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ethics interview questions

leahmaria

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    So, I'm making a list of ethics questions I should be prepared for in interviews, I thought I'd share. Please add on others.

    Anything involving:
    pregnant teenager
    drunk colleague
    euthanasia
    classmate cheating
    health care access

    Thanks guys!
     
    - would you rather kill an old person or a young person? (not put so bluntly)
    - jehovah's witness refusing a blood transfusion
    - choose a new procedure that is supposedly more effective but not yet proven or an old procedure that is less effective but proven to be consistent.

    can't think of any others right now.
     
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    leahmaria

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      is there supposed to be a right answer? :scared:

      i know, i feel the same way, some of these scare me to death...i think your answer should be well thought out--like you know these issues exist in medicine.

      I took an class last semester "Ethical Implications of Health Care Issues" with a brilliant and passionate professor and left knowing that as a doctor i'll be put in situations where to be ethical is also to be wrong...that there are situations where you need to act and either way you you'll be made dirty in the process. My foundations in many things were torn from under me, but I think that admitting that there isn't a perfect way to go about some of these things may be a decent way to start your answer.
       

      Erina

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        - would you rather kill an old person or a young person? (not put so bluntly)
        - jehovah's witness refusing a blood transfusion
        - choose a new procedure that is supposedly more effective but not yet proven or an old procedure that is less effective but proven to be consistent.

        can't think of any others right now.

        about the jehovah's witness one...i've heard the one about parents not wanting the transfusion for their child. in that case, i would make the argument that the doctor has an obligation to go against the parents' wishes for the sake of the child yadda yadda yadda. but if it's the patient who is refusing the transfusion based on religion, i would be more inclined to respect the patient's right to decide what should be done to his/her body. any thoughts? am i completely off base?
         

        RokChalkJayhawk

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          what did he say?

          Obviously he said he hates Extra-terrestrials :D

          Actually, he took the very PC route and said that you can't judge anyone based on their ethnicity, but rather you have to consider each person as an individual and evaluate them on their personality characteristics rather than their race or color of their skin.

          He got into the school so I guess he did fine.
           

          leahmaria

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            I read this one on interview feedback:

            "What would you do if you knew one of your coworkers (a phlebotomist) was drawing blood directly from the patients' hearts?"

            How the heck do you answer this?? I can't imagine that this actually happened!
             

            RokChalkJayhawk

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              about the jehovah's witness one...i've heard the one about parents not wanting the transfusion for their child. in that case, i would make the argument that the doctor has an obligation to go against the parents' wishes for the sake of the child yadda yadda yadda. but if it's the patient who is refusing the transfusion based on religion, i would be more inclined to respect the patient's right to decide what should be done to his/her body. any thoughts? am i completely off base?

              An adult practicing a religion that does not allow treatments such as transfusions has every right to REFUSE treatment.
               

              leahmaria

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                while i was trying to find that one, i ran across this general trend:

                --how would you fix the (insert medical problem here) problem?

                think bird flu, anthrax, situation in new orleans right after katrina, fighting in middle east etc...
                 
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                is there supposed to be a right answer? :scared:
                no there isn't. the point of the question is to see if you can rationally think on your feet. for example, the old proven procedure vs new experimental procedure with better results, i said i'd go for the new experimental treatment (provided there are no contraindications) because i want to give my patient the best shot they have. of course, this depends on how much better the new is over the old. you can argue it the other way; the old procedure is a sure bet while you feel the new stuff carries too many risks.

                adcoms as these questions not to grill you and make you pee your pants. they're probing your brain and seeing how you think.

                about the jehovah's witness one...i've heard the one about parents not wanting the transfusion for their child. in that case, i would make the argument that the doctor has an obligation to go against the parents' wishes for the sake of the child yadda yadda yadda. but if it's the patient who is refusing the transfusion based on religion, i would be more inclined to respect the patient's right to decide what should be done to his/her body. any thoughts? am i completely off base?
                i'd agree with you on the parents and child since the child is your patient. you have a duty to your patient not the parents.

                on the actual patient refusing, i'd inform them of the risks of not receiving the transfusion i.e. death or debilitation, and strongly urge them to take the transfusion. in the end, they have the right to deny medical treatment, just as there are DNR orders (another grey area). shrugs, we can discuss this more; i just don't see a compelling reason to force a patient to receive a transfusion when he/she is well informed.
                 

