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View Poll Results: Would you
Decline to do the consult? 2 4.26%
See the patient and bill afterwards? 16 34.04%
See the patient and absorb the cost? 6 12.77%
Offer the patient the choice of having the consult and being billed, or not having the consult? 23 48.94%
Voters: 47. You may not vote on this poll

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Old 07-22-2009, 12:48 AM   #21
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I agree with lightspeed, though I am not a doctor. Life threatening issues come first. if there is time, take care of the others. Let the office bill them. Decide later to pursue if necessary.

Does a consult take an hour? I've never been with a doc for a whole hour...even when they did a colonoscopy, and it was the main doc. I'm probably wrong, but I can't imagine a consult taking that long...

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Old 07-22-2009, 07:53 AM   #22
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I always try to remain payment-source-naive, so the question for me is whether to see a patient for whom there is no medical indication for the consultation.

FWIW, I just see them. Of course they always seem to come in at 4:45 Friday afternoon, but that's another discussion.

Just an annoying part of the job, not because of the patient, but usually because of a lazy colleague.
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Old 07-22-2009, 08:28 AM   #23
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Very interesting! Currently there are 15 votes, with 10 for "see the patient and bill afterwards, four for "give the patient the choice", one for "decline" and NONE for the freebie.

What did I do?

This was NOT a life threatening situation and the patient was an adult foreigner who knew perfectly well what it meant to come to this country without insurance. It was a "nice to have" consult initiated by a new trainee (it's July!!!).

I spoke briefly with the patient and offered the choice of having the consult as a noninsured service for which a bill would be generated, or declining it. The patient indicated that he/she had a budget for his/her healthcare and did not consider that this consult was a priority, therefore he/she declined the service.

My rationale for offering the consult as an uninsured, billable service is that my time and expertise has value, and in an elective situation, I see this as a consumer's choice. Had this been an emergency, or had the patient been unable to make this decision for him/herself, I would have provided the service without hesitation and dealt with the cost later. If such a patient did not have the means to pay, I would have absorbed the cost.

I also polled my residents as to how they would handle this. All of them would have done it for free. Some indicated that they would hate to have to ask anyone for money. However, my secretary would have done as I did. It seems to me that residents who grew up with a "socialized medicine" system (which I did not!) are conditioned not to think of healthcare as an economic transaction. This probably makes them very humane, but poor managers.
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Old 07-22-2009, 08:32 AM   #24
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Originally Posted by Bestwifeever View Post
I didn't vote as I think my answer would be "it depends."
The same for me. Not enough information.

How often does this occur? Is it a favor to another physician, and they will return the favor? What is the effect on the patient if the consultation is not provided?

Plus, just because they "don't have insurance" does not mean they won't pay. They could be self insured. My son is now self insured up to $5,000, and I would expect him to pay for services rendered.

My spidey-sense is tingling with "set up" on the question, but we will see.

BTW, I'm an engineer - almost every answer to almost every question is - "it depends". And this situation isn't unique to the medical profession. I was often called in to assist or consult on program x,y,z which I was not directly associated with (and would not get the glory if it succeeded) - and since I was salaried, none of it was "billable". And no one's life depended on it either. You do what you gotta do.

edit - I posted this before seeing Meadbh's previous post - interesting with the added info


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Old 07-22-2009, 08:42 AM   #25
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... the patient was an adult foreigner who knew perfectly well what it meant to come to this country without insurance.

I spoke briefly with the patient and offered the choice of having the consult as a noninsured service for which a bill would be generated, or declining it. The patient indicated that he/she had a budget for his/her healthcare and did not consider that this consult was a priority, therefore he/she declined the service.

My rationale for offering the consult as an uninsured, billable service is that my time and expertise has value, and in an elective situation, I see this as a consumer's choice.
Some great observations there. Basically, it shows that when health care is "free" people don't give much thought to using it. When they are paying for it, they more carefully consider cost/benefit.

That should not be surprising, it is the rule in just about everything we do. So it's probably pretty safe to generalize form this example.

OTOH, "free" health care might get people in for more preventive care, which could have cost benefits. I wish I knew which would be the predominant effect in the USA.

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Old 07-22-2009, 08:55 AM   #26
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I want to say that I would do it and bill afterwords.

But. When this situation came up at the law office I would usually require a retainer up front if I had any question of the client's ability or desire to pay. Burned too many times. Our policy was to require a retainer for most new clients and to have a fee agreement in any event. I did some work for free but I wanted to chose what I would do for free. Of course, they weren't in the hospital either.

EDIT: posted before I read Meadbh's post with the facts.
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Old 07-22-2009, 09:02 AM   #27
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What if you did the consult for free and later they decided to sue and of course named everybody including you to get more money how would you feel then ?
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Old 07-22-2009, 10:17 AM   #28
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I have two completely different thoughts here....

