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When Your Advice Carries Some Weight
Like any neurologist, I see patients with all kinds of weight-related issues: lumbar pain, type 2 diabetic neuropathy, stroke and cerebrovascular disease, and many more. So, in addition to being a neuro doc, I hand out a lot of general medicine advice: lose weight, eat better, exercise more, and take your statins and other pills.
The funny thing in all this is that I am myself about 60 pounds overweight. And, from what I see on hospital rounds, I’m not the only doctor who falls in the overweight category. My tall frame helps me hide it, but the scale and body mass index charts don’t lie.
While I preach a healthy lifestyle, I don’t live one. Granted, I don’t smoke, and I take my simvastatin and niacin, but otherwise I make far from the best eating choices.
I think there could be a whole support group for physicians with poor eating and exercise habits. An ironic part of this job is that while we lecture patients on exercise, our schedules don’t allow many of us the time to do it ourselves. My average workday is about 14 hours, and when you try to get about 5-6 hours of sleep at night, help your kids with homework, and do other stuff at home and with your spouse, you pretty much find your exercise time limited to the hospital staircase on rounds.
I don’t know how medicine became this way. Certainly, I didn’t pick it for the lifestyle, but it’s sad that a field centered around the health of others often limits that of its practitioners.
Like any neurologist, I see patients with all kinds of weight-related issues: lumbar pain, type 2 diabetic neuropathy, stroke and cerebrovascular disease, and many more. So, in addition to being a neuro doc, I hand out a lot of general medicine advice: lose weight, eat better, exercise more, and take your statins and other pills.
The funny thing in all this is that I am myself about 60 pounds overweight. And, from what I see on hospital rounds, I’m not the only doctor who falls in the overweight category. My tall frame helps me hide it, but the scale and body mass index charts don’t lie.
While I preach a healthy lifestyle, I don’t live one. Granted, I don’t smoke, and I take my simvastatin and niacin, but otherwise I make far from the best eating choices.
I think there could be a whole support group for physicians with poor eating and exercise habits. An ironic part of this job is that while we lecture patients on exercise, our schedules don’t allow many of us the time to do it ourselves. My average workday is about 14 hours, and when you try to get about 5-6 hours of sleep at night, help your kids with homework, and do other stuff at home and with your spouse, you pretty much find your exercise time limited to the hospital staircase on rounds.
I don’t know how medicine became this way. Certainly, I didn’t pick it for the lifestyle, but it’s sad that a field centered around the health of others often limits that of its practitioners.
Like any neurologist, I see patients with all kinds of weight-related issues: lumbar pain, type 2 diabetic neuropathy, stroke and cerebrovascular disease, and many more. So, in addition to being a neuro doc, I hand out a lot of general medicine advice: lose weight, eat better, exercise more, and take your statins and other pills.
The funny thing in all this is that I am myself about 60 pounds overweight. And, from what I see on hospital rounds, I’m not the only doctor who falls in the overweight category. My tall frame helps me hide it, but the scale and body mass index charts don’t lie.
While I preach a healthy lifestyle, I don’t live one. Granted, I don’t smoke, and I take my simvastatin and niacin, but otherwise I make far from the best eating choices.
I think there could be a whole support group for physicians with poor eating and exercise habits. An ironic part of this job is that while we lecture patients on exercise, our schedules don’t allow many of us the time to do it ourselves. My average workday is about 14 hours, and when you try to get about 5-6 hours of sleep at night, help your kids with homework, and do other stuff at home and with your spouse, you pretty much find your exercise time limited to the hospital staircase on rounds.
I don’t know how medicine became this way. Certainly, I didn’t pick it for the lifestyle, but it’s sad that a field centered around the health of others often limits that of its practitioners.
Being Sued
I’ll admit it. I’ve been sued for malpractice.
I’m not going to go into the details of the case, but I’ll tell you this: It is absolutely the worst feeling you will ever have as a doctor.
Like most doctors, I try very hard to do my best for patients. I believe in "do no harm." I believe that my patient care decisions are guided by my belief in what’s best for them. Not what’s more convenient, or more financially lucrative, for me. Yet, I still got sued.
What’s amazing to me is how many doctors still believe it can’t happen to them, or that only the truly incompetent (whatever that means) get sued.
It hurts more than you could ever believe. It puts your life on hold. It adds a whole new burden to the huge weight you normally carry from day to day.
