Doctor's Fees...A Rant!

well, medicine isn't an exact science and you are paying for "best guess".

personally, i'm grateful to have a knowledgeable specialist looking after my newborn in NICU who is on call all hours of the day. this doc is driving a brand new jag and my medical aid is covering all his bills. don't ask me the exact amount as i haven't looked at the details. but from what i have seen, in 3.5 weeks, my son is in NICU and the only thing we are paying for is nappies and wipes that we have to bring in (oh and cotton wool).

i don't like the fact that some docs that i hear about think they can charge first world rates on third world economies. if you want to earn a first world salary, then move to the first world.
 
funny...just read the Hippocratic oath for the first time and don't see anything in there that says a doc will work for free.
 
Your argument about the cost of equipment and drugs and whatever else being a justification for doctors fees.

Ok lets read it. Explain Why Mr Business analyst
 
Rip-off. Netcare is about R400. That's the ER and doctor's fee.
I dont know anything about Netcare. We mainly have Life private hospitals here. Thats (the R1400) just the ER fee, it does not include the doctors fee. When I have used their ER rooms the doctors fee is one of the cheapest things on the bill.
 
@RiaX

Why did you not study medicine or become a doctor? Did you have a choice?

I wanted to study medicine BTW because that is where my interest is. Did not get in though after 5 years of application.

I'm into finance at the moment and in the process of becoming a CA. I wished I could be in medicine though. All the fuss about doctors having to study so long and doing internship cant be that bad compared to CA. CA has 4 years compulsory studies and the final year requiring all 4 subjects to be passed in one sitting, or repeat. There is a minimum of 3-5 years internship/articles where you earn a third of what doctor interns earn. Attorneys are even less. I dont think the fact of long studies and internship is the reason for high fees. I rather think it is a combination of the patient not really have an alternative choice with public health in the state it is in (or the public image thereof) and secondly the role medical aids play. Medical aids lower the bulk of the fee and because you contribute to it monthly, you have to make use of it. Lastly, opportunities overseas are lucrative for doctors, so they charge as much they can here because if they cant have it here they move to Canada etc and SA loose doctors.

The frustration with patients is that even though you contribute to medical aid, you often still have to pay in and have cash available. And it is not as if you can postpone if its serious. So is the problem high fees or medical aids being stingy?
 
Ok lets read it. Explain Why Mr Business analyst
Do you know whats the cost of medical equipment ? Lets leave the R&D costs because those are numbers beyond your imagination. Take an MRI for example. It requires specialised software, specialised computers, a liquid helium coolant (which costs about R200 000 per month per machine), the machine itself is going to cost about 10 million, not to mention a couple million to magnetically seal the room the machine is in. On top of that you require highly qualified people to operate it. So the procedure may only last a few minutes (because it has been designed that way to be comfortable for the patient) and you expect it to be cheap ? you think the neurologists equipment is any different ? hell even a scalpel is damn expensive and its just a blade. There are stitches that cost R20 000 why ? because they have been designed to disolve once you healed and its expensive to manufacture sterile equipment.
All the more reason you want people to use it. Why are CTs then still used? It has a much greater radiation risk, its contrast agents are more dangerous, and if anything I'd say the algorithms to calculate a 3D image are more complex. And what about PMRI which is only a fraction of the cost and much better for some applications? Medicine is indeed wasteful like that article said. Even so as doctors don't own the equipment themselves and you get a separate bill for it it doesn't affect the consultation fee.

Now imagine if they didnt have a high consultation fee ? they wouldnt be able to pay their support staff, the electricity bill for these machines and they wouldnt have an income to justify a loan with the banks in order to apply for a loan to make a 15 million rand purchase from general medical or siemans medical for diagnostic machines.
As I said I can imagine being sent the bill in any case. And everything doctors use they usually charge for separately in any case. You don't get a needle without paying a couple 100% above its cost.

