A Letter to My Physician Colleagues: The State of Medicine 2014

A healthcare lesson from old German Proverb, “Who’s bread I eat, him song I sing.”

THE SOVEREIGN PATIENT

There is an old German proverb that states, “Whose bread I eat, his song I sing.” That saying was a colorful way to explain the loyalty or service that was due a benefactor from a debtor. It encompassed everyone from traveling musicians to the serfs performing and serving at the behest of a gracious, or often a demanding, lord.

As we gradually assumed the role of “providers” for insurance networks over the past 40 years, physicians have been obliged to sing someone else’s tune due to the precariously lopsided terms of our once ostensibly beneficial contractual agreement with managed care payers.  We have essentially become subcontractors for, or de facto employees of, the insurance company as evidenced by the reality that every interaction with a patient falls under the purview of a third-party who dictates the terms of the encounter.  Doctors are obligated to document our compliance regarding charting criteria…

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