academy of Pediatrics’ Community Access to Child Health (CATCH) program.

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To Teen Guys: Yes, We Really Need To Check ‘Em

Recently, I was called to our community hospital to consult on a teenager with severe lower abdominal pain. The young man, whom I’ll call Dan (not his real name), lived outside of our community, and I’d never met him before. I arrived in Dan’s hospital room, introduced myself, and started talking to him and his mom about his symptoms. After reviewing his chart and getting his history, I proceeded to examine his heart, lungs, and belly. Then I told him, “OK, I need to check your privates, to make sure everything looks healthy and normal. Is that OK?” I was unprepared for Dan’s surprised, negative, very forceful reaction: “NO WAY!” and his mother’s simultaneous exclamation, “No, you DON’T need to do that!”

I asked permission, as I always do, and he definitely hadn’t given it! So I backed up a little bit. “I know it’s embarrassing to have your privates checked. But we don’t have a good explanation yet for the pain you’re having, and if it’s related to something going on with your genitals or your bottom, I definitely don’t want to miss that.”

Dan was still pleasant, but I could see in his eyes he was definitely not buying my explanation. “If you would feel more comfortable with a man doctor, or without your mom in the room, we can definitely do that.” His horrified expression spoke volumes; I think he would have preferred a spinal tap without anesthetic.

His mom said, “Why do you have to do that? The emergency room doctor and the surgeon who’ve seen him today didn’t feel that was necessary.” I explained, in that case, if no one else had checked “down there,” I felt even worse about blowing off that part of the exam. Dan, still with the deer-in-the-headlights look, volunteered, “I had it checked at the clinic where I got my sports physical done. Can we count that?”

We talked about it some more, but Dan stood firmly to his position: “My genitals are not your business, doc!” In the end, I never did perform this important exam.

Clearly, I failed Communication 101 with Dan at explaining the importance of a complete body check, especially in a kid who’s sick enough to be in the hospital. I suspect if I’d known Dan better, he might not have felt so awkward. What I really wanted to communicate was this:

  • It needn’t take very long. A comprehensive external genital exam takes under a minute in boys.
  • We can do whatever it takes to satisfy modesty and cultural appropriateness. It’s OK to kick your mom out and have your dad come in. Or vice versa. It’s OK to request a male doctor. Or vice versa. It’s OK to have a chaperone — in fact, I prefer it that way.
  • We do find problems “down there.” Honestly, most doctors are in such a hurry – we wouldn’t waste time doing something if we never found a problem. In Dan, a rectal exam for his kind of pain would have helped reduce his need for expensive, high-radiation tests. From time to time, either as part of a problem check or as part of a checkup, we’ll find hernias, hormone problems, cancer, eczema, abnormal birthmarks, ulcers, urinary issues, and infections of many kinds (not just STDs). Many years ago, a wise pediatric infectious disease physician taught me to check the whole body – even the unmentionables – for clues to “mystery patients.” He was right, and since then I’ve diagnosed herpes encephalitis, Behcet’s disease, and Crohn’s disease – based primarily on what I found in the genitals and rectal area.
  • Parents, assume nothing. You may think your child has no concerns about his genitals because he’s never mentioned them to you. You may think your son could never have an STD. You may think your son would notice if he had a small amount of blood in his stool. You may think he knows what a hernia or testicular mass feels like. And all these things might be completely true. But they might not.
  • Getting it all “out in the open” makes it easier for a child to bring up a concern. Let’s say a young man discovers a small lump on his genitals, and it’s worrisome to him. When I’m doing a genital exam and already have things uncovered, it seems easier for a concerned teen to “casually” point to the spot and say, “Hey, [indicating] is this OK?” I can easily say, “Oh yes, that’s a ______ and lots of guys have those. They’re normal and won’t interfere with peeing or sex or anything. I have a great handout about that for more information.” It’s harder for a kid to bring up issues “down there” if he thinks that a genital exam isn’t part of the equation. Will I think he’s a pervert or weird for asking: “So… doc…. I have this… thing… on my… privates?”
  • Your female counterparts seem to have gotten over this. I’ve noticed (and I’m not sure why – maybe because I’m a woman) that I rarely have girls or their parents look horrified or surprised when I ask to check a girl’s breasts or pubic area. Much more frequently, I have mothers ask me, “Are you sure 13-year-old Kathy doesn’t need a complete pelvic exam, now that she’s having periods?” Sometimes this is a subtle hint to check for pregnancy or STDs; sometimes parents are trolling for information about their child’s sexual activity, or lack thereof. But much of the time, parents know that ensuring “the lady parts” are important to keep healthy, just like everything else.

