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Muks77
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| | Wednesday, June 18, 2003 - 7:29 am: | 
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recently i came across 2 reports in news paper.in one a well know physician was arrested for providibg a fake death certificate for 10 lacks,and a doctor couple booked for selling children rom their nursing home.i've noticed that its a general perception that doctors overcharge or theres a higher rate of negligence inspite of charging a high fees.what do u think?have u come acroos any such incident?
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Mahaguru
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| | Wednesday, June 18, 2003 - 7:40 am: |
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Asao gaOr vyavahar p`%yaok xao~at hÜt Asatat ...vaOVikya xao~athI AsatIla vaa Asau XaktIla ...pNa ek Aaho
Ê ho popr vaalao baatmaI Kup maala masaalaa BaÉna ilaihtat ... Anaok vaoLa baáyaaca GaTnaa GaDlaolyaahI
nasatat
popr vaalyaaMnaI ra caa pva-t kÉna Caplaolyaa kahI ³vaOVk xao~aXaI saMbaMiQat´ GaTnaaMcaa maI mauk saaixadar
Asalyaanao ho ilaiht Aaho.
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Zakki
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| | Wednesday, June 18, 2003 - 4:07 pm: |
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I don't think it can be called 'malpractice' necessarily, but I am thinking that to avoid future lawsuits of 'negligence' many doctors overprescribe medications, for high blood pressure, high cholesterol etc. I will not be surprized if there are bypass surgeries recommended prematurely, based upon 'risk factors' alone. There will be no way to dispute the doctor's decision, but it certainly affects lifestyles of many patients.
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Asami
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| | Wednesday, June 18, 2003 - 6:27 pm: |
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There will be no way to dispute the doctor's decision >> normally during medical malpractice cases, a reviewer panel is been recognised which consists of doctors of in respective fields. tyamule doctorcha nirnay barobar hota ki nahi hyacha achook nirnay milanyachi sandhi vadhate.
Arthatach hyaat perspectivecha bhaag asanarach. Pan agadi blanket decision asanyapeksha he bare.
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Mukund
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| | Wednesday, June 18, 2003 - 7:25 pm: |
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Being from medical field I can tell you guys this-- there is a whole group of people in usa who thrives and prays and lives on disability benifits and filing the malpractice lawsuits and gaining financially.Do u guys have any idea how many frivilous malpractice suits avarage physician in usa has to face? and if you are in the field of anasthesia or ob-gyn you r paying 33% of your income in malpractice insurance! off course the cost is eventually passed on to all the patients even though majority of patients are not claiming frivilous malpractice!
Zakki: cardiologist recomends open heart based on FACTUAL DATA of your result of cardiac catheterization(coronary angiogram) which tells him how many of your coronary arteris are blocked and if the blocks are severe enough to warrant intervention such as angioplasty or bypass (decision of which depends on your age,physical condition and you!)so where is the question of premature recomandation?And answering your concern of overprescription---- PEOPLE DONT WANT TO CHANGE THEIR LIFE STYLE AND HABBITS! WE DO ASK THEM TO DO REGULAR EXERCISE AND QUIT SMOKING AND SENSIBLE DIET BUT UNFORTUNATELY PEOPLE WANT MAGIC PILL INSTEAD! AND WANT TO INDULGE IN (BAD)FOOD THEY WANT TO ENJOY AND BAD HABBITS THEY WANT TO ENJOY AND DONT WANT TO EXERCISE!
mahaguru: I agree 100% with your newspaper analysis!MASALA is a right word!sensationalism! it sells!
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Yogibear
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| | Wednesday, June 18, 2003 - 7:48 pm: |
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Not sure if this belongs here:
I just happen to see a program 2 days back. Especially after an operation when the patient is 'unconscious'. Young students who are either doing interns or working under a surgeon are allowed to do examination of the patient while the patient is unconscious. In many cases patients are not told about this in advance and no consent of the patient is taken in writing. Woman patients are especially victim of this due to gynocological issues.
