I Had a Tough Day, Hillary
Boren, Stephen D.
New England Journal of Medicine. 1994 Feb 17; 330(7): 500-502.
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.
Administrators; Alcohol Abuse; Alternative Therapies; Bone Marrow; Breast Cancer; Cancer; Congenital Disorders; Cosmetic Surgery; Consultation; Economics; Financial Support; Health; Health Care; Health Insurance; Hearts; Industry; Insurance; Illness; Kidneys; Kidney Transplantation; Livers; Newborns; Patient Care; Patients; Physicians; Prognosis; Reproductive Technologies; Research; Resource Allocation; Selection for Treatment; Self Induced Illness; Surgery; Tissue Transplantation; Transplantation;