Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Sunday, September 26, 2004

    Charitable Servitude: What do you do when a charitable impulse leads to more than you bargained? Once, when we lived in a very cold and snowy northern climate with very long winters, I promised the little boy next door that he could shovel our walk for $5 every time it snowed. But, instead of waiting for a snow shower to end, the kid would shovel the walk every thirty minutes and come up to the door asking for his five bucks. I didn't have any trouble telling him to either wait until the snow ended or our deal was off. But now, I've gotten myself into a similar situation in the office that isn't so easy to end.

    I was asked if I would be willing to take on a new patient who was deaf and needed to have a sign language interpreter with her at each visit. I accepted, knowing that I would end up breaking even at each visit once I paid for the interpreter. The patient had traditional insurance, which would pay me about $50 for a fifteen minute office visit, and the interpreter services charged $25/hour with a two hour minimum. But now, my patient has switched to Medicaid, which pays I don't know how much for a fifteen minute visit, because I've yet to be paid. But you can bet it will be less than traditional insurance. In an added blow, the interpreter services have raised their rates to $30/hour with a two hour minimum. I'm no longer breaking even. I'm paying for the privilege of caring for my patient.

    I know that the charitable and kind thing to do is to ante up and not complain. Even as I write this, I feel miserly and mean. But my patient has turned out to be a somatisizer. She's also started recommending me to her friends in the deaf community. This has the potential to turn into some very serious giving. And I can't put a halt to any of it without breaking the law.

    Now, my patient is not illiterate. She could communicate with me through writing, but she prefers sign language. English isn't her first language, sign language is. And although the portion of the ADA relevant to the hearing impaired includes written materials as an appropriate aid, the reality is that written material may be considered inadequate. And, although the law also says that a business doesn't have to comply if doing so will be a financial hardship, the reality is otherwise. Physicians can not plead poverty. (A similar situtation exists for foreign language interpreters although the feds have cut small practices some slack in that regard. )

    The most frustrating aspect of it all is that I have no choice. I have to give and give again, even if the giving exceeds my capacity. Charity given freely is at least attended by some warm and fuzzy feelings. But forced charity feels more like being robbed.

    UPDATE: Another physician had a similar experience:

    I, too, became a "victim" of the ADA , and I was forced to stop accepting Medicaid because of this. When I suggested that the patient might be better served by going to one of the two local family practice residency programs where there were full-time institutional supported American Sign Language interpreters, I received a letter from an attorney from a local disability advocacy group threatening to sue me if I did not treat this patient. After consulting with two attorneys, I was basically told to "suck it up and see the patient" because I had no defense against an ADA suit.

    The patient turned out to be a nice enough person, but I realized that a couple of dozen patients for whom I would have to pay for an interpreter could financially destroy my practice. Even though there are institutional practices in the community with employed interpreters, the ADA states that I am obligated to take any patient like this one unless my practice is closed to all patients. Therefore, my only recourse was to terminate my contract with Medicaid. About 100 patients were forced to find a new doctor so that I could protect my practice from financial ruin.

    Sadly, this is one of the alternatives I'm considering. It means that some of my patients will have to find a new doctor, and it isn't easy to find doctors who accept Medicaid. It's one of those government mandates that's meant to improve care but only ends up making things worse.

    UPDATE II: In a related vein, Dr. Mental notes that doctors in Tennessee had to drop Medicaid when the state expanded its program to include all the uninsured. Which, by the way, is Senator Kerry's plan for the whole country - to expand Medicaid to include families making 200% of the poverty level. We'd have fewer uninsured, but they'd have a heck of a time finding a doctor.

    posted by Sydney on 9/26/2004 09:59:00 AM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006