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Have you ever given a patient money?

Home The Lounge Have you ever given a patient money?

  • MPMD MPMD 
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    Status: Physician
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    Joined: 05/01/2017

    To the original question: I don’t. I have been tempted several times but have resisted. Honestly I am most tempted not by the saddest cases but by things that would streamline dispo. Example a homeless pt w/ cellulitis who could be rx’ed w/ a $4 rx from Target but repeatedly states they won’t leave b/c they don’t have money to fill it. I have been tempted but haven’t given in.

    It helps that my shop is loaded and tends to have lots of resources to deal with this — vouchers, SW assistance etc.

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    Your hospital doesn’t have any prescription medication benefit? Our uninsured patients get a free 30 day supply of medications at hospital discharge. There are some limitations on the medications they have but they carry most common things.

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    I honestly don’t know all the details. We have onsite SW most of the time, plus the residents are usually managing this nitty gritty stuff.

    #179726 Reply
    Avatar treesrock 
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    Status: Physician
    Posts: 268
    Joined: 08/14/2017

    Probably like $50 total over the course of a couple years for cab rides home.  The patients did not know it was coming from me and it expedited their discharge.  Our hospital does not allow “discharge to street” so this was preferable to rounding on them the next day.

    #179735 Reply
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 2043
    Joined: 05/01/2017

    Probably like $50 total over the course of a couple years for cab rides home.  The patients did not know it was coming from me and it expedited their discharge.  Our hospital does not allow “discharge to street” so this was preferable to rounding on them the next day.

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    Whoa. Really?

    That sounds like a pretty bad policy esp for malingering patients.

    #179736 Reply
    Avatar FIREshrink 
    Participant
    Status: Physician
    Posts: 845
    Joined: 01/11/2017

    One of my schizophrenic patients came to clinic one day disheveled and thin. Stated had not eaten in days because he lost his EBT card and couldn’t figure out how to get another one. Have treated him for more than a decade. Smokes, but no drugs. Single, elderly, disabled. Damn right I gave him a twenty. I hope he bought himself a steak. We also gave him snacks out of our pantry.

    Our staff collects petty cash throughout the year for situations like this but in this case I also wanted to feed the man myself.

    Avatar wideopenspaces 
    Participant
    Status: Physician
    Posts: 920
    Joined: 01/12/2016

    I have definitely been tempted to help my patients out financially. It’s always been for larger sums of money, not just cab fare, and I have no way of doing it anonymously so I have not. But if I won the lottery you better believe I have a list of patients I’d be giving money to. In general I think it’s important to help patients help themselves, to empower them, to make sure I’m not doing something they can do for themselves. In psychiatry( especially outpatient) I think the boundaries are trickier and I admit it can be difficult for me. I genuinely care about my patients, I get attached to them, I worry about them and if I was allowed to there are some I’d love to be friends with. So I am constantly having to question my motivation to make sure I don’t cross any lines. I imagine if I was in the ED or primary care I’d have a hard time not handing out petty cash in a lot of these situations.

    #179743 Reply
    Avatar Kamban 
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    Status: Physician
    Posts: 2124
    Joined: 08/01/2016
    Multiple times. I once gave a person a ride home (nice older lady, husband couldn’t derive at night due to vision, couldn’t find a cab). These circumstances have to be unique, but I have and will again in the future I’m sure.

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    I have done this too since on a few occasions it is not too far off the way to the hospital from my office. At other times the patient comes to our office for treatment but is unable to drive home safely. So my nurse or I drive his / her car to their home with the person and we use one of own cars to return with our office staff. These things happen very, very rarely and the drive to the patient’s home is usually < 5-10 miles. Usually we drop them off when we are closing for the day.

    I agree that this is not advisable in certain fields like psychiatry but in our case it has worked out well so far. Also, since I own my practice I can do these things without needing permission from any hospital administrator. Of course I can do this only if my staff is fully willing and two of my long standing staff have openly agreed to do this without any pressure at all.

