Another ethical question

[Maeve]

I have been going to a neurosurgeon who does not take insurance but was told he worked with patients with payments. According to the office the patient tells him when they want surgery so he sets that day aside to operate, but the patient is to check into the hospital emergency room as an emergency patient stating they have an emergency. Since he is the on call doctor he is the one the hospital will call. Since the patient is admitted into the ER as an ER patient the insurance will pay. I have a problem with going to an emergency room with an emergency that is not an emergency. Like it is pre planned. Not only does it feel wrong but the hospital that he prefers to operate from is 25 miles from my home and I bypass the two closest hospitals to my home and 4 more on the way.

Mary

[nancyann]

Hi Mary:  if it feels wrong it is, go with your gut.   I don't like the sound of it at all.  Pretty sneaky if you ask me.
             Any other surgeons in the area you could go with ??

[tony]

Perhaps we should ask a different question
I am sure, most, if not all this group
support the notion that the best AN surgery results
usually come from the most experianced AN surgery teams
Given that you may have to live with the surgical outcomes
for 20 or more years - it may be proudent to check
out options that maybe are further away from home
- but have done 100 or more such surgeries ?
Just a suggestion - its your call
Best regards
Tony

[Evan]

Not only is it unethical, but it is potentially "insurance fraud", not necessarily on your part, but on the part of the physician.   The real question is whether he is doing this to "help the patient" or merely doing this to get paid for surgery that he would not otherwise get paid for.  Also, since there are so few neurosurgeons in each state (I believe New Jersey has less than 50 board certifed neurosurgeons), the fact that he has to resort to this does not sit well.  As one of the others has asked, the most important question for you is whether he is the best qualified doc for the procedure.  Many doctors, especially with uncommon conditions such as AN's will work with patients without insurance.  I suggest that you look around and explore all of your options.

Evan

[Shrnwldr]

I agree with everyone on this.  Has the doctor performed this type of procedure before? And if so how many? If he has performed these surgeries then why isn't he signed up on your insurance whatever it is called...approval list?  Then there is the whole question of what happens if you need to see him for complications?  What about followup visits?  hmmmmm  Is there any other surgeon in the area that you would feel as comfortable with?  Arent' these slow growing so there would be enough time to alteast find a doctor in your network that would work? 

This just doesn't feel right.

[Omaschwannoma]

I agree with everyone above!  If it does not feel right, it most certainly is not right!  Go with your gut and realise you have time to seek out a doctor and hospital that falls under the criteria of all, insurance, experience with AN's and your peace of mind.  Your "gut" talks to you for a reason, don't ignore it.  You have done the right thing by asking this question yourself and "putting it out there" the answers are coming back in overwhelming response. 

[ppearl214]

Mary,

I read your 1st post on this site and you note that you have a large schwannoma in your neck (not an AN)..... and now this dr is telling you this.  IMO, run! run fast!  Do not pass go! Do not collect $200!  (for you Monopoly players.....)

If you are going to let someone operate on your neck (and for those here that have AN microsurgery), we all have learned to research, research, research.  I, personally, would report this to your State Board of Registration of Physician for insurance fraud and find another neurosurgeon, one hopefully affiliated with an acute care/teaching facility.

Again, just my opinion.

Best wishes to you as you go through this.....

Phyl

[tony]

Sorry a 1,000 appologies - I hadnt connected the two posts as being the
same patient.
There is a 1000/1 chance, if you have a neck Tumour
- you may have tumours elsewhere (I did - so it can happen)
You do need to find someone reliable that will conduct
the proper tests - if nothing else just to take away that possibilty
There is no immediate threat as such - its just that its not usually
a good thing to ignore
May I suggest you repost looking for suggestions
in your state for someone to do the tests
Best Regards
Tony

[Jackie]

Hello Everyone,

Just curious regarding going to a teaching facility for an AN procedure?? Do we want to be a guinea pig?? I don't mean to be disrespectful, it's just that I had always been told the contrary. I look to all of your experience and advice on this matter. Thanks toall,
Jackie

[ppearl214]

Hi Jackie,

IMO, going to an acute care facility with an association with a teaching hospital (ie:  Harvard School of Medicine with Mass General/Beth Israel or even Stanford) tend to have the funding to get the newest equipment/treatments available, as well as keeping in line with new treatment options or discoveries that may be going on. I, personally, don't have an issue being part of the Cyberknife Study program at Beth Israel for the following reason.... my sister died of a malignant brain tumor over 30 yrs ago... thus, if it wasn't for folks like her, then today's treatments may not have been available for us.. .thus... I participate to help those down the road as well that may need this kind of help.  I have never and do not see myself as a guinea pig and am more than happy to help future generations.

Again, just my opinion and hope others chime in as well.

Phyl

Hello Everyone,

Just curious regarding going to a teaching facility for an AN procedure?? Do we want to be a guinea pig?? I don't mean to be disrespectful, it's just that I had always been told the contrary. I look to all of your experience and advice on this matter. Thanks toall,
Jackie

[macintosh]

Jackie--

I went to a teaching hospital (Shands at the U. of Florida) for radiosurgery.  The procedure was done by the doctors whose names I recognized as the ones who have done hundreds of ANs, and it was observed by a cluster of what I assume were trainees. I was a little dopey from Valium throughout, but my wife commented afterwards on the five young guys in white lab coats who were moving in a pack and watching everything very closely. I took this as a good thing.

And I completely agree with Phyl that the doctors at teaching hospitals are likely to be the ones who are up to date on the latest research.

Mac

[Maeve]

Thanks for your responses. I made an appointment this week with a different doctor. This whole thing makes me so nervous. I will be glad when it is over. The frustrating thing is this doctor is known as the best in this field, but I just don't feel like it is ethical or honest to have a pre planned emergency so I am not going to go that route.
Mary

[Battyp]

Mary what an interesting ethical delimma. I'm studying ethics in my  masters program...boy oh boy....
I'd look elsewhere too.

[Jim Scott]

I note that the post that originated this thread is about 5 months old at this point (August 8th) and that Mary made her decision.  I'll simply add my observation that, for whatever it may be worth, this doctor's proposition sounded unethical and dishonest. I'm no saint, but I would refuse to participate in such a scheme.  Even if ethics or morality didn't matter - and they certainly do - the risk of being charged with insurance fraud would stop me, cold.  I really believe that Mary made the right decision.

As for having surgery at a teaching hospital: I had my AN surgery performed at such a facility.  MY very experienced neurosurgeon assured me that he didn't even allow any residents or interns in the surgical theater.  "I only permit my 'A-team' in the operating room - no rookies allowed" was his actual comment.  I liked that attitude.  I assume that doctors-in-training were able to observe the surgery, but I never asked ,as it had no impact on me, one way or the other.  By the way, this surgeon was highly respected and well liked by the other doctors (and all the nurses) in that hospital. 

[NF-2er]

Hi;

   "Color", would represent density which is also significant of growth or not outside size increase. So, in that regard, color is probably important. Especially with comparison w/o contrast to image with contrast.

   NF-2er