Greed, now there
is a subject to turn off a medical audience, to send patients packing. I know, having been
laughed off the podium for broaching the subject at a medical meeting, this despite the
"Me" generation's glorification of greed in films such as Wall Street.(1)
Granted that the exchange of money, albeit tax money, information, medications, and
information between doctor and patient is generally respected as an ethical enterprise yet
with the doctor and patient relationship it is never out of place to cock a clinical eye at
any nidus of greed.
Greed is frequently thought of as excessive acquisitiveness for
money. Chaucer underlined medical greed by describing the Doctour of Phisik as, "lovede
gold in special."(2) The medieval church was more explicit, placing the medical
profession in a class with usurers. The judgment proved more economic than theological,
based, as it was, on greedy priests, bishops, and cardinals-scholars at the recognised
cutting edge of medical information, with lucrative, independent incomes from flourishing
private practices. The Vatican found such entrepreneurial clerics difficult to control (read
medical autonomy); consequently Pope Innocent III insisted that the Fourth Lateran Council
should condemn the practice of surgery by ordained members of the
church.(3)
Practitioners' greed for money in our world is
pretty much held in check by government control of reimbursement, tightly reined in Britain,
medium tightly in Germany, and with a loose but tightening rein in the United States. Since
human nature's fixation on "ever increasing more" is fashioned out of the infant's
discovery that there are more than one pair of breasts in the world, no one should be
surprised at some doctors and patients greedily developing new ways for excessive self
aggrandisement.
Not always loaded with gold
Appetites enabling greed are as many
as the tastes of mankind. Aside from money, significant forms of greedy "more," include an
unslakable appetite for power, recognition, time, or mind altering substances. Some targets
of greed may seem obscure since the avaricious devil can reside in the details, whence he
appears under the guise of commonplace happenstance rather than loaded with bags of gold.
Consider "busy" Dr Silas Marner, a time miser who comes to the clinic late and leaves
early. Is he a sinner in his greedy accumulation of personal time? His reimbursement may not
be different from other staff members but what he gives in return is different when his
patients are up and out of the clinic with their minimal medical needs unmet. Nor does his
greed of time hesitate at short changing the institution. The clock watching doctor may show
up with an armful of personal work and telephone calls to deal with on clinic time. Greedy
Dr Marner may have switched his menu but not his insatiable appetite.
The greedy patient
resides on the other side of the healing relationship, identified by a demand for service,
not bits and pieces but all, "and now." His motivation has little to do with
hypochondriasis and much to do with maximising every opportunity for personal gain, no
matter the cost to others.
Alfie of movie fame is a stunning example of a service miser.
The Alfies of our world have an insouciant manner of riding an ambulance to casualty to
demand a sleeping pill or immediate treatment of chapped lips. They know their rights and
use them for relentless demands, "Doc, what I need is a shot, pill, renewed prescription,
admission to the hospital, excuse from work, or a pension." Failure to comply with these
ill disguised orders carries with it the threat of trouble. In the United States trouble is
voiced as threats of malpractice, physical violence to staff, or, as one patient put it,
"Doc, check me in now or I will throw myself through a store window. Then you will have to
spend the rest of the night picking glass out of me." From soliciting a passing nurse for a
fresh fluff of the pillows to fiddling the system for a disability pension these greedy
patients sin, along with greedy doctors.
Apollo, ancient God of medicine, hear our plea.
Save us, all too miserable patients and doctors, from our sins.
2525
NW Lovejoy,
Portland,
Oregon 97210,
United States
Ralph Crawshaw,
physician
All pictures are published with special permission of Harper's (copyright 1987
by Harper's Magazine. All rights reserved. Reproduced from November
issue)
References:
1 Crawshaw R. They all
laughed when I spoke of greedy doctors. West J Med 1985;142:267.
2
Chaucer G. In: Kermon F, Hollander J, eds. Oxford anthology of English literature.
London: Oxford University Press, 1973:145.
3 Fourth Lateran Council (1215). In:
Herbermann C G, Pace E A, Pallen C B, Shana T J, Wynne J J, eds. Catholic encyclopedia
(9). New York: Robert Appleton Co, 1910:18.
