Blog posts

Are US Docs Just Quacks in a Box?

By Dr. Robyn Liu
. 1 Comment(s)

We here at Doctors for America take our mission very seriously, and we work hard to bring you accurate, relevant information each day about health care policy and delivery systems. But it's important to keep our sense of humor, too, and to that end I bring you today's blog post. 

An ER doc in rural Pennsylvania named Chris (not, as far as I know, a DFA member, but maybe we should recruit him!) long ago began to realize the brokenness of our system and its perverse incentives, the very topics our blog team is exploring this week. Chris combined this insight with his love of games and created “Quack in the Box,” a new card game that gives a darkly humorous but frighteningly recognizable perspective on American medical care. My husband got a review copy of the game and asked me to check it out with him for accuracy. Am I happy or sad to report that Chris is spot-on? I can say with certainty that my non-medical spouse understands current problems in physician reimbursement better than he used to!

The game goes like this: Each player in the game is a doctor and is dealt a "patient," one at a time. Based on a die roll, the doctor administers a certain number of "treatments" to his or her patient on a turn. The treatments might not match the patient's illness, but that's OK -- as long as the damage points on the treatment card are less than the patient's kill points (i.e., the number of damages it takes to kill him), the patient is alive at the end of the turn and will pay for the treatments he received. Some of them are quite lucrative, like $2000 for an exploratory thoracotomy. Chloramphenicol for an infection, however, is only worth $20. Others, like prescribing prenatal vitamins to a pregnant woman or recommending yoga to a “routine” patient, will gain the player cure points and cause zero damage, but the reward for these services is a flat $0. A thorough H&P will help each and every patient move toward a cure, but also pays the doctor nothing. (Is this sounding familiar to any other primary care docs out there?)

If you have cured your patient, congratulations! You receive payment in full and move on to the next patient. But if you dole out too many harmful treatments, your patient might die, and you obtain "infamy points," also known as malpractice suits. The patient's presenting health status determines how many infamy points you get -- the alcoholic GI bleeder was probably going to die anyway, so just one point for that. But the 40-year-old executive coming in for a routine physical, oooh, seven! Kill him and you're probably in trouble. Too many infamy points and you get chased down by the Angry Mob, unless you've played your cards right and escaped to Switzerland just in time (in Switzerland, you can't make any more money, but you're also safe from the mob). 

If you have non-medical friends who just don't really get the whole reimbursement problem, and who don't mind a little morbid humor, invite them over for a game of "Quack in the Box." They'll quickly see how lucrative it is to give their patients unnecessary but costly procedures, at the expense of cheap but effective preventive care. 

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  1. Dr. L. Burke-Galloway

    This was an excellent post. Humor is a form of healing. The game was hilarious and true. It should become incorporated in medical school curriculum. Well done, Dr. Liu!

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