Dr. Bette Catoe and Dr. Lillian Beard are Washington pediatricians, with offices on Fifth Street NW., not far from Rock Creek Park. By reports of other doctors and patients, they are highly competent and caring physicians.
They are also innovators in a still unusual yet modestly growing way of practice: they charge for some telephone time.
Some psychiatrists have been charging in some cases for 30- or 50-minute telephone psychotherapy, in some cases for shorter conversations. Mainly, they say, this is to suit their patients.
In Peoria, Ill., a prominent pediatrician, Dr. David Copeland, says: "I started charging for some calls 17 years ago, and now, I'd say, all the pediatricians here and I think most family practitioners do the same."
Usual or unusual, the practice is defended by those who do it -- and by some patients -- and criticized by others.
"I can understand the feeling of physicians who may be bombarded by unnecessary telephone inquiries," says Dr. David Morowitz, chairman of the D.C. Medical Society's medical ethics committee. "But I think taking patients' phone calls is part of private practice. It is a burden, but it's one of the things tradition says we provide to the patient we care for."
And he does not find such charges by any type of physician "justifiable."
Dr. Bette Catoe feels otherwise.
"We charge only for what we call 'telephone consultations,' " she says, and the charge then is a modest $8 to $13. "Compare this with the cost of calling a lawyer," she notes. "I've called my lawyer and been charged $100 for half an hour."
She describes a "telephone consultation" as: "One where the parent gives the symptoms and history, a diagnosis is made after reviewing the chart, medicine is prescribed, a druggist is called and the parents are called back to tell them the medicine has been ordered. But only if we've given that child long-term care, and on the basis of the symptoms, we can prescribe. And the parent is instructed to call back immediately if the child does not improve."
As an example, she cites "a nursery school child with recurring tonsillitis, where we know several kids in the same school have the same problem."
"We do not do this lightly," she adds. "We prefer not to do it and frequently will not. It's mostly where the patient doesn't want to come in or just can't get in . . . We do not charge for emergency calls or just giving advice."
But a full-scale phone consultation with a prescription, she said, "takes a good 30 minutes of office time . . . Starting at least eight years ago we realized that we were spending a lot of time on the phone and some parents were abusing it."
Such calls also took a great deal of staff time, plus phone and other expenses, she notes. "We wanted to discourage this," she says.
Dr. Stephen P. Hersh, psychiatrist on upper Wisconsin Avenue, codirector of a nonprofit Medical Illness Counseling Center, says: "We don't turn people away if they can't afford to pay . . . But as responsible, nurturing people, my partner and I realized we could end up filling close to two days a week with telephone conversations."
So partly to fill some patients' needs, he said, and partly to make some "a little more considerate," they started 10 months ago to charge for calls of "more than 10 minutes." Ten minutes with a psychiatrist would be $17; with other professionals, somewhat less. "Otherwise we just couldn't afford to operate."
Dr. Steven Hirsch, another upper Wisconsin Avenue psychiatrist, says he does not charge for brief or emergency calls, but does charge for some half-hour or 50-minute sessions, though "only if a patient can't come to a regular hour and chooses this. It's not my choice, it's theirs. In an ongoing relationship, I think this is very much in the spirit of good psychotherapy."
Another psychiatrist, Dr. Fred Hilkert, said "therapy hours on the phone are not unusual today" where "somebody is ill, somebody has a sick child, somebody is trapped out of town." But "if it's 10 minutes or so, it's usually no charge, unless I regularly get two or three calls a week."
Are any Washington area family doctors or internists or others charging? Morowitz said he has heard of "some" making $3 or $5 charges.
Medical practice consultant Lynne Merryfield said that, at her suggestion, some of her clients, mainly downtown internists and cardiologists, are billing for some phone consultations at the same fee they'd charge for an "intermediate office visit," perhaps $25 to $45.
"It's new," she adds, "and they're doing it very infrequently and reluctantly."
Yet, she predicts, "I think within the next few years we're going to see it more and more." She is advising her medical clients to do so more often -- mainly for "extended calls," not brief ones, "more where the patient needs emotional support" -- for "many good reasons": many patients are busy professionals short on time; doctors' overhead costs have been climbing while their fees have been restricted; dealing with selected patients by phone can be "more efficient and cost-effective."
Another well-known practice consultant, Duane Johnson of Atlanta, said he mainly opposes such charges, though they might be appropriate sometimes for psychiatrists and he understands the pediatricians' case. By and large, he said, "If a call is that significant, the patient ought to be seen. Realistically, most patients feel that nothing worthwhile has been done unless the doctor has put hands on them."
Patients' reactions? A Maryland man, 48, said: "I'd feel less guilty about calling my doctor if he did charge me a bit. My problems have not been serious, and more often than not when I call him, he just handles it on the phone without charge. So I'm now almost reluctant to call him."
But a mother told how her husband called a psychiatrist to ask if their troubled adolescent daughter should be sent to a boarding school, "and the conversation lasted about two minutes, and we got a $15 bill. I didn't pay it.
"I wouldn't have minded so much if we knew that was his policy," she said. The psychiatrist involved replied that his instruction sheets described the policy, but only for much longer calls.
Whatever the facts in that case, it is clear that telephone charging angers some patients and doctors. The American Society for Internal Medicine says charging patients might mainly "provoke resentment." Still, some doctors who charge can make a plausible case, and pediatricians like Drs. Catoe, Beard and Copeland have thriving practices.
What's right and what's wrong? As a patient, I, too, sometimes want telephone advice or a prescription renewal. I'm not charged, and I hope I don't overdo it so much that my doctor starts to bill me.
Next Week: Hearing from the patients.