Comments on: http://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html Tue, 14 Feb 2012 22:04:00 +0000 hourly 1 By: Mike Figurski, MDhttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-69274 Mike Figurski, MD Sun, 03 Dec 2006 05:23:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-69274 I'm new to the site, but work as a family physician at a ski resort in Canada. I previously practiced private Hospital anesthesia Los Angeles. I charge $200 for house calls, including shots. I'm all for private enterprise, but the bill here was clearly gouging (unethical), and IM steroids are ineffective (larcenous if done for profit). Treating patients is a privilege, and they rightly expect us to do what is best for them. This was clearly not the case. I’m new to the site, but work as a family physician at a ski resort in Canada. I previously practiced private Hospital anesthesia Los Angeles. I charge $200 for house calls, including shots. I’m all for private enterprise, but the bill here was clearly gouging (unethical), and IM steroids are ineffective (larcenous if done for profit). Treating patients is a privilege, and they rightly expect us to do what is best for them. This was clearly not the case.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59705 Anonymous Sat, 25 Feb 2006 18:50:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59705 My name is Steve and I am new to this site. I am amazed at what I have read. I learned in school that doctors are there to help the sick. Anyone who happens to be ill is just that, regardless of nationality. What does it matter if they are from Fort Lauderdale, Boca Raton (where I live), Riviera Beach (a poor area of Palm Beach County), or Canada? The important thing is that they get the help that is best for them, and that it be for a reasonable fee. <br/>Ps. why all the anonymous posting? My name is Steve and I am new to this site. I am amazed at what I have read. I learned in school that doctors are there to help the sick. Anyone who happens to be ill is just that, regardless of nationality. What does it matter if they are from Fort Lauderdale, Boca Raton (where I live), Riviera Beach (a poor area of Palm Beach County), or Canada? The important thing is that they get the help that is best for them, and that it be for a reasonable fee.
Ps. why all the anonymous posting?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59587 Anonymous Wed, 22 Feb 2006 14:18:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59587 Actual Bill<br/><br/>Housecall $675<br/>Demerol 50 mg J2175 @ 300 x 2 $600<br/>Solumedrol 125mg/ml J2930 x 1 $900<br/>Toradol 60mg/ml J1885 x 1 $300 <br/><br/><br/>Total: $2475<br/><br/>Dx codes Herniated disc 722.2<br/> Sciatica acute 722.1<br/><br/>And plenty of docs (I presume they are docs) think that this is reasonable. Go Figure. Actual Bill

Housecall $675
Demerol 50 mg J2175 @ 300 x 2 $600
Solumedrol 125mg/ml J2930 x 1 $900
Toradol 60mg/ml J1885 x 1 $300

Total: $2475

Dx codes Herniated disc 722.2
Sciatica acute 722.1

And plenty of docs (I presume they are docs) think that this is reasonable. Go Figure.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59585 Anonymous Wed, 22 Feb 2006 04:06:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59585 BTW, the figures quoted in the bill add up to more than the total bill. Not that they aren't bloated either way. BTW, the figures quoted in the bill add up to more than the total bill. Not that they aren’t bloated either way.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59566 Anonymous Tue, 21 Feb 2006 18:16:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59566 That's a very fair comment/estimate.<br/>I think the call was late at night which kind of precluded some of the cheaper alternatives. I doubt any insurer would pay more than a couple of hundred bucks for the care delivered. I think the mark-up on the shots was obscene.<br/><br/>Many critics on this site advance the notion that the free market should prevail. However, the playing field isn't exactly level when one guy's in pain and the other guy has<br/>the painkiller.<br/><br/>Let's face it someone in severe pain may willing to pay any price to have it eased. And guys that will take advantage of that fact and hold those patients to ransom are beneath contempt. That’s a very fair comment/estimate.
I think the call was late at night which kind of precluded some of the cheaper alternatives. I doubt any insurer would pay more than a couple of hundred bucks for the care delivered. I think the mark-up on the shots was obscene.

Many critics on this site advance the notion that the free market should prevail. However, the playing field isn’t exactly level when one guy’s in pain and the other guy has
the painkiller.

