General Question

JLeslie's avatar

If a doctor made a poor diagnosis which caused you to have to seek another doctor (I am not talking about second opinions for treatment) do you think you should have to pay the first doctor?

Asked by JLeslie (65075points) July 15th, 2009

For instance someone I know had a fairly extensive case of warts on their feet and in their cuticles on their fingers, I told him to go to the doctor, it did not look like you could just go to the corner drug store and buy meds off the counter to treat it. The patient was prescribed Lotrimin, a yeast medication. That is ridiculous! I told them to go to a pediatrist, which he did a couple of days later, and received proper diagnosis and treatment. The problem was resolved. I am not a doctor, I have never seen warts like that before, I also have never had athletes foot, but I know athletes foot is basically an irritation and that was not what was presented. I really think that is inexcusable. It is such a minor thing that it is not like he is going to sue someone over it, but he had spent money on the appointment and the medication, and his health insurance spent money on both things also.

Not to mention that this is not trying to interpret a patients description of pain or symptoms, this is right there for the doctor to observe, or even if he is unsure I assume you can send it to a lab?

In many other industries we would not pay, or at least not pay in full, for bad or incomplete service.

Observing members: 0 Composing members: 0

35 Answers

whatthefluther's avatar

It would be wonderful if one did not have to compensate poor performance in any field

marinelife's avatar

There is no mechanism for not paying as a recourse to poor treatment. Your friend’s only recourse would be to report what happened to his insurer and to the local board that disciplines doctors.

Do I think that is right? Certainly not. The professions protect themselves at the expense of the public all the time. Did you see the story about the California Nursing Board refusing to discipline physically abusive nurses?

SirBailey's avatar

You don’t know if what the first doctor did the second doctor would have done as well if the patient went to HIM first. I am sure your friend told the second physician what the first physician said and did. That COULD have enabled the second physician to think “Well, Lotrimin didn’t work. Let’s try “Plan B”.

marinelife's avatar

@SirBailey Lotrimin (a fungal treatment) is not a treatment for warts, which are viral.

SirBailey's avatar

It shouldn’t surprise you when doctors are VERY ignorant of basics outside their specialty. It amazes me all the time. However, the patient makes the initial decision to go to (ex.) a cardiologist instead of a dermatologist, no? The first doctor makes the best diagnosis he can. Can you fault him? Not always.

Look at Radiologists. Do you know how often a Radiologist will interpret an X-ray one way, but when the specialist sees it (which is why they want to see the actual x-rays themselves) they interpret it differently?

Do you fault the Radiologist? I hope not.

Judi's avatar

@SirBailey ; You shouldn’t fault radiologists, whose expertise is interpreting X-Rays for misinterpreting an X ray?

SirBailey's avatar

But they’re not misinterpreting. They’re interpreting the best they can based on their level of expertise. If you look hard enough (including the questioner’s friend) you’ll find a THIRD medical opinion better then the SECOND doctor’s. Do you fault the second doctor?

Suppose the patient DID go to a Dermatologist first and the Dermatologist prescribes something based on what he thinks the problem is. Problem doesn’t go away when the patient goes back for a follow-up visit. Then the Dermatologist prescribes something else and the problem goes away. This happens all the time. I’m sure it’s happened to yourself or someone you know.

Should the patient get the money back for the first office visit and the first medication? Why not? Didn’t the Dermatologist “misdiagnose” initially? No.

marinelife's avatar

@SirBailey If I accepted you premise, which I don’t, the doctor should not presume to make a diagnoses outside their expertise. If they are not sure, they should refer the patient.

The_Compassionate_Heretic's avatar

If the doctor is being professional. There’s no reason they shouldn’t be paid for their valuable time just because a patient doesn’t agree with them.

SirBailey's avatar

@Marina, I don’t know the answer to that. Personally, I WANT the Radiologist to look at my x-ray and say I don’‘t have anything that is fatal. If he tells me that, in fact, my brain scan is normal and the large vacuoles he reports are nothing to worry about (like the Neurosurgeon did after HE saw the x-rays), that would be nice but I don’t expect him to.

