Did you ever wonder why it seems like doctors don’t care as much as they used to? The images painted by Norman Rockwell or the iconoclastic TV personality of Marcus Welby MD of yesteryear are a rare find today, and if found are probably on the brink of retirement. Is it because medical schools now only attract cold-hearted business men who just want to make a good living in return for their hard work, or are other factors at play? Let me share with you a few thoughts that have tainted my practice just in the short span of 24 years that I have been in medicine.

More and more the message is clear that we as individuals are not to be trusted in thinking or even feeling for ourselves, but must yield to the infinite wisdom of our society as a whole. I will elaborate: there was a day when one of the primary draws for men and women into the practice of medicine was a calling, a deep seated personal burden to ease the suffering of our neighbors from the weight of sickness and the fear of death. This compassion was daily renewed in both large and small ways, at times from victories hard won at the side of courageous patients and other times from the dark stabbing pain of loss shared with grieving families. The older, purer meaning of ‘charity’ as synonymous with ‘an expression of love,’ was a foundation upon which the practice of medicine was built. I still search for that every day.

But I am not to be trusted, my heart might not be true, and so Big Brother must guide me in my compassion, and tell me who I need to have special concern for and to whom I must show special favor. Enter Medicare (or Medicaid, or any other government payer, VA, SSI, IHS, etc.). For example, if I accept Medicare reimbursement in my practice it works like this: I provide one dollar of medical service. I then receive 65 cents for my dollar of service, and am expected to provide 35 cents of charity to this individual, because the government has determined they deserve this, whether or not I am so moved in my heart.

Next, I encounter one who may not have insurance and doesn’t qualify for Medicare, or may have special circumstances that add to their burden, and my soul is moved to compassion for them in a special and unique way, and I want to help them as best as I can. So, I might desire to reduce their fee or even waive it all together. But … if Big Brother Medicare finds out I charged this patient less than the going rate, I have just committed fraud against the Medicare system! In other words, I can be severely punished for thinking that I could trust my own heart to show charity of compassion to one they haven’t approved and enrolled. How dare me!

Thus, it is that I must show charity to whom Medicare tells me to and I better not have compassion on anyone they don’t. It really warms your heart doesn’t it? How did we get here? All these programs sounded so good at the start but have slowly stripped the truest motivation for the heart of medicine. So pardon me, your doctor, please, the next time you sit across from me at the office and I seem just a little bit bitter and empty of compassion.