Monday, December 10, 2012

$5

Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5/visit. He doesn't take insurance.

This led to several online threads featuring comments such as "Finally! A doctor who cares!"

Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don't care.

I respect Dr. Dohner, and am not putting him down. I think highly of what he does. I actually like what I do, and if I were independently wealthy and could see patients for free, I probably would.

It isn't until almost the end that the article notes Dr. Dohner is supported by his family's farming business, and NOT his medical practice. By that time most readers have moved on to the football scores and "Dancing with the Stars" results, and therefore are left with the impression that any doctor can do this for $5 a head.

Bullshit.

I do care.

But that doesn't mean I don't have my own responsibilities: like office rent. And paying Annie & Mary. And a mortgage. A wife. 3 kids. If I can't support those things, then I'm not going to be able to keep my office open to care for people.

Regardless of what people may think, just because I charge for my services doesn't mean I don't care.

I care enough to call in your seizure medication to a pharmacy at 2:00 a.m. because you're out of pills, even though you knew you needed a refill for at least a week.

I care enough to call you from my family vacation to go over your MRI results, because I didn't think they should wait until I got home, or that you should get bad news from a covering doctor who doesn't know you.

I care enough to come in early and see you at 7:00 a.m. because you can't get time off work, but really do need to be seen.

I care enough to spend time arguing with some pinhead at your insurance company about why you need an MRI, when they don't think you do.

I care enough to rush in to the hospital to see you on my weekend off, rather than let a hospitalist who doesn't know you from Adam try to figure this out.

I care enough to call a drug rep and beg for samples of your medication because you lost your job and can't afford it.

I care enough not to order unnecessary EMG's and EEG's on you, even though doing them would improve my revenue.

I care enough to face worsening reimbursements and rising expenses every day, when many colleagues have given up and gone into another field.

I care enough to try and give you hope, even when I'm not sure there is any.

I care enough to help you find another neurologist who will take good care of you, because your crappy insurance won't let you see me anymore.

I care enough to step out of my kid's music recital and take your call, because I know you're scared.

I care enough to take the time and explain why the drug you saw advertised on TV isn't a good idea in your case, rather than just writing a script to shut you up.

I care enough to stay in a job that has deprived me a of decent night's sleep, family time, and likely shortened my overall lifespan, in spite of the fact that my financial goal nowadays is just to break even.

I care enough to refer you to a neurological subspecialist who can take better care of you than I can, even though in doing so I'll lose you as a patient.

I care enough to call your spouse at 9:00 p.m. to reassure them that you'll be all right.

I care enough not to force you to have a test you can't afford, even though you can sue me for malpractice if I miss something.

I care enough not to dismiss you from my practice, in spite of your insanely annoying personality, because I know that you really do need my help.

I care enough to still be doing this job, even though every day a little bit of my idealism dies.

I care enough to be a doctor. I hope I always will.

73 comments:

Anonymous said...

Bravo! Well said & appreciated beyond words. I hope you're not the only one that cares. I care, as a pharmacist.

Anonymous said...

Wish there were more doctors like you out there, Grumpy. Thank you for caring so much - your patients are lucky to have you.

murgatr

Pharm.Tech. RDC '06

Reflex Hammer said...

You're the best, Dr. Grumpy!

Marcia said...

And with a sense of humor too.
You ARE appreciated.

The Reader said...

THIS is the kind of doctor we need more of. Thanks, Dr. Grumpy.

jimbo26 said...

Also , I care enough to talk to you and listen .

Maya Resnikoff said...

And since you charge a rate that reflects the training and experience that you bring to the table, hopefully your patients take coming to you seriously, as well- rather than something that they can get for the price of a box of cereal.

Sometimes it fascinates me how people can mistake charity and generosity for "this should be the norm"...

C said...

I'm a firm believer that you get what you pay for.

Miss Liabilities said...

The world needs more men and women like you and less of the idiots who gobble up anything on Facebook

Anonymous said...

