Is it Cancer?
Today I called someone who may have cancer. This is always a tough call, since at this stage, there are no clear answers yet. We often know more about what things are NOT before we know what they are.
- "There is something on the ultrasound that looks suspicious"
- "What is it?"
- "I'm not sure"
- "Could it be ... ?"
- "Cancer? Yes .. it could .. but it's not likely to be ..."
- "What should we do?"
- "We'll need to do some additional testing ... such as .. "
This is usually how it goes. I always say the "C word" early in the conversation. This gives us both permission to say it .. since it's always lurking in the background if we don't bring it out in the open. Next, I need to reassure the patient that the likelihood of cancer is small. This is often calming, but of course the worry persists. Why do I say that the likelihood of cancer is small? Because it usually is. Much more often, abnormal findings are just abnormal findings.
Of course we need to do our very best to follow through carefully, do appropriate and thorough physical evaluations, etc ... and not ignore abnormal findings. Yet the fear of the "really bad" outcome can be enormous and unnecessary, since a great deal of the time, the final result is reassuring.
----------
Last week's billing episode now resolved .. I tackled one this morning much more promptly.
6 months ago, I removed an infected sebaceous cyst from a patient's neck. My progress note adequately described the procedure and the indications for the procedure. The insurance company denied payment - insisting that it was a cosmetic procedure. We submitted the note - and they denied it again. So billing people call patient and tell her she must pay. She says no way .. and calls insurance company and they say ... ok .. re-submit bill .. we will pay this time. Bill got re-submitted in late May .. but patient still getting bills from us .. has appointment with me next week .. and our staff now being told to get the $$ from her when she comes. Feels bad ... so I call insurance company and very nice lady tells me that check was mailed and we were paid! ... I say think you and hang up.
.. but I wonder why it took so long .. and required so much effort.
Another unfortunate reality: being paid 6 months late after three submissions and many phone calls = a success.
