8.31.2007

Asshole doctors...why is it so?

Ass. Hole.

"Why are doctors such ass-holes?"

I have a couple of friends and family members discuss with me their recent interactions with their physicians. I've had many patients thank me profusely for "listening more than any doctor has so far...". You've got to be kidding, right? *I'm* listening to you more than any doctor to date...in the emergency room? That's sad.

Then, a close family member told me how frustrated she was with her doctor because he wouldn't give her...basically what she wanted. And instead of making her understand why what he was doing was 'better' or 'more appropriate'...he just (in her words) flat out refused to give "this" antibiotic over "that" antibiotic. Actually, it wasn't even the antibiotic they disagreed upon, it was merely the dosage (which were both appropriate dosages in the clinical setting). How stupid. This family member is a 30 plus year RN...and has been in clinical medicine longer than that. No, she's not a physician...but she probably does know about her particular issue (and her particular body) much better than this physician. Dear Doctor, why not just listen, and if you want to get rid of the patient fast...as long as what they're asking for is reasonable...just give it to them and be done. Especially since, really, this wasn't that significant.

I've gone to the doctor, armed and ready to plead my case. I'm sure many other doctors have done the same thing themselves. I actually choose my family physicians based on, not how smart they are...but rather who will allow me access to the ancillary testing I feel is appropriate. There's nothing worse than being denied a possibly helpful diagnostic exam to allow the HMO to save money. If I have a headache, and I feel I need a head CT...I want a head CT. And unless the doctor explains to me why this may not be the best course of action...I want a head CT. Or, like the elective c-section I wanted....(and got, thanks to a listening OB who understood my concerns and agreed to my completely appropriate although 'unprotocoled' birth plan).

Because I've been blessed with really great doctors (after switching, and switching, and switching...until I find people I connect with...and who listen to me), I haven't had to argue much (knock on wood). And, yes, I've absolutely been talked out of all sorts of things "I thought I (or my kid/husband) needed." And even if things "go wrong" I feel that together we all made the very best decision possible with the information we had available to us at the time. And that decision is made by mutual understanding of expectations, explanation/education, and the overall feeling by both parties that the desired outcome is the same...which is that of health and happiness.

If what has been happening to my friends and family is the normal operating procedure of most docs...then it's no wonder we're getting sued so much. People are unhappy, and feel docs don't listen, and don't care. They don't educate, and aren't personable. This is a problem.

I understand the system is all fucked up...and this is why many (otherwise very empathetic, listening, caring) docs seem harried, unfocused, uncaring, and don't explain anything. This is why they come across short tempered, and basically rub people the wrong way. But, this is why the physicians should be the grassroots organizers for change. This is why they (I mean *we*) need a unified voice...because as it is, no one is listening.

I saw a nurse practitioner the other day. She had over 30 minutes with me. She seemed focused, and interested. She was rested...and her room was decorated with all sorts of cute pictures and informative posters and such. Her room had so much personality and I was completely absorped and put at ease. Then she came in, smiling, sat down, and looked at me. She had time to actually come in. sit down. and look at me. I felt like...I was the only patient on her schedule for an hour (and I probably was).

This is interesting since the PAs and nurse practitioners see the 'less complicated' patients, you would think that it would be they who had only 15 minutes per patient...with their easy patients and all. And the physician would be graced with over 30 minutes per patient....to decipher the nuances of the more complicated patients, and make more difficult medical decisions. Besides, there are (theoretically) more physician extenders than physicians...so it seems that the physician could busy herself with more 'doctor things' (i.e. things that require that a doctor do them) while the extenders saw the routine things which comprise the large majority.

But...this is not how it seems to be.

Physicians need a louder unified voice....lest our patients continue to think we're insensitive and uncaring, and suing us as a result. We need to be nicer. We need to listen more...and explain more. We need to change the system to encourage (or in some instances *allow*) us to be physicians...and really 'help people' and not simply stress them out and piss them off....

8.29.2007

Made up name? Made up person?

"I've seen cases and case histories of patients who essentially have come up from Mexico for the express purpose of being treated here, and then leaving to return home," Dr. Rogers said. "I've watched illegal immigrants brazenly demand free, non-emergency health care that was meant for our poorest citizens. I've heard them and their families complain. They feel entitled to it."

