Another opinion needed from doctors and patients on the board

[Surfdaddy]

So my DW has had some tests in the last year and looks like she has a low thyroid. She went to an expensive doctor in the city for a second opinion. She seemed to like him, he gave her a prescription and she has returned a few times, a few months apart, for visits/monitoring.

Last visit about 2 months ago she went in and had another blood test. After the results were in, she didn't want to drive the hour to the city to see if her meds level should be changed, so she called the office. They gave a time she could call the doctor.

She called the doctor, talked 5-10 minutes, and he said she shouldn't change the med level.

So a few weeks later I get our credit card bill and there's a charge for $175 from this doctor.

DW calls the office, office indicates the charge was for a "scheduled 30 minute phone call". DW complains and says she only talked 5-10 minutes. Office says sorry, that's their policy.

So I think this is bogus and I'm inclined to dispute the charge. Reasons:

1. Office never informed us in advance that this was a charge phone call, nor that 30 minutes had been scheduled.
2. We've used many doctors over the years with ourselves and kids, and have NEVER been charged for a short phone call such as this.
3. Office never sent us a bill or otherwise let us know they were going to charge our card for the call.

I'm open to opinions!

 

[wabmester]

Doctors are scarce resources. If you watch them work, they multiplex like mad. Their admins overschedule them, and they bounce from room to room optimizing their face time with patients.

When they're on the phone with you, you own that resource. If they really scheduled that phone conference, then they allocated a time slot for you, and they scheduled other patients around that slot.

I would view it the same as an office visit.

 

[Rich_by_the_Bay]

She called the doctor, talked 5-10 minutes, and he said she shouldn't change the med level.

So a few weeks later I get our credit card bill and there's a charge for $175 from this doctor.

DW calls the office, office indicates the charge was for a "scheduled 30 minute phone call". DW complains and says she only talked 5-10 minutes. Office says sorry, that's their policy.

$175 sounds high to me. Here is some perspective:

Charging for phone consultations is legitimate (just ask the lawyers here). It's a fairly recent trend. Such calls will eat you alive in a medical practice and contain the same risks and responsibilities as advice given during a visit. It's "just a call" at the patient's end, but the doc has to pull the chart, review the notes and results, talk to you, make judgments to give advice, accept the liability should mishaps occur, then document the whole thing. I sense you are not disputing the act of being charged so much as the amount.

That said, for a 10 minute call (20-30 min work for the MD), this sounds a bit high. Problem is, in advance the doc can't know how much time this will turn into and thus allotted the full half-hour (lots of "Oh, Doc, as long as I've got you on the line..."), so they block off to allow for that (thereby not filling that office slot with another appt).

Also, they should have advised you of their policy in advance, and that is your strongest argument. So, now you know. Is it worth antagonizing a doctor she likes and may be seeing again.

In my dream world, I'd call the doc and say this:

"We really appreciate the advice you have given us, and understand that phone advice uses your valuable time. Our only concern is that we were not advised in advance as to how you  handle this and would have probably reconsidered how we handled this had we known. So, we fully intend to pay your bill unless you feel it should be reduced or cancelled and hope that in the future your staff will do a little better job of communicating your fee policy in advance."

Hope that is helpful.

 

[dory36]

I agree it is good customer service and courtesy to advise you up front.

But the fact that you chose to have your appointment from your home instead of in his office isn't otherwise relevant to the charge. If you had driven in, would the charge have been about the same? If so, well, hard to argue.

If he doesn't charge you, and presumably a handful of others who want their consultations by phone instead of in person, then that otherwise billable time goes into the overhead that is part of the rates that are paid by those who do come into the office. I doubt any of them would say, "oh sure -- not only am I willing to wait for my turn while he helps you on the phone, just put it on my bill as well!"

 

[SteveR]

I agree on the billing thing. If you use a doctor's time, education and experience in a medical matter then he deserves to be paid for the time. This would apply to an office visit or a phone consultation.

On the other hand, it is nice to see a professional extend some basic courtesies to a patient without charging for it. My wife is having some major health issues and her doctor has called her in the evenings on several occasions to discuss tests, procedures and test findings with her. He has done this at least three times in the past couple of months and has never charged her for any of the phone calls; some of which lasted more than 30 minutes. He initiated all the calls himself too. We have fortunate to have a doctor that sees his profession as more than a business.

 

[Gpax7]

Then there is, of course, the latest billing trend:
The doctor says," Don't set foot in my office if you have an HMO. But if you have a good PPO plan, make an appointment. No, make that an "aboutment". I will try to get to you at "about" the time we agree on, but understand that my office staff has been instructed to make 4 aboutments for 10 a.m. For an extra $5000. a year to me, I will return your call after hours and on weekends . For an extra $7500 to me, I'll be available 24 hours a day."
It is a growing trend sadly, because malpractice premiums and med school tuition rise faster than nearly any other sector of the economy.
Many of our specialists are leaving the state due to malpractice insurance rates.

 

[razztazz]

As long as the patient is exploitable there is no motivation for them to do anything other than shake you down till the insurance runs out. So,waddaya gonna do about it? is the basic business model

 

[Martha]

The cover story for Business Week this week is about how much guesswork there is in medicine and efforts to use more evidence as to outcomes in medical decision making.  Interesting reading. 

For example, for years diabetics were pushed to control their blood sugar to minimize risks of heart attack and strokes.  But evidence shows that the best way to reduce heart attack and stoke in diabetic patients is with aspirin, statins and BP meds. Controlling blood sugar levels don't do it.

http://www.businessweek.com/magazine/content/06_22/b3986001.htm

 

[Nords]

Rich, that's a great Business Week article (but don't put a copy in your waiting room!).