    #179747 Reply
    Lithium Lithium 
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    Status: Physician
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    Joined: 02/15/2016

    I remember this from Dear Zachary:

    https://www.theglobeandmail.com/news/national/psychiatrist-sanctioned-for-posting-patients-bail/article705362/

    Astonishing that a physician could be that stupid.

    #179749 Reply
    wonka31 wonka31 
    Participant
    Status: Physician
    Posts: 495
    Joined: 03/24/2018

    That’s a weird story, seems like there must be something else there. I guess I was referring to a cab fare a few times, not paying someone’s rent or bail with regards to my initial post. We also got a family some clothes/shoes for goodwill, they really needed it.

    #179756 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 842
    Joined: 11/07/2017

    Interesting perspectives from everyone, thank you for your replies.

    I recognize that I have a core reaction of giving money to a patient crossing some sort of line, but I don’t know why that is, other than maybe something I was implicitly fed in medical school.  I mean, I can tell you exactly why things such as dating a patient is wrong, but why would giving money to solve a specific problem affecting someone’s health and wellbeing be wrong?  The most I can come up with are: you could offend someone, the money could be used for other than the intended purpose, or you could reveal some weird boundary issues with the patient/start down a slippery slope.  I think the difficulty is choosing who would benefit from the help vs who would be potentially harmed.  Probably the opportunity for benefit is more frequent than the risk of harm, however the magnitude of the harm when it does occur could be much greater than that of the benefit.  In my patient’s case, he certainly wasn’t asking, he was expecting to just set aside the money from his next disability check, and I certainly didnt feel a need to feel charitable.  It’s more like five “dollars means a snack for me, but it means a big deal to you.”  (Bonus points if you can name that song!).

    I agree with people that I wish giving money on a personal level could be easily done anonymously.  There are a lot of people I would like to help out directly (with sums greater than $5!) but only if it could be done anonymously.  Someone here must have the skill set to be able to figure out how to develop that.

    A couple years ago I had a patient who had hemiparesis with spasticity after a traumatic brain hemorrhage.  He made huge progress with therapies and regained his gross motor function but then plateaued with poor fine motor coordination of his dominant hand.  It affected his ability to work, to write, and especially his self esteem and he got really frustrated and it seemed like he quit trying.  I was talking to him one day about things he could do to work on his fine motor control and nothing was sparking his interest until I mentioned drawing and he sort of lit up but then he said there was no way he could do it.  So I suggested he get one of those coloring books for adults and give it a try and he verbally agreed but then on the next couple visits hadn’t done it.  I stressed for some reason about whether it was ok to buy something like that for a patient, but then went out and found a geometric coloring book and got him that and some colored pencils.  And the next time he came to visit I was like “oh, look what I got in the office white elephant gift exchange!  Remember when we talking about these adult coloring books?  I’m never going to use this, why don’t you take them?”  And lo and behold, he did, and he used it, and the next thing you know he starting drawing cartoons and following how to draw videos on you tube.  I have 3 sketches of animals he gave me, they are incredibly good, I have framed them and put them in my library.  They are the antidote to that jaded feeling we all get sometimes. And I feel silly for stressing about whether it was ok to buy a coloring book for a patient who was stuck in a funk.

    Avatar Anne 
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    Status: Physician
    Posts: 842
    Joined: 11/07/2017

    I remember this from Dear Zachary:

    https://www.theglobeandmail.com/news/national/psychiatrist-sanctioned-for-posting-patients-bail/article705362/

    Astonishing that a physician could be that stupid.

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    Wow, I remember the story of Andrew Bagby’s murder when it happened in 2001.  I didn’t know the rest of this story or that someone made a movie about it.  I’ll have to check it out.

    #179765 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 1789
    Joined: 09/18/2018

    Is it a requirement that physicians “emotional” detachment from the objects (patients)?