And you want this specialist doctor to charge what ? R200 ? they not doing something simple like cutting grass. Also the cost of your health is your own fault, you not suppose to be jumping doctors if they dont refer you. When you go to another doctor you suppose to take all your lab works and history with you so the doctor can build a picture of whats going on, if not he IS going to repeat the tests so that he wont have a malpractice lawsuit on his head. If they refering you to every doctor around then your case isnt a simple case of pins and needles and they doing it out of your best interest.
He didn't say he wanted it for R200. He was referring to the doctor not wanting to do a R200 test when his fee is almost R1k. That is just mind boggling. If they don't want to do the necessary tests then really they have no right to an extra consultation fee if it's required later and if they didn't do everything that was needed even after all those years of study then it's only a partial service and they shouldn't get the whole fee. On the other point I've heard many times doctors still doing the same tests even when you do bring your whole history. Hell I've even heard of the same doctors doing the tests again but they can't do even one different test because it isn't "justified." It seems to be of no benefit then and is actually advantageous not to do so as you can then get a second opinion that isn't influenced in any way.

Bloods will be done multiple times depending on your condition because the status of your blood varies and changes over time with respect to diet, drugs and pathology progression.
While labs should sometimes be done again in most cases I've heard of it wasn't really "justified" to do so. For instance before parathyroid op you want to make sure it really is high calcium and not low calcium. Lab artifacts do occur and mistakes happen but 95% of doctors will do it 3 times and cherry pick one "normal" result then say all is fine. Ironically when it comes to a TSH test which isn't even a real indicator of thyroid status it only gets done once.

Why dont you rant about why ferraris are expensive ? or what aeroplanes are expensive ? because you dont need those things. Since when you are entitled for cheap PRIVATE medical care ? if you want entitlement to cheap/free medical care there is the state option which is open to all.
I don't think anyone has a problem with paying. What you like to ignore is that the same can be said for patients. Many people work even harder (actual physical labour) for the little they earn. Then you need to come back multiple times because they didn't do the correct tests or end up without a diagnosis even because they refused to do a test. All those years of study seems to be worth squat then and they are earning way more than what they're worth. Medical aids seem to agree. They have access to even more financial information than you and come to very different figures. Yes we all know they don't like paying but if doctors are charging 3x their rates there is a problem and I don't think it's with them as their rates for medicine and procedures are more or less in line with the industry. Besides they'll just up rates if they had to pay more.

And don't even come with the public health option. You only choose that if the other option is dying and you will die in a state hospital. I wouldn't have a problem with them otherwise if it wasn't for the long queues where nobody seems to be helped most of the time but their wards and theatres are a non-option. If public health care wasn't in the state it's in doctors won't be able to charge what they do.

Limit the doctors on their consultation and you will have no doctors, the decent ones will just close shop and leave. then what will you do?
Define decent. My mother had varicose veins removed. He removed the wrong ones and the tumor he removed grew back. I had a nose bleed last year. The guy charged about R500. The next day it started bleeding again. Had to go to the hospital for them to pack it. That night the blood running into my throat again. Hospital couldn't get hold of him, apparently on a plane to some conference. They phoned around and we rushed to another hospital where someone came in to cauterise it. Apparently this Indian doctor did the front with his little stick. I asked him if he can see it. Turns out the bleed was actually in the back at the concha. The whole procedure that Sunday evening cost just over R300 but it was worth more.
 
someone explain this strawman term? new thing for me.
Its origin comes from the ancient druid practice of burning a "man of straw" or as it is known a wicker man. It was burnt as a stand-in in place of real human sacrifice. When someone uses a straw man in an argument they are setting up a weaker or different version of the argument. This is often done by leaving out key aspects or exaggerating or understating points. It's a very effective form of argument if the new argument isn't easily distinguishable from the real one but it's intellectually bankrupt. In attacking the straw man version of the argument and refuting it the person then forms the impression that the real argument is refuted when it isn't. It's therefor important to point out a straw men. In this case Riax was justifying the cost of medicine and procedures which has nothing to do with doctors fees in most cases as it's something paid for separately.
 
@RiaX

Why did you not study medicine or become a doctor? Did you have a choice?

I wanted to study medicine BTW because that is where my interest is. Did not get in though after 5 years of application

I got in to study medicine, i declined. I have very bad stability with my hands (almost like parkinson) so I wouldnt have been able to perform surgeries or anything delicate, sometimes you got to accept your limitations.

Besides I like drugs and making them and being a pharmacist was always my first choice. Doctors work to hard for my liking.

EDIT:

I did not see your question at the end. No its not being stingy to complain. Obviously we understand it and yes there are rogues in the profession as with all professions. Though medicine is different, its a science that requires extreme skill and perfection, there is no room for error. That is why when people design equipment they design it using the best materials possible. Medicine research is also not easy to do, with the ethical implications it progresses very slowly, not like cellphones.