How can this be avoided!!! Why arent a family person allowed to be in the operation room or allowed to watch the operation through a window while the operation is in progress!
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Asami
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| | Wednesday, June 18, 2003 - 7:48 pm: |
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you are in the field of anasthesia or ob-gyn you r paying 33% of your income in malpractice insurance> Is it true that few of the states are more vulnarable to fraud cases and hence are facing shortage of specialists, thanks to unaffordable cost of insurance ...
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Mukund
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| | Wednesday, June 18, 2003 - 8:02 pm: |
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yogibear: i dont know what kind of exams u r talking about but sure it is unethical to do things without pts consent but may be exams u r talking about are routine anasthesia tests to see the pts post op status and when u r a patient in a teaching hospital mostly in those hospitals consent forms it is clearly mentioned that interns or residents will be working on the case. Yogi if teaching hospitals do not allow this then how the hell a new doctor is going to be trained?
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Yogibear
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| | Wednesday, June 18, 2003 - 8:40 pm: |
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Mukund: "in a teaching hospital mostly in those hospitals consent forms it is clearly mentioned" <<< I am not sure if it was teching hospital or not! As of my knowledge all/Many hospitals are generally attached to a Medical School. I am certainly not talking about cases where the patient prior approval is already taken. In many cases its not even mentioned to the patient. What I mean by student examination is more of a physical nature (touching various internal organs etc) rather than checking the readings.
"if teaching hospitals do not allow this then how the hell a new doctor is going to be trained" <<< I understand your point of view but I fail to understand why is it kept secret from the patient in many cases!!!
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Mukund
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| | Wednesday, June 18, 2003 - 9:54 pm: |
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yogibear: sorry for thr tone in my language.It wasnt meant to be personal attack on you. I cant comment on your views since the program you are basing your views I did not see.But I will again say that its highly unethical to do anything to patient (including physical exam) without his/her consent.I always instruct my students and residents under me to have female nurse present during physical exam of a female patient(even if it does not involve gynacological exam) for the possibility of getting sued for unethical conduct. Yogi its not always possible to allow a family member to be present during the examination for various medical(e.g.infection control) and
patient privacy issues but as I said a prudent and wise physician ALWAYS should have a female nurse present in such examinations.Keeping anything secret from patient is first of all very unethical and secondly can land a physician in big lawsuit.
muks: we r sorry we r diverting from your main issues and from your profile it looks like you are in india so i am sure some of the things i am talking about it may not apply in india.sorry.
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It has always been my observation that doctors in USA are more concerned about getting paid from insurance and lawsuits than about patient treatment.
After reading above posts, it appears that my thinking is on right track.
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Abedekar
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| | Thursday, June 19, 2003 - 4:17 pm: |
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doctors in india are equally concerned about getting paid ... except its directly from the patient's pockets. apparently, its necessary to have a sufficient amount of cash for emergencies to cover for the amount that hospitals demand even before they look at the patient ...
on the other hand, as far as i know, any hospital in the US is obliged to take in an emergency case irrespective of whether the patient is a millionaire or a commoner ... how they recover that cost is a totally different issue
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Mukund
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| | Thursday, June 19, 2003 - 5:48 pm: |
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upashi boka: you are entitled for the way you think but at least make sure you read muks comment(very first in this bb) on the state of medical establishment(off course muks observation is not a norm in india please bear that also in mind!) when you base your opinion.muks started this bb telling us the 2 cases he read in the news paper in india! not here!secondly expecting to get paid for your services is TRUE FOR ANY FIELD IN USA AND ALL OVER THE WORLD! please dont be knive to expect free service on your car when u go to a mechanic(agian its not my intention to compare humans to cars so dont conclude wrong conclusion!) or free service from a computer programmer for his/her services either,just to give you few examples.And for your information in USA the whole medical system is based on insurance system and medicare/medicaid ,its not the physicians who are dictating the payment system,its the INSURANCE SYSTEM AND MANAGED CARE EXECUTIVES! I am extremly sorry if in your personal experience if you did not get proper medical treatment from doctors in USA.Please give us factual data to undestand your opinion.Also please keep in mind that medical lawsuits here are in multimillion amount! Dont you think (without sacrificing patient care) a doctor here should be concerned about it? wont you in your field if this real threat is constantly hanging on your head and your livelihood and your hard earned license depends on prevention of such lawsuits? Please dont tell me you wont!
