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Ideas and Opinions |

Rewarding Medicine: Good Doctors and Good Behavior

Robert M. Arnold, MD; and Lachlan Forrow, MD
[+] Article and Author Information

Grant Support: In part by a grant from the Vira I. Heinz Endowments, by the Harvard Community Health Plan Foundation, and by the Program in Ethics and the Professions, Harvard University.

Requests for Reprints: Robert M. Arnold, MD, Division of General Internal Medicine, University of Pittsburgh, Lothrop Hall, Room 167, 190 Lothrop Street, Pittsburgh, PA 15261.

Current Author Addresses: Dr. Arnold: Division of Internal Medicine, University of Pittsburgh, Lothrop Hall, Room 167, 190 Lothrop Street, Pittsburgh, PA 15261.

Dr. Forrow: Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.


© 1990 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1990;113(10):794-798. doi:10.7326/0003-4819-113-10-794
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Many patients think that there are shortcomings in the ethical dimensions of patient care, and research supports their view. In this issue of Annals, Erde suggests that physicians' incomes should depend on patients' assessments of their ethical behavior in much the same way that waiters' incomes depend on patrons' tips. Although Erde's solution is satiric, the problem is a serious one. The experiences and perspectives of patients regarding their own illness are undervalued by physicians. A truly patient-centered care demands that physicians elicit, understand, and respond to patients' perspectives. Tying physicians' pay to measurements of patient satisfaction is unlikely to dramatically improve the ethical quality of patient care as long as attention to the patient's perspective is seen as peripheral to "good medical care." Rather than relying on a single, easy "fix," we must re-examine all of professional development and practice. We need to choose persons for medical careers who will find patient-centered care rewarding; we need to provide such persons with training and socialization that underscores the value of personalized medicine; and we need to build institutions and systems that facilitate and reinforce patient-centered practice. The best ways to achieve these objectives are as yet unclear, but if we, as physicians, are offended by Erde's "modest proposal," then we must respond by proposing and implementing our own ideas about how patient care can become more humane.

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