I am very unsatisfied with a doctor I recently visited. How do I say so?
January 24, 2014 9:10 AM   Subscribe

I recently went to a functional medicine doctor. The administrative staff has been negligent. She misdiagnosed me and recommended unnecessary testing. Not to mention the cost! I don't think I should go back, but should I write a letter? Details behind the cut.

The functional medicine doctor is an M.D. with a specific interest in food allergies and alternative treatments. She is not my primary care physician.

Complaint #1: the doctor suggested a follow-up appointment to take place 3 weeks after the initial meeting. The administrative staff booked something for 7 weeks later, despite my insistence on the urgency of my symptoms. The day of the appointment, I showed up only to find out that they had no record that an appointment was to take place, and was told to come back 5 weeks later. I tried to explain my frustration and ended up crying, but did not receive any empathy or apology for the clear error on the office's part.

Complaint #2: the doctor told me that I have an obvious heart murmur and expressed concern that I had never been told this before. I went to see my primary care physician, who could not hear one. Out of continued fear, I got an echogram, which was normal. This makes it hard to trust her.

Complaint #3: Not that I know everything in the world about how much medical care should cost...but the doctor billed my insurance company over $1000 for an initial 1-hr consultation during which no concrete recommendations were made. That's in addition to the labs she ordered. My insurance company is generous, but this is a lot more than I was expecting (my understanding is that most functional medicine doctors charge $300-$400 out of pocket and do not take insurance).

In short, my impulse is to cut my losses and have my primary care physician look at the lab reports. However, I am also really upset. Am I right to be? Should I write a letter? What should it say?
posted by munyeca to Health & Fitness (13 answers total) 1 user marked this as a favorite
What outcome do you expect from a letter? You will probably get no response, so almost any answer to that question will result in disappointment.

You could put it on Yelp and that might be more satisfying.
posted by Lyn Never at 9:16 AM on January 24, 2014

Yes, yelp.

If there is licensing oversight, I would def pursue a complaint about the heart murmur.

I also don't think a letter will help. These people don't care.
posted by jbenben at 9:20 AM on January 24, 2014 [1 favorite]

Yes, you are reasonable to be upset. You may have bought some snake oil from a highly trained and licensed professional. I understand getting murmurs wrong, but if she was sure it is worth telling her that her cardiac exam skills are off. As you have experienced, false positive reports from bad exams cause harm from anxiety and additional testing which can snowball. I also understand busy clinics having trouble scheduling, but it's unprofessional to tell you 3 weeks and her admin staff whenever.

Write a letter if it will make you feel better (did writing this make you feel better?). If it helps, it is unlikely that your insurance actually paid $1000.
posted by a robot made out of meat at 9:36 AM on January 24, 2014 [1 favorite]

I agree that this smells fishy. If she was not an alternative practitioner, but more of a specialist working within a clinic or other team, I would suggest writing to the team/clinic's medical director, who might have oversight.

I would absolutely cut your losses as far as seeing this doctor again. Even if she was competent (which it sounds like she's not), her administrative team is not.
posted by mitschlag at 10:04 AM on January 24, 2014

Murmurs can be challenging, and you can also have a murmur sometimes and not others (i.e. a benign flow murmur). I wouldn't write the doc off over that (I actually question more someone who's willing to send you for an echocardiogram when you aren't having a murmur at the time, although maybe you had other symptoms that suggested this was necessary).

Doctors also routinely bill insurance for far more than what they expect to be paid. If they were billing you directly without going through insurance, the bill would also be different.

I'd ignore those things and focus on the fact that you were treated poorly by the staff and they did a bad job scheduling for you. Yelp about that.
posted by treehorn+bunny at 10:18 AM on January 24, 2014 [5 favorites]

the doctor billed my insurance company over $1000 for an initial 1-hr consultation during which no concrete recommendations were made

If the physician had instead had six 10-min office visits, she could have easily billed more than $167 for each one. Billing more than $1000/h is not really notable for a U.S. physician. (Now whether an hour-long visit with a physician is medically necessary is another story.)
posted by grouse at 10:46 AM on January 24, 2014 [2 favorites]

Is there a healthcare regulatory body in your jurisdiction to which you can complain? Here in England we have NHS Choices where people can leave reviews about healthcare providers, and the Care Quality Commission (who regulate healthcare services) who you can contact to share your experiences, in addition to the General Medical Council who are the professional regulators for GPs. Who is evaluating and regulating healthcare in Rhode Island? Contact them and tell them of the bad practice you experienced.
posted by goo at 12:37 PM on January 24, 2014

The answer to goo's question is that complaints can be made to the Rhode Island Board of Medicine. However, that mechanism is meant to be reserved for complaints of negligence , abuse, or illegal behavior by a physician, not because you don't like them or the way they do business. I really don't recommend you complain to the board about this.
posted by treehorn+bunny at 1:40 PM on January 24, 2014

Well that's unfortunate, if your first point of recourse is the Board of Medicine. Have you (the OP) made a complaint through the practice's complaint procedure? That should be your first step and you can escalate from there. Their complaint procedure should be clear about the steps for escalation.
posted by goo at 2:17 PM on January 24, 2014

I'm a 25 year nurse. Admittedly, I've only worked for two doctor offices and both for a very short period of time. That said, I hate them.

