The Economical Charges

Dr. Dev (fictional name) was visiting his friend Dr. Akshay Kalekar (fictional name), the famous ENT surgeon. We had read his smart way to cut cost in his day to day practice in ‘The Tongue Depressor’ http://agnipathdoctors.blogspot.com/2015/05/practice-tips-tongue-depressor.html

While Dr. Dev was sitting in his consultation chamber, a patient came to show his problem. Dr Akshay examined the patient, made his diagnosis and asked to see his previous treatment papers.

After examining his previous papers, Dr. Akshay explained to the patient, that he requires operation to treat his condition.

The patient agreed to undergo operation, as his previous doctor has also advised operation as part of treatment. He asked Dr. Akshay his professional charges for the operation.

‘It will be Rs. 12,000’ replied Dr. Akshay.

Dr. Dev was surprised because Dr. Akshay normally charges just Rs. 10,000 for that procedure. He keenly waited to see the patient’s reaction to hearing the charges.

Much to his further surprise, the patient happily agreed to the charges without even requesting to give him discount or reduction in the charges.

As soon as the patient had left the consultation chamber, Dr. Dev curiously inquired, ‘Dr. Akshay, why did you tell the patient your charges will be Rs. 12,000 for the operation, when you routinely charge just Rs. 10,000 for same?’ ‘And, more importantly why did the patient so readily agreed to the charges without demanding for some discount as patients usually do?’

‘Well Dr. Dev’ replied Dr. Akshay, ‘your surprise is justified.’ ‘I do charge Rs 10,000 for this operation. But while going through patient’s previous treatment record I found that he had consulted Dr. R. S. Sharma (fictional name), senior ENT surgeon of the city and he had also advised operation for the same.’

‘Now, being a senior ENT surgeon with an advanced setup, Dr. R. S. Sharma’s operation charges are generally 50% more than what most of us generally charge. So, he must have told the patient that the charges for this operation will be Rs. 15,000.’

‘So, when I told the patient the charges for this operation will be Rs. 12,000, he happily agreed as my charges appeared economical as compared to Dr. R. S. Sharma’s charges. The patient was getting a reduction of Rs. 3,000 or 20% in the operation charges as proposed by Dr. R. S. Sharma.’

‘So’, elucidated Dr. Akshay, ‘It pays to know whom the patient consulted before coming to you and what your other colleagues are charging for their services.’

(Based on true incident)
— ND
© Author. All rights reserved. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 


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The Super Cooperative Patient

Life is about checks and balances, positive and negatives, Ying and Yang. The negatives in life are many times balanced with something positive. If there are uncooperative patients such as in  ‘The Un-Cooperative Patient’ then there must be extra cooperative patients to restore balance in the world.

 

For the sake of medical ethics and doctor-patient relationship I cannot recommended such behaviour. Therefore read only for knowledge and not for practice.

One of my very senior colleagues, Dr. Ramesh Sharma (Fictional name) recounted his experience during his MBBS exams.

When he appeared for his final MBBS Medicine ward clinical exam, Dr. Ramesh was allotted a patient suffering from heart (cardiac) problem.

On reaching the allotted patient’s bed, Dr. Ramesh become dismayed. The patient was calmly having his food and seeing the full plate it appeared that he had just started. Dr. Ramesh estimated that it may take 20 to 30 minutes before he will finish his lunch.

In India, the majority of the older generation treats eating food as a ritual or homage to Food God. Just like while praying to God, they do not get up, talk in between or take break once they started eating food. This will amount to disrespect to food and God who have provided the food.

The patient looked up and noticing Dr. Ramesh asked, “Are you a MBBS student?” Dr. Ramesh glumly nodded his head. “Have you been allotted my case for your exam today?” the patient enquired. Again Dr. Ramesh nodded his head in affirmation.

“Look doctor,” the patient calmly proposed, “You can either disturb me while I am taking my food and take my history and do examination on your own, or  you can wait I have my food. While you are waiting you can write my clinical history on your own. I am suffering from moderate Mitral Valve stenosis with mild Aortic valve stenosis (heart valve disease), symptomatic for last 10 years. You must have at least studied so much that you know what history to write in this condition. If you cooperate with me, I will tell to your examiner, that the history written by you is given by me, and confirm whatever you tell him. Once I have finished my food, I will also tell you what findings to write in my clinical examination, including heart sounds and murmers.”

In India, most patients (at least at that time), did not knew English language. So, they were not aware what the doctors and students discuss during ward teaching and exams. They were also not able to read what was written in their case sheet record.

But this patient was engineer by profession, well versed in English language and having a keen mind. Because of his clinically important disease he was discussed many times in the ward rounds, clinical classes and was allotted multiple times during exams.

The patient was now well aware what his diagnosis was, what was his clinical findings and what questions were asked regarding his illness from the students during exams.

Dr. Ramesh weighed the options of either disturbing the patient while he was having food, antagonize him and take a history and examination from an irritated uncooperative patient, or agreeing with the patient’s suggestion.

Finally Dr. Ramesh deicided to let the patient have his food in peace, while he constructed and wrote a fitting history.

True to his words, once the patient had finished his food, he checked Dr. Ramesh’s history, gave some helpful suggestion to enhance the history, and dictated his physical findings to him.

Once the examiner came, Dr. Ramesh presented his history and examination and needless to say, passed with flying colors.

(Based on true incident)
— ND
© Author. All rights reserved. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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