There is an interesting story about patients who are charged more if they ask too many questions of their doctors. In the case of Susan Krantz, a doctor charged her for two visits because she asked too many questions about his diagnosis. It is an interesting trend since consent is the common defense to malpractice. However, if you ask too many questions before giving consent, you are charged by some doctors.
As a registered nurse, Krantz was shocked by the added charge. The new charges reflect the “coding” required by insurance companies where doctors add a charge to a “wellness” visit when a patient like Krantz asks about a hip problem or other concern.
Krantz received a letter from the medical provider that stated “the insurance company may require that patients pay or make a co-pay for services beyond the ‘preventive’ part of the appointment.”
I am waiting for the first malpractice case to raise the added charge in the context of a claim of consent. When the doctor is claiming that he received consent, I hope the plaintiff’s lawyer asks him if he doubles the bill if the patient asks too many question. It is a rather curious message: ask whatever you want but be prepared to be charged extra if you do.
Source: CBS
mespo,
Good stuff.
Mike I think it was was right, as usualy. One pain may seem unrelated but be a diagnostic aha.
When I go to a specialist I do not ask about things unrelated to his specialty. When however I go to my GP I expect to be able to ask about issues other then my cold.
Here’s Alan Norton’s classic definition of a professional. In his case it’s about IT but it has universal application.
Let’s see how our billing machine MD stacks up:
10 things that define a true professional
By Alan Norton
The term professional is thrown around quite a bit these days, perhaps too much. I do it myself. But what exactly does it mean to be a professional? As you read through the items below, consider how you compare with each trait.
Note: This article is also available as a PDF download.
1: Put customer satisfaction first
Understanding and satisfying your customer’s needs are the cornerstones of a successful business. Do what is necessary to meet those needs. After all, without the customer, there is no professional.
You may not view those you work with as your customers, but in many cases, they are. I remember when one of my managers perceived that I was overly stressed. He pulled me aside and sat me down in his office where he told me stories and jokes for the better part of half an hour. He recognized my needs and acted accordingly.
Professionals identify and satisfy their customer’s needs.
2: Make expertise your specialty
The very word professional implies that you are an expert. Technical competence is essential in IT.
Become an expert in the skills and tools necessary to do your job.
Always perform to the best of your abilities.
Keep your knowledge up to date.
Professionals know their trade.
3: Do more than expected
Professionals aren’t bound by a time clock. They are given wide latitude in their daily self-management. They are expected to manage their time and work habits. Don’t abuse the privilege. If you take an hour for personal needs, give back two hours.
The reality is that professionals are expected to exceed the standard 40-hour workweek. There are times when you may be asked to work weekends. You may have to forego a vacation or work 12-hour days to complete an important project. All are part of the job description of most professional positions.
Professionals are expected to produce results. Strive to complete deliverables before their due dates and under budget.
Professionals meet or exceed expectations whenever possible.
4: Do what you say and say what you can do
This is one of my favorite sayings especially in view of the fact that talking the talk is so prevalent and walking the walk so rare in this age of sound bites. You should “engage brain” before speaking — can you really do what you are about to say? If you can’t, the wizard behind the curtain will eventually be revealed and hard-earned trust can be lost.
Professionals deliver on promises made.
5: Communicate effectively
I go out of my way to patronize a dentist who has excellent communication skills. He takes the time to explain the available options, make recommendations, state the total costs, and promise a date when the work can be completed. I then feel empowered to make the right decisions.
I recently ordered Internet and phone service from the cable company. I told the salesman that the existing cable had been ripped out during a landscaping project. Perhaps I wasn’t clear or perhaps the salesman wasn’t listening — it doesn’t really matter. The message didn’t get through and the wrong person was sent to do the installation. As a result, Qwest, not the cable company, got my business. Not only did the commissioned salesman lose his sale, he and his company both looked unprofessional in my eyes.
Resist the urge to blame the customer when communication goes awry. Effective communication is ultimately your responsibility — not your customer’s.
Whether verbal or written, professionals communicate clearly, concisely, thoroughly, and accurately.
