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Medical Consultants — Grasping, Greedy, Lazy, and Cynical

I had reason to consult a “Consultant” recently.

He (and they are nearly always a “he”) sent me an appointment, with headed notepaper showing that he “consults” in four private hospitals in three different counties.

My appointment was for his “rooms”.

This means that the man has four “jobs”, and probably more if he does his quota in public hospitals also.

He charged me €140 for the “first consultation”, and V.H.I. probably had to pay him some more – “the excess”. I don’t know because V.H.I. didn’t tell me, but his receptionist asked for my V.H.I. number and details, so I can assume that V.H.I. were involved somehow.

Haiti Appeal

At this first consultation (which lasted definitely no more than 5 minutes), he asked me about 6 questions: examined me very briefly (about 45 seconds); dictated a few sentences to his receptionist / secretary, including telling her to arrange an M.R.I. for me.

Last week, I received a letter inviting me to return to “discuss” the results of the M.R.I.  €100 this time.

This second visit lasted no more than 5 minutes, during which time he also took two calls on his mobile phone and went into his bathroom to blow his nose!

He rummaged through his computer, asked me twice what was my name again – found and read the M.R.I. results in front of me (I was not impressed at the zero preparation).

He explained the results in medical-speak in about 2 minutes flat.
He asked me the exact same questions that he asked me on the first visit; gave me the exact same 45 second examination; and dictated almost exactly the same sentences to his secretary, substituting a course of treatment for the M.R.I. (treatment that he will not be providing).

This man took €240 from me for 10 minutes work plus whatever V.H.I. paid him.  He didn’t help me in any way, but fobbed me off to the next conveyor belt in this insane system.  I was treated as a piece of meat to be moved along as quickly as possible, but to squeeze as much money out of me and out of V.H.I. as possible.  I would have been better off staying at home, certainly financially.

This is not my first experience of consultants acting like this. Our Health system is a joke, a very, very dangerous joke.

Is it just me, or do you think that the system that allows consultants to behave like this is disgraceful and just downright wrong?

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Also on Bock:

A visit  to the specialist
Irish Medical Consultants
Tribunal Lawyers’ Fees (and Hospital Consultants)

20 replies on “Medical Consultants — Grasping, Greedy, Lazy, and Cynical”

I’m afraid you’re right, MT.
Some would say I’m lucky to be able to afford VHI and afford to consult these guys.
On the other hand, I “afford” VHI by cutting back in other areas, and the treatment from consultants in my experience is, well, not good.
Maybe I’d be better off spending my VHI money in the pub, then I wouldn’t be able to “afford” VHI or consultants, and I wouldn’t get ripped off.

Mairead, disgraceful is all i can say.. all though your experience doesn’t really suprise me. Our healthcare system is a bureaucratic systemized farce. It seems like we are just a number to the gods in the medical field. A lot of these ‘consultants’ don’t give a rats arse about you or me.. well they care that we keep them in the lifestyles they have become accustomed to.

Mairead,

And here I was thinking I was the only idiot susceptible to medical quackery – you know? Like I’m the only idiot out here and they recognize me straight off?

Feck sake. I will never again visit ‘rooms’ to seek assistance nor will I ever give as much as a brown cent to any mother fucking ‘consultant’ to sort me out.

Thanks be to fuck for your powers of observation – ‘I recognise that I do need to pay more attention’.

Go you Mairead.

Excellent post, truly.

Audrey, isn’t it shocking that we’re not surprised!

Thanks Unstranger.
I also vowed that I wouldn’t be visiting “rooms” ever again after the last fella prescribed life-long drugs for me, costing €140 a month (every month) that didn’t help a single jot!! After his prescription ran dry, I should have returned for another (at €100 a go?) or the GP (at €50). Instead, I said feck this for a game of cowboys, and I gave up on them. Guess what? I have been grand!
This is a different “speciality”, but I should have learned my lesson! Still though, if we’re not well, we need to do something about it, so we get sucked in to it again. No wonder people don’t seek medical help, but that’s wrong too.

