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Medical specialist appointment - cancellation

I have a serious medical issue.
In early 02/21 I called to make an appointment with a particular specialist. I was told she could see me in mid March, but that would be a tele-health appointment. I asked what the fee would be (circa $400, ie the same as a face to face meeting) and promptly rejected tele-health. I asked when I could see her face to face. I was told 6/04/21 and I accepted. I was told that if I cancel within 2 business days of the appointment date, then I would be up for the cancellation fee.

2 or 3 days before the appointment date I was sent a reminder of the appointment and asked to reply to confirm my attendance. I did so.

On 6/04/21 about an hour before the appointment I received a SMS informing me that the doctor just changed the appointment to tele-health (no reason given, no apology made) and I will be called at the appointment time.

I immediatly called the practice and asked if the tele-health is to be bulk billed because I am not paying full freight for a lower quality appointment. I made clear that I was assured in 02/21 that the appointment would be face to face. That is why I waited 2 months!
I was told full freight would be the charge for tele-health.

I said to the receptionist that this in fact a unilateral cancellation by the doctor of a service agreed to and a lower quality substitute is being offered. I rejected the tele-health and asked when can I see her for a face to face.

I was told “we have a couple of days in mid May”. Before agreeing to a date I asked “is there any guarantee mid May will not at the last hurdle be unilaterally changed to tele-health”? The receptionist could not guarantee that it may be changed, like the 6/04 appointment was. I did not proceed to make a new appointment.

To find an alternative specialist is quite hard. So far no luck.
Question: Can NSWFT or NCAT compel the specialist to provide the service (without delay) contracted in 02/21, given an alternative is either hard to find or if found, will require a long wait until an appointment is actualised.

Note: I am not after money. I am after seeing this doctor and arranging medical tests asap. I really do not have the stamina to wait another 3 months or so for another specialist.

All views welcome.

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Today is 16/4 and you posted your booking was 6/4. Was that a typo?

My first response is the surgeon is quite full of herself and ethically challenged regarding her business practices.

I doubt it, noting they cannot compel any business to do anything.

Since the government mandate on bulk billing telehealth during the lockdowns GPs have also joined that ‘give me the money’ approach to their customers, and we are their customers not that they care since a good number are no longer taking new ‘patients’.

Your only path forward seems obvious. Pay the fee for a telehealth consultation and play the game. During the consult consider if there was anything she could have gleaned about your case face-to-face that was not done. Share your views with the specialist, who will probably hold fast.

As an aside my long term GP has been really good but the practice she is in is increasingly focused on maximising revenue and income to the point of penny pinching. I shared the issues I had and her only response was that she was obligated to adhere to the clinics business practices, and most local clinics are now ‘pay for play’ (ie not bulk billed and now more than 2X over the schedule). I found an excellent doctor in a bulk billing clinic nearby that reinforces one does not always get more for paying more. Specialists are not so easy…

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What information do you have that says that they ‘guarantee’ a face to face appointment?

Notwithstanding this, do you have any information that states that you must have a face to face appointment and what happens if there is a change?

Irrespective of the above, the specialist is likely to say that due to Covid (and possibly their Covid Safety Plan) that they need to minimise face to face appointments and where possible, hold teleconference appointments. If this is the case and your consultation can be done over the phone, they could be in breach of their Covid safety plan and subject to infringement notices/enforcement action if they did a face to face consultation.

So legally, there may be no choice but to have a teleconference if the specialist deems that this is the most appropriate consultation method.

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Thanks for the reply. To clarify: In Feb I booked for a face to face for 6APR. Less than an hour before the consultation (on 6APR) I was told it will be tele-health and cost the same $400. I wanted face to face as I prepared a history with logs etc which cannot be explained properly on the phone, but makes a lot of sense if handing it to someone and explaining what’s what.
The tele-health can be arranged for mid May and the required testing no doubt a month later, as there is a wait list.
I bit the bullet today, called around, found another physician in the same specialty (granted I don’t know how good he is and he is a little further away) and booked in for next week. If indeed I find him unsatisfactory, at least I would have performed the test (circa one month after next week’s consultation) and then have those results to follow up with him (if he’s good) or if he’s not satisfactory, I can partake with the original physician, by tele-health as by then I will not need a face to face.
Unsurprisingly the physician booked for next week’s fees ape those of the original doctor.

