DISCOUNT DEALS OF THE MEDICAL TYPE
Most doctors in India, particularly those in the private sector and those practicing in smaller places, dread the term “discount.” It is difficult for a doctor to put a price on his or her professional services. How does one calculate? For someone like a lawyer, it may be easy. A lawyer typically receives half of the property in dispute. Well, maybe not half. It can be more, too. Can a surgeon set rates based on the patient’s potential lifetime earnings? However, the courts have established this formula to provide compensation to patients in the event of a mishap rather than determine the operating surgeon’s fees.
I envy my government colleagues, who do not have to bother about projecting the expenditures. Additionally, I envy my corporate colleagues who send the patient to the billing department with a cryptic note mentioning the duration of surgery and the estimated hospital stay. At smaller places, like where I practice, the surgeon has to include in the estimate the cost of the tea outside the hospital for the attendants.
This is a highly edited version of a typical conversation at my place:
Patient: What is the cost of surgery?
Me: X rupees, which excludes the cost of medicines and investigations.
Patient: Gasp! That is too much. The surgeon at my place quoted one-fourth (or one-fifth or one-sixth or one tenth) of that.
Me: Well, get it done there. I do not mind.
Patient: Of course not. We want the best for our child; we came because of your reputation!
Me: Thank you. But then, you have to pay for the surgery. Aside from the surgeon’s fees, there are many other payments involved.
Patient: We are very poor, sir. To get money for this, I must sell my ornaments (or land or sheep or cattle or gold or silver or vehicle or house).
Me: Oh, my God! I don’t want that kind of money. I’m not the only person in the world performing this surgery. I will direct you to the government hospital for a free procedure.
Patient: Oh, no, doctor. We cannot go to the government hospital.
Me: Why?
Patient: We have no idea who is there. We may not get optimal treatment.
Me: That is a big myth. The doctors at the government hospital are equally qualified, and perhaps even more, to treat your condition. They may not have time to answer your every query in great detail.
Patient: Of course, of course. You know, we can afford the fees.
Me: But you just said it was difficult.
Patient: Oh, no, we will put the money in, but we need a discount.
Me: OK. We will arrange for a 5% discount.
Patient: No, no. Please give us 25%.
Me: That is not possible. Please go somewhere else.
Patient: 20%
Me: No, leave, please.
Patient: 15%. Done. We are not going anywhere. Please also include medicines in the package.
Me: No, you have to buy the medicine.
Finally, the deal closes at 10%. It is really touch-and-go. There is a deep game here, and both parties know it. It is all the more confounding when the patient who is bargaining holds an iPhone. A useful tip for bargaining patients: when discussing fees, an intelligent patient will never wear fancy clothes or sport fancy accessories. In such situations, most doctors will be able to smell a rat easily. Ladies should avoid gold ornaments. Indeed, artificial gold is difficult to discern from real gold these days, but the patient is visiting a doctor and not a jeweler. As a corollary, you will never, ever get a discount if you are visiting the doctor on the way to a wedding.
My wife and daughter call me Discount Baba, hopefully affectionately. My wife criticises me for many things, but she believes that the word “discount” tattooed on my forehead is the biggest issue. No patient leaves without bargaining for the surgery fees. The discount is generally in two phases. The first phase occurs before the operation, and the second follows. Of course, this is when things go well. In the rare event that the results are not satisfactory, a hundred attendants will come baying for the doctor’s blood. The first act of compensation, of course, would be a complete waiver of the fees.
However, there is an extremely rare patient who does not bargain and pays the quoted price. It is both stunning and scary. I actually become uncomfortable when the patient does not ask for a discount and just leaves the hospital. In the follow-up clinic, I see a patient with a little bit of apprehension. Is he approaching with a benign and genuine smile, or with the malicious grin of a stabber? In rare cases, such as patients not asking for a discount, I worriedly call the hospital twice to make sure. Maybe they are preparing for a bigger lawsuit. All such thoughts gnaw at me while I spend a sleepless night.
Once, my aunt in Delhi offered to pay five rupees for an item when the shopkeeper quoted a hundred. My dear uncle ran out of the shop, afraid that the shopkeeper might start hitting him in anger. I used to run off, taking a cue from my favorite uncle to not be around when my wife is bargaining. However, after some years of surgical practice, I have now become so used to discounts that I start automatically asking for discounts wherever I shop. A new me stands defiantly and tries to take a discount. And when they refuse, I seriously get offended. I rarely get one, and even when I do, I can see a trace of a peculiar smile on the shopkeeper’s face. There’s just a slight twitch, but it’s clear that the crook has inflated the price and then made a scam discount.
Perhaps there is a critical inflation and deflation of price involved, where both the patient and the doctor are happy. But that rarely happens, at least in my case. Beyond a certain critical point, the patient runs off somewhere without coming back for a discount. One keeps learning. Is it an Indian thing that one forgets the cost price and looks at the discount amount while buying something? On the other hand, if it is general human nature, then perhaps there is some gene involved that confers an evolutionary benefit. Is there ever a real cost reduction—except (ahem!) for my patients, of course?