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1. Surely I did read all the posts before making my post. The original post did mention malpractise in India. However, that does not mean it does not happen in USA. It happens in each country and almost every field, be it medicine, engineering, insurance or something else.
2. Expecting to be paid is fair enough. However, do you think refusing medical treatment is fair enough? I took my son to emergency room at 11:30 pm and I showed my insurance card, but they started treatment at 2:27 am until they could talk to insurance company. Do you think it is fair enough? I was willing to give them credit card number also, but they would not start treatment until talking to insurance. Well here you (I mean doctors) can blame insurance companies. How about refusing to take new patient or saying earliest appointment for dental pain is after "2 months", sending inflated bills ($3700) and then agreeing to "payment in full" ($1675) when insurance company just pays that much.
3. Car mechanic is really a good example. I am not talking about the "quality" of medical treatment. When I go to a mechanic, he will first tell me what needs to be done, give me an "estimate" and give me an option to go to another mechanic. How many medical practitioners would do that? A pediatrician asked me to have my 6 month old son's blood tested. Lab near my home refused because my son was too young, so I had to take him to a hospital. It took 2 nurses and quite some time for taking his blood. Afterwards, I asked the doctor why did you want the blood test? "Oh, I just wanted to check his hymoglobin"
Well, I can go on and on. But that is not the real topic of this discussion, so I will stop here.
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Mukund
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| | Thursday, June 19, 2003 - 10:16 pm: |
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upashi boka: i am extremly sorry for the kind of treatment you got for your infant son in emergencuy room.NO EXCUSE, but where i work there is a policy that no patient can be refused a treatment if it is life threatening condition, e.r. must stabilize the patient before reffering it to facilty where they will take uninsured patients!In e.r. usually there is a triage nurse who decides after doing a small preliminary exam whether this patients warrants an immidiate medical attention or not. The very nature of emergency room is such that they have to priortize the patients and thats the job of triage nurse.so if in her expert opinion if pt does not need immidiate attention other critical patients get seen first before this patients gets the attention. so it is not uncommon in e.r. for patients to wait 1 to 2 hrs.lot of times unlike in india doctor is not avilable here 24 hrs a day so many pts go to e.r. even for non emergency reasons just to see a doctor.and confirming with insurance companies is for your good! most insurance companies will not pay if preaproval from them is not taken. if she didnt do that u would have ended up paying everything from your pocket!
about inflated bills i dont have comments because i dont know which insurance company and what procedures.for your information there is thing such as DRG(DIGNOSTIC RELATED CATAGORIES) according to which differant insurance companies have differant set of rates they will pay doctors
depending on dignosis and procedures.thses rates are differant for differant insurance companies so i dont know if your doctor made a mistake of sending u a bill acording to a all together differant insurance companies rates or may be he was just unethical doctor i dont know.
about your sons hemoglobin there must be some reason. i mean nobody should do tests for the fun.u have right to ask why he wanted to check hemoglobin.and for your future referance YOU DO HAVE A CHOICE TO GO TO ONOTHER DOCTOR PROVIDED THAT DOCTOR IS IN YOUR INSURANCE COMPANIES LIST OF DOCTORS YOU CAN GO TO! In emergency life threatening situation you dont have a choice but in elective procedures you can choose the doctor you want.
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Muks77
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| | Friday, June 20, 2003 - 8:21 am: |
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condition in india is totally different.the percentage of law suits is very low,this may increase with the time.and about the CONCENT thing,in govt hospitals ,most of the time patient or relative are just handed over a paper 2 sign without giving any information.
even in private practice the situation is not different .
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Nirakar
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| | Friday, June 20, 2003 - 7:21 pm: |
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Mukund, good to know that you in medical field.
