Archive for category political medicine
The Health Service must learn to listen to its patients and be more caring, Prince Charles said yesterday. Modern medicine and technology are putting the ‘human touch’ at risk, according to the heir to the throne. In a heartfelt plea, he said medical schools should try to foster a climate of care and compassion among doctors. Charles’s intervention follows a series of reports of appalling treatment by NHS staff, including dying patients left screaming for water. He called on doctors and nurses to heed what patients say so they can develop the ‘healing empathy’ so badly needed.
I love political hacks putting their feet into their orifices. So based on a few reports, Prince Charles decrees that doctors and nurses should listen to their patients? Well thanks Charlie, I really appreciate your help.
As I read this story my thought went to a famous princess who is known to have said: “Let them eat cake!”
Modern medicine is under stresses about which I very much doubt the Prince has any real knowledge or empathy. His US political counterparts have similar perspectives I suspect. The aforementioned pressures are similar in the UK and the US. In order to make a living in medicine, today’s doctor must treat more patients than his (or her) predecessors of decades before. That means less patient contact time. While this is not ideal, this is the state of affairs. I don’t see any movement on the issue of doctor’s reimbursement in anything but a downward direction, so expect the lack of “face time” to increase.
At least in the US, the climate has worsened to the extent that if things do not go well for a particular patient, a doctor is encouraged by counsel not to ever apologize. We are told that an apology indicates guilt. This is just another example of the system’s progressive pounding of humanity out of medicine. The law and politics have something to do with this evolution.
John Di Saia MD
I described my friend’s experience with the Canadian Healthcare system previously and got some comment action on it. The patient’s mother I believe asked that I post a follow-up. Allison continued with the Facebook messages to describe the surgery day:
“[S]he was awake. They just numbed her foot. It was in the exam room.”
Here’s another socialized medicine outtake for you: surgery to repair a small sensory nerve and tendon is not traditionally performed in an exam room at least not here in America. I wonder if they used magnification?
“They fixed her for now….
He tried for like 2 hours. The ends became frayed. It kept shortening up and he had a hard time. He was a 4 year resident. So the big doc came in”
Great, so she was a resident case done under local in an exam room. The environment was low key. Nurse Allison was present and took pictures during the case. I’d bet medical malpractice in Canada is a less common event than it is here.
Sure there are health insurance issues in the United States, but the quality of care is better…at least better than that which Allison’s friend experienced in Canada. Hopefully she will do fairly well. I sincerely doubt the nerve repair was very good. She will likely have sensory loss on that part the foot. Whether or not the tendon repair will fare better time will only tell. Delay and lower quality are natural consequences to socialized medicine.
I still conclude with the same statement: Are we ready for this in America? The President keeps talking about “cheaper, better healthcare.” This case in Canada was much cheaper than what would have occurred in America, but it is doubtful if it will turn out to be better….really doubtful.
John Di Saia MD
Part of the problem with aspects of Obamacare is the thought that better quality has anything to do with the idea:
ACOs are meant to move us away from an expensive, broken health care system that rewards doctors for providing a high volume of care and move us towards one that rewards higher quality. They involve groups of doctors accepting flat fees to manage the care of a given set of Medicare patients. If the doctors deliver high-quality care in a cost-effective way, they net any savings left over.
Accountable Care Organizations (ACOs) are about saving money: plan and simple. Over the last decade, better quality care has been re-defined as cheaper care. When is the last time you got something better that was cheaper anyway? ACO performance bonuses are tied to saving healthcare dollars. That sounds fine and dandy unless you actually need expensive care. Then you put those providing that care in an ethical bind: they make more money if you don’t get it.
I have seen the specs on a few ACOs as they are being bandied about now that the Supreme Court ratified “Obamascare.” The one that I saw most recently initially pays a fee for service rate for care. At the end of the year, the total cost for the care of the patients included is tallied and compared to the same figure for the year before. If the ACO saves more than 2.6 percent, the ACO members are awarded half of the savings. That is a bonus for cheaper care. Quality is not a part of that payback equation.
So if the Obamascare ACO concept takes root and you need surgery or intensive care, your healthcare providers will be at a financial incentive to not give it to you. Sounds like high quality to me.
John Di Saia MD
Well I was working my way into a weekend, when I got a Facebook message from a nurse friend visiting Canada:
“Sitting in the ER in Canada. A glass was dropped on my gf’s foot….finally after being here for 3 1/2 hours doc comes in….”oh that’s quite deep” he says….no kidding, she can’t move her pinky toe. So he says the tendon is severed. And to follow up in 4 days with plastics. No X-ray was done. Just sutures. How long can she go with it being severed?”
Welcome to socialized medicine. We are always told how great everything is in Canada, but today nurse Allison got a preview of how ObamaCare might just turn out for us here in the old US of A.
Her lady friend has a tendon injury at the least. Another Facebook message reveals:
“But the last 2 toes on her foot feel like they are asleep.”
So add a nerve injury to that.
When I was in training a few decades ago, we would have repaired these injuries that day or the next. The nerve gets harder to find and repair as time passes. Cut tendon ends also tend to move out of position as time passes making more surgery necessary to repair them. Earlier repairs do better with less abnormal sensation and a better chance of a good functional outcome.
These days we would probably not repair them as rapidly as we once did anyway in the US either. Now we need to get insurance approval and we know we will not be paid well or rapidly for them via insurance. The standard of care today is to repair them in a week or so. We too are moving toward more mediocre cheaper medicine unless you are in with a plastic surgeon who knows you will be paying cash. This is one of those times in which being friendly with a plastic surgeon pays off.
