How to be an Authentic Doctor#15: Professional Courtesy


Times have sure changed. It is nothing like it was in the good old days. I say this admitting that I am in my late 40’s and really was never part of the good old days but is just sounds good.

A few years back, when I was in Maine, I made a phone call to a local endocrinologist. You see, I had this condition that we will call congenital adrenal hyperplasia (CAH) because for one, that is not what it is and secondly, no one really knows what congenital adrenal hyperplasia really is.

I asked the secretary to speak with Dr. Richard Dickhead (not his real name) who I had seen before. Within minutes he got on the phone. Here is the conversation:

“Hi, Dick, I don’t know if you remember me but I saw you about a year or so ago.”

Silence. Now this guy isn’t exactly located in town but may travel a measly twenty minutes once a week to the local hospital clinic. I do know, however, that he heard the secretary say, “Dr. Farrago” is on the phone.

“No, I don’t remember you.”

“Okay, anyway, I have this CAH that I want to talk to you about.”

“You need to make an appointment”

“Sure, I will, but I have a couple of quick questions first. What are you doing with….”

“I don’t have time for this. Call 888-9999. I am in the clinic seeing patients.”

Click. The phone goes dead.

Where is the professional courtesy there? Sure I was technically a patient but if any physician curbsides me for a question or calls my office or even comes to my house, I would give him the shirt off my back. What happened to taking care of your own?

Here are your answers. In a medium sized town, some specialists have monopolies. I don’t want to name which ones (endocrinologists) but they exist. With monopolies comes the death of capitalism. In other words, you don’t have to worry whether you are an asshole to you peers because you know they have no where else to send their patients. What this meant for me personally was that I had no choice but to go this prick’s office for my CAH. Go somewhere else you say? My insurance only allows me to see physicians “in network”. Who is “in network”? Dr. Dickhead. For me to see someone else for my CAH would cost me out of pocket. What are the chances that another endocrinologist would comp me for his or her service? Zilch. In today’s world, only mafia bosses get something for free or what we used to call in New York “four on the arm”. We physicians, it seems, don’t give a shit about each other enough to give professional courtesy.

That being said, I do remember an exception. One of my physician partners got his vasectomy for free or what I like to now call “two on the arm” if you will. The urologist is a nice guy (besides my buddy’s insurance wouldn’t pay for this procedure anyway) and he is not part of a big urology group to ruin his compassion for other docs.  It was a swell thing to do for a peer.

So where do we go from here? The answer is simple. If we all banded together as physicians (all except endocrinologists) we can be one big happy monopoly that takes care of each other (again except endocrinologists) and totally screw the hospitals and the insurance companies. Unfortunately, there are laws against this and we are too busy seeing patients to every come together on anything. Instead, maybe we could be a little nicer to at least our fellow docs (except Dr. Dickhead) so that in some small way that compassion can leak back to our patients. Or maybe this is just my congenital adrenal hyperplasia talking.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “How to be an Authentic Doctor#15: Professional Courtesy

  1. Mamadoc
    May 7, 2014 at 10:14 pm

    Have met very few endos that didn’t a personality disorder. Who is this clown VN?

    • Doug Farrago
      May 8, 2014 at 6:01 am

      It’s taken care of.

  2. Kurt
    May 7, 2014 at 3:32 pm

    To be an Endo, one has to be an anal retentive type to memorize all those chemical pathways. They are
    a-holes from the get go. Find a “normal” one and that’s like winning the lottery.


  3. May 7, 2014 at 10:00 am

    I practice in Minnesota. Our group of neonatologists routinely offered professional courtesy, and we also frequently wrote off remaining bills from insurance for many of our patients- young families with not much money for the most part. We were told by our business manager that both practices were illegal, and constituted a discriminatory billing practice which could attract regulatory attention. So, no more write offs, no more professional courtesy. Im haven’t been extended professional courtesy for many years.

  4. RB
    May 3, 2014 at 9:14 am

    I had a costly outpatient procedure done last year and didn’t get any professional courtesy. Not from the physician, not from the anesthesiologist. Recently we had to forgo our monthly payment for two months to bone up for taxes and they sent is to f*****g collections! Guess what a**h**e… No more referrals for you. Come to think of it, his name is Dr. Dickhead too!

    • V N
      May 3, 2014 at 5:30 pm

      I’m sorry but doctors like this need to publicized. If they can say the hospital forbid it, that’s one thing but they should communicate it to their fellow HCP’s. Not diss them like this.

      We complain about how we’re treated but if you treat your own kind like this, they’ll treat us as bad or worse.

  5. Sir Lance-a-lot
    May 3, 2014 at 7:22 am

    Right on, Doug!

    On the other side of it, I hate having to essentially sneak around when we DO give some professional courtesy to another doc or a staff member, because if the Administration caught us, we’d be “in trouble.”

    By the way, I’m not entirely certain, but, to show you how bad things are, I believe that if you were intending to communicate with anyone specific when you said this:
    “If we all banded together as physicians… we can be one big happy monopoly that takes care of each other… and totally screw the hospitals and the insurance companies,”
    you committed a federal felony.


    • Dr Bobz
      May 6, 2014 at 7:26 am

      Docs who work for hospitals often CANNOT offer professional courtesy. I have a buddy who couldn’t see his own wife without her getting a bill.

      • V N
        May 6, 2014 at 2:39 pm

        Stuff like this makes my blood boil. Yes I am a patient. However, doctors can get familiar with other doctors work that way. This is the best way for them to make judgements about who they send patients on to. Good Lord I could see if it was surgery but please, some friendly talk, it might help another doctor who hasn’t seen something to get another professionals’ wisdom and pass it on.

        I sure do wonder when the profession gets so you can’t talk to your fellow professional. Its like emails and phone calls to patients and peer to peer with insurance. Its an office visit, it needs to be paid.

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