Transparency in U.S. Healthcare: Has It Gone to the Dogs?

January 9, 2012

Have you been challenged by such insolent (open-minded?) patients before, who demand cost information on your recommendations?

My adopted son recently was noted to have some ear junk. Nothing that was bothering him, best I could tell - he wasn’t scratching at it, and I don’t think he had a fever - but the doctor nonetheless said, “Let’s get an ear swab.” Then, I was told, with the results we could decide whether he’d need antibiotics.

Given that everything was seemingly well and there was no true clinical emergency, I decided this would be a good opportunity for me to tiptoe across the line.

“How much does an ear swab cost?” I inquired.

“Uh…I’ll have to look it up,” he replied. Shortly thereafter: “$30.” Reluctantly, I agreed to the procedure, unclear in my clinical mind if the benefit outweighed the risk, and admittedly a bit skeptical about the potential fiscal motivations (conscious or otherwise).

My adopted son has some other issues that are of even less clinical concerns, with a diffuse blonde hirsute coat and a wonderfully delicate, almost reclusive disposition. He has struggled with infestations, I must concede, and no amount of special-shampoo baths has eliminated this problem (yet). He’s been treated for worms twice.

He also sits and stares at me a lot. And, he is a decidedly finicky eater.

The medical trials of otherwise healthy Gibson Fine - who, I’m assuming you’ve guessed by now, has four legs and likes to lick himself - have been fascinating to me, as a first-time, adult owner of a dog. Of course, they are distressing, such as when he had a limp for a week that I never figured out.

But, in the spirit of financial decision making and doctor-“patient” relationship, I must concede to eagerly learning quite a bit, and even testing out some of the cost theories that patient-driven healthcare tenets espouse.

I am fortunate that, in my family, I have a bona fide veterinarian, as my sister realized her lifelong dream in May 2010 when she graduated as a DVM. She has done Face Time exams on Gibson as I stood him on my desk, instructing me via telemedicine to articulate the hip joint and test his paws for proprioception with a standard technique. She has also explained to me, multiple times, how persnickety fleas can be.
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I have sent her some of my blogs, and received this response:

“Interesting that most doctors spend NO time even thinking about money while I spend SO much time discussing it, and absolutely making clinical decisions based on cost.”

At his most recent visit to the local veterinarian, when I mentioned that I’d seen a worm in his poo, I was asked if I’d brought in a sample of stool. I shyly admitted that I hadn’t. The tech proceeded without hesitation. “That’s OK. We’ll give you a plastic bottle and you can bring it in a week or two. We’ll just make it easy on you and charge you now.”

“How much?” I asked, of course.

“$25,” he replied, after going out to the front desk to inquire.

At this point, I gained some confidence. I had read up on worms, on fleas, and was fairly confident in the diagnosis - rice-grain appearance, early-morning prevalence.

“Can’t we just treat?” I asked.

He went and talked to the doctor, who I suppose concurred and provided me with the single pill that I could hide in a piece of cheese. (The pill cost me about $20.) They did ask that I still try to bring in a stool sample if possible, though I didn’t pay in advance.

Imagine this type of scenario in our medical practice. Have you been challenged by such insolent (open-minded?) patients before, who demand cost information on your recommendations? What would your response be?

It certainly didn’t help that, on the morning when I actually did bring in a stool sample with a clearly visible worm, the front office assistant coolly described how “they always come back negative anyway.”

“But, there’s a worm right there!” I exclaimed, pointing dangerously close with an ungloved finger and probably offering a smarmy smile.

“Yeah, well…,” she trailed off.

Oh, and that ear asymptomatic ear swab? That was negative.

The good ol’ test-that-doesn’t-add-to-clinical-decision-making dilemma - beyond the scope of this column.

However, my sister’s ending comment is worth noting:

“Sometimes I wish I were a physician and then I could be happily oblivious. But then I wouldn't get to cuddle adorable puppies all day.”
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