8 Comments
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Marc Haspel's avatar

Sometimes it’s less like a doctor-patient relationship and more like Let’s Make a Deal

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Michael Kirsch, MD's avatar

Ha! Should we offer a patient what’s behind Door #1 or to choose the small gift wrapped box? Give and take comes naturally when there is a strong foundation of doctor-patient trust. Thx for reaching out.

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Lewis M Horowitz's avatar

Rationing medicine! Doesn’t the patient know best? 😉. What percentage of physicians would have simply performed the medically inappropriate procedure because it was easier and more lucrative than negotiating given the $ incentives to do so (including the extra time it takes to negotiate against the procedure and the liability risk if a plaintiff’s attorney someday claims that the procedure would have saved her life by diagnosing some unknown malady)?

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Michael Kirsch, MD's avatar

I will concede that the medical profession is not pure and there are financial incentives riddled throughout. Despite this, me experience is that most physicians want to do the right thing. I think a stronger case can be made the pharmaceutical industry, hospitals, nursing homes and insurance companies have goals and objectives separate from serving the public good. I’m not saying that they don’t do good work; but their agenda is broader.

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Lewis M Horowitz's avatar

Most assuredly. The nature and true benefit of a profession is to be more concerned about patients and clients than about their own profit. Corporate practice of medicine, and soon to see of accounting and law, is about profit maximization. We all know how Corporate ownership/oversight alters behavior for the benefit of the investors, but allowing them to undermine the professional focus on the client/customer/patient seems inexorable.

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Michael Kirsch, MD's avatar

Lewis, superbly expressed! Medicine writ large needs to aspire to a fiduciary standard.

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Elliot Davidson's avatar

Yes, and we are also farmers, planting seeds for future discussions that are often negotiations. For example, suggesting that the patient quit smoking and letting her know there are options for us to help when she is ready. As you point out, one of the keys to successful negotiations is trust, something you clearly had built up with this patient over time.

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Michael Kirsch, MD's avatar

Elliot, very well expressed. Your farmer analogy is apt. I hope that you and your patients enjoy a rich harvest this year!

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