In South Africa, medical doctors bill for their professional time and not according to diagnosis or resolution of the problem. Blood tests and imaging procedures form part of the consultation and will impact on the formation of a solid diagnosis from the differential diagnosis.

Abnormal results need explaining, and the reformulation of a plan of action. Some abnormal results can be devastating if it is one of cancer and is not the type of thing you would want to be discussed over the telephone. Where the set of results or imaging report is normal, the nursing sister will make contact with you to give you the normal results.

If we look at the way consultations are gazetted, it says the following: “Code 0190 – New and established patient: Consultation or visit of new or established patient, of an average duration and/or complexity. Includes counselling with the patient and/or family and coordination with other health care providers or liaison with third parties on behalf of the patient.

RULES GOVERNING THE STRUCTURE. Definitions: (a) New and established patients: A consultation/visit refers to a clinical situation where a medical practitioner personally obtains a patient’s medical history, performs an appropriate clinical examination and, if indicated, administers treatment, prescribes or assists with advice. These services must be face-to-face with the patient and excludes the time spent doing special investigations which receive additional remuneration. (b) Subsequent visits: Refers to a voluntarily scheduled visit performed within four (4) months after the first visit.

It may imply taking down a medical history and/or a clinical examination and/or prescribing or administering of treatment and/or counselling.” You will note that the consultation code 0190 is for a first visit or a follow-up visit and the same cost is applicable where it is the same problem or a different one, for taking further history with or without examination or for counselling.