Wednesday, March 31, 2010


It is difficult. I have often wondered what preachers do. Wondering aside, I know physicians are often intellectually dishonest. How so? To talk with us you would think we are the poorest, most maligned people on the planet. Health care reform is going to kill us.

Yes, medicine as we know it today will probably go away. I have to tell you that I don't believe that to be all bad. This is opinion you understand but the facts get distorted usually by the person reporting them.

Here is a fact I was confronted with yesterday. "Well, one of the reasons health care costs so much is we are practicing 'defensive medicine.'" Honestly, I am not. I try to see the patients, go through my list of differential diagnoses, order the appropriate tests to rule out all but one, and come up with a cause for and a solution to the problem. Often, I encounter other problems which have to be dealt with along the way but I don't believe I am doing tests defensively. My liability insurance, though expensive (remember I deliver babies and have 20 years of liability for each one), is half of what it was when I entered private practice 25 years ago thanks to tort reform.

When I entered private practice twenty five years ago, 9 months of obstetrical care, the delivery and six weeks of post partum care cost $850. Today, in the same zip code, most major carriers will pay over $2000, some go as high as $3000 (and if you don't have insurance you are paying over $3000 which is another reason physicians don't want everyone to have insurance). And physicians I know well are gaming the system by doing sonograms at almost every visit, charging $300 each. One of the reasons I left private practice had to do with our sonography practice and what I believe was unethical behavior. Again, this is my opinion, so don't get me sued for slander.

So why does health care cost so much today? Well, first off, there are all those uninsured people out there but that doesn't affect your visit to your local obstetrician. No, the local OB's office is filled with people to monitor your insurance, make sure you are covered, what level you are covered, and how much you will have to pay for that sonogram. All that along with someone to make sure the sonogram is coded properly so the insurance company will pay for it.

If you feel like your doctor is managing a business rather than your health - you are correct.

Now, I am going to ask a question. Of those 16 million Americans who are at the lower income levels and now required to purchase insurance, how many of them are going to go out and buy a policy or take the chance that they can use that money on a 52 inch flat screen TV and not get caught?
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Thursday, March 25, 2010

It's here!

Yes, the healthcare reform bill is signed and no, you can't drop your existing health insurance. As a matter of fact, my health insurance premium is likely to rise. BUT in six months, my son, who has a pre-existing condition that no health plan in this state will cover will no longer be denied coverage because I changed jobs.

I, like many Americans, have approached this health care reform bill with caution. Unlike most of my friends and colleagues, I have tried not to mix my own opinions with the facts. A friend of mine reported on her blog, "We are entitled to our own opinions but not our own facts."

So here is a fact which has helped me support healthcare reform: The United States ranks 41st on the World Health Organization's list of maternal death rates.

You read that correctly. It is safer to have a baby in South Korea or Bosnia than it is to give birth in the United States. My colleagues are all up in arms that someone (the President and the Speaker of the House) are going to take away their fortunes and tell them how to practice medicine. Honestly, I don't know anyone who is practicing medicine so poorly that women are dying as a result. Yet, I see many ways were physicians could all do better.

Isn't that what reform is about, doing better? I know that your definition of better and mine maybe different, but we can both agree that there are many facts here which need to be changed. As a country America can get better health care for everyone for the money which is spent on a few. Many of the few are not receiving the best, even as they pay for it.

In my mind, healthcare reform will work not just when everyone gets coverage, at any price. Health care reform will be working when the maternal death rate, which has risen steadily in America over the past decade, begins to fall. I believe reform, which will require more documentation and over site will help accomplish this.
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Wednesday, March 17, 2010

Reforming the patients

I am first and foremost a patient advocate. But sometimes the patients push me to my limit. Today is one of those times. No matter how many times you give a patient the clinic number. No matter how many times you explain to the patient that her contractions must be 5 minutes apart, lasting one minute for at least one hour, she will still show up in the emergency room via an ambulance for false labor. I have no idea how much this cost but I know it comes out of an ever shrinking state Medicaid budget which also pays my salary.

We are at least two generations into this welfare mentality. Most of my patients have never had a job. That is almost as shocking to me as the number of 19 year olds I see pregnant with their third child. I don't know how to change this. In the current economy, it is difficult to imagine a change. I am not even sure there is a way to change it. I do believe it will take at least two generations to begin to reverse this trend. I hope America has that much time and I hope we begin soon.
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Wednesday, March 10, 2010

The enemy

I have tried to stay away from talk about health care reform as much as possible. I find the clinical aspects of medicine and the people I serve far more fascinating than those who are involved in trying to make our health care system work better. For one thing, I believe if doctors spent more time serving patients and less time worrying about how to make more money, even our current system would be a better one.

In a meeting I was recently required to attend, I saw this problem up close. Present at the meeting were several physicians who have been practicing medicine about as long as I. They were in several hospital based specialities. The discussion was not about a great new discovery in medical care which would improve quality or limit suffering. The sole purpose of this meeting was to present a new financial venture between three large physician groups and the hospital. If I could have titled the meeting, it would be: "How to get more money for those who already have too much." I say this because all of the speakers have 7 figure salaries supplemented by investments in pharmaceutical companies, device makers, and surgery centers. I was particularly thrilled to hear this group has "hired a national law firm experienced in defending against legislation which makes [ventures such as this one] illegal."

Please understand, I see many problems with pharmaceutical companies, insurance carriers, and hospital systems. Yet, when our brightest, most energetic physicians are rushing to get an MBA and become managers in these new business rather than spending their energies in direct patient care, something is wrong with the profession. It also explains why my primary care colleagues are selling vitamin supplements and preforming LASER hair removal to supplement their office income.
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