I read with interest and concern an article entitled "The Low-Probability Lung Scan: A Potentially Lethal Reading" by Bone.1 He has clearly made a very good point that every clinician should remember in taking care of patients with potentially very serious illnesses. However, I believe that the example that Bone cited is just one particular example of a much more general and pervasive problem in American medicine today. That problem is the reluctance of third-party payers, the government, and, yes, even our own colleagues, to put proper value on the clinical evaluation and assessment of a particular patient. That reluctance leads to innumerable hassles for the practicing physician who bears the responsibility of caring for patients but whose judgment is constantly questioned by those who have the luxury of hindsight and, most importantly, a lack of responsibility for the consequence of their actions.
As a rheumatologist, I often have