GP - dispute over charges and professional conduct

Newaglish

Firstly, apologies for the huuuuge post, I’m just trying to keep it as factual and accurate as possible:

Full version

In June of this year, I became sick while at work with a gastric bug. It required that I take seven days’ sick leave from work. I visited my GP immediately to be checked out an got a sick cert for seven days. I paid €60 for this appointment. Coincidentally, these seven days immediately preceded a scheduled operation I had for a routine, elective procedure (tonsillectomy). Despite the fact that I wasn’t 100% better before the surgery, I decided to go ahead with it regardless, as I didn’t want to have to reschedule the operation and was looking forward to it being over and done with. Surgery went fine and the consultant provided me with a two-week cert for post-op recovery.

In mid-July, the HR department informed me that the policy in work was to claim for Illness Benefit in cases where sick leave was greater than three days and that I would need to get a form from my doctor in order to claim for this.

I called my GP and spoke to the receptionist, explaining what form I needed and what the dates were – including the period of both illnesses. I asked her if it was necessary to get the second illness certificate from my consultant who carried out the surgery, and she said that it would be fine to get this from the GP. The receptionist said she would speak to the doctor to confirm the dates and then call me back.

The receptionist called me later that day and said the doctor would need to see me to “check the dates”. I said that I had already explained the dates and I didn’t need to call in to do something that could be done over the phone – I said I was happy to speak to the doctor directly. The receptionist said that she couldn’t post out the forms and that I had to collect them in person, from the doctor and asked what time I would like an appointment for. I was feeling pretty unnecessarily inconvenienced at that stage but I agreed to call in personally to pick up the form. Before the call ended we had the following conversation:

Me: “Hold on – I’m not going to be charged for this appointment, am I?”
Receptionist: “The charge will be at the discretion of the doctor”
Me: “Sorry, I think there might be some confusion – I’m just picking up a form, I’m not actually sick and I don’t actually need to see the doctor”
R:“Oh, well in that case no, there wouldn’t be a charge”

I said great, see you in the morning, all was good.

Next morning, I went in to see the doctor and literally sat down, told her the dates, she signed and dated the form (without checking any of the details on her system) and gave it to me.

When I was leaving the doctors’ office, the receptionist called me over and presented me with an A4 sheet of paper outlining the €35 charge for a “review consult”. I explained that the girl I had booked the appointment with had confirmed there would be no charge. The receptionist apologised for the “miscommunication” but said I had to pay it anyway. I said it was unacceptable, explained why the receptionist had said there would be no charge, and that I wouldn’t be paying for it. The receptionist phoned the doctor upstairs, said “He’s refusing to pay”, paused while the doctor was speaking and then turned to me and said “That’s fine”. I presumed the doctor had explained why I didn’t need to pay the charge, and then left.

I assumed this was all over, until I received in the post on Friday evening what I can only describe as one of the most unprofessional documents I’ve come across in quite some time. Littered with numerous spelling mistakes and grammatical errors (some of which changed the entire meaning of the letter) – it basically was informing me that I refused to pay this charge and that I should “sort it” as soon as possible. It also said “However, just like accountants* we charge for our time, even if that is paperwork.”

*I’m an accountant

First thing Monday morning, I called the office and left a message. I was told they would get back to me. I called again on Monday afternoon, I was told they would pass on the message. I called for a third time on Monday evening (5pm) and I was told the doctor had only been in for the morning. I was pretty surprised that this hadn’t been mentioned when I’d called earlier at 2pm and wondered why she couldn’t still make a 5-minute phone call in that time. I explained that I would be calling again the next day to try to speak to the doctor and if I didn’t have any luck, I would happily call in to the office and wait until she was available.

I went home that evening and to my surprise, found another letter from the doctor. Naively I assumed this would be an apology, explaining that the receptionist finally told the doctor that she had told me there would be no charge. Sadly my optimism was misplaced. The GP was writing to inform me that she had called the social welfare office in an attempt to get my illness benefit frozen until such a time that I settled the outstanding €35 debt. I was pretty surprised that the social welfare office would hold welfare entitlements (to which people have legislative entitlements) on the basis of outstanding private debts. It’s possible that this is in the legislation although I’d be pretty surprised and I haven’t seen it.

I spoke to the doctor this morning explaining in a very calm tone firstly why I didn’t pay the charge, as I had been told in advance there would be no charge. She didn’t seem to care about this, again apologised that I had been told that but that the €35 fee was standard and apparently on a sign in the doctors’ office (I haven’t seen it). I explained that if someone in her office makes a mistake with pricing, it’s her mistake, not mine, and that I don’t have to suffer the expense to rectify it.

