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How Much for an Hour of Schmoozing, Doc?
By THOMAS W. GROSS, M.D.
In our economy, productivity is often measured in units of time. Time is then converted to money. We hire architects, lawyers, plumbers and piano teachers, and we pay them by the hour.
The current medical reimbursement system pays by the job performed, not by the time spent.
Your appendectomy is charged on a flat rate, like a brake job. The surgeon who performs your appendectomy gets paid the same if he takes one hour or two, as long as he takes out only one appendix.
Your family doctor receives the same reimbursement for diagnosing a sinus infection in 6 minutes as he does if he takes 30 minutes.
In our current system, there is no way to buy an hour of your doctor's time just to talk.
The doctor can give you that time free, but under most health plans he cannot bill you for it.
With the current rate of exchange, as dictated by the health insurance companies, an hour spent talking with your physician has no value.
One night when I was an intern, the nurses paged me around 2 a.m. and requested a sleeping pill for an elderly man with an infection. Imagine that - being unable to sleep in a hospital. That hardly ever happens.
I was up anyway. Interns never sleep, except at lectures, and sometimes in the hospital cafeteria. I was waiting for the results of some laboratory tests for a recent admission.
Because not all sleeping pills are created equal, I went to see this patient before ordering any medication for him. I pulled up a chair, and sat by his bedside. We started to talk.
I learned that he was Hungarian. Before World War II, when he lived in Budapest, he had been a lawyer, a specialist in international law.
Given his description of Eastern Europe in the late 1930's, I tried to imagine how challenging his job must have been.
After the war broke out, he was drafted, and rose to the rank of lieutenant colonel, ultimately serving in six different armies, first in Poland, then back in Hungary and then in Romania.
He was later drafted into the German Wehrmacht, and then escaped and was captured by the British. So desperate were the various armies for cannon fodder that original allegiances were immaterial.
He eventually served in the Canadian forces, and then the United States Army. After that, he immigrated to this country and obtained American citizenship.
Ineligible to sit for the bar exam, or to practice law in the United States, he found a job as a janitor in the university library. He eventually worked his way up to become the assistant librarian at the law school.
In his hospital room, we sat and talked for quite a while, but about history, not medicine. I got a glass of water for him and a cup of burnt coffee for myself. He taught me some jokes in Hungarian, and a few in Polish and Ukrainian.
Most of the jokes were about the Communists. It took him forever to get me to understand the punch lines from different languages and cultures, but once I did, we both laughed.
He finally said he was becoming tired, and he fell asleep as I was turning out the light. I slipped away and wandered down the quiet hallway to check my overdue lab reports.
Even in my sleep-deprived state, I was not oblivious to the lesson he had taught me. Rather than prescribe a medication to make him drowsy, I had let him talk himself to sleep.
The next morning, he was more alert than he would have been if I had prescribed a sleeping aid. His infection had abated enough to allow him to go home.
The colonel slept through the night. Twenty years later, I remember more about him than I would have if I had called in a tranquilizer.
I still remember how to say "to your health" in seven Eastern European languages. You'd be amazed how frequently that comes in handy.
I still remember how many K.G.B. agents it takes to screw in a light bulb.
I hope I never forget what I learned that night: Time is not money. Time is medicine.
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