23 November 2018

Entitlement and the #mememegeneration

General Practice RedHerring

Finishing off my notes on the pleasant 38-year old patient I had just seen, I felt satisfied that she was now up to date with her CST. 

And the 21 minutes (and 35 seconds) of consultation time had been worthwhile in terms of a preventive health discussion, contraception advice, STI screen, and there was even enough time for her to vent about her frustrations about work, in addition to the HPV test.

But then came the call from the receptionist to inform me that the patient had

left without paying. Perhaps she had forgotten? 

Unfortunately, it appears she also conveniently forgot to turn on her mobile phone to answer calls from us over the following five days.

Hmmm …

This was hot on the heels of another seemingly innocuous consultation I had had with a middle-aged male patient only two days prior, for a chest infection. He too had left without paying and failed to answer our phone calls in the following days.

In what other industry do people get away with such bare-faced theft such as this? 

If someone tries to exit the local supermarket with $82 worth of unpaid groceries the security guards will have them on the floor in seconds. If someone drives off after filling up the car with petrol, the local highway police will be on the case in a flash, sirens sounding. 

And just try jumping the gates at the Flinders St station in central Melbourne if you want to see the PSOs leap into action, quick smart.

But walk out of the local, privately-billing medical clinic without paying for services rendered, and there seems to be no expectation of consequences, and certainly no penalty. 

Instead, we appear to give a collective, resigned shoulder-shrug and head shake, and turn to the government to provide us with the compensatory bulk-billing fee – less than half of what we’re worth – to recoup at least something from the consultations with these con artists. 

While I had spent the consultation minutes, focussing on these patients’ diet, exercise and treatment plans, their focus must have been on getaway plans.

That glazed look that I put down to them thinking about how to reduce their calorie intake or deciding on contraception alternatives, was, in fact, from the grinding of the mental gears of how to escape out the clinic door while evading detection.

When did health, or more particularly primary healthcare services, fall so far down the list in terms of being worth the expense?

Women with high incomes and pushing new $1000-plus designer prams demand to be bulk-billed, even though they are well-aware that we only bulk bill concession-card holders.

Men toting BMW car keys cry poor, asking to be sent to a bulk-billing radiology service. Patients about to depart on multi-thousand dollar overseas trips baulk at travel vaccinations due to their (minor) cost.

And I have lost count of the unpaid hours I have spent on dealing with requests from patients, from finding an appropriate specialist to speaking with concerned relatives. 

We all do it, of course, it’s part of the job. 

But what really grates is when this unpaid or underpaid work becomes expected – when you have the sense that patients feel entitled as opposed to appreciative, as demonstrated by my free-loading fee-dodgers.

This sense of entitlement is, of course, not confined to the world of healthcare.  

Talking to mothers about the career plans of their teenage offspring, being rich and famous seems to crop up fairly often as the key aspiration. What they do for a living, or what they achieve for the good of humankind, is far less important than the seemingly very achievable trappings of mega-success. 

The nearly instantaneous nature of social media gives the impression to many an adolescent that fame and peer acceptance is only a nose job or mouse click away. Because, let’s face it, it’s all about me.

And just to digress a little, if ever there was to be an emblem for the entitled generation, it would surely have to be the selfie stick. Nothing ruins the ambience of a major tourist attraction more than dodging these weapons of mass self-obsession that each require a metre or so of air space.

Being trapped with a couple of dozen strangers in a glassy gondola on the London Eye last year, the view of Big Ben was all but obliterated by a corps of selfie-stick diehards hogging the prime viewing position for almost the entire time. 

Glaring at them, I managed to push my way into the middle of the stick-wielding crowd, photobombing for all I was worth. Vengeance has no greater fury than a middle-aged Asian woman in a floppy hat toting a DSLR.

Entitlement is the new word for narcissism. When we are constantly told “you can achieve anything”, “you need to do what makes you happy”, “you deserve the best” and “you’re worth it” is it any wonder that a “me generation” exists? 

When my much-loved innercity park is invaded by 10,000 people on New Years’ eve for a free rave, leaving behind tonnes of broken glass and rubbish, these people obviously feel entitled to believe that the local council will pay tens of thousands for the clean-up. Especially when the event is then repeated the following year, this time with 15,000 people attending.

In the current climate, many people come to feel entitled to what they can get for free, or, in many cases, what they can get away with for free.

If a government subsidy for a GP consultation exists and there are no consequences for not paying the additional out-of-pocket cost clearly required in a private practice, what is stopping them from walking out of their local clinic without paying?

They forget that everyone pays. That healthcare is not “free”, and that funding comes from taxpayers. Private fees help this subsidy, which is already inadequate to cover the cost of providing high quality primary care to those who can’t afford to pay. 

Failing to pay the agreed fee is stealing, no matter how entitled a person feels.

Sighing, I close down the notes of my CST nonpayer. I hope one day she will recognise and appreciate the value of quality healthcare. 

And maybe she’ll understand it is no more free than groceries in the supermarket, and recognise that the security guard at Woolworths is simply not as generous and forgiving as we are, when faced with a shoplifter.

Dr Dawn Oi is a GP working in metropolitan Melbourne who hones her skills by writing referral letters all day 

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4 Comments on "Entitlement and the #mememegeneration"

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5 months 25 days ago
Then take a principled stand- do not claim the Medicare component – technically they have not given you permission to do so. Send them a private bill for the whole lot – you do have the advantage of knowing their address and Medicare number. If they ever want to see your practice again they will not be able to book without paying the whole bill first. Remember the Medicare rebate is the patients rebate paid to them not you. They owe you the whole lot, not the government. If they refuse to pay you could take them to small claims… Read more »
5 months 26 days ago

I agree. It was not like that in the 1990s. The Government had by stealth, entitled a whole generation of bogans to additionally maliciously and falsely make complaints which are then accepted by the regulators of AHPRA. They are not charged but glorified despite s 136 of National Law in all jurisdictions and the Crimes (Bullying) Act 2011 in Victoria.

Gary Kilov
5 months 26 days ago

Great article Dawn. Beautifully written.
At various times it had me smiling, indignant and frustrated.
A bit like general practice really.
Not entirely generational though. I have encountered no shortage of baby boomers with the same inflated sense of entitlement.

Vanessa Elliott
5 months 27 days ago
Dr Oi – assuming of course you are writing about your own experiences – why on earth would any self-respecting , fully trained and qualified GP, work in a Practice that did not fundamentally support you in ensuring timely remittance of your value in fees?! Goodness gracious – run – as fast as you possibly can! Find a new Practice, engage a new Practice Manager. Discover the (obviously!) hitherto unknown liberation of working in a supportive environment where Patients, Staff and Doctors alike are encouraged and taught to respect the value of your work – and ensure you go home… Read more »