Regardless of the specialty, doctors’ first communication with their patients begins with talking to them face to face, listening to their complaints and most importantly physically examining them.

Communication with doctors without face to face meeting

If you cannot reach a doctor personally regarding your complaint, you can contact him/her by phone, live video call and/or internet. Your doctor can give you some suggestions based on the impressions he/she has gained from the conversations. Among these suggestions, he/she may also ask you to have some laboratory examinations done. However, let’s not forget that the most important tool for diagnosis is to physically examine the patient. During the interview, the doctor cannot do this. Even if the pictures give some idea, they are never as effective and reliable as touching patients with hands, listening with ears, smelling a strange odor, and viewing the problematic area in three dimensions from different angles.

Medical examination

For most doctors the most important way to go to the diagnosis is to see and examine the patient physically. Today, as imaging and laboratory techniques have advanced so much, the examination may seem to lose some of its importance. This is not true. A good physical examination saves the patient from a pile of unnecessary tests and allows them to decide which tests are necessary. This means both saving time for the patient (as well as institutions) and reducing the financial burden.

Consultation fee

Since the emergence of medicine, the concept of a “consultation fee” has been developed. Physicians have to earn money to survive. For this, they charge a fee for each patient visit (at least for the first time). This fee is for the following services:

• Understanding the patient’s problem (ie diagnosis)
• Deciding the seriousness of the patient’s condition (Is it life threatening?)
• If it is a treatable condition, deciding how to do the treatment
  • Prescribing if medication is required
  • If a surgical treatment is required, to provide the necessary information about the surgery (whether the patient accepts or not).
• Suggesting to the patient that a new consultation by another physician should be done (the patient accepts the suggestion or not).
• Deciding that the patient does not have any problems and reassuring his/her (this is very important, especially in people with hypochondriasis).

Surgical patients

The situation may be slightly different in patients requiring surgical treatment.

Patients sent with an established diagnosis

In some cases, the patient may have been previously diagnosed and sent to an operator for surgical treatment. However, for the surgeon, this is a new patient, and although the diagnosis has already been made, the surgeon has to re-examine this patient, see the laboratory reports  and decide what kind of surgery to perform. The surgeon will then inform the patient about the surgery. All these activities require a high degree of knowledge and effort. Surgeons have the right to receive a consultation fee, whether the patient accepts the operation or not. It is wrong to ask the surgeons to do it for free just because he made a decision by looking at one x-ray graphy or only making one touch to one area. The important thing here is to make a decision, and this decision is made with the knowledge and experience of many years. It is the nature of labor to demand a wage in return.

Patients whose diagnosis and/or treatment could not be definitively established

Some patients may be sent to a surgeon before their treatment can be fully decided. The surgeon will make a very important decision here.

• This patient needs an operation. The reasons for this, how the surgery will be performed, the risks, the recovery period, etc. will be explained to the patient.
• Surgery is not suitable for this patient and the treatment should be performed by physicians from other branches. This will be explained to the patient with the reasons.

Both decisions are of vital importance for the patient and it is the physician’s right to demand a consultation fee in return. The complaints like “If he/she wasn’t going to operate on me, why did he/she get the examination fee?” are wrong. In fact, the surgeon may have saved the patient from unnecessary surgery and future setbacks.

Plastic Reconstructive and Aesthetic Surgery patients

In this group, patients who need to be diagnosed and who need to decide on the treatment method are in the majority. However, there are also patients who apply only for cosmetic surgery. For example if a person doesn’t like the shape of his/her nose, the only reason for going to the doctor is to find out how much this surgery will cost. Of course, these people also wonder what kind of surgery they will have, the risks, etc. Since these patients want to consult many doctors for the same request, they generally do not want to pay for the examination. Unfortunately, some of our colleagues (very wrongly) examine and inform such patients free of charge.

Buying a commercial product

The aim of business is to sell the product. For this, it must display its goods, declare its price and determine the differences between it and its competitors. Buyers decide which goods to buy with the information they obtain from stores, various printed and visual sources, media and the internet. They do not need to pay a visit fee to see the goods here.

Getting Treatment in Plastic Reconstructive and Aesthetic Surgery

According to the laws currently in force in Turkey, medicine is definitely not a business, and doctors cannot engage in advertising or similar initiatives as in commercial rules. However, the physicians must somehow announce their presence to the society. There are rules set for this. The physician can clearly announce where he works (address and contact information), his working hours, which diseases he/she treats, and his/her title. Unfortunately, in recent years, medicine has been seen as a commercial event, especially in western countries, and it has changed its practice according to the rules of free trade. Accordingly, before and after pictures (some of which may be computer-edited) are displayed publicly (often without the patient’s consent) on the internet and in magazines, implying and/or saying that the best surgery was done by them, and circulating untrue patient praise and advice in the virtual environment and such activities are common.

Finding the treatment that fits the patient’s budget

There are some cases where patients are right. The first of these is to know in advance how much the required treatment will cost. Most patients do not want to pay for an examination fee to learn an unaffordable treatment cost. There are several ways to find out the possible cost. The most common of these is virtual examination or contacting the doctor remotely. Prof. Dr. Ege Özgentaş provides this service free of charge. However, this also has its drawbacks. Operations are not performed in the same way for every patient. In addition, despite previously taken pictures being taken into consideration a completely different surgical plan can be made after the actual physical examination of the patient. The information provided by the virtual examination is also limited and not as reliable as in the real physical examination. For this reason, patients are informed that the information and prices given are estimates and may change after the real examination. In this way, although it is estimated, patients will have a rough information about the treatment and prices and can make a decision about whether or not to come for a paid examination.

Preliminary consultation with the physician

Many patients make requests such as “we will not be examined, we just want to get information” when making an appointment. There is no concept of “come to get information” in the doctor’s office. Procedures in the practice always require a fee. There are virtual ways to consult, as described earlier. However, not every physician is obliged to provide such a virtual service. In addition, especially during the Covid19 restrictions, some physicians also provided virtual services for a fee.

Conclusion

In today’s money and capital-first world, people search for the best and cheapest of every service on the internet (and social media) on many subjects. In medical matters, this can lead to wrong decisions. Because there is no control mechanism (yet) in the internet and virtual world. All kinds of false news can be published by giving false images and people can be deceived. The biggest task in this regard falls to institutions such as the Ministry of Health, Medical Chambers and Medical Associations. These institutions should disseminate objective and accurate information on diseases and treatments. This is somewhat done today. There is also a minimum (base) price list determined by the Turkish Medical Association for all treatments. But it has an annual registration fee and is only available for members. Prof. Dr. Ege Özgentaş has the opinion that it would be beneficial to publicly publish this list. Thus, patients can learn what the lowest cost of the surgery they are considering is. However, physicians who rely on their experience and skills can charge as much as they want above this basic price.

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Note: The above article was written for self-employed physicians. Institutions pay the fees of those who have social security in state-owned hospitals and outpatient clinics. Prices for paying patients are already fixed and a similar situation exists in private hospitals. There are no concepts such as free calls, consultations etc.