I find it extremely frustrating when you go to a doctor for a check up, and they send you in for one diagnostic test, when that comes normal, other diagnostic, and if thats normal, so on.. and charge you for every visit, and most of hte time, still not find a cure or a cause... And whats pathetic is they will ask you to come in to get a referral and even charge you for that?? ***...
Ne other services, you dont get what you come for, you dont pay, but iwth medical service you get screwed and still dont get what u want most of the time..

No, this is not unfair. You have the choice (at least for a while...) as to which doctor you want to see. Most doctors follow an algorithm for a diagnosis, so yeah, you may do a few tests before one if any is abnormal. There's still not a single test that can rule in or out every disease or disorder. You are paying for the doctor's time and expertise, and that is an important part of the relationship.

Also, many doctors don't charge for follow-up visits. I know everyone at the surgical office where I worked (secretary) did all follow-up visits for "free."

If you are unhappy with the person you are seeing. If you aren't allowed to switch b/c of some managed care/HMO, just imagine how bad it would be if we had mandatory nat'l healthcare...

Have you ever been to a car mechanic? Oh, it's awesome.

Car shaking at 50mph:

--Balance tires (tyers) = $, but no fix, return visit
--Alignment = $, but no fix, return visit
--New rotors = $, but no fix, return visit
----We should change your brakes while we replace your rotors ... oh, your caliper is leaking, probably unrelated, but important
--Well, having replaced/repaired everything else (list is actually longer), that only leaves one thing, it must be the run-out. To fix that, we'll need to get new bearings, dealer spindles, and remove and send the knuckles off to have them pressed out/in. You'll need a new alignment after that, but I guess we'll throw that in for free cause we're nice guys. That'll be $500 x2 to fix the actual problem, the $300+ spend so far on diagnostic repairs and labor, cannot be returned/refunded.

Oh the stories just go on and on. In the meantime, you have no car.

At least you get to keep your kidneys when they send off a urinalysis.

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SGUSOM --- cause of the Ah blood type.

Yeh, exactly and how annoying is that. Does that make it right??
I am on both sides.. I am a customer now, and a few years I will be a doctor, and I cant justify myself charging someone without delievering what they wanted, (if it takes more than a few visits its not the patients fault, its my fault i couldnt find the cure), and sure as hell cant justify charging someone, if some innocent person came into my office and all i had to do was to give him a refferal.

Neways just wanted opinions..

Just a thought, but there are going to be two types of cases in your practice. Some people will be only one or both.

For the otherwise healthy patient, reasons for a visit might include ab for a bacterial infection (bronchitis, conjunctivitis), or vaccinations, or birth control, or a physical, or a yearly blood work up, etc. So, they need a script or some education and bloodwork and they are fine, see you next year.

Yet, the patients you will see a lot of have chronic conditions, so it more maintenance than cure for those patients. If there is a cure, it is not fast and easy. It takes, not only the diagnostician to find out what is going on, but it also takes the patient to do some work (exercise, take their insulin on schedule, eat healthier foods, take their medicine (all of it and on schedule), quit smoking, stop doing drugs, minimize alcohol consumption), etc. So, while the doc can give the patient a plan and provide them with the periodic testing to see their progress, then a lot of the work is on the patient.

So, if they come in 2 or 3 times with elevated glycated Hb but they swear they are taking their insulin, properly dosing, and on time, then whose fault is that?? Are you going to keep footing the bill for your time when the patient is not doing what they need to on their end? Or the mom who stops giving the child ab because they "appeared well" so their child now has a raging strep infection. Or the guy who won't stop smoking and has COPD.

Another factor to consider is the that hospitals charge a lot to not only offset their rising costs, but to also pay for those who turn up at their door and can not pay. So, keep in mind that all of us are paying for those who can not as well.

Finally, do you really want to give a referral to someone without examining them? If they come in so you can evaluate them for the referral, do you want to do it for free? Regardless, this is your practice on the line. To refer your patient without knowing what is going on is just asking for trouble. Now, if you have seen them two days ago, got results back, and they need to see a specialist, then fine. Just do it over the phone and don't charge for it. That will make their lives a little nicer.

I think it is great that you are asking these questions to yourself. I think a lot of us are fed up with our own medical care and that is one of the reasons we are going into this field, to help change it.

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~~SGU M1~~
Class of 2012

Your observation is basically correct. Medicine is unusual in that patients get billed to fix errors; however, there are some signs of change. There are a number proposals for health care reform that incorporate some kind of "pay for performance." Some of these proposals limit payments to a fixed rate for resolving a patient issue. I believe at least one major hospital or HMO has adopted this as a means to motivate quality improvement.

yeah I love that idea. Basing part of my salary on patient compliance is an awesome potential development. It's like paying teachers based on how well their students perform; how can they make the kids study/do homework?? Ludicrous (and I don't mean the rapper)

medicine isn't a perfect science.

docs don't misdiagnose on purpose. otherwise there would be even more lawsuits

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But remember that, even when those who move you be kings or men of power, your soul is in your keeping alone. When you stand before God you cannot say "but I was told by others to do thus" or that "virtue was not convenient at the time." This will not suffice. Remember that.

Capping payments is simply one tactic in the broad strategy of pay for performance. While the articles don't specifically relate to capped payments, pay for performance is definitely coming. There is no reason why doctors should be exempt from performance measurement.


NEJM -- Pay for Performance in Commercial HMOs

NEJM -- Public Reporting and Pay for Performance in Hospital Quality Improvement

JAMA -- Pay-for-Performance: Will the Latest Payment Trend Improve Care?, February 21, 2007, Rosenthal and Dudley 297 (7): 740

too funny....

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