The patients speak up:
"My father had a basal cell carcinoma on the side of his nose," a skin cancer like President Reagan's, a woman writes.
"So I asked about a dermatologist, and the home her father's residence called one in. When the report came back, the pathologist sent my husband a copy. My husband was a pathology professor, and he could tell from the report that the dermatologist hadn't gone far enough. There was cancer right out to the edges of the sample, posing a risk to some cells beyond it.
"I called the dermatologist, and he said, 'What are you worried about? Your father's 85.'
"I said with some restraint, 'But he would like to keep his nose. He thinks he's going to live to be 100.'
"I then took him to another dermatologist."
The same woman, long close to the medical world, says: "Despite 'informed consent,' doctors are loath to tell patients what to expect in non-life-threatening situations.
"Radiation treatment can be more agonizing than the disease it is used for, but, when my husband had cancer, his doctors never told him to expect the great weariness, lack of interest in life, nausea, etc., that came with radiation treatment.
"He was convinced that his increasing debility was due to advancing disease.
"The head nurse finally talked to him at my behest about his symptoms being normal for people with intensive X-ray treatment. I had tried to tell him that I thought they were normal reactions, but I wasn't a professional.
"He accepted it from her and became more optimistic. He lived another five years."
A Washington woman, formerly married to a doctor, phoned to say:
"I just had an experience with an orthopedist. It was like Mastercharge Medicine.
"I got to the physician's office. I'm used to being billed and paying within 30 days. Instead, I was told I'd either have to pay up front or put the bill on a charge card. They really pushed for it. The office manager told me, 'We don't send bills.'
"I signed a charge slip. I had no choice. I was an emergency patient -- I'd had an accident and hadn't been walking."
Then, she added: "I had 12 minutes of the doctor's time. He talked at me -- he didn't give me a chance to ask questions. I had some neck and back problems, but he wasn't listening. He did watch me walk on crutches.
"But I wasn't helped toward rehabilitation. And I learned later that I was holding the crutches in the wrong way to achieve normal gait."
More and more doctors -- or, mainly, their office staff -- are asking patients to pay on leaving or, commonly now, use a charge card. These physicians often post a sign saying this cuts their overhead -- the indeed high cost of billing -- and helps them hold down their fees.
In that case, this woman said: "I should have been told on the phone about their payment policy when I made the appointment. Then I'd have been prepared.
"Also, if I'm going to pay for medical care like I pay for my dress or car, I want a tangible product. I'd like to know how much I'll have to pay per minute or per 15 minutes. And my expectations of physicians are greater than what I was granted."
Sometimes you have to push to get past the staff.
Someone I know tells this story: "My wife decided one noon to try cleaning out some seemingly troublesome ear wax with a drugstore ear-drop kit, but by mid-afternoon she nonetheless had a fierce pain in one ear.
"I called a nearby ear doctor to ask him to see her. The woman who answered said, 'We're about to close up. He's leaving in five minutes.'
"I said, 'Will you ask him?'
"She came back to the phone and said he would wait if my wife could get there in 15 minutes. I said it would take a bit more but she'd be there as soon as she got parked and up to his office.
"His diagnosis was otitis media" -- an ear infection that can threaten hearing and requires prompt attention -- "and the doctor told her it was a good thing she came in."
The lessons to patients: It pays to be firm. It's harder for a doctor to say no than to have the staff say it.