Striking a deal: The criterion for success

Commentary. By Leonard J. Marcus, PhD, and Barry C. Dorn, MD, AMNews contributors. Jan. 29, 2001.

COMMENTARY

Observations on the state of medical practice and medical life

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In the real world of medical practice, doctors are negotiating the give and get of their work all the time: with colleagues, medical administrators, hospitals, insurers and patients. In the best sense of the word, we are all dealers.We exchange services, goods, materials and relationships. How do we distinguish the "good deal" from the "not such a great deal," or even worse, the "bad deal"?

Not as easy a question as it first appears. Why? Because when we deal, we do not exchange exactly the same thing. To illustrate the point and then its complexity, we start with a very simple analogy.

You give me five logs: I give you $5. That's a deal. What we exchange is dissimilar.

You give me five logs: I give you five logs. That's not a deal. Unless there's some clear difference between all these logs, the effort is pointless.

One measure useful in distinguishing the "goodness" or "badness" of a transaction involving dissimilarities is a tool to assess the value of what we are exchanging. The problem is that it is often difficult to put a dollar amount on the value of what we swap with one another. And what might be a great sum of money to you could well be a paltry figure to me. We often use prior benchmarks to impose a monetary value on things -- for example, what doctors in similar practices are getting -- and time -- the standard fee per hour for the capabilities of a surgeon, internist or consultant.

Let's return to the log analogy. Is a dollar a log a good deal? If others are selling the log for $5 each and I just got it for a buck, well, that could be a great deal. If others are selling it for 10 cents and I just paid a buck, well, that's a lousy deal. Same price: very different assessment. [...]