‘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.”