So: It’s OK to be embarrassed. It’s OK to sigh, blush, groan, and/or roll your eyes at the doctor. But guys, yes, we really need to check ’em.

Suzanne Berman is a general pediatrician in rural Tennessee. She tries to minimize embarrassment to her husband and son, too.

Crossing State Lines: Crossing the Line?

In the search for reducing healthcare costs, some public policymakers have suggested allowing consumers to purchase health insurance across state lines. Theoretically, this would allow families to shop around for the best insurance deal, even if they aren’t a resident of the state in which the insurance is sold or regulated.

In general, increased access to choices drives down prices and increases competition; given the proliferation of online shopping for all kinds of other products, you might indeed find a great deal in another state. Even some state-based financial products, like 529 college savings plans, are marketed across state lines, allowing flexibility and consumer choice.

However, I’m opposed to selling health insurance plans across state lines: out-of-state insurance plans (including ERISA plans) can thumb their noses at a state’s consumer protection laws.

Here’s an example: Tennessee mandates that newborns be covered from the moment of birth to 30 days of age without any special action required on the part of the baby’s family (TCA 56-7-2301.) This is a good idea: moms shouldn’t have to call their insurance company’s 800 number in between contractions to ensure her baby gets added to her policy. The thirty-day rule gives families a short grace period to get their paperwork in order.

However, Tennessee law doesn’t apply to all infants born in Tennessee. Families who are employed by a big-box corporation headquartered in another state often have an insurance plan domiciled in that state. If mom and dad have, say, Blue Cross Blue Shield of Alabama — the company does not have to follow the 30-day rule of newborn care. They’re shocked to find out after their child is born (and too late to make other arrangements) that they owe hundreds or thousands of dollars to doctors and hospitals. It’s even more depressing when you realize these costs are incurred during a period when moms are taking time off work and family incomes are tight as a result.

Tennessee law also requires insurance companies to be transparent in their dealings with doctors: to pay clean claims promptly (56-32-126); to credential doctors fairly (56-7-1001), and to be up front about what doctors will be paid for their services ahead of time (56-7-1013). These laws protect employers, patients, and doctors from unfair insurance company tactics – but again, only as long as the company is an in-state company.

Our practice already spends a lot of resources policing our own state’s insurance companies. If they violate regulations, we can appeal to our state’s Department of Commerce and Insurance, our state’s legislature, and our state’s judiciary, all of whom are accountable to voters for their actions. Yet insurance companies in other states can blissfully ignore directives from our state, even though they’re insuring our state’s citizens. At last count, there were over 1300 out-of-state insurers during business in Tennessee; until consumer protections are more consistent, we need less of this, not more.

The Cost of Servicing Your Child

Written by Suzanne Berman MD

Several years ago, when I took my car in for servicing, I noticed this clever message printed on the back of the mechanic’s invoice:

This simple, honest explanation of my bill impressed me so much that I kept the invoice. More recently, I’ve thought about using a similar illustration for patients who ask, “I don’t understand why my pediatrician’s bill is so high – I only saw the doctor for about 10 minutes!”

Using the auto mechanic’s model, I’ve taken our practice’s actual expenses for 2010 and broken them down by category, as well as percent of our total budget, to give you an idea of where the money goes.

So with apologies to the creator of the automobile piece, here’s what goes into the cost of servicing your child:

