Acromioclavicular joint injury treatment in 144 Orthopedic surgery clinics in Americas

We unfortunately had a five night stay at the NICU over the Thanksgiving holiday. The staff provided excellent care to our kid and were extremely compassionate to us as parents. We were grateful for the private sleep rooms and shower, and they even had a free Thanksgiving dinner for everyone. The parent / family lounges have places to grab coffee and store food, and everything is very clean and organized. The doctors and nurses were very communicative and kept us in the loop the entire time.

Absolute terrible service , my child who has a seizure disorder and potential c- diff was made to wait in the ER for 3 and half hours plus without even being properly triaged . She didn’t receive a wrist band , at any point & we can run the cameras back , no one was alerted to her allergies , there was no band received for that as it typically is .. and she begin to have diarrhea thru the long wait due to the virus she’s had the past week and in turn she begin to get worked up and her fever returned . I asked how much longer the wait would be abd for an approximate timeline .. as I’ve observed plenty of patents come in after one in which I knew personally with less servere circumstances… literally come and go and my child was still suffering in the ER … the Nurse on duty was unaccomidating and almost seemingly unwilling to engage .. as I waited for some kind of answer on when my severely sick child would be seen . I asked if it would be more then another 30 mins and he said he couldn’t promise but shouldn’t be . Well it was . After 45 mins of them calling more then 3 patients who arrived after us .. I reluctantly decided it best to take my fevering , baby who now was covered in feces home.. as she was in her 3rd bowel movement and we had difficulty changing her in the nasty public restroom . I ultimately watched them call two more patients who had come after us exhibiting no signs of eminite health scares then I ordered our ride so I could take my child home to change her and give her medicine to help reduce fever and prevent seizure . I am pissed and very upset that my child and I spent. 3 plus hours we can’t get back in the ER after already being across the street at the Berger building for 3 hours prior this was wayy less then pleasant This is the second poor experience in this particular Emergency Dept but this is the first time it was so horribly handled that I had to leave with not only an even sicker baby then I arrived with . She still now will have to go to another ER to be seen .. because she did infact have a seizure once we got home from her fever that arose& I informed them but that did nothing to medicate the situation or get her seen. Now my kid is home fevering still sick potentially has c-diff and I am skeptical to return her to this terrible hospital because they haven’t even returned my call. I called to speak with charge nurse after filing formal complaint and was told by Jennifer in WR I could not speak to any charge nurse and then she took my information and said a nurse on duty would call back and it’s been an hour with out a returned call. This is negligence and unprofessionalism tht promoted us to leave in the first place and CHOP is looking at a pretty decent lawsuit if we do go to another practice and something is severely wrong with my child with so much documented instances of me trying to get her helper seen and have a team leader consult about next steps. This place wasted my time , cash as it’s costed money I didn’t have to travel to and from and I felt like the poor treatment was racially motivated , as as kid who came in after us was pulled to the back cuz her mother told them she was seizing but I was looking at the child. Who literally just had woke out her sleep. This place is incompetent , and of all the amazing experiences we’ve had here . Today ultimately casted a shadow on them all and I will be contacting the PA board of insurance aswell to file a formal complaint because they need to do better on managing and transparency in the ER wait times. We got there at 12:15 and didn’t receive a text saying my child’s room was ready until 4:15 pm that’s 4 freaking hours for a child who had 2 seizures in past week, has a virus, and cold and caught fever while there … when she has a history of febrile seizures … 0/10 would not recommend. Shame on u all

Very friendly staff and amazing doctors. The information desk is very helpful. The front lobby is well designed and honestly fun to be in due to it's design: there is a meandering ramp that goes up several stories with interesting interactive stops on the way. The lobbies on each floor are also all well laid out: they have great views outside and inside were designed with children and comfort in mind. The plaza out front and the cafeteria/Cafe are both relaxing places to recharge.