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Emails to/from the receptionist at the facility clearly demonstrate that a face to face was booked and was unilaterally changed by the doctor. The receptionist apologised for this.
Of course it was nice of her, but the fault lies with the doctor.

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I have emails showing my intent was face to face meeting and certainly not tele-health. That is why I turned down appointments in March which were all tele-health. The doctor returned to face to face on 1 APR, hence I delayed making an appointment until her until APR.
What I find most objectionable is that the doctor was IN the practice when I was to have the face to face, so said the receptionist.
and was to attend the pract

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I doubt that argument would fly.
If it possibly could, why was I told categorically that as from 1APR face to face is the modus operandi of the doctor?
The email from the practice makes clear that some patients are consulted via tele-health and some face to face.

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It would. The specialist may have been anticipating that restrictions would have eased by now and that more face to face can occur. Many businesses are hoping that restrictions are eased quickly so things can return to pre-Covid conditions.

The relevant agencies where you live take non-compliance with Covid Safety Plans very seriously (see the other link as an example in my previous post). If you look at the linked RACGP template document, one of the measures is:

encourage telehealth consultations (where appropriate)

It has been a standard measure with doctors and specialists for about 12 months. It isn’t something new and unfortunately because of COVID, there has been disruption to pre-Covid standard practices.

It may be that they have assessed your case as being suitable for teleconference rather than face to face to meet their safety plan. This would be reasonable based on the current environment we all live.

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I hear you on the point of safety plans regarding the coronavirus, but in talks with the receptionist I learned that the practice does take face to face patients, in fact the doctor took face to face patients the previous business day I was told.
I think the change was to suit the doctor on a particular day or week. For her benefit and not in compliance with any regulation.
Anyway I have solved the problem to some degree by finding another specialist via an online search who can arrange the test I want. Of course I have no idea if this newly found fellow is any good, but I don’t have to worry about that at this point as I am after a test analysed by a hospital and thereafter a face to face with him or any other available specialist to discuss the result.

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As outlined above, a doctor can determine whether a face to face meeting is required. If it isn’t and what is likely to be the case under the COVID safety plan, they can arrange teleconferences to those patients that don’t need a face to face consultation.

It could be that these other patients needed a face to face consultation, while your particular consultation could be done by teleconference.

I wouldn’t hold your breath…it is possible that the doctor/specialist may also do a teleconference rather than face to face when the results are received. Don’t be disappointed if this is the case.

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You could make a complaint to the Health Care Complaints Commission https://www.hccc.nsw.gov.au/ as they are tasked with hearing complaints about Health Care in your State at the following address https://ecomplaints.hccc.nsw.gov.au/myComplaint or find out further information by phone at 1800 043 159.

NCAT or Fair Trading will very likely not consider your complaint as no service was provided and Health Care has specific Complaint proccesses in place for those matters nor did you have a binding contract but rather it was an offer of appointment which could be cancelled/amended for any number of reasons that the provider does not need to explain to you in detail. They may even decide not to provide a service to you as a private patient, if it was a Public Health facility you would have more rights about being seen but even with that dates and times and method of attendance could be changed for a vast number of reasons that again they do not have to explain in detail, but if you did complain they would need to respond to that complaint to the relevant authority.

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Have you considered that your ‘history with logs etc’ could be emailed to the Dr. with a request for her to peruse them prior to your appointment ? This works for me.

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Good points. Thanks.