Give these people who think they are ENTITLED to free and Wal-Mart style medical care the opportunity to sit through one semester of med school, one semester of clinical rotations, or one semester of residency...along with paying the mountain of debt incurred.

(I'm not even going to touch the concept of insurance or medicare, of which these naive idiots have no grasp.)

Then maybe they'll understand why the price of medicine is what it is.

When will people learn that medical care doesn't come in an extra value menu?

Anonymous said...

I loved this post. I'm a university professor at a state u. Tuition here is relatively low but the students think it is exorbitant and the state legislature kicks and screams about the lazy faculty. I am so fed up with the total ignorance about how hard we work, and for very little $$. None of us are "rich professors" who get paid 6 figures for working 4 hours/week. Nobody has any idea how hard we work, and for how little $$. It can be difficult to persist and I try every day to remind myself why I am doing this and why I care so much.

Anonymous said...

Amen. Hoping and wishing my veterinary clients are reading this.

Anonymous said...

i am sure you care enough to spend a long time or write a letter or fill out forms 27 times to get a patient a medication that the insurance company no longer wants to pay for and suggests alternatives that don't work, the patient is allergic too or the substitution is not even a compatable substitution.

I am sure you care enough to call your patient after learning that their spouse, child or sibling passed away that afternoon to see if they are okay or need anything.

There are so many other things I can think of that I'm sure you do that my doctor's do. Just because you don't just charge $5 doesn't mean you (or any doctor) doesn't care. People have this misconception that doctors and teachers are overpaid and that is FAR FROM THE TRUTH.

Thank you for caring about your patients.

Pam said...

Too many people in this country resent the educated, the business owner, the doctor, the wealthy, (people we used to admire) because they are too lazy to do the hard work that it takes to get there. And we have a president now who fosters and feeds this attitude. God help this country.

Thank you for doing what you do, and thank you for the hard work you put in to get to this point.

Moose said...

Ah, I see the problem. You read the comments on an article on Yahoo News.

While I read a lot of my news info through the Yahoo aggregate, I have long since learned that the majority [but thankfully not ALL] of the people who comment and read comments there are completely ignorant. I could go into the fine details of what I've seen, but many seem to be the stereotypical white, claims-to-be-Christian, didn't pay attention in school, ignorant boob. I am not sure how many are trolls, but the ignorance I see written and supported in the comments is just horrific.

Next time, try not reading the comments.

Anonymous said...

Doing my last visit to the doctor,what treated me for a broken knee, I said that I wanted to comment my treatment by his staff and him. He looked at me, like here goes another ungrateful patient.

I told him that considering that his staff and him, see us under the most unfavorable circumstances, pain, I felt they had shown a great deal of compassion. From the look on his face, I don't think that many patients had shown any appreciation for his services.

Dr Grumpy, tell us a few more stories of patients, who show an appreciation for your stall and your services.

Carol Saha said...

My guy is very fortunate to have a neurologist that cares like you do. She has gone above and beyond to make sure he has what he needs. And our gp is just as awesome. We love them both.

Anonymous said...

Well said. I wish you the best. And, don't forget that you also have Snowball and Mello to take care of. The kids...eh. :)

RebeccaJ said...

I'm glad you still do care, dealing with the everyday stupidity of the general populace must get very taxing. Thank you.

Anonymous said...

I am glad you and my own doctors care. As for Medicaid and the per cent this and that, well, I fall into the side that has to depend on the kindness of my fellow citizens to get through the day.
Thank You.
Maybe being a Yak herder in Mongolia would be easier.

Packer said...

I think you should have a sign over your entry. I work for overhead.

Not to cry in my cups, the last 3 years many of us have been working for overhead. Small, small businesses are the least understood element of the American economy.

Me said...

Thank you for reminding me that my doctor cares.

Dr.M said...

Right on.

Packer said...