We didn’t get on to the topic of her attempts to freeze my illness benefit as she actually started to explain that illness benefit claims should be submitted to the social welfare within 7 days of you becoming ill and as a result, she had told social welfare to refuse my claim. I was appalled at this – she seemed to be taking delight in the idea that she could punish me through social welfare in order to extort money from me for charges that, in my opinion, she has no legal entitlement to. I told her that I was very disappointed in the unprofessional tone of her letter given that she hadn’t made any attempt to clarify matters with me before sending it. She became fairly agitated at this point, continued cutting me off and eventually raised her voice, said “I think you’re going to need a new GP” and slammed the phone down.

I don’t take huge issue with the €35 charge as I’m completely satisfied that I don’t need to pay it. I agreed a price with one her employees (effectively acting as agent), and they carried out the service. As this was a unilateral contract (i.e. it conferred no liability on my part), they could have cancelled the contract at any time prior to carrying out the service. What they can’t do however, is change the fee after the service has been carried out, citing an error on their part. It would be different if I arrived and they said “sorry, before you have an appointment we have to tell you it’s actually €35”.

My main issue is her conduct in contacting social welfare and trying to get them to cancel my welfare entitlements. To me, this smacks of professional misconduct / poor professional performance.

I’m wondering if people have come across a similar issue, what their thoughts are of the above and if I should make a complaint to the medical council?

tl;dr version

Disputing an outstanding charge with the doctor. Doctor has tried to cancel my illness benefit with social welfare in order to force me to pay the amount, which I don't believe should be paid. Who is in the right? Can I make a complaint?

jimmycrackcorm

Inform the doctors office that you are making a complaint to the IMC : www.medicalcouncil.ie, that it is unethical to attempt to get SW to cancel your claim purely on the basis of a payment dispute.

foggy_lad

I would look for a new GP or go in to see this GP in person and sort this out, you can also tell others about your experiences with this GP as word of mouth especially about "bedside manner" is very important for business.

dudara

Contact the Medical Council.

looksee

foggy_lad wrote: »

I would look for a new GP or go in to see this GP in person and sort this out, you can also tell others about your experiences with this GP as word of mouth especially about "bedside manner" is very important for business.

Presumably that would lead to another bill?

looksee

I think I would be inclined to compose a document pretty much how you have explained it here and send it to the doctor with a covering letter saying that you were disappointed with the standard of professionalism you found, but you understand that she is in a very demanding profession and maybe was stressed when dealing with this problem.

Since she has suggested it, and anyway your relationship has broken down, you will move to another gp, but in the meantime, if she does not wish to back down from the situation as you have outlined it, you will be obliged to forward the report to Social Welfare and also the Medical Council. (don't hold your breath for a response from them!)

wmpdd3

Your place of work should have informed you that you have to claim sw illneess benefit. We sign a letter when we start and we can be removed from the sick pay scheme if we dont claim the money. He should never have signed the post dated forms, sw were probably never going to pay.
as a consumer issue, the receptionest did act as an agent of the company and her words did form part of the contract you entered into. But it will be a losing battle, dont pay, report him to the medical council, move doctors and have your notes moved asap,

Ken.

wmpdd3 wrote: »

Your place of work should have informed you that you have to claim sw illneess benefit. We sign a letter when we start and we can be removed from the sick pay scheme if we dont claim the money. He should never have signed the post dated forms, sw were probably never going to pay.
as a consumer issue, the receptionest did act as an agent of the company and her words did form part of the contract you entered into. But it will be a losing battle, dont pay, report him to the medical council, move doctors and have your notes moved asap,

Could the doctor the op is in dispute with refuse to hand over the record's to a new doctor till the bill they claim is owed is paid?

Newaglish

Just to update people on the above - I spoke to social welfare who have no problems with the fact that my forms were late and say they have everything they need to pay the illness benefit and will do so. Notwithstanding that, in any case where SW refuse an application for illness benefit, my workplace reverses the deduction they took for the amount of illness benefit I'm due.

Cheers for all the replies - I'm going to look into making a complaint to the medical council based on their conduct, although as I have no actual damages, I'm not sure will they accept it? I'm not looking for anything for myself, I just think the doctor should be reprimanded for attempting to manipulate the social welfare system to extort money from patients.

If I have time tomorrow, I'll post up a (redacted!) copy of the letters I received from the doctor. To say that I was surprised to read them would be an understatement.

wmpdd3

I'm surprised the SW will pay out (not really like them, is it?) nbut that's great.

You may have to send a letter entitled a 'official complaint' to the surgery by registered post outlining you complaint and asking for a letter showing you no longer owe the money.

This is to prove you have exhausted their complaints procedure and now need to move on the medical Council.

Miaireland

Rather than reporting to the Medical Council I would make a formal complaint in writing to the Social Welfare Department about the Doctor.

There are strict rules that a Doctor has to adhere to with the issueing of S.W. certs and by the sounds of things the Doctor broke these rules.

