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.