Reimbursement, combined with the liability climate that demands objective testing in court, is quickly killing the history and physical:

One of the problems with our medical system is the bias to pay doctors more for performing a test or procedure than for using our heads to make a diagnosis or manage a disease . . .

. . . If I spend 30 minutes in an extended office call for a patient with diabetes, high blood pressure and heart disease, I get paid an average of $69. If I remove a skin cyst off the patient’s back in that same time, the minor surgery would bring $110 . . .

. . . I’ve tried to take the high road on this type of stuff, but I’ve still got to have a margin to keep up my mission of quality care and good service. I’ll add ancillary services if I can provide a convenience to my patients and offer a high-quality service at a lower price than the hospitals in the region.

I’m well aware that if I invest in equipment and can make money on it, or can make money doing a procedure at the hospital, I’ll be incented to use the equipment or do the procedure. It’s my job to walk the ethical line and make sure we only proceed when it’s appropriate for patients.