When Janice and Ralph arrived at the medical healing center, they were met by a confusing scene. Men and women wearing white coats were walking around in all directions, many of them talking with patients or doing what appeared to be complicated medical evaluations.

Ralph's eye caught one who had a long line of patients waiting to talk with him. The sign said, "Free Evaluation and Professional Recommendations." Free? He jumped in line and waved Janice to join him.

The practitioner was a pleasant man who, oddly enough, was wrapping the blood pressure device around his patients' ankles. When he pulled out his stethoscope, he would apply it thoughtfully to the patient's forehead, nodding with a wise expression on his face.

 

THE SAME DRUG

Stranger still, no matter what the patients' symptoms were, he always prescribed the same drug. An elderly woman was told that a yearly payment plan for Lunagra would cure her bunions. A gentleman learned that a nightly dose of Lunagra would help him recover from his heart attack. A person with a high fever, who complained of vomiting and diarrhea, was also prescribed a lifetime supply of Lunagra.

While the practitioner applied the blood pressure device to Ralph's ankle, Ralph nervously ventured a question.

"How much is this visit actually going to cost me?"

"Nothing," the practitioner replied cheerfully.

"Nothing?" Ralph could hardly believe his ears.

"When I'm your practitioner, the advice is free," he said with a friendly smile, pausing to glance at the blood pressure reading. "337 over eight and three quarters. It definitely looks like you're going to need some Lunagra."

"What about my health insurance..."

"You may have to dig into your wallet with some of the white coats around here," the healing practitioner said with a snort. "But here, we believe in free service. You just go right over there and sign up for monthly payments for your..."

"But I'm not sure I need anything," Ralph protested weakly.

"Ralph, you're being difficult," Janice broke in quickly.

"I'm not sick. As far as I can see, all he does is recommend one drug, no matter what the problem is. I don't understand how he can feed his family if all he does is sit here and treat people for free."

"Oh, I get paid," the practitioner said. "I make a darn good living. Whenever I sell you some Lunagra, the drug company pays me half of what you pay for it in the first year."

"What?! I didn't come here to get sold something!" Ralph cried out. "What if it turned out I needed some other kind of medication?"

"I'm not licensed to sell you those," the practitioner sulked.

"Maybe we should look for somebody who's a little more professional," said Ralph. He stalked off, Janice following in his wake.

 

THE FINE PRINT

"That man looks nice," Janice ventured as she noticed a second practitioner. "And he seems to have a very busy practice."

Ralph looked over. There was a long line of would-be patients. At the front, the practitioner was applying the blood pressure system to a patient's upper arm.

"Maybe you're right," he said as they claimed a place in line.

Ralph and Janice were relieved to see that each patient in this line was given a different prescription. As they moved up the line, they were given a lengthy document, which they had to sign before the practitioner would speak with them.

"It looks like a lot of legalese," Ralph ventured, scanning the document with growing perplexity.

"See? Look here, on page seven-the recommendations the practitioner makes might not be in our best interest. Why would something important be all the way back on page seven?"

Later, he noticed a provision that said that the practitioner owed his primary loyalty to his employer, a firm that manufactures medical products and drugs. Some other manufacturers of medical products and medicines might have paid fees and other considerations for the privilege of being on the practitioner's shelf.

There was also a clause stating that you couldn't sue in a court of law no matter how bad the advice turned out to be; the dispute had to go to an arbitration hearing in a venue where the majority of the arbitrators would be industry representatives, and there could be no possibility of punitive damages. Much of the rest of the legal language was indecipherable, but it looked like a blanket apology and disclosure in advance for acting on conflicts of interests. By the time they had finished reading it, Ralph and Janice were startled to realize they were at the head of the line.

"What can I do for you today?" the practitioner in the white coat said with a friendly smile.

"I'm wondering about this document," Ralph began. "Can you explain it in plain English for me?"

"I'd like to," the practitioner said with a warm smile. "But the company lawyers won't allow it."

"Okay," Ralph said. "Is it all right if you do your professional evaluation without us signing this document?"

"No."

"Just sign it," Janice urged. "All the other patients didn't seem to have a problem with it."

"We had a bad experience with the last healing practitioner we talked to," Ralph continued doggedly. "Can you at least tell me how much this is going to cost us?"

"Nothing," the practitioner said.

"Nothing?" Janice said.

"I'll take my compensation from the drugs that I recommend. The company will pay me."

"But you're going to recommend what's best for whatever our medical problems are, won't you?" Janice asked, sounding agitated.

"Maybe you should take a deep breath," Ralph suggested mildly.

"You take a deep breath," Janice answered hotly. "I want to hear what this jerk has to say."

