We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
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Wednesday, November 2. 2011
I have a GI friend and colleague who makes most of his living sticking tubes down people's esophagi and up their behinds.
He told me that he recently took on a 1 day/week job at a Medicaid clinic to keep busy in this economy, and to do some low-fee work for the benefit of the community. Apparently people who pay or partly-pay for their own scopings are putting it off.
After four months of it, he was frustrated. He told me that over half of the scheduled patients do not keep their office appointments, and 2/3 do not show up for their scope appointments. He is quitting that experiment (leaving them without any GI person), and told me "No wonder these people are on Medicaid. If they cannot at least treat their doctors' time with respect, how can they hope to function in the normal world? It almost seems like they just do whatever they feel like doing. I end up just sitting there, like a chump while I pay my malpractice insurance bills to cover the work."
Well, yes, often enough. That is, of course, not an effective life plan for them. A sense of entitlement will get you nowhere in life.
Readers know that I donate one day each week to a charity clinic at which I decided to take no compensation. It is a component of my tithing. I told him that I give my charity patients two chances, but he rightly explained to me that, as a specialist with only consultation appointments, people feel no ongoing relationship with him, view him as a free government technician while he wants to be caring, engaged, and of help to them. Their physician, in other words.
I told him what he had already learned. The poor often do not have good health stats because they do not take care of themselves, and are often stuck in bad circumstances because they do not function reliably or behave respectfully in the world. I advised him that he was wrong to take it personally. He said that he could not help but to take it personally because he had made a serious decision to be of help to people in need and could not tolerate the lack of gratitude and respect. Said he would rather be on the golf course where his frustration would be on his own terms.
Also, forgot to mention his relevant unpleasant detail that when they do show up, they often have not accurately followed the pre-scoping directions, making his job impossible and disgusting. "It's a set-up for lawsuits," he said. "Can't see a freaking thing. I am not Roto-Rooter."
I tell him that that is the same as people who lie to me. He is right that some greedy and dishonorable people are looking for lawsuits anywhere they can find them, but you cannot practice good medicine with that at the top of your mind. Medical care is not a "service," it is a very human collaboration. Fortunately or unfortunately, you cannot "service" your body and/or mind like you do your car.
That is something that the bureaucrats just don't get. They will want us docs to be auto mechanics.
Tracked: Nov 03, 09:06
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It's not a "right", either. But I keep hearing "healthcare is a right." Just like "education is a right." Or "having a job is a right."
There are responsibilities, which you described, that coincide with rights. If you choose to describe healthcare as your "right", then make it your goal to fulfill the responsibilities you described.
Too bad more people don't understand this.
Not only that, but one's rights do not require another to give up something. If I have a right to healthcare, that implies that a healthcare worker is required to take care of my illnesses without pay.
Here's a flip side of that situation. I have an autoimmune disease of the gut that's currently in remission. I was diligent and responsible about getting the colonoscopy I needed for an initial diagnosis and now am on appropriate medication, something I got from an initial doctor in a moderately distant small city and confirmed with a bigshot in a medical center in a more distant large city.
I located a new GI guy who comes a couple of times a month to my tiny town, and began to establish a relationship with him so that I'd have local options in an emergency. He recommended several blood tests, one of them extremely expensive and experimental, as well as an ultrasound and an upper GI endoscopy. Checking with the medical center guru, who was actually the local guy's professor in medical school, I got a second opinion that the expensive blood test, the ultrasound, and the upper-GI endoscopy were quite unnecessary risks and expenses that were highly unlikely to alter my immediate treatment.
In the meantime, I was very clear with my local doctor that I wouldn't be in a position to have the endoscopy (which likely will cost about $1,500) until I could nail down the cost and figure out if I could get a cash discount, since I have a high-deductible policy and intend to pay cash. His office simply could not get it together to give me the diagnostic codes and other data my insurance company requires in order to tell me anything useful. That, together with the skeptical second opinion, left me pretty well convinced not to have the endoscopy, even assuming that the doc's office ever bothers to provide me with the info I would need to make the final financial decision.
It's been nearly a month now, and I'm sure the local GI guy thinks I'm a complete flake for not having scheduled the endoscopy -- because my phone calls with his office make it obvious that the clear information I gave about my intentions went in one ear and out the other.
In the meantime, the local doc's office screwed up and overrode my instructions to the blood lab to do the three reasonable blood tests but to cancel the unnecessary expensive blood test -- all without checking with me first. So now I'm looking at a huge bill for the test I didn't want.
I'd never schedule something like an endoscopy and then simply not show up, or not prepare properly, but it is a two-way street. The doc needs to communicate effectively with me, too.
