The issues raised by the anecdote cited are quite complex. The doctor in question was a primary care physician, and PCPs are an endangered species. PCPs earn less than half the income of specialists, work as much or more, and have more bureaucratic hassles. Burnout is rampant. About half of our PCPs (150,000) plan to retire or cut back on their practices in the next three years. None of this justifies a $100 charge for a 1 minute throat evaluation or dumping a patient for challenging the bill.
The first chapter of a preliminary draft of my book, Physician Managed Care-Universal Coverage Now with Free Market Health Care Reform, addresses the crisis in primary care: http://doctormanagedcare.com/DMC/PMC.pdf
After and ordeal like that, I can see why a patient would not trust the doctor--any medical intervention could be seen as a cash grab. Maybe doctors should have meters on the wall as they used to in the UK for gas and you put in as many coins as you can afford.
As an American who has lived in Canada 20 years, I can't emphasize enough how nice it is to have your medical care disconnected from money. (the Canucks probably swing too far the other way, not minding how much they cost the system). I remember the first time I saw a doc and wasn't on the Ontario insurnance, they had to charge me and felt terribly for accepting a $30 check!
I hope that we can shave a little bit of the profit motive out of health care in the US--maybe doctors should be paid if patients reach good blood pressure, health weight, and vitamin-enriched diets.
amy cross
women make news
Since there is no longer a relationship to destroy and since it is such common practice (in South Africa where I live similar items pop up regularly) i would have thought that there is at least a contractual or financial challenge. Certainly there is an ethical challenge to be made. Although our legal systems differ, they all have some basic things in common. One of these is not having been informed before hand that certain things are extra and can be charged for. Supposing this had arisen in a contract over financing the purchase of a car and that some of the charges were hiden, undisclosed and appeared only when the gun is at your head and payment is being extracted. Adding insult to injury, an item which seemed an obvious part of the car, was called an "extra fitted luxry" (light fitting, or gear lever) and was part of the charging system. Ethically, The American Medical Association has a useful, if heavy, publication: "Code of Medical Ethics of the AMA" and it is the opinions and annotations (2008 - 2009 edition) of their council on ethical and judicial affairsl. these types of issues arise regularly and differing ways -- one of which is part of the informed consent procedure, another would arise out of a contract between the doctor and insurer, etc. i use this reference book regularly in some bioethical studies I am doing, and as a journalist too, I have some knowledge of how health insurers work (we appeared to have learned from you!)
It is indeed difficult to challenge doctors -- i do it all the time but have learned to preface it with items like: "You're not hampered by a bloated ego are you? There's something I wanted to ask....." But there are many who jump no matter what is being asked or how. As I was about to have an epidural anaesthetic for the birth of my daughter, I asked of the anaesthetist, with nothing particular in mind: "what are your qualifications for this type of procedure?" Journalists ask those questions and I didn't know the anaesthetist. He was very angry and about to plunge a needle into my spine.
Often however, the type of phenomenon you encountered begins with the insurance company which has stipulated what it will pay for and what rate. To maximise that, the "added extras" are slipped in. Not even a bank would easily get away with slipping in an item disguised in such as a way as it is not distinguishable from the rest of the transaction, but then charging more for it without any warning. I am often called anti-doctor and I no longer care. As the daughter of a doctor and who sees doctors at the drop of a bump, what I really hate are crooks. Some doctors unfortunately allow themselves to get tarred with that brush by behaving peculiarly when an insured patient pops in (worse when an uninsured one comes in) others bring it upon themselves with their belief in their own god-like status. of course some are crooks. But overwhelmingly, the kind of behaviour exhibited by the doctor described in the article, will have started with restrictions from insurance companies and is then mixed with a slightly inadequate ability to deal with it all openly with patients. And it need not be the insurance company of the author -- it develops over time and through many insurers and becomes ingrained. A letter to the doctor dwelling on her dubious ethics backed up with research from the AMA's book and offering her the golden opportunity to be judged by her peers in the AMA, may at least make her less likely to do it to anybody else. This business of firing patients I know happens in the USA -- but it doesn't happen in South Africa (too greedy to fire them). But my gut feel is that when it is because the doctor misbehaved and won't face a challenge, the decision of the doctor will constitute some kind of malpractice. By the way, that nice hipocratic oath (which is also in the book) always starts with something that amounts to "do no harm" and then specifies a number of other injunctions. this doctor has done harm not to mention some of the other problematic areas. But what I can't understand is why her identity is shielded. What doctors really don't want is bad publicity about their professional conduct.
I had a similar thing happen at the dentist. After the dental hygenist does all the work, the dentist comes in and pokes around for less than a minute. One day the dental hygenist said, "Do you want to see the dentist?" And I asked if I had a choice. She said that it costs an extra $39 for the dentist to come in and I of course declined. The rule of thumb is the patient has to see the dentist once a year. I go to the dentist every 4 months. I had gone several times before they told me about that little out.
Thanks for your very informative post.
The CFPA would have authority to determine which products consumers can choose from. In short, the bill would create a regulatory overlay of the entire business community, extending far beyond traditional financial services. We need to take control of consumer choice. How does CFPA affect you? http://www.friendsoftheuschamber.com/issues/index.cfm?ID=469
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