Blocked

Last week the senate blocked legislation that would allow the government to negotiate Medicare drug prices. To me this is criminal. If you haven’t read what I had written on this issue or seen the 60 minutes piece on how the pharmaceutical industry basically paid off the politicians, please go and refresh yourself here:

http://placebojournal.blogspot.com/2007/04/mediscare-d.html

http://www.placebojournal.com/shopexd.asp?id=204

I am absolutely amazed how Republicans can talk about a free market economy and yet allow this to happen. Here is a quote from Senator Mitch McConnell, a Republican from Kentucky, “If it isn’t broke, why fix it?” Yes, we want to help the elderly but we also want to pay as little in taxes as we can. Wouldn’t lowering the burden of the Medicare D Prescription Plan do that?

Big Pharma wins again. There is no doubt in my mind that they have saturated the lawmakers with enough “donations” so that they couldn’t get the 60 senators needed to bring the bill up for a vote. This includes Democrats who talked a big game upon being elected but now are showing their greed as well. The truth about these payoffs will come out but until then we all, as taxpayers, will have to pay for it.

On-call

Call sucks. I have been doing it for too many years and still hate it. No matter how you slice it, there is nothing fun about doing call. The cherry on top has always been that we don’t get paid for anything by phone and yet it is our highest liability in our job. When we do have to go into the ER at 3:00 AM, the pay is minimal. Obviously, I am not the only doctor who hates this aspect of our profession. A Boston Globe article recently pointed out how some Massachusetts hospitals are paying surgeons and other medical specialists $1000 a night to be on-call. This has brought on the debate between some of the older docs who think being on-call is a physician’s responsibility and some of the younger ones who don’t. The latter consider themselves “contractors in a competitive market dominated by insurance companies seeking to control healthcare costs”. Amen.

Federal law requires emergency rooms to provide specialists on-call to handle all types of, well, emergencies. The problem is that the hospitals don’t really want to pay much for this requirement. Many specialists who have had the option to bail from call have done so and this has created somewhat of a crisis in our country. There are different opinions about whether docs are ethically, morally and professionally obligated to do call but I say that is crap. The article makes a good point by explaining that in the good old days when doctors made a fair reimbursement from insurance companies and the government they would feel this obligation for call. No longer. Some of the doctors now feel like it is indentured servitude. And I agree.

There are a lot of interesting points to this phenomenon. One is that if physicians band together we can make the healthcare system bend in our favor. This “pay for call” issue proves it. It turns out that hospitals have some extra cash laying around and will pay a fair wage if you pressure them. Second, the older generation of physicians may feel an obligation to do what they did 50 years ago but they have to realize that times have changed. Right now a little thing called managed care rules the land. All bets are off and all rules can been broken. The second point is more personal. No where in the article is the issue of primary care doctors being paid mentioned? You have got to be kidding me! We come into the ER more often than the specialists! We get paid less than the specialists! It seems, according the Boston Globe article, we still are the steerage class of medicine.

Aetme!

Americans don’t like being told what doctors to go to or what healthcare plans to sign up for. This was what it said in a nice article by David Wessel of the Wall Street Journal on April 12th. Basically we, as a country, do not like our choices limited. Also saw in the piece was a horrifying quote by Ronald Williams, chief executive of Aetna Inc. For those who haven’t heard it before, here is his perspective:

"One of the lessons of the '90s is that every consumer insists on the right to choose a poor-quality physician”.

This is the kind of mentality that is basically running our healthcare system. Now you know why he wants to use P4P to judge physicians. How can we trust someone who has such disdain for our profession? Here is a guy that made over $19 million in total compensation last year (that would cover a lot of uninsured people, by the way) who really doesn’t like those who his gruntwork. Well, Mr. Williams, if you want to grade us and have patients migrate based upon those grades then about we allow those same patients to shop all managed care plans in ALL 50 states? You want to dance? I’ll dance. Let’s let the patients do some comparative shopping and choose their health plan the same way you want them to choose a doctor? Stop blocking passage of bills that allows this and we settle this the old-fashioned way; through supply and demand. Then we will see prices drop. Oh, wait a minute, you don’t want that to happen. How will you keep up your exorbitant pay package if we do that? Exactly. Poor-quality physician? How about poor-quality CEO? Aetme, Mr. Williams.

Celebrities

It is amazing how celebrities can impact the amount of screenings for many diseases when they come forward about their illnesses. This was brought up in a recent edition of the American Medical News. In 2005, the Journal of the National Cancer Institutes found that at least one-fourth of the public who had seen or heard a celebrity endorsement said that the endorsement made them more likely to undergo mammography, PSA testing, or sigmoidoscopy or colonoscopy The public is very much attuned to these people and devour the personal information they share. Betty Ford influenced the use of mammograms. Rudy Guiliani influenced prostate screening. Katie Couric influenced colonoscopy screening. Our celebrity focused culture is easily influenced by these people both for the good and the bad. Obviously, Elizabeth Edwards and Tony Snow are examples of the former. Anorectic magazine models are examples of the latter.

What really scares me is the true power these people have. I can educate patients all I want and still not get them to go for the colonoscopy. “You’re going to put what? Up where? No you ain’t!” I recommend some blood tests to young man, mammograms to elderly women, and the need for lead testing to the parents of toddler. Sometimes I get them to buy into it and sometimes I don’t. The problem is that I am not a celebrity. This brings up the negative side to the “celebrity phenomenon”. Many patients want screenings done even though it is not appropriate at their age, appropriate for their situation or appropriate for their insurance. In other words, “over screening” can lead to more problems. An example would be those full-body CT scans which has lead to many false-positives which causes excessive anxiety and needless procedures. Explaining this to patients isn’t easy and guess who becomes the bad guy when they are alerted that the screening is either not recommended or won’t be paid for by their insurance company? Me, the family doctor, that’s who.

I predict the best celebrity endorsement in the future will come from an actor with Munchausen’s Syndrome. What a brilliant coup that would be. Of course, he would never admit his disorder but instead be exploited by every medical foundation out there. Who will question him? It would be years later that anyone ever asks, “Hey, why is that dude still alive?” Of course, being a Munchausen and an actor, he will convince the world how he was saved from disease X only to get disease Y. Imagine a narcissistic actor with Munchausen’s. What more perfect combination could there be? And who would have the guts to call him on it? No one. Theoretically, this could go on forever. He would be a never-ending perpetual disease-pitching machine; a real life example of a Transformer. The question is would he would turn out to be a super-hero or super-villain? That is the same question we are asking of every celebrity today (can you say Tom Cruise?). It’s funny how some things never change.

Recommended Website

I recently met the man behind the website called Health News Review. I was impressed enough to use them as a feed onto my blog. His goal is to “improve the accuracy of news stories about medical treatments, tests and procedures and help consumers evaluate the evidence for and against new ideas in health care”. Three independent reviewers look at the story and rate it on a standardized system. The site is non-profit and funded by the Foundation for Informed Medical Decision Making. Check out the site via the left side of my Placebo Journal Blog. I think you will be impressed on how they truly shred some of those stories that come out on the nightly news. To be fair they also give credit due when the stories are done well.