Patients Who Bill Their Doctors For Being Late

Meet Elaine.

We lost touch for a while, but caught up with each other recently.

Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.

Elaine shared: ”If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment and, at the thirty minute mark, I will start billing at $47/hour.”

Wow! I had to hear more.

Elaine scheduled her physical as the first appointment slot of the day. She waited thirty-five minutes in a paper gown before getting dressed, retrieving her copay, and informing the receptionist to expect a bill. The doctor pulled up just as Elaine was leaving.

Prior to her initial visit, Elaine signed the standard agreement outlining no-show and late fees. On follow up, Elaine knocked on the door and discovered her therapist with another client. He apologized for his scheduling error. Elaine sent a bill; check arrived the following week.

Elaine values herself and her time.

When the Comcast guy told her to wait at home between 3:00-6:00 pm, she said, “Expect a $141.00 bill. Is that okay with your boss?” A compromise: The driver agreed to call fifteen minutes ahead of arrival.

I was intrigued. Who pays for waiting?

Cab drivers charge hourly for waiting. Restaurants may provide a discounted meal for the inconvenience. Airlines cover hotel rooms for undue delays. Some physicians apologize. I offer a gift.

Central to medicine is a sacred covenant built on mutual trust, respect, and integrity. What happens when physicians fall into self-interest or self-pity? Or when physicians are so emotionally, physically or financially distraught by their profession?

Patients suffer. And their wait times increase.

So what’s a doc to do?

1. Remember: Respect is reciprocal. If physicians are on time, patients will be on time. If physicians don’t cancel appointments with little notice, patients won’t either. Doctors should stop charging fees they are unwilling to pay themselves.
2. Functional clinics attract functional patients. Patients fall to the level of dysfuntion within a clinic. A chaotic, disorganized clinic attracts chaotic, disorganized patients. Take care of yourself; uphold high standards and healthy boundaries.
3. Don’t wait. Doctors should apologize for delays. And if presented with an invoice for excessive waiting, doctors should gladly pay the fee. Fortunately, most patients don’t bill at the doctor’s hourly rate.

My opinion. Share yours:

Comments

[thuc huynh, md]

it sounds crazy, gutsy, and cool. were i practicing in an IMP style office, i'd gladly accept the challenge (confident that i'd be able to meet it without a hitch.) but as it stands, in my traditional practice of high volume, i couldn't make that guarantee. sometimes it's because the office is understaffed and the one nurse can't triage calls, receive/fax scripts, plus room people. others it's because the 15 minute visit turned out to be 30 or heaven forbid 45 or maybe an acute walked in so now everyone who made an appointment the normal way now gets less time. and with trying my best to help each person who comes in with a patient ear, a succinct but thorough eval, treatment, counseling and patient education for 9 hours a day each day with nary a break, the last thing i want is to be served a bill. i don't like to wait either. truthfully, i hate it; but i wouldn't bill the doc knowing how the system is. it's the main reason i prefer my own doctor to be an IMP or a concierge physician. now if those doctors are late, then there's an issue! but maybe if there were more Elaine's out there hurting a practice's bottom line, corporate would take heed at over extending their staff. i wish i had her moxie, good for her!

[Gail Hacker]

Hmmm, I would agree with this idea if I was late to appointments because I was sitting in my office eating bonbons. I try to stick to my schedule as much as possible, but medicine isn't predictable. I, too, have left the private practice of medicine for a number of reasons. I now practice at a community college health clinic that functions as a safety net clinic, serving a largely uninsured population. It's a bit like practicing third world medicine a mile down the highway from the mecca of medicine.

I have been late to appointments for a number of reasons: at the end of an appointment, as my hand is on the door to excuse myself, a patient wants to know if the crushing chest pain that she gets walking up the stairs means anything serious; the mother of a new baby wants to know if it's normal to want to through her 2 week old infant out a window; the patient in the hospital with pneumonia suddenly gets much sicker and needs to be transferred to the ICU and put on a ventilator; a baby refuses to come out on schedule. There is no way to predict what might happen in a "routine" office visit. I would assume that Elaine would want her doctor to attend to her if she presented with any of the above problems and not walk out saying that's very interesting but I have to stick to my schedule. Or perhaps we should starting charging patients for every minute over the allotted time they use? Think that would make those lazy moms push harder?(obviously said facetiously, having been a lazy mom myself that set my delivering physician way back by taking almost 3 hours to push out my average sized baby boy).

[Samuel Bledsoe]

Not a great idea. The reasons that doctors will run late has little to do with a lack of respect by the physician for the patient. I agree that respect is reciprocal as Dr. Wible points out. However, there is often a third party being missed in the equation...other patients. Elaine needs to understand that her physician has other patients, and she needs to respect them. I don't know how to rush a patient out of the office who just received a diagnosis of cancer. I don't know how to walk out of a half completed colonoscopy that took three times longer than expected. I don't know how to tell a patient that I'll see them in 6 weeks when their problem requires immediate attention. I suspect if Elaine were the person any of the previous examples, she would want the doctors undivided attention and would expect others to wait on her.

I do think doctors have to be thoughtful of the time of others. I don't charge late fees or no-show fees. Deliberately overbooking, extended visits in the doctors lounge, and long lunch breaks should not be done, especially if people are waiting. But we are also taking care of people who sometimes need your attention now- not a week from now, not a day from now, but now. If Elaine told my receptionist that she would start billing me at the 30 minute mark, I would have them politely explain to her that she was free to leave and free to find another physician. If I received a bill, it would not be paid. Forget the doctor, Elaine needs to respect other patients.