My brother was in this hospital because he had appendicitis and had to get surgery and He said the nurse was nice! I think this place is really nice because it's clean and Its nice looking, I know that because I was there to visit him in the hospital. I also want to thank you for saving my Brother before more consequences happened to him and that he could've died.. but thank God this hospital was there! Once again, thank you for saving him🙏🤍 Also I definitely Recommend this place if you want nice doctors and want to feel less anxious and comfortable here.👍

This hospital isn't what it used to be! It seems to be loosing patient focus and fast. We've been a CHLA family for 11 years and I think it's time to switch. My autistic son was SCHEDULED for Dental Surgery. Originally it was supposed to be at 1pm and us be here at 11am. When we got the call from the nurse last night that we needed to be here at 530 AM we were like no one told us! But we got here right on time. We'll let me tell you that they took him upstairs to Surgery PreOp it took over 4 hours to get him into the the surgery room, because he needed to be admitted after surgery and no beds were available. This hospital needs to have better planning for these types of things OBVIOUSLY there will be emergencies that come in over night THAT SHOULD'VE ALREADY BEEN ACCOUNTED FOR!!! Maybe you need more staff and more beds!!! Because to have a child basically starving because you couldn't plan Accordingly is just plainly ridiculous! Then when I spoke to the Charge Nurse in the Surgery Dept she tells me that if my autistic son has an outburst that the anesthesiologist and nurse are there to help give him something to calm down. So basically if my son has an autistic outburst they will just drug him up. I'm like realistically drugging my son just to calm him down because your hospital didn't plan accordingly is uncalled for and unnecessary! Again I am seriously contemplating switching hospitals even though my son is on the Heart Transplant List!!! -A Frustrated Autistic Heart Mom

Ok so I had open heart surgery 20 years ago. I was well cared for and was in icu for three days and then went to a step down room where I was later discharged home after only three days at the hospital. My team was so amazing and so supportive and loving. And a picture of me twenty years later.

I found some english speaking doctors here and they have an international office to help you translate if you dont speak spanish. Thank you very much Carolina 🙏

Horrible! Dont go to this clinic. The most unfriendly employees I have experienced in this Hospital. Yes I do speak spanish but once I didnt understand smth the lady just ignored me! Errors start already in front of the Clinic. Apparently they don't know the difference between a Swiss flag and a medical (red!!!) cross. So my question: is this a Swiss Clinic??? Of course not...

My mom got a well planned surgery in this Clinic. Excellent outstanding service what a relief. Fast service, very diligent and well trained all staff. Great place to get well and get some recovery. If you get sick go there you will be fine quickly. Do not visit Los Nogales clinic or La Colina. Marly is the best! Thank you all for your service! Mom is doing great. The doctor was very profesional!

They do not do their job well, 7 hours in the emergency room and do not attend and then say that they cannot attend to a patient

Undoubtedly one of my best experiences, location in the center of the city, excellent medical and administrative staff, old but well-kept infrastructure, spacious with gardens.

This opinion is directed to block 6 of the hospital, which is in an area where you can see people who consume drugs, although there is surveillance and once inside the hospital it is safer, if it is scary, at least walk to the hospital at dawn, and block 6 is opened at 6 in the morning and meanwhile everything is dark or with little light, a perfect place for homeless people, you have to travel with great caution and at least if you are patient and come from somewhere other than Medellín, it is not advisable to be in line before 6 in the morning to check in at block 6, arrive with 5 minutes left or at 6:00 am, there a guard opens the door and when you are already inside the place is much more pleasant and neat, there is a waiting room with chairs where you can wait for them to call you for the billing card, there are elevators, there is natural ventilation in that waiting room, almost all the staff there are friendly to the extent they should be. I give it a 3 star rating, for a not very pleasant event that I had to go through in there, I think that of all the possible days in which that bad event had to happen, it happened just on the day of my appointment, I don't know who it was from the fault of that negligence but thanks to a call to my eps I was able to quickly solve that difficulty so as not to continue in that unpleasant situation in that hospital block.

Excellent...!

3 days waiting in que for gallbladder surgery to be scheduled! Why does the patient get to wait? And why doesn't the clinic approach and explain what's going on to the patient's children.?

Customer service people on their cell phones while helping zero people in the que. The pictures say it all. Look at the customer service people chatting on the phone and the video board showing zero people in the que.

The medical staff at that hospital seem more like a gang of robbers and drug addicts than professionals. Never in my life have I seen such "doctors" and "nurses" so stupid and stupid. They speak ugly, they answer people in a bad way, they morbidize the patients, or rather the little gaminitos are in the wrong place.