                Erina

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                  no there isn't. the point of the question is to see if you can rationally think on your feet. for example, the old proven procedure vs new experimental procedure with better results, i said i'd go for the new experimental treatment (provided there are no contraindications) because i want to give my patient the best shot they have. of course, this depends on how much better the new is over the old. you can argue it the other way; the old procedure is a sure bet while you feel the new stuff carries too many risks.

                  adcoms as these questions not to grill you and make you pee your pants. they're probing your brain and seeing how you think.


                  i'd agree with you on the parents and child since the child is your patient. on the actual patient refusing, i'd inform them of the risks of not receiving the transfusion i.e. death or debilitation, and strongly urge them to take the transfusion. in the end, they have the right to deny medical treatment, just as there are DNR orders (another grey area). shrugs, we can discuss this more; i just don't see a compelling reason to force a patient to receive a transfusion when he/she is well informed.

                  ethics questions are so hard because your answer is going to depend on so many variables. and i personally tend to think about all of the possible affects of my decisions...so that makes my answers even more complicated.
                   

                  Erina

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                    and they're going to be harder when we have real patients and situations to deal with.

                    i kinda think i may do better with that (i hope, at least). i hate hypothetical situations. it's so hard for me to sit there and say what i might do but in real situations, it's so much easier for me to quickly analyze my options and pick what i think to be best.

                    hypothetical situations make me think too much...thinking is bad.:p
                     
                    ethics questions are so hard because your answer is going to depend on so many variables. and i personally tend to think about all of the possible affects of my decisions...so that makes my answers even more complicated.
                    yup. it's not fun but interesting to hear what you say. you really learn where you stand on a lot of things. i always make sure to preface the answer with something like "i don't hate xxxx type of person, but..." so they know i'm not biased but making a weighted decision.

                    should we know the laws for these things as well before we interview...
                    for example, teenage pregnancy/abortion confidentiality from parents laws?
                    i don't think you should have to know them, at least not obscure things. i think you should have an idea of your duties as a future physician but not laws. it actually makes the conversation more interactive when they ask you the question and you say, "well, i haven't been exposed to this subject material and i don't know if there are any laws concerning teenage pregnancy/abortion confidentiality. can you tell me what they are so i can give you a good answer?

                    that drunk superior one is the kiss of death. i might just start throwing things if i get asked that.
                    i don't think it's that bad. whatever the case, i'd take him aside and talk about it. still behaves like a lunatic or wields his position over me? i'd go to his superior. if he's not harming patients, i wouldn't be as proactive about it but would still do something. i just personally think trying to fix the problem internally before starting a whole mess is better than jumping straight to the mess.


                    also on a side note, i love this multi quote feature. better than copy pasting text and placing quote tags around it.
                     
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                    LizzyM

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                      should we know the laws for these things as well before we interview...

                      for example, teenage pregnancy/abortion confidentiality from parents laws?

                      The laws vary by state. If that's the question, a good answer might include checking with a lawyer (the lawyer for the hospital where you practice will know that law and you'll learn it in residency, and look into it if you move to another state after that).

                      How about being asked not to tell a pt the diagnosis (family doesn't want pt to know)? what if the patient is a kid?

                      What should you do if a patient asks you to "be creative" in describing the reason for the visit so that insurance will cover it? What if a patient asks you not to put something in the medical record because it would hurt insurability?
                       

                      leahmaria

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                        i don't think you should have to know them, at least not obscure things. i think you should have an idea of your duties as a future physician but not laws. it actually makes the conversation more interactive when they ask you the question and you say, "well, i haven't been exposed to this subject material and i don't know if there are any laws concerning teenage pregnancy/abortion confidentiality. can you tell me what they are so i can give you a good answer?

                        thanks. thats a great way to look at it, and it'll save me some time in preparing for interviews :)
                         

                        modelslashactor

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                          why is it the kiss of death? although i definitely see how it's a difficult question...

                          yeah just because it's difficult. recommendations from your superiors seem to be one of the few tools of evaluation for students and residents, so if you stuck up for the patient you would be potentially be doing your future self a great disservice.

                          Edit: just read your post, yourmom, and that's the logic I was thinking too. Still, it'd be pretty scary to actually do it.
                           

                          leahmaria

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                            The laws vary by state. If that's the question, a good answer might include checking with a lawyer (the lawyer for the hospital where you practice will know that law and you'll learn it in residency, and look into it if you move to another state after that).

                            How about being asked not to tell a pt the diagnosis (family doesn't want pt to know)? what if the patient is a kid?

                            What should you do if a patient asks you to "be creative" in describing the reason for the visit so that insurance will cover it? What if a patient asks you not to put something in the medical record because it would hurt insurability?

