Where Do YOU
Draw the Line? by Manuel M. Quiñones, Jr., MD
Bexar County Medical Society
President 2008
Think back into your past for just
a moment. How many times
have I, or someone just like me,
called you at 3 in the morning asking
for help? Some of you come help me
with a COPDer who I know is going to
tire out before the sun comes up. And
some of you come in to look at a tender
belly — an appendix that begs to see the
light. Sometimes you come in to cath
that diabetic, or treat that hyperlipidemic
who never did stop smoking until he
recovered from the emergency CABG.
Only once in 23 years has someone
said they refuse to see any of my
patients because of the insurance that
some of them may have. The other
2,000 times, you come in and do what
you do, never once asking if you’re
going to get paid. We all do it, every
day. In the office we try to determine
insurance eligibility, but we still see the
sickest, regardless.
Then, 30 to 60 days later you get a
check in the mail. Your office manager
opens the envelope, her eyes widen
and she puts it on your stack with a
yellow sticky that says, “You see — I
told you.” And you can’t help but
think three things. First of all, you
assume it must be a mistake — how
can anyone stay in business this way?
Then you get angry — I don’t have to
take this. Then you get a slight feeling
of nausea in your gut when you realize
that what you and I do is not what we
started off doing. And you and I don’t
know how to do anything else.
So where do you draw the line?
When do you say, “Enough is
enough”? (Sorry, I didn’t mean to
sound like a Presidential candidate,
but these days, you can’t say a thing
one of them hasn’t already said.)
When do you finally put your
dreams, your hopes, and your family’s
well-being in front of what you promised
to do for the rest of your life? If you
are reading this right now, then you took
the same oath I did. Did it say I have to
do this for free? “I will treat without
exception all who seek my ministrations…”
is in the modern version of the
Hippocratic Oath, but interestingly, not
in the original version. As it turns out,
there are several parts of the Oath that
have been removed or re-shaped over
the years in various countries, schools,
and societies as the social, religious, and
political importance of medicine has
changed. And although today there are
many complex issues that seem to tear
the Oath apart, it continues to be the
ethical and moral boat on which each
and every one of us sails in our own
ocean every day of our lives.
But just for a moment, think of this.
If you had to choose between your
family and doing what you do, what
would you choose? I thought so — I
would choose my family also. So why
do we allow ourselves to work harder
and harder every day, spend less and
less time with our families, and do it
with the expectation of taking home
less? The reason is that none of us did
this for the money.
If you were lucky like I was, you had
a mentor in medical school or residency
who meant so much to you, who
you wanted so much to be like, who
you admired so much for what he or
she did for the good of the patient and
had such an enviable family life that
you knew from the start — it’s not
about the money.
When you walked across that stage
and shook hands with the President of
the Medical School, took your picture
with the Dean and looked inside to see
if they signed your diploma, you took
the loudest sigh of your life — the sigh
that was heard around the world. It’s
about who you are, how society places
you on a pedestal and respects your
opinion in all areas of life. It’s that threeyear-old that runs down the hall to hug
your leg, or the waiting family that hugs
and thanks you at midnight after a long
surgery or that dying patient you stayed
up with all night who tells you that
when he gets to where he’s going, he’s
going to tell your dad he raised a good
son or daughter. That’s why you do it.
Yes, the money makes it easier, but anybody
who works two full-time jobs
after training for 12 years should earn a
comfortable life.
I’ve never believed there is any easy
answer when you stop seeing a patient
based on his or her insurance plan or
lack of it. I know that there is no correct
answer for everyone. I also know that I
am happy with my answer to this question,
and you have to be happy with
yours. And I also know that no matter
how commendable the mission, if you
can’t make money, the mission is over.
But never lose sight of the big
picture — who you are to your family,
and who you are to your patients.
Tonight when you go home, hug and
kiss your children, tell them you love
them “just because.” If they’re older like
mine, call them or text them. Take your
wife or husband to dinner this week for
no reason at all and don’t tell them why.
And finally, tonight just before you go
to sleep, thank God for letting you do
what you do, thank Him for the day
about to end, and promise if He guides
you through one more, you’ll do the
same good job all over again.
From the back porch, feet up and sun
going down, I am your President.
Manny Quiñones