In Canada, Allison’s friend is to see a surgeon in 4 days or so she said. When she gets surgery is also up in the air at the moment. As a Canadian citizen she will just wait her turn and hope for the best. Are we ready for that in America?
John Di Saia MD
Reader Laura’s Comment:
“This report states that 83% of doctors have considered leaving practices over Obamacare. What are your thoughts on this? Do you prefer a patient that has insurance to one that will/can pay you up front?”
Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association. “Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,” she said.
Doctors understand more than that as a matter of fact: we understand that pushing patients into the State Medicaid systems will drive down reimbursement. Physician reimbursement is already low relative to training and expenses. Physicians understand that this President cares little about their problems in trying to make a living while caring for the ill. He is not their ally, but their nemesis. As a former left wing law professor we would expect nothing less.
To answer your question on physician’s payment, I always look favorably on defined payment before a service is provided rather than playing the insurance game. With medical insurers, doctors try (often in vain) to get paid fairly after having already provided a service sometimes months or years earlier. Insurers and politicians have stacked the deck against us in this regard.
As I deal with very few HMOs directly, I find patients who have received poor care in their HMOs sometimes willing to pay cash to get it corrected or to avoid further poor work. Sub-specialty care in HMOs is poor or nonexistant. We will likely see more of this with ObamaCare as people are pushed out of Medicare into more managed (mangled?) care systems.
The American Medical Association, which endorsed Obama’s health care overhaul, was not able to immediately offer comment on the survey. Spokesperson Heather Lasher Todd said it would take time to review the information in the survey.
Why do you think the American Medical Association represents so few of America’s doctors? They sold us out decades ago.
John Di Saia MD
A bill that would ban makers of brand-name pharmaceuticals from paying to stop cheaper, generic drugs from hitting the market has the support of key lawmakers ahead of a House subcommittee hearing on the matter set for Tuesday. The bill is aimed at stopping payments lawmakers characterize as anticompetitive and costing consumers and the federal government billions of dollars a year by forcing people to continue to pay for higher-priced, brand-name drugs.
My friends, it is legal (I obviously do not make the laws) for a drug company to pay a competitor to delay release of generic drugs that compete with their drugs. So drug company A can pay drug company B to not release a drug that would cut a person’s medication costs by three to five times.
Physicians put up with far too much regulation and drug companies still rake in the cash…at least for now.
John Di Saia MD
Originally posted 2009-04-15 07:30:00.
3M to take one-time charge after loss of health care tax deduction
The company said it would take a one-time, non-cash charge of $85 million to $90 million after tax, or about 12 cents a share, in the first quarter. The charge reflects the loss of a tax deduction on subsidies the company receives from the government to provide prescription drug coverage for its retirees.
The health care reform bill will cost us money. We continue to watch.
Remember in November.
John Di Saia MD
Originally posted 2010-04-30 09:00:30.
A recent study conducted by Ohio State University projects the U.S. will be short 1,300 general surgeons within two years’ time—and lacking 6,000 of these specialists by 2050—due to increasing population demand.
This is by design and it is not just a function of “population demand.” When you take their life style, increased regulations and pretty poor reimbursement, you get fewer general surgeons. Formerly double-boarded surgeons like myself do not re-certify in general surgery when the requirements get more time consuming and expensive. I technically counted as one less US general surgeon when I decided not to re-certify. I was board certified in general surgery and plastic surgery for nearly ten years until 2007.
John Di Saia MD
P.S. Maintenance of certification is another cottage industry in medicine anyway.
Originally posted 2008-12-18 08:30:00.
[T]heir ranks are dwindling, The Washington Post (NYSE:WPO) says, caused in large part by educational, medical and sociological forces.
We have discussed before that general surgeons do not enjoy lifestyle or reasonable reimbursement. Few surgeons want to live a general surgeon’s lifestyle and get paid like a plumber. I see some surgeons paid $200 to wake up at 3:00 am and operate. That is a joke!
Formerly double boarded surgeons like myself are not re certifying because of the expense and hassle. Why should we?
John Di Saia MD
Originally posted 2009-01-05 08:30:00.
Mr Steven Pearlstein puts forth an argument on how the high cost of medicine is the primarily the fault of physicians:
At the end of the day, however, it is physicians who have the greatest impact on the cost and quality of health care we get.
Well maybe indirectly, but have you written a single word as to maybe why this is the case? Doctors order tests based often on the concepts of “Defensive Medicine,” the thought that we need to guard ourselves against scrutiny later, and the “Standard of Care.” Take the liability out of the equation and things might be different.
The problem comes when doctors’ decisions about treatment aren’t based on the latest scientific evidence about what works and what doesn’t.
This evidence as you state it is not always so easy to discern. Studies notoriously disagree. Which study conclusions would you like to base the care of your loved ones upon? It is always cheaper to “pull the plug.” Would you like us to do that to your family member?
Business people frequently do not understand how “real” medicine works probably because it is a very unusual business – over regulated with liability mine fields and relatively meager financial rewards from the standpoints of many physicians. This is amongst the reasons you see cosmetic surgery boutiques operated by ex-Emergency Room physicians.
I am not saying the system couldn’t use some changes: it can. But solutions must be made will full knowledge of the problems and we know the problems Mr Pearlstein. We live them.
John Di Saia MD
Originally posted 2009-06-11 08:00:50.