It even affects your family. You lie awake at night. Your hairs get grayer, or jump off entirely. You have many sleepless nights, trying to find a way to go on for your family and the patients who still need you.
You worry about rumors you’ve heard. That they can take your house, cars, and all belongings. That they can come to your house and pick out whatever items (including pets) they want. You realize why medical professionals have the highest rate of suicide, drug abuse, and alcoholism.
You question your own skills. Now, every patient you see needs a big-time work-up. Every patient with carpal tunnel syndrome needs a brain and cervical spine MRI "just to cover the bases."
Whether you win or lose, it devastates you as a person, and can kill the person deep inside who once celebrated getting a medical school admission letter.
I’ll admit it. I’ve been sued for malpractice.
I’m not going to go into the details of the case, but I’ll tell you this: It is absolutely the worst feeling you will ever have as a doctor.
Like most doctors, I try very hard to do my best for patients. I believe in "do no harm." I believe that my patient care decisions are guided by my belief in what’s best for them. Not what’s more convenient, or more financially lucrative, for me. Yet, I still got sued.
What’s amazing to me is how many doctors still believe it can’t happen to them, or that only the truly incompetent (whatever that means) get sued.
It hurts more than you could ever believe. It puts your life on hold. It adds a whole new burden to the huge weight you normally carry from day to day.
It even affects your family. You lie awake at night. Your hairs get grayer, or jump off entirely. You have many sleepless nights, trying to find a way to go on for your family and the patients who still need you.
You worry about rumors you’ve heard. That they can take your house, cars, and all belongings. That they can come to your house and pick out whatever items (including pets) they want. You realize why medical professionals have the highest rate of suicide, drug abuse, and alcoholism.
You question your own skills. Now, every patient you see needs a big-time work-up. Every patient with carpal tunnel syndrome needs a brain and cervical spine MRI "just to cover the bases."
Whether you win or lose, it devastates you as a person, and can kill the person deep inside who once celebrated getting a medical school admission letter.
I’ll admit it. I’ve been sued for malpractice.
I’m not going to go into the details of the case, but I’ll tell you this: It is absolutely the worst feeling you will ever have as a doctor.
Like most doctors, I try very hard to do my best for patients. I believe in "do no harm." I believe that my patient care decisions are guided by my belief in what’s best for them. Not what’s more convenient, or more financially lucrative, for me. Yet, I still got sued.
What’s amazing to me is how many doctors still believe it can’t happen to them, or that only the truly incompetent (whatever that means) get sued.
It hurts more than you could ever believe. It puts your life on hold. It adds a whole new burden to the huge weight you normally carry from day to day.
It even affects your family. You lie awake at night. Your hairs get grayer, or jump off entirely. You have many sleepless nights, trying to find a way to go on for your family and the patients who still need you.
You worry about rumors you’ve heard. That they can take your house, cars, and all belongings. That they can come to your house and pick out whatever items (including pets) they want. You realize why medical professionals have the highest rate of suicide, drug abuse, and alcoholism.
You question your own skills. Now, every patient you see needs a big-time work-up. Every patient with carpal tunnel syndrome needs a brain and cervical spine MRI "just to cover the bases."
Whether you win or lose, it devastates you as a person, and can kill the person deep inside who once celebrated getting a medical school admission letter.
When Studies and Real-World Neurology Don't Jibe
Late last year, a study suggested that patients in the emergency department with a transient ischemic attack could be more cost-effectively treated by being sent to a neurology clinic for urgent evaluation, rather than being hospitalized for the 48 hours it takes for an average inpatient work-up (Neurology 2011;77:2082-8).
I entirely agree with this. The trouble is that these studies are always done at an academic institution and don’t take into account the nature of "trench warfare" neurology as it happens in private practice. I’ll point out some practical considerations.
How do you plan on getting a patient seen on the same day (or even the next day) after they went to the ED? Most neurologists are booked up at least 1-2 weeks in advance. I personally start seeing patients at 8 o’clock each morning (sometimes 7 o’clock) and don’t break for lunch. I work straight through. So where am I (or anyone else) going to put them in? I suppose some people might say, "Just send them over and I’ll squeeze them in," but (in my opinion) that doesn’t work very well. You just end up trying to see them AND the rest of the patients in a rush and do a half-assed job on all of them. Quantity of care is NEVER equal to quality of care, no matter how hard you try to make them the same.