Let me tell you my observation here:
1. Go to emergancy room in hospital, they will not accept you till they are sure of payment, this I experinced. They first go and verify insurance etc.
2. almost all doctors inlcuding your famility doctors do not attend call at night. My Father many times get severe asthma attackes and our doctors (not one but atleast 5-6 in differant cities) entertained him even after midnight. I cannot expect this here. Isn't it true?
3. Even on weekends doctors don't attend your calls, you are supposed to speak to on call dr and many times he cannot access proper information.
I strongly feel, in US Medical is profession like any other business while in India (though there are not good facilites) Medical is SERVICE.
Here I belive Dr , Insurance and phamacitical compnies has tight nexus. A amoxicilin cource cost you Rs 100 in india so bet it's mfg cost is just a dollar. Here you have to pay $75 (without insurance), so you are forced to take insurance.
Why did phamacies take away prescription from you and didn't return it? Why X ray copes are not given to patient?
My sun has UTI last month, his urine test came only after 3-4 days (reason they give is weekend!), In India any pathology lebortaty can give you reasult in day in case of urgancy.
If you have tooth pain and dr is not free, he will tell you to take pain killer and come back after 2-3 days, this was exp of my friend.
I really want to know your views on this.
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Nirakar
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| | Friday, June 20, 2003 - 7:23 pm: |
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One more do not tell me in your hospital you have xyz policies etc, I am talking in general and hope you will not take this personally
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Nirakar
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| | Friday, June 20, 2003 - 8:03 pm: |
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about inflated bills i dont have comments because i dont know which insurance company and what procedures.for your information there is thing such as DRG(DIGNOSTIC RELATED CATAGORIES) according to which differant insurance companies have differant set of rates they will pay doctors >>>
In any isurance bill (that comes from insurance provider even after level 3 visit) you can see how much dr claims. But intresting thing is Dr gives descout to Insurance comppanies and that is also mentioned on same bill. You have to pay only a differance between discounted charges and what you provider agrred to pay.
Point here is if somebody is not having insurance can Dr apply disciunt?
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Mahaguru
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| | Friday, June 20, 2003 - 8:17 pm: |
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I strongly feel, in US Medical is profession like any other business while in India (though there are not good facilites) Medical is SERVICE. >>
Picture in india will change soon since indian court has allowed people to file law case against doctors under consumer act law that means court is assuming that doctors are businessman. Then what is wrong if they behave like a businessman? If you want to go to court agianst doctor just like u are fetching macdonald for hot coffee, then there is nopoint in blaming doctors
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Mahaguru
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| | Friday, June 20, 2003 - 8:21 pm: |
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about the test in pathalogy labs >>
in India, generally they don't ask for test for every small reason. Here they have to do, else tomorrow one will ask doctor in court, how come he has not done this test. So workload in labs is much higher than in India.
Also if doctor calls the lab and requests for urgent reports, they prioritize your case and give reports in few hours. (this has been told to me by one doctor working in USA)
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Nirakar
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| | Friday, June 20, 2003 - 8:33 pm: |
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Mahaguru, in that case Dr shoud not take oath that they take at graduation. I need not have to tell you what that oath is, it is displyed in waiting room of all drs.
No other business does this.
This does not mean that they can do anything, point here is if your profession is dealing with humman life you can not be so materealistic. We apply same logic to police right?
Your Mc example: Yes, everybody is answerable for ones doing. We work in engineering and any engineering fault that that causes harm to humman life , we are responsible and we pay price for that. That's the mechanisum by which we acive perfection, new improvements. Take an example of child seat, you get one from store and if it has falw, mfg will recall it free of cost. now this cost is passed on to customer, no doubt abut this but due to competative environment businesses pass only necessory cost to meet market price compitition. But in case of Dr they assume everybody will sue them this is where problem lies.