I like to think that when a doctor sees a patient with a SERIOUS problem that is outside his expertise he refers the patient to a specialist. Just the same, I like the idea that he can tell me what he thinks it is and prescribe something for me to the extent he can.

Mexican Medical Schools are considered inferior to American schools (at least that was the case at one time). Should anyone seeing a doctor in Mexico get a refund if they follow up with an American doctor who diagnoses differently?

Don’t get me wrong. There are incompetent doctors all over. I can not be sure that the doctor in the question is incompetent. But I do know that a lot of people are quick to judge doctors as incompetent for the wrong reasons and out of ignorance.

marinelife's avatar

@SirBailey If you look at my post above, you will see that I said a refund was not an option.

cwilbur's avatar

If it’s something that the doctor legitimately should have done or known, then you can sue for malpractice. But you’re unlikely to get more than the actual damages—in this case, the cost of living with warts for a week or so longer, when apparently the person needed to be told to go to the doctor in the first place.

There are a lot of variables here, too. You admit that you aren’t a doctor yourself; I’m not either. Maybe there are varieties of athlete’s foot that present the way these warts do. (I know myself that there are several varieties of athlete’s foot and ringworm, and they all have different symptoms—just one of the many things I learned on the high school wrestling team.) Maybe this was a borderline case, and it wasn’t clear to the original doctor that the warts were not fungal, and the second doctor used that information to determine the correct course of treatment. There’s not nearly enough evidence in your anecdote that the doctor made a poor initial diagnosis, except that the second diagnosis turned out to be correct. Sometimes that happens, especially in cases where the condition isn’t life threatening and there’s time to try more than one treatment approach.

When you pay a doctor, you’re not paying for the right answer, you’re paying for the doctor’s expertise—which the first doctor did provide. And when you pay for a prescription, you’re paying for the pills or the ointments. An incident like this might make me think twice about going back to the first doctor—assuming that your take on it is close to factual, since you’re reporting it all second-hand—but I’d still pay the first doctor’s bill.

JLeslie's avatar

Any GP should be able to diagnose warts…please. I have a marketing degree and I diagnosed it. He never used the Lotrimin, because I told him that medicine will not do anything, this guy is the type that just does what a doctor tells him, except he also trusts my opinion too. He didn’t walk into the second doctor saying a treatment didn’t work. The doc appts were two days apart, nothing significanlty changed in the appearance of the warts.

I understand that outside of specialty a doc may not know anything, but come on! GP, derm, podiatry, should all be able to diagnose that.

And the case was very bad by the way, the intial treatment after the proper diagnosis did not cure it all, they had to hit with some other treatment to get rid of all of it, it was not a mild case, it was not confusing, it was not a simple rash.

JLeslie's avatar

The more I think about everyone’s posts here, the more I am pissed off that doctors don’t like to be questioned. I’m a little off topic, but just two weeks ago I said to a doctor, I think we are miscommunicating, and he said, “patients don;t know how to describe things, everything looks fine.” He had barely looked at me. A week later I went to a doctor you used a scope to examine me and saw irritation exactly where I was complaining.

If a doctor is going defend a bad diagnosis by saying they can’t know everything, and sometimes you try one thing and then another, then don’t be so f@&king condescending, and listen to me.

Now, just to explain myself a little further; why I am so emotional about this…I feel compelled to share…I was misdiagnosed 17 years ago and lived in a lot of pain for 8 years. It was a GYN problem, and I many times said what I thought it was and the doctors diagreed. I got lucky about 5 years into it and took a medicine for something unrelated that “cured” my gyn problem, but when I stopped the medicine I got sick again. Long story short, after 5 bad pregnancies I had exploratory surgery which helped prove what I had said all along!!!! FInally a doctor in NY treated me with intravenous medication and I am 90% improved. Mine was more complicated than the wart example, so I did just chalk it up to te idea that I could not expect a doctor to know, helped me to get over my anger at the situation,but still very dissappointing. I needed a doctor who is willing to think outside of the box, and work with me as a partner and believe my own observations, believe I knew my body. So I am left with having suffered for years, it has some lasting affects on my marriage, I am infertile, and I have a very difficult time at the doctors office.

