I Had a Tough Day, Hillary

Abstract

My main office is different from that of most physicians: I am assistant medical director for a very large insurance company. I am paid a straight salary. I do not receive any kind of bonus. In no way am I penalized or rewarded for any decision I make about the payment of a claim. I made seven decisions today that were complex and will profoundly affect the lives of the patients and families involved. The decisions concerned three requests for high-dose chemotherapy with autologous bone marrow transplantation to treat breast cancer, one request for a liver transplant to treat alcoholic cirrhosis, one for treatment of an infant with a hypoplastic heart, and two for kidney transplantation in patients with renal failure. All these requests came from physicians or hospital transplantation coordinators.