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The Cost of Anesthesia and Ketchup

Last year my wife and I went to Iceland for a spring visit. On our last night, we wanted to get a bite to eat. The only restaurant open so late was the hotel’s. We were already used to exorbitant prices for eating out in Iceland. So, when we ordered french fries and salad (limited late night menu), we were not shocked by the $40 tab. The salad consisted of a few wilted leaves of lettuce. There might have been one tomato. I don’t remember anything else. And the French Fries were forgettable.

Then my wife asked for ketchup.

No problem.

When the server returned, she informed the ketchup packet was $1.

That’s when smoke emerged from my ears.

The $40 for the “meal” I expected. The one dollar for a packet of ketchup…that was outrageous.

Pause to think about that for a second.

That brings me to a recent call I had with a California plastic surgeon.

He told a patient the anticipated charge for the procedure. He explained that anesthesia would likely be $X. Sometimes, the case goes longer than expected, so the charge for anesthesia might be a bit higher. Presumably the patient heard this and nodded. Also, the cost for any extra amount for anesthesia would be minimal compared to the total outlay.

Well, the case did take longer than anticipated. And the patient was billed about $100 more.

The patient went ballistic.

The surgeon explained why the case went over and the extra unanticipated work that was necessary to create a better long term outcome. For that, the patient was appreciative.

Next, the surgeon offered to refund the extra amount billed for anesthesia. The patient was ecstatic.

So, crisis diverted. Everyone was happy.

My point is that patients fare better with known expectations than surprises.

Now, had I gotten my $1back for the ketchup, the trip to Iceland would have been perfect.

Just saying.

What do you think?

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By |2017-10-13T16:27:24+00:00October 10th, 2017|Practice management|4 Comments

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If the fries were nothin special, I would have considered asking the server to shove the little packet where the sun don’t shine – for $5.

Bradley J. Artel, MD, FACC, FASE

Years ago, one of my colleagues did a pre-op clearance for a patient who was to undergo cosmetic surgery that would cost in excess of $10,000. The doctor did the exam, performed and interpreted the EKG, ordered the appropriate blood tests and a chest X-ray, approved the results, wrote the letter to the surgeon, and most importantly, took responsibility for whatever the outcome might have been. He then told the patient that his [patient’s] health insurance did not have a billing code for a pre-op exam, so he would need to charge the patient $175.00 for the clearance. The patient… Read more »


In our current system of prepaid healthcare (let’s not call it insurance) patient’s expect to pay nothing (despite the fact that copays and deductibles have been going up for years). In the days before “health insurance” patients had a reasonable expectation that if they someone who rendered care to them there would be a charge. However as medicine has gotten more expensive there is more resistance to these costs because they are “unexpected”. Yet no one complains about paying $200 for a Broadway show ticket or even more for an NFL game ticket. This all comes back to what society… Read more »

John D Woody MD

Just got back from Iceland. $1 is a deal. Don’t go to Iceland to eat or buy things, 24% sales tax on top of outrageous prices. Had one suitcase, just for FOOD! Canada would have been a better trip! Cold, rainy, windy, geothermal, waterfalls, volcanic landscaping, accommodations expensive, northern lights and the gas station had the best FOOD.