This wart thing is compeletly straight foward, not like what happened to me, it is inexcusable.

marinelife's avatar

@JLeslie I agree with you. Such a doctor is a gem whose price is beyond measure and just as rare. People must be their own health advocates.

JLeslie's avatar

@Marina thanks Marina, I needed that today, I needed someone to understand my frustration :).

cwilbur's avatar

@JLeslie: If you’ve already made up your mind about what the answer should be, why ask the question in the first place? Fluther is a place for discussion, not mindless validation; if it upsets you that people answer your question in a way that doesn’t match how you think we should answer it, perhaps you shouldn’t have asked the question in the first place.

JLeslie's avatar

@cwilbur No, I am interested in how people think about it. Just because I am upset about a situation does not mean I cannot listen to other opinions, it actually helps me to be more understanding of the other side sometimes, which can be a gift. Not just on this topic, but on others as well. Sometimes I ask a question because I truly do not know the answer to something. Sometimes I ask a question because something is upsetting to me, and I want to see if it upsets others, kind of check my take on things. Sometimes I ask a question because I have not formed an opinion on an issue yet and I want to hear other people opinions and information they may have on the topic that I am not aware of. All sorts of reasons to ask a question.

I wanted to know if other people thouoght it was right to pay a doctor for bad service. Mostly what I got back was people defending the doctors, that they probably did not make a “bad call” BUT, what if it is a bad call, is the only recourse to sue? On minor things that is a ridiculous solution. If I made a mistake I would not feel right taking money, especially not a full amount, but doctors seem to feel fine with it.

YARNLADY's avatar

What I would have done is send a letter instead of the payment, with the correct diagnosis, and explain that I will not pay for the mistake he made. That puts the ball in his court. If he threatens to turn you over to a collection agency, pay rather than ruin your credit.

P. S. Something similar happened to my son, and we had to have a very expensive, painful treatment for him, but it never occured to me to not pay the first doctor, simply because he made a mistake.

I am lucky because my sis is a paralegal, and she is allowed to write letters to people on our behalf on legal stationary.

SirBailey's avatar

@cwilbur , you hit it right on the money! Maybe people seem to be sticking up for the doctor in THIS scenario because he didn’t do anything wrong. I was a pre-med student in college and I STILL would never think I know more then my doctor. And if I truly felt I did, I have no one to blame but myself. I walked into HIS office. I could have walked out.

JLeslie's avatar

@SirBailey this last time, the situation I described two weeks ago, I did cut it shorter than I would have in the past, because he basically told me he wasn’t listening to me, but I had already paid my co-pay and he will collect the insurance money. I faxed him a flippin’ diagram of the anatomy the next day, because I looked it up to make sure I was not crazy, and put an X in the spot that was causing me pain, it felt very inflamed. I asked them to tell me if the doctor was able to see the area when he examined me, because I felt like there was a such poor communication between us, I was trying to figure out if there was any point to see another doctor. Anyway, from the picture of the anatomy it did not seem possible he actually observed the area. I had already been in pain for two weeks, I did not run into his office the first day I had a twinge.

He did not call me back and answer my question, instead his nurse called me to say I would get something in writing. Today, in the mail, I got a copy of his report with my age, weight, etc., and his summations that I had nothing wrong with my sinus (I KNEW THAT!! I told him in his office that the pain is not in my sinus).

The next doctor I saw to address it looked at the are I described. How can you defend the first doctor? Sure people can have deferred pain, but at least observe the area the patient is complaining about if you can.

I guess you have not been sick and had a doctor not even listen to what you are saying. God forbid you learn the hard way that sometimes you have to question a doctor’s ability.

I don’t think I know more in general, but I know where I hurt, and moms diagnose warts all day long on their own children without a doctor.

Did you see Oprah where a woman had breast cancer, had her entire breast removed, but once her pain had reduced after surgery she felt the area and believed the cancer was still there. On her follow up visit she told the surgeon, and he did not agree. She persisted. He finally relented and ordered xrays, probably to shut her up, and to be nice, maybe to reassure her because she was so distraught, She was right. He had left the cancer, removed her whole breast and left the cancer, which I guess was close to the wall of her chest..not sure of the anatomy. They did another surgery. If she had not been “in touch” with her body she probably would have been back a year later with stage 4 cancer, and they would have just said it reoccured. Crap like this happens too often. Doctors should listen to their patients, even if they have to deal with some looney ones sometimes.