                            being asked not to tell the patient the diagnosis is another one for the list--though i would say that it is certainly my responsibility to my patient to tell them the truth of their situation. and it always gets trickier when the patient is a kid, but if i couldn't get the parents to agree that their child should know, i would still find it my place to tell them, i think.

                            as for insurance stuff, i suppose it doesn't work so well to say that I'll put the truth on the insurance papers and that I'd eat the rest of the cost? I'm going into medicine so that i can play a part in making health care accessible to those it's not accessible to...i don't want all the insurance stuff to get in the way...:(
                             
                            How about being asked not to tell a pt the diagnosis (family doesn't want pt to know)? what if the patient is a kid?

                            What should you do if a patient asks you to "be creative" in describing the reason for the visit so that insurance will cover it? What if a patient asks you not to put something in the medical record because it would hurt insurability?
                            1) patient should know the diagnosis. i don't see how there would be any dilemma here, but i'm inexperienced.

                            2) concerning the insurance issues, i'm know doctors do those things all the time, but as an (again) inexperienced applicant/student, i'd spin a patient's diagnosis if the patient would otherwise die w/o treatment or the family would go into massive debt, which will lead to other problems. it's not that i feel insurance companies are inherently evil. i just think, they pay for insurance, they should at least get something out of it instead of being jipped.
                             

                            kypdurron5

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                              about the jehovah's witness one...i've heard the one about parents not wanting the transfusion for their child. in that case, i would make the argument that the doctor has an obligation to go against the parents' wishes for the sake of the child yadda yadda yadda. but if it's the patient who is refusing the transfusion based on religion, i would be more inclined to respect the patient's right to decide what should be done to his/her body. any thoughts? am i completely off base?
                              To this and the "laws" post on this thread. No, we are not expected to be familiar with local or state laws regarding specific medical care questions. I faced this question during my interview and I started by saying "well, I'm not sure whether there might be some kind of legal intervention available" and the interviewer jumped in by saying "yes, there is...the state can take custody of the child to allow the procedure to occur." Thus I said that I would pursue that action in the interest of the patient. I argued that a 4 yr old (in this case) is not really old enough to make an informed decision about his healthcare or even the religion which he will practice, thus it's up the physician to make the most relevant medical decisions. If the parents do not agree with this then legal intervention should be sought. The judge will agree with the party that is most in accordance with the law, and the situation will be resolved.

                              His counter-point was "Then you would be willing to condemn his soul to eternal damnation?" I hesitated more than I should have, but I essentially said "yes, if that's what it takes to make the best medical decision possible."

                              Just my experience...but on a side note...does anyone know if it's possible for Jehovah's Witnesses to obtain "redemption" after doing forbidden things like this? What about the fact that it was out of the child's hands? Finally, aren't JW's the people who believe only 144,000 people will make it to "paradise" anyway....therefore, the child would have a better chance of winning the lottery and might as well live a long, healthy life than hope to be one of these few. Just some thoughts...but if anyone has more experience with JW's I would appreciate some insight. I am unfortunately under-educated when it comes to this particular religion (or "cult"...depending on where you stand).
                               

                              neurodoc

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                                Back in the 1980's when I was applying to med schools, one of my fellow UC Berkeley pre-meds told me about an interview he had at a religious med school in California (you figure out which school...). He was asked, "Who was the greatest physician?" He had thought about this beforehand and said, "Jesus Christ...He made the blind see, and he raised the dead." I think he was accepted.


                                Nick
                                 

                                kypdurron5

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                                  1) patient should know the diagnosis. i don't see how there would be any dilemma here, but i'm inexperienced.

                                  2) concerning the insurance issues, i'm know doctors do those things all the time, but as an (again) inexperienced applicant/student, i'd spin a patient's diagnosis if the patient would otherwise die w/o treatment or the family would go into massive debt, which will lead to other problems. it's not that i feel insurance companies are inherently evil. i just think, they pay for insurance, they should at least get something out of it instead of being jipped.