First, I would want to know UPFRONT that you were going to bill me if that is what you were planning on doing... I can make an informed decision if I want to spend the money or not... if you just came in and consulted, and later I found out that it was 'chargeable', I would be upset as the patient.


My second is one of experience. When I was in my early 20s I had a dentist remove my wisdom teeth... as a side note, it was PAINFUL as they were all impacted and he could not get them out easily... cut through my jaw and hammered them out.... OUCH... ok, end of sidetrack... Well, he 'packed' the holes he created so I would not get dry socket... but I was going to college in a different town... he said wait a week and go to another dentist to get them repacked...

Well, I made an appointment, went to the dentist.... he looked at what I had... made jokes about the boot print on my chest (I asked 'what?', he said that is the only way he could think someone could have ripped them out of my mouth ).... but he said they sould not be packed again... so I thanked him and asked how much.... he said "Free"!!!

SOO, he spent his time, his assistants time, had to clean his tools etc... and did not charge me at all.... a very nice gesture for a college kid....
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Old 07-22-2009, 01:38 PM   #29
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Quote:
Originally Posted by Meadbh View Post
I spoke briefly with the patient and offered the choice of having the consult as a noninsured service for which a bill would be generated, or declining it. The patient indicated that he/she had a budget for his/her healthcare and did not consider that this consult was a priority, therefore he/she declined the service.
I wish the Dr's were that explicit about costs here in the US of A. The more likely scenario is, you'd get the 5 minute consult (including a quick scan of the chart) and a bill for $210 two months later which your insurance refuses to pay for some arcane reason. Then you waste hours of your time, the insurance company's time, and the Dr's billing staff's time arguing the bill. Medicine. American style.
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Old 07-22-2009, 02:06 PM   #30
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What you did seems reasonable to me. If the person wants your expertise, which you have spent many years obtaining, then it is reasonable to expect them to pay for it. Everyone can afford to donate some time, but no one can afford to donate all of it.

Safeway (food store chain for those out of the U.S.) doesn't take good feelings, they want cold hard cash.
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Old 07-22-2009, 02:13 PM   #31
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Good idea to boot the decision to the patient. Since your colleague seems to have generated the idea for your consult, it might not even have been something the patient was interested in.

Now, could you just take a quick look at this rash on my leg
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Old 07-22-2009, 08:11 PM   #32
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What if you did the consult for free and later they decided to sue and of course named everybody including you to get more money how would you feel then ?
Exactly!!! Why should I accept the liability AND the cost
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Old 07-22-2009, 08:12 PM   #33
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First, I would want to know UPFRONT that you were going to bill me if that is what you were planning on doing... I can make an informed decision if I want to spend the money or not... if you just came in and consulted, and later I found out that it was 'chargeable', I would be upset as the patient.
I quite agree!
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Old 07-22-2009, 08:16 PM   #34
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So......do I get a cookie?
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Why not? A cookie for everyone who answered #4
Old 07-22-2009, 08:21 PM   #35
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Why not? A cookie for everyone who answered #4

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Old 07-22-2009, 08:35 PM   #36
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YAY!!!
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Old 07-23-2009, 08:49 AM   #37
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I voted 4 - which is the way I would want this to be handled if I were the patient. I have been in this situation, as have my children, and I find it terribly offensive that 1) a physician engaged in my health care can involve another physician without my prior consent or involvement, 2) a physician can make a choice regarding my healthcare without determining my capacity or willingness to pay.

Meadbh handled it quite well, IMHO. And cookies without calories - what a great idea.
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Old 07-27-2009, 05:42 PM   #38
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Thanks heaven these are calorie free cookies or you would have ruined my diet!
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Doctors !
Old 07-27-2009, 05:53 PM   #39
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Doctors !

You know it makes me sick :
I have a dental problem and I can not find any doc that will let me pay out dental work:
This just makes me want to puke ; why you say, cause they wnat to look at how much money you have first before work is done !
What happened to the good willed men of the U S A ?
Money is more IMPORTANT that care for you fellow man !
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Old 07-27-2009, 05:56 PM   #40
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Basically, it shows that when health care is "free" people don't give much thought to using it. When they are paying for it, they more carefully consider cost/benefit.
-ERD50
DING DING DING

I think, no, believe any system that allows "all you can eat" will have problems. There has to be a copay or something to slow down the hypochondriac or the patients who want MRI for any headache. Yes, medical care is a resource, a limited one like any others.

By the way, I didn't vote because of "insufficient information". I thought this was a trick puzzle, and did not give the choices serious consideration.
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