Recently, there was a post on Sermo.com, the online physician community, concerning a doctor taken to small claims court. A patient decided to seek a second opinion in another city and was trying to recoup travel expenses by suing him for plane fare.
That hit home. A few years ago, I ordered an MR angiogram to see if a patient had an aneurysm. His insurance covered the test, but he still had to pay about $500 as part of his deductible. He threatened to sue me for the entire amount unless I agreed to pay half.
I refused, and he tried very hard to make life miserable for me. He threatened several times to file a malpractice suit, telling me that he’d make sure my rates rose more than the $250 needed to placate him. I even reported it as a possible risk to my carrier, and they told me issues of this sort were quite common (to my surprise). I was told that they generally don’t go anywhere and are often used as a way of giving doctors ulcers.
I stood my ground, and after a few weeks he gave up and stopped calling. The experience left me quite shaken, which I suppose is what he wanted. I don’t routinely discuss tests and other costs with a patient unless asked. The variability in insurance plans makes it impossible for me to know how much of a study will come out of a patient’s pocket.
This doesn’t mean people haven’t tried. Patients do occasionally ask me to pick up part of a test’s cost, or to cover cab fare because I referred them to a tertiary care center downtown, or to pay other miscellaneous charges. I always refuse.
Obviously, there are significant differences between the two cases. My patient was following treatment recommendations, whereas the other patient sought a second opinion. But the point is similar: Should we be held liable for a patient’s ancillary expenses?
My answer is no, and I suspect I’d be hard pressed to find a doctor who disagrees. I certainly don’t expect my own internist to cover my deductible for routine tests, or to pay for time I take off work to go to his office or the cost of gas to drive there.
At the end of the day, we are only advisers. No one can force a patient to have a test or procedure, or take a medication, regardless of whether or not it’s within their financial means.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.