ABSTRACT
At a meeting, the director of the outpatient clinic pointed out that a particular resident's patient had accumulated a rather large unpaid clinic bill. This represented the "co-pay" for each session of psychotherapy; the patient's insurance covered the rest. The treating physician in this case the resident, Dr. Sarkar was responsible for collecting the "co-pay." For several months, the clinic's administrative director had been asking Dr. Sarkar to take care of this, without success. The clinic director, a thoughtful clinician with a psychodynamic orientation, tried to explore what the reason might be for Dr. Sarkar's protracted delay in talking to his patient about this unpaid bill of several hundred dollars, which represented many sessions' worth of "co-pays." The clinic director said there must be some meaning to this, since Dr. Sarkar was a conscientious doctor who tried to help his patients, and generally abided by the clinic's guidelines.
