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Going For The Throat: Random Acts of Kindness–A Human Medicine Dodo Bird?

Post Published: 17 February 2010
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Category: Column, Going for the Throat, Health Care Column Thyroid Diseases and Thyroid Cancers
This post currently has 12 responses. Leave a comment

For the first time since starting writing for Dear Thyroid, I struggled a bit for a topic for today’s article.   To start, I felt like there was no way I could top last week.   The response to Six Word Thygraphs was overwhelming (thank you, everyone, a winner to be announced soon)–it would be like following Elvis at a karaoke bar.   Secondly, I’m elbow deep in two different books about how doctors and patients relate to each other, but neither is what I would call a gripping read, subject matter notwithstanding.   Lastly, well, one word: Olympics.

So I decided to “go with what I know” and talk about myself.   And philanthropy.

I am a veterinarian.   I briefly debated becoming a “real” doctor (we love when people say that, by the way), but then decided something about touching strangers in such a personal way was not for me.   In the past couple of weeks, I have been reminded why I love what I do.   A few Sundays back,   a man came in carrying a dog that had been hit by a car.   He was the owner, technically, but not emotionally–he had just “adopted” this pet from someone who found him, and upon getting home and out of the car, the dog spooked, bolted, and was hit.   The young dog was beautiful–thick soft coat, amazingly muscled, and adorable face–we instantly fell in love.   He was clearly in shock, and his left front leg dangled a la Joe Theisman.   We got right to work–catheter and fluids to support his cardiovascular system, morphine for his pain, and radiographs to assess the leg damage and check for internal injuries.   Within 20 minutes he was stable and comfortable, with a splinted significant fracture of his radius and ulna, but no other serious injury.   He was lucky.   The owner didn’t quite see it that way.   A dog he’d owned for less than an hour had now cost him $600 before he’d even gotten him in the house.   When I discussed the options and costs for repair of the fractured leg, it was clear that while he felt badly for the dog, he was not willing or able to pay the cost for such repairs.   I can’t and don’t blame the man–they had no bond–the dog was just a dog, not a pet.   He opted for euthanasia.

This is where the magic happens.   As a policy, we do not take in surrendered pets.   We’d love to, but you cannot image the numbers of animals we would have routinely relinquished to us.   When I walked back into treatment with the news, one of the technicians stepped up–no way would he allow it, he would take responsibility for the dog.   Unsure if he could even keep this pet, or if the dog would be compatible with his current dog and cat, he decided at the very least he’d pay for the fracture to be repaired and find the dog a suitable home.   The owner agreed to pay the current bill and sign him over.   After our new charge was placed in a comfy cage, it was time for my fingers to do the walking.   I called a veterinary orthopedic surgeon friend who has a mobile surgical practice with the story and she immediately offered to perform a surgical repair in the next couple of days for half price.   I agreed to come in on my day off to act as anesthesiologist to defray that cost.   This was no simple repair, and reducing the fracture and implanting the plate and screws clearly takes significant time as well.   As a bonus, while the dog was under I removed a broken incisor tooth and the orthopedist neutered him for free.

The technician named him “Caso” Italian for accident or random, and took him home the next day to start his long recuperation.   The story, however, does not stop there.   Two weeks into his recovery, he popped the latch on the front door and let himself out, re-fracturing the leg and completely disrupting the implant’s lower attachments.   I happened to be working that night as well when the technician came in and dejectedly carried Caso to the radiology room for confirmation and assessment of the degree of damage.   After sedating Caso, I reduced the fracture to the best of my ability and placed another splint.   Even with all the discounts and help we had all given this staff member, his bill was not small, and now he was back at square one.   Despite this, there was no doubt of his intentions to do whatever needed to be done.

The orthopedist came back the next day and fixed the fracture a second time, this time, totally free.

I’m not trying to make myself out to be some kind of hero.   I’m not.   In my field, stories like this are pretty much the norm.   My boss, the clinic owner, gives each of the doctors she employs a “charity account” each year to be used at our discretion.   Additionally, we log returned items that cannot be resold into a “rescue stock” for needy pets.   I have no idea how many hours of our (vets and associated staff) time are donated along the way.

In human medicine, there is charity too.   Programs like Doctors Without Borders and Operation Smile help thousands of people who would otherwise not have access or financial means for care, and many doctors (from all over the world) have flown to Haiti to aid in that recent disaster.   But I have no knowledge of doctors just deciding that the right thing to do is to run a certain expensive test for free, or arrange for a half price surgery for a needy patient.   Why?,   When I searched the internet for information, I saw stories of doctors treating medicaid/medicare patients when they suspected they would not be reimbursed, which to me is not quite the same thing.   A study out of Atlanta from 2003 demonstrated that 25% of female physicians participated in pro bono work in their communities or practice.1 I assume some of this is volunteering time at free clinics.   But I ran across this gem accounting for the bulk of physician charity:

“Researchers said the services that are going un-reimbursed are not unusual or luxury services, but are basic elements of good patient care and include such things as talking with adult children, managing pain over the telephone, calling pharmacies, coordinating home care services like physical therapy and visiting nurses, and ordering equipment like canes and wheelchairs…

So this is what the medical community calls giving free services to needy clients?,   Talking with patient families?,   Calling pharmacies and physical therapists?,   As stated by the researchers in the quote, THESE ARE BASIC ELEMENTS OF GOOD PATIENT CARE (and things I do everyday and have never considered “billable”)!

Am I alone in thinking this does not constitute true generosity?

I don’t mean to insinuate that human doctors have no sympathy or regard for their patients or human kind in general–I think just the opposite.   But I wonder why the culture or structure of human medicine is so fully different from veterinary medicine (and dentistry and law as well, which both encourage or even mandate pro bono work) that small–and large–acts of assistance or philanthropy are not more routinely practiced?

1.   Pro Bono Work and Nonmedical Volunteerism Among U.S. Women Physicians

Erica Frank, M.D. M.P.H. Jason Breyan, M.A. Lisa K. Elon, M.S. M.P.H.09/26/2003

Robyn

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12 Responses to “Going For The Throat: Random Acts of Kindness–A Human Medicine Dodo Bird?

  1. Kaytee says:

    “But I wonder why the culture or structure of human medicine is so … that small—and large—acts of assistance or philanthropy are not more routinely practiced?”

    One major reason– lawsuits. If I perform some sort of first aid on somebody, even if I do it wrong, “good Samaritan” laws protect me. If my husband, a pathologist, performs first aid– even if he does everything perfectly right, he could be sued– “good Sam” laws do not apply to “professionals” doing a good deed. Lawsuits go after perceived “deep pockets”, not necessarily whoever is at fault; if, say, the person needed first aid because he got hit by a car driven by an uninsured and unemployed driver, they won’t bother suing that person– but hubby could be sued, even if he saved the victim’s life, because it isn’t “standard of care” for a pathologist to provide emergency care to patients….
    Most of those charity medical providers provide insurance coverage for the professionals volunteering, so they are not at risk. And most of the charity work is performed outside the lawsuit-happy US of A….

  2. LAC says:

    (quote) “Researchers said the services that are going un-reimbursed are not unusual or luxury services, but are basic elements of good patient care and include such things as talking with adult children, managing pain over the telephone, calling pharmacies, coordinating home care services like physical therapy and visiting nurses, and ordering equipment like canes and wheelchairs…

    So this is what the medical community calls giving free services to needy clients? Talking with patient families? Calling pharmacies and physical therapists? As stated by the researchers in the quote, THESE ARE BASIC ELEMENTS OF GOOD PATIENT CARE (and things I do everyday and have never considered “billable”)!

    Am I alone in thinking this does not constitute true generosity? (end quote)

    ————————————————
    No you are not alone, Robyn. When I worked in the hospital setting mainly on an orthopedic floor and ICU, on the weekends I handled overflow from the social workers in arranging home care for patient discharges. The list looks just like what you found doctors to call “BASIC ELEMENTS OF GOOD PATIENT CARE” Yes, the doctors wrote the order to discharge and if they needed home PT, wheelchairs, etc. but they did not arrange any of it. I also contacted the family to make sure everyone was on board with the plan. In the office setting, it’s also the staff but I suppose they consider that “their time”.

    During the 10.5 yrs I worked at the hospital I came to know the physicians very well. It was a small community hospital outside the city so you knew most of them and a lot of them lived in the same town and were also your neighbors. What these doctors did provide free, and most did participate, was 5% of their practice in free care but in those days most physicians were solo practices. Now a days most are in groups and the solo doc is rare now. I came to find this out through the orthopedist I went to. When my daughter was in 5th grade she blew out her ACL while playing softball. Somehow the insurance info was misfiled and he thought I had none so he did the films and office visits all free. I ended up having it put through insurance when I realized what had happened but that led me to ask questions because I didn’t realize they provided anything free. This particular doctor probably fixed every elderly person’s hip in that town so he gave most of the free care he provided to the elderly patients. He would also save the medication samples for them (but that was not really “free”). However, anything they provided only came from what they had to offer out of their office, which was time. If a patient needed further studies, procedures or surgeries, there was nothing they coordinated with the hospital that would be discounted or free. I don’t know if most doctors do this or if it was just this small community, but all that was free was the charge for the office visit and an x-ray if they had an x-ray machine in their office.

    It does not seem like much compared to what you describe giving routinely. Is it because most people do not have “pet insurance”? But still, it seems like the animals are being treated more humanely and compassionately than people are.

    I do know that in MA, hospitals were required to have a free care pool. Each hospital was required to offer a certain amount of free care in dollars each year, but to qualify you had to have income within the poverty guidelines. Many things have changed in MA recently and I’m not sure if this still applies but still it’s not like anything you provide.

    I am in a bind right now just like probably a million other people. My adult son is in a health crisis right now at this moment with no insurance or doctor. We just filed paperwork for insurance but that takes time and there is nothing we can do but wait for that to go through. I avoided an ER visit last night because I have some old meds at home. I’ve never needed help before and I’d have always been to proud to take it, but at this moment I wish there was some kind of help for him right now. Even if I could get someone to prescribe something in the meantime, these drugs cost over a thousand dollars. Health care costs have been draining us for the past ten years even with insurance. I don’t know how people keep it going long term.

    I wish we were animals and Robyn was our doctor right now!

  3. Dear Thyroid says:

    Kaytee;

    Thanks for sharing such invaluable information.

    I have a question for you, it seems as if most doctors don’t provide resources for uninsured patients or offer any kind of resources for medication for those patients, why do you think that is? I realize that doctors are struggling with insurance issues the same way that patients are.

    Would love your thoughts on this.

    xo

  4. dearthyroid says:

    LAC;

    Thank you SO MUCH for sharing your story and insight about health care from your POV!

    I am very sorry to hear about your son. Have you been able to find insurance for him with a pre-existing condition? I hope that he gets well soon.

    You made an excellent point, well many really. I absolutely loved this, It does not seem like much compared to what you describe giving routinely. Is it because most people do not have “pet insurance”? But still, it seems like the animals are being treated more humanely and compassionately than people are.

