What Should Be Transparent In Healthcare?


I just received a complaint from a patient that the massive monster amount cerumen I had to pull out her kid’s ear cost an extra $79.  The mom stated I didn’t ask her to pull the wax out (I didn’t but it was implied) and so she shouldn’t have to pay.  She stated that they could have done the same at home (no they couldn’t).  She has some points, though. I just mark the EMR and the system bills her later.  Is my skill of retrieving this thing worth $79.  Probably, but the fact that no one knows the cost of healthcare is just stupid.  I am learning that now because I am starting my next practice, Forest Direct Primary Care, in 3 weeks and I am learning a lot about prices.  Did you know that a suture costs me $10 and the damn thing has an expiration date?  Or that the stupid little Histofreeze can is $300 and runs out in a jiffy? Back to the ear wax.   Mosts thing will be included in my new office so the wax removal issue would be irrelevant. If something is not included, patients will pay what it costs me to buy and I will know that price.  Since they will have to pay right there then the discussion is simple.  This comes with their $75 a month membership. That is transparency.

What is not transparency?  I also hate getting hit with fees later.  An example it the colonoscopy problem.  It you can a screening colonoscopy that is covered by your insurance then it is probably free.  If they pull a polyp out (and most of us have them) then the insurance calls it diagnostic and you may get stuck with the bill. Or, how, about orthopedic surgeons getting kickbacks from the prosthetics they put in.  That’s bad.  I get that.

What shouldn’t be transparent?  Well, check out this article.

  • Dr. Leana Wen wants her patients to know she was born in Shanghai, China, that she has no kids but would love to someday, and that she drinks the occasional glass of wine. She believes such transparency — along with a full disclosure about how she earns her paycheck — is a must for keeping doctors honest and helping patients get a sense about how their doctor’s personal views and financial interests factor into the care they receive.
  • On a new website she launched in the spring called Who’s My Doctor, Wen wrote in her profile that she receives 55 percent of her annual income from her clinical practice at the George Washington University Emergency Department in Washington and doesn’t get paid based on how many tests she orders or procedures she performs. She also disclosed the sources of her research funding and which hospitals and patient advocacy groups have paid her to give speeches.
  • Johns Hopkins internist Dr. Zackary Berger revealed on his profile that he’s Jewish and a Democrat. Dr. Tanner Caverly, a Unitarian, also described his work philosophy: to strive to practice in a way that meets the demands he places on physicians who treat his own family members. He and more than 300 other health care providers signed a “transparency manifesto” on the site stating that they believe a patient’s informed consent isn’t given “without doctors’ disclosure of how their financial incentives align with their treatment recommendations” and that “patients have a right to know” their doctor’s views on issues like end-of-life care, integrative medicine, and shared decision-making.

Go ahead and read the rest of the article on your own but I think you get the feel of what happens when someone swings the pendulum too far.  No one should have to disclose their religion, their political party or when their last bowel movement was. That’s a little less important than giving a price for ear wax removal.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “What Should Be Transparent In Healthcare?

  1. Sir Lance-a-lot
    September 19, 2014 at 12:20 pm

    Patients only get to know two things about me: My name and my title.
    I walk in and say, “Hi, I’m Dr. ‘Lancelot.'” That’s it.

    Now, there may be times when I find it helpful to the therapeutic relationship to add a little more, like”I got stitches in the same place when I was your age,” or “My fathers got the same problem, and he’s doing okay with it,” but if they want to know how I vote, they’ll have to come into the voting booth with me.

    • Pat
      September 19, 2014 at 12:49 pm

      Amen. I consider it optimum if the patient leaves the ER and can’t even remember my name.

  2. Dave Fitzpatrick MD
    September 19, 2014 at 8:11 am

    For the first time, I am going to disagree with the King. I believe that there is value is safely and (relatively) painlessly removing a cerumen impaction. They hurt and they can hurt a whole bunch. We have seen the sad results of individual’s or others’ efforts at removing these things. It ain’t pretty.
    My dad (82) tells a story about getting a typewriter repaired. “I handed it across the counter while describing the problem. The fellow listened, turned to an extensive rack of hammers, and chose one. He then tapped the machine on the side. He demonstrated it was fixed and said, ‘That’ll be $100’. I was shocked and I told him so. The repairman explained, ‘that’s $1 for the tap and $99 for knowing where to tap’.”
    Medical skills have value. In an effort at cost containment, transparency, or whatever, do not sell yourself short just because the admin schmucks want to devalue you into the poor house.

    • Doug Farrago
      September 19, 2014 at 8:30 am

      Dave, no you are not disagreeing with me. I think we are aligned on this. I agree that we devalue ourselves too much. I thought what I put in parenthesis showed my agreement with you. I was kind of being snarky about it.

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