The truth is that it seems like a hospital with a very bad service, how is it possible that the patients who are in the ICU do not have the attention they deserve or at least what is necessary. On weekends there are no doctors to give information and the nurses who are there never know anything. In addition to this, during the week they only give one report all day and it is almost at 6 pm. The truth is that they seem very inhuman to me, they should improve this service since it is one of the main clinics in the capital.

Outpatient consultation, terrible service, at 7 AM and only one person serving more than 50 people. By saving a salary they harm us users. Terrible.

All staff member needs an urgent training to learn the meaning of empathy and serve to patients.

The best in town.

Omg I had to walk to the nurses station for everything from a blanket to medication. They have no tv in the rooms. They take for ever. You have to wait 6-8 hours to get something done. Just go to a regular clinic in Barranquilla they are not as nice but they get things done.

An amazing facility with an amazing level of care. Better than any US or German hospital I have ever been in. The office of international patients is very professional and thorough. Dr. Taboada is very thorough and professional. I can't recommend this hospital enough. Super experience.

I came to see if giving birth at Serena del Mar was an option. When I was given a tour of where the mothers and babies stay it was great. I was told to male an appointment to be seen by an obgyn so that they would have a history of me. The nurse took my info days before my appointment but apparently never followed through with setting up my profile. I showed up for my appointment and was never told who I would be seen by. Dr Maria Fernanda Toro Wils was upset that she had to wait on me because the staff had not created my profile. I finally went into my appointment with the doctor and she scolded me and told me she had no time we had to rush. I told her I did not understand whybinwas being treated this way when her staff was a mess. She told me she always does 40 minutes and she dedicated about 20 minutes if that. I left there feeling so upset and totally changed my mind about having my baby there. The treatment from Dr. MARIA Fernanda Toro Wils was terrible. I would not recommend her or her staff in a million years.

They neither answer their phones nor respond to emails seeking an appointment! Terrible customer service. I communicated in Spanish as well so not a language issue.

Malpractice. My grandmother was left to die. After an isquémic stroke. Proper measures were not taken within first 6 hours. Instead of ICU, she was put in a regular room. Nurses shifts had no records of prior shifts. Avoid at all costs.

I was supposed to have surgery in this clinic on 10/17/22. I arrived around 10:30 at the O.R floor, 4th floor in the building, and no one was there. The reception desk was dark with zero employees. While I sat waiting for someone to show up I looked at my paperwork handed to me at check-in, when I realized they had me as a Colombian citizen born in Barranquilla. I'm a U.S citizen. The address, phone number, and emergency contact provided by me earlier had been overlooked and ignored. I went downstairs and corrected it. Finally, the nurse showed up; she was a nice lady. There isn't anything negative to say about her. Around 3:30 a nurse assistant brings a wheelchair and wheels me into the OR. My surgeon, Dr. Carlos Cala was running late, she said. The O.R had a two way-in, bidirectional, restaurant style, swing door with small windows. At his point I had not been sedated, medicated, nor given a relaxant to prepared me for the cultural shock I was about to experience. There was, right in the middle of the room, an overwhelming sight of a surgical bed dressed in brown sheets ready for a bloodbath; and a dented, shallow bucket, right at my feet. The pan was wide enough for my feet to fit in. The N.A explained to me that she was going to bathe me with antiseptics and soap before surgery. I followed her with my gaze, noticing a disturbing sight of two soiled, worn out, filthy, and grotty, styrofoam coolers. There they kept the antiseptic and soap warm that she was about to use on me. She asked me to stand in the pan facing the door and those swinging doors started to open and close while medical staff came in and out. I was naked and a swing away to be seen by everyone sitting at the desk just outside the OR (recovery area). Then, as I’m looking around in dismay, I spotted a recording video camera IN the OR. All the feelings of humiliation, indignity, disrespect, and violation of privacy took over me at this point. I complained about this to the NA and she called the floor manager. The manager explained to me that the video was for liability reasons and to cover their backs, privacy wasn't a concern to them and video recording was a common practice. I requested an appointment with the clinic’s director and It seemed as if I threw a stone in a hornets nest. The floor manager called the anesthesiologist, Dr. Bernal, and he asked me what was the problem. All of this time I was still naked. I tried to explain to him that I felt my privacy was not being respected as I had never gone through anything like I was experiencing at that moment before and his replied was: “you should go back to the United States and get surgery there.” I don’t know what was more upsetting; the fact that this doctor represented COLOMBIA so poorly, not aspiring to anything beyond mediocrity as a professional, stepping over his Hippocratic Oath, and having a condescending tone towards a CUSTOMER (I’m a paying client in a private clinic, I reminded him), or the fact that his lack of character, dignity, and vulgar behavior, were an irrevocable proof of his unprofessionalism. When did lack of HYGIENE and violation of privacy became a common practice in healthcare?! Both, Dr. Bernal and the floor manager, proceeded to tell me to calm down and that if I wasn’t ready for surgery I could reschedule. I kept saying that I still was interested in an appt with the clinic’s manager. The floor manager kept hinting that there was not going to be a surgery if I insisted to see the director because that meant I was upset, while Dr. Bernal kept using my request as leverage pertaining to the final success and outcome of the surgery. Again, all of this time I was naked. Because I didn’t shut up and submissively obeyed, the surgery was canceled and I was scorted out of the OR while the nurse assistant was making signs behind me at everyone we were passing by (medical staff, patients, and their families around) that I was crazy. I did speak to the director days later. Even though he was nice, I opted to have my surgery elsewhere. Avoid at all cost unless you're dying.

