‘Truth in Billing’ Informing
Daily Observer
Felix
Gautier appeared shriveled, his moustache drooped, but his eyes brightened when
we entered the room. “Ah, Lapius,” he
called, “Over here, I am glad you could come to visit. It isn’t every day that an old friend is
about to have his gall bladder removed.”
They
shook hands. “When are they going to do
the operation, Felix?” Lapius asked.
“Sometime
in the morning. I hope it is early. I would like to get it over with. My goodness, Lapius. The bills.
You have no idea how expensive it is to be sick. They are not only doing a cholecystectomy,
but a panhystapocketbook and collectomy besides. I will be broke. I will have to double my medical liability
practice when I get out, just to break even.”
“At
least the medical profession doesn’t charge a contingent fee, Gautier. Relax.
The important thing is that you get well.”
“It
doesn’t only matter whether I get well, Lapius.” Gautier shot back. “It matters also whether I will have enough
to eat after you blood suckers get done with me. But we have you in a vise now.”
“We
have PSRO’s coming to regulate your practice and they just passed a
truth-in-billing law in
“A
pity,” said Lapius soothingly.
“Nevertheless,”
Gautier continued as soon as the pain had subsided, “just the fact that they
should pass such a law makes it evident that there’s something fishy in
medicine, the way you fellows overcharge.”
“If
doctors charged the way lawyers do, Gautier, your surgeon would be able to
claim a fee for his surgery contingent on your earnings for the rest of your
life. Now why not calm down and try to
get some rest?”
“Oh
no, Lapius. You don’t get out of it so
easy. First you have to explain to me
the basis of the large fee for just a few hours of work in the operating
room. It’s the truth I want, that’s
all. Just the truth.”
“Harry,
say ‘goodnight’ to Gautier. He looks
like he wants to go to sleep. He is
becoming incoherent.” Lapius reached
over and patted Gautier on the shoulder, “Goodnight, old friend. Everything will be all right. And when you recover we can finish the er..ah
discussion.”
Lapius
and I had no sooner entered the door when the phone started to ring. It was the hospital. There was a problem with Gautier. When we arrived there were fire trucks,
firemen holding a net, and perched on the third floor ledge was a solitary
figure in a nightgown. It was Gautier. When we reached his room Lapius raced to the
window. Gautier was shivering on the
narrow ledge.
“Come
back in here,” Lapius said, trying to reach out for him.
“Never. If you come one inch closer to me I’ll jump.”
“Well,
sit there if you like, Gautier. But what
prompted this bizarre behavior?”
“What
prompted it? I don’t want to get
murdered, that’s what prompted it,” Gautier said, cringing against the wall.
“No
one is going to hurt you, Gautier, come in.
I still don’t understand what happened.”
“What
happened?” Gautier shrilled, “What happened is that the surgeon came into the
room to tell me about the operation.
Instead of making me feel confident, he listed all the terrible things
that can happen to me. According to him
gall bladder surgery is lethal. First I
can get an abscess in the wound, 13 percent of the cases. Then I can have a hemorrhage, 5 per cent of
the cases; then he can slip and cut some nerves or a blood vessel, 7 per cent
of the cases; then he can cut the hepatic duct by mistake or damage the
pancreas, or snip the liver, or puncture some bowel. By the time you add all the possibilities it
comes to 100 per cent.”
Lapius
started to laugh. “Oh that’s what
happened. Well, don’t take it seriously,
Gautier.”
“Don’t
take it seriously?” Gautier yelped.
“It’s me that all this is supposed to happen to tomorrow. If it was you that was being operated on I
wouldn’t take it seriously. Then you
would be on the ledge.”
“No,
no, Gautier. You have it all wrong. The problem is that the lawyers have won so many
judgments from doctors on the basis of the fact that doctors didn’t get what
you people like to call informed consent from patients, that doctors now
believe, under threat of possible law suit, that they had better tell each
patient all the possible risks of surgery.”
“I
don’t want to know the risks. All I want
is to have my gall bladder out.”
“Of
course, Gautier. It is reasonable that
when a patient is about to undergo serious surgery, that he understands that
there is a risk. This was implicit. As a result, in the old days doctors used to
comfort their patients and try to reassure them. But you lawyers wouldn’t have it that
way. So this is the price you have to
pay. You have to listen to the category
of catastrophes that could possibly befall you.
But don’t take it seriously. The
surgery is really quite safe.”
“I
don’t believe you, Lapius. It can’t be
safe with all those things that can happen.”
“But
they are all controlled. These are just
the statistical possibilities that the courts insist the patient should know
about.”
“But
they are true, aren’t they?”
“Well,
yes.” Lapius admitted. “We have truth in
billing, and now we have truth in surgery.
I rather thought you should like that.
Now be a good fellow and come in from that ledge.”
Lapius
reached for Gautier. “Don’t come near
me, I’ll jump.”
Lapius
peered down to see that the firemen’s net was properly positioned, then lunged
for Gautier. He missed. Gautier jumped, and landed bottom first in
the net. The firemen trundled him up in
a blanket, and brought him up to his room.
“Restrain
him and sedate him,” Lapius told a startled nurse.
“What’s
going to happen now?” I asked Lapius as we left the hospital.
“Search
me. They won’t operate unless he signs
permission.”
“His
gall bladder might burst.”
“It
sure might,” said S.Q. Lapius. “Gall
bladders rupture and worse things happen when reasonable men are not permitted
to do their jobs in a reasonable way.”