Something To Do With Money

        We used to have an old Doc in town who had the same answer for every problem.  Regardless of the issue at hand, when something was wrong he’d say, “I don’t know what the problem is here, but it has something to do with money.”

        Most people in health care want to do right by people, and they are easy to work with.  But, whenever I run into folks who will not act in the patient’s best interest old Doc’s adage can be used as a powerful  motivational tool.

       Take a case last month.  I had a patient with a couple risk factors and a good story for a pulmonary embolus.  (Blood clot).  I wanted  a CT chest to rule out a clot.  The little chart review person at the insurance company told my people we would have to do a plain chest x-ray instead.  With the diagnosis in question, that is a little better than a coin flip, but not much.  They would not budge.

       Often I have to call, but this time our referral tech was able to make them understand.

       “What should I tell them Dr. B?”

       “Hmn.  Why don’t you go with the BBQ speech?”


       In a minute she was back with an accession number.  The CT was approved. 

        The BBQ speech goes like this:

        “Y’all like BBQ?” 

        They usually say yes. 

        “Well, I’m glad, ’cause Dr. B says you might need to visit us for an extended stay.”

        “Why is that?”

        “He wants you to know if anything happens to his patient while you obstruct their care he keeps a lawyer on retainer.  And boy does this lawyer love BBQ.  We have the best down here.  He thinks it won’t take more than two or three years to sort out.  With her being a mother of three, he believes a jury would have enormous sympathy in the event of death from a delayed diagnosis of pulmonary embolism.”


        “Yeah.  He said not to worry too much.  This is a rural area, he doubts it would go for more than three mill or so.   Old Dr. B is  a very patient man.  Why he’s like a little terrorist; he ain’t going away.  You’ll love it here.  Like I said, the barbeque  is great.

         There are all sorts of variations on the theme, but the fundamental principle is always the same.  You have to speak to what motivates them.  I gave a up a long time ago trying to make them understand I hoped to help a human being; that matters to them not in the least.  But when you start to talk money they will often listen.  Like the Old Doc said, there’s something wrong here and it’s got  something to do with money.

        By the way, my patient’s blood clot treatment went well, and she should do fine.

Dr. B

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8 Comments on “Something To Do With Money”

  1. julius Says:

    Placebo effect, it works great!

    Again, another great post Dr. B. It’s informative, tells a great story at the same time, and it’s something I/we all can use in the future.

  2. drtombibey Says:


    Those of us who take care of patients gotta stick together, or the inmates (politicians/ administrators etc) are gonna take over the asylum.

    Dr. B

  3. I wonder, Doc, have you seen the movie “Sicko”? Some say that it exaggerates things, but from the doctors that I know, it really doesn’t. Insurance companies are disgusting and it’s horrible how hard it is to get the patients the treatment or check-ups they need. It’s one of the thing that truly terrifies me about living in the US – the horror stories I hear about how hard it is to deal with the insurance companies.
    It must be extremely frustrating as a doctor to have to think about the problems with money when all you want to do is help a patient!

  4. drtombibey Says:

    ms slightly,

    I need to see it. My guess it is is somewhat exaggerated, but has enough truth in it to make the insurance companies nervous.

    It is very frustrating. You fight for your people with one hand tied behind your back, but do your best.

    Insurance works well as long as you pay your premiums and don’t get too sick.

    Dr. B

  5. julius Says:

    In reply to slightly, as a med student, it is particularly hard to deal with insurance co. Not directly involved in dealing with them per se, but you are not taught the insurance company’s formulary (ie drugs they will pay for) for each co. while in school; so when getting into our clinical years, we as students are thinking we’re going to do some good, with the best drugs. These drugs are never/hardly ever covered. So in addition to trying to learn medicine, we also have to learn all the different insurance companies, and indirectly having to deal with them to give inferior medications to people. It’s all a hassle.

    By the way, the best “insurance company” I’ve found that helps the most: Wal-mart’s $4 plan.

  6. drtombibey Says:


    We have to keep you guys going. Someone will need to look after me in the Nursing Home someday.

    Dr. B

  7. Ted Lehmann Says:

    If the Obama administration really does its job, then maybe he’ll figure out how to bypass insurance companies or (doubtful) actually make them insurance companies rather than using the word “insurance” as a means to gather money to make investments with. They’re really not there to help distribute risk. That’s an idea from the past. – Ted

  8. drtombibey Says:


    They have a major task ahead of them to correct the major mess we are in.

    Dr. B

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