Your post points to the inherent problem of lack of insurance. The ER in incapable of providing primary care. It cannot provide screening exams, manage follow-up care, or diagnose non-emergent medical conditions. If this unfortunate woman had a primary care provider she could have sat down at her appointment and reported her symptoms, then had the appropriate measures to diagnose the problem. Uterine cancer does not become end stage in a matter of weeks or even months, it is a slow growing tumor.

In regard to the healthy 24 year old. If the facts are as you state, the breakdown is possibly in poor diagnostic management. If it was current, there are basic standards of care for the management of suspected meningitis, if it presents with standard symptoms -headache, stiff neck, blurred vision, and fever. Unfortunately, meningitis can present with vague symptoms, that appear to be a simple influenza. Also, pneumonia, sore throats, acne, simple colds can progress to severe meningitis very quickly. I hope healthcare reform and returning the power of medical decision to the physician and patient, would allow greater freedoms - non-pressurized medical stays to allow observation of patients.

Also, patient education is key. A knowledgeable patient, gets a second opinion or can recognize severe symptoms in a timely manner. As a medical student, I myself had a cancer diagnosis from which I have seen many patients die. I had foolishly waited several months, telling myself my symptoms were in my head and it was just a cold. As the symptoms progressed, I could not deny the severity of the symptoms. I saw my doctor, explained my symptoms and requested the appropriate screening evaluations. I would like to think that I would have had the same care if I was the average patient and did not know what I needed. But, I had been seen at the university health center 5 months before with vague symptoms and was sent away with a diagnosis of stress.

No physician is perfect, and no healthcare system is perfect. But, patients should have at least he same right to diagnosis as their automobile. If you take your car in for a problem, you will get a full diagnostic work-up. They will notify you of the problem and advise you of the cost, then you will be given the option of repair. Your mechanic is not being pressured by his boss to control costs, your credit card company telling him what to do, or pushed to rush you out the door. We would riot in the streets if our automotive repair system was as dysfunctional as our healthcare system. But, we do not take our healthcare as seriously as we should, until it slaps us in the face.

Would this system allow physicians to independently make decisions with their patients, based on the standards of practice? Would prior graduates, with well over an average of $200,000 in student loan debt (before interest and fees) be able to opt in? Would physician work hours be limited (I work an average of 80-90hrs/week -in a physically demanding field)? Would physicians be allowed to unionize? Who would cover the liability costs? What type of incentives would there be for excellence of care, innovation, research? What would decide where physicians work? Would there be cost of living adjustments for the community the physician works in? What are the entrance requirements for medical school and how are admissions encouraged? What determines which physician is assigned to each patient? What will be the incentive for physicians to train in specialties that require a high level of training? Will patients have the freedom to choose the best physician or just the available one? What about the non-financial costs of training (family life, physical, emotional costs of the lifestyle)?

What other professions should have a fixed income? Teaching -the education budgets have spiraled out of control in this country. I think that your solution is too simple. The high cost of medical care in this country is much more than physician salaries. Yes, physicians get a substantial pay, however the service that is provided is detrimental. Teachers, nurses, police, military personnel should also be appropriately compensated. Establishing a broad range of reforms is the answer. Controlling insurance bureaucracy, pharmaceutical costs, liability are a good start.

If you review the current physician salaries to those of the past, particularly up to the 1970s, you may note that physician salaries have stabilized and some fields have comparatively gone down (before taking into consideration the increased cost of medical education and length of training). Yet, the cost of healthcare has substantially increased. There has also been a disturbing downtrend in medical school admissions and trainees in the primary healthcare fields. I think you plan is likely to result in a loss of innovation, poor alternative care, and a more disillusioned workforce.

Since this one came into practice. Also, I cannot name one professional field where the expectation of pay is considered inappropriate. Much like my mechanic, a fee is expected for service (except my mechanic gets paid precisely what s/he bills directly from me). As DrL below noted, most physicians' billing collection supports overhead costs -including the nurses/medical aids/billers salaries, equipment suppliers, lease. As you provided a service for these physicians, you expected your salary to be paid.

I am a physician, I have worked a in broad range of hospitals from the wealthy private to the cash-poor inner city hospitals. I have never seen a patient turned away for care. I have personally provided care that I know that I cannot recover the cost, but aIso have opted to not bill for the service. The liability involved with the denial of care is much greater than the actual cost of care. I have a very difficult time believing the authenticity of this claim. Also, a clinical brain death is a death, there would not be days to spend at the bedside with a clinically dead patient. The declaration of a brain death is a death note and all supportive measures ceased. I doubt that this individual participated in the direct management of this patient. Please, do not post heresy as a statement of fact. This defeats the purpose of the discussion.