In regards to moving Doctors you could always ask your new Doctor to request your notes if you prefer rather than having to get them yourself.

I do know that Social Welfare Certs have to be issued to the person who is claiming and that they have to be given to the person in question not posted out etc.

The Doctor should see you each time you get a cert but to my knowledge the fee is paid by the S.W. so you shoudl not have been charged unless you were given non social welfare certs (normally small white forms) as well or received any other treatment or advice not relatiing to the cert.

Newaglish

Thanks for all the responses so far. Just to illustrate what actually happened, and to give you an idea of the tone coming from the doctor, I've attached redacted versions of the two letters I received. Keep in mind two points:

1) I called them repeatedly once I received the first letter but received the second one before having any further communication with them

2) They do, in fact, have the correct phone number for me, contrary to what it says in the first letter. The first thing I asked when I spoke to them on Monday morning was to confirm they had the correct number on file, and the receptionist called it back to me.

3) The first letter says that I did pay. I didn't actually - you can tell that from the rest of the letter - but it's just one of the many mistakes that are made.

Newaglish

With regard to the medical council complaints - is there anyone that I can speak to before submitting a complaint; to see if I have a case? Or is that a question for a solicitor?

Newaglish

Newaglish wrote: »

With regard to the medical council complaints - is there anyone that I can speak to before submitting a complaint; to see if I have a case? Or is that a question for a solicitor?

Write a good strong letter documenting EVERYTHING you can think of, as accurately as you can regarding your situation to the Meidcal Council and send it in to them ASAP to get the ball rolling, you don't necessarly need to go to a solicitor. If you think it will give you peace mind do consult one before sending it in, by all means do. After that, AFAIK it is the Medical Council themselves who decide if you have a case or not.

mrsbyrne

This is one of the most outlandish things ive come across in manys the long day. This GP or any other GP cannot order Sw to freeze your Illness benefit. She sounds like a black-hat landlord threatening an unfortunate tenant with eviction, empty threats, nothing to back it up.You must bring this to the attention of the Medical Council

oggy8

Chat with Patient focus about making a complaint to the medical council...I dont have their contact details on me!

My own advice would be to definately change your GP....that doctor seems totally unprofessional...aside from needing a lesson in medical ethic's.:mad:

For the moment I'd hold off making a complaint to the medical council... I'd literally give her enough rope where she's quite likely to hang herself....;)

I'd write a nice polite letter to the doctor to request access to all your medical records pursuant to Section 4 of the Data Protection Act's....but I wouldn't tell her why you are requesting access to your medical records. If you do choose to change your GP, you would need to hand over this file to the new GP for continuity of care.

Now if she refuses access to your medical records under the Act's (which is something that's quite likely given her level of stupidity to date)....the next port of call is to make a formal complaint to the Office of the Data Protection Commissioner. You might also check to see whether this particular doctor is registered under the Data Protection Act's as being a data controller...its a statutory offence is those holding medical data fail to register under the Acts.

If this doctor does refuse access that refusal would also give you valuable additional ammunition for any formal complaint that you may want to make to the medical council.

I'd also write a note to the DSP about this doctor "threat's". The fact of the matter is that this doctor certified you as unfit for work for this period of time - so exactly how is she going to put a stop to social welfare issuing payment.

I'd contact your consultant and get him/her to re-issue the certificate for IB if there's any problems with social welfare. Each GP get's paid a set fee for every sw cert that they complete.

P. Breathnach

A great deal of this issue is discourtesy on the part of the doctor. That is not easy to act on.

What would really interest me is to know if the GP did actually contact the DSP, or if it was a bluff. If she did indeed make such a contact, then she was seriously out of order.

oggy8

P. Breathnach wrote: »

A great deal of this issue is discourtesy on the part of the doctor. That is not easy to act on.

What would really interest me is to know if the GP did actually contact the DSP, or if it was a bluff. If she did indeed make such a contact, then she was seriously out of order.

Miscommunication, discourtesy and poor professional standards. Personally speaking, I wouldnt waste my energies complaining about this GP, I'd just change my GP!

It would be interesting to see whether this GP made sure on her threat to contact social welfare though...to stop to the payment of the IB claim...though I very much doubt she done anything! She's a very stupid doctor to be documenting that kind of threat! The IB file of the OP would note any communications that was received from this GP....I should think!

UrbanSea

I say name and shame.


Also,I'd drop in her 35 euro in 1 cent coins.

DanWall

Is she a witch doctor?

dudara

UrbanSea wrote: »

I say name and shame.

Please do not name the doctor in question.

Also,I'd drop in her 35 euro in 1 cent coins.