Good service but they would have bigger watings rooms...

The emergency service was not able/ willing to apply an intramuscular injection. Clowning.

My recent experience at this medical facility was incredibly disappointing. Despite paying for the premium plan, the service was incredibly slow and disorganized, and the communication was almost non-existent. The nurses and security staff were consistently rude and unhelpful, making the already stressful situation even worse. We had to ask multiple times for updates on the patient's health status, and even then, we were met with angry faces and a lack of information. It took hours before we were given a decent status update, which was an awful experience. I hope that this facility can improve their customer service and communication skills to better serve their patients in the future.

It was a horrible visit. The nurses and stuff are not professional at all. Went in to get some exams done and just because they did want to they didn’t do it correctly. I don’t recommend this clinic.

Terrible service as health officials from the doorman to the nurses, most lacking in humanity. Do not bring your families here because the sick must have a complementary plan or be prepared to be cared for on their own because one pays to be cared for like others because there must be discrimination, they need a lot of humility and empathy so that it is not noticeable that They work only for the salary. This career is about love and patience and serving.

That clinic is a complete hell, they leave the emergency patients in chairs, on the floor, they are not attended to, they lose their papers, there is overcrowding of patients in hydration, men and women, in the emergency room observation, please if you love your family member, don't take him there, the eps famisanar is rubbish, we need to transfer a patient from that hell, my son @supersalud, @famisanar. I attach photos that I was able to take in the terrible places that prohibited me from taking photos.

Foreign and locals please abstain from attending these very old and outdated hospital facilities. I've been a patient in the US, Spain, Germany and Colombia. This is by far one of the most frightening hospitals sub standard even for a tiny 3rd world town. Readers beware. Avoid at all cost, unless of course you happen to be a malpractice attorney. 1. Patient surgery intake. Expect a minimum of 2 hours 2. Nursing and Patient Information Systems. Pre and post surgical nursing staff use notebooks and handwritten notes as a the regular protocol for patient care. Despite revealing allergies with 5 different people and 5 different notebooks, the staff failed to write patient allergies in the surgical board and also failed to place the standard red bracelet. It had to be bluntly requested by the patient in the OR. The nursing staff laughed it off as normal noting it was goog "they" caught it on time. OMG. The nerve. 3. Institutional tardiness. Expect 3-4hour delay past scheduled surgical start time. Do not expect an apology nor a justification for tardiness. 4. During surgery expect nurses to answer questions to family at 8am, 11am 3pm. Should your family happen to run into a nurse and ask a question expect nurses to raise their voice rudely, only to be reminded to wait until the scheduled time. If your family receives a call from the OR team with a request (for information or supplies) and wish for you to ring the door, expect no responses to either of the two doors and one window. A family member witnessed a lady who could not find her father for 2 hours. Whiled the nursing staff dissed her, she had to appeal to a surgeon that was leaving the area. The information systems could not locate the patient. Frightening. Very Frightening. 5. After surgery expect 2 nurses to handle patient care for all 16 ORs. OMG. Frightening very frightening. Little help, fend for yourself. 6. Patient out-take. Expect the process to last a few minutes. But by all means do not expect it dignified changing room and or patient lockers. It's pretty gross 6. One week surgery follow up. Expect two hours wait on the 3rd floor of a brand new building just for check-in. Expect rude and insufficient check-in staff. Then expect another hour for the doctor to see you. I hope my comments help you make an informed decision. I hope my comments save lives and hardship. Steer clear if you can. Colombia has great hospitals. This is by fas substandard even for small towns in a 3rd world country.

