Your Relationship With the Medical Community

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By Roger C. Bone, MD, reprinted with permission

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6. What resources are available from the medical community?

When hospitals as we know them today were first organized after the Civil War in the late nineteenth century, many were created as "doctors' hospitals." A group of physicians often joined together and converted an old mansion in order to shelter patients who were severely ill and could not be treated at home. Incidentally, home care was the preferred method of treatment throughout the history of early medicine. It was generally accepted that the doctor was the "outsider" who made house calls to the sick and frail.

During the social evolution of medical care in the twentieth century, these roles were reversed. The patient now, in effect, visits the doctor's house. Hospitals have subsequently became one of the most democratic and socially conscious institutions in the country. The poorest man in a city might very well share a room with the richest and they both, regardless of their ability to pay, receive identical care. Physicians treat all classes of individuals from a variety of social, demographic, and economic backgrounds. Over the years, hospitals have responded to this increase in demand by providing services that are not directly related to medical care. For example, health institutions commonly offer psychological, financial, and religious counseling, and physician referrals.

It is important for a terminally ill patient and his or her family to know what their particular medical institution offers in terms of special services, even if they are able to rely on their own private resources. A visit to a hospital financial counselor to inquire about insurance benefits and payment plans is a wise move. In the rush to admit a patient, information is sometimes left out or incorrectly recorded. A fifteen minute meeting may avoid later stress and anger over incorrect bills. A conversation with a social services coordinator may provide you with previously unknown information, such as government entitlement programs, home health care services, and area hospice locations.

7. What should we do if it seems like nothing is being done or, on the other hand, things are being done that we know nothing about and have no control over?

There is no question that hospitals can be the source of confusion and agitation during these trying times. You may feel very calm and seemingly in complete control when all of a sudden a group of individuals sweeps in and rushes you away because Dr. So and So (Who? I didn't catch the name!) has ordered a MRI right away. Unfortunately, these types of events are inevitably going to happen. Again, it is always important to go to the individual whom you have identified as your primary contact. Have him or her paged in the hospital or called at home if the situation is truly upsetting. It is this person's obligation and responsibility to help. Most of the time he or she will know exactly what is happening and will be able to reassure you. If not, that person will be happy to investigate the situation as soon as possible.

8. How will my family and I pay for the hospital?

Monetary issues will be discussed in more detail in the next chapter. However, I will briefly discuss in this section the fiscal relationship between the terminally ill patient and the medical community. First, you should be aware that financial professionals in the health care field are experts in explaining complex billing procedures and private insurance or Medicaid/Medicare requirements. The labyrinth of hospital accounting departments can be more easily navigated with their assistance. If you are careful to correct errors and update pertinent information in a timely fashion, you and your family will be able to avoid any future hassles. Patients with even the best of insurance policies will most likely owe money on the remainder of their hospital balance. If the amount is significant, you may want to inquire about payment plans.

Often, several different physicians and medical organizations will send you a bill for their services. A hospital does not appear to be like a shopping mall where you stop in at different stores and expect to pay each time you buy something. However, it actually operates financially in a similar manner. For example, your family doctor, specialist, and radiologist may bill you separately. You may receive a request for payment from the hospital emergency room and/or the ambulance that carried you there. In addition, the television in your room and your medication will most likely appear as an additional cost on the invoice. This is because hospitals commonly contract these services and they are billed separately.

Above all else, it is important for you and your family not to panic. Hospitals and physicians usually do not want to be overly aggressive and often will not turn over outstanding bills to collection agencies until considerable time has passed. Check all bills thoroughly, ask questions when you do not understand something, and keep in touch with the appropriate financial professionals.

These eight questions will not answer all the problems a terminally ill patient and his or her family will encounter at the hospital. They also will not resolve any interpersonal conflicts with your primary caregiver.

However, America also offers the best medical care available in the world today. The most riveting book ever written about cancer, Alexander Solzhenitsyn's novel Cancer Ward, portrays a terminally ill individual in a Soviet hospital at mid- century. We have improved vastly over those primitive conditions. Yet, a patient and his or her family, who are understandably in severe distress, may not be able to appreciate a modern medical institution's efficiency, courtesy and helpfulness. That is perfectly understandable. Nevertheless, almost uniformly across America, hospitals are available to help terminally ill patients and their families. Interacting with medical organizations and health care professionals wisely will bring comfort and relief for those afflicted.