Oh, one last note: That bit about stepping out of the kid's music recital to make a call---PURE BS, I sat through Hot Crossed Buns enough times to know that . I was almost feeling sorry for you , but then I realized you didn't have to listen to hot crossed buns.

Grumpy, M.D. said...

Packer - Believe me. I've heard more than my fair share of screechy renditions of Hot Crossed Buns.

MDaisy said...

Dr. Grumpy,

I hope your post is shared throughout the Internet and just about anywhere else as what you wrote is is so true.

The other day I told my family doc (a family practice doctor) I wish I could pay him more for the reasons you gave. In fact, I told my doctor he was worth gold as he's taken care of my family for close to 30 years with the same care that you have given. We consider him a friend of the family and a part of every decision making process.

Like you, I suspect, he will be watching my back and making sure I get the best medical care possible.

It's not so much money you spend, it is how it's spent. For my hardworking family doc, the generalist who makes sure everything ticks, that is money well spent.

As I've written before, if I ever have to see a neurologist, I hope to find someone as good as you are.

Jen in Cincinnati said...

We know you, and most of your colleagues, do care! So sorry you have to get out there and toot your own horn. You should send this post to the editor of the paper that was stupid enough to publish that misleading drivel.

Anonymous said...

I had a long time opportunity to work in the pharmacy that services Dr. Dohner's patients. As article mentioned, he does charge $5 per visit, but he has virtually no overhead cost. His nurse (who is well in her golden years, as article mentioned) does not even make outgoing calls or faxes, if you need any clarification on scripts written by him YOU have to call them with question and then call back to get the answer if doctor is not available at the time. And most of his prescriptions are very basic: antbx for URI, UTI, zpacks and cough syrups, some HTN and diabetes meds, etc. Definitely not specialized medicine or seizure meds or anything of the sort. And cost of living in that geographical area is unbelievably low. His clientelle is mostly people from very small towns and surrounding farms (i.e. farmers and their families). I think what he does is a great form of charity for local populace, and something to keep him occupied during the day (there are no appointments, you come in that day and wait, you may be seen or may not, depends on the day and his hours), but definitely not something that would be even remotely sustainable in more populated/expensive-to-live-in areas. Just my 2c from personal experience. So don't believe everything you read in PEOPLE magazine (they did the story, I actually brought in the page to work).

Lo said...

Grumpy, I love you! Actually, I am lucky to be able to say I love all of my many Doctors and I try to tell them so pretty damned often.

Hope a patient hugs you this month.

T said...

And we thank you

Because we're not all going to think that a $5 fee is a sign that a doctor cares, or is invested in our care

gloria p said...

You and most of the medical profession DO care but no one today can live on a 1940s income. The answer to the $5 Doc question may be "I'm sure he is independently wealthy; medicine must be his hobby."

--Sunrise-- said...

Bravo!

Your Doctor's Wife said...

You service your patients exactly the same way my husband does. Loved this! Will be sharing for sure!

Anonymous said...

Thank you for reminding me I need to send thank you cards to all the doctors who see my family. I honestly think there are about 2% of doctors who really are bad and give people like the $5 doctor credence when in reality its not feasible for me to spend a day in a doctor's office.

Anonymous said...

Dr. Grumpy,
Thank you for caring.

Jaxxy said...

I find it astonishing that people (even those with very little money) won't bat an eye at spending $20 to see a movie, or over $100 a month for cable TV, yet they are loathe to pay a $20 office visit copay. Why shouldn't someone who's potentially saving your life be payed for his services? You did, afterall, have to pay for the years of medical school that enabled you to practice medicine in the first place. It's great that one doctor is able to charge only $5, but why must ignorant people demonize those who charge a reasonable ammount?

Jaxxy said...

This actually reminds me of all of the people who complain about the cost of drugs and the evil pharma companies, when they have no idea that clinical trials cost literally billions of dollars, and then the few drugs that even make it to FDA approval are only profitable until the patent expires.

kdoglady said...

