Reply to comment

I can only guess why things went as they did in this patient's encounter. A number of motivations come to mind which are too numerous to describe here. She points out, however something I have noted which is that some of my colleagues have become experts at gaming a system that rewards for doing more. One sign of a person's shift from compassionate care is a doc's shift in everyday conversation from care issues to material things or money-making schemes.
A system that rewards one for the skill in handling cases, outcomes, interpersonal skills and all the things desired in a "good doctor" would be ideal but hard to develop. Attempts are being made to incorporate this but with little data to support the metrics so it is a little scary for the average doc who just wants to give good care. Best, I think, would be to support and incorporate the best models out there, such as at the Cleveland Clinic where doctors are salaried and not paid by production and number of procedures.
I am in emergency doctor. I don't do "wallet biopsies" and can't (and don't want to) choose my patients. I like that but is is not for everyone. Most emergency docs burn out and retire or move to something else by my age. My heart goes out for patients with limited means and I will game the system to save them a few bucks. Universal healthcare would solve that problem. Obamacare is only a start. It has deep flaws and will get bad publicity but keep aware of developments and lobby your representatives to improve it. Be aware that corporate interests are always trying to improve their bottom lines so look at where their lobbying money goes and press for alternatives. It's tiring but eternal vigilance is more important now than ever.