The attention was terrible, I had to be there from 4 o'clock to reach a shift of 40 that they gave for a panoramic x-ray of the spine (goniometry and orthogram) 14" x 36" format (adults) and despite getting up so early there were already people queuing, additional They did not inform me that the numbers to make x-ray appointments do not work, no one is going to answer you and I found out about the appointments because I missed the first trip that I made at 1 in the afternoon so I got my appointment this time but I did not know that it was time to take copy of the history and if you have more than one exam in the order you must also make a copy, in short photocopy everything up to the ID so as not to be running if you do not have the order at the time they give you your turn they will not give it to you And even if you get up early and your turn is delivered at 6 in the morning, they begin to distribute them because customer service starts at type 7 or 8 so you have to wait and wait, there are very few who pay good and human attention, almost no one gives you gives reason for nothing and it's up to the users themselves to look for solutions, the photocopier in the cafeteria will be type 6 and there is another one inside where you wait your turn according to what they informed me on the second floor, if you still need to print something it is better to do the queue to receive your turn and after you enter, go up to the second one to make copies. It happened to us that together we sent someone else to make the copies and we kept him in place and when the time came for the turn to be handed over, the guard refused to wait and without order there was no take a turn! Another thing is that you have to line up for everything for the laboratory, for MRIs or diagnostic images, to make appointments with specialists for everything! Before standing in such long lines, ask carefully where it is your turn, many arrive and lose their turn for being where they should not be, where the photo public is where you have to line up for the laboratory, x-ray and in front is for appointments with specialists.

This hospital has modern facilities and good qualified and humane staff who provide good care to their patients.

I arrived at 10 when they say they open, no one. A girl arrived at 10:10 and they couldn't open the door for 10 minutes. We went in and another 10 minutes waiting to be attended to. I ask to be shaved and a boy who looks like he is 16 attends to me. I cut myself 3 times; He leaves the sideburns different and finishes them with a shaver. I could do better at home. Horrible service…. Avoid this site!

Terrible service, the worst a consultant can have, it shows that there is no level of supervision, they cancel appointments at the last minute because the doctor “left” I had to see people who were assigned appointments in a different place without taking into account that They are low-income people, Dr. Mauricio Osorio Manrique, it would be appropriate for you to pay more attention to the service of your clinic.

In the UROS clinic, what is the EMERGENCY part is the attention, a doctor,,, select a meeting chair 💺,, narrow structure for the emergency area,,,,

Overcrowded clinic, patient on stretchers in corridors in view of everyone, one calls insistently to ask for appointments or scheduling for exams and they don't have an agenda or you have to wait for them to "activate the service" because it is not available but when you go to Super health there if they have, pregnant women do not have the right to be accompanied by their partners or parents unless they pay for VIP service.

My gratitude to all the professionals who work in this hospital. It is a sacrificed job, my admiration goes to the entire team, who carry out their work with professionalism, patience and a good attitude. God bless you.

Terrible service, it is a clinic of low quality and deficient medical care without professional ethics. Due to malpractice, a great doctor died when he was only admitted for an appendicitis operation, the operation went wrong and it became complicated. All for a hospital without a well-sterilized and clean room to do their operations.

Very professional in patient care and attention. Currently they are one of the few hospitals that has prostheses for knee arthroplasty. They have a very good rehabilitation service. The facilities are very clean and permanently disinfected.

Just was released yesterday after being admitted last Thursday in need of a pacemaker. My husband and I were so pleased with our experience. Dr Marlon and Dr Francisco from the cardiology department were amazing. I was treated very well. I will be forever grateful.

Such an amazing experience! I went to the emergency with a stomach issue and they immediately took me in for checks and tests. Super professional - totally recommend!

Terrible (i.e. no) pain management after severe accident. Got also pain chock due to rush in changing linnen. As I chose to be operated at my home hospital (one of the top three hospital in pelvis operations in the whole World) they got upset and delayed my ambulance flight with a day (by not filling in papers on time). You can imagine the cost of having an ambulance flight waiting for you one extra day..

