The story goes that a man was upset that his neighbor kids would always play on his lawn and damage it. So he decided to pay each child to play on his lawn. The surprised kids gladly accepted. After a few days the man told them that he could only afford to pay them half of the initial rate. The kids accepted this reduced rate but were less then enthusiastic. After a few more days the man cut his pay to almost nothing and the children were so upset that they left, vowing never to play on his lawn again unless he increased their pay. Problem solved.

Why pay for performance does not work and may impair patient care

Fascinating. As you dive deeper and deeper into what makes a good doctor, it starts looking like we’ll never know. However, I do believe that deinstitutionalizing medicine and bringing back the concept of the neighborhood doctor would do wonders in making people “feel” like they’ve got a good doctor. It’s just a hunch, but I believe in the therapeutic power of good relationships.

The vast majority of doctors are average and above. We should really be worrying about making the bottom rung doctors average doctors.