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Metered Fees


I've always been bothered when patients view the value of their sessions with me in terms of time spent, rather than quality of experience. This happens most often with patients who are seeing me for med checks and are getting the counseling through another clinician.


The other day this happened. My administrator came into the office after a patient visit reporting a complaint, 'the doctor only saw me for 15 minutes and the appointments are so expensive.' I knew that an appointment that appeared cursory to my a patient was much deeper, but on the spot I couldn't think of a way to help my administrator deal with a similar situation that might occur in the future.


The following weekend I was ambling with my wife down the main street of a small town and noticed a jeweler at his work table through his crystal clear display window. We entered the shop with hopes of getting my wife's wedding ring cleaned. The little shop was beautifully appointed with rows of little display cubbies along the wall, much like museum dioramas, each containing an item for sale with a little succulent plant beside the object.


The jeweler came out to great us and accompanied him to a little table where he put the ring under and magnifier. A shared display on a computer screen allowed us to see the charm and intricacies of the ring. After a moment he gave a little, 'humph,' and said that he wouldn't be able to clean the ring without special care. The emerald in the center was subtly chipped. Did we know that emeralds were very fragile? And did we also know that some of the tiny display diamonds surrounding the emerald had been replaced with stones that did not exactly match the cut of the originals? Regardless, he admired the over hundred year old piece and promised that he would be able to do a proper restoration.


All this took but a few minutes. I was captivated by his expertise and the charm of his little store. My wife and I were confident that this was the man we could trust to take care of our ring.


The following week I had a response to suggest to my administrator. She might remind her patients when necessary that the doctor is like a jeweler. Even though it might not be evident he exercises during every visit careful observations that are built upon a skill set developed over many years. When he notices possible areas of difficulty, and many of these can be quite subtle, he mentions them in a way that he hopes will further the progress of the patient's treatment. If the patient is doing well, he may not say much other than to encourage progress along the path the patient is already on.

Patients are not paying for the doctors time. They pay for his experience.

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