What would you do?

[Meadbh]

Imagine you are a physician who is asked to consult on a patient. The problem is not life threatening, there is no diagnostic or therapeutic dilemma, and the main function of the consult is to provide information and support to the patient......who does not have insurance.

 

[Texas Proud]

How is asking me? A friend who is also a doctor? Someone off the street?

How much time and effort do you have to put into the consult? Will you be out cash or just your time?


IOW, I am an accountant... I get questions all the time about taxes etc... I will usually answer someone if it takes a minute or two... and tell them they need to do their own research as this is not 'official' from me... I would do the same if I was a doctor...

 

[Meadbh]

It's a patient in a hospital. Not a friend or a relation.

A consultation requires your expertise. There is no cash outlay on your part. Just an hour or so of your time.

 

[KB]

All the medical offices I've been to require payment at time of service, for a new patient. Is that a possibility?

 

[Meadbh]

The patient is in a hospital bed. Not likely to produce cash on the spot.

 

[W2R]

I voted to see the patient and bill afterwards. As a physician, you want to help people, so do what you can. If you truly feel that the consult you provide will not help the patient, then make it short.

The patient (in the U.S., anyway) owes you the money whether or not he/she is insured. If he/she is poor, lower the fee as you see fit.

You DO have to earn a living - - I really do understand that. But you also have to sleep at night so I would at least see the patient briefly.

 

[bbbamI]

I'd go with option # 4. If they want the consult, I would oblige and if it were not unethical, I'd probably give them a discount.

 

[Meadbh]

Keep 'em coming!
When we have a good number of responses, I'll tell you what I did, and what my colleagues said they would do.

 

[bbbamI]

Keep 'em coming!
When we have a good number of responses, I'll tell you what I did, and what my colleagues said they would do.

Will there be a prize for matching answers?

 

[crazy connie]

Option 2 was my choice. If they recover and pay that is great. If they die, oh well. If they are truly indigent, you just helped a fellow human and your billing clerk writes it off. Or, if this is only for information and support, is there not a lesser skilled professional able to provide the service (Social Worker, Cancer Society Volunteer or Diabetes Foundation etc...)?

 

[Meadbh]

Will there be a prize for matching answers?

A free consult!

 

[crazy connie]

A free consult!

When will you be in Phoenix so I can schedule that?

 

[Meadbh]

By the time I get to Phoenix....

YouTube - Glen Campbell - By The Time I Get To Phoenix

 

[kumquat]

Do you have options 2 and 4?

Edit to add:
Since your patients are kids (I think), can you live with yourself if you don't help?
Or is this just theoretical and not a part of you practice?

 

[Bestwifeever]

I didn't vote as I think my answer would be "it depends." Once my dr. called in a colleague in her office to weigh in on a problem I was having as a courtesy. Another time she referred me to a (different) colleague in her office and that was a billed appointment.

But even if billlable, in the situation you describe, that is nice of you (or any doctor) to do.

 

[calmloki]

YouTube - Glen Campbell - By The Time I Get To Phoenix

Dang - with the arrow over Glen's face i thought that was kd lang at first.

I voted offer consult after letting the patient know it would cost if they wanted the consult. As a mechanic in my own shop i did a lot of free consults - but they sure didn't take an hour! 5-10 minutes free, maybe 15 or 20 for a good customer or friend, but an hour? really? that has to include reading the whole chart, personal checkup, and some phone calls right? I don't think I've had a doctors undivided focused attention for an hour in ... ever? and free? Wait - this is a trick question - aren't you in Canada?

 

[bbbamI]

Wait - this is a trick question - aren't you in Canada?

Yeah...but, but, but we were to imagine ourselves as a physician. Since I'm in the US, I had to go with that...

Calling Dr bbbamI!

 

[Purron]

I voted to see the patient and bill afterwards. The most important thing is to take care of the person. If this were a situation requiring a large commitment of time and resources, perhaps more analysis would be required. Plus, no insurance does not necessarily mean no money. Furthermore, even if the patient has insurance this doesn't mean you would be getting paid a fair amount for your work.

 

[CuppaJoe]

"See the patient and bill afterwards."

Or, as my eye doctor said, looking deeply into my eyes, "no insurance, so, this one's on you." His office has signs everywhere, something like, "pay on your way out."

 

[lightspeed]

In my specialty, most pts I am asked to see have cancer, so I see the pt and prescribe therapy no matter what and don't even check ability to pay now or later.... I let my office worry about that. I am fortunate to be in a position to be able to do that, and no one will stop me from treating a patient for free. Now, if the problem was not life threatening..... and just for an opinion...... it would probably depend on how much time I had that day, or if I was doing it as a favor for a friend, etc... After all, as doctors, don't most give opinions and advice regularly to family, friends, friends of friends, barbers of friends of friends, etc....

 

[Rambler]

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...

R

 

[Rich_by_the_Bay]

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.

 

[Meadbh]

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.

 

[ERD50]

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


-ERD50

 

[ERD50]

... 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.

-ERD50