The idea of doing the work-up as an outpatient is compelling but brings up its own issues that the article didn’t consider:
• Insurance. In the hospital, whatever you order gets done. But as an outpatient, you may have to go through several layers of authorization to get an MRI and MRA. This could include having to make a doctor-to- doctor authorization phone call and can take 1-2 weeks depending on the insurance. A lot more can go wrong in 2 weeks than in a 48-hour hospital stay.
• Convenience. You need an MRI, echocardiogram, and labs? Maybe an EEG in some cases? In the hospital, they all get done THERE. But for an outpatient, you need three to four different facilities. This will likely increase the time of the work-up and make it harder for the patient. The tests will have to be done on different days, and some people will have trouble arranging transportation.
• Compliance. Let’s face it – a hospital patient is a captive audience. Aside from watching daytime TV and eating, there’s not much else to do but go have tests done. But if you spread the tests out over 1-2 weeks, the compliance factor may drop dramatically. A patient may start to think in terms of "I feel fine today, so why do I need this?" or cancel the test to attend a grandson’s birthday party and then never bother to reschedule it.
Lastly, there are the legal issues. How many of you neurologists out there want it documented in the chart that you personally told the emergency medicine doctor to discharge a TIA patient for outpatient follow-up? How many of you can envision an ED doctor wanting to take the legal risks of writing that order? And, perhaps most important, how many of you can easily see yourself being cross-examined by Marty Malpractice, J.D., about why you ordered a TIA patient sent home who then suffered a massive stroke that night? All the literature supporting your position may not make you look good in those circumstances.
The only way I actually see this working out is with a national set of solid guidelines telling us to do this and tort reform to help protect the doctors who follow them. And let’s face it, neither is likely to happen in my lifetime.
Late last year, a study suggested that patients in the emergency department with a transient ischemic attack could be more cost-effectively treated by being sent to a neurology clinic for urgent evaluation, rather than being hospitalized for the 48 hours it takes for an average inpatient work-up (Neurology 2011;77:2082-8).
I entirely agree with this. The trouble is that these studies are always done at an academic institution and don’t take into account the nature of "trench warfare" neurology as it happens in private practice. I’ll point out some practical considerations.
How do you plan on getting a patient seen on the same day (or even the next day) after they went to the ED? Most neurologists are booked up at least 1-2 weeks in advance. I personally start seeing patients at 8 o’clock each morning (sometimes 7 o’clock) and don’t break for lunch. I work straight through. So where am I (or anyone else) going to put them in? I suppose some people might say, "Just send them over and I’ll squeeze them in," but (in my opinion) that doesn’t work very well. You just end up trying to see them AND the rest of the patients in a rush and do a half-assed job on all of them. Quantity of care is NEVER equal to quality of care, no matter how hard you try to make them the same.
The idea of doing the work-up as an outpatient is compelling but brings up its own issues that the article didn’t consider:
• Insurance. In the hospital, whatever you order gets done. But as an outpatient, you may have to go through several layers of authorization to get an MRI and MRA. This could include having to make a doctor-to- doctor authorization phone call and can take 1-2 weeks depending on the insurance. A lot more can go wrong in 2 weeks than in a 48-hour hospital stay.
• Convenience. You need an MRI, echocardiogram, and labs? Maybe an EEG in some cases? In the hospital, they all get done THERE. But for an outpatient, you need three to four different facilities. This will likely increase the time of the work-up and make it harder for the patient. The tests will have to be done on different days, and some people will have trouble arranging transportation.
• Compliance. Let’s face it – a hospital patient is a captive audience. Aside from watching daytime TV and eating, there’s not much else to do but go have tests done. But if you spread the tests out over 1-2 weeks, the compliance factor may drop dramatically. A patient may start to think in terms of "I feel fine today, so why do I need this?" or cancel the test to attend a grandson’s birthday party and then never bother to reschedule it.
Lastly, there are the legal issues. How many of you neurologists out there want it documented in the chart that you personally told the emergency medicine doctor to discharge a TIA patient for outpatient follow-up? How many of you can envision an ED doctor wanting to take the legal risks of writing that order? And, perhaps most important, how many of you can easily see yourself being cross-examined by Marty Malpractice, J.D., about why you ordered a TIA patient sent home who then suffered a massive stroke that night? All the literature supporting your position may not make you look good in those circumstances.