Utilities and rent: 10% We spend a tenth of our budget just keeping the lights on, the telephone ringing, the heat and A/C running, and the rent paid.
Supplies: 9% Nearly another tenth of our expenses go to supplies, both clerical (appointment cards, copy paper, and pens) and medical (gauze pads, diapers, and casting supplies.) The largest single supply expense we have is vaccines; it’s not uncommon for a busy pediatric practice to have many thousands of dollars in vaccine inventory at a time.
Clinical staff: 13% Our nurses and medical assistants are busy from open to close – they weigh and measure our patients, draw blood, give shots, answer medical questions, complete school and camp forms, return phone calls, coordinate referrals, talk to the home health agency, refill prescriptions with the pharmacy. All these astute individuals are friendly and talented; we want to keep them, so we try to pay them well.
Receptionists: 5% Our front office staff answer the phone, verify insurance, check in patients, distribute paperwork, send and receive medical records, mail and fax documents, process co-payments, confirm appointments, order supplies, and more.
Insurance jockeys: 4% We don’t have “car jockeys,” but we do employ three full-time staff who could be described as “insurance jockeys.” These longsuffering individuals send claims to insurance companies (a big task) and argue with insurance companies when payments aren’t made properly (an enormous task, as it’s estimated that 20% of insurance payments are wrong.) They try to keep up with policy changes in the 200+ insurance plans our office sees in a year. They also work with families who need to establish payment plans, need to get insurance, or who are having trouble navigating their insurance plan.
Supervisory staff: 8% All our other staff have to be trained and supervised. Someone has to approve their mileage forms, overtime requests, time clock totals, and benefits changes. Someone has to negotiate scheduling squabbles, process payroll, conduct staff meetings, plan the office’s Christmas party, write policies (then rewrite them when they’re unclear), meet with vendors, fix the computers when they’re acting up, call a plumber when a toddler accidentally flushes a toy down the toilet, and about 384 other major and minor things to keep our office running. These staff also have associated professional costs, like dues and subscriptions.
Building maintenance: 4% Keeping our office clean and well-maintained is hard work for the husband-and-wife team who spend several hours 5 evenings a week cleaning, disinfecting, dusting, vacuuming, waxing, touching up the paint, wiping fingerprints from walls, emptying the trash, getting bugs out of the light fixtures, and more. Seasonally, we also pay a landscaping service (to maintain our grass and plantings) and a guy with a big truck (to salt and de-ice our parking lot). This also includes budgeting for major repairs, like resealing and restriping our parking lot every couple of years, fixing leaks in the ceiling, and cleaning up fallen debris after a bad storm.
Specialized physician training: 22%. This represents the salaries for the pediatricians in our practice and, yes, paying the doctor is the largest single expense in a practice. Much of this goes to the doctor’s personal overhead: Physicians now graduate med school with an average of $150,000 in educational debt.
Capital investment: 6% We use electronic medical records at our office, so all of our staff have their own computers, and there are computers in each of our exam rooms. Computers have to be replaced every few years, as do other electronics, furniture, appliances, and tools.
Taxes: 6% The largest part is payroll taxes for our employees and self-employment taxes for our physicians – but also unemployment tax (federal and state), property tax, professional privilege (license) tax, and sales tax.
Insurance: 7% We pay malpractice insurance for our professional employees, of course, but also insurance on our building and equipment, health/dental/life/disability for our employees, worker’s comp insurance, and some other odds-and-ends premiums.
Fringe pay: 5% This includes vacation/sick pay, holiday pay, and our company’s contributions to our staff retirement plan.
Wage and hour regulations: 1% Overtime wages for our employee constitute nearly 1% of our total annual expenses.

 

When you pay your pediatrician’s bill, your pediatrician certainly takes home a portion of that, but most of it goes to other things to keep the office ready and running. While our practice isn’t necessarily representative of all pediatric practices – and I know from published benchmarks that our practice is atypical in at least a few ways — this hopefully gives a rough idea of where the pediatric healthcare dollar goes.

Suzanne Berman is a practicing general pediatrician in rural Tennessee.

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Mr. Obama Has Some Reading to Do

By Suzanne Berman, MD

The Obama administration recently announced plans to use a series of “mystery shoppers” to see whether it’s true that patients with Medicaid have problems getting appointments with doctors.

This isn’t just idle curiosity; Medicaid patients are supposed to get care equal to privately-insured individuals. The equal access provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(30)(A), states that:

“A state plan for medical assistance must . . . provide such methods and procedures relating to the utilization of and the payment for, care and services available under the plan to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population.”

While I’m pleased to see that someone at the federal level appears to be paying attention to Medicaid access problems, this initiative wasn’t all that novel, and in fact seems downright redundant: for years, doctors have been documenting the difficulties with Medicaid access in peer-reviewed medical journals.

About ten years ago, pediatrician and AAP president Steve Berman published a study that documented that, nationally, children with Medicaid indeed had much poorer access to private pediatricians than their privately-insured counterparts. Based an excellent cross-sectional survey of private pediatricians nationwide, its results were impressive for their comprehensiveness; the conclusion wasn’t that surprising or novel, even in 2002.

Since then, the Medicaid/private insurance access to appointments disparity has been studied broadly, again and again – with strikingly similar results every time. Just a few of the studies conducted within the past decade (many of which have even used the “mystery shopper” technique) include evaluation of:

Even yours truly at Survivor: Pediatrics compiled a survey of Tennessee pediatricians showing that Medicaid-insured children in Tennessee do not have the access to pediatricians enjoyed by their privately-insured counterparts.

A few days after its announcement, the Obama administration announced that it was cancelling its mystery shopper initiative. Hopefully, someone decided that re-inventing the wheel wasn’t necessary after all.

Suzanne Berman is a practicing general pediatrician in rural Tennessee. Her study of Medicaid access was supported by a grant from the American Academy of Pediatrics’ Community Access to Child Health (CATCH) program.

Unplugged from the EMR: Now what?