Great Service, Doctors are so respectful of patients times. Very clean hospital. Quite a different experience from other hospitals. Very pleased.

I went in with back pain. Got excellent care ,x-rays, diagnosis in less than 2 hrs.

This hospital is amazing! My husband had to attend and I was so impressed with the staff! As we do not speak Spanish, they were all very amazing and did their best to help us. They were kind, caring and detailed to ensure that we were well taken care of. Thank you so much for taking care of my husband! You are the best!

Without a doubt it is an incredibly efficient hospital with great human warmth. The guardian service is one of the best I have known in public institutions. I hope they continue like this, the demands of their doctors and area heads make it one of the best hospitals in the country, if not THE BEST

I really say this government hospital really awesome . One week I spend here. Stuff very friendly and helpful.

The experience I have is sitting outside on the sidewalk, my wife arrived an hour before me for emergency treatment and entered without problems, since I did not enter with her I have to wait outside, the doctor tells her that only the guard can decide if I go in or not and he tells me that only the doctor... well, there is my wife feeling very bad and unable to accompany her. I thought patients had the right to a companion... terrible!

In Sept 2023 in Cuenca, my upper arm was broken in 4 places and I needed surgery to repair the bones (titanium screws, metal plate,). I was hospitalized at Mt Sinai for two days, required a month of 6 hr/day in-home care by rotating team of Mt Sinai nurses, and had subsequent 5x/wk physicaltherapy x 2 months .The care I received was extraordinary at every level. I can't praise the competence and personal care enough.

I was just digging through some old boxes and I found the paperwork from when I had to make a visit to Monte Sinai hospital when I got sick in Cuenca back in 2017. It brought back the memories of the amazing treatment I received there. I got insanely sick while visiting Ecuador. Before I got to the hospital, I thought I was going to meet my demise and I was saying my prayers. Thank goodness to the wonderful doctors and staff at this place because they took great care of me. I didn't get to see the entire hospital, but from what I saw from my point of view, they seemed to have pretty much everything there that you would find at a regular United States hospital. Plus, all the doctor's I saw there spoke English too. The experience also really opened my eyes to make me aware of how the statesides hospital rip Americans off. I don't know if their prices have changed since then, but my entire cost with testing and treatments and medication was right around $100. No you did not read that wrong, ONLY about one hundred dollars USD. Another way Ecuador helped me to realize that the United States is good at taking advantage of their citizens, is that when you go into the pharmacies there, the medication is a fraction of the price in the United States and many of them you do not even need a prescription for. Well I just thought I would share my experience for whoever wanted to read a real review on this place.

There is only one internationally rated hospital in Ecuador and it is in Quito. After 10 days in this hospital, they are decades away from being accredited. They do not have a lot of basic equipment. Suffice it to say… it took 5 days just to find me a washcloth. Had to stay an extra 3 days due to their neglect. Ecuadorian health care is ranked 101 in the world. U.S. is ranked 32. You chose.

Good attention

They take good care of patients, they are treated as they should be. The facilities are well maintained. The parking lot is ample.

Madhouse, worst service at ER

Please remove Cynthia Solís (plastic) from this hospital. My family and I were her patients and she almost killed one of us. She is ignorant, an extreme danger to patients and commits medical malpractice for which she is currently under investigation.

My second time here in the past month…this is one of the best Hospitals I’ve ever been in. Excellent staff, World class service. No problems whatsoever like the other reviews. Blue Cross insurance was accepted and I was taken care of around the clock. HIGHLY RECOMMENDED.

Went in to get an abscess removed on three different visits. I was scheduled at 10am but the room wasn't available until 8pm. Told to wait. I luckily asked for a written cost estimate and was told 58,000 PESOS (not including blood work, ultrasound and "hospital fees"). I said "no" and before I left, I paid the receptionist the 2,000 peso consult fee which she strangely handed over to one of the doctors. I never got a receipt for the two times that I paid. I went down the street and had the abscess removed for 2,000 pesos. BE SURE TO GET A WRITTEN COST ESTIMATE BEFORE ANY PROCEDURE. GO ELSEWHERE- THIS PLACE IS A RIP OFF! 30x more than the competition. Shady billing, accounting, payment, no receipts and handing cash to doctors?