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Money Over Patient Care

Updated: Jul 2, 2019

Physicians graduating from medical school take The Hippocratic Oath where they agree to “first do no harm,” but what is “harm” and does the oath stand for anything in a world filled with avarice? A simple perusal of the headlines or a Google search will disabuse you of any naïve beliefs you have in regard to how the oath is viewed in the profession.

Many aspects of the “first do no harm” can be explored and I couldn’t possibly do an extended discourse on it, but I’ll scratch the surface a bit for you. Of course, we shouldn’t paint all healthcare providers with the broad brush of disbelief or dishonesty. Many try their best to do their best for their patients, but the temptations are many. One would be the free breakfast or lunch “seminars” or “educational” sessions held in healthcare practitioners’ offices.

Those who are willing participants in this charade can easily be picked out. I happened to be dropping someone off at a large group practice when a restaurant worker was unloading large trays of breakfast foods and equally large canisters of coffee and juices. Do you think the group was treating their workers and MDs, nurses to a free breakfast?

No, a pharmaceutical detail person (aka salesperson) was coming to give a PowerPoint lecture on their latest medication and leave a large supply of free samples and discount coupons for patients. The same can be seen at lunchtime or evening invitations to steak and champagne dinners where a paid speaker/MD makes a presentation about their “research” and, of course, the med is the one sponsoring the dinner.

You’d think the MDs couldn’t afford a dinner the way I’ve seen them scurry to these events. At one yearly meeting, scores of physicians pressed against the doors to the large banquet room in an effort to get in first. I’ve heard stories of the same thing happening at a prestigious luncheon meeting of oncologists in Europe. The US does not have a lock on greed.

But breakfasts, lunches and dinners are but a small part of the problem as we’ve now seen with the opioid epidemic. One integral part of the marketing plan was to induce healthcare providers to prescribe opioids and some did it in unimaginable numbers. Their DEA licenses were up for sale to the highest bidders. The docs were paid for prescribing.

How else do these professionals dishonor their oath? The simplest matter is to give diagnoses to patients that justify a medication or payment from insurance. Have you looked at the codes on your medical bills lately or ever? Do you have what they indicate you do have and have you ever questioned why you were given a certain code? You can easily find the codes on the internet.

A physician, who was open with me, made a comment about another physician (almost unheard of) that was quite revealing. The second physician gave a code that was reimbursable even though the patient didn’t have that particular disorder. “He must know how to code,” the first physician said. How many physicians “know how to code” in order to increase their reimbursement?

One physician, involved in a research project, indicated to a patient (I head the conversation), “Don’t worry, we’ll give you the codes that will insure that insurance will pay for any tests we order for the study.” He indicated, in other words, fraud was a part of the project and he was willing to participate in it. Further attempting to ensure that this patient would agree to all of this, which she didn’t, he called after her, as she left, “You could drop dead right after you leave this office.” She kept on walking away. The patient wanted no part of medical fraud.

One physician, who was admitted to a hospital for chest pain after chopping fire wood, reviewed his bill upon discharge. He saw charges he knew weren’t valid and he questioned the billing office. After several attempts to have it rectified, he was told, “Just pay the bill and forget it.” In other words, if he didn’t want any problems with hospital administration, he was in a residency, he would be wise to pay it. He did.

Medicine is a “game” if you will. The prime initiative, in group practices or hospitals, is to bill in order to help the bottom line. Surgeons are lured to work at hospitals not just for their skill but for the income they can generate. No, I am not being caustic, but pragmatic. It’s no different from legal practices where “billable hours” is the golden standard you have to meet or lose out on promotions or partnerships.

Look around your physician or nurse practitioner’s office and see how many items are blatant advertisements for medications. There are pens, prescription pads, note pads, charts, models of anatomy, calendars and other items. Does every office have them? No, because there have been caps put on the value of items to be given to healthcare professionals. The ethical constraints are clear and the profession is aware of it.

No longer can they accept computers, medical equipment or large, expensive textbooks. But some medical schools still allow new physicians to accept a bag with small medical equipment items. On the outside, as I’ve seen, is the name of the pharmaceutical company “donating” the bags. And they are still invited to seminar trips that include fly-fishing or skiing, aren’t they? Yes, they are. Take a look at the “educational grant” part of any brochure, usually found in 8 pt. type at the bottom.

Have you been offered a discount coupon for a medication? Why do you suppose that was? Usually, it’s a new med that is quite expensive and this is part of the marketing campaign. Once you begin taking the med, would you be willing to switch to another, older med, or do you want the latest one? Consider that the “latest” may not have that many patients who have used it for five years or so. Safety in numbers is still a good thing to remember. The serious side effects only show up after enough time and use.

Money truly is the root of evil, not all evil because we know there are other inducements that can increase the likelihood of knavery. We’ve come a long way from Dr. Marcus Welby and the kindly physicians who came to our homes. They’re still out there, but the temptation and the competition is formidable in a time when hospitals are buying up practices and the single practitioner is going the way of the horse and buggy.

As always, question and read the charges on your insurance bills. A diagnosis may seem like a small thing, but it can lead to improper treatment or diagnosis In the future.

A simple mistake, such as one made on a patient’s chart I recently saw, mistook an inhaler med for an antipsychotic med. What would that mean for that patient in the future?

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