Now for the Floor Mats!

Good article today about all the extra bills that get tagged on to a hospital stay that you have no idea you asked for.  In fact you often didn’t.

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know   

The version I see is what I call “consultorama.”   A patient gets admitted for an orthopedic procedure – but instead of getting admitted to the orthopedic surgeon he gets admitted to my service; Internal Medicine.  The stated reason is “medical management.”  Often the patient really does need a lot of medical management that may be beyond the surgeon’s skill set, but often it’s a straightforward case and the surgeon just doesn’t want to do the “scut work.”  The surgeon is going to get paid the same whether he is a “consultant” or the “attending.”  The patient is now going to get 2 bills.  But wait… there’s more!  The patient had a dog who’s uncle had a pet parrot who had a heart attack.  We better get the patient’s heart checked out – consult the cardiologist!  But wait… there’s more!  The anesthesiologist demands some blood work before the surgery.  There is a slight elevation in the kidney test because the patient hasn’t had enough to drink because they are in pain from their broken hip.  Better consult the Nephrologist!  Wait the patient is in pain …. Consult Pain Managment.  Consult Physical Therapy, Occupational Therapy.  Pt is constipated Consult Gastroenterology!

In my job I often have to do the :”discharge summary” when a patient leaves the hospital.  Part of the dictation is to list all of the consultants.  It is not unusual to list 10!  Sometimes their might be 4 different nephrologists.  If they work for different groups the patient will get four different bills!    I have the lowest rate of consults in my group.  It’s not because I’m smarter, it’s just because I think that too many cooks in the kitchen make the soup worse.

Tell me your experiences as either a doctor or a patient.  I’m interested in what others have seen.

Dr. Nick

Panel Urges Overhauling Health Care at End of Life

Report pretty much states the obvious but I’m glad some “experts” are coming out with this information.  I’ve spent the last 4 years watching people die in hospitals. I would estimate less than 20% have their act together and make it home with hospice.  Granted I’m only seeing those who came to the hospital in the first place.  Leave me some comments on your experience with end of life issues.                              (NY Times article about topic)