                                  Hrrrm, I agree with what you're saying about insurance on a personal level, but there is only so far you can ethically go when it comes to modifying diagnoses or treatment codes on insurance claims. When we think of "insurance fraud" we usually think it's the doctor trying to pocket extra money, but inaccurately reporting information to an insurance company to benefit a patient is still insurance fraud...and it's a very serious criminal action. Certainly I'd be willing to use a more generic diagnosis code vs. a specific one if it made a difference....or leaving something off that didn't have to be included, but actually misrepresenting something is not just ethically questionable...it's illegal. Thus my personal response would be along the lines that I would be willing to do anything to benefit a patient short of breaking the law. "Knowing lots of doctors that do it" is similar to "everybody else does it"; this isn't an excuse. Now, I do think there are cases where the law and doctor-patient ethics collide, but in the end doctors are not above the law, and we must recognize that the laws of our country are one of the primary sources where we obtain our ethics in the first place.
                                   

                                  RokChalkJayhawk

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                                    DNR orders really aren't that complicated... if the patient has one, you don't try and do anything "heroic" to save their life. It's what they want, end of story.

                                    Most of the time you encounter these, you will understand why the patient has a DNR. Breathing from a ventilator while in a coma is not living.
                                     

                                    Duchess742

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                                      DNR orders really aren't that complicated... if the patient has one, you don't try and do anything "heroic" to save their life. It's what they want, end of story.

                                      Most of the time you encounter these, you will understand why the patient has a DNR. Breathing from a ventilator while in a coma is not living.

                                      not to sound too girl or anything, but there have been like 3 episodes of grey's anatomy with these situations. it's good to keep up w/ your pop culture ;)
                                       
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                                      kypdurron5

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                                        DNR orders really aren't that complicated... if the patient has one, you don't try and do anything "heroic" to save their life. It's what they want, end of story.
                                        But what if I'm just a hero by nature? >). DNR's usually specify what they will and won't accept. For instance, someone may wish to be defibrillated but not intubated, etc.

                                        Breathing from a ventilator while in a coma is not living.
                                        True, but then again.....dying isn't living either >).
                                         

                                        meehawl

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                                          So, I'm making a list of ethics questions I should be prepared for in interviews, I thought I'd share. Please add on others.

                                          I've been thinking of this one a lot: force feeding of hunger strikers. The World Medical Association says it's wrong and docs should not force feed anyone against their wishes, but WMA decisions aren't binding on U.S. doctors or AMA.
                                           

                                          Robizzle

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                                            let's not forget the.. you have 1 liver and you have 2 patients who need it. One is an inmate serving a life sentence .. he has a wife and kids. the other is a 75 year old woman with no family but is rich and frequently donates to the hospital.

                                            dun dun dunnnn
                                             

                                            LizzyM

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                                              let's not forget the.. you have 1 liver and you have 2 patients who need it. One is an inmate serving a life sentence .. he has a wife and kids. the other is a 75 year old woman with no family but is rich and frequently donates to the hospital.

                                              dun dun dunnnn

                                              that's going to get at your values & decision making strategies but in reality the person highest on the UNOS list gets the organ. Of course, when to list the person and whether to play the system to get someone a boost on the list would be a moral decision.

                                              On the insurance question, if insurance doesn't cover routine eye exams (when someone needs a stronger prescription for eyeglasses, for example) can/should a doctor write that the check-up was necessary to examine a retinal abnormality (which is abnormal and was checked as part of the exam but stable and not in real need of checking). The "lie" is going to save a patient $75.
                                               

                                              Sol Rosenberg

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                                                On the insurance question, if insurance doesn't cover routine eye exams (when someone needs a stronger prescription for eyeglasses, for example) can/should a doctor write that the check-up was necessary to examine a retinal abnormality (which is abnormal and was checked as part of the exam but stable and not in real need of checking). The "lie" is going to save a patient $75.

                                                I hope they're all this easy. No way. Next.
                                                 

                                                kypdurron5

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                                                  On the insurance question, if insurance doesn't cover routine eye exams (when someone needs a stronger prescription for eyeglasses, for example) can/should a doctor write that the check-up was necessary to examine a retinal abnormality (which is abnormal and was checked as part of the exam but stable and not in real need of checking). The "lie" is going to save a patient $75.
                                                  But what's $75 in the long run? I make $55 a week just donating plasma...you're telling me that someone can't find some way to come up with such a small sum? Plus, let's face it...who ever said healthcare was supposed to be free in the first place? What if I told you I could download a CD for free and use this "little bit of theft" to save $14? What if my desire for the CD is just as strong as my need for the glasses? Wrong is always wrong...unless it's right, which it isn't here lol >).
                                                   

                                                  Fermata

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                                                    let's not forget the.. you have 1 liver and you have 2 patients who need it. One is an inmate serving a life sentence .. he has a wife and kids. the other is a 75 year old woman with no family but is rich and frequently donates to the hospital.

