Secret Doctor Conferences...

Well I have worked for a "staff model HMO for 30 years" and I am a strong proponent at this time of universal health care. That was not always. I do not apologize for what I make. I spent many years paying for an education (and paying back) and that many more working below minimum wage. I started my lives work on April 1 at age 30. Most of the people I graduated with in college had already been working for 8 years. I don't know about everyone but most of the people are fairly dedicated and work 60+ hours a week. Steps off soap box, tired today!

 

Actually, the myth regarding health care costs is physician salaries. Not that we don't get paid well but a very small percentage of the american healthcare dollar goes to physician salaries.. under 10%. If I remember my medical management statistics, it is more like 8%. Everything else goes to administrative costs, high tech equipment costs, insurance, various regulatory compliance maintainence costs, pharmaceutical costs, etc.

 

Weehoo, major thread hijacking time.

For the record, no one is going to be as hard on any decent doctor (for a mistake he makes) as he already is on himself. (Hm. Except maybe a plaintiff's attorney. Ha ha.)

Depending on whom you ask, you'll get a different answer to the question about what *most* drives up the costs of healthcare. People spend all kinds of money when it "has a long tailpipe" -- when it isn't obviously VERY directly related to being THEIR money being spent at the time.

The number I really want to know is -- how much less would the cost of healthcare be if people quit smoking, got regular exercise, and quit eating cheese fries, watching TV and drinking vodka?

(I'm waiting for the ER guys to weigh in on the consumer expectation/CYA medicine factor. Chest pain in the anxious overweight fifty year old male, anyone? Want a positive D dimer or two? Oh, wait! I have some narcotic seekers with abdominal pain for you, too! )

(Oh, and make sure not to tell them about the really super-secret doctor meetings...)

 

Demands on time and demands on fmaily. My wife is a hospitalist and I rarely see her as it is. If I also spent all day in the hospital, we'd never see each other, or the kids. I wasn't willing to make the trade-off, my family is too important for me to miss so much time with them.

Also, I don't see the time I spent in med school as a waste, as I plan on specializing in health law. I'll be able to put my knowledge to good use. And while lawyers may say it's not so, the free time of a lawyer is considerably more than a doctor (lawyers can be a whiney bunch at times, I hope I don't become like that...). I plan on dealing with medical malpractice and tort reform, being a crusader for the physicians side. Too many personal injury lawyers. It's my mission to change the system. Reform it so that the real victims are taken care of, the "bad apples" are punished, and the BS is all washed away. Lofty goals, but it's one I believed passionately when I was in it, and even more so now that I'll be in a position to make REAL changes.

Anyhow, for me it's not a matter of money or anything like that. I'd just like to actually see my kids grow up. As a physician it can be tough to do that. So I made the change.

 

I appreciate this advice from hdrygas

"I would ask two questions of a doctor. First are they Board Certified in their specialties? Second do they have privileges in the local hospital? "

My major beef with the healthcare system is that it so hard for the consumer to "shop around" like we do for everything else; mostly because information is not accessible for the consumer or buried in information overload. Consider these stats: More people die from medical malpractice (80,000) than combined drunk driving (17,000), poisoning (16,000), and suicide deaths (30,000). Which do we hear about the least? If any other insiders have tips on how regular people can make informed health care choices I'd love to read them. Links for stats are below.


http://www.cdc.gov/ncipc/factsheets/suifacts.htm
http://www.wrongdiagnosis.com/p/poisoning/deaths.htm
http://www.madd.org/stats/0,1056,1112,00.html
http://www.consumerlaw.com/medical.html

 

There is also the national practicioner database. Not an ideal source but what is used by all hospitals etc. as they make decisions on hospital privileges. It list malpractice suits and settlements. Realize though as you look at the numbers that if the suit was settled for 10-20 thousand dollars it was probably just a nuiscence suit that was felt not worth the time and effort rather than real malpractice.

Also be aware that there are a number of studies out that show a poor correlation between true medical malpractice and malpractice lawsuit filings. In other words, true malpractice doesn't always result in a lawsuit and lawsuits are often filed because someone is pissed at the doctor, or unhappy with the outcome even when no malpractice was done.

Hydragas's suggestion is the place to start. Then talk to people about their experience with a particular doc. Then go talk to the doc and get a feel for that doc yourself. Not scientific but not much else to do right now. I believe that the National Practicioner Database is publicly available but not sure.

 

Yep, all you get are codes. We get yelled at if we don't use the codes. There are diagnosis codes rather than words(ICD-9), proceedure codes(CPT), and visit level codes(don't know what acronym is). Coming soon to a doctor near you are performance codes (did the doc have you on a certain class of med based on diagnosis etc. These will be part of ICD-10)

The logic is computers only understand numbers and all insurance is computer based.

 

Do they involve entering a British police box and travelling through time?