By Suzanne Berman, MD

The surgical metaphor often used for home improvement is “a face lift,” but our thirty-year-old house needs a quadruple bypass and liver transplant. Because it’s going to be so dusty and disrupted, we opted to temporarily move out. Two weeks ago we moved to a quiet rental house in the country, where we can watch fabulous Tennessee mountain sunsets and wake up to the sound of cardinals singing.

The price of solitude is something of a challenge: no cell phone service at our home. Neither my husband’s AT&T phone nor my Verizon service gets any solid bars at our new house. We’ve arranged to get Internet service, but the cable guys haven’t come out to our home yet. We’re not quite 19th century, though, as we have a functional land line.

So last Saturday, on call, I had just returned from a morning at the office to my home (now a 25 minute commute rather than a 10 minute one) when I received a call (land line, of course) through our answering service. A mother apologetically confessed that her daughter was about to leave for summer camp but had just run out of her routine medication. Would it be possible for me to call in a refill?

“No problem,” I said. Although I almost always decline to call in new medications over the phone, refills for established medications are different.

This young lady was well known to me, as she’s been my patient for about 8 years now. Her medical issues are familiar to me without having to look at her chart, and her problems are well-controlled on her current medication. Indeed, I didn’t want her going out to camp without her prescription. After confirming the pharmacy with mother, she thanked me, and I hung up.

…And about two seconds later, I realized I wasn’t sure of the dose of the medication. This particular medication is often used in both 20 mg and 40 mg preparations, and while either dose would probably work for this young lady, I wanted to be sure to refill her usual dose.

Now I had on my hands, for me, a relatively unusual problem. My lifelong geek tendencies made me an early adopter of an electronic medical record (EMR). I can log in securely from home over the Internet, call up the child’s chart, and double-check the dose myself. But stuck at home without Internet service, I was clearly going to have to find a creative solution to this problem.

Maybe I can call the mom back. Unfortunately, I didn’t ask for her number while I had her on the phone. My caller ID read our answering service’s number, not the mother’s;

unfortunately our answering service doesn’t record the number of callers unless they have trouble reaching the physician quickly.

Well, I’ll call the pharmacy. They’ll have her previous prescriptions and can confirm the 20 mg vs. 40 mg question. Clearly, I should have thought of that initially. “No problem,” I muttered aloud, while wishing that the cable guy had come last week as expected.

And I realized I didn’t have the number for the pharmacy, a chain drugstore in a neighboring county. Our phone books were still buried in some packing box. Aha, I can look it up on the Intern…..uhhhh, no I can’t.

I considered getting in the car and driving to the office. 50 minutes just to get a phone number? No, surely I could find another way.

I started calling my co-workers, who have the same ability to look up charts from home as I do. Maybe I could cadge a favor from them. No answer at one number. Oops, don’t have the current number for colleague #2. The third answered her cell phone, but alas, she was in the grocery store shopping with two small children. And frozen food. Could she call me back in, say, an hour?

Hey, I can do this! Call the local branch of the pharmacy! They could give me the number to the other pharmacy. Or I could even give them the prescription, and they could send it to the branch pharmacy! Woohoo!

The pharmacy tech couldn’t enter the prescription for me because I didn’t have the patient’s date of birth handy (!), and “it would take three hours to send it to the other pharmacy” (when it takes me thirty seconds to send it electronically from my office to either pharmacy?). I did, however, get the number for the other pharmacy.

Which I called — only to get an endlessly looped recording, without the ability to leave a message at the pharmacy. “Press 8 if you are a doctor’s office,” an anthropomorphic impossibility, but I complied. After a few clicks, it looped back to the main menu, “Thank you for calling Quik-Drugz. Press 8 if you are a doctor’s office…”

This poor girl, stuck at camp without her meds! I ended up getting the car with my smartphone and laptop, driving around about 15 minutes until I got a steady two-bars. I pulled over to the side of the road, the spring heat baking through the window, my blinkers flashing, while I fired up my Internet connection…. logged in…. found her chart (aha, only 20 mg, not what I would have guessed)…. and sent the prescription to the pharmacy, yes!

And then got another page. “Dr. Berman,” the answering service explained, “we’ve been trying to reach you for a while…”

Fortunately, the next call was a discussion of high fever in a toddler. We reviewed fluid intake, ibuprofen dosing, and what to watch for – much less complicated than having to call in a refill.

I guess you can take the geek out of Internet range, but you can’t take Internet out of the geek.

Dr. Suzanne Berman is a practicing pediatrician in Tennessee. She recently celebrated 17 years of marriage to fellow geek Robert Berman, MD, who continues to impress her with his Holy Grail quotations.