The only way I actually see this working out is with a national set of solid guidelines telling us to do this and tort reform to help protect the doctors who follow them. And let’s face it, neither is likely to happen in my lifetime.
Late last year, a study suggested that patients in the emergency department with a transient ischemic attack could be more cost-effectively treated by being sent to a neurology clinic for urgent evaluation, rather than being hospitalized for the 48 hours it takes for an average inpatient work-up (Neurology 2011;77:2082-8).
I entirely agree with this. The trouble is that these studies are always done at an academic institution and don’t take into account the nature of "trench warfare" neurology as it happens in private practice. I’ll point out some practical considerations.
How do you plan on getting a patient seen on the same day (or even the next day) after they went to the ED? Most neurologists are booked up at least 1-2 weeks in advance. I personally start seeing patients at 8 o’clock each morning (sometimes 7 o’clock) and don’t break for lunch. I work straight through. So where am I (or anyone else) going to put them in? I suppose some people might say, "Just send them over and I’ll squeeze them in," but (in my opinion) that doesn’t work very well. You just end up trying to see them AND the rest of the patients in a rush and do a half-assed job on all of them. Quantity of care is NEVER equal to quality of care, no matter how hard you try to make them the same.
The idea of doing the work-up as an outpatient is compelling but brings up its own issues that the article didn’t consider:
• Insurance. In the hospital, whatever you order gets done. But as an outpatient, you may have to go through several layers of authorization to get an MRI and MRA. This could include having to make a doctor-to- doctor authorization phone call and can take 1-2 weeks depending on the insurance. A lot more can go wrong in 2 weeks than in a 48-hour hospital stay.
• Convenience. You need an MRI, echocardiogram, and labs? Maybe an EEG in some cases? In the hospital, they all get done THERE. But for an outpatient, you need three to four different facilities. This will likely increase the time of the work-up and make it harder for the patient. The tests will have to be done on different days, and some people will have trouble arranging transportation.
• Compliance. Let’s face it – a hospital patient is a captive audience. Aside from watching daytime TV and eating, there’s not much else to do but go have tests done. But if you spread the tests out over 1-2 weeks, the compliance factor may drop dramatically. A patient may start to think in terms of "I feel fine today, so why do I need this?" or cancel the test to attend a grandson’s birthday party and then never bother to reschedule it.
Lastly, there are the legal issues. How many of you neurologists out there want it documented in the chart that you personally told the emergency medicine doctor to discharge a TIA patient for outpatient follow-up? How many of you can envision an ED doctor wanting to take the legal risks of writing that order? And, perhaps most important, how many of you can easily see yourself being cross-examined by Marty Malpractice, J.D., about why you ordered a TIA patient sent home who then suffered a massive stroke that night? All the literature supporting your position may not make you look good in those circumstances.
The only way I actually see this working out is with a national set of solid guidelines telling us to do this and tort reform to help protect the doctors who follow them. And let’s face it, neither is likely to happen in my lifetime.
A Day That Will Live Forever in Fashion Infamy
I’ve never been a stickler for dress codes. In fact, I’ve never really understood them.
My colleagues down the street at the Mayo Clinic Scottsdale show up for work each day in the traditional uniform of our profession – a nice business suit, with tie. They look very fashionable.
That’s not me.
My choice of clothing has evolved over the years. In residency it was a shirt, tie, and slacks, sometimes with a white coat. Eventually, I ditched the white coat when I decided it was easier just to carry my neurology toys in a black bag.
When I became an attending physician in 1998, I continued this outfit for about 6 months, then dropped the tie and switched to more comfortable short-sleeve shirts. I did this until June 15, 2006 – a day that will live forever in fashion infamy.
I was getting dressed that morning. It was supposed to be around 114° F, and I suddenly had an epiphany. I realized that dressing like that every damn day was insane. So I decided to go with a decent pair of shorts. But business shirts and shoes don’t go with shorts, so I pulled on a Hawaiian shirt and sneakers.
Nobody complained, so I continued. Because of the weather here I can do this year-round, too.
As I’ve learned, the vast majority of patients don’t care. Granted, there are exceptions, as this post about me on the doctor review site vitals.com notes: "HOW CAN YOU TRUST A DOC THAT ... SHOWS UP IN HAWAIAN SHORTS AND KHAKIS? REALLY?" (Caps and misspellings are sic.)