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I thought of that but then I may be up for double the fees if the doc says that she anticipated the consult to be at the upper end of the $300-$470 fee (let’s say $470 because my case is complex) and that as I provided her with paperwork before the consult, which I did as a courtesy with no expectation that I would be charged additionally for her reading that, then I would possibly be charged for that as well. She could claim that she provided me with two consults. I am unsure if such a position could be sustained.

As indicated, I found another specialist (whose experience and reputation) are unknown to me, but at least I can see him this week. Once I rcv the test results I’ll have to consider who to consult for an explanation. For that consult I am happy to have a tele-health chat.

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You could make a complaint to the Health Care Complaints Commission

https://www.hccc.nsw.gov.au/ as they are tasked with hearing complaints about Health Care in your State at the following address https://ecomplaints.hccc.nsw.gov.au/myComplaint or find out further information by phone at 1800 043 159.

Whilst I sympathise with the patient, I’m not sure that they would be able to do anything in reality.

In defence of the medical specialist, she could reasonably argue that in this case, a telehealth consultation was a clinically suitable method for her to diagnose and present a treatment plan. Particularly in these Covid times.

Other factors
Was this the first time this patient had seen this or any other medical specialist?
Was there a referral letter from the patient’s GP stating exactly the patient’s condition (in detail)
Was there any need for a physical examination?
Had laboratory tests been sent to the specialist prior to the appointment.
Had medical imaging details been sent to the specialist prior to the appointment.
Just some alternate thoughts on the matter.

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I don’t dispute the right of the specialist to a telehealth appointment. In fact that is what I was offered for March and reje ted it in favour of a face to face in April which was confirmed 2 days before the appointment and was unilaterally changed to telehealth one hour before the appointment.
Also a shorter telehealth appoinment should be far cheaper than a face to face, I would think. But this doc wanted the same $.

As to your other points:

Other factors
Was this the first time this patient had seen this or any other medical specialist?
No, I saw one 2 years ago who has since retired.

Was there a referral letter from the patient’s GP stating exactly the patient’s condition (in detail)
The referral was brief mentioning that I would inform the specialist in detail.

Was there any need for a physical examination?
Yes.

Had laboratory tests been sent to the specialist prior to the appointment.
No labs needed.

Had medical imaging details been sent to the specialist prior to the appointment.
I was told by the medical practice to bring previous reports (from the former specialist) to the face to face.

Just some alternate thoughts on the matter.

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No necessarily. A specialist may take some time to review case history, past test results and other paperwork etc before the appointment and/or complete consultation notes/prescriptions/referrals/Medicare claims etc after an appointment.

While the appointment itself could be say slightly shorter, usually a time allocation is made for an appointment by a doctor. This is why when one visits a GP, it could be a short consultation for a simple visit (e.g. getting blood pressure done or getting a referral) to a longer consultation for say temperature, blood pressure, ear and throat examination, listening to chest, sugar levels etc. For these two consultation, the Medicare or patient charge is the same for the above reasons. A specialist is no different.

Having a standard consultation time (say 15 minutes) is standard across the medical profession and also many other industries (lawyers, plumber etc). If you hire a plumber or lawyer, they charge by time blocks not by the exact number of seconds taken to do the work.

I can’t help. But I wanted to let you know I hope you get somewhere with all this! Very upsetting for me to read your comments, as to me it all seems extraordinarily unfair: changing at the last minute WTF, that should NOT be allowable… sheesh. So sorry you’re going through this, I send you much strength and courage and wish for the best outcome possible for you as this must be so frustrating and affecting your health negatively. Big hugs.

Many thanks for your kind words. I managed to see another specialist who as I requested organised the tests which as expected will take place in 6 weeks. No matter who I saw initially, I would wait 4-6 weeks for the tests, so I am glad things are moving ahead.

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Hi, I can’t recall if I replied on this issue of date but “yes” I posted my comments on 16/04 but the face to face appointment which was axed was for 6/04. I rejected the substitution of tele-health. I hoped that in the days after 6/04 that a rescheduled face to face would be agreed to, but 10 days later, still nothing booked, I decided to post my saga.

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