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December 18, 2014

Exposing the underbelly of medical lowlife

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Dr Garrett FitzGerald writes that unscrupulous doctors in the US have been exposed on the internet… but that could not happen here, right?
Nowadays, you can blog away without any possibility of being sued. You can say anything you like about anyone, name and shame, make the wildest accusations that emanate from your daft interpretation of the world and its perceived conspiracies against you. The cyberspace shoe is decidedly on the other foot. Laws of libel do not apply.


There are numerous websites for bringing to light the failings of your doctor, your nurse, your hospital. Most sites are unedited and anything goes. A few, however, manage to give a reasonably believable account of some of the darker practices of medics; ‘believable’ because the criticism comes from several different sources addressing the same little game, same little doctor, same greedy skitter.
h4. Acres of correspondence
On one blog concerned with iffy practices in the United States, there are acres of correspondence given over to the subject of ‘excessive billing’. Much of the input is from nurses, secretaries and other health-workers who have watched the ‘games’ from close-up range, often for many years. It seems that a minority of US docs are experts at playing the health insurance system to fine-art level.
Examples include the grey-backed crow who only does his inpatient consultations at 11:45 at night. Doctor X sees the patient at ten-to-twelve, writes a quick note in the chart, has a fag, has another quick look in at yer wan in the bed at five-past and writes a few more words. His notes have two different dates either side of midnight, and Bob’s yer uncle. He is very productive. He has generated two fees to help pay the college bills. Sleeps sound as a bell. The blogged information comes compliments of the charge-nurse in the ICU, who has been keeping an eye on this medical gay-blade for years. She says there are plenty more where he came outta. Just Google ‘excessive billing by doctors’ to enter the wonderful world of – mainly American — medical Pandora.
Slicker (and quicker) is Doctor Y, another blogee. He only sees the patient for a minute and writes his note in the chart, dated that very day. He has brought with him a consultation form with an earlier date. He takes this to the nurses’ station, which has the tray containing the as-yet unfiled reports. The second note finds its way into the chart in due course. At discharge, the billing office puts mo dhuine down for two visits. Job is OXO. Harvard is fierce expensive.
h4. Medical lowlife
Temptation abounds for medical lowlife. Once upon a time, doctors hired some consultation space and a part-time secretary to carry out the private work. Overheads were expensive, but not prohibitive. Then came the ‘carpet-baggers’. If a consultant wants to thrive in private medicine, he/she must come up with the price of a suite, mid-to-high six-figures right up to early seven-figures. Add the price of a heifer and Jane, I’ll be bound, will come out on top be a couple o’ pound.
Your – the vast majority — honourable five-eight will work all the hours God gave to make a few quid for his family, while remaining ethical, decent and considerate to his patients. More luck to him/her.
It is established in the health/insurance literature that fee-per-item payment to doctors opens the doors. Many more procedures are perpetrated on patients who come through this sort of system. The shyster will take the golden-brick road to financial paradise.
For instance, a referral for upper GI endoscopy for dyspepsia usually goes like this: patient is booked for scope, has history/exam by consultant pre-scope, scope is carried out, patient comes around from sedation, result of scope given to patient, letter sent to patient and to GP, slán abhaile. Total cost: about 500 dollars.
h4. Cash extracted
More from the blogs: a mark, referred for dyspepsia/gastroscope, comes for ‘consultation’ first, cash extracted, keep dealing out the fifties until the secretary shouts ‘Stop!’, northern scope booked and might-as-well southern scope, you better have a scam as well while we’re at it, boss (sorry, scan), come back another day for the ‘results-consultation’. By the way, that’s an awful-looking knob under your lip, could go bad on you sometime, and you could do with an auld chin-tuck as well, me auld pal happens to be in today (he’s a genius; take wan look at my secretary outside, smashin’ lookin’ altogether isn’t she? When she came here first she’d haunt houses for you, look at her now after only thirty operations!), draw off more fifties until mark is a stone lighter. Total cost – sky’s the limit. Quare place, cyberspace.
Naturally, this sort of thing couldn’t possibly happen in the land of medical Saints and Schemers. The Gouging Games are as old as greed itself. They will be with us all days, even unto the end of the world. God forbid any of this stuff would ever come to Ireland.
Yet…one of my brothers went to his GP lately (a decent man) with a touch of chest discomfort. GP asked him to phone a consultant’s office. Secretary tells brother that the first consultation would be €400. Brother, master of repartee, issued two words; one was ‘off’. In the unlikely event that there are amongst us doctors who gouge your patients, could I suggest tar and feather therapy?
Maybe, it would do no harm if a few shots were fired. And be warned if you see – or think you see — the old Latin logo over the door: Gougeamus Eejitur.