I want to UNDERSTAND what is wrong with me. But, I see most doctors don’t like to explain anything. When I go to a doctor I don’t only go for a diagnosis, I go to gain information about my condition.

YARNLADY's avatar

@JLeslie—I sympathize with you. Whenever a new doctor sees the mutilation on my abdomen where a doctor botched an appendix operation, they always wince. It never even occurred to my parents to sue him for malpractice, in spite of the fact he nearly killed me.

SirBailey's avatar

@JLeslie , I’ve been addressing the question and scenario you asked about initially. Why you are throwing in all these other scenarios is clearly because you feel you have some axe to grind against doctors and maybe you do. But your friend, well, that’s another story.

JLeslie's avatar

@SirBailey because you wrote this ” I STILL would never think I know more then my doctor. And if I truly felt I did, I have no one to blame but myself. I walked into HIS office. I could have walked out.” You are saying you don’t know more than the doctor, which kind of set me off I admit, because even you know about YOUR body. My examples were to show that sometimes the pt does know more. Take the Oprah example…in my opinion the doctor should not be paid for the original surgery, he knows for sure he did not remove the cancer, and maybe he should pay her hospital bill also. If she had become sicker and they could link it back to his incompetence he would have been sued, and she would have endured who knows what in treatment. Maybe if doctors felt more responsible for their mistakes we would not need to take legal action.

But, I thought more about what you said…I am assuming you are a man…I think maybe men are better at saying “f$!k you” to a doctor that seems incompetent, and moving forward (I am not trying to group all women together, but I will generalize here). I think maybe I am hoping they know what they are doing,

With my friend he doesn’t know anything, medical stuff is not his thing, he just follows a doctors advice, so he would have had that cream not work, and then went back to the doctor, I was the one who knew. So he was not angry and may never have been angry, except I knew better and he had asked for my advice. I knew more than this doctor this particular time, and have before. But, not every time, I don’t think I always know more than doctors, when I don’t know I say so.

SirBailey's avatar

“I don’t think I always know more than doctors, when I don’t know I say so.”

Something tells me you haven’t said “so” for decades.

Like I said. I was a pre-med student in college majoring in Biological Science. I Supervised in a hospital clinical lab for many years. I consider myself fairly knowledgeable when it comes to health care advances and the like. I also keep the company of many, many health care professionals. Yet I would NEVER assume I could diagnose better then my doctor. I can decide whether or not I want to follow my doctor’s advice. That’s how it works. He gives me advice. You go to your doctor for advice. Then you take it or leave it. Ever hear of second opinions? Shouldn’t everyone who gets a second opinion that differs from the first not pay the first doctor?

Now maybe I do better research about the doctor BEFORE I select that doctor? Maybe I just understand how they work. I don’t know. But when I select one, I have confidence in that one.

I will tell you…if I had a skin problem I WOULD immediately go to a dermatologist or, in the scenario you describe, a podiatrist (If the doctor he went to had a sign saying “pediatrist”, it’s no wonder he got bad care! :) ) If I went to an internest, I wouldn’t be surprised that he didn’t diagnose correctly.

You’ve seen “House” on television? Do you see how they go through SEVERAL diagnoses before House figures it all out? That’s what happens for real sometimes.

Watch a new show on the “Animal Planet” channel called “Monster Inside Me”. It’s about people who get rare parasite infestations (a parasite is an organism that profits in some way from the human it finds [a simplification]). Because the problem is so rare, these poor people go from one wrong diagnosis to another to another. And I understand and accept that.

Whenever you have someone who sees a large number of cases with the same symptoms, whenever you perform a procedure a large number of times, the more knowledgeable and better you get.

That’s why very often the Blood Technician with only a GED getting paid minimum wage but who does countless needle sticks to draw blood, does a far better job then even the Chief of Service physician.