I am impressed that he thinks insurance isn't worth the hassle. My mother's dementia specialist doesn't take insurance either. She stopped taking insurance to be able to spend as much time with each patient as is needed. She's expensive and worth every penny. She's a lot like you - has called me while on vacations, Friday evenings and weekends. What's the burn-out rate for such caring docs?

brent said...

Dr. Grumpy-Remember this holiday season as those few, wonderful folks bring in those special treats, home baked goodies, and small gifts. They bring those to you because they do greatly appreciate all of the wonderful service that you and your staff provide. It is the token of appreciation that these folks show that helps to make up for those less appreciative (to put it mildly).

Anonymous said...

Appreciate the iteration of ways that the physician cares outside the body of knowledge that intensive training entails.

I greatly suspect many of us in healthcare find a similar list of evidence.

On the other hand, our patients may not realize this intangible value from a dedicated physician.

In some ways, a system that foments chaos (especially in urban situations), upsets a balance of trust and integrity (with an insurance person in the middle) and is more likely to result in a faux patient-physician relationship.

As for $5/visit, well, it's very unrealistic. I found an NPR discussion of $50.00/month concierge physician for well-care, maintenance medicine, etc. an interesting concept, but I've heard a lot of interesting concepts over the years.

It would be interesting to hear what people really would want in their healthcare provider services. I would guess basically a mandatory requirement, that they are working with someone that cares. Insurance adjudicators might not fit that bill, perhaps.

In my father's final days, he made a follow-up visit to a podiatrist for consultation. It was everything we could do to get him dressed, in the car, keep the oxygen on his face and the wheelchair on the sidewalk, but that last visit with someone that cared (no one knew how ill he was at the time, including Pa), was one of the lovelingest and loveliest memories I care to treasure.

I don't want to leap into politics from the medical professions, but it is quite unfair to snarklily bring up President Obama in the discussion. Enabling more young people to afford being seen for medical treatment by a physician is a good thing in my book. Sooner or later someone is going to find a way to bring medical-related (drugs, tests, equipment, etc.) costs within reason. However, there is no skimping on the cost of a physician's visit. And, someone will have to find a way to pay pharmacists without direct association to drug costs!!

Andrew_M_Garland said...

Stories about $5 doctors and other heroes of the new social-justice society fit into the plans of socialists and totalitarians. As productivity drops and people are not paid, there must be myths about the minimal costs of great medical care.

Cuba is exalted as the land of great medical care for everyone. In fact, it has a two-teir system. Great care for the top 10%, and lousy, make-believe care for the rest.

Russia's dictators have always exalted the dedicated, low-paid worker who devotes himself to his country and not to his own selfish desires

Putin Revives Stalinist Cult of the Worker Hero
=== ===
[edited] The cult of the industrious worker reached its peak in Stalin's era. Its revival under Putin will bring back horrific memories of slave-labour working conditions and frequent punishments for alleged misdemeanours that often led to a spell in the gulag. Stalin told his people that they must imitate Stakhanov, a miner who hewed more coal in a day than anyone else.
=== ===

These worker stories are always needed to explain away what people see with their eyes. They see lines, poor quality, poor supply, and rationing. These stories suggest that we would all be better off if they merely worked as hard as those Cuban doctors, Stakhanov, and the $5 doctor. Don't be selfish with your skills, and proudly serve the common man under the wise state.

Ivan Ilyich said...

I met a lot of doctors in the past two years, including neuros, and I never met one I thought wasn't worth his or her keep. I'm grateful to them all.

Doctors aren't the problem where inflated salaries/fees are concerned. Neither are nurses, therapists, pharmacists, and techs of all kinds. The suits at the top of the large corporations which own most hospital groups today are the real villains, in my opinion.

Anonymous said...

Right on, Dr Grumpy!!!

MDaisy said...

