FROM THE COLLECTIONS
Assuming Responsibility for Patient’s Pockets
By Neel Shah '05 MD'09
As a Brown medical student, and now as a resident at Brigham & Women’s Hospital in Boston, I’ve had the privilege of working alongside some of the most compassionate doctors imaginable, doctors who inspire me to always go the extra mile for our patients, to diligently attend to each physical symptom.
But even the best doctors can neglect something critical.
In a time when tightening belts and pinching pennies is especially important, our patients often pay exorbitant amounts—enough to bankrupt 2 million Americans each year—on medical care they may not even need.
Recently, I cared for a 45-year-old single mother of three who presented to our emergency room with a fever and abdominal pain. After a full work-up that included a CT scan and pelvic ultrasound, we determined that she had a small adnexal mass, most likely an abscess, which would require antibiotics and possible surgery. However, when describing the imprecise CT and ultrasound images, the radiologists wrote, “cannot rule out malignancy” in their final report, and suggested an MRI for further characterization.
The MRI, a study that bills for an average of $2500 in Boston, was unlikely to affect her management. Both clinical and statistical evidence strongly pointed to an abscess and not cancer. We had ample time to test our hypothesis, to trial treatment with antibiotics. It was likely we would directly visualize the mass during surgery and send it to pathology regardless. But still, I ordered the MRI.
That expensive decision was one of many we made during the course of her stay. While most decisions helped her get better, others (from the hundreds of dollars worth of “routine” serial labs we or dered reflexively to the thousands of dollars worth of extra hospital days we spent coordinating care) did not. Nonetheless, each decision we made was tabulated into a billing claim that ultimately inflated the out-of-pocket share she owed.
Posted By: MGHdoc
Alpert Medical School