Let’s face it someone in severe pain may willing to pay any price to have it eased. And guys that will take advantage of that fact and hold those patients to ransom are beneath contempt.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59563 Anonymous Tue, 21 Feb 2006 17:45:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59563 Maybe better advice is to first buy travel medical insurance when going to the US. Then advise vacationers to go to the doctor's office or a walk-in clinic or if seriously ill, an ER, rather than ordering a housecall consultant. That isn't hard advice to follow.<br/><br/>I think the charges are high enough in this case to call fraud. That is something the patient should take up with the credit card company and possibly the hotel, himself. If he needs an advocate, call a lawyer, that is something they are supposed to be able to do.<br/><br/>All the same, if you asked me to give an estimate for the fair charge for a housecall like that, I would expect the charge to start at whatever I would expect to collect in gross on average in my office for the time spent in the consultation, including my travel time. Any procedures done or materials consumed might be extra. Roughly figuring, giving a half-hour travel time each way and a half-hour visit, and that is likely to be at least $600, minimum. It is a lot, which is why no one does house calls anymore, because you can't get people to pay that and you can't run a practice on less. Maybe better advice is to first buy travel medical insurance when going to the US. Then advise vacationers to go to the doctor’s office or a walk-in clinic or if seriously ill, an ER, rather than ordering a housecall consultant. That isn’t hard advice to follow.

I think the charges are high enough in this case to call fraud. That is something the patient should take up with the credit card company and possibly the hotel, himself. If he needs an advocate, call a lawyer, that is something they are supposed to be able to do.

All the same, if you asked me to give an estimate for the fair charge for a housecall like that, I would expect the charge to start at whatever I would expect to collect in gross on average in my office for the time spent in the consultation, including my travel time. Any procedures done or materials consumed might be extra. Roughly figuring, giving a half-hour travel time each way and a half-hour visit, and that is likely to be at least $600, minimum. It is a lot, which is why no one does house calls anymore, because you can’t get people to pay that and you can’t run a practice on less.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59553 Anonymous Tue, 21 Feb 2006 14:48:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59553 Actually the ticket is to warn Canadians to be very careful when navigating US healthcare. To avoid it if at all possible as they are considered fair game by many of you folks. Actually the ticket is to warn Canadians to be very careful when navigating US healthcare. To avoid it if at all possible as they are considered fair game by many of you folks.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59550 Anonymous Tue, 21 Feb 2006 12:59:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59550 Guy takes a Florida winter vacation. Has a history of longstanding back problems, even surgery. Has seen plenty of doctors. Back starts acting up again on vacation. Should I just go see a doc here in town? Naw, I'll just call the front desk and have them call one in. Doc comes, gives me a couple of shots and goes. When the bill comes, holy smoke, I could have gone to the doc for five years for less than that back home. What to do? Call the credit card company? Call the doc who must have made a mistake here? Naw. I call that doc I see at home and have him take care of it.<br/><br/>Advocate or lackey?<br/><br/>Patient complaining about bill in Florida? Got burned I think, really high charge. $600 for Demerol! What a ripoff; I pay what, 0.40 CAD for that. Do some math.<br/>Patient thinks I should do something here. What? Tell him to call his credit card company and complain of fraud? No. Tell him to call the hotel and complain? No. Tell him to complain himself to the hotel and the doc? Tell him to write to the Florida board and ask them to investigate? Call other doctors in Florida to get a quote for a hotel visit of the same kind? No. I've got it, I'll do all these things myself, and then to validate my outrage, I'll post on an internet blog page just to make myself feel virtuous and justified in taking such a strong and leading role here. That's the ticket. Guy takes a Florida winter vacation. Has a history of longstanding back problems, even surgery. Has seen plenty of doctors. Back starts acting up again on vacation. Should I just go see a doc here in town? Naw, I’ll just call the front desk and have them call one in. Doc comes, gives me a couple of shots and goes. When the bill comes, holy smoke, I could have gone to the doc for five years for less than that back home. What to do? Call the credit card company? Call the doc who must have made a mistake here? Naw. I call that doc I see at home and have him take care of it.

Advocate or lackey?

