One Dozen Things
Who Pays the Bills?
Scenario Analysis
In this scenario, the doctor quickly writes multiple prescriptions for a patient and orders a diagnostic ultrasound. He appears to be in a hurry and does not allow the patient much opportunity to ask questions. The one question the patient does ask, whether the ultrasound is necessary, is answered very briefly and dismissively. The doctor never broaches the issue of whether the patient can afford the medications or the ultrasound and defers any other questions the patient may have to the nurse.
When the nurse enters the examination room, she appropriately asks the patient if he has any questions. He responds that his main question is how he is going to pay for the medications and the diagnostic test the doctor has prescribed. He has just lost his job and has no medical insurance coverage.
Even if the doctor had no reason to suspect that the patient could not afford the treatments and test, it would have been appropriate to ask the patient why he had concerns about having the ultrasound. The answer could have been as simple as a worry about the safety of the procedure, but if the doctor had pursued this line of questioning, he would have learned of the patient’s concern about paying for the test. This would have given the patient the opportunity to express his concern about paying for the prescriptions as well.
Payment for medical treatments and tests in the U.S. health care system can be very complex. Some patients have excellent medical insurance coverage that pays for even the most expensive procedures or treatments. Others have restricted coverage that may only authorize certain drugs or procedures or may require preauthorization from the health insurance company before the drugs can be dispensed or a procedure can be performed. In some cases, even within a single class of drugs, only certain medications are covered. You will need to work within these insurance restrictions as much as possible. A significant number of patients have no medical coverage at all. In these cases, involve social workers and other staff to try to find ways to get patients the treatments and tests they need.
Patients’ medical records generally include information about the type of health coverage that they have, so you should be in the habit of checking this information to ensure that medications or tests will be covered before prescribing them. If you are new to the system, you should not hesitate to confer with supervisors, colleagues, nursing staff, and others to find the optimal solution for each patient.
In this scenario, the way the doctor abruptly deferred additional questions to the nurse is unprofessional. His abruptness caused the anxious patient even more distress. The patient may infer that the physician does not care about his circumstances, and, in this case, that unfortunately appears to be true. Even in a very busy clinic, taking time to address patients’ questions and concerns is essential. In the long run it will actually save time by improving patient satisfaction and compliance.