I am with you. I have a high-deductible policy too. It is possible that the new guy is covering all of his bases, as young docs often do nowadays, so you cannot sue him for not doing so.
Docs are very gun shy these days.
In addition, docs are terrible with paperwork. It's just not what they signed up to do. You must be forgiving of that.
I agree the young doc is probably gun-shy and too inexperienced to know when it's not cost-effective to throw everything against the wall and see what sticks. On the other hand, in the short time I had with him I made my insurance situation really clear, and he seemed to understand me, even promising me cooperation in getting crystal-clear information about the costs of procedures before I committed to them. I don't expect him to be good with paperwork, but I expect him to hire staff who can return phone calls with diagnostic codes necessary to my dealing with the insurance company and other providers. It's up to him to communicate with his own staff and give them guidance.
The guru guy in Houston didn't have any trouble discussing the cost-benefit trade-offs of various expensive but speculative tests, and his office staff never did anything to confuse the picture. So I guess it's back to long-distance medicine for me!
I have had very similar experiences. I volunteered at a free clinic 2-3 Saturdays a month for 9 years. I was taking care of a male couple one weekend and they requested a Z-pack as an antibiotic instead of the available Antibiotics we had in our supply room. I told them I would be glad to call it in to the pharmacy for them. The rub came when they thought I should pay for it also. They saw the vehicle I drove in with and thought I "could afford it." I was not charitable in my response.
I have also had the opposite experience. An hispanic man and his family came in all afflicted with a stomach virus. Not much to do for them but the brat diet and some OTC meds. The father came back the next week in overalls and worked 8 hours in the garden adjacent to the clinic. He said "friends help each other."
Go placidly amid the noise and haste,
and remember what peace there may be in silence.
As far as possible without surrender
be on good terms with all persons.
Speak your truth quietly and clearly;
and listen to others,
even the dull and the ignorant;
they too have their story.
Avoid loud and aggressive persons,
they are vexations to the spirit.
If you compare yourself with others,
you may become vain and bitter;
for always there will be greater and lesser persons than yourself.
Enjoy your achievements as well as your plans.
Keep interested in your own career, however humble;
it is a real possession in the changing fortunes of time.
Exercise caution in your business affairs;
for the world is full of trickery.
But let this not blind you to what virtue there is;
many persons strive for high ideals;
and everywhere life is full of heroism.
Especially, do not feign affection.
Neither be cynical about love;
for in the face of all aridity and disenchantment
it is as perennial as the grass.
Take kindly the counsel of the years,
gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.
Beyond a wholesome discipline,
be gentle with yourself.
You are a child of the universe,
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.
Therefore be at peace with God,
whatever you conceive Him to be,
and whatever your labors and aspirations,
in the noisy confusion of life keep peace with your soul.
With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Strive to be happy.
Max Ehrmann, Desiderata, Copyright 1952.
You're forgetting something else: whatever is free is not respected.
...or, as the sales manager beat into all the sales and support staff, free is worth every penny they paid for it... pretty much worthless.
Your sales manager must have been the instructor for mine: "Inexpensive, fast delivery, high quality: pick any two."
My father was a salesman for a pharmaceutical company in the south when I was a child. Dad would visit doctor's offices, hospitals and pharmacies explaining his company's products as well as providing information and samples. He often told of the change in relationships and attitudes that occured when medicaid was introduced in the early 60's. Up to that point, GP's would see their patients and would extend time to pay the bills, or would accept barter in lieu of cash. There was a respectful relationship between the provider and the patient. Once medicaid was introduced and healthcare became a "right" the attitudes of the patients morphed into one of entitlement and expectation.
When the government gets involved, gratitude and respect goes out the window.
Please Dr. B - analyze why when you said "I have a GI friend and colleague who makes most of his living sticking tubes down people's esophagi and up their behinds." I wondered why a GI would be doing that - as in Government Issue as in soldier.
I think I'm having a breakdown. :>)
I believe she refers to Gastroenterologists, known as "GI" which is short for gastro-intestinal.
Gut specialists, in other words.
"teacher" for "doctor"
"education" for "medicine/healthcare"
"student" for "patient"
and the final sentences of your post still work:
"Medical care is not a "service," it is a very human collaboration. Fortunately or unfortunately, you cannot "service" your body and/or mind like you do your car.
That is something that the bureaucrats just don't get. They will want us docs to be auto mechanics."
Bureaucrats see people as numbers, never individuals capable of making choices either good or bad. Doctors, teachers...those who work with people...know better. Collaboration is a necessity for success. As the saying goes, it takes two to tango.