Though it is getting cheaper. Generic pharmaceuticals allow for cheaper treatment. As techniques are refined they become more effective and cheaper. For example, in the old days if you have arteriosclerosis with in the heart, you had to go for open thoraic surgery which is extremely expensive and dangerous since the heart must be stopped. Today its treated with stent at a fraction of the cost.

The future of medicine is cheaper as well as the future lies with nanomedicine.

If anyone is interested in nanomedicine here is a presentation done:

http://www.youtube.com/watch?v=d8djH0UmZQo
 
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sigh swa. Stop reading rubbish on the internet when you dont understand half of it.

Why are CTs then still used?

- Cheapest to equip
- reliable: tried and tested
- radiation is less than you get in standing a day in the sun.

And what about PMRI

its experimental ? dont be dumb. As trechnology progresses things will get cheaper. Until then MRI and CT will be used.

Even so as doctors don't own the equipment

They do. Who you think owns the equipment ?

You don't get a needle without paying a couple 100% above its cost

so the Dr shouldnt turn a profit ? please ...

If they don't want to do the necessary tests

and you know whats necessary ? I didnt know you have mbchb and an FC number in all possible fields. Wow.

they have no right to an extra consultation fee

You took their time, they have every right to charge you for it. Sigh these are simple things a 5 year old can understand this.

I've heard many times doctors still doing the same tests even when you do bring your whole history

Yes because we all know your cells in your body go "hold on guys they just did a test on us nobody do anything funny because we have to be cost effective" ... idiotic

most cases I've heard of it wasn't really "justified" to do so.

Really and you heard this from who a whining miser patient ? again how you know whether its justified please tell me this. Power of hindsight

Lab artifacts do occur and mistakes happen but 95% of doctors will do it 3 times and cherry pick one "normal" result then say all is fine

wow its called statistical significance. Like how you take the average of 3 blood pressure readings if the patient is anxious to prevent white coat hypertension. You really doing well tell us more. rofl

Ironically when it comes to a TSH test which isn't even a real indicator of thyroid status it only gets done once.

If you say so. Though that test is to see if the thyroid is malfunctioning or if its a malfunction with the hormone release from the pituatry does not warrant a second test. See when you use example to "show" off how much you know its shows you know nothing :p

Many people work even harder (actual physical labour) for the little they earn. Then you need to come back multiple times because they didn't do the correct tests or end up without a diagnosis even because they refused to do a test

They dont refuse to do tests like they out to get you. With the physical labour thats called capitalism, nothing we can do about that.

All those years of study seems to be worth squat then and they are earning way more than what they're worth. Medical aids seem to agree.

Medical aids dont "agree" with you, they trying to minimise spending.

You only choose that if the other option is dying and you will die in a state hospital

Too rich to go to state. Too poor for private and complains. This is utter rubbish ... im sure there are people on this forum that will tell you about the state. The state might not give you the first class treatment because its economy class but its will get you to your destination.

long queues where nobody seems to be helped most of the time but their wards and theatres are a non-option

Yes this is true. I cant argue with that. Unfortunately the government doesnt pay for the staff and the available staff try their hardest. I used to serve over 600 patients a day by myself when in the government sector. 10 pharamcists to manufacture, handle an outpatient (15 clinics each having abou 5 dr), inpatient (30 wards), the dispatch between stores and provincial supply, the 40 odd surrounding PHC. The volume is too much

Define decent

See its already started.
 
@RiaX

Why did you not study medicine or become a doctor? Did you have a choice?

I wanted to study medicine BTW because that is where my interest is. Did not get in though after 5 years of application.

I'm into finance at the moment and in the process of becoming a CA. I wished I could be in medicine though. All the fuss about doctors having to study so long and doing internship cant be that bad compared to CA. CA has 4 years compulsory studies and the final year requiring all 4 subjects to be passed in one sitting, or repeat. There is a minimum of 3-5 years internship/articles where you earn a third of what doctor interns earn. Attorneys are even less. I dont think the fact of long studies and internship is the reason for high fees. I rather think it is a combination of the patient not really have an alternative choice with public health in the state it is in (or the public image thereof) and secondly the role medical aids play. Medical aids lower the bulk of the fee and because you contribute to it monthly, you have to make use of it. Lastly, opportunities overseas are lucrative for doctors, so they charge as much they can here because if they cant have it here they move to Canada etc and SA loose doctors.