JLeslie's avatar

Some of your assumptions are incorrect. In the last few months my husband had a rash, and I said, “I don’t know what that is, I think you need to see a dermatologist,” and his father had what seemed like cysts to me near his jaw and I said, “I’m not sure, I would get that checked by a doctor,” and a girlfriend of mine is having excessive bleeding and I said, ” could be your fibroids, or hormonal, but I would definetly get it checked by a doctor .” I don’t think I know MORE than doctors. I really value the amount of time it takes to become a doctor, and the knowledge they have. My examples are about doctors who have not done their job well. I think my friend went to primary care first, personally I think they should be able to diagnose warts, but lets say that you are right and my expectation is improper. Obviously, the doctor himself felt confident he could diagnose the problem, because he went ahead and prescribed medicine for the patient. Shouldn’t he say, “I’m not sure, I think we should refer you to a specialist.” Part of good medicine is saying I don’t know. This has happened to me twice, and I was grateful the doctor said it.

I admit I have baggage from a very bad chronic illness. But, your idealism about doctors is very interesting to me. I have example after example of doctors not listening to pts, but most of the time the pts concern may not go along with the standard of care or offical information that is out there in the medical establishment so I guess you cannot fault the doctor. I hope in the future I can be less emotional about medical care, I strive for that, so your comments are welcome, even if we are fighting :) JK.

House is an extreme example of rare, or complicated diseases and syndromes.

I realized I spelled Podiatrist wrong, but it was too late to edit, you will see my first post I spelled it correctly, but thank you.

Here is are just 4 examples of things that have happened in my close circle, feel free to skip reading this if you are not interested in examples.

-My mom needs a colonscopy and last time her blood pressure was uncontrollable afterwards for a couple of days. Of course she told her doctor, but it was dismissed. We talked about it and I hypothesized it might have something to do with the electrolytes in the prep, and in fact there are warnings on the prep for her type of blood pressure medication. We looked up alternative preps…she is going to call the doctor to see if that might work for her, but I think he should be concerned about her concerns, and know if she falls under the warnings on a drug he precribes every day.

- My father had Propulsid and Sporonox prescribed at the same time years ago by the same doctor and the pharmacy filled it. That is a black box warning. The only reason I knew was because I had helped my friend study a little before her sales training with Janssen pharmaceutical. That doctor probably prescribe those drugs all of the time, he should know the black box warnings. And wtf are these pharm reps talking about when they are at the docs office?? Both drugs were Janssen.

-My girlfriend asked her doctor on two different occasions if her sons asthma medication might be stunting his growh. The doctor was sure the answer was not. My girlfriend and her husband did not even think the asthma medication was necessary for their son, so finally, they decided to take him off it on their own. Turns out he didn’t need the med, he started growing within weeks, and now there is new information about this med possibly stunting growth. The doctor didn’t know, so I don’t fault him, but don’t be dismissive, or maybe try a different med. Maybe know that sometimes science doesn’t know the answer yet.

-I complained for years that I felt like my heart was stopping for brief moments late at night when I was resting or sleeping, and sometimes I woke short of breath and like I am going to wake up dead one day. They did an ekg in the office at my GP, and he said I was fine. One day at a GYN apptmnt I told my doctor, because he was listening to my heart, and he said, “I think you should see a cardiologist.” I did, and my heart does miss beats, and at night my heart rate went down to 48. Wound up to be benign, but at least I now feel like it was addressed and I don’t worry about it. I think my primary doc should have told me to go to a cardilogist rather than telling me I am fine, I knew SOMETHING was going on. I was not diagnosing myself, I just wanted an explanation. I was not a hypochondric about it, I did not go running from doctor to doctor, rather I just mentioned it at a regular apptmnt and relied on my doctor, and honestly I felt like if I went to a cardioligist I would seem paranoid, hypochondriacal, and questioning.

I could go on and on. I believe doctors make many many many more right decisions and diagnioses than wrong ones, but as a patient I think you need to be educated.

marinelife's avatar

@SirBailey Your type of arrogance and unwillingness to listen to patients is precisely what’s wrong with the current health care system.

