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On Being a Doctor |

The Cost of Medicine

Shyam K. Bhat, MD
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From the Southern Illnois University School of Medicine, Springfield, IL 62794.


Requests for Single Reprints: Shyam K. Bhat, MD, Southern Illinois University School of Medicine, PO Box 19642, Springfield, IL 62794-9642; e-mail, SBhat2@siumed.edu.


Ann Intern Med. 2003;139(1):74-75. doi:10.7326/0003-4819-139-1-200307010-00017
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It is obvious that the patient is dying. She is 92 years old with “multiple medical problems”—so many that my tired intern mind can barely list them on morning rounds. “History of metastatic colon cancer, diabetes, advanced dementia, congestive heart failure …” But the family wants everything done—so we do our job efficiently and thoroughly. The attending physician recommends an MRI to clarify the diagnosis of the patient's sudden limb weakness, and I write the order down, then initial it. It feels routine now, this mundane ordering of expensive tests with no questions asked about cost. No more do I feel the sense of wonder and amazement that suffused me when I first started working as a physician in the United States. Like “Medical Disneyland”—as many diagnostic and therapeutic rides as you want. And no lines in this amusement park, Sir! So I ordered them all, the MRIs, the CTs, the PET scans—this was larger-than-life medicine.

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