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What I thought would be common knowledge for this physician-patient turned out not to be.A medical oncologist I work with named Dr. Smith called about a patient with a relatively uncommon form of cancer called a MALT lymphoma. He told me that the patient, Dr. _____ had recently retired after many decades at the Mayo Clinic. He moved back to our city, because his daughter lived here with her physician husband.At the appointment, I introduced myself to Dr.______ along with his wife and daughter. I began by reviewing his history. I do this when I am first seeing a new patient to make sure they understand the situation we are addressing. I had talked for a few minutes when Dr.____ asked “Now what’s the duodenum?” I’m sure my surprise was evident in my facial expression as I tried to think of what to say. During the pause, Dr.____’s wife said “maybe Dr. Smith didn’t clarify that my husband has a PhD in economics - he worked as a hospital administrator at the Mayo Clinic”. Just a little embarrassed, I started over with the vocabulary I would use for a “non-physician” patient and the consult continued.

Several points, I believe:They don’t understand what major depressive disorder is. They may think it’s sadnessThey don’t understand the physiology of depression, and that it’s due to brain dysfunction.They don’t see depression as a psychiatric disorder, which it is. Calling it a “mental illness,” “mental health issue,” or some other euphemism, trivializes the nature of the condition, and leads people to believe that anyone with a “mental health” designation is the proper person from whom to seek treatment.Most people don’t understand that a thorough evaluation is first necessary, before a diagnosis can be made, and that can’t be made about oneself. It must be an objective third party. Most people assume they have a depression, and then immediately seek a treatment option, such as some form of psychotherapy.Most people don’t know what they don’t know. They don’t know that they may have bipolar disorder, low thyroid, alcohol related problems, medication induced problems, cyclothymia, and so on. There are an enormous number of conditions and situations that I rule out with every new patient during the one and one half hour initial consultation that I do with every new patient. Their entire medical history, social history, and so on.They think that antidepressants are no more effective than placebo. They don’t understand the nature of clinical trials is to use the lowest dose that separates from placebo to get the medication approved. In clinical practice, we use higher doses, along with adjunctive treatments, and get much higher remission results.They think that medications should “cure” these ailments, and they don’t. Very little in the field of medicine cures anything. We do a good job of treating the illness. Eyeglasses don’t “cure” nearsightedness, since the cornea doesn’t “learn” how to see better. Neither does the brain.Most people don’t understand how the brain works, so they don’t understand what happens when it doesn’t. The physiology of major depressive disorder is complex, and the result of genetically inherited vulnerabilities that cause dysfunction in various brain circuits.Major depressive disorder is the condition we are referring to when we use the term “depression.” Not sadness, not grieving, not loss, not a bad day, but a bona fide brain illness.

New Patient Evaluation and Management are ALWAYS much more comprehensive, and therefore yes, costly. The first time a physician sees a patient, they know nothing about them. They have a plethora of intake forms, personal medical history, family medical history, presenting complaints, visual assessment, etc that they must pour through in order to get this first ‘snapshot’ of who is sitting in front of them. What is their lifestyle and how does it affect their health? What is their family and psychological history? What surgeries, major illnesses or hospitalizations have they had to undergo?It’s much simpler once all that info has been assembled into a chart and the Dr gets to know you. It takes a great deal more time, on the average, to consult with a New Patient.They can do this because it is not only legal but REQUIRED by law. There are codes specific to New Patients that go on an insurance claim. If an insurance company gets a claim for a patient, from a provider they’ve never seen before, and the claim form has an ‘Established patient’ service code on it, guess what happens? Ya. The insurance kicks it back and says, ‘Wait a minute. We’ve never seen a claim for this patient from this provider. It should be a New Patient visit’. Denied. To code an established patient service, which costs less, is called ‘downcoding’. It’s illegal.So I hope that this answers your question from both a logical and legal standpoint. From here on, your bill won’t say ‘new’.