Fortunately, good doctors know exactly how much they don’t know. They are secure enough in their own skills not to feel threatened by intelligent patients who take an interest in their own well being.

Unfortunately, they are not the average doctor today. Much of that I blame on the system of training doctors. Patient care should be a partnership between the professional and the person whose body it is.

Judi's avatar

@Marina ; that’s ONE thing wrong with the health care system. The fact that doctors are owned and trained by grants from pharmaceutical companies makes it hard for them to look at or find natural ways to treat, cure and prevent disease.
Hormones are a prime example. Bio-identical estrogen is cheaper, safer, and more effective than premarin, yet doctors don’t even think of prescribing it unless the patient requests it. They have been so indoctrinated by the pharmaceutical companies that they start to believe that the answer to all our problems lies in a pill.

marinelife's avatar

@Judi Excellent point and one more reason that many health care consumers have lost faith in the system.

SirBailey's avatar

@Marina, you said “Your type of arrogance and unwillingness to listen to patients is precisely what’s wrong with the current health care system.”

On the contrary. It’s people like you who make so much noise about their care and complain about everything even when they get GOOD care that make the people who DO make legitimate complaints get dismissed and go unheard.

It’s easy to see why your doctors don’t want to listen to YOU. They probably dread it when they see you in their waiting room.

JLeslie's avatar

I barely know what to say @SirBailey you have no idea how @Marina is when she visits a doctor. Have you ever been sick and not heard? Or, had a difficult time getting better from an illness? I have always generalized that most doctors have no idea what it is like, especially young ones, because to even fathom the idea of going through what it takes to be a doctor you have to be pretty healthy I think, it is physically and mentally so much work. AND, I think a lot of doctors had a parent who was a doctor, and never had to go through the gatekeepers to get to the doctor, or beg for treatment or attention. Maybe you fit my generalization? I don’t want to assume.

Obama said it well, medicine in the US has been turned “from a profession – a calling – to a business.

SirBailey's avatar

This will be my last post because, once again, you only want people to agree with you. I gotta tell ya, frankly I don’t know of ANYONE complaining about ever being sick and not heard. I’m not saying it NEVER happens. I’m just saying I don’t know people who ever claimed to have experienced that. And having “a difficult time getting better from an illness” you apparently interpret as a fault in the healthcare system, so be it.

But it’s interesting you criticize MY comment yet you said NOTHING about hers!! LOL!!!

I wonder if the way you’re selectively attending here you also do with your doctors?!!

JLeslie's avatar

@SirBailey I’m sure the people who know you know not to complain to you. I did not ignore you, I responded to your points, and even said that I was going to think about your position, that maybe some of your points might help me. Bye Bye.

marinelife's avatar

@SirBailey I find it surprising that as a pre-med student you would not have heard of the issue of doctors not listening to patients.

I am concerned that it was projection when you said to jleslie that she only wants to hear from posters who agree with her. If that is not the case with you, then I hope that you will take a look with an open mind at these references.

By the way, just because I want good medical care, does not make me someone who complains about or rejects the entire system. I just believe it could be made better.

“There are in fact many reasons why physicians do not listen well. Most relate to deeply imbedded myths within the profession that interrupt listening. One example is the myth that medicine is an art and a science. With this split firmly in place, what is considered ‘science’ becomes funded and taught and what is labeled ‘art’ is often given scant attention. A good example of this is auscultation. Considered science, students are trained to use their stethoscopes for listening to internal organs. They learn for example to identify abnormal from normal heart sounds as well as what to do when they hear an abnormality. When listening to the person (versus the organ) most physicians function as amateurs not knowing what to listen for nor how to respond appropriately. As a consequence, vital communication clues tend to be missed as are opportunities for healing.”

Dr Barry Bub, in the Healthcare Communication Review. Source

Not listening to patients has negative consequences for doctors.

In addition, I could go on with patient anecdotal story after story. I am not bothering, because you do not seem to be open to input from the patient side of the equation.

Answer this question




to answer.

This question is in the General Section. Responses must be helpful and on-topic.

Your answer will be saved while you login or join.

Have a question? Ask Fluther!

What do you know more about?
Knowledge Networking @ Fluther