 

Luckily, the other 17% keeps him from putting on the tinfoil hat.

 

Ah, The Tardis and the innimitable Dr. Who. I miss that series.

 

I must agree... finances are where the real demons lie.

As far as practice.. laws are made to protect against doctors that are reckless, careless, and heartless but not against being human.

Anyone in the medical profession makes mistakes because they are human!... there are always times when you could have done it different based on how that the results didn't turn out so hot.

As long as we do what is reasonable within our power and do the best with what we have to work with, we can sleep at night.

There are always limited resources for the load at hand. Sometimes we could spend 3 hours with a patient but only have time for 5 minutes. Does that make us negligent?.. no... its just modern medicine! As technology increases, we shave off time. There are never enough doctors or nurses.

Most mistakes are benign and are easily reversed. But we get tired, fried, and irritated. Does that mean we shouldn't work unless we are fresh, happy and sharp?... Well thats Ideal, but when you put in 60 hours a week on a regular basis because there is no one else to do it and administration will not hire more because they don't want more benifits to pay you do what you can.

I find I have little tolerance when I deal in the business world and deal with people who are totally incompetent to do thier job!... if you ask of them anything they don't do every day, they are clueless wonders!.... In medicine you don't have the luxury to get lazy, sloppy, or incompetent!

Whats sad is even when you do a good job and things turn bad... people want to sue.

We are human and its always chancy and scarey being dependent upon another humans. We are not perfect! and not all Doctors and nurses and techs are equal in their talents, instincts, and heart.

We use laws to draw a line in the sand between what is acceptable and what is not.....

We all hope to get someone who loves to help people when its our time to be helped. Humans are not perfect, but if medical personnel have a heart, they will do ok when they treat their patients. But hopefully they are not too stupid!

Many patients are just flat out trying to deal with.... they come to us "the experts" for help, and then want to tell us the terms of how to treat them, if they can get away with it.

We see people at thier worst, thier weakest, and thier ulgyest! We get their body fluids all over us and breath their terrible breaths as we assess them! Anybody who can stand that loves people!

Unfortunately some people spend years and thousands of dollars getting into med school just to find out they really don't like people once they are in practice, but they still continue to practice?.... thats whats scary!

 

Sounds like several of my patients. They've gone to the ER for falling down steps, migraines, sprained ankle ten times in the past year. The clumsiest people out there. Then they all of a sudden they learn about endometriosis! Painful cycles, nothing helps, I've tried birth control, depo provera and lupron. After that, it's intractable back pain and their off to someone else.

Of course they let you know that Ultram, Motrin 600, Tylenol #3 won't work. Only Vicodin.

There are times when I consider letting my DEA license expire, just so I can tell them, sorry, I can't write prescriptions for narcotics anymore. Anyhow, renewed it last week, I'm good for 3 years.

 

It's like reading an autobiography of my life! Every time I get a drug seeker(and eventually lose them), I'm thinking, finally, no more of that.

I had a woman who tried to convince me that because she worked for the county sheriff's department, she's not drug seeking. Just because you're wearing nice clothes, are bathed and have a good job doesn't mean that drug dependance can't happen. I told her this, offered and scheduled surgery for her, but told her I wouldn't prescribe narcotics. Two days later she cancelled the surgery and is not seeing me anymore.

Problem is that it gets to the point that every one who walks in with pain is drug seeking, until proven otherwise.

Getting back on topic about mistakes:

I had a woman with heavy menses, so I did an endometrial biopsy in the office, and it came back normal. So I did an ablation on her.(I burned the inside of her uterus so she'll never have menses again). However, I did a D&C just before that to take a tissue sample, even though it is not considered standard of care after having had an office biopsy. It came back cancer. If I had not done that, she'd be walking around now with a tumor spreading around inside her...even though I had done what would be considered the normal "standard of care".

You can bet I do that D&C before every ablation now!

 

Truth is posted here

 

A lot of studies will often discuss the economic impact of the disease they are discussing.

I'll give you a clue where some of the money goes.

Our hospital decided they needed to replace every CRT with a LCD screen. This was 2 years ago when LCD's were not cheap. We have about 300 patient rooms and there are about 25 monitors in every wing. I didn't even bother doing the math. There was nothing wrong with those old monitors.

We replaced an old hysterscopic insufflator, $6000 for the new one. There was nothing wrong with the old one, but this new one uses a little LCD screen to tell us what blinking lights used to tell us.

It is also proven time and again that cheap, generic medications work as well as the new branded, patent holding medications do. Lexapro is the breakdown product of Celexa. Clarinex is the breakdown product of Claritin. Nexium is the breakdown product of Prevacid. That means that when you digested the old pill, your body broke it down to an active molecule. The drug companies patent the breakdown product so that when the patent expires on their drug, they start marketing the breakdown product as a "new" drug.

You can find instances in every segment of healthcare with waste.