    I 100% agree.

    xo

  5. Kaytee says:

    >>it seems as if most doctors don’t provide resources for uninsured patients or offer any kind of resources for medication for those patients, why do you think that is? I realize that doctors are struggling with insurance issues …<<
    Drs have TWO kinds of "insurance issues" to deal with…. Getting payment from health insurance companies/govt programs for work done, and malpractice insurance issues. Both are very costly to the drs– they need paying patients to make up those costs. Even if patients are willing and able to pay "fee for service", this will not cover all the costs involved– mostly administrative (like billing)costs, from what I can gather. Very little medication is provided by individual drs– unless their group has a pharmacy as well, and in that case, it wouldn't be up to the individual dr to give out "free" medicine… somebody has to pay for it. Because of various scandals/conflict of interest suits, less and less "free" samples are available from drug companies, either. Kaiser drs are not allowed to have ANY "freebies" from ANY vendor– no pens, notepads, pizza lunches, etc. even if that vendor is not selling medical supplies. Drs who are EMPLOYED (not just performing part-time contract work) by Kaiser, and most other "groups" have professional liability insurance paid by the group as part of their contract– and usually are not ALLOWED to work outside the group… and if they are, must carry (pay for) additional liability insurance (which is not cheap…). My hubby worked part time "moonlighting" while he was on active duty– his insurance was costing him almost $20K/year… and cost him close to $40K to "close" it when he went to work for Kaiser: if he didn't pay to "close" it, then he wouldn't be covered if somebody sometime in the future decided to sue him as a "participant" in a medical malpractice suit… and he doesn't even see/treat patients directly.

    Most new drs have a lot of student loan costs and practice set-up costs to pay off, as well, as well as continuing education costs (a few thousand/year minimum), books (also can cost a few thousand/year…)and other job related expenses; if they are in private practice– they also have office staff and nurses (and associated workman's comp, SSI, etc) to pay out of what they get in payments.

    So why, or who would be able to, provide free medical care if it would cost them tens of thousands of dollars to do so, as well as take their time away from paying work?

  6. Robyn says:

    I have a few minutes of computer access…I hope!

    Kaytee,

    I think my article sounds overly harsh on docs, when I really mean the whole “business”. I realize that many docs are or feel unable to do any close-to-home philanthropy. BUT–and this is a big but–I’m not sure IMHO the “lawsuits” defense is the crux. Dentists, lawyers, and veterinarians can be sued, too, and all carry malpractice insurance (at significant cost).

    Dentistry is under the the “health insurance” umbrella and manages to do more than physicians as well. My dentist, granted a younger guy probably working hard to establish his practice, has given me things (above the complimentary toothbrush!) and I’m not even “needy”.

    There must be something about practice management groups, non-physician practice owners, etc. that have pushed the average doctor away from the ability to help out here and there. I’m not talking about implanting a bone plate for free–that surgery costs (retail) about $2000. What would that be in a human–$10,000? (Don’t get me started on why that should be the case–same amount of school, same skill set, same critical care. It can’t REALLY be $8000 difference due soley to malpractice insurance, can it?–please correct me if I’m wrong.) I’m also not talking about rendering aid in a impromptu emergency. What I *AM* talking about is giving the little things here and there–the add-on blood test that insurance won’t cover this time, or the free second opinion consult for a colleage. It costs nobody anything but their time for a doctor to say to the colleague in the building–“Hey, could you be a fresh set of eyes on this lab work?” or “I know you’ve had success with X diet in these cases, would you mind talking to this person a little bit about that?”

    Maybe this stuff does happen and we are not aware of it? I suspect not, only because someone would be shouting this from the rafters.

    So, again, I don’t think it’s necessarily the doctor’s fault, but a total or global practice thing.

  7. Robyn says:

    LAC,
    The small community hospitals/offices are set up much more like veterinary practices, giving the doctors more power over how they practice. I think the shift to “doing less” has come with the doctors being a part of this bigger “machine” now.
    If only we could go back to that simpler time!

  8. Robyn says:

    Kaytee-

    “Most new drs have a lot of student loan costs and practice set-up costs to pay off, as well, as well as continuing education costs (a few thousand/year minimum), books (also can cost a few thousand/year;)and other job related expenses; if they are in private practice— they also have office staff and nurses (and associated workman’s comp, SSI, etc) to pay out of what they get in payments.
    So why, or who would be able to, provide free medical care if it would cost them tens of thousands of dollars to do so, as well as take their time away from paying work?”

