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[Perspectives] Paying for performance: money, motivation, and uncertainty

Mr Watson, a new patient in my practice, sat on the examination table, clutching his hands. He studied the floor without speaking, rubbing his knuckles for a while before finally looking up. “So, are you advising against the PSA test because of the cost?”, he said. It was when I had finished his physical examination that Mr Watson had asked if I would do a prostate-specific antigen (PSA) test, something his previous primary care physician had done as yearly screening. I told him that, on the basis of his age, risk profile, absence of symptoms, and the risks versus benefits of testing, I did not think it was necessary.