The frustration with patients is that even though you contribute to medical aid, you often still have to pay in and have cash available. And it is not as if you can postpone if its serious. So is the problem high fees or medical aids being stingy?
Which year are you in? and where are you studying?
 
Why are CTs then still used?
because its cheaper and doesnt use magnet.
It has a much greater radiation risk, its contrast agents are more dangerous,
they both use contast and can also be used without it


If they don't want to do the necessary tests then really they have no right to an extra consultation fee if it's required later and if they didn't do everything that was needed even after all those years of study then it's only a partial service and they shouldn't get the whole fee.
doctors know more about the necessary tests than you do.
On the other point I've heard many times doctors still doing the same tests even when you do bring your whole history. Hell I've even heard of the same doctors doing the tests again but they can't do even one different test because it isn't "justified."
was it really justified? problem is with the internet people can easily request an MRI for a simple headache because of the information they get there. now medical students syndrome is no longer for medical students only.

While labs should sometimes be done again in most cases I've heard of it wasn't really "justified" to do so. For instance before parathyroid op you want to make sure it really is high calcium and not low calcium. Lab artifacts do occur and mistakes happen but 95% of doctors will do it 3 times and cherry pick one "normal" result then say all is fine. Ironically when it comes to a TSH test which isn't even a real indicator of thyroid status it only gets done once.
even a crappy doctors knows that TSH is used to asses thyroid function. in hyperthyroidism, increased TSH suggest a pituitary/ problem. decreased TSH suggest a thyroid problem(graves, hashimoto adenoma etc). another point is that there are risks with some diagnostic procedures and doctors need a very good reason to do them because they will get sued if things go south because of something unnecessary.

And don't even come with the public health option. You only choose that if the other option is dying and you will die in a state hospital.
You couldnt have been more wrong.
I wouldn't have a problem with them otherwise if it wasn't for the long queues where nobody seems to be helped most of the time but their wards and theatres are a non-option.
long ques because of shortage of doctors yes. ive been in theatre a lot and you hardly see any patient dying there. thats unless there were other co morbidities that increases the risk .
If public health care wasn't in the state it's in doctors won't be able to charge what they do.
that applies to every service rendered by public and private.

the other poster answered some of the things i excluded here.
 
- Cheapest to equip
- reliable: tried and tested
- radiation is less than you get in standing a day in the sun.
I'll respond to this one by one.
- Yes but also partly because their widespread use has been established. Iow its cost is offset BY its widespread use.
- So is MRI
- Love how the sun argument is so casually thrown around. 0.4% of U.S. cancer cases is estimated to be caused by CT scans. With the 2007 rate of scans this estimate is expected by some to rise to as much as 1.5-2%. They are clearly not so safe as the sun. For one thing the radiation is different and the real metric used is to compare it to similar exposures experienced during the atomic bomb explosions in Japan.

its experimental ? dont be dumb. As trechnology progresses things will get cheaper. Until then MRI and CT will be used.
Of course it's experimental. The thing is you can have one for US$50,000. The experimental part is in refining it to make it even better. It is said that a medical advancement takes on average 20 years to reach mass market. Why that is nobody can tell as it's always available and needed well before that.

They do. Who you think owns the equipment ?
Not the doctor referring you. As someone here said it's owned by an outside party and all the doctors have access to it. Or do they all chip in X amount to pay for it?

so the Dr shouldnt turn a profit ? please ...
They turn a profit alright. A pretty big one. But you're ignoring the point that everything the doctor does is charged for separately so you can't claim all those extras are included in the consultation fee.

and you know whats necessary ? I didnt know you have mbchb and an FC number in all possible fields. Wow.
I knew the vitamin D test was necessary, it was! Even after presenting symptoms of hyperthyroidism I needed to ask for a calcium test. Surprisingly though it wasn't the usual high but borderline low. The doctor protested a bit against the T4 test but turns out I was right as it was high normal and almost on borderline advising against treatment as prescribed by the other doctor. Earlier in the thread Alan also remarked how his doctor didn't want to do tests until he did them at a private lab and found out what the suspected problem was. You really are full of yourself acting like all those degrees always mean you know better than the patient. :rolleyes:

You took their time, they have every right to charge you for it. Sigh these are simple things a 5 year old can understand this.
Nice taking it completely out of context. They have no right if they didn't do what they were supposed to the first time. We expect a professional service so if it's not professional... I wonder how that CPA applies to doctors? Perhaps we should start testing it?