Patient complaining about bill in Florida? Got burned I think, really high charge. $600 for Demerol! What a ripoff; I pay what, 0.40 CAD for that. Do some math.
Patient thinks I should do something here. What? Tell him to call his credit card company and complain of fraud? No. Tell him to call the hotel and complain? No. Tell him to complain himself to the hotel and the doc? Tell him to write to the Florida board and ask them to investigate? Call other doctors in Florida to get a quote for a hotel visit of the same kind? No. I’ve got it, I’ll do all these things myself, and then to validate my outrage, I’ll post on an internet blog page just to make myself feel virtuous and justified in taking such a strong and leading role here. That’s the ticket.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59549 Anonymous Tue, 21 Feb 2006 12:39:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59549 Sodomite? Greek chorus? Do I detect a theme? This isn't about left of center poliitcal correctness. Talk about tiresome! Is someone going to whip out Rush Limbaugh talking points? Hey, I know where Rush can get some primo demerol and Percs. Forgot to tell you all when I spoke to the housecall doc, who berated me for questioning his bill, he told me he thought the patient was drug seeking. Which must be why he gave him two demerol shots and prescription for Percocets. And yes, I think Visa is the place to go with this complaint.....not.<br/><br/>I also detect a certain hostility toward what some of you believe to be a wealthy, visiting tourist, as if that somehow makes him fair game. <br/>I wonder if when you have a severe toothache your first question to the dentist is, how much? I doubt it, and I doubt you feel like haggling a la Turkish bazaar.<br/><br/>You know I'm really not shocked.Why should US doctors hold values that differ substantially from the society as a whole? Heck a majority of US doctors voted for Bush. Most of you want to be rich visiting tourists somewhere else, and believe <br/>me each and everyone of you will scream bloody murder when you get ripped off. <br/><br/>I find it amusing to see so many of you circling your wagons around a scoundrel. The really interesting thing is this undercurrent of hostility towards the rich. Is it because US physicians as a class have fallen so far in rank, both socially and economically? I suspect so. I've never seen so much "right-of-center" contempt for wealth. <br/><br/>And why should you feel less sympathy for the patient because his physician is outraged? Or because "it's not even his own country"? Are you in kindergarden? You guys should be purging your own profession in your own country of crooks like this. And if you don't see it, well then maybe its you who needs to get a life. And if I've riled some of you, so much the better!<br/><br/>PS. I really do like that Greek chorus line. Sodomite? Greek chorus? Do I detect a theme? This isn’t about left of center poliitcal correctness. Talk about tiresome! Is someone going to whip out Rush Limbaugh talking points? Hey, I know where Rush can get some primo demerol and Percs. Forgot to tell you all when I spoke to the housecall doc, who berated me for questioning his bill, he told me he thought the patient was drug seeking. Which must be why he gave him two demerol shots and prescription for Percocets. And yes, I think Visa is the place to go with this complaint…..not.

I also detect a certain hostility toward what some of you believe to be a wealthy, visiting tourist, as if that somehow makes him fair game.
I wonder if when you have a severe toothache your first question to the dentist is, how much? I doubt it, and I doubt you feel like haggling a la Turkish bazaar.

You know I’m really not shocked.Why should US doctors hold values that differ substantially from the society as a whole? Heck a majority of US doctors voted for Bush. Most of you want to be rich visiting tourists somewhere else, and believe
me each and everyone of you will scream bloody murder when you get ripped off.

I find it amusing to see so many of you circling your wagons around a scoundrel. The really interesting thing is this undercurrent of hostility towards the rich. Is it because US physicians as a class have fallen so far in rank, both socially and economically? I suspect so. I’ve never seen so much “right-of-center” contempt for wealth.

And why should you feel less sympathy for the patient because his physician is outraged? Or because “it’s not even his own country”? Are you in kindergarden? You guys should be purging your own profession in your own country of crooks like this. And if you don’t see it, well then maybe its you who needs to get a life. And if I’ve riled some of you, so much the better!

PS. I really do like that Greek chorus line.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/02/reader-writes-im-family-doc-in-toronto.html#comment-59545 Anonymous Tue, 21 Feb 2006 05:40:00 +0000 http://clients.emmense.com/kevinmd/2006/02/20070.html#comment-59545 As a doc who has worked in both Canada and the US, these ad hominem comments about our Canadian colleague are uncalled for, ridiculous, and offensive. First of all, to denigrate family physicians in Canada is to denigrate the entire Canadian medical system , since the majority of physicians in Canada are family docs. Most of them are excellent and take care of a large group of patients without the CYA technology we use here in the U.S. Regarding this topic this family Doc was being an advocate for his patient. I don't see how you can fault a family doc for being a good patient advocate. Patients in Canada don't sue their docs, so they have a better relationship then in our country. As a doc who has worked in both Canada and the US, these ad hominem comments about our Canadian colleague are uncalled for, ridiculous, and offensive. First of all, to denigrate family physicians in Canada is to denigrate the entire Canadian medical system , since the majority of physicians in Canada are family docs. Most of them are excellent and take care of a large group of patients without the CYA technology we use here in the U.S. Regarding this topic this family Doc was being an advocate for his patient. I don’t see how you can fault a family doc for being a good patient advocate. Patients in Canada don’t sue their docs, so they have a better relationship then in our country.

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