    To a large degree, it’s ethically required and in many cases it is absolutely necessary in order to maintain your own sanity. The situations, pain and suffering have to be left at work. Too many people and too many problems. One shouldn’t be seeing the same patients repeatedly, like ED. Having a “no cash” on top of emotional detachment makes perfect sense. It allows you to work the next day and next week. It’s not a lack of humanity or charity and shouldn’t be faulted, it’s a performance technique for handling the job.

    From a humanitarian and charity viewpoint, one can donate in many ways. If one views being close and involved with charitable efforts as having a lot of value, that’s about as close as one can get. Choose wisely.
    That shouldn’t be faulted either.

    #179768 Reply
    Avatar Dicast 
    Participant
    Status: Physician
    Posts: 394
    Joined: 01/09/2016

    I understand why many physicians would not give out cash to patients. The thought that patients will come running back for more is probably enough to keep most of us from handing anything out. I have a personal distaste for panhandlers. If you can work that hard at asking for money, you can get a job. I’ve taken care of schizoaffective patients that have plenty of income and I don’t see why many on disability fail to work just a little bit.

    Despite my dislike of handouts I’ve given 2 patients money over the last 5 years of my emergency medicine practice. Each time when I’ve given them money I was met with the response of “you don’t have to do this”. The first patient was a young female with a breast mass. No insurance. She lived in the wrong county for assistance. I made an appointment with a specialist but she needed the office visit fee. I don’t have it in me to tell a young woman there’s no way to get her checked for cancer. I gave her money with the out that she could pay me back. I’ve never heard from her and I don’t care because I did everything I could.

    The second patient I gave money to was a bit different. She needed an antibiotic that was going to cost about $40 using goodrx. As I do with all of my patients, I verified that she would be able to get the med. She had no money. Her next paycheck didn’t hit for 5 or 6 days. My options were to admit her for risk of “failure to follow up” or to discharge her knowing she couldn’t complete treatment. Admission would be over the top expensive so I gave her $40. 2 weeks later I got an envelope with $40 back and a note thanking me.

    On both occasions I discussed with the patients that under no circumstances should they ever expect similar treatment. I’ve never had another patient arrive asking for money. I’ve never had any fallout from either experience.

    My hospital does not provide any handouts. No meds of any kind. The population I deal with is very different than that of a county hospital, but most county hospitals have programs for these situations.

    Get outside of your bubble.

    #179798 Reply
    hatton1 hatton1 
    Participant
    Status: Physician
    Posts: 2848
    Joined: 01/11/2016

    I have never given a patient cash.  When I owned my practice I wrote off number of copays and other bills.  I also sent my office manager to a grocery store to buy some healthy food for a pregnant diabetic.  My office manager took multiple people home and to the ER over the years.  If you practice long enough some patients do become friends.  Going above and beyond is part of being a doctor.

    #179829 Reply
    Avatar JWeb 
    Participant
    Status: Physician
    Posts: 106
    Joined: 02/21/2017

    My state Medicaid does not have a liquid narcotic medication that does not require preauthorization. I reduced a badly displaced distal radius fracture in a 7 year old and casted it on a Friday at 5pm. I wrote for lortab elixir and she went home that evening. Got a call from the pharmacy at 9pm that they couldn’t fill it without the preauth. I spent 70 infuriating min on the phone trying to get it approved. Then I just called the pharmacy and put it on my credit card so she could have some for the night. I think it was $34 or something.   Soon after I did that the auth went through and the pharmacy removed the charge from my card.

    I would spend $134 to get those 90 minutes back. . .

    #179847 Reply
    Avatar ko 
    Participant
    Status: Other Professional
    Posts: 64
    Joined: 02/03/2016

    I agree with people that I wish giving money on a personal level could be easily done anonymously.  There are a lot of people I would like to help out directly (with sums greater than $5!) but only if it could be done anonymously.  Someone here must have the skill set to be able to figure out how to develop that.

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    Not very hard, especially if we’re talking about small sums. You have an address for the person (or can look one up), I presume? Put $50 in an envelope with no return address, drop in the mail. Easy.

    #179858 Reply

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