No more than 50 coins can be offered in a sinle transaction as legal tender. (European Regulation EC 974/98). A shop or retailer can of course accept more but they are not legally obliged to do.

rmnrgn

Welcome to the real world of medicine in Ireland. As part of the introduction my I also suggest that you accept this experience as a learning tool and move on.
I wouldn't bother with the Medical Council as you'll have gray hair waiting for them to do anything or indeed even deign to respond to you. (Although I do know that the board was changed recently to include more non medical members so maybe......)
Ask around your circle of friends for another GP and then ring the surgery to see if the will accept new patients. Also ask for their fees and any other charges eg paying double for mother and child consults. Once you have a GP that ticks all the boxes, ask them to request your notes from your current GP.

UrbanSea

dudara wrote: »

Please do not name the doctor in question.



No more than 50 coins can be offered in a sinle transaction as legal tender. (European Regulation EC 974/98). A shop or retailer can of course accept more but they are not legally obliged to do.

I knew that but she might not.

Mr. Presentable

This looks like a misunderstanding. It is plain from the letters the doctor's first language is not English, so tone and intent can be misplaced.

The receptionist made a mistake, conceded as such by the OP. In this case the OP must pay the standard fee, much as a mis-price in a shop, as he knows it was a mistake. He has no "contract with an agent".

With resp of the threat to interfere with Welfare payment, the doctor is clearly out of line here.

Newaglish

Mr. Presentable wrote: »

This looks like a misunderstanding. It is plain from the letters the doctor's first language is not English, so tone and intent can be misplaced.

The receptionist made a mistake, conceded as such by the OP. In this case the OP must pay the standard fee, much as a mis-price in a shop, as he knows it was a mistake. He has no "contract with an agent".

With resp of the threat to interfere with Welfare payment, the doctor is clearly out of line here.

Firstly, the doctor is Irish and educated in TCD, although I do agree that's pretty surprising from the way the letters are written.

I'm not sure what you mean about paying the "standard fee". Any price listing is an invitation to treat from the service provider, it doesn't form part of the contract of sale particularly if I'm told in advance there will be no charge. If this is a mistake by the receptionist, who is the only person I can speak with prior to my medical appointment, the cost should be borne by the service provider rather than the unsuspecting customer. That's what stops them from turning around and charging 50, 100, 500 euro or whatever they decide is appropriate.

Mr. Presentable

Newaglish wrote: »

Firstly, the doctor is Irish and educated in TCD, although I do agree that's pretty surprising from the way the letters are written.

.

Holy crap!!! Did she get a 5 year old to write them?

drkpower

Unfortunatealy, you dont have a case at all (aside from the 'freezing your SW payments bit which sounds a bit weird!).

This extract from your OP shows why:

Me: “Hold on – I’m not going to be charged for this appointment, am I?”
Receptionist: “The charge will be at the discretion of the doctor”
Me: “Sorry, I think there might be some confusion – I’m just picking up a form, I’m not actually sick and I don’t actually need to see the doctor”
R:“Oh, well in that case no, there wouldn’t be a charge”

I said great, see you in the morning, all was good.

Next morning, I went in to see the doctor and literally sat down, told her the dates, she signed and dated the form (without checking any of the details on her system) and gave it to me.

It seems that the receptionist was under the impression that you were simply collecting an already completed form. You werent. You saw the doctor and she filled out a form.
While €35 might be a bit steep, it is clear from your own description of events that the service you received (seeing the doctor and her filling out the form) was not the service that the receptionist indicated would be free (simply collecting the form).

Newaglish

drkpower wrote: »

Unfortunatealy, you dont have a case at all (aside from the 'freezing your SW payments bit which sounds a bit weird!).

This extract from your OP shows why:

Me: “Hold on – I’m not going to be charged for this appointment, am I?”
Receptionist: “The charge will be at the discretion of the doctor”
Me: “Sorry, I think there might be some confusion – I’m just picking up a form, I’m not actually sick and I don’t actually need to see the doctor”
R:“Oh, well in that case no, there wouldn’t be a charge”

I said great, see you in the morning, all was good.

Next morning, I went in to see the doctor and literally sat down, told her the dates, she signed and dated the form (without checking any of the details on her system) and gave it to me.

It seems that the receptionist was under the impression that you were simply collecting an already completed form. You werent. You saw the doctor and she filled out a form.
While €35 might be a bit steep, it is clear from your own description of events that the service you received (seeing the doctor and her filling out the form) was not the service that the receptionist indicated would be free (simply collecting the form).

But at this stage she has already booked my appointment to see the doctor and confirmed it afterwards?

January

Doesn't the doctor get a fee from Social Welfare for filling out those forms and seeing the patient to confirm it? It even says it on the back of the form, so she was basically getting a fee from DSP AND charging you a fee for filling it out?

Hal Emmerich

What age is this doctor?

Newaglish

Hal Emmerich wrote: »

What age is this doctor?

I guess around the 40 mark. Graduated in 1995, qualified in 2000, according to their website.