Yes because we all know your cells in your body go "hold on guys they just did a test on us nobody do anything funny because we have to be cost effective" ... idiotic
Completely ignoring the argument :rolleyes:

wow its called statistical significance. Like how you take the average of 3 blood pressure readings if the patient is anxious to prevent white coat hypertension. You really doing well tell us more. rofl
You're misrepresenting what I said. They do a couple of tests and cherry pick the single result they want IGNORING the others. Most hyperparathyroid patients go undiagnosed for years because doctors IGNORED statistical significance. Because hey it's rare after all so the patient can't possibly have it. In reality it's estimated the figures are far higher and most people with it die without a diagnosis because of doctors underdiagnosing it. Your parents must really be wondering what's going on every time you're laughing on the floor.

Medical aids dont "agree" with you, they trying to minimise spending.
Within reason. When there was still specified rates all of the rates seemed to agree with one another. If they were really trying to minimise spending so much why did they pay the full rate then? Why is it only the doctors that hiked their rates? Explain THAT.

Too rich to go to state. Too poor for private and complains. This is utter rubbish ... im sure there are people on this forum that will tell you about the state. The state might not give you the first class treatment because its economy class but its will get you to your destination.
Sure there are people who'll tell you about the state. They'll also tell you it gets you to the destination you're trying to avoid. Economy class? More like slump class. Come on man, you can't seriously be defending it as being "good enough." I was in state hospital so I know what it's supposed to be like. It isn't supposed to be perfect but it was good back then. They even had the most modern equipment, which ironically was causing the problems. 10 years later I couldn't recognise the place as the same.
 
I'll respond to this one by one.
- Yes but also partly because their widespread use has been established. Iow its cost is offset BY its widespread use.
- So is MRI
- Love how the sun argument is so casually thrown around. 0.4% of U.S. cancer cases is estimated to be caused by CT scans. With the 2007 rate of scans this estimate is expected by some to rise to as much as 1.5-2%. They are clearly not so safe as the sun. For one thing the radiation is different and the real metric used is to compare it to similar exposures experienced during the atomic bomb explosions in Japan.

BS. Do you know what radiation is ? Because from what im reading you dont. Sigh yes our patients are still triggering geiger counter's 10 years after a CT. For the record a MRI doesnt emit any radition in the sense you thinking of. (i will give you a tip check ionizing radiation)

MRI is around and its more expensive than CT because of the COST TO RUN. An MRI unit will have 2000 liters of liquid helium to super cool its magnet. Do you know how much liquid helium costs ? R100 per litre in SA. Why BECUASE MRI IS A SUPERCONDUCTING MAGNET, you cant mise on the temperature then the machine wont work properly

Of course it's experimental. The thing is you can have one for US$50,000. The experimental part is in refining it to make it even better. It is said that a medical advancement takes on average 20 years to reach mass market. Why that is nobody can tell as it's always available and needed well before that.

Because its experimental ... stop arguing for the sake of it.

Not the doctor referring you. As someone here said it's owned by an outside party and all the doctors have access to it. Or do they all chip in X amount to pay for it?

They are wrong. They are owned by the radiology practice. Life, netcare, mediclinic have no say in what machines are placed within these rooms. The hospital owns the radiology wing nothing else. Not even their staff within the department. Gosh you dont even know how referals work.

They turn a profit alright. A pretty big one. But you're ignoring the point that everything the doctor does is charged for separately so you can't claim all those extras are included in the consultation fee.

Show me where you were charged for electricity ? you sat in the nicely air conditioned room ? show me where you were billed for the paper the script was issued from. Come post up your bill, as an out paitent there is no way you getting billied for all running expenses, HENCE THE FEE. His business he can charge what he wants, you cant have a say and you dont have a say. Just like the price of nike shoes in edgars. Cant afford it SHAME.

