My wife gets robocalls from her primary care provider. Every 60 days, as best I can determine. They are all the same: "Please call our offices to schedule an appointment."
My wife, nor I, have medical insurance. The doctor's office knows that. Or, at the very least, the front office staff knows it. I have no idea what the actual doctor is aware of. I suspect he's aware of nothing...but that assumption might just be a symptom of my naivete. He may or may not know what the insurance status of his patients are...and he may or may not care. Perhaps he is just a businessman. A businessman in the career field of providing medical care. Perhaps he sees his career choice as a means of providing for his family, and supplanting his lifestyle, after several years of post graduate studies...and his patients are the means toward that end. I really don't know.
But it seems to me that an aspect of the health care debate that doesn't get discussed much is the reasons why health care costs keep going up. And up. And up.
It also seems to me that the Hippocratic Oath perhaps needs to be updated. "First do no harm" should be updated to include a broader sense of what "harm" consists of. If you perform a risky and unnecessary operation, that results in permanent maiming or even death, you have obviously done harm. But what if you did none of those things...but merely provided medical care that you had every reason to know, with certainty, that your patient cannot afford, and was not absolutely necessary for a satisfactory result? What if you over treat? Knowing that your patient is of limited means? Leaving them in debt that they cannot easily repay?
Have you done harm? At least economic harm? If you have the discussion up front with that patient, and explain the costs and benefits, and allow them to choose the medical course that they feel they both need and can afford, you have, as far as I'm concerned, fulfilled your duty. My experience, though, is that most doctors don't feel comfortable with that conversation...and that it rarely happens.
And soliciting business from your patients by calling them up on the phone and suggesting that it's time to schedule a visit with the doctor, whether they have any medical complaints or issues, is in my mind unethical. It is an abuse of trust...the trust that most people implicitly place in the doctors to know what's best for them...and it smacks of ambulance chasing.
There must be several members here who are either doctors, or staff members in medical offices. Can we discuss this? And for the rest of you...do you get calls like this as well? Do they bother you the way they bother me, or do you appreciate them?
My wife has no underlying medical conditions other than one: She had an AVM (aterio-veinous malformation) burst in her head about 12 years ago. That episode has, indeed, left her with recurrent medical needs. But not of a such that her medical clinic, where her primary care provider, can address. For that, she has a neurologist, who is not associated with the clinic. Other than that, she has no diabetes, no arthritus, no osteoporosis, no high blood pressure, no cholesterol issues...in short, no chronic medical conditions that would warrant even the most prudent of doctors to contact her on a 60 day basis to suggest she needs to come in for a checkup.
I can only assume that he does so because it is all about revenue flow.
And I can only assume, since no trip to the doctor is complete without the billing Nazi at the front desk grilling you upon your current address, your current phone number, and requesting that you proffer your medical insurance card, if you have one, that the entire staff is intimately concerned with your ability to pay, and how you can be contacted in the event that such payment is late.
Why is it, then, that the Doctor, when they finally see you 45 minutes after your appointment time, seems to be so completely oblivious to your insurance status?
What is so fucking hard about having this conversation: "I see from your paperwork here that you don't have insurance...That's unfortunate, but here are a few options. We can do "THIS*...which will cost you this much, and here are the benifits. Or we can do THIS, which is a less costly alternative, and here are the results that I have observed... Or, we could even do this....and here's the cost out of pocket.
Is that such a fucking hard conversation to have with someone?
Or is it easier to just do this: "I'm prescribing this treatment...and I'd like to see you in another two weeks. Check with Anne at the front desk an make a follow up appointment."
My wife was run over by a car in mid May...not run over run over...just her foot. The driver had the required insurance stipulated by the State of Oregon. 15K in medical liability. You know how long it took for the medical vortex to suck up $15K in invoices? About 14 days. The icing on the cake was when, after the first follow up visit with the surgeon after the initial surgery, she casually said to her staffer: Have you requested a bone stimulator? I'd like her to have a bone stimulator." He said to her that he hadn't yet requested it, but would immediately do so.
And he did.
You know how much a bone stimulator costs? How about 4 grand. Do you think anyone told us that? Or asked if we thought it was a good uses of the 22K we live on over the course of a year? No...they did not. It never occurred to the medical vortex that such a decision was even up to us...and as I type these words, it occurs to me that I could have, and perhaps should have, interjected and asked..."Wait a sec...how much does that cost?" I didn't, though trust me the thought occurred to me. But like most people, when I find myself in a doctor's office my default mode is that they wouldn't suggest something that isn't both efficacious and necessary. There is the rub...we trust our doctors to do the right thing.
When I found out how much it cost, which was never explained to me, I was upset. Of course, the insurance company approved the expense...they knew that the medical bills had already exceeded their liability, and that it would be on our dime. You will excuse me, I hope, if I feel like we were completely irrelevant to that medical decision. The doctor prescribed a costly device, which helps her bottom line, and the insurance company signed off on it, knowing all too well that they wouldn't pay for it. We are left with the bill.
I run into this with other relatives I find myself responsible for schlepping to and fro to their doctors. My mother and father. My Mom goes to a podiatrist now...She never did until my father started seeing him (they are divorced). When she learned that he could go to a podiatrist and get his toenails cut, and that Medicare covered it, she was damned if she wasn't going to get a piece of that action. So now I take them both to the same podiatrist. To get their toenails clipped. My Mom also has rheumatoid arthritus, and one of the symptoms if that her second toe on one foot has curved over her big toe. It looks worse than it is...she readily admits that it doesn't actually cause her any pain...it's just unpleasant to look at. She has been using a foam spacer for about 2 years now to separate the toes and keep them from crossing, but really, she never complains about her toes killing her. The podiatrist is a nice guy...I like him.
But he's a businessman, as well. He, more than any other doctor I take my family to, knows the ins and outs out Medicare compensation. He immediately informed us that Medicare would pay for a pedicure every 60 days, and suggested we set everyone up on a 2 month schedule. Just 3 weeks ago, he told my Mom that, even though her errant toe doesn't bother her physically, Medicare will pay for an amputaion, and suggested that...well..."why the fuck not?" "I can do it on an outpatient basis."
That's drumming up business. That's not Medicare fraud, but it comes close to it. And I'm sorry, but robocalling patients in your rollodex and saying "we haven't seen you in awhile, so please call our office to schedule an appointment" is drumming up business.
And when you know that your patient doesn't have insurance, and is getting up in years...I'm sorry...there's something predatory about it. Unseemly. Avaricious. It tells me that you see your patients as a revenue stream. A dairy cow. A food source.
Regardless of their financial situation.
And it is a business practice that takes advantage, as I said, upon the trust that most people implicitly place in their doctors.
Having filled out more forms than I care to remember at innumerable doctors over the years, I know for a fact that the first thing that the front desk staff does is to ascertain your insurance status.
Why can't...why shouldn't...the doctor be made imminently aware of your answers to those questions? I would suggest that an uninsured patient's paperwork be copied on colored paper before handing it off to the doctor, so that it is completely understood by all parties that...yes, I have a medical issue that brings me to you, but I have no insurance...so please bear that in mind when you devise your regimen for addressing the issue at hand.
Is that not reasonable? Would that not be ethical?
Or am I Naive?