‘Truth in Billing’
Informing
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 contingency 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 New
Jersey that makes it a criminal offense for a doctor to hide the true cost of
his laboratory billing. You might even go to jail, Lapius, haha,” Gautier
suddenly clutched at his belly. “It hurts when I laugh,” he complained.
“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 returned
home just in time to hear the phone ring. 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.”