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Do MDs ever work for free?

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  • Do MDs ever work for free?

    We dentists are quick to take the blame.  When something we did fails, we will often redo it for free.  Could be a filling that fell out in a year, a crown that decayed in 3 yrs, or an implant that got infected - we are expected to do it for free and eat the cost.

    But usually, it's not that we did anything wrong - not our fault that THE PATIENT'S HEAVY BITE caused the filling to break, the PATIENT'S HORRIBLE HYGIENE that caused the TOOTH UNDER THE CROWN to decay, or that the PATIENT'S BODY rejected our perfectly placed implant.  Doesn't matter, we still redo it and eat the cost.

    Much of it has to do with dental insurance.   Most insurances will cover a new crown on same tooth every 5 years or more.  So they've set the expectation that anything under that is the dentist's fault and should be fixed for free.

    To my knowledge, that never happens in medicine.  If my PCP fails to cure my cold in 1 week, I don't demand my money back for the visit.  Orthopods don't do another hip replacement for free if the first one fails in 3 yrs.  And certainly if a patient continues to smoke, drink, and eat garbage, a cardiac surgeon isn't going to guarantee his work either.

    So I'm just wondering - is there ever a time when MDs redo their work for free?

  • #2




    We dentists are quick to take the blame.  When something we did needs fails, we will often redo it for free.  Could be a filling that fell out in a year, a crown that decayed in 3 yrs, or an implant that got infected – we are expected to do it for free and eat the cost.

    But usually, it’s not that we did anything wrong – not our fault that THE PATIENT’S HEAVY BITE caused the filling to break, the PATIENT’S HORRIBLE HYGIENE that caused the TOOTH UNDER THE CROWN to decay, or that the PATIENT’S BODY rejected our perfectly placed implant.  Doesn’t matter, we still redo it and eat the cost.

    Much of it has to do with dental insurance.   Most insurances will cover a new crown on same tooth every 5 years or more.  So they’ve set the expectation that anything under that is the dentist’s fault and should be fixed for free.

    To my knowledge, that never happens in medicine.  If my PCP fails to cure my cold in 1 week, I don’t demand my money back for the visit.  Orthopods don’t do another hip replacement for free if the first one fails in 3 yrs.  And certainly if a patient continues to smoke, drink, and eat garbage, a cardiac surgeon isn’t going to guarantee his work either.

    So I’m just wondering – is there ever a time when MDs redo their work for free?
    Click to expand...


    that seems right to me..

     

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    • #3
      When I was in private practice I saw many uninsured hospital consults (often the most difficult patients) and rarely rec'd any compensation.

      As a salaried employee now, I respond to an avalanche of pt calls every day. Unlike lawyers, we don't bill for any of this.
      Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

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      • #4
        Probably 1/4 of the patients I see don’t pay, so, yes, we do plenty of free work. What you’re asking is do physicians charge for failed treatment and the answer is that it depends. If someone comes in with a problem and they have a complicated course, often billing is done based on the DRG and it’s bundled.

        If your PCP doesn’t cure your cold in a week, that’s because it’s a cold and curing it in a week isn’t possible. That’s like being mad that your dentist couldn’t make your tooth grow back.

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        • #5
          I have the honor of providing quite a bit of uncompensated care in the ED. They present to the ED and I have to evaluate them according to EMTALA. They don't have to pay their bill but they still reserve the right to sue me. It's a pretty great system.

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          • #6
            You expect your PCP to cure a cold? Save everyone some time and take 3 days of Afrin and some DayQuil.

            As for working for free, every time a payer or patient doesn’t pay I am essentially working for free. And then there’s the opportunity cost issue of no shows or seeing a Medicaid patient (also likely a no show) where the marginal revenue doesn’t offset the overhead costs on a time related basis.

            You can’t guarantee an outcome in medicine. Everything has risk. Does your investment advisor guarantee a certain return? Does your auto mechanic pay you back if your AC still doesn’t work well? This isn’t like a hamburger or Amazon widget that can be returned.

            If someone has done something wrong/improper and an outcome is not ideal then I think it’s reasonable to expect the doctor to sacrifice their time to correct that free of charge or not charge them. But if the standard of care is followed the patient has to accept that one of the risks of a visit or procedure is always “failure to achieve benefit”.

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            • #7




              We dentists are quick to take the blame.  When something we did fails, we will often redo it for free.  Could be a filling that fell out in a year, a crown that decayed in 3 yrs, or an implant that got infected – we are expected to do it for free and eat the cost.

              But usually, it’s not that we did anything wrong – not our fault that THE PATIENT’S HEAVY BITE caused the filling to break, the PATIENT’S HORRIBLE HYGIENE that caused the TOOTH UNDER THE CROWN to decay, or that the PATIENT’S BODY rejected our perfectly placed implant.  Doesn’t matter, we still redo it and eat the cost.