I must say though that a heart murmur is sometimes difficult to hear and an echo will only tell you if there is a problem. Some people have heart murmurs all their lives and are never told because it hasn't effected them. I don't think it's unreasonable that she sent you to have that test since if she didn't tell you about it, then you found out later, you could sue her. You see, doctors are paranoid because of frivolous lawsuits. They happen all the time for reasons such as this. It's sad, but there it is and now you, the consumer, is paying for it.

Regarding #1, I agree that Yelp is your best friend. I'd also post it to Google Maps' review system as well.

As for the charges, I don't know what to say on that. They are free to charge what they wish. Whether they'll get it is another story. A lot of doctors are beginning to go the non-insurance route because they never get paid. Hospitals are plagued with that problem as well. At this rate, the US will not have a medical system in years to come.

The majority of doctors offices will have a business manager. I think perhaps you need to write a letter, outlining your concerns and send it to the business manager. Then, make an appointment to see him/her to discuss the letter.

They're in it to make money, after all, and the manager is usually willing (not always, but usually) to make adjustments with complaints.

Good luck and I hope you can get this resolved to your liking!
posted by magnoliasouth at 2:18 PM on January 24, 2014 [2 favorites]

When I was in my early 30s I underwent a physical for a job that required lifting and other exertion and they found a heart murmur. The doctor doing the exam was rude as all get out, I guess because he thought I was trying to sneak into a job that I could then submit an L&I claim against later. He hammered at me about how long I'd had this heart murmur and what treatment I'd been under, etc. When I told him I had no idea I had a heart murmur he acted like he didn't believe me. He, at least, didn't flunk me for my exam - instead, he sent me to a Cardiologist within their group, who determined that the heart murmur was "functional" and of no concern.

A short time after that I had to see my regular doctor about something and told him about the heart murmur. He couldn't hear it, but said sometimes that happens - not to worry.

Years later, filling out a form for my past medical history, I didn't know what to put - did I, or did I not, have a heart "condition"? I didn't check the box - and, of course, the physician heard the murmur, described it as "very loud," and insisted that I have a treadmill exam, which showed nothing.

Over and over this has happened to me. I'm an old lady now, had an echo last year, and still have no problems with my heart. I've decided that, like all mysterious physical ailments, it's "just gas" (tongue in cheek).

Don't blame either doctor for this part of the problem - it won't make any impression because it's a common thing. As for the very high charge, if the doctor was truly engaged with you for an hour, well ... my guess would be that you would have had the same kind of charge if it was your first visit to a therapist who spent an hour with you and ran you through the gamut of personality tests and stuff they're fond of; much of that is what I'd call "snake oil" of its own kind.

I think it's a point here that identifying someone's food allergies, or allergies period, is likely to take a lot of tests - as well as the usual baseline tests required by a new doctor. Allergies can be very serious, too - my granddaughter spent a week in the hospital a year ago with angioedema that took a six-week course of prednisone to curtail; there's still no certainty of the cause (she was a week+ into recovery from an appendectomy when it hit, very fast, very hard, and nearly deadly).

I'm sorry you had such an experience - I would have collapsed with a bill like that - and if you need to, put your experience on Yelp. In fact, maybe there are other stories on there about the same physician?

Take care of yourself, and if you do have a possibly dangerous level of allergies, I'd seriously consider seeing this doctor again (bill won't be as high for 2nd visit) and explaining to her about the staff and your "sticker shock," but see what she says about your test results and your allergy problems.
posted by aryma at 10:25 PM on January 24, 2014 [1 favorite]

Since nobody else has mentioned it, "functional medicine" is just the newest name that medical doctors who practice "alternative medicine" are using. Like you said, many of these doctors don't even take insurance, because insurance is unlikely to pay for many of their services because they are not medically proven or necessary. Posting on Yelp could help warn future people off and I agree that's probably your best move. Really and truly, this person is on the scammy quacky side of medicine, and it's not surprising that they're not that good at their job. Practitioners who operate in that world tend to be certain of their rightness, and so a complaint letter from you would likely be ignored.

I'm sorry this happened to you. An allergist would be much more helpful in testing you for allergies.
posted by hydropsyche at 5:07 AM on January 25, 2014 [3 favorites]

Your insurance will probably negotiate the bill down to half of that or less. Billing insurance high and then haggling to the final price is basically how medicine works these days. It's annoying but you shouldn't have to do much, if anything, just keep all your paperwork handy until things settle down.

You could always write a bad review on ratemd/rate my doctor/etc. sites, focusing on the horrible scheduling.

And definitely don't go back. There's no reason to go to a doctor if you don't feel like you're getting anything out of it, regardless of any of the rest of it.
posted by anaelith at 4:05 PM on January 26, 2014 [1 favorite]

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