Chapter 38


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.

FREE PREVIEW. Purchase online access to read the full version of this article.

Fam Pract Manag. 2002 Sep;9(8):56.


I’ve always loved to barter. Trading for services is a great way to get to know my patients better, and it keeps me from contributing to the gross national product besides. Sometimes it works out and sometimes it doesn’t, but it’s always interesting. For my services, I’ve received gastronomic delights, legal advice, plumbing and electrical repairs and assorted works of art from local artisans, most of whom eke out a living. So I was blown away recently to learn that several of the pieces I’ve had for over 25 years might actually be worth something.

Jane, a new patient, was a Bay Area artist who was retiring in my community and had just finished construction of a large studio. When I looked at her registration form, I noticed she had listed one Larry Thomas as a person to call in case of an emergency.

“Say,” I remembered, “I used to know a Larry Thomas when I first started out in practice here in the late 70s. In fact, I still have two of his pieces.” (One was on my living room wall, but I couldn’t remember what had happened to the other one. It used to cover up my electric panel.)

“It’s the same person,” Jane said. “Next year he’s retiring as dean of the San Francisco Art Institute. He shows in several galleries and has some of his work in the Oakland Museum.”

“Wow, 25 years ago he was a hippy artist and I was a hippy doctor. Now he’s collectable. Lucky me,” I said.

I raced home after work with visions of exchanging my Larry Thomas print for a new dirt bike or the nude, which was one of a kind, for my daughter’s first year’s college tuition. But what the devil had I done with it? My wife remembered that, some years ago, it had fallen off the wall and the glass in the frame had broken; we had stashed it in our guest cabin and replaced it with a pastel of calendulas. “Great,” I thought, “the only art I’ve ever owned that actually appreciated in value and it’s probably all moldy now.” Luckily, it only had some minor water stains –eminently repairable. Jane was kind enough to recommend someone who could restore it.

“You know,” my wife told me, “not to rain on your parade, but I’ve never been particularly fond of that drawing. Perhaps you could hang it in your office while you’re waiting to become a rich doctor.”


My business friend Charlie was recently traumatized to learn that his beloved primary care physician was canceling all his PPO contracts – including Charlie’s. As Charlie put it in an e-mail to me, “He’s fed up with taking discounted fees, angry that other professionals (such as lawyers and dentists) don’t have to, wants and needs the money, and feels that he deserves to have his professional credentials (Harvard and Stanford) recognized.”

Charlie went on to say that he would have to pay double what he’s been paying to continue seeing the same doctor, which didn’t make him happy. He also wasn’t excited about getting care from a physician who “isn’t in a good mood about the underpinnings of his life work.” But Charlie bets that his doctor’s patients will not abandon him.

He’d bet wrong. “sorry and sad to say,” I wrote back, “but physician loyalty doesn’t extend past the pocketbook anymore. I’ve had many patients transfer to me just because I am a ‘preferred provider’ for their insurance company. They’re unhappy with the thought of paying more than a co-pay and their deductible, just as you are, while facing rising premiums.”

In his last e-mail, Charlie put in a personal note about his doctor: “I think he always wanted to be appreciated as a healer, medical advisor and professional man. He deserves to be, and I think that in his early years he was treated that way and grew to like it. But in this world of global competition and cost cutting, he’s being treated as a vendor. He’s still in business only because the medical software systems aren’t good enough yet to replace humans.”

Interesting how our cynicism has trickled down to our patients.


I just plain don’t understand dentistry, and I don’t know many doctors who do. That may seem odd, seeing as how the mouth is, after all, part of the human anatomy, but long ago, some time during medical school, I think we ceded it to the dental students. But we let it be known that the rest of the body was our turf.

They seem to have made the most out of our largess. My wife just had a root canal, for example, which took 90 minutes and cost $900. There is nothing I can do in that amount of time –or all day long, for that matter – that will generate that kind of income. I’ve saved lives and been paid less. Even my surgical colleagues can’t get that kind of reimbursement. I asked Ken, a general surgeon, how many organs he would have to remove to make $900. “At least two appendixes or a gallbladder,” he said, “and that includes the pre- and post-op care.”

Remember when we thought dental students were the ones who couldn’t get into medical school? Who has the last laugh now? Open wide. Hardy har har.

Dr. Brown, a solo family physician living in Mendocino, Calif., is a contributing editor to Family Practice Management. These excerpts from his journal illustrate the many characters, stories and lessons family practice has to offer. No real patient names have been used.

Conflicts of interest: none reported.

Send comments to


Copyright © 2002 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Sep-Oct 2016

Access the latest issue of Family Practice Management

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free FPM email table of contents and e-newsletter.

Sign Up Now