I have always found it somewhat unsettling to say the least,on presenting at the A and E hatch with my head in a Tesco bag or some such ailment,that one of the first questions is always-Do you have VHI?I have rarely had anything but the best of experiences(as far as medical experiences go)with the on the the ground staff in hospitals,those who do the real graft for little return but slap me sideways with a bed-pan if a consultant turns up.I did say IF.A quick glance down his nose at you,a few mmms and gone.Makes me think I’m as well off without insurance.

Mairead, Hope you are well, Thanks for the very apt reminder of where we are being fleeced.
Is there any time better than now to question all pricing ?
We have the right to ask for a breakdown of all charges.
Who creates the standard for these price structures ? The Medical Council, The HSE ?
Lets garner the necessary info for questioning this price structure, Compared to a lot of other countries, The cost of health care here is ludicrous.
I have to manage the budget to stick with health ins, last year i switched from VHI to Aviva, same cover substantial saving.
I’m on a mission for 2010, My personal anthem is ” The dog days are over ” Florence and the machine, uplifting, No more shit for me, questions, questions everywhere and I want answers, Download that song Mairead, It’s uplifting !

Mairead, This is a bit OT but this kid needs a chance. I have a heart kid myself and I know that HLHS which this little fella below has is the most insidious of all heart defects. It involves a 3 stage palliative treatment. Basically 3 very, very complicated open heart surgeries to keep him alive until a transplant in his teenage years. It’s standard for HLHS because it’s a death sentence at birth. The timing of each operation is critical. My son (a transposition of the greater arteries boy) has a friend with HLHS. She’s 6 and was operated on in Boston. I know how critical the time window is. This kid needs his surgery STAT. Is there any way to help this family??? Would pressure make the HSE send him to England maybe??

http://www.independent.ie/national-news/parents-wait-in-hope-for-baby-henrys-operation-2020811.html

MT, it is disconcerting. We have always had it, we started with VHI for maternity benefits, and later it was in case the children needed anything, and mostly so that we could schedule around work. Now, we’re paying VHI mostly out of fear of the public system, having witnessed old people without cover left on A&E trolleys for days!

Hi Norma, I hope things are going well with you. I have a long-standing problem that I’m tired of “putting up with” and being old before my time – nothing that will kill me, just very restricting.
I agree with you that we need to ask questions, but where do we ask them? Does anyone know? We will probably be told that this is the price of megafantastic skill and expertise! Maybe we could insist on the same basis as the solicitors – No win, no fee – or in this case – No Cure, No Fee!!

EGW, I really don’t know I’m very sorry.
I’m only a “customer” myself.
Calls to Joe Duffy’s radio show seem to have the “kick up the a**** power” in this country!
I think Gerry Ryan has been highlighting a case like that?

It’s simple really, if everybody forsook health insurance, consultants would be available to everyone all the time.

Mairead, is there a medical ombudsman?

I had VHI through my old job, and when I left it to become self-employed I kept it for a couple of years. But eventually, having never made a claim, I gave it up. I had to cut corners, and that is the corner I cut. My husband subsequently had to have a diagnosis and a procedure done, and although there was a wait, the treatment was excellent. I wonder if the “fear” you mentioned is what perpetuates the system.

And I return to my theme for the transformation of Irish political culture, to opine that public representatives should not have any option but to avail of the same public health service they preside over. If that was the case, it would be a far better one.

I don’t know if there is a medical ombudsman, I think there would be no harm drafting a letter to the Irish Medical Council for further info, There is also a Patients Council of some kind, I used to know, will check.
I don’t agree that if we scrapped Private health insurance there would be more Consultants available for everyone.
An example of cost, When my Grandchild was initially diagnosed with a life long illness, for which the first hospital stay was 9 day’s, There were tests and treatments, primarially IV intervention, The cost of that initial hospitalisation for 9 days was almost 13,000 euro, her medication per month is around 2,300 euro,
How are those costs broken down ? It would be out of the question for us to be dependent on a system which may undergo even more dramatic cuts this year, The respiritory ward in Temple st hosp is now closed, At least having health ins entitles us to travel for specialised care.
Scotlyn. I’m glad you had a good experience but that is not a dependable or standard process, Unfortunatly there are just too many horror stories.
The Consultant charges though are not justifiable, I wonder if you asked for a breakdown of fee’s what the response would be.
I will write to the Medical Council for info and let ye know.

