Gone are the large tins of popcorn and the nuts; ditto for the cookies and fruitcake. My practice administrator and I reflected last week about what our staff kitchen used to look like the week before Christmas 10 years ago. The counters were overflowing with gift baskets, fruits, and all kind of holiday treats. The doctors’ desks had bottles of wine gifted by referring doctors and grateful patients. Now these areas are empty. Save for the few Christmas cards taped to the cabinet wall in the patient check out area, it would be easy to miss the traditional signs of the holiday season. Not even the hospitals are sending us gifts anymore. Why should they? They now seem to spend money buying up medical practices instead.
It is a fitting sign of our medical and economic times that the simple act of giving to one another to say “thank you for your loyalty and business,” is going the way of the “Walkman” cassette radio player. Perhaps it is our fear of government regulations and anti-kickback rules. Or maybe that we stand yet again on the precipice of the annual new century 25 percent to 30 percent Medicare pay cut due to SGR (Sustainable Growth Rate). As has become our yearly new tradition, we will write, call, and e-mail senators and congressmen pleading with them not to cut our Medicare rates … again. If the carrot doesn’t work, then we try the stick –– if this passes, we will post signs stating that we can no longer afford to see new Medicare patients after January 1. If history repeats itself, there will be an 11th-hour repeal form the legislative executioner, as politicians suck up to seniors, cook the numbers and books, and miraculously put off the SGR cut for another year, adding another few billion dollars to our federal debt.
When medical doctors graduate, they all recite the Hippocratic oath. Here is the second line: “To consider dear to me, as my parents, him who taught me this art, to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art, without charging a fee.”
Many of us have interpreted this last line that we should also not charge our colleagues or families for our medical care, i.e. professional courtesy. Thanks to Congress, and in particular Rep. Pete Stark of California, it is now illegal not to charge a colleague for medical care.
We used to give boxes of chocolates to nurses at the hospitals. This year we took the money we would have spent on that and gave our office employees a bonus instead.
Everyone it seems is cutting back –– be if for legal or pure economic reasons. And yet something profound has been lost here. No I, and my waistline, do not miss the plethora of sweets and calories. What I believe is missing is simpler than that. It is gratitude. Thankfulness for our referring doctors, and from home healthcare agencies, patients, and oxygen supply companies. I cannot be bribed to send business to someone simply because they gave my office staff and me a large tin of popcorn.
What has been lost in this entire minefield of government regulations and compliance worries is the death of giving to one another to show our appreciation. And that more than anything is what is missing from this holiday season.
Find out more about David Mokotoff and our other Practice Notes bloggers.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy