August 30, 2008 (Original publish date) • By Dennis Beaver
If you’ve recently had an appointment with an attorney, you were probably seen at or very near your scheduled time. The same can probably not be said for your last doctor’s visit, with good reason much of the time. Physicians have emergencies to deal with, and many office visits take longer than expected — frequently because patients raise issues other than what was mentioned to the scheduling nurse. But there is no way to justify spending hours in the waiting room because patients have been double and triple booked — in other words, money, honey.
From the many e-mails and phone calls this column has received over the past few years, I could publish a list of doctors to avoid, unless you want to take up residence in their waiting rooms. The following e-mail came from a reader in Santa Rosa:
“Mr. Beaver, if a doctor keeps the patients waiting for hours, due to ‘over booking,’ would it be reasonable to expect a reduction in the bill? Could a patient refuse to pay a portion of the bill? If so, how do you determine what’s fair? If it wound up in court, what do you believe a judge would say? I am in that situation right now. Can we discuss this?” Pete.
More than a three-hour wait
Pete developed cataracts at 60 and was referred to “one of the best ophthalmologists in the San Francisco area,” for treatment. After surgery, a follow-up visit was scheduled, which led to his contacting You and the Law.
“That appointment was for 8:30 in the morning and I was told that it would only take a few minutes to be examined. At the time it was set, I explained that I also had a dental appointment at 11:30. I arrived at 8:15 to a waiting room so filled with people, they had to bring out folding chairs. By 11:15, I had not been called and reminded the receptionist of my dental appointment,” he told me. “The young lady explained the delay in being seen was because they over booked far more patients than they could ever see according to the schedule. She was tired of making excuses, knowing that so many people had to wait hours while the doctors and other staff attended to the high-paying cosmetic surgery patients. This was her last day on the job. She instructed me to go to the dental appointment and return, as they would get me in as soon as possible.
“I went to the dentist’s office, was seen within 10 minutes of arriving, and back at the eye doctor’s by 1 that afternoon. I was finally examined at 5 p.m.
“If things had gone as planned, I would have only lost a morning from work, but instead the whole day’s wages went down the drain. I earn $50 an hour, making the loss over $200. When I received the doctor’s bill I deducted that amount and enclosed a letter explaining my reasoning. It was sent back to me with a nasty note, stating that no allowance would be given and if I did not pay promptly, the matter would be sent to a collection agency. This seems unfair, especially as there is a sign at the receptionist’s desk which warns: Without 24 Hours Notice, we bill for the missed appointment and for no shows or if patients arrive late. What would you recommend I do?”
This doctor is a thief
While physicians in general earn much less than they did 10 years ago, many ophthalmologists are making fortunes by specializing in cosmetic surgery. For years, upper and lower eye-lid operations offered a modest added source of income, but as appearance-improving technology evolved — laser skin resurfacing, vein treatments, hair removal, Botox — for many physicians, treating vision problems has become much less interesting. Or profitable.
Physicians have every right to earn a good living. But there is something wrong in stealing time from the very patients who make lease payments on the doctor’s Mercedes. And that is what is going on at a shockingly high number of medical offices, not just those eye doctors who prefer to inject Botox rather than help a patient.
An eye surgeon client of mine puts it this way: “If a patient has real visual problems, the wait in some cities to get into the doctor’s office can be enormous because there is little economic incentive to treat visual problems. Fortunes are being made on everything except the practice of medicine. I am embarrassed by many of my colleagues.”
If the doctor is running behind because of a true emergency, or other unavoidable issues, that’s understandable. But to cram as many patients into a waiting room as possible, knowing there is no way they can be seen remotely close to their scheduled time, in my book, this amounts to theft.
It is theft of the patient’s time. No matter who we are, or what we do for a living, our time translates into money. Physicians who run those kinds of offices are little more than burglars with a medical license. And in their case, it is a license to steal. There is no other way to put it.
The legal take
I spoke with a number of candid representatives at several California Medical Societies, all of whom admitted these are common problems. “It’s the love of money, greed,” is the way several put it. They recommend that patients speak up.
“Don’t tolerate that kind of abuse. Politely ask the doctor’s collection person to make an adjustment of the bill, and do not be afraid to change doctors if you are in an area well supplied with physicians.”
However, I can’t recommend putting yourself in a situation where you get sued and credit is harmed, or the record of that suit makes you look somehow irresponsible and interferes with getting a job. You need to weigh the risks of a refusal to pay.
When it is a question of ethics, honesty and reputation, sometimes second or third “best” will do just fine.
Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.