Is there a reasonably priced doctor in the house?


WHEN ARLETTE Lyons went to her Dublin GP last March to get a medical certificate to cover a week’s sick leave from her job, she was taken aback to be told it would cost her €50, without a consultation.

She had visited the same GP six times since the beginning of the year, either for herself or her two children, paying the same amount for each consultation. She then was in hospital for an operation, of which her GP was aware, and needed the cert to cover a week’s recovery at home.

“I rang the secretary in the practice who told me to come up and collect the cert. There was no mention of money on the phone, so I was pretty shocked to be asked for €50 when I got there,” says Lyons. “When I challenged her, she just shrugged her shoulders and said they weren’t a free service.”

Because Lyons did not have €50 with her, having not expected to be charged, she asked could she take the cert and drop in the money later that day. She was refused.

“I said ‘I’ve paid you over €300 since the beginning of January, can I just have the cert?’ And she again refused to give it to me.”

Lyons subsequently got a certificate from the hospital in which she was treated and has changed doctor.

Another woman in west Dublin who does not wish to be named was charged €60 for a repeat prescription by her local GP.

“It really stands out in my mind because I was pregnant with my second child and at one of my free antenatal checks. My older child’s prescription had run out and I asked for a repeat. He charged me €60 for it. When I queried it, saying the visit was supposed to be free, he told me asking for the prescription made it ‘another consultation’. I paid it but I was furious,” she says.

There is a big variation in what GPs charge, both for consultations and for issuing repeat prescriptions and medical certificates, depending on where you live and what doctor you attend.

There are also significant variations when it comes to treating several members of the same family.

Some doctors will charge the full consultation fee for each person where others will give a reduction or a “family rate”.

One woman in north Co Dublin is considering changing GP after being charged €55 for each child when she brought her two children to see the doctor.

“This has happened a few times. I’m charged two full consultation fees, so €110, when it doesn’t take up the time of two separate appointments.”

A practice in Athlone town centre, on the other hand, offers a family rate of €60 if two or three members of the same family need to be seen. For a single consultation, it charges €35 for a child and €45 for an adult.

At the College Road Medical Centre in Cork, a consultation is €50 and a €20 charge is levied for a repeat prescription. If a number of people from the same family need to attend, two children for example, the charge would be €65. Two full consultation fees would never apply, according to a spokeswoman for the practice.

“The doctors are very fair,” she said.

In Donegal town, the Millrow family practice charges €40 for a consultation, €10 for a repeat prescription and €10 for a medical certificate. Presenting with two children, the price would still be €40 and would only rise to €50 for three. “The price would never be doubled,” a spokeswoman said.

At the Galway Bay Medical Centre on Merchants Road in the city, a consultation is €50, it is €15 for a repeat prescription and €15 for a medical certificate. Two members of the same family presenting would be charged €35 each.

“We wouldn’t charge the full consultation price for each person,” a spokeswoman said. “It depends on the situation, of course, and it’s up to the doctor to decide, but we would never charge €100, for example.”

In Dublin, Mercers Medical Centre charges €60 for a consultation, €10 for a repeat prescription and €10 for a medical certificate. It would be “up to the doctor’s discretion” what charges would apply if several members of the same family needed to attend, according to a spokeswoman.

The practice would “not normally” charge a full consultation fee for each member of the family, she said.

A spokeswoman for the Irish Medical Organisation said she could not discuss GP prices “due to competition law”. This law precludes the organisation from setting fees or making recommendations on the level of fees GPs should charge.

The Irish College of General Practitioners also cited competition law for the lack of standardisation of fees.

“Each GP is an independent small business and so sets their prices according to their individual costs and circumstances,” it said.

While both organisations are correct in their interpretation of the law, they cannot deny that the laws they cite suit them down to the ground as they can effortlessly absolve themselves of all responsibility for the actions of the members they represent.

Effectively, there is no control over what doctors charge, making it important for consumers to vote with their feet and attend another doctor if they feel they are being overcharged. This is easier said than done, of course, as people build up a relationship with their GP and do not like changing.

Last month, the National Consumer Agency (NCA) said it was important that GPs display price lists at their surgeries so that people could make informed decisions about what doctor to attend.

In cases where a price list is not displayed, they urged people to ask their GP why such information was not available and whether they intended displaying prices in the future.

This is on foot of a recommendation last year by the IMO to its members to introduce price lists for routine medical treatments. An NCA survey in 2010 showed only half of GPs displayed prices.

“The NCA is firmly of the view that pricing displays are an important means of empowering consumers,” its chief executive Ann Fitzgerald said last month. “Having access to pricing information enables them to consider all factors such as quality of treatment, the doctor/patient relationship, convenience and also price when they choose a GP.”

A spokeswoman for the Medical Council says people can complain to it about doctors fees, but they “had no authority” to set fees.

Of the complaints received by the council in 2010, 32 fell into the “other complaints category” which includes doctor’s fees and professional indemnity insurance.

The council recommends that doctors charge fees “appropriate to the service provided” and that “patients are informed of the likely costs before consultation and treatment” in its guide to professional conduct and ethics.

Stephen McMahon of the Irish Patients Association says people need to start shopping around for GPs.

“People are deferring going to the doctor because of the costs involved,” he says. “Charging €60 for a repeat prescription is totally outrageous. I don’t see how you can justify that. Every area of our economy has taken a hit but that doesn’t seem to be reflected in private practice. People need to tell their doctor what their financial situation is and let him or her make a judgment call.”

People are deferring going to the doctor because of the costs involved. Charging €60 for a repeat prescription is totally outrageous