Medical Consequence of a Business Bonus

You have a persistent cough and poor appetite, but for six months your doctor has prescribed an assortment of antibiotics after an initial chest x-ray showed a small pneumonia.  Finally, short of breath, you go to the emergency room where a CT scan reveals untreatable lung cancer.  Later you find your doctor has received a bonus from your HMO insurer for not ordering a CT scan earlier.

Physicians count on experience to pursue patient symptoms, but does dangling a bonus suppress their learned instinct from medical school and residency training?  Ethically, is it also a violation of the Hippocratic Oath to do no harm if the bonus was more important than the patient?

Increasingly, employed and contracted doctors face this moral dilemma.  Sometimes authorities at a higher level “deny” procedures, consultations, and treatments.  When though the decision falls on your physician, how do you know outside employer influence will not effect the care you receive?

All of us have seen the mechanized changes in healthcare with a “drive-thru” atmosphere devoid of emotions. Not only have statistical goals been mandated, but contracts are dangled with bonuses swaying medical decision-making.

Who though would violate a physician oath and go against their moral character?  When you have a 6-figure education loan to pay off, a new mortgage, and a young family, having a job is paramount.  With over a decade invested toward a worthy career, one cannot easily walk away.     

There is a doctor shortage but disgruntled and emotionally “burned out” physicians are quitting or retiring at an alarming rate.  Sadly also, their annual suicide rate has risen sharply.

So on the one hand some patients are being short-changed in the care they are receiving, while doctors are finding they cannot live under the compromised care they are providing.


Business.  Mainly hospitals, insurance companies, and Big Pharma.

Over the past two decades, healthcare costs have surged at an exorbitant rate.  Government decided drastic action would be needed, so they changed laws attempting to rein in costs.  Unfortunately, they were written by K Street and rubber stamped by financially influenced legislators giving us the problems we have today.  This business-created healthcare system continues to be a major contributing factor in personal bankruptcies, mortgage defaults, and even homelessness.

What is the solution?  Just as Henry Ford absconded with the mass production idea from Japan over one hundred years ago, we must look around the world for healthcare models and contour it to the needs of the American people. 

How will it be paid for?  Remove the major profiteers, and don’t allow K Street involvement.  Then make sure the bureaucrats who make the law live under the law. Until then, our children and grandchildren cannot compete economically against other countries in the world marketplace if they don’t have viable medical care.

For now, the next time you see a doctor, make sure you know who signs their paycheck.

Gene Uzawa Dorio, M.D.


  • H says:

    Thank you for this column. Can it be linked to other medical web sites (e.g., Doctors For Patient Care, KevinMD, etc)?

  • H. E. Butler III M.D., F.A.C.S. says:

    See also “The Healing of America” by T. Reid, and Code of Virginia 58.1 regarding tax credits for charity-care.

  • Physicians for Social Justice says:

    I’m all for universal health care coverage, but NOT at the expense of pulling physicians thin in different directions. We’re pressured by insurance companies to NOT order medically necessary tests or treatments, yet expected to meet patient’s satisfaction scores. If our requested treatment or imaging is denied and leading to misdiagnosis of a patient (as in the case with the lung cancer patient denied a CT), the patient then sues their physicians and writes bad reviews on their yelp page. Nurses walk out of hospitals to strike their grievances, yet WHY CAN”T PHYSICIANS MOBILIZE TOGETHER POLITICALLY TO GET OUR VOICE HEARD? Are there organizations we can form other than the AMA (arguably another puppet of Big Pharma and Big Insurance Co.)? Dr. Dorio, I’m a physician as well, so please let us know how we can get politically involved to protect our profession and livelihood!

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