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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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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