    I have all those costs too. Education = $100K, books = $$$$ (I just purchased an updated opthalmology book = $400), continuing education, etc. Because I have been only working part time while my daughter is young I get no benefits–no CE money, no book money, none of my annual licensing paid, etc. I provide services for free ALL THE TIME. Usually time based, not inventory based so that I am costing my boss POTENTIAL revenue, not costing her money–but sometimes I give free stuff too. “Here, take the rest of this roll of Elasticon so you can patch up the bandage at home if you need to…”

    Depending on human specialty, my malpractice is not as expensive. And I don’t have to answer to insurance companies (we have many clients on insurance, but so far it’s all reimbursement style). But I do have to answer to my boss and practice manager, and I do hear it when they feel I’ve gone a little “too far”. I’d rather be (stay) poorer.

    I am not saying doctors should feel obligated to help, and many may be prohibited by their practice management. The definition of philanthropy assumes no obligation involved. But, my questions were why has this happened? Why the disconnect? I’ll go toe-to-toe with any human GP out there for knowledge and experience, bring home half the salary, and do small acts of charity when and where I can.

    But maybe that is precisely why I make half the income.

  9. LAC says:

    So true Robyn. Those times are pretty much gone now. Most of the solo docs are now in big practices and they hate it because of the restrictions and the demands. One old GYN I worked for many years ago decided to join a large group practice the last few years leading to retirement. He thought it would make things easier when it came time to retire and allow him to work and care for his patients longer. He was a doll that guy, a rare find. Anyway, he could not stand the demand for him to see 30 patients in one day. He could not “give quality care”. He never did what the insurance companies told him to do, i.e. 15 min. visits. He saw each patient for 30 minutes regardless. He managed to provide for a large family and live very, very well! They did not want me tagging along and he fought to keep me working for him but he eventually retired earlier than he wanted instead of dealing with the demands. It was amazing how they went out of their way to make us feel unwelcome because he did not want to conform. It reminded me of high school in a weird way. I wonder if there are any docs like him left any more? I know of at least one vet. A breath of fresh air! I thank you for the animals 🙂

  10. robyn says:

    So, a point about lawsuits and malpractice. I used to practice equine medicine, the most likely to be sued because horses are big bucks (but never was). Now I do small animals and have been (unsuccessfully) “tried” to be sued and reported to the board TWICE. First one: a cat with bad teeth that needed extractions. Cat was overweight, maybe 10# on an 8# framed cat. O became livid that I called her cat fat and said she couldn’t trust me because I would overdose the anesthesia by giving too much. Huh? Overweight pets get LESS anesthesia because of fat redistribution… CASE DISMISSED/BOARD INQUIRY DISMISSED. Second one: dog came in with large, but not serious fight wound. Older pet, so I would not do anesthesia without lab work. Owner felt I was too expensive/price gouging, and went somewhere else where the pet died under anesthesia due to some liver issue. I was named in the lawsuit along with the other vet. WHAT? I WOULDN’T TOUCH YOUR DOG FOR THE EXACT REASON OF THE UNFORTUNATE PASSING!!! CASE AGAINST ME DISMISSED/BOARD INQUIRY DISMISSED. Other vet found not liable because the owner had declined labwork and signed an against medical advise waiver.

    So, it’s not like I don’t understand the lawsuit mentality. People will sue for anything (hot coffee, anyone?), and thing doctors and vets have deep pockets, but it should not affect how we practice.