6: Follow exceptional guiding principles
Appreciate and support those you work with. Practice good manners and proper etiquette. Have high ethical and moral standards. Be honest and fair in all of your dealings with others. Obey the law. These may sound like the attributes of a Boy Scout, but they are basic values that all professionals should follow. Many companies have a document that outlines their operating principles. Have you read yours?
Professionals adhere to high values and principles.
7: Praise your peers not yourself
Respect and acknowledge the talents of your peers. There is nothing more unprofessional and self-serving than telling others how wonderful you are.
Professionals are humble and generous in their praise of others.
8: Share your knowledge
When I was hired at Hughes Aircraft, a second person with similar skills was hired with me. It didn’t take a rocket scientist to figure out that one of us wasn’t going to survive. The competitive nature of the situation was palpable. I am no stranger to the belief that it is not in your best interest to share your knowledge with your associates, AKA the competition.
It is easy to find yourself in that comfortable place with “unique” knowledge. If you are a hoarder of information and are of the opinion that all of the nuts you have squirreled away grant you immutable job security, think again. The harsh reality is that nobody is irreplaceable.
Information isn’t a limited resource. Contrary to what some might think, your mind won’t be emptied by giving away kernels of wisdom or experience. Think of knowledge as an ocean of facts and not a stream of data. It is possible to share what you know and still keep one step ahead of the competition — simply apply yourself and learn something new daily.
Professionals help their peers and are respected for doing so.
9: Say thank you
I always tried to find a way to thank others for their help. When their help was above and beyond the call of duty, I would buy them a Coke – a testament to the marketing power of Madison Avenue and Mean Joe Greene.
The items I value the most in my personnel file from Hughes Aircraft are two AVOs (Avoid Verbal Orders memos) to my manager from frontline employees. The AVOs thanked me for the support I provided that helped them do their job better.
Silly me — what was I thinking? I was sharing a Coke when I should have been sharing my thanks in a printed internal document to the employee’s manager.
Professionals thank others in a meaningful way that most benefits the recipient.
10: Keep a smile on your face and the right attitude in your heart
This has been the hardest item for me to do consistently over my working years. I believed I was lying to myself and the world by smiling when I was miserable or unhappy with an ongoing issue at work.
I now realize it’s not dishonest to be pleasant when you are having one of those lousy days. It is in fact thoughtful to care about how your attitude affects those you interact with. Share your unhappiness with your manager only. “Share the misery” is not the mark of a professional.
Professionals are pleasant even during trying times.
The final word
Working with professionals is a pleasure, and I have been fortunate to work with some truly exemplary ones. There have been a few who liked to be treated as professionals without having to work and act like one.
“A Dr. can practice medicine or a Dr. can perform within the confines of a fear driven vacuum thus putting both himself AND his pt at risk.”
This statement assumes that (proper) malpractice laws don’t exist for a valid reason and that informed consent is not vital for the patient’s interests within that context.
However, as you point to W=^..^, more information about the scenario would be helpful.
Gene H.
1, October 23, 2012 at 11:28 am
False equivalence.
———————————-
Not from the patients ($$$) perspective….
“Healthcare is not legal services but the two are certainly going to meet when this practice blows up in some doctor’s face. Informed consent should be in the end a far greater concern for the litigation adverse doctor than his hourly billing concerns. But hey, people have been known to cut off their nose to spite their face before. Doctors are not immune to that folly. ” ~Gene H
——
A Dr. can practice medicine or a Dr. can perform within the confines of a fear driven vacuum thus putting both himself AND his pt at risk.
In the presented scenario you can see that in the same visit the patient was there for general health check-up and asked specific questions regarding an operation or procedure that fell into another category which also took up a signficant amt of time but also demanded the expertise of the Dr. What is not specifically addressed is whether the pt actually had the procedure to which the ????’s were geared….more information would be very helpful…
“This happens when you go in to the doctor for a sinus infection and then ask all the other questions that have piled up in the last year about your insomnia, your toe fungus, etc”
AA,
If you believe this your are either insane, or in such good health that you don’t understand diagnosis. Many conditions that people suffer are indicated by symptoms that would appear unrelated. Any worth their salt would want to know as much about how a patient has been faring physically since their last visit, to be able to complete a thorough diagnosis and treatment plan. I would drop any Doctor that treated me in this manner.