I'd be interested in hearing your opinons on Dr. Eddy and his evidence-based medicinal approach.

 

[Rich_by_the_Bay]

The cover story for Business Week this week is about how much guesswork there is in medicine and efforts to use more evidence as to outcomes in medical decision making.  Interesting reading.  

For example, for years diabetics were pushed to control their blood sugar to minimize risks of heart attack and strokes.  But evidence shows that the best way to reduce heart attack and stoke in diabetic patients is with aspirin, statins and BP meds. Controlling blood sugar levels don't do it.

http://www.businessweek.com/magazine/content/06_22/b3986001.htm

Careful - you don't want to get me started ... .

I've made my academic career in evidence-based medicine and decision analysis, so it's dear to my heart (even wrote a little textbook or two on the subject). I really like to see articles like the one you cited make it to the nonmedical press. There is alot of culture to change, and most doctors are quite receptive in theory but find it hard to change their practice for many reasons.

But, it's happening. The leaders on the front line are the general internists (including hospitalists) and pediatricians. EBM is not a passing fad -- it is the only proper way to practice medicine. Not all questions can be answered using these techniques (10%), but when they can (90%), why not use them?

 

[razztazz]

The cover story for Business Week this week is about how much guesswork there is in medicine and efforts to use more evidence as to outcomes in medical decision making. Interesting reading.

Oh so right. It's all about playing Russian Roulette and having the patient roll the dice. Roll the dice with the possible disease or condition, then roll the dice with whether the dr knows or cares about knowing what he's talking about, roll the dice with the drugs or treatement and the associated adverse reaction , roll the dice with whether you were even properly diagnosed or not.....

 

[SteveR]

Every science shares the illusion of knowledge. The more we learn the more we realize we don't know as much as we thought. Medicine is comprised of several sciences-primarily biology, chemistry, and physics with their various sub-divisions of microbiology, virology, biochemistry, pharmacology, mechanics, engineering, genetics, ergonomics, kinesiology, etc. Each one of these carries with it the limitations of knowledge within and between each of these individual sciences. Add to that individual genetic differences and you have an environment where statistics are the rule of the day; probabilities of occurence and variations around the mean for each treatment plays a major role.

It should not be suprising that most of medicine is not much more than an educated guess for many diseases or conditions. Physical injury is about the only area where direct evaluation of a condition has a high correlation to fact. A broken leg has a number of very defined symptoms and can be observed directly or with instruments to confirm the condition. However, many other conditions are masked by inaccurate data from the patient and there are no direct measurements of the condition to provide correlation of the suspected condition.

How about we cut the MDs a little slack? If you can do better then by all means get your MD and hang out your own shingle. Just make sure you have your malpractice insurance paid up.

 

[donheff]

Then there is, of course, the latest billing trend:
...if you have a good PPO plan, make an... "aboutment". ...For an extra $5000. a year to me, I will return your call after hours and on weekends . For an extra $7500 to me, I'll be available 24 hours a day."

Interesting that my wife was recently wishing she could find a ggod doctor that will take BC/BS and offer a premium quick answer service (even email responses) on the side. Is this really becoming a common practice?

 

[Caroline]

she didn't want to drive the hour to the city to see if her meds level should be changed,

Couple of thoughts...

First, this phone appointment was a benefit to your wife. She asked for it, and she saved over two hours of HER time not having to commute, not to mention travel costs. Unless her time isn't worth anything, she got a benefit.

Second, I wonder if you would be disputing this bill if she had taken up only half of a face-to-face appointment? If so, you'd be effectively asking the Dr. to bill by the minute, not the half-hour. In which case, if you go over the time allotted he'd be entitled to MORE than the 1/2 hour fee.

All things considered, I'd let it be. I figure that if I worry too much about saving small amounts of money, I'll be so stressed I'll end up paying my savings, and then some, to the cardiologist!

 

[wabmester]

http://www.businessweek.com/magazine/content/06_22/b3986001.htm

Oh, the medical profession must love that guy.   "You mean to tell me that after spending a couple hundred grand on an education, all they taught me were barbaric and ineffective procedures!?"   I'm surprised he's still alive to tell his tale.   He's taking on egomaniacs who are pretty good with knives.

 

[BarbaraAnne]

Surfdaddy,

I have hypothyroidism, as does your wife, and have had the diagnosis for almost 20 years.  I have yearly blood work done and my synthroid dosage is adjusted accordingly.  When the blood test shows that the dosage needs to be adjusted, the nurse, not the doctor, calls me and lets me know the result and calls in the new prescription.  Hypothyroidism is a very common diagnosis and your wife should not be overly concerned.  Synthroid is one of the most prescribed medications and is not anything to worry about.  Next time, just have the nurse call in the adjusted prescription to your pharmacy and you can avoid the doctor's charges to inform your wife of the blood test results.  It will save you the cost of the doctor telling your wife what the nurse can tell her for no additional cost.

 

[Surfdaddy]

Thanks to all for thoughts, especially message from BarbaraAnne. My wife is going to print RichinTampa's dream reply and use it to see what the office says.

But we are not going to use this doctor again, in any event.

I appreciate all of the great feedback.

 

[Nords]

I'm surprised he's still alive to tell his tale.   He's taking on egomaniacs who are pretty good with knives.

By that reasoning there must be something to EBM.

If they're so good with knives, then why is he still alive?