I did drop off the homemade fruitcake and a batch of freshly made shortbread cookies to my favorite family doctor.

I also bring treats throughout the year to spoil my favorite doctor and his hardworking staff.

Leslie said...

And we appreciate it! For every good doctor who cares, bravo! Well said, Grumpy!

disabled dreamer said...

Awe, I want you as my neuro more than ever now! Er, I mean yak herder....

You should frame this and hang it in your waiting room.

Vicki said...

My parents and I always bring Christmas presents and souvenirs from any trips we take to give to my mom's and my neurologist and my dad's podiatrist. I also send her postcards when I'm out of town. Our friends think it's funny, but we think it's just a personal way of showing our doctors just how much they mean to us!

gin4407 said...

Whew! I'm glad you got all that out of your system! Holding on to it would have made you sick!

Hospitalists....smh

You sound like my doctor. I won the lottery when I found my internist in 1983!

Your patients have also won the lottery because they have you as their doctor.

Vicki said...

P.S. I love my neurologist so much that she's even on my list of people to invite to my wedding, along with a couple of the nurses I know the best. They've been rooting for me to find a good man for a long time, and one nurse even tried to keep her eyes out for any nice, eligible men either among her patients or from elsewhere to set me up with! She teased that soon we'd be getting double appointments in neurology! But then eHarmony did the trick, and the wedding is in May! And as I said, my neurologist and a few of my favorite nurses will be getting invitations!

That is about as good a sign of how much I ADORE my neurologist as anything else!

Brittles15 said...

Like. Oh not facebook... love this Grumpy. Thanks for careing, we need more of You!

Mallory said...

I hope you are appreciated by your patients - you deserve to be.

Thank you for blogging, I visit several times a week, and always enjoy your posts.

At this time of year, I bake multiple batches of cookies, and distribute them to the people who have helped me throughout the year. My doctors, their staff, my pharmacy, physio, the nurses at the hospital. Everyone deserves to know they are appreciated.

I'm not into sending christmas cards, or doing the christmas think, but making thank you cookies is my favorite part of the holiday season.

I hope someone brings you (and Mary and Annie) cookies this year.

Anonymous said...

Dr. Grumpy - thank you. And you did not even mention the hours you need to keep up with continuing education classes and the ever-increasing numbers of license numbers (state board, DEA, NPI and whatever else your state requires, like DPS here in TX).


Wv Pederati - when feet rule?

Anonymous said...

Dr. Dohners lucky that he doesnt have to live by the rules of the insurance industry. And Im sure its a conscious decision on his part. I bet all doctors wish they could practice like him.

Kat's Kats said...

Like my pcp Dr. Katherine White (Mt. Juliet, TN if anyone needs a family practitioner) you meet my late pediatrician Dr. Joe Strayhorn's gold standard of medical care. I judge all my doctors that way.

Thank you.

'nuff said.

Olivia said...

I think it's sad that so many people have gotten so stupid that they can't figure out basic math, or even realize that the cost of a visit (which they normally have no idea about anyway, if they're insured) includes more than the money going directly into your pocket.

Don't give up your idealism, it would be a shame to punish the majority (I hope!) of your patients by souring from the idiocy of a few.

Charles said...

Just $5 a visit?

As the saying goes - you get what you pay for. You might get less, but, rarely, ever so rarely, do you ever get MORE than you pay for. Something for those who "praise" this $5 doctor to remember.

Anonymous said...

Thank you...

We have patients who yell at us that we don't care, because we tell them no... They don't seem to understand that we tell them that because we do care, and we don't want them to be hurt by the medications they are prescribed, by multiple doctors and received from multiple pharmacies... :D

The Quirked Eyebrow said...

Idealism never dies. It gets dented and dinged up but it never dies. The sense of humour makes a good boo-boo strip for it.

impetua said...

