As I See It

What the regulatory mindset taketh away …

New rules threaten old courtesies.

By Paul S. Koch, MD, Editor Emeritus

A few years ago I was getting ready to pull anchor in a secluded harbor in Down East Maine when a turn of the key failed to get the diesel to turn over. Now I’m a fairly handy sort when it comes to keeping the iron genny happy and I was confident that a few minutes with the tools would get her purring like a kitten.

An hour later, all I had to show for my efforts were bruised knuckles and sore knees. That baby would not cough, at least not for me, so it was time to go on deck and call in the cavalry.

THE SEAMAN’S CODE

About a half-dozen boats were in harbor, one of them an oversized motor yacht with a captain resplendent in white. I hailed on 16 — for you non-sailors, that means I appealed for aid on the VHF radio on universal channel 16, which all boats are required to monitor — and asked if the yacht had a mechanic on board. The captain disappeared below and reappeared in workman’s khakis and carrying a toolbox.

Two more hours passed. Together we pretty much pulled the engine apart, stopping only when we found the problem — a wasp’s nest in the air intake line. We had a laugh and when he was about to leave I gave him a beer and offered a tip. He didn’t take it.

“If I was having a problem in my boat and you came over to help me, would you expect me to pay you?”

“Of course not,” I answered. “On the water we always help each other.”

“I feel the same way.”

And then he was gone, taking the beer but leaving the tip, and a lesson. Sometimes you do things for money: He is, after all, paid well for managing his boss’s yacht. Sometimes you lend a hand just because you want to, or because it’s the right thing to do.

SO MUCH FOR ‘PROGRESS’

This story comes to mind as our compliance officers — sorry, if you missed earlier installments we sold the practice to a private equity firm; I now work for The Man — develop protocols for professional courtesies, discounts and no-charge visits.

Since the days of Hippocrates physicians have cared for each other gratis, as a sign of collegiality and to eliminate a reason why we might want to treat our own families. But government agencies and federal laws are actively dismantling this 2,500- year-old tradition. If you extend a courtesy to a referring physician, beware! That can be an illegal inducement.

We see neighbors we know are indigent. Beware again. You may have to humiliate them and ask for their tax returns before being permitted to give them a break.

Our corporate lawyers will ensure we follow all the rules, but I believe that we sacrificed not only our freedom, but also our dignity when we let our elected officials steal our ability to be generous whenever we want, to whomever we want, just because we feel like it. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, R.I. His e-mail is pskoch@clarisvision.com.