Maggie's Farm

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.