Curiosity is obviously a dangerous pre-existing condition. See also Ceiling Cat.
It’s thinking like THIS here in PA that gives me to understand how it will all be okay before much longer . . .
http://www.shalereporter.com/industry/article_fcd5b9cc-1a35-11e2-9cdc-0019bb30f31a.html
Two points:
Who do I bill for making the diagosis of my heart problem?
As for my extensive questions, there are at least ten patients who say: “Uh huh”. It balances out.
Today it took 20 minutes before the doc realized that I had been sent from ER on to the ward for investigation. Thus all info on what happened at the ward had not connected to her brain, and had to be repeated. Thus in sync, we parted happily.
GeneH is right. Docs are people too. But here they are NEVER motivated by insurance company payments and malpractice suits.
I see the question about extra fees for questions becoming a boilerplate question by plaintiff attorneys very soon. There is a fascinating dynamic I’ve seen working on med malpractice cases. Most docs don’t trust attorneys, even the ones representing them. And many attorneys are jealous of docs, partly because many make more money but also because docs are generally held in higher esteem than they are. “Damning w/ faint praise” comes to mind regarding the latter.
Fairly, that’s my philosophy.
@AA ” This happens when you go in to the doctor for a sinus infection and then ask all the other questions that have piled up in the last year about your insomnia, your toe fungus, etc. And it does have to do with how insurance billing works, as Donald says. A normal visit is coded as one thing, and if the visit includes extended counseling, that’s another code.”
If that is the way it works, I imagine that is a surprise for most of us. I thought saving up non-pressing questions for the next appointment was exactly what one is supposed to do. Who knew doctors charged on a per subject or a per question basis.
My guess is that under ACA we will be moving away from fee for service anyway and this will eventually go away – but it may take decades.
With health care costs increasing at, maybe, 2 to 4 percentage points faster than growth in GNP, we are definitely going to change the way we deliver health care. The only question is whether we manage the change in a reasonable way.
P.S. I just pulled this from Fox news if you consider them an authority:
“The projected growth rate of 7.5% for overall healthcare costs contrasts with expectations for growth of 2.4% in U.S. gross domestic product and a 2.0% rise in consumer prices during 2013, according to the latest Reuters economic survey.”
Avoid doctors like the plague. Or avoid doctors offices and clinics like the staph infections that you will get there.
What Gene said. If I go to my HMO primary doctor she answers any of my questions and refers me to a specialist if there is anything she can’t answer or deal with. I concur with Prof. Turley that it will be interesting to see the first malpractice case that is brought when the victim was unable to pay for the additional questions to be asked and therefore was unable to make an informed consent to the procedure or treatment.
Doctors and lawyers USED TO be much different in the way they practiced. Just imagine if they are getting “streamlined” to practice the same way — uh oh, I can see it coming. We are all money and time is money and care is money and pretty soon there ARE no doctors, there are “medical service provision units.”
False equivalence.
Healthcare is not legal services but the two are certainly going to meet when this practice blows up in some doctor’s face. Informed consent should be in the end a far greater concern for the litigation adverse doctor than his hourly billing concerns. But hey, people have been known to cut off their nose to spite their face before. Doctors are not immune to that folly.
More exaggeration from the Turley camp…this has nothing to do with being charged more for asking more questions. This happens when you go in to the doctor for a sinus infection and then ask all the other questions that have piled up in the last year about your insomnia, your toe fungus, etc. And it does have to do with how insurance billing works, as Donald says. A normal visit is coded as one thing, and if the visit includes extended counseling, that’s another code. No fraud is going on, and no one is being charged for being informed for consent purposes.
Hi, Jonathan – It seems to me that this looks odd only because of the way doctors have to bill for insurance purposes. If doctors charged just like (many) lawyers, on the basis of time spent on client matters, it would be utterly normal to charge more when the client asks for more of their time. Any service provider who charges by the hour works like this.
The insurance lobbyists are the best paid….. Gentlmen and ladies of the evenings……