“I tip like crazy. They’ll remember me.”
I think I am a reasonable person. All in all, pretty average. I like to get where I’m going at a rate that is conducive with staying alive and not wasting lots of time. I sometimes take 3 hours to eat and other times I eat while in the elevator. Yin and yang. On the other hand, I feel that health care should inherently be a “measure twice, cut once” thing, unless you’re in trouble in the OR or the ED. Unfortunately, it is increasingly becoming anything but that.
Like, oh... for example, radiology in my town. “I want a (fill in the blank), and I want it now” is what we hear. I have learned there is another gear. “My amplifier goes to 11.” It makes me crazy. It would be different if these requests were a unit jockey calling with someone as sick as you can imagine, in need of answers NOW. But, it is almost invariably an outpatient study: symptoms for weeks, and not too bad. But a multifactorial symphony is blaring—impatient doc, impatient patient (oxymoron there, eh?), and system pressure. What the patient probably needs is “observation.” What they get is rapid-fire, kitchen-sink test ordering. “Yep, one of those MR scans. And that PET thing. And, can I get fries with that?”
I have a small suggestion. These same-day tests will only be done if the request is accompanied by a tip. You know what I mean—a little “something.” View those requests like showing up at a restaurant early or without a reservation. You might get it done, but it is going to cost you. As our reimbursements plummet, and that second career as a plumber looks more favorable, these tips may actually comprise the majority of our income.
Same-day MR? Can do. How about $50 for the radiologist, $20 for the staff and techs? Same hour MR will cost you—$250 for the radiologist, more for the staff, and a BIG tip for the driver who gets you there that fast. CT is very reasonable: $50, and we will get you done. PET-CT is tough: That machine is a time sump—same day, $250.
And, living now in NYC and having doormen, I’m thinking about that little holiday season “packing-of-the-bank accounts.” If I am consistently working your patients in, I would appreciate a little something at the end of the year. Don’t be timid. A nice watch, a case of good Scotch. If I really help you out a LOT—yes, for sure. I’ll take a Cayman—S model, please, in red? But, beggars can’t be choosers.
I think the only problem with the tip jar approach might come at tax time. I’m not sure I want to fight the IRS for scraps. We all know how THEY are.
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Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.