"I'll recommend whichever of my company's drugs most closely fits your medical condition," the practitioner said cautiously. "We subscribe to a fair dealing regulatory structure here, which means whatever we recommend has to be plausibly related to whatever is ailing you. We're actually much more highly regulated than those so-called fee-only professionals; there are a lot more rules that we have to follow when we sell our company's products and services."

"But what if we need something that your company doesn't manufacture?!" Janice fairly screamed at him.

"Oh, there are a lot of other drug manufacturers who have paid us shelf space fees or signed revenue-sharing contracts..."

"Maybe we should go," Ralph said nervously, pulling Janice away from the practitioner before her fingernails could find his throat. "Thank you for your time," he called out over his shoulder.

"Didn't he say something about fees?" Janice said after a moment.

 

A THIRD WAY

"Yes," Ralph said shortly. He was looking at another person in an identical white coat, whose sign said that he was fee-based. "What about him?" he said to Janice.

"Let's give it a try."

They took their place in another line, and watched as the patients in front of them appeared to be thoroughly examined. The recommendations were many and varied. They stepped forward with confidence.

"What brought you here today?" the healing practitioner asked them.

"We're really looking for somebody to handle our healthcare needs going forward," Ralph said. "We may have some health problems we don't know about, but mostly we're here to find somebody we can trust. I shudder to think that we might have spent years working with one of those other two people, throwing our money down the drain. You aren't like that, are you?"

"I'm a comprehensive practitioner," the fee-based advisor said smoothly. "Let's have a look."

During the examination, the practitioner found a few minor issues like Ralph's bad case of halitosis and Janice's high blood pressure. He evaluated their blood work and recommended a wellness program where he would be paid quarterly based on whatever drugs they purchased. Then he recommended another medical contract that would be paid for monthly.

"What do we need that for?" Ralph asked.

"If you pay in yearly while you're young, when you get older, it will cover some of your medical bills. There are a lot of really terrific bells and whistles that mean that you're guaranteed to at least get all your money back, plus 7% rate of return."

"Does our quarterly fee cover that too?"

"No."

"Do we pay you for recommending it?"

"I get paid a commission for selling it to you."

"What?!" Ralph was beginning to feel a sense of déjà vu. "I thought you were recommending whatever was in our best interest."

"Oh, that was just during the evaluation phase. Once I finished that, I put on a different hat and became a salesperson of drugs and my own wellness program."

"I didn't see you put on any different hats," Janice said in a confused tone of voice. "You aren't wearing a hat now, are you?"

"It's just an expression," the healing practitioner said nervously.

"I don't get it," Ralph said, sitting down in the chair and wrapping the blood pressure device around his head like a compress. "Isn't there somebody who simply evaluates our health and then prescribes what we need, for a fair price?"

"There are people like that, but not very many, and they mostly only work for rich people," the practitioner said.

"What do you mean, rich people?"

"Well, they charge actual fees, and nobody but a rich person would think of writing a check, just for the privilege of not being sick."

"How are we supposed to tell you apart?" Janice demanded. "You all look the same. We could have wandered in this maze for years, working with one person after another, having them take our money and giving us whatever they were told to recommend. Isn't there a regulatory body in charge of all you medical practitioners?"

"Yes," the fee-based practitioner admitted. "The person in charge used to work for the brokerage folks over there, who are employed by the product manufacturers. I saw you talking with one of them. They have a lobbying and self-regulatory organization, and it paid her millions in retirement money before she took over regulating them and the rest of us."

"So is she going to help us figure out which of you is which?"

"Her group did a study some years ago which found out that people were confused."

"Well, duh," Janice responded.

"So they concluded there isn't any difference between us, and we should all be regulated as if we were selling stuff. You know, rules to make sure we don't screw you when we make self-serving recommendations."

"God in heaven," Ralph said. "Isn't there some kind of professional standard for what you do?"

"Not really," the practitioner said cheerfully. "There's an educational credential and a code of ethics that goes along with it, which only a handful of us bother to get, and a lots of other credentials, some of which you can get in a weekend that look just as impressive on the business card. Meanwhile, the regulators are studying whether we should all work on behalf of the patients, but our trade organization has joined with the product manufacturers in arguing that this is some kind of big government power grab and would raise costs for consumers and small businesses. Their hope is that all of us, including those do-gooders, will be put under the regulatory arm of the organization that lobbies on behalf of the manufacturing firms, whose board of directors has a lot of product and sales executives on it."

"And that helps us... how?" Ralph asked.

"Could you just show us one of those holier-than-thou people?" Janice said wearily.

"There's one over there," the healing practitioner said, nodding his head toward a middle-aged woman wearing a white coat that was identical to every other one they'd seen. "There aren't very many of them," the fee-based advisor added. "Maybe, instead, you'd be willing to pay a discounted commission.

 

Bob Veres is editor of Inside Information (www.bobveres.com), a service which helps advisors become more effective, efficient and successful by identifying best practices in practice management and client services.