Wednesday, July 15, 2009

Essay: An unusual charitable contribution

Urologist Neil Baum submitted this essay recently, and we thought it was great. Please read his full essay here about his unusual payment option for a payment, and join in the discussion.

"I performed a neonatal circumcision in the office on a 7-day-old child. After the child was taken home, the parents called the office that there was excessive bleeding on the underside of the penis. I suggested that they compress the area with a sterile sponge for a few minutes and then call me back. When that suggestion did not solve the problem and the bleeding persisted, I requested that they bring the baby back to the office. Read more

Upon examination I noted a small blood vessel that was actively bleeding at the frenulum. This was easily controlled with a single absorbable suture and the baby was sent home.

I contacted the family multiple times during the evening to check on the baby and to reassure the parents that the child was going to be okay. The next morning I called the baby’s pediatrician and reported the complication and suggested that the baby come in for a CBC as several four-by-four sponges were soaked with blood with an estimated blood loss of 50 cc.

The baby was seen an additional six times in the office. At the last visit, nearly three months later, the parents pointed out a one- to two-mm area of adhesion between the glans and the ventral shaft skin where the suture was placed. I asked the parents if they observed his erection and if there was there any ventral curvature as a result of the adhesion. The parents said that his erection was straight without any angulation. I reassured them that this was of no consequence and that it would not affect his urination or his ability to have an erection. I also asked about the force and caliber of the urine stream and they indicated that it was also normal.

I submitted a bill to the parents. The parents responded with an e-mail note that they were unhappy and concerned about the adhesion and that they wanted to obtain a second opinion with another urologist. The note said that they were going to have added medical expenses, and as a result, they were “uncomfortable” paying the fee.

I called the family and asked them when they were going to obtain the second opinion and they gave me the date. I called the family after that date and they indicated that the pediatric urologist whom they contacted said that the tiny adhesion was of no consequence and he reassured the parents that nothing further needed to be done.

I told the family I was going to submit another bill, and I received a check for half the amount with a note on the bottom of the check as “payment in full for medical services.”

I called the family and politely informed them that I was not accustomed to negotiating my fees after the services are rendered and that I don’t allow patients to determine the value of my services. I told him that I would return the check and that he should do what he felt was appropriate.

After several weeks with no response, I contacted an attorney. I suggested that the attorney write him a letter requesting payment. However, I wanted to demonstrate that I wasn’t personally interested in receiving the money. Through the attorney I offered an alternative plan suggesting that the patient’s parents should make out a check to my synagogue’s social justice fund for the full amount and that the parents could use the donation as a tax deduction.

The check was soon sent to the synagogue and I received a nice note of thanks from the rabbi. I sent the baby’s parents a note thanking them for the donation and hoped that we could all put this behind us.

I believe this outcome was not only satisfactory to me, as I was not forced to have a patient determine the discount for my services, but also to the patient’s parents as well. It is another example of my wise mother’s advice: you can likely get your own way if you have more ways than one!"

1 comment:

  1. I just heard from a physician whose patients keep threatening to sue if he asks them to pay. To me, this sounds like a relationship gone awry.