From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 26 Apr 1999 08:00:12 GMT

In <3723E776.D353300E@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>"Steven B. Harris" wrote:
>
>> In <3722A523.15CB6CF9@emory.edu> Andrew Chung <achung@emory.edu>
>> writes:
>>
>> >I do believe market forces and competition are necessary for
>> >innovations in business. At the same time, I also believe that
>> >business (employers, insurers, managers and investors) fosters a
>> >competitive depersonalized spirit that is incompatible with patient
>> >care.
>>
>>    Then why don't the same forces foster a competitive depersonalized
>> spirit that is incompatible with good hotel service, restauraunt
>> service, airline service, taxi service?
>
>Stop tipping and see what happens.


    It would get worse until employers discovered other incentives.  At
some very expensive hotels the employees won't take tips.  On the other
hand, they are evaluated on performance in secret by management, and
rewarded with a high salary job if they please, and by a pink slip if
not.  I don't tip my auto mechanic and my airline pilot, yet both do an
excellent job (so good that I often wish that socially it was
possible-- I've often felt that passengers should be allowed to mark
off a box voluntarily for $5 or $10 for the flight crew, who are
getting even more underpaid than doctors these days).

    Of course, you know that there actually is a little bit of tipping
in medicine.  The occasional doctor is personally thanked by a rich
patient, and some take it proudly.  Why not?  It makes both feel
better.  It just isn't *expected.*  On a smaller scale, I once had a
patient who was a professional cook, who in gratitude for managing her
difficult heart failure, brought me handmade fruit pies every couple of
weeks for a year, until her insurance plan changed.  I think I gained
10 lbs.  Had we kept it up she probably would have outlived me.  I've
no doubt she's busy killing some doctor somewhere else as we speak.
But we were always just a little happier to see her at my clinic.
We're human.