Through blogs and comments, patients and experts explore what it takes to find good health care and make the most of it.

Paying to Participate


For three years in college, I suffered from recurring, painful infections.'  I did everything a good patient should do.'  I spoke first with the nurses at the campus health clinic, followed all their recommendations and took all the antibiotics on schedule. ' The infection went away but returned a few weeks later.'  After months of this pattern, I made an appointment at the nearby hospital, followed all the doctor's instructions, took the medicine'and the infection returned.

Frustrated and in pain, I sought an opinion from a specialist, who prescribed yet another set of antibiotics.'  I was desperate and thought, "This has to work."'  Alas, the infection returned and he referred me to a different specialist.' 

This time, I wasn't going to leave any stone unturned.'  I wrote down all the behavioral changes I'd made, put together a timeline of the infections, and made a list of all the prescriptions I'd tried and questions to ask.

After my physical exam, I told this new specialist that I had a few questions and pulled the pieces of paper out of my bag. He stared at me blankly for a moment and checked his watch.'  He said he didn't need to know what approaches had been unsuccessful in the past, so I proceeded with just my questions.'  He checked his watch again and responded briefly to each.'  After about fifteen minutes all my questions had been answered, however begrudgingly.

A few days later, I got the bill for my appointment.'  The office had billed me for an extended consultation at a hefty price.'  Confused, I called to dispute the charges, but they wouldn't budge. ' Since I was on my college's health insurance plan, I ended up paying for the visit out-of-pocket.

How could I have known I would be charged double?'  I hadn't had much experience with health care to that point.'  I had interpreted the frequent glances at his watch as impatience, not as tracking the billable time.'  Besides, the appointment didn't seem unduly long to me.' 

I didn't realize at the time that the average physician visit is about 16 minutes.'  But that's average ' sometimes more, sometimes less.'  I guess I thought there would be extra time allotted since I had spent the last two and half years making my way through doctors and prescriptions.'  He was supposed to have the answers, I thought.'  Logically, wouldn't my conversation with him be somewhat in-depth?'  In-depth is what I expected from a specialist.' 

We're encouraged to engage in our health care and with our health care providers, but our participation takes time.'  If we make our lists and ask the right questions, should we expect to pay extra to participate?'  And if so, then give me options: email consultations, helpful online resources or research, and advance notice of fees seem like small offerings to ease costs ' both of time and money ' both scarce resources for patients and physicians alike.

More Blog Posts by Goldie Pyka

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Health Care Cost   Communicate with your Doctors   Pay for your Health Care   Inside Healthcare   Health Insurance   Goldie Pyka  

Comments on this post
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Sarah Jorgenson says
July 15, 2010 at 11:49 AM

Goldie, this is a really unfortunate experience with health care. Though, I think you hit on three important challenges that the health care system must respond to. One, costs are not transparent in health care. It is a challenge as a patient to be prepared to handle the costs of care. Though resources are increasingly becoming available online and through insurance companies, it is still a hard to get ball park figures for what a doctorâ??s visit will cost. This is especially true if there is discretion on the part of the physician, say, in the form of keeping track of time he or she spent with you.

Two, poor communication in health care can have lasting impacts on patients. This experience obviously influenced you. For some, it may deter them from visiting the doctor again if costs are high, they do not get their questions asked, and they are still sick!

Three, fragmentation exists within health care. The multiple visits that you had with different health care professionals demonstrate this. I think anyone who has had a complicated condition has felt like they were just being shuffled around from one professional to another.

I am aware of efforts taking place nationally, state wide, and locally to address these issues, but it is also the responsibility of the individual health care professional to be sure that they are clear to the patient. Are they answering the patientâ??s questions? Does there need to be a follow-up visit or multiple follow up visits? Does the patient leave the office satisfied and ready to modify lifestyle behaviors or sure of what medications to take, for what and when? This is crucial for patient safety, satisfaction, and simply, to get better.