                                                    dun dun dunnnn

                                                    Simple answer: whoever asked for it first.
                                                     

                                                    Erina

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                                                      But what's $75 in the long run? I make $55 a week just donating plasma...you're telling me that someone can't find some way to come up with such a small sum? Plus, let's face it...who ever said healthcare was supposed to be free in the first place? What if I told you I could download a CD for free and use this "little bit of theft" to save $14? What if my desire for the CD is just as strong as my need for the glasses? Wrong is always wrong...unless it's right, which it isn't here lol >).

                                                      $75 is a huge amount of money to some people.

                                                      i just read a case about a woman who had to pay $80 for a medicine. that medicine wasn't effective for her and so she was then prescribed a medicine that cost $8. but she only had $2 left over from paying for the first medicine and therefore couldnt' afford the second. when people are living on very little money, every dollar makes a difference.
                                                       

                                                      Fermata

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                                                        $75 is a huge amount of money to some people.

                                                        i just read a case about a woman who had to pay $80 for a medicine. that medicine wasn't effective for her and so she was then prescribed a medicine that cost $8. but she only had $2 left over from paying for the first medicine and therefore couldnt' afford the second. when people are living on very little money, every dollar makes a difference.

                                                        That is why in practice many docs give out free samples that people can try before they go to their pharmacy with their script.

                                                        One of the very few good services that pharm companies perform are free samples.
                                                         

                                                        captainbsm

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                                                          Back in the 1980's when I was applying to med schools, one of my fellow UC Berkeley pre-meds told me about an interview he had at a religious med school in California (you figure out which school...). He was asked, "Who was the greatest physician?" He had thought about this beforehand and said, "Jesus Christ...He made the blind see, and he raised the dead." I think he was accepted.


                                                          Nick


                                                          Just venturing a guess. LLU?
                                                           

                                                          Haemulon

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                                                            DNR orders really aren't that complicated... if the patient has one, you don't try and do anything "heroic" to save their life. It's what they want, end of story.

                                                            Most of the time you encounter these, you will understand why the patient has a DNR. Breathing from a ventilator while in a coma is not living.

                                                            Sometimes situations are not that clear. Its not always as simple as having a nice and clear signed paper with designated wishes stated, or even a single clear physician order. There can be conflicts and lack of clarity. It is when situations do not fall nicely into the rules that one has to really work through them carefully. But for many circumstances, I agree with you.
                                                             

                                                            Fermata

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                                                              Sometimes situations are not that clear. Its not always as simple as having a nice and clear signed paper with designated wishes stated, or even a single clear physician order. There can be conflicts and lack of clarity. It is when situations do not fall nicely into the rules that one has to really work through them carefully. But for many circumstances, I agree with you.

                                                              There has actually been an increase in "ethics committees" at various hospitals who sometimes influence these decisions. Kind of scary really........
                                                               

                                                              LizzyM

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                                                                on the insurance fraud question:

                                                                $75 is a lot for some people. Let's say the patient is a long time patient in the practice and she's had some personal setbacks and she's feeling very stressed by a bill she wasn't expecting. She says, "Dr. So-so (who has retired) has always worked it out so that the insurance pays for everything except the $25 co-pay. Now I'm getting a bill for $100 for my annual visit. I can't afford this with my husband out of work."
                                                                 

                                                                kypdurron5

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                                                                  on the insurance fraud question:

                                                                  $75 is a lot for some people. Let's say the patient is a long time patient in the practice and she's had some personal setbacks and she's feeling very stressed by a bill she wasn't expecting. She says, "Dr. So-so (who has retired) has always worked it out so that the insurance pays for everything except the $25 co-pay. Now I'm getting a bill for $100 for my annual visit. I can't afford this with my husband out of work."
                                                                  I agree with the above post. If your heart bleeds that much over $75 it would be better to pay it yourself rather than commit insurance fraud. Also, doctors must bill charges for services rendered...but they do have the option of writing off unpaid bills as well. Look, if we were talking about a $10,000 surgery it would be one thing, but we're talking about the kind of money you can make anywhere...sell your TV in the newspaper, donate plasma, pull an extra shift, sell some old items on Ebay using library computer/Internet access, etc. You can't tell me that any American can't find a way to scrounge up $75 for a once-a-year expense. Just because someone doesn't want to give up their new 22's to do it doesn't mean they can't afford healthcare- it also doesn't mean that doctors should commit insurance fraud for their unwillingness to make personal sacrifices. Afterall, shouldn't our health be the first priority when it comes to money management?
                                                                   
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