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Monday, March 4, 2013

DOCTOR , PATIENT,.AND (the unspoken) MONEY.

Sign in doc's office: "If you are a new patient and have a high deductible you will be required to pay $100.00 at your first visit."

I was incensed when I first saw it. 

For the most part insurance keeps the money part of medical care invisible: some of us may have to pay a (usually) small deductible for each visit.  Rarely do we have to pay a lot of money to our doctors, face to face, as it were.  (But it rarely is, if ever.)

I started thinking about the sign.  Wait a minute,  they are saying they do not trust new patients: maybe they will cheat me if they have to pay a good deal of money because of the kind of insurance they have.  I had better get at least some of it upfront.

But he (or she) is my doctor.  This person, whom I am invited to call by his title but who usually calls me by my first name.  This stranger who asks me to reveal what may be intimate information about my body, possibly about my life, but about whom I know nothing equally revealing.

We often feel like supplicants, begging, pleading to be healed, the doctor opening to us his font of knowledge and bag of balms.  We lay ourselves bare, hope exuding from every pore.  The relationship is slanted.  Money makes it, well, icky.

It can be looked at as a form of prostitution; the referring doctor (or hospital  friend, stranger, or even phone book)  the pimp, the doctor the prostitute, and us - the client with a bodily need that requires a fix.

In that scenario money is always the motivating factor. (I know the analogy is off a little, kickbacks to referring doctors are illegal)

For those of us who see the relationship as a skewed one, usually in favor of the doctor, maybe it is time for us to remember the money we pay, whether it is $0.00 (but remembering the cost of our insurance premiums) , $15.00, $100.00, or more.  This makes us his employer.  It gives us a higher standing then a dependent 'help me' petitioner.

We need not necessarily like our doctor but at a minimum, hopefully, we respect his knowledge and ability.  And we trust him.

The other side is that he must be someone who trusts us; our knowledge, intelligence, and autonomy as a person.

In most other business relationships there is an equality between the two parties.

We need to bring that to the medical relationship as well.


  1. Carol.

    Here is a solution. If this bothers you, see another doctor.

  2. Richard,
    That was not the point of my post. (I was not a new patient so it was not relevant to me.)
    The point was the inequality that happens/we let occur and to be mindful of it in order to change it if we feel we need to.
    Thanks for taking the time to comment.

  3. Carol,

    As a board certified anesthesiologist and fellowship trained pain physician, I have invested 16 years and well over $750,000.00 in student loan debt and lost wages to become your employee.

    I get lied to and BS'd everyday by people trying to tell how to do my job, which usually involves them telling me that the only thing that will work in Oxycodone, not PT, CBT, BF, TENS, Diet, Sleep modification, Smoking Cessation, daily exercise, leaving an abusive spouse, stopping a job that is eating up their mind, soul and body, etc.

    Pain doctors rarely get to treat the real injury - a broken soul.

    Get over yourself and pay the $100.00.

  4. It is interesting: you seemed to have missed the point of the post, your apparent anger at those in pain so loud, you can only your own feelings.
    Both these comments, which I do appreciate by the way, I write the blog in the hopes of engendering communication, ignore the idea of equality between doctor and patient.
    For those with MS, Lupus, trigeminal and other neuralgias, CRPS, phantom pain secondary to amputation or as in my case rhizolysis, a broken soul may be a part of what the person has endured or is currently dealing with, but it does not negate the reality of true physical impairment and disease/disorder.
    Thank goodness, most of my doctors and surgeons did not say "You suffer from a broken soul. We will ignore the birth defect and the neurovascular disorder throughout the left side of your brain that is causing the trigeminal neuralgia.
    We will pretend that your anaesthesia dolorosa is not the result of a thermocoagulation rhizolysis but is emotional/existential suffering."
    When a doctor says he is lied to everyday and that his patients are drug seekers I wonder if it moght not be time to take long vacation or change profession/specialty.

  5. Let me add, I have insurance and was a known patient. It did not refer specifically to me.

  6. Perhaps this hollow shell of a human being should stop projecting his (or her) feelings of inadequacy and impotence onto his patients. The alternatives you have listed are expensive and untested (physical therapy, Cognitive Behavioral Therapy, electrostimulation... whatever). They have suffered plenty already and obviously do not have much of a choice when it comes to doctors.

    To the "impoverished" doctor:

    While I understand that you had to sacrifice a lot for your MD, I don't see why we should pay the exorbitant and arbitrary fees charged for your services. The treatments are not guaranteed to work. At best, they are ineffectual. At their worst, they cause horrible side effects like weight gain (everything, antidepressants, antipsychotics), crippling fatigue (Cymbalta) and foggy stupidity (Topamax).

    Your patients are not responsible for your lost wages. Or your student loans. You could have worked at a minimum wage job for the rest of your life. Instead you chose to go to college. They didn't put a gun to your head and force you. Besides, your earnings now as an anesthesiologist easily outpace the wages you lost from working 16 years at Safeway.

    1. Amen. Who the heck would try to gain sympathy because they chose a profession that would (unjustly) make them rich. I hope a house falls on that person. Quit your job or kill yourself if your job is so very terrible. It's easy, just drive off in your Lexus and don't come back!

      (Sorry, but that type of person really makes me sick. Had to vent a bit. :D)

    2. Venting's always good and I understand where you both are coming from.

  7. Carol, I believe money shouldn't come into our health. Obviously, Doctors must be paid, but I believe in a universal health care policy, so that everyone is equal.
    Our health isn't and shouldn't be something we can help or maintain, due to how much money is in our pockets. Do some Doctors treat some patients better because they pay more.....I am sure that to be the case.

    As for the anonymous "board certified anesthesiologist and fellowship trained pain physician" above.......perhaps he needs to take a dose of his own medicine and mend his broken soul.

    Most pain patients live a difficult life. There are maybe some people who abuse the system trying to obtain drugs. Obviously he has come accross a few of those and it has made him think we are all the same. But we're not. I know that I (and I think I can speak for most people I know) certainly don't enjoy living in pain, and certainly don't enjoy having to take meds.
    If our pain was only as simple to treat with "PT, CBT, BF, TENS, Diet, Sleep modification, Smoking Cessation, daily exercise, leaving an abusive spouse, stopping a job that is eating up their mind, soul and body, etc." well, wouldn't we be laughing.

    1. The issue of money is a big one. When you can pay for more, you tend to get more.
      He evidently has been burned, if he is what he says he is, but, yes, to take his anecdotal experience and try to paint all pain patients with that one brush of anger, is sad, for him as well as his patients.
      I agree, would that it were that simple.

  8. All I have to say is once you loss health insurance, you quickly learn medical care is for those with insurance or with enough money to afford it. The rest of us are pretty screwed.

    The burned out doctor needs to stop take a breath and listen I mean really listen to his patients stories. His anger about his losses is nothing compared to what his patient face every day. Don't be another doctor that adds more stigma & misjudgement onto those with chronic pain or illness. They already deal with it enough. Do no harm also means not damaging your patients mental well being...

    Most chronic patients want to get better more than anything and have done all those treatment & life style changes. Sadly, for some patients the end result was drive their family deeply into debt. Some treatments only help very short term and other not at all. Not every patient wants pain meds or even asks their doctor for them, but sometimes its the only option left.

    Burnt out doc I think your a good man, but your angry about your own situation might be leading you down a road that will harm your patients in the end.. Stop, take a much needed break away from patient interactions. Then try again when your anger has healed and you can see things from a healthier perceptive. Maybe try some of the none medical treatments you wrote about for stress and anger.