Mairead

Sorry to hear of your experience.

I’ve had a lot of experience of seeing consultants. Generally, I find them to be genuinely caring and determined to sort out whatever problem you bring to them. I’ve learnt from the many years of being a patient, not to be in awe of consultants but rather to treat them with the same respect that I expect in return. If you’re not happy about something, don’t be afraid to voice your concern. It’s been my experience, that doctors respect patients who interact with them constructively rather than those who do not question the diagnosis/treatment.

I did come across one consultant some years ago who played the same game as your consultant. I foiled his game though by refusing to pay his receptionist on the way out. I instead wrote to him voicing my valid complaints and received an abusive phone call (from him in person) in return. I’ve not heard from him since, nor have I paid his bill. I reported his behaviour to my GP and we had a good laugh about it.

As regards health insurance, your VHI cover should have paid for your MRI scan upfront without anything coming out of your pocket. As far as I know, the referring consultant cannot add any further fee to this claim. You, instead, are expected to foot the consultation fees with very little recourse to reclaim when submitting your end-of-year out-patient expenses.

Our public health system is fantastic once you get into it although the conditions are far from ideal. I hate to break it to you but having health insurance won’t protect you from spending days on a trolley in A&E if you become ill/have an accident and require urgent treatment. Equity of care does exist in emergency medicine where patients are treated according to need, and rightly so.

I agree with you entirely that some private consultants are charging outrageous fees and giving very poor service in return but not all consultants are guilty of this. You make a very good point about your consultant ‘consulting’ in multiple locations. I think this boils down to greed and patients suffer the consequences of a service that’s spread too thinly.

As regards patient complaints, I know that Emily O’Reilly (Ombudsman) deals with complaints about public hospitals and HSE service providers but I’m not sure who you should turn to with a complaint about the private sector.

The role of the Ombudsman is clarified here… http://www.irishhealth.com/article.html?id=14489

The Medical Council deals with fitness to practice issues… http://www.medicalcouncil.ie/

The Irish Patients Association is presently updating it’s website but may be able to help you at:

Ground Fl 22-24 Mt Street Lower
Dublin 2 Co. Dublin
Ireland.
Telephone: 01-6610662

Sorry to go on so long and thanks for raising the topic.

aboysham, that’s a fair point. I wonder?

Scotlyn, you are quite right, it is the “fear” that keeps us paying.
I agree with you that we should all have the same health service, especially the policy makers.

Norma, there are horror stories, and too many of them.

Hi Steph. I am in awe of nobody, and hopefully nobody is in awe of me, I agree that respect is the way to go. I paid the receptionist before I went in, but know what to do in future! (Good woman!) The MRI was covered by VHI, sorry if I wasn’t clear about that. O God, those trolly stories are just the pits. I agree that A&E seems to be “equal” in that we all have to wait 7 or 8 hours there, but I’ve seen VHI patients given a trolly-bed in a curtained off area while those without remain in the main thoroughfare. Thank you for your comments, Steph, and I wonder do we need to keep on paying this private health insurance? It is very dear for a family. Then again, Norma brings me back to reality, so….

What a country.