  11. Lolly says:

    Robyn I totally agree with you if your in the medical profession be it Doctor Vet then you can’t let lawsuits stand in the way of what you do. If someone needed emergency road side treatment you mean to say that person say doctor nurse or Vet,would be so worried that they could have a lawsuit for treating someone incase it didn’t work out Load of BS I’m sorry but a duty of care is always there even on or off duty and if all that is standing in the way is the fear of being sued then i would choose another profession because you can’t live in fear and people or animals could lose there lives because of this threat or fear of a Lawsuit. I wouldn’t think twice about helping someone and have done numerous times when I was off duty, afraid we don’t sue as much in the UK as you do in the states.

    I’m so pleased you were able to help that dog hope it makes a full recovery and settles with it’s new owner.
    I’m a dog lover. Well animal lover infact sometimes I would rather be with them than people.At least they can’t sue, Or can they?

  12. BL says:

    (quote) “Researchers said the services that are going un-reimbursed are not unusual or luxury services, but are basic elements of good patient care and include such things as talking with adult children, managing pain over the telephone, calling pharmacies, coordinating home care services like physical therapy and visiting nurses, and ordering equipment like canes and wheelchairs…

    So this is what the medical community calls giving free services to needy clients? Talking with patient families? Calling pharmacies and physical therapists? As stated by the researchers in the quote, THESE ARE BASIC ELEMENTS OF GOOD PATIENT CARE (and things I do everyday and have never considered “billable”)!

    Am I alone in thinking this does not constitute true generosity? (end quote)

    ————————————————
    No you are not alone, Robyn. When I worked in the hospital setting mainly on an orthopedic floor and ICU, on the weekends I handled overflow from the social workers in arranging home care for patient discharges. The list looks just like what you found doctors to call “BASIC ELEMENTS OF GOOD PATIENT CARE” Yes, the doctors wrote the order to discharge and if they needed home PT, wheelchairs, etc. but they did not arrange any of it. I also contacted the family to make sure everyone was on board with the plan. In the office setting, it’s also the staff but I suppose they consider that “their time”.

    During the 10.5 yrs I worked at the hospital I came to know the physicians very well. It was a small community hospital outside the city so you knew most of them and a lot of them lived in the same town and were also your neighbors. What these doctors did provide free, and most did participate, was 5% of their practice in free care but in those days most physicians were solo practices. Now a days most are in groups and the solo doc is rare now. I came to find this out through the orthopedist I went to. When my daughter was in 5th grade she blew out her ACL while playing softball. Somehow the insurance info was misfiled and he thought I had none so he did the films and office visits all free. I ended up having it put through insurance when I realized what had happened but that led me to ask questions because I didn’t realize they provided anything free. This particular doctor probably fixed every elderly person’s hip in that town so he gave most of the free care he provided to the elderly patients. He would also save the medication samples for them (but that was not really “free”). However, anything they provided only came from what they had to offer out of their office, which was time. If a patient needed further studies, procedures or surgeries, there was nothing they coordinated with the hospital that would be discounted or free. I don’t know if most doctors do this or if it was just this small community, but all that was free was the charge for the office visit and an x-ray if they had an x-ray machine in their office.

    It does not seem like much compared to what you describe giving routinely. Is it because most people do not have “pet insurance”? But still, it seems like the animals are being treated more humanely and compassionately than people are.

    I do know that in MA, hospitals were required to have a free care pool. Each hospital was required to offer a certain amount of free care in dollars each year, but to qualify you had to have income within the poverty guidelines. Many things have changed in MA recently and I’m not sure if this still applies but still it’s not like anything you provide.

    I am in a bind right now just like probably a million other people. My adult son is in a health crisis right now at this moment with no insurance or doctor. We just filed paperwork for insurance but that takes time and there is nothing we can do but wait for that to go through. I avoided an ER visit last night because I have some old meds at home. I’ve never needed help before and I’d have always been to proud to take it, but at this moment I wish there was some kind of help for him right now. Even if I could get someone to prescribe something in the meantime, these drugs cost over a thousand dollars. Health care costs have been draining us for the past ten years even with insurance. I don’t know how people keep it going long term.

    I wish we were animals and Robyn was our doctor right now!

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