Patients who bill their doctor for being late

[okarol]

Patients who bill their doctor for being late
by PAMELA WIBLE, MD | in PATIENT | 392 responses

Meet Elaine.

We lost touch for a while, but caught up with each other recently.

Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I  host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.

Elaine shared: “If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment and, at the thirty minute mark, I will start billing at $47/hour.”


Wow! I had to hear more.

Elaine scheduled her physical as the first appointment slot of the day.  She waited thirty-five minutes in a paper gown before getting dressed, retrieving her copay, and informing the receptionist to expect a bill. The doctor pulled up just as Elaine was leaving.

Prior to her initial visit, Elaine signed the standard agreement outlining no-show and late fees. On follow up, Elaine knocked on the door and discovered her therapist with another client. He apologized for his scheduling error. Elaine sent a bill; check arrived the following week.

Elaine values herself and her time.

When the Comcast guy told her to wait at home between 3:00-6:00 pm, she said, “Expect a $141.00 bill. Is that okay with your boss?” A compromise: The driver agreed to call fifteen minutes ahead of arrival.

I was intrigued. Who pays for waiting?

Cab drivers charge hourly for waiting.  Restaurants may provide a discounted meal for the inconvenience.  Airlines cover hotel rooms for undue delays. Some physicians apologize. I offer a gift.

Central to medicine is a sacred covenant built on mutual trust, respect, and integrity. What happens when physicians fall into self-interest or self-pity?  Or when physicians are so emotionally, physically or financially distraught by their profession?

Patients suffer. And their wait times increase.

So what’s a doc to do?

1.  Remember: Respect is reciprocal. If physicians are on time, patients will be on time. If physicians don’t cancel appointments with little notice, patients won’t either. Doctors should stop charging fees they are unwilling to pay themselves.

2. Functional clinics attract functional patients. Patients fall to the level of dysfunction within a clinic. A chaotic, disorganized clinic attracts chaotic, disorganized patients. Take care of yourself; uphold high standards and healthy boundaries.

3. Don’t wait. Doctors should apologize for delays. And if presented with an invoice for excessive waiting, doctors should gladly pay the fee. Fortunately, most patients don’t bill at the doctor’s hourly rate.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care.

http://www.kevinmd.com/blog/2011/07/patients-bill-doctor-late.html

[okarol]

  Hmmm... what happens when they refuse to provide you with future care?

[cattlekid]

I've never resorted to sending out bills, but I have "fired" doctors for not being able to keep to a schedule.  I do give them a reasonable amount of leeway, and have been known to call ahead to ensure that the doc is running on time.  If he is running late, then there is no reason to just sit around the office waiting.  I also try to book first appointment of the day whenever possible. 

Of course, I live in an area where there are dozens of doctors of every specialty imaginable.  If you live in a more rural or underserved area, I think you would be more at the doctors' mercy.

Hmmm... what happens when they refuse to provide you with future care?

[Cricket]

I have not yet billed any doctor for being late, but I have walked out, and will continue to do so, telling the receptionist I have other things to do with my life than wait for the doctor forever.  This was met with sarcasm from both the receptionist and my doctor and I simply said this sort of irresponsible behavior is not tolerated.  My time is worth just as much as his.  The idea of billing people who are notoriously late is a great one, and I may put it into practice very soon.   

[jbeany]

I think you have to give a little leeway.  If every appointment is seriously behind schedule, then by all means complain, send a bill or switch docs.  But emergencies happen all the time that call docs away.  Hey, I've been the emergency that has dragged the doc out of his regular office hours and up to my hospital room.  When it goes the other way, then I figure that's just karmic balance.

What really gripes me, though, is the lack of information from the staff.  They know when the doc is behind schedule and have at least an idea of when he's likely to get to you.  I see no reason why they can't be straightforward about that when I check in.  A simple "I'm sorry, the doc is running behind schedule due to another patient's medical emergency.  The wait may be up to X number of hours.  Would you care to reschedule?  Or come back in x hours?  I can also take your cell number and call you when he's nearly ready to see you." 

I had a fab doc before I moved whose staff was awesome at this.  I'd leave for two hours, run all my errands or even just go to the bookstore and relax with a nice meal and come back when they called, no problem.  I think leaving you sitting in a waiting room for hours with no information is inexcusably rude.