Stark account of pay for treatment, instead of pay for wellness, from a 2006 award winning submission:
No one who reads the chart will know of my struggle [as the attending physician]. Not the billing department, not my boss, and I doubt even Mr. Nickels understood the nuances of our interaction. Anyone who reads the chart will see that I was compliant with the established practice guidelines: i.e., I practiced "good medicine." But I know differently—and now you do, too.
Should I start statins on the drooling demented to lower their LDL? Should I preach to paranoid schizophrenics that they must quit smoking? Doing so might help ease my burdens—will it ease theirs? Without a financial incentive, I treated practice guidelines as guidelines, and I treated patients as patients. With financial incentives, will the guidelines become my goal? Will I lose patience for patients who are just a means to my means?