              Much of it has to do with dental insurance.   Most insurances will cover a new crown on same tooth every 5 years or more.  So they’ve set the expectation that anything under that is the dentist’s fault and should be fixed for free.

              To my knowledge, that never happens in medicine.  If my PCP fails to cure my cold in 1 week, I don’t demand my money back for the visit.  Orthopods don’t do another hip replacement for free if the first one fails in 3 yrs.  And certainly if a patient continues to smoke, drink, and eat garbage, a cardiac surgeon isn’t going to guarantee his work either.

              So I’m just wondering – is there ever a time when MDs redo their work for free?
              Click to expand...


              due to the higher comparative complexity of medical procedures versus dental procedures there's a higher understood expectation of complications.

              Comment


              • #8
                -take call at a level 1 (50% have no insurnace)
                -provide 100% free ortho care to a religious clinic
                -answer patient calls daily
                -intraop complications that require a longer surgery are free besides the original procedure (ie. If I break the femur during hip replacement)

                So if I understood what you were saying is that if my hip replacement falls and breaks their hip, I should redo it for free? Or if I fix their broken bone and they rebreak it, I should do the revision for free? Why?

                Metal on metal hips are typically reimbursed 100% by medical companies who made them, so that's "free" to the patient.

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                • #9
                  There's the 90 days of post-operative care global period under Medicare in which I can't bill for follow-up visits related to the surgery. I suppose I could think of the fee I get for the surgery spread out over that time period as compensation. But if I did that and calculated the hourly for all the training I went through to provide that surgery in the first place, I'd probably feel a deep sense of remorse and injustice. ;-)

                   

                   

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                  • #10
                    Depends on what’s included in the price.
                    Post op follow ups, implant post failures , cataract complications. Your point is valid, it’s not an unlimited lifetime warranty. Managing patient expectations is probably more important. No problem with policies clearly stated. No returns and time limit or even “may not work, no guarantees.

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                    • #11




                      You expect your PCP to cure a cold? Save everyone some time and take 3 days of Afrin and some DayQuil.

                      As for working for free, every time a payer or patient doesn’t pay I am essentially working for free. And then there’s the opportunity cost issue of no shows or seeing a Medicaid patient (also likely a no show) where the marginal revenue doesn’t offset the overhead costs on a time related basis.

                      You can’t guarantee an outcome in medicine. Everything has risk. Does your investment advisor guarantee a certain return? Does your auto mechanic pay you back if your AC still doesn’t work well? This isn’t like a hamburger or Amazon widget that can be returned.

                      If someone has done something wrong/improper and an outcome is not ideal then I think it’s reasonable to expect the doctor to sacrifice their time to correct that free of charge or not charge them. But if the standard of care is followed the patient has to accept that one of the risks of a visit or procedure is always “failure to achieve benefit”.
                      Click to expand...


                      I don't expect my PCP to cure a cold.. I don't even expect to see one about it... the example was in jest, as most of our patients expect us to fix their problems immediately and completely.  We deal with people all the time who are disappointed they can still experience discomfort for days after the treatment... we can tell them to save everyone some time and take some Advil, but they don't usually react well to that.

                       

                      I agree you can't guarantee an outcome in medicine.  But somehow in dentistry, we are expected to, no matter whose "fault" it was.  Just wondering if medicine has a similar problem.

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                      • #12




                         

                        So if I understood what you were saying is that if my hip replacement falls and breaks their hip, I should redo it for free? Or if I fix their broken bone and they rebreak it, I should do the revision for free? Why?
                        Click to expand...


                        Exactly!  But dentists do it all the time.

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                        • #13





                          Click to expand…


                          due to the higher comparative complexity of medical procedures versus dental procedures there’s a higher understood expectation of complications.
                          Click to expand...


                          with respect, there are many dental procedures that can be highly complex.

                          If they look simple to those who don't understand every consideration that goes into them, it is because we make them seem that way.

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                          • #14


                            We deal with people all the time who are disappointed they can still experience discomfort for days after the treatment… we can tell them to save everyone some time and take some Advil, but they don’t usually react well to that.
                            Click to expand...


                            You're preaching to the choir.

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                            • #15








                              Click to expand…


                              due to the higher comparative complexity of medical procedures versus dental procedures there’s a higher understood expectation of complications.
                              Click to expand…


                              with respect, there are many dental procedures that can be highly complex.

                              If they look simple to those who don’t understand every consideration that goes into them, it is because we make them seem that way.
                              Click to expand...


                              That's what experts do: make things look easy.

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