There’s a very special kind of magic that happens when the person telling you that you urgently need something is also the person who happens to sell it. You’ve seen this before. The AC repair guy walks in, sighs heavily, and suddenly your perfectly functional unit is on the brink of catastrophic failure. Conveniently, his “trusted colleague” can replace it today—for only slightly less than a used car.
Now, let’s talk about medicine. Because we like to pretend we’re above that. We are not.
The White Coat Sales Pitch
Medicine has this comforting narrative: doctors are purely altruistic, guided only by science, compassion, and a deep love of humanity. That’s adorable. In reality, doctors are human. Humans have mortgages. Humans have student loans that could fund a small country. Humans also respond to incentives—financial, professional, and psychological—whether we like to admit it or not. So when someone says, “You need this procedure,” it’s worth at least acknowledging the obvious: sometimes the person recommending the thing is also benefiting from the thing. Is that always malicious? No. Is it always harmless? Also no.
Referral Roulette
Let’s start with the cleaner version of events. Your primary care doctor evaluates you (or your kid), applies actual medical criteria, and refers you to a specialist because—you know—there’s a reason. Ideally, that specialist: Reviews the records. Confirms you meet criteria. Explains risks, benefits, and alternatives. Occasionally even says, “You know what? Let’s not do anything right now.” That’s how this is supposed to work. Now let’s discuss the alternate universe we all pretend doesn’t exist.
“My Neighbor Said That He Needed Surgery”
You bypass your primary care doctor because your neighbor, your cousin, and a Facebook group collectively decided your child’s tonsils are personally offensive. You walk into a specialist’s office. No records are requested. No prior documentation is reviewed. No one seems particularly interested in whether your child actually meets criteria. But—shockingly—you are told surgery is a great idea. What are the odds? If no one bothers to verify the medical necessity before recommending an intervention, that’s not efficiency. That’s a business model.
The Uncomfortable Middle Ground
Here’s the part no one likes to say out loud: most doctors are not villains. They’re just… conflicted. They live in the tension between: The Hippocratic Oath and….RVUs, productivity metrics, and reimbursement models. Institutional pressure. Personal financial reality. And that tension doesn’t always resolve in favor of restraint. Because doing nothing doesn’t pay very well.
I Am Not Your Salesperson
This is the part that bothers me more the older I get. I am supposed to be your advocate. Not your closer. Not your upsell. Not the person gently steering you toward a procedure because “it might help” when the evidence is weak and the incentives are strong. If I recommend something, it should be because your child actually needs it. Not because it’s available. Not because it’s convenient. And definitely not because it’s profitable.
A Simple Reality Check
If you ever feel like: The recommendation came too quickly. No one reviewed prior records. The explanation is vague but the solution is very specific. The only option presented is the one that involves doing something billable. It is completely reasonable to pause. Ask questions. Or get a second opinion. Because good medicine can tolerate scrutiny. Sales pitches don’t like it very much.
The Jaded Conclusion I Wish I Didn’t Have
The longer I do this, the less surprised I am—and the more disappointed I become. Not because medicine is uniquely corrupt. But because it isn’t. It’s just another human system. And humans, left unchecked, are very good at convincing themselves that what benefits them also happens to be what’s best for you. Sometimes they’re right. Sometimes they’re the AC guy with the clipboard and the concerned face. And your job is figuring out which one you’re dealing with.
Any advice or information given in this blog should not supersede consultation with your pediatrician or practitioner of choice. Every child is unique, and medical decisions must be made in partnership with the healthcare provider who knows your child’s full history. This blog is intended for educational and informational purposes only, not as a substitute for personalized medical care.If you are looking for medical advice that is evidence-based, ethically grounded, and uncompromised by industry influence, you are in the right place.
Sources:
American Academy of Otolaryngology–Head and Neck Surgery. Clinical Practice Guideline: Tonsillectomy in Children.
Institute of Medicine (National Academy of Medicine). Conflict of Interest in Medical Research, Education, and Practice.
JAMA. “Physician Financial Incentives and Treatment Patterns” (various reviews on incentive-driven care).