Thursday, August 06, 2009

Something for Nothing

I have a patient who is a very old Boxer, one of my favorites, forever young at heart. I like his owners, too; they are totally dedicated to him and call me often with updates on his condition.

Being a boxer, he has had many skin tumors, some benign, some that I've had to surgically remove. I've also sewed up some lacerations on him. He has a chronic digestive problem, and I have consulted with the owners via phone and email in between visits on how to manage this condition.

His owner called today to say that he felt a new lump, and asked the receptionist if he could bring his dog by and just have me pop out to the waiting room, feel the lump, and tell him if it was something he needed to worry about. It would take just 5 minutes of my time, tops.

For no fee, of course.

I asked the receptionist to call him back and let him know that on any new lump we recommend a small needle aspirate, a type of mini biopsy, which would obviously require an office visit. Make an appointment.

He called back to say the original receptionist got it wrong, its an old lump that was aspirated before, it feels different now. He just wants me to briefly feel it. He can come by any time tomorrow and wait in waiting room.

This is a lump that was aspirated 10 months ago. I sure don't remember how it felt then. Besides, you cannot make a diagnosis on a tumor based on feel alone. But what is worse is that he wants my expertise without paying for it.

I offered to do a brief exam, just examining the lump only for a much reduced office visit fee compared to the fee for a comprehensive exam, but he protested still. He got angry, threatened to transfer to another clinic, then asked to pick up his records.

I am sad that I won't get to keep seeing this patient after over 5 years, but I am more sad that the owner does not see the value of my time and expertise. He actually asked me a few months ago if he could bring his dog in on a weekly basis so that I could auscult his lungs (part of evaluating his chronic medical condition), and I said sure, make a 10 minute, $15 brief consult appointment. Then he could not believe I would charge him for it. "Couldn't you just make it part of value added service, based on how much we've spent here already?" He played that card again today, stating with all the past aspirates and lump removals he's had, he deserves a freebie. But this is a lump last checked nearly a year ago.

I suppose he also doesn't realize that every time he comes in, I have to make a note in his medical record. Its just bad medicine to give an opinion based on limited evidence. And in the end, I value the years I spent in school learning medicine too much to give it away.

I really wish I understood where this client is coming from better. Would he ask his physician to come out to the waiting room and give a brief, off the cuff prognosis?


get2eric said...

Well I had a cardiologist in ELP who wanted to check up on me and said he would do it on the cuff if I was concerned about the ins. coveraqe.

Unusual I know and the only one in ....all these years of seeing physicians.

But I do see your point and as Grandad Brooks told Grandma Dulce in 1972 when she was trying to sell home decorating products, "Don't give your time away"

Laura said...

My guess: he's feeling a pinch in his wallet and is asking for similar things from other providers, too. We get that all the time at work... People want freebies because they've been good customers.
Maybe he should check into doggie health insurance.

Miss Mandi said...

I can understand the growing cost of pet expenses when you take them to the vet. But you are right he wanted you to make a diagnosis after just feeling this lump when it could be life threatening. That's not cool!! I wish I lived where you were so I could take my cat to you!

Lula said...

I imagine that, like a lot of people, this guy thinks that being a vet is the childhood dream job, therefore, not really a JOB so much as a fun thing you get to do all day to make a little money. Also, I find that people tend to not understand the process behind someone else's my position, folks always want me to approve their form 'in a rush', becuase to them, its the most pressing thing they have going on. They dont get that I have to actually read the thing and possibly check mileage and such, then get a signature from my boss, which could take a day or two. There is no 'in a rush', you know?

Am I blabbering? Anyhoodle, I DO appreciate your expertise and how you got it, so I thank you very much for the free advice re: declawing and fleas for KittyKitty and P-Loo! I've got to check with my vet to see what the declaw is going to cost, and if he does it humanely as you described. As much as I dont like cats, I dont want to rip their fingernails out, either. ;)

Sinda said...

I do admire those people who can ask for what they want, but really, they should accept the answer with grace. If you don't like it, leave, but no need to be a jerk about it.

And it sounds like you were already giving them plenty of perks. They were jerks with perks!

OK, I'm going now. Thanks for the poke last night.

Anonymous said...


Aunty Norma.x

@eloh said...
This comment has been removed by the author.
loveforlife said...

Hey mrs.martin it's Heather. Man that guy was REALLY stupid! And i mean it! Comon! Is'ent making shure your pet is safe and not anyware near any sickness or even death (although i dont think that his situation would of led his pup to death)Be inportent to you? It's 15 doller's. SO WHAT?! The money is ALL worth it and i guss he dosent understand you expertyst enough if he's going away to another vet when the fact is that any other vet would proboly pay the same thing to get the same thing done. Well i hope that he relize's that and that your a GREAT vet and he'll come back to your vet so that way you can see your favorite dog again...Best of luck...-Heather

Emily said...

I agree with you, and it's too bad the owner handled it this way.

Melissa said...

I guess it never hurts to ask, but he should understand why you're saying no and respect that.