You really are full of yourself acting like all those degrees always mean you know better than the patient

LOL because generally we do the lay person reads a few things on the net they think they a) understand what they are reading B) comprehend the medical language C) able to relate it to the most complex device known to man (and you did what? 45 minutes of reading WOW), you know what we in the medical profession call patients like you ? ... idiots. We laugh our asses off over tea and coffee and we let your attitude be doesnt matter when your body declines in a good years you will pay the price and it usually comes back to us :D ... keep thinking you know more. What you just described is rubbish as well LOL.

You cant learn to swim by reading on the internet ...

Completely ignoring the argument

No you too stupid to even understand the point. Sigh really can a person be THIS DUMB.

They do a couple of tests and cherry pick the single result they want IGNORING the others

Its called investigation. Its easy to say with the power of hindsight. Then again I doubt you even understand this.

In reality it's estimated the figures are far higher

In reality ITS ESTIMATED ? please explain. Have you ever been in a clinical situation ? how many patients you see a day ? please enlighten me ? where do you even get this garbage from ? your @ss is not a source of information.

You speak as if you have EXPERIENCE. Anyone will tell you theory means **** WITHOUT EXPERIENCE, whether you a programmer, engineer, surgeon, chemist, plumber, electrician, mechanic .... EXPERIENCE is everything. I can find you theory saying that putting healthy fecal matter in the large intestine helps with IBS ... will you go tell people to start eating s**t ?

If they were really trying to minimise spending so much why did they pay the full rate then? Why is it only the doctors that hiked their rates? Explain THAT.

Its the law of the state.

I was in state hospital so I know what it's supposed to be like. It isn't supposed to be perfect but it was good back then. They even had the most modern equipment, which ironically was causing the problems. 10 years later I couldn't recognise the place as the same.

Its the same, just the paint has faded. Funding is used elsewhere. You were a patient once, Ive worked there for years seen 1000s of patients. The last meeting I remember we saw 800 out patients a day on average for the entire year we had a total of 4 incidences (things like the disabled patient feel of his wheel chair, ok that sad but so ? guys with stabs wounds and ER cases and we must worry about a oke that fell he wont die he can wait). The media likes to blow things out of proportion. This is like saying every arab is a terrorist - same thing you will die in state care.

Swa you clearly have no idea what you are talking about. You dont know how the business works (or any business for that matter). You have no idea on the law. Your biology skills are just very sad. You think your arguements are good but they are s**t. Every so called reason you claim is "estimated" "couldve" or simply made up come the first search result that google gets you, then you rave about it like you have a dissitation.

this is the last time im responding to your garbage, you can carry on its fine. Though you making yourself look silly. Have a nice day
 
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Doctors fees are justifiable.
Just because the diagnosis may be incorrect the service was provided and needs to be paid.
It's like going to a hair salon and choosing a colour. If it didnt turn out right you still had to pay.
Also the value of the fees may vary but as long as u know upfront then I don't see a problem.

Before ranting about doctors fees who should see what lawyers charge to fill in template forms like property transfers etc.
 
well, medicine isn't an exact science and you are paying for "best guess".

personally, i'm grateful to have a knowledgeable specialist looking after my newborn in NICU who is on call all hours of the day. this doc is driving a brand new jag and my medical aid is covering all his bills. don't ask me the exact amount as i haven't looked at the details. but from what i have seen, in 3.5 weeks, my son is in NICU and the only thing we are paying for is nappies and wipes that we have to bring in (oh and cotton wool).

i don't like the fact that some docs that i hear about think they can charge first world rates on third world economies. if you want to earn a first world salary, then move to the first world.


The amounts are quite literally huge for that but here you are talking about a very specialised field. The last thing you want is a nicu pead that's cheap. Our pead charges very reasonable rates now but during that time it was very expensive ( about 200-300% ma tarrif ). If you have a decent medical aid ( covers hospital and 100% tarrif ) and with GAP the balance is sorted. You would only suffer the normal costs of the child ie: nappies etc.

*edit* Oh and bills will still come through for about 2-3 months post NICU so keep a careful eye on them.
 
Is it just me or oncologists never get the respect they deserve ?

Here you have a person who has become a doctor and chose to pick a disease that is the most difficult to handle known to man. Their reputation with survival of patients is never going to to be a positive result and the sensitivity of the issue will result in a lot of angry family members (some get violent). Also the cost for chemo is not really the Dr's fault, cytotoxics are very expensive to manufacture due to the hazard they present. From a pharmacy point we get charges per gram to dispose of cytotoxic waste :/
 
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