Thursday, November 17, 2011

The Hearse Horse Snickers Now for Doctors Too

Carl Sandburg wrote a poem expressing the public’s negative attitude towards lawyers that has the arresting line, “Why does the hearse horse snicker hauling a lawyer away?”  The poem was presented to us as first-year law school students to encourage us to be compassionate in our law practice, to help those who cannot afford to pay, to deal with our clients as people rather than just a source of billing hours, and to contribute our talents for the wellbeing of our community.  Back in 1965, we were in an indirect way told that lawyers should be more like doctors.

How times have changed.  While of course there continue to be compassionate doctors of the old school, the average contemporary doctor is a very different animal.  They are concerned mostly with how much money they make, which translates into seeing as many patients as possible in a given amount of time and finding ways to bill patients (and their insurance companies) for as many procedures, tests, and consultations as possible.

Doctors like to blame the federal government and insurance companies for this transformation.  They say they have so much paper work to do that they have little time left for doctoring, and that the fees they are paid are so inadequate that they have to charge as many billing items as possible just to get a decent financial return.

Nonsense.  While there is no question that there is lots of paper work today, the main culprit is that doctors have become capitalists.  Both in their practice groups and in most hospitals, the healing profession has become a for-profit corporate entity whose main concern is the bottom line.  As such, they find every conceivable way to milk money from their patients, just like one would expect from a corporation.  And the relationship between doctor and patient has been transformed accordingly.  Small wonder that some now refer to the Hippocratic Oath that all doctors take as the “hypocritic” oath.

Let me illustrate with a case in point.  Recently a friend of mine had to go to an eye-ear-nose-throat specialist to have the remains of a silicone earplug removed from his ear.  He has no insurance and so was informed by the receptionist that his bill could be “up to” $200.  The extraction of the plug took a minute or two.  The doctor spent a further couple of minutes “examining” his nose and throat, much to my friend’s bewilderment as there was no reason for the further exam.

When he went to pay his bill, he was told by the same receptionist that it was $254 … no apology, no explanation.  He was dumbfounded but paid it.  When he got home, he looked at the bill and found he had been charged $107 for the extraction and $147 for a “minor consult.”  He then wrote a letter to the doctor explaining his consternation. The letter the doctor wrote in response boldly displayed the mindset of the contemporary doctor.

The whole situation was blamed on the inadequate fees paid by the government for Medicare and Medicaid patients.  For that reason, he said, insured and self-pay patients had to be charged more. He neglected to mention that, as everyone knows, doctors only get paid a percentage, perhaps 50%, of what they bill insurance companies, which means that it is only the uninsured person who pays the full amount. 

He did not address the ethical issue that uninsured persons should be given a break, and especially not charged for sham services rendered, such as in this case the exam or “minor consult,” which are only conducted so as to be able to bill insurance for another service and thus get a reasonable payment, even at 50%.

Bottom line ... doctors and hospitals should not be profit centers.  That orientation is inimical to the ideals of medical practice and caring for patients.  By all means, doctors and others involved in the profession should make good livings because they provide a valuable service to people and society. But beyond that, to profit from ones patients should raise ethical questions.

Why does the hearse horse snicker when hauling a doctor away? Isn’t it obvious!