From the Editor

When my friend Anne's longtime primary care physician dropped the insurance company that covered her, Anne decided to stay with her doctor and see him out of network. She liked him and trusted him, and felt he was worth a $700 deductible and the subsequent noncovered reimbursement percentage.

But something odd happened when she had to cover the full cost. The office visits that she appreciated when the insurance company paid suddenly became less satisfactory.

Anne tried to put her finger on what made the difference. She realized she wanted her doctor to acknowledge and appreciate her decision to stay with him. Perhaps a simple "thank you" would suffice. Anne felt that her recent office visits were rushed, and she hoped that by becoming in essence a higher-paying patient, she would earn a couple of minutes more with the doctor.

Although it's possible that Anne's doctor had indeed sped up his schedule in recent months, I got the sense that it was her expectations that had changed.

I asked some doctors if they take any special note of patients who stay with them despite insurance changes-if they know the patient has done so.

One internist was incensed. "I give each patient excellent care, and I treat all patients equally, regardless of how much they're paying," she said. "I don't change my style or timetable based on how much I make. As long as a patient pays his bills, I don't want to know who's paying what."

An endocrinologist had a different take. "I definitely appreciate when patients don't jump ship because their insurance changes and they're forced to pay more out of pocket. I like patients who pay cash, I'd even encourage more of that."

But should that buy the patient more time with him? "Theoretically, I have nothing against giving a couple more minutes to a cash-paying patient, but trying to schedule it would be impossible," he says. "Also, there's something about it that would make me uncomfortable."

Differentiating between patients based on payment type would be anathema to most doctors, of course. And maybe extra time isn't the real issue anyway. Perhaps the answer lies in quality-not quantity-in that a warm, caring physician who relates well to patients can convey interest and concern (the essence of a relationship) without requiring extra time.

Still, Anne's sentiment is not uncommon. A colleague who stayed with his gastroenterologist out of network made a point of telling his doctor that he had done so. The doctor clapped him on the shoulder and said "Thanks, that means a lot." It meant a lot to my friend, too.

Many doctors put money and effort into marketing and promotion to gain new patients. Expressing appreciation to a loyal patient who decided not to switch-if you knew about it-may be a simple way to help keep the patients you have.

Do you try to give loyal patients something extra, and, if so, what is it? Or does the idea offend you? Let us know. Later, we'll share some of your insights in these pages. Until then, we'll offer you one thing in advance-our thanks.