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Nirakar
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| | Friday, June 20, 2003 - 8:35 pm: |
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So workload in labs is much higher than in India >> I said they give me reason for delay is weekend !.. point blank
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Mahaguru
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| | Friday, June 20, 2003 - 8:50 pm: |
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This does not mean that they can do anything, point here is if your profession is dealing with humman life you can not be so materealistic. We apply same logic to police right? >> I can understand this point ...but unfortunately Indian supreme court doesn't agree with this.
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Mahaguru
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| | Friday, June 20, 2003 - 8:53 pm: |
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reason for delay is weekend >> why they should work on weekend if doctor says it is not urgetn? who will pay extra money to lab techs who are workg weekends? In USA lab tech resources are very limited unlike in India
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Mahaguru
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| | Friday, June 20, 2003 - 8:58 pm: |
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about the oath ...have you been to any medical graduation? I have not noticed such oath, but if you have seen what has written in that?
in that way, everyone takes oath ...the oath printed on first page of every text book ..
In my point of view, that has no value ..
finally you will react to the world in the same way they treat you.
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Mukund
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| | Friday, June 20, 2003 - 10:34 pm: |
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Nirakar: you raised some good points. I promise I wil answer all questions to the best of my ability but today I am busy and do not have time to go in details. Please forgive me and wait till tommorow 9 am cst.you will have my answers I promise!
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Nirakar
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| | Friday, June 20, 2003 - 10:45 pm: |
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Thanks Mukund, I think you with autority can throw some light on my (mis?)understandings
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Nirakar
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| | Friday, June 20, 2003 - 10:47 pm: |
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So Mahaguru, what's your point? Whatever is happning is fair and should be done that way?
If yes - fine , differance of opinion.
If No - ??
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Mahaguru
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| | Friday, June 20, 2003 - 10:47 pm: |
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maukund - tumacyaa kDuna maaihit kLalaI tr Da^@TraMcaI mato AiQak spYT kLitla ... maI eikva maaihitcyaa AaQaaro
dusair baajau maaMDNyaacaa p`ya%na krt hÜtÜ
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Mahaguru
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| | Friday, June 20, 2003 - 10:54 pm: |
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what's your point? >> though it is not fair to everyone ... I am not sure if it can be changed ..becuase society has made doctors to businessmen.
puvaI- Da^@Tr rÜgyaacyaa GarI jaat Asat Ê Aaja kÜNaIih jaat naahI ..tsaoca kaihsao
anyways, I cannot write with authority reagrding this. mukund will provide more information.
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Yogibear
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| | Saturday, June 21, 2003 - 1:41 pm: |
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maMDLI USA maiQala AaiNa Baartaitla Da^@Tr naa ekaca trajaut tÜlata yaoNaar naahI Asao maalaa vaaTto² dÜnhI zIkaNaI
vaogaLI nyaayaalayaIna pwtI Aaho tsaoca ka^Ta-caa inakala Baartat patient cyaa hyaat imaLalaa tr %yaacao naiXabaca mhNaayacao. %yaat gairbaIcaI Bar AsalyaamauLo baroca KoD\yaatIla
/ ijala(atIla Da^@Tr ho Da^@TrI poXaa mhNauna na vaaprta %yaaMcyaa Aajaubaajaucyaa laÜkaMnaa medical help ]plaBQa vyaavaI (a hotunao vaavart Asatat.
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Arch
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| | Saturday, June 21, 2003 - 2:51 pm: |
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(a saMdBaa-t ek ikssaa ilahavaasaa vaaTtÜ. Aamacaa ek ima~ OB/GYN maQyao practice krtÜ. %yaacyaa eka patient caa navara lawyer hÜta. tI baa jaoMvha delivery saazI AalaI toMvha itcaa ha lawyer navara itcyaa barÜbar hÜta. He accompanied her to the delivery room with his video camera sagaLI delivery cover krayalaa tÜ saarKa [kDUna itkDo krt hÜta. The main reason was,he wanted to cover all actions of the doctor, in case there was any error on the doctor's part mhNajao tÜ mainly laagala tr case saazI sagaLa evidence collect krt hÜta. XaovaTI Aamacaa ima~ %yaalaa mhNaalaa I know exactly what you are trying to do but stay in one place and let us do our work
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Mukund
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| | Saturday, June 21, 2003 - 3:40 pm: |
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nirakar: Sorry I am late! Before I explain anything I sincerely want to tell all you guys who are reading, that I know there are lot of problems in medical establishment(doctors,insurance companies,payment system etc) and its not perfect. Since I am representing this establishment please dont look at me as the villain and take all the anger and frustration of your bad experiences on me since I am one of the member of that establishment.