I think the $5 doc is a great guy and helps a lot of people, but he's a special circumstance. I think YOU'RE a great guy and help a lot of people and I'm glad you point out all the stuff you do once in a while. I'm glad because it serves to remind people like me, who are not patients of yours, to really stop and think about our own docs and the other people who in some way help us and go above and beyond in doing so. Bravo, Dr. Grumpy. God bless us, every one!

Anonymous said...

I am sure it's the up coming PMS, but reading your post me tear up.

I think many ppl would say a doctor "cares" when they look you in the face, listen to your list of issues, and take the time to openly discuss the options, give an explaination ats to why you think it is X and not Y or X, or why this tx will work vs another.

a GREAT doctor is what you just described.

Jenn said...

Hopefully you never get tired of hearing this: "Thank you, Doctor."

Valendar said...

Yep and you care about have a fat wallet too. Whould you like some cheese with that whine?

Anonymous said...

This post is one of my favourites, thanks for making my day a bit better knowing there are doctors like you.

Ami said...

I have not had occasion to see a neurologist, and would rather not HAVE to, but it's good to know there are ones like you out there.

I have an amazing pcp, have been seeing her for 14 years.

I have, indeed given her a hug. Tie dyed clothing for her. I can talk to her AND SHE LISTENS!

Caring about what you do and how you take care of people is a very admirable thing.

Clarity in thinking and ability to see past fluffy stuff like that article are important, too.

Dragoness said...

Where's the "like" button here? So many people forget about everything but the money, then of course they accuse you of being all about the money. Very well said.

Anonymous said...

There are always the haters and complainers; they're everywhere, festering through every system. Sure, its good to know we're not being ripped off with exorbitant greedy fees, but we all generally understand quality care will cost us something. In every field we just want people who are specialised in their jobs and to do the job well. From bakers to plumbers to bus drivers..the people who love their jobs tend to do them better - but its funny we don't hear stories of mass complaint when a teacher waives their paltry pay because they love their job.... Haters and complainers.They keep lawyers in jobs..and sadly would never read such posts.

Anonymous said...

Anybody know a good caring neuro in the GSO, NC area?
Who sees pts for just 5 bucks...
above operating costs, salaries, etc.

Veronica Reilly said...

I wish some of the doctors I see at the VA were as caring. They draw a salary and get paid with or without my seeing them. I've had a few who treat me as another number, don't listen, click-clack at the computer while ignoring me and telling me they can't help. Shoot, one of them prescribed a medication I had just told him I was allergic to. I'm glad to hear there are some doctors out there that still CARE about their patients. Thanks, Doctor, you are appreciated!

terri c said...

Thank you Dr Grumpy!!!!!

ladycrim said...

Thank you, Dr., for caring. I've just found this blog, and I love the stories, but this post really moved me.

My mother's oncologist talked a pharmaceutical company into giving her potentially lifesaving medication for free after her insurance spent three months refusing to cover it. And when it turned out those three months had been too long a wait, he brought the whole family to her bedside and cried with us as he broke the news. Why? Because he CARED.

It's wonderful Dr. Dohner is able to do what he does. But it doesn't make what you and other hardworking, caring doctors do any less wonderful.

Anonymous said...

Dear Dr. Grumpy,
Thank you for being you. I have a neurologist with whom I have an excellent working relationship, as well as a personal one. I am grateful for all that she does for me to keep me healthy and functional. I wish that I could only pay 5.00 a visit, but her time and yours are worth much more than that. So I gladly pay more knowing that she is there when I need to call her if I have an issue. Lately we've been dealing with drug interactions and side effects. I appreciate all that she does and that doctors like you do.

Rusty Daisy said...

Dr Grumpy, you made me cry. Thank you! I am thankful that my doctor is like you and if I need a neurologist I hope he (or she) is as caring as you are.

Rusty Daisy

peace said...

I'll keep this page to re_read it every time I feel there is no point behind all this suffering in medical school.

Wait... Do I hate myself?

 
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