Reimbursement over the Atlantic

Two unrelated issues came to mind as I reflected on a recent harrowing experience. One was the heated debate over the imbalance in financial reward between medical-surgical procedures and so-called cognitive activity or (forgive me) non-procedures. The second was the solid foundation of traditional Western medical education on which I was fortunate enough to capitalize.

It seems that in medicine we have developed a curriculum that is effective, even for those of us who only practice part-time and cannot be on the cutting edge of technology with its latest generation of cephalosporins. It is a credit to traditional medical education that when occasionally challenged by friends, family, and the few patients for whom I take responsibility, I can draw on the strong foundation of fundamentals available in every U.S. medical school. This method does not require enormous amounts of detail close at hand, but simply a logical sequence of steps to organize symptoms and signs, focus on a few potential organ systems, and then make a diagnosis. This leaves the obscure and the incurable for textbooks and keener minds.

Now, having said this, I must quickly admit that I do not have the same confidence when it comes to medical emergencies. I have willingly stepped aside for the eager emergency medical technicians in public places where my interim help as a physician was sought. Frankly, I was glad to yield as I barked a few officious platitudes so that all present might have no doubt as to who was in charge. A once-proud knight in white cotton pants who could cannulate any orifice in an emergency, I now secretly hope none of my middle-aged golf partners suffer a medical catastrophe over a 2-foot putt.

This introduction will explain why I was less than eager to respond when an announcement requesting …