This is my very humble attempt to shade light on why some of you might have had bad experiences in the past. Its not in any shape or form an attempt to minimize the anger,frustration and genuine headache many of you have faced when you came in contact with the medical establishment in USA.I genuinly sympathize with the emotional and physical turmoil you and your loved one went through.So here is my humble attempt!it might take me long time to cover as many aspects as I want to cover to shade some light on your concerns and questions so have patience ,I am typing..........
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Mukund
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| | Saturday, June 21, 2003 - 4:35 pm: |
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I think here I am going to try to answer 4 questions you raised and 2 quiestions upashi boka raised.
upashi boka' first question:
1: why inflated bills then settle for less later?
Explanation: I think you all need to know that as I mentioned in my answer to upashiboka earlier there is a federally mandated regulation about the amount a physician or hospital can charge a patient and it is based on DRG( DIAGNOSTIC RELATED GROUPINGS)So when a doctors office sends you a bill it should not be more than the customary reasonable and fare charge decided by DRG.i.e. there is a an amount considered as fare and reasonable charge as a doctors fee acording to the diagnosis of a patient
and what services patient recieved.Your insurance company knows what that amount is and they will pay the hospital and doctors(these are 2 separate entities---i.e. doctors fee is not synonimous as hospital fee!)acordingly.Some doctors will send you a larger bill than what your insurance company has paid on your behalf.There could be two reasons for that
a: doctor might think that he/she has provided you a service not covered by your insurance company because if you carefully read (200 odd!)pages of your contract with your insurance company you will see that there are lot of services your insurance company will not pay! you as a consumer has to shell out the money for those services!Here I will let you know that YOU CAN TALK TO THE BILLING OFFICE OF THE DOCTOR AND EXPLAIN THEM YOU CANT PAY THAT MONEY OR FIGHT WITH THEM AND CONVINCE THEM WITH ALL THE SAVED DOCUMENTATION THAT HOW THAT BILL IS NOT JUSTIFIABLE AND DEPENDING ON WHICH GROUP OF DOCTORS YOU ARE TALKING TO THEY MIGHT WRITE THAT BILL OFF! OR THEY MAY NOT!
b: If you read carefully your policy with the insurance company lot of companies will have 500 or 1000 dollars deductible and then they will pay 80% of first 10000 dollars bill and then after that they will pay 100%of your bill.With an example it will be easy to understand. Lets say your father had a surgery. Total medical bill is 20000 dollars. you have 1000 dollars deductible. so you will have to pay 1000 dollars from your pocket PLUS 20% of first 10000 dollars i.e. 2000 dollars. So you will have to pay total 3000 dollars from your pocket and insurance company will pay remaining 17000 dollars.So you will still get a bill from doctor about 3000 dollars(which is your share) even after your insurance company paid them their share of the bill!Are you guys with me?
Upashibokas's 2nd question:
In E.R. they will not see you untill they confirm with your insurance company!
Explanation: Please go up and read my answer to upashi bokas's this question. Only thing I want to add to that is its just not in my hospital where I work ,but again its a fedaral law that irrespectiv of if the patient is insured or uninsured-- no E.R. can turn down the patient specially if he/she is in life threatening condition.If they do that you can file a fedaral law suit!But if it is not a life threatening situation and you are uninsured,then they still have to traet you for the reason you went (it might be a temparory relief treatment and not the hospital admission or more permanant treatment!) They will refer you to the facility where they will take uninsured patients or they will ask you are you willing to and able to pay from your own pocket?
continuing......................
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| मायबोली |
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| चोखंदळ ग्राहक |
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