Patient relationships with their doctors over time

by Sandeep Grewal, MD

We as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues, insurance and financial issues and not to mention the complicated ICD 9 and CPT code system.

Conversation between a doctor and patient in 1960s:

Patient: Sir, I am having a sore throat for last few days with some cough but no fever.

Doctor: You need to go home, take some rest and don’t forget to drink some nice hot tea.

Conversation between a doctor and patient in 1980s:

Patient: Doc I am a having a sore throat for last few days with some cough and no fever.

Doctor: Why don’t you take this antibiotic for five days. Also don’t forget to rest. And let me check you for strep throat too.

Conversation between a doctor and patient in 1990s:

Patient: Doc I am having a sore throat without fever. I need to know what it is right now. Do I have cancer? Do I have something more horrible than cancer?

Doctor: Well seems to me just a simple infection. But to be on the safe side let us send you to ENT specialist for further check up. By the way the strep test is negative.

Patient: Are you sure there is no cancer? My brother is a malpractice lawyer.

Doctor: Ah well! Let us also get a CT scan on your throat.

Conversation between a doctor and patient in 2000s:

Patient: Doc I am having a sore throat and cough. What can I do to make it go away right now?

Doctor: Let me see. Your strep check is negative. My lawyers want me to send you to an ENT specialist and get a CT scan of your neck. Also some blood work. And I have this big gun antibiotic for pneumonia you can use.

Patient: But will my insurance pay for it? I need something they will pay for.

Doctor: Then why don’t you just go home and take rest and drink some hot tea. I will write in the chart you declined my recommendations due to financial reasons.

Conversation between a doctor and patient in 2010:

Patient: Doctor I have sore throat and fever. I tried everything I was told to on a health forum online. But it is getting worse.

Doctor: You have 462. Your 87880 was negative. My lawyers require me to get 88.38. In fact if 88.38 shows that you have 475 rather than 462 then you will need 42821. You have to remember that your chances of having 475 rather than 462 are quite low. But an undiagnosed 475 can lead to 995.92. That will lead to 99223 and possibly 99291 or 99292.

Patient: I don’t understand but will my insurance pay for it?

Doctor: Well 99212 is covered because 462 is a covered diagnosis. Your 87880 is also covered by 462. 88.38 may not be covered because of medical necessity but my lawyers need it.

Patient: I really don’t understand

Doctor: Don’t worry! Neither do I.

ICD-9 and CPT code key:

99212 Low level Physician Visit

88.38 CT Scan NOS

87880 Strep test

462 Acute Pharyngitis.

475 Quinsy (Peri-tonsillar abscess)

995.92 Severe sepsis

99292 Critical Care attention

99291 Critical Care attention

99223 High level Hospital Admission

Sandeep Grewal is an internal medicine physician who blogs at CareerMedicine.com and is the author of CareerMedicine.com’s Mini-Guide to Physician Job Search.

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  • KP Internist

    Funny post.

  • Diora

    LOL — btw, does anybody in all that checks for reflux laryngitis? This is what my sore throat turned out to be. OK, not exactly, I thought it was a fish bone, called the doctor, he told me to go to lariygologist who diagnosed it. But had I not eaten fish the day before, it could’ve easily been just a sore throat.

  • http://noevidenceofdiseasebook.com Susan R. Rabinowitz

    Will the complication ever end? It really does seem ridiculous that helping someone heal has come down to “only if my insurance will pay for it”. Currently I a in between medical insurance. I will be back on it in two months. The antibiotic I needed to get refilled will cost me $300 which I don’t have due to our unemployed household. Those crazy tests that cost so much actually save my life because the CT scan showed that I did have cancer.
    So i wrote a book. Here’s a quote that I included in my book:
    A Short History of Medicine
    2000 B.C. – “Here, eat this root.”
    1000 B.C. – “That root is heathen, say this prayer.”
    1850 A.D. – “That prayer is superstition, drink this potion.”
    1940 A.D. – “That potion is snake oil, swallow this pill.”
    1985 A.D. – “That pill is ineffective, take this antibiotic.”
    2000 A.D. – “That antibiotic is artificial. Here, eat this root.”
    ~Author Unknown
    It reminded me of the doctor’s response in your blog when the doctor repeated “Then why don’t you just go home and take rest and drink some hot tea.” Funny how life repeats itself.

  • Doc99

    I think you just posted Medicine’s equivalent of “Who’s on First?”

  • stargirl65

    For your example, most people don’t even have to see a doctor. No treatment is needed or indicated for most adult sore throats.

  • MB

    If for some reason I needed to be seen for a sore throat, it would be unlikely that I would see the doctor, only the physicians assistant or the nurse practitioner would be available. Since the training for the PA or NP isn’t as extensive as a physician, I doubt that the PA or NP would have the skills to make such a complicated diagnosis.

    • Anonymous

      Ha Ha – seems like the billing/coding specialist making $10/hr should be handling “such a complicated diagnosis

  • paul

    i often wonder what is going through a patient’s head when they disclose that they have a medmal lawyer in the family. so? that means you should get extra-high quality care? shouldn’t all my patients get the same high quality care?

    in fact the only way i change my management of these patients is to be extra careful what i write in the chart. i don’t think it influences how many tests i order (since really, anyone could be a lawyer and just not tell me about it)

  • Campykid

    I laughed so hard my throat got sore (can I sue?).

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