SIC TRANSIT GLORIA MUNDI

When I entered private medical practice many years ago, there were two things that were true then that are true no longer. First, I worked with a group of “colleagues,” not merely competitors. Secondly, my medical brethren (and sisters) composed a family, of which I had just become a part. When I needed help getting started (advertizing was prohibited then), physicians whom I barely knew helped by getting me onto hospital staffs and giving me consults so I could begin to earn a living, and show how good I actually was. Almost as important was that I knew, with certainty, that neither I, nor my family would ever lack for the best medical care because regardless of the circumstances, I could count upon the professional courtesy that we all felt morally and professionally compelled to provide.

The world has changed, and Medicine along with it. Because of the insurance companies and bureaucrats, it is increasingly becoming an industry rather than a profession. Where once there existed only the good of the patient, and we all took our oaths seriously, today there is no other god than money, and the insurers are the self proclaimed prophets.

About three weeks ago, I referred my son to a group of physicians I had known for many years. I knew they were good; we had worked together at several hospitals, and had even published a paper together. Fortunately, his problem was minor, the examination took less than fifteen minutes, and he is now fine. When we left, because he had signed up with an HMO where he works (against advice), he was told that he needed a referral but, after we paid his co-pay, he was informed that his Primary Care Physician had 90 days to submit the referral to them. “Fine,” he answered, and away we drove.

In the three weeks since his visit, my son has received nine (9) letters demanding an additional $150 since they did not yet have the referral in hand. When he called to explain that he was waiting for his PCP to send the referral, he was verbally accosted with, “don’t you think Dr.[ XXXXX] deserves to be paid?” Yes, they will be paid. Yes, they will get their referral. Yes, we know that health care is in deep trouble in the US. Still, nine letters and a telephone call in the three weeks since his visit is unacceptable even from a purely business prospective; how much less so from colleagues.

I mourn the passing of Medicine as a profession and other physicians as my colleagues but, if physicians want to understand why they get sued so much more frequently than they used to, perhaps they could begin with an examination of the cavalier manner with which they treat their own colleagues, then extrapolate that to the general public. “It is not now as it hath been of yore . . .”[1]

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[1] Wordsworth, William; “Ode on Intimations of Immortality.”