Rethinking How Doctors Get Paid

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ILLUSTRATION: THE MEDICAL ARCHIVE
House calls were once a hallmark of medical civilization

Doctors make a lot of money. Most people accept this as being probably OK, given all the time we spend saving lives and eradicating disease. I do bear a little grousing now and then when some life that I’ve saved doesn’t much resemble the condition it was in before I went to work, or when a nasty disease I had wiped out is reincarnated just as I’m congratulating someone on his or her cure. Yes, at times like these the grapes can get pretty sour.

Take the case of Howard Grimstone, my auto mechanic. Grimstone came to see me because he got a twinge in his chest after chopping four cords of wood. By the time I saw him, he felt pretty good. “Don’t think it’s much, Doc,” he said. “But I just thought I’d have you check it out.”

I wasn’t fooled for a second. Quicker than you can shake a stick, I had him up to the medical center for one of those bypass operations. They fixed his coronary slick as a whistle. I was quite pleased with my prompt action. Grimstone was less impressed. During surgery he had a stroke, and now he can’t use his right arm. “Helluva way to get a guy to stop chopping wood,” said Grimstone. “I coulda cut the thing off myself and saved 50 grand.”

As if that weren’t enough of a blow to my sensibilities, Grimstone added insult to injury. “Suppose you came to me because your car wouldn’t start. Then when you got it back, the car started fine, but ran only in reverse. How much do you think I’d charge?”

Grimstone had a point, but if I had to guarantee my work, I’d be out of business in a flash. Asking a doctor to stand behind his treatment is like asking a politician to live up to his campaign promises. It just isn’t done. (And nobody expects it, either. When I first started my medical practice, I offered my patients a one-week guarantee on my work, parts and labor included. One week may not sound like much, but for the patient clever enough to see me every week, it could mean immortality. In theory anyway. Nobody was interested.)

  • Published on May 1, 1990
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