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Set a policy about extra exams in a single appointment

Practice Management. By Mike Norbut, amednews staff. Dec. 27, 2004.

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Maybe you have a name for them, like "two-fers," "freeloaders," or some other term that's probably best kept to the back offices at your practice. If you go a day in primary care without a family asking to get an extra exam out of one appointment, you probably wonder what's wrong.

The requests can happen under many different circumstances: a parent asking you to examine more than one child; a husband and wife who go to an appointment together; or even just friends, if they share the same physician.

Some of the requests, of course, are innocent, like the parent who makes an appointment for one sick child for later in the day, but by the time he or she arrives, another child is showing symptoms as well. There also are those families who, when you see their name on the schedule, you know will be asking you for a favor.

It's a delicate situation. On one hand, you have patients who may have been coming to see you for years just asking for a little extra advice. On the other hand, it's time wasted and revenue lost if you don't pull a chart and charge them for an office visit.

Whatever the circumstances, physicians should be prepared to handle patients asking for quick and seemingly harmless medical opinions. While doctors may hesitate to set ironclad policies, having a protocol in place can prevent them from wandering too far down that free-care road.

"We're torn between wanting to be nice guys and wanting to run a business," said John Sattenspiel, MD, a family physician with Salem Family Physicians PC, a three-physician practice in Salem, Ore. "If you talk to practice management people, they say, 'Pull the chart and make clear it's another appointment,' but if it's just a quick glance, it's hard to justify charging for that."