Another person on the site criticized me for wearing jeans to work. This is a LIE! I’ve never worn jeans to work. Only shorts since 2006.
In 6 years, I’ve had four patients fire me over my appearance. And I don’t care. If a nice outfit makes you feel I’m a better doctor, there are plenty of others you can see.
If I have to spend my day at a high-stress job, I might as well be comfortable. And I am.
I’ve never been a stickler for dress codes. In fact, I’ve never really understood them.
My colleagues down the street at the Mayo Clinic Scottsdale show up for work each day in the traditional uniform of our profession – a nice business suit, with tie. They look very fashionable.
That’s not me.
My choice of clothing has evolved over the years. In residency it was a shirt, tie, and slacks, sometimes with a white coat. Eventually, I ditched the white coat when I decided it was easier just to carry my neurology toys in a black bag.
When I became an attending physician in 1998, I continued this outfit for about 6 months, then dropped the tie and switched to more comfortable short-sleeve shirts. I did this until June 15, 2006 – a day that will live forever in fashion infamy.
I was getting dressed that morning. It was supposed to be around 114° F, and I suddenly had an epiphany. I realized that dressing like that every damn day was insane. So I decided to go with a decent pair of shorts. But business shirts and shoes don’t go with shorts, so I pulled on a Hawaiian shirt and sneakers.
Nobody complained, so I continued. Because of the weather here I can do this year-round, too.
As I’ve learned, the vast majority of patients don’t care. Granted, there are exceptions, as this post about me on the doctor review site vitals.com notes: "HOW CAN YOU TRUST A DOC THAT ... SHOWS UP IN HAWAIAN SHORTS AND KHAKIS? REALLY?" (Caps and misspellings are sic.)
Another person on the site criticized me for wearing jeans to work. This is a LIE! I’ve never worn jeans to work. Only shorts since 2006.
In 6 years, I’ve had four patients fire me over my appearance. And I don’t care. If a nice outfit makes you feel I’m a better doctor, there are plenty of others you can see.
If I have to spend my day at a high-stress job, I might as well be comfortable. And I am.
I’ve never been a stickler for dress codes. In fact, I’ve never really understood them.
My colleagues down the street at the Mayo Clinic Scottsdale show up for work each day in the traditional uniform of our profession – a nice business suit, with tie. They look very fashionable.
That’s not me.
My choice of clothing has evolved over the years. In residency it was a shirt, tie, and slacks, sometimes with a white coat. Eventually, I ditched the white coat when I decided it was easier just to carry my neurology toys in a black bag.
When I became an attending physician in 1998, I continued this outfit for about 6 months, then dropped the tie and switched to more comfortable short-sleeve shirts. I did this until June 15, 2006 – a day that will live forever in fashion infamy.
I was getting dressed that morning. It was supposed to be around 114° F, and I suddenly had an epiphany. I realized that dressing like that every damn day was insane. So I decided to go with a decent pair of shorts. But business shirts and shoes don’t go with shorts, so I pulled on a Hawaiian shirt and sneakers.
Nobody complained, so I continued. Because of the weather here I can do this year-round, too.
As I’ve learned, the vast majority of patients don’t care. Granted, there are exceptions, as this post about me on the doctor review site vitals.com notes: "HOW CAN YOU TRUST A DOC THAT ... SHOWS UP IN HAWAIAN SHORTS AND KHAKIS? REALLY?" (Caps and misspellings are sic.)
Another person on the site criticized me for wearing jeans to work. This is a LIE! I’ve never worn jeans to work. Only shorts since 2006.
In 6 years, I’ve had four patients fire me over my appearance. And I don’t care. If a nice outfit makes you feel I’m a better doctor, there are plenty of others you can see.
If I have to spend my day at a high-stress job, I might as well be comfortable. And I am.
Let Them Eat Cake: Challenging Same Day Visit Rules
You’ve gone to a nice restaurant for dinner, and after a good meal want chocolate cake. The waiter tells you, "Sorry, we can’t serve both at the same meal. You’ll have to come back tomorrow for dessert." You’d be surprised, maybe angry, and definitely not inclined to go back there again. Yet, doctors do that EVERY DAY in the United States.
