Wednesday, October 8, 2014

Housecalls Are Not Cheap

A lady fell, catching herself on outstretched palms. That often breaks the tip of the radius where it meets the wrist, and she felt pain in that precise area. She needed an X-ray and an office visit.

A man accidentally bent his forefinger far backwards lifting a heavy box. He suffered excruciating pain over the knuckle. I suspected a fracture or torn tendon. He needed the same follow-up.

Both patients lived in Santa Ana, a fifty mile drive. The director of the housecall service who phoned admitted that these were not typical clients, but someone wanted the visits and was paying generously.

The next day, the director informed me that a mobile X-ray van had gone to both apartments. The patients’ employer wanted to know my plans. That’s when I realized that I shouldn’t have made those visits. These patients had been injured at work, and the employer had decided a housecall was the cheapest way to handle them. That was his first mistake. The major advantage of a housecall is convenience; it’s cheap only for trivial problems.

Far worse was his failure to know that job-related injuries must be handled through Workers Compensation, a system most doctors, me included, take care to avoid. It is a bureaucratic nightmare, wildly expensive and corrupt. Your state legislators, Republican and Democrat, know this but keep quiet. Workers Compensation is the state government equivalent of Israel: no elected official in Washington dares criticize Israel.

I told the housecall service that I was out of the picture and that the employer should read the law, and find a doctor who deals with Workers Compensation.    

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