1. If we consult a specialist, that usually means we have no idea what's going on. Sometimes, we do it for "customer service" if a patient really wants the consult and doesn't seem to trust what we're telling them. If we know ahead of time that a specialist is going to say that they don't know the cause of the pain and there's nothing to be done, then in absence of customer service issues we usually don't consult the specialist. I'm sorry you feel you got a raw deal on that.

Why we focus on customer service issues is another interesting topic. It basically comes down to hospital admin, like most other bureaucrats, love customer feedback surveys (Press-Ganey being the most common) and doctors can get in trouble or even lose their jobs if their customer service scores drop low enough.

2. Unfortunately doctors are completely ignorant about the financial aspects of this. Likely the specialist didn't even know you would be charged $450 for his consult. I don't see any good solution to this problem, especially as we're taught in med school that the patient's health is the most important thing and financial aspects should be secondary. Not saying I agree or disagree with this, just that even if a doctor disagrees with this there's no way for them to change the facts.

I’m just about the most free-market person you’ll ever meet, but the current situation in the US is completely untenable. I’m beyond caring about how the insurance companies tie your hands, how you’re just a doctor focused on patient-care/“customer service” (that’s a new one) or anything else. Here’s the bottom line: doctors have the most to lose by not fixing this nonsense. Insurance execs, hospital administrators, and other various parasites can go MBA something else. You lot are the ones with specialized and non-transferable skills. If you all collectively don’t start using your knowledge of the medical system to propose real changes, then the rest of us about going to impose changes on your profession that I promise you will not like.

It's rather mind-boggling to have someone say they're completely ignorant on the financial end of things but simultaneously replying and seeming to defend what happened.

I remember helping a friend get plastic surgery, dealing entirely with a physician for the surgery before hand and then arriving at the hospital and being handed a request for several thousand dollars for the hospitals end of it. And when this was broached to the physician, he made noises whose meaning were somewhere between "I just work here" and "isn't that what you expect when you go to a hospital?".

I don't see any good solution to this problem, especially as we're taught in med school that the patient's health is the most important thing and financial aspects should be secondary.

I'm not sure why you knowing how this works means it is insoluable. An obvious solution is the California bill which keeps hospitals and doctors from making such outrageous charges (of hospitals think the consultants are necessary, they can find a way to engage without the out-of-network charges - as a "your problem, you should solve, not us" thing).

The sort of discussion veers in just weird implications - "I'm a doctor and I'm ignorant of these, that means you should be too and you avoid considering obvious changes to make thing more rational just as I do..."

It was a good doctor. I googled his name and apparently he is co-author of nobel-nominated work, so I think his time really worth much and I am little bit sorry ER bothered him about such trivial thing.

ER doctors really seemed to care, they tried to eliminate all possible things why my kid got stomach pain. Did x-ray, maybe even ultrasound (don’t remember) and ultimately it was nothing.

It was a surprise bill nonetheless, one I could barely afford at the time.

I have heard stories of some doctors and consultants making biased recommendations that are ultimately to line their pockets not cure the patient.

The problem is that the profit motive is hard to deny, simply because healthcare is run as a profit seeking venture, which makes money on the difference between the cost of running a test and the price a patient's insurance will pay. Pharmaceutical companies bribing doctors to prescribe specific medication doesn't help.

But, in the first place, these bills were never really valid: in no other market am I informed of the cost after I have received services. This fact is why the law was passed, though it shouldn't need to have been passed. The "contract" is already unenforceable.

It takes a lot of courage and knowledge to say yes, my child is in pain, and I will decline additional medical treatment and testing and just wait it out. I have declined a lot of tests and some interventions. I can do this because I have a physician in the immediate family who I can call for a second opinion at any time, and I read said physician's medical journals, and I have academic access to journals so I can do some of my own research and decisionmaking. And maybe I'm a little hard-hearted or hyperrational or something, and I can plan out a course of watchful waiting and stick to it much more than other people I know.

Of course. You're within your rights to refuse any medical test or procedure whatsoever, including one that would save you from imminent death, unless you're first declared mentally incompetent, which is not a quick or simple process.

But most people will trust the doctor when he says "we need this test to treat you effectively." He's the expert, and I don't want to bet my health on the possibility that he might be scamming me.

The single most helpful question I have if you're deciding on whether to take or refuse a test is this: "How will knowing the result change the course of treatment?" I avoided an intestinal biopsy once this way, as the answer was, "It won't. It would just be nice to know."