Times have changed. Here I am in a small town in Maine and I recently received a "gift" from one of the local OBGYN physicians. It got me thinking how comfortable this time of year has gotten for everyone in the medical field. Years ago I would get a bottle of wine or even a thank you from local specialists to whom I would refer patients. It was nice to be recognized and it was also nice to see that they realized that I could send my patients to many different physicians but instead chose them. Don't get me wrong, I have never used this small power as a weapon or a way to make money (think Blagojevich) which is a Stark violation. I don't even know how that last part can be even accomplished? If the specialist gave good care and treated my patients well, however, then I would continue sending more patients their way. That being said, it is still good business to thank the little people (me). All this ran through my head as I opened my little gift from the OBGYN office. It was in a special bag with wrapping paper inside. There was a "personal" pre-printed letter addressed to the wrong person. In my case it was a nurse practitioner in a different office. My two other medical partners got the same "gift" and both had the wrong person on the header of the paper as well. Instead of a basic "thank you" in the letter there was information about Essure, a permanent birth control method. In fact, when I emptied the bag what fell out was two very small Ghirardelli chocolates and two large pamphlets about Essure. Nothing makes my heart feel warmer than a non-personalized 67 cent gift begging for a future referral. Times have changed. Happy holidays.