Declining reimbursement gets all the insurance attention, but there are plenty of stupid rules. My personal peeve is the one that won’t allow certain tests be done on the same day as a patient visit.
Take an electromyogram/nerve conduction velocity study. I see a patient in the office. He has a fairly straightforward case of carpal tunnel syndrome, and so the immediate course is to confirm it with electrical studies. BUT, under most insurance guidelines, I can’t do the test on the same day as the consult.
Even if I have time to do an EMG/NCV during the visit or had a new patient cancel so I can see this guy back for the test that afternoon, IT’S NOT ALLOWED. So I have the options of either billing for the consult or test (not both) or having the guy come back another day (which is what I do).
I honestly don’t understand this because:
• It costs the insurance company the same amount (roughly) to split it up on 2 days instead of 1.
• It helps other patients, because now I can use the hour I’d have spent on his EMG with them.
• It helps my bottom line (all done in 1 hour, instead of 2).
• It’s good for the planet (less gas burned driving back to my office for the test).
• Most important, IT’S GOOD FOR THE PATIENT. He has his test results back, so we can move on to the next step, instead of waiting a week for the study. It also saves him a copay, since he only came in once instead of twice.
To me this is common sense. But to most insurance companies, it’s fraud.
You’ve gone to a nice restaurant for dinner, and after a good meal want chocolate cake. The waiter tells you, "Sorry, we can’t serve both at the same meal. You’ll have to come back tomorrow for dessert." You’d be surprised, maybe angry, and definitely not inclined to go back there again. Yet, doctors do that EVERY DAY in the United States.
Declining reimbursement gets all the insurance attention, but there are plenty of stupid rules. My personal peeve is the one that won’t allow certain tests be done on the same day as a patient visit.
Take an electromyogram/nerve conduction velocity study. I see a patient in the office. He has a fairly straightforward case of carpal tunnel syndrome, and so the immediate course is to confirm it with electrical studies. BUT, under most insurance guidelines, I can’t do the test on the same day as the consult.
Even if I have time to do an EMG/NCV during the visit or had a new patient cancel so I can see this guy back for the test that afternoon, IT’S NOT ALLOWED. So I have the options of either billing for the consult or test (not both) or having the guy come back another day (which is what I do).
I honestly don’t understand this because:
• It costs the insurance company the same amount (roughly) to split it up on 2 days instead of 1.
• It helps other patients, because now I can use the hour I’d have spent on his EMG with them.
• It helps my bottom line (all done in 1 hour, instead of 2).
• It’s good for the planet (less gas burned driving back to my office for the test).
• Most important, IT’S GOOD FOR THE PATIENT. He has his test results back, so we can move on to the next step, instead of waiting a week for the study. It also saves him a copay, since he only came in once instead of twice.
To me this is common sense. But to most insurance companies, it’s fraud.
You’ve gone to a nice restaurant for dinner, and after a good meal want chocolate cake. The waiter tells you, "Sorry, we can’t serve both at the same meal. You’ll have to come back tomorrow for dessert." You’d be surprised, maybe angry, and definitely not inclined to go back there again. Yet, doctors do that EVERY DAY in the United States.
Declining reimbursement gets all the insurance attention, but there are plenty of stupid rules. My personal peeve is the one that won’t allow certain tests be done on the same day as a patient visit.
Take an electromyogram/nerve conduction velocity study. I see a patient in the office. He has a fairly straightforward case of carpal tunnel syndrome, and so the immediate course is to confirm it with electrical studies. BUT, under most insurance guidelines, I can’t do the test on the same day as the consult.
Even if I have time to do an EMG/NCV during the visit or had a new patient cancel so I can see this guy back for the test that afternoon, IT’S NOT ALLOWED. So I have the options of either billing for the consult or test (not both) or having the guy come back another day (which is what I do).
I honestly don’t understand this because:
• It costs the insurance company the same amount (roughly) to split it up on 2 days instead of 1.
• It helps other patients, because now I can use the hour I’d have spent on his EMG with them.
• It helps my bottom line (all done in 1 hour, instead of 2).
• It’s good for the planet (less gas burned driving back to my office for the test).
• Most important, IT’S GOOD FOR THE PATIENT. He has his test results back, so we can move on to the next step, instead of waiting a week for the study. It also saves him a copay, since he only came in once instead of twice.
To me this is common sense. But to most insurance companies, it’s fraud.