...a prevailing culture that has emerged in government: a culture that will not tolerate anyone who dares to draw a distinction between American citizens and illegal immigrants. It is a culture that now pervades police departments, public schools and universities, social services and health care.



***

Interesting. While I think the clinic is a far better place to treat non-emergencies than the ER, for everyone, period; I do hear frustration with allocation of resources 'taken from poor Americans' and given to illegal immigrants frequently. (This brings to mind an interaction I had with one of my PAs...)

There was a PA I worked with. Not long ago his brother was dying of lung cancer, after being a fire-fighter his entire career. He had health insurance, but still, he had to liquidate his assets to pay for end of life medical care. He sold his house, borrowed money from family...you know, that sort of thing. His money ran out before his life did.

The PA vented to me one day how frustrating it was to provide free care to "all of these people" when his own brother, who served the county for 25 plus years, could no longer afford his medications/healthcare costs despite being insured, and a citizen of this 'great' nation. Working at the County, we regularly admit patients (over and over again) to TICU (trauma ICU) who aren't citizens, and are at war with American Blacks in the innercity. People from all around the world having babies here. Referrals from Mexican doctors to 'go to the US' for continued care. Hundreds of thousands of dollars in (free) medical care rendered at (what he believed was) the expense of poor Americans...


...he asked me, what would happen if someone who appeared to be an American Caucasian or American of African descent presented to our ER, and gave an obviously (or not so obvious) fake name, said they were homeless...received treatment...then disappeared. What stops all people from presenting as 'illegal' with no ID, social security card, or proof of residency (either within the county or country). He wondered if his brother could've/should've just presented as a "homeless" unverifiable person to the ER one day...been admitted....and subsequently entered into the system as "Mr. B.S." From then on...treated until death under this alias, thereby able to keep his house, and his family members their money. It was difficult for him to treat poor (and not so poor) Americans losing everything in medical costs when we do provide so much "free" care to those who cannot even show proof of who they are, where they are from, what they are able to contribute, and where to find them. He was very frustrated, and upset with the system.

Perhaps that's what Dr. Rogers was feeling.

For those with an opinion (and maybe better understanding), why can't Americans just make up a persona and receive free medical care? Especially since no one dares check for fear of being called racist? Seems possible...although hardly a 'solution' on a large scale, obviously.

Perhaps for this PA's brother (as an individual) things would have worked out better....

8.28.2007

A better answer for Lauren Caitlin Upton of South Carolina

Question: “Recent polls have shown a fifth of Americans can’t locate the U.S. on a world map. Why do you think this is?”

Answer: “I personally believe that U.S. Americans are unable to do so because, uhmmm, some people out there in our nation don’t have maps and uh, I believe that our, I, education like such as uh, South Africa, and uh, the Iraq, everywhere like such as, and I believe that they should, uhhh, our education over here in the US should help the US, uh, should help South Africa, it should help the Iraq and the Asian countries so we will be able to build up our future, for us.”

Miss Teen USA Contestant - probably represents the average American teen...no?
Especially those from South Carolina...heehee.


I propose a better answer. How about:

The lack of adult leadership/participation and focused schooling that is the current tread in early childhood education which deemphasizes the need to teach kids academics in their formative years, may be a major contributor to our failing educational system. A system that is overly focused on kids doing what *they* want to do in lieu of learning proven valuable academic lessons, will surly result in a society of adults who cannot locate their own country on a world map. Quite possibly too much 'play' and not enough 'work' is contributing to the stupidity of Americans.

Having said that...she'd get my vote. ;o)

8.26.2007

Just being a doctor

The other day, while working in an off-site urgent care center, there was a guy...

...this guy was a 40ish y/o man, who was working at a construction site when a 2x4 fell and hit him on his right ear. He presented to the UCC with a 2cm laceration to the external ear, involving the cartilage. At first glance it didn't seem that bad. But, then when I realized that the cartilage was involved...I was reluctant to repair the wound. Eventhough I'm able...and know all about auricular lacerations and perichondrial hematomas (thanks