Re: Another lament about why we need change

[Guest guest]

In all seriousness, it would be very appropriate to send her a bill. We never think aboit doing it, but if this case doesn't deserve it, nothing will. Idle thoughts from an idle mind!Ira WarshawSent from my Verizon Wireless BlackBerryFrom: " Brady, MD" Date: Sat, 13 Dec 2008 13:11:17 -0500To: < >Subject: Another lament about why we need change So I’m on my run today (nine miles) when my cell phone goes off. I don’t really ever mind when patients call and this is a patient who is somewhat distraught. She states, “I know I haven’t seen you in a while, but we switched insurances and so we started going to another physician. I tried to call the new doc, but was transferred to the Ask-A-Nurse call center. After talking to the nurse, I was told to go to the ER because I am having some atypical chest pain and she was concerned I was having a heart attack and needed to be evaluated. My husband thinks I am not having a heart attack and told me to call you—well, because you are always available.” Some background—patient is 35 years old, has 2 young kids (the last with cleft lip), and has been seen over the past couple of years for dizziness, palpitations, shortness of breath and the work-up has always been normal. She states since she last saw me she has gained 15 pounds and has a constant bloated feeling in her abdomen. Her husband is out of town over the weekend. She complains of a sour taste in the back of her throat for the past week or so and the pain resolves with Mylanta (which she took while I was on the phone with her). So here is my lament. In a 10 minute phone conversation between mile 6 and 7, I have just saved a patient a $50 co-pay and 6-7 hours in the ER, and I have saved her insurance about $1000 in unnecessary ER testing. Even with the obvious poor access and poor continuity, she will see her doctor (who will know nothing of any of this) early next week ensuring her doc gets paid. The Ask-a-nurse program is funded through the hospital owned physician association to which this doc belongs, so they get paid even for their wrong advice. But I get zero except the satisfaction of a job well done. Well, at least it gives me something to think about during my long runs….

[Guest guest]

In all seriousness, it would be very appropriate to send her a bill. We never think aboit doing it, but if this case doesn't deserve it, nothing will. Idle thoughts from an idle mind!Ira WarshawSent from my Verizon Wireless BlackBerryFrom: " Brady, MD" Date: Sat, 13 Dec 2008 13:11:17 -0500To: < >Subject: Another lament about why we need change So I’m on my run today (nine miles) when my cell phone goes off. I don’t really ever mind when patients call and this is a patient who is somewhat distraught. She states, “I know I haven’t seen you in a while, but we switched insurances and so we started going to another physician. I tried to call the new doc, but was transferred to the Ask-A-Nurse call center. After talking to the nurse, I was told to go to the ER because I am having some atypical chest pain and she was concerned I was having a heart attack and needed to be evaluated. My husband thinks I am not having a heart attack and told me to call you—well, because you are always available.” Some background—patient is 35 years old, has 2 young kids (the last with cleft lip), and has been seen over the past couple of years for dizziness, palpitations, shortness of breath and the work-up has always been normal. She states since she last saw me she has gained 15 pounds and has a constant bloated feeling in her abdomen. Her husband is out of town over the weekend. She complains of a sour taste in the back of her throat for the past week or so and the pain resolves with Mylanta (which she took while I was on the phone with her). So here is my lament. In a 10 minute phone conversation between mile 6 and 7, I have just saved a patient a $50 co-pay and 6-7 hours in the ER, and I have saved her insurance about $1000 in unnecessary ER testing. Even with the obvious poor access and poor continuity, she will see her doctor (who will know nothing of any of this) early next week ensuring her doc gets paid. The Ask-a-nurse program is funded through the hospital owned physician association to which this doc belongs, so they get paid even for their wrong advice. But I get zero except the satisfaction of a job well done. Well, at least it gives me something to think about during my long runs….

[Guest guest]

I agree with sending her a bill; she

clearly isn’t an established patient with you. You should be paid for

the medico-legal risk you took by giving her advice. She may never pay you,

but then she probably won’t call you for free care again.

An amazing insurance story: 78 y.o. Cauc.

Male with recently dx’ed osteoporosis will pay THREE dollars for 3 months

of Forteo if he gets it from Medco mail pharmacy, but would pay $700 per month

if he gets it from a local pharmacy! I didn’t believe it when he told

me, so I called Medco to verify it!

Mutt

[Guest guest]

I agree with sending her a bill; she

clearly isn’t an established patient with you. You should be paid for

the medico-legal risk you took by giving her advice. She may never pay you,

but then she probably won’t call you for free care again.

An amazing insurance story: 78 y.o. Cauc.

Male with recently dx’ed osteoporosis will pay THREE dollars for 3 months

of Forteo if he gets it from Medco mail pharmacy, but would pay $700 per month

if he gets it from a local pharmacy! I didn’t believe it when he told

me, so I called Medco to verify it!

Mutt

[Guest guest]

,

I had almost this exact experience two weekends ago with a previous patient, only he was having an exacerbation of his overriding depression. At the time, it really upset me (much more than I thought it should).

I was upset with his doctor, whom he could not reach, and upset that I had to interrupt a very fun time with my kids for a patient, to whom I had offered excellent care in the past, but who did not value my services in any way. (He told me at the end of the 25 minute conversation that he was happy that I had " fulfilled my duty as a doctor. Many other doctors would not have done this. Click. " No thanks for the help, just impressed that I had somehow fulfilled some contractual agreement with the ethers to provide my care on demand with no expectation of any payment or other fulfillment other than " pennies in heaven. " )

Great. Now I am upset again. I am off to do an additional 2 miles on my Nordic track and use my son's Walmart " punching bag, " after which I know I will be back to my nice, peaceful stage of acceptance!

Durango, CO

I agree with sending her a bill; she clearly isn't an established patient with you. You should be paid for the medico-legal risk you took by giving her advice. She may never pay you, but then she probably won't call you for free care again.

An amazing insurance story: 78 y.o. Cauc. Male with recently dx'ed osteoporosis will pay THREE dollars for 3 months of Forteo if he gets it from Medco mail pharmacy, but would pay $700 per month if he gets it from a local pharmacy! I didn't believe it when he told me, so I called Medco to verify it!

Mutt