Steph. In my experience, drawn from people close to me but not family, The public health system is anything but “fantastic ” , I have seen it first hand to be a total ” luck of the draw ” criteria, Some patients requiring short term procedure and care seem to fare reasonably well in the public system, However people requiring long term care from spinal injuries through cancer, dialysis and the full spectrum of long term care, suffer abysmally from the most basic breakdown of delegation and communication through that system.
One prime example would be the discovery of a breast lump for a woman, the waiting time in the public system is at least a month to 6 weeks, if not longer, With private health care this entire procedure from discovery to pathology and diagnosis can be as little as 10 day’s.
Whereas i agree that there is a very real fear based drive toward private health care, It is a real and tangible fear, To be denied immediate access to the necessary route to sustain and prolong one’s life is a right, This right cannot be accessed easily through the public system in Ireland.
Everyone is treated more or less equally in A&E but with regard serious or potentially serious illness, The public system here is close to hopeless.
I met someone recently who rushed their young son screaming in pain after an injury to their nearest A&E, they were told the wait would be a minimum of 9 hrs, in that time the child would recieve no pain meds, He left with a hysterical child and drove to the nearest VHI a&e clinic, despite having no VHI , He was treated immediatly, The child had multiple fractures in his shin bone, he was medicated, plastered, and given prescription, It cost 5,000 euro which he paid on his credit card, I asked myself, how ? how could it possibly cost that, how could anyone justify that cost ? It’s shocking but true.
When you or a member of your family is seriously ill, You become so vulnerable that fear can overcome all logic, To have to fight through a maze of red tape and fraustration when you are on your knees is beyond destructive, But there are harsh realities surrounding the vulnerability and whatever has to be done to not allow one to overcome the other just has to be done.

Mairead – I , too, ‘afford’ private health insurance by cutting back in other areas because I’m very aware that I can’t afford to be without it. With our present 2-tiered system of healthcare, you don’t need health insurance as an in-patient but it certainly helps with out-patient expenses for getting investigations carried out swiftly. I’m 100 percent in favour of a universal system of healthcare but until we get a health minister who is prepared to back it, I’ll continue to fork out for health insurance for my own safety.

As regards VHI patients getting put in curtained off areas of A&E, how do you know that this was the reason they got privileged care? Perhaps there was a medical reason for segregating them? I’ve never got preferential treatment in A&E because I hold health insurance but I have certainly been treated differently when I was infected with MRSA.

Norma made the point that having health insurance entitles a holder to travel for specialised care. I’m not sure if she means by this, to travel ‘abroad’ for treatment? It’s been my experience, that my health insurer has made it difficult for me to get treatment outside this country even though the specialised care I’ve needed, is unavailable in Ireland. I can certainly go anywhere I like for treatment but my insurer won’t pay for it unless the referring consultant applies for prior approval and even so, they still try to find reasons why treatment abroad will not be approved.

In response to Norma – when I said that the public health system is ‘fantastic’, I was talking about the care provided. I also made the point that public hospitals are fantastic ‘once you get into them ‘ because I agree that ‘getting in’ is where the public system often fails miserably unless you’re an emergency case. I totally agree that the outpatient appointment system in public hospitals is dysfunctional and badly needs to be improved. I’ve been in and out of hospitals (both private and public) for surgery/treatment all my life and I can assure you that I’d much prefer to be treated in a teaching hospital (public) even though it sometimes means putting up with horrendous conditions. The medical care in private hospitals is okay for routine, elective surgery but it’s not the right (or the safest) place to be if your condition is in anyway complicated. I’ve spent long periods of time in public hospitals and received brilliant medical/surgical care. You put up with a lot of crap (literally) but it’s worth it to get the expertise needed.

If I had been the parent of the young child Norma describes as screaming in pain, I would have stood my ground in A&E and insisted that the child was at the very least, assessed by the triage nurse. This usually happens anyway fairly quickly, even when A&E is very busy. You then do the long wait to see a doctor after that if you’re not considered urgent. I can’t believe that a triage nurse wouldn’t organise a doctor to see a child in serious pain! It’s possible that the parent in question was unfamiliar with how hospitals work and was fobbed off by a hard-nosed receptionist rather than a medically trained person. Having said that, I’m very familiar with going through A&E which I know, makes it easier. I totally accept that people who are not used to pain, tend to be much more vulnerable when faced with an emergency. That child was lucky to get all the treatment he needed in a SwiftCare clinic as I’ve heard, that often they simply do the investigations and charge huge money for them before sending you packing back to the public A&E to wait for the expertise needed.

Incidently, I contracted an MRSA wound infection in a private hospital while recuperating from surgery so I don’t consider these smaller hospitals to be necessarily safer when it comes to hospital-acquired infections.

Mairead, I could on and on but enough is enough! I really don’t mean to offend anyone by what I say, it’s purely based on my own experience over the years.

Thanks for providing the forum.

Norma:

“Scotlyn. I’m glad you had a good experience but that is not a dependable or standard process, Unfortunatly there are just too many horror stories.”

You are absolutely right, Norma, but my point is that the horror stories are not restricted to the public health sector, they go right across the board, throughout the whole of what passes for a health system in Ireland. A two-tier health system is basically rotten at the core, and promotes all sorts of abuses and inefficiencies – none of which favour patients, whether they are public or private.

There is no reason in the world not to have consultants and hospital treatments available to all on the same basis as GP’s – ie a single waiting list, a single waiting room, and let the issue of “who pays the bill” be sorted out afterwards – as it is in the GP’s office, where both private and medical card patients sit in the same waiting room and wait their turn. A single health “system”, with multiple payment options.

I realise my experience is anecdotal, but a) it justified for me the fact that giving up the health insurance was the right thing to do, (although it means lobbying hard and constantly for improvements in the public health system) and b) that the public health service’s main strength is still the people that work in it, despite all the reasons they would have to become disillusioned – the doctors and nurses are as dedicated and well-trained as anywhere, and when allowed by budget constraints to use and provide the resources they need, will do their very best for you. The main problems arise with a lack of facilities and resources, which limit the access to the service in the first place, and create endless and inexcuseable waiting lists, and difficulties in accessing proper diagnostics and treatment – delays which often worsen the course of disease. Also, a top-heavy bureaucracy is inefficient, and exists more to reproduce itself, than to streamline the work of the “frontline” personnel. (I met a woman who works in a critical care ward at Crumlin children’s hospital, and she spoke about nurses from different wards having to “steal” bits and pieces from other wards, and hide them, in order to ensure their own patients beds are properly equipped to provide specialised care!)

The most efficient hospital managers organise care in a modular system – start with each team of doctors, and find out what they need in terms of staff, equipment, beds, consumables, etc, in order to deliver their speciality of care to X number of patients. Provide what’s needed, and then review and evaluate depending on how many patients are successfully brought through the diagnosis/treatment process. Do not provide resources for cancelled appointments/operations, for example, and provide funding disincentives for treatment delays.

But do not put doctors in a position where they have every piece of their puzzle present except one, and that one forces them to cancel! (Eg. one case I know of – operation room scrubbed, equipped and ready, surgeon, surgical nurses standing by and ready – no anaesthetist – patient prepped after occupying a hospital bed previous night to fast – operation cancelled – no actual savings in the system, because all staff, hospital bed and equipment were paid for anyway).

Scotlyn, you’re right that going private is no guarantee of good care.
A good friend of mine discovered a lump in her breast in April 2004, and was not “seen” until September. Cancer was found and the breast removed. After five years and several other instances of medical doodling, she died.
She had VHI for 30 years.

Mairead and Scotlyn; I am in total agreement with everything you say, It may come across that i’m a big supporter of private health care, quite the contrary, I am very fear driven due to personal circumstances, Therefore I choose what i percieve as the lesser risk or the better of two evil’s.
I was left on morphine for 3 day’s awaiting a procedure under VHI protection, Only that my eldest daughter on the third night threatened them with all manner of legal and media action was my procedure carried out at midnight.
Sometimes it’s down to ” he who shouts the loudest ” I for one do not want to be that person but in this present health system public or private it might be who i have to be.
We are travelling outside of Ireland this year for assessment and further investigation for my grandchild and luckily any procedures which may have to be carried out will be covered by insurance.
Another shameful example is that there is now a new test for diagnosing CF which is not available in Ireland even though we have the highest carrier rate in the world, This test can only be carried out in the UK.
I am extremly lucky and all of my children have great health and have only had one simple hospital visit, therefore my experiences of the health system at the deep end and a personal level is relativly new, i’m learning fast and it’s harsh.

You don’t come across like that at all, Norma.
You are pragmatic and logical. Me too, and I know that however bad the private system is, I would be terrified to chance my life (or worse, my children’s lives) on the public side of life.
It is terrible, shocking, shameful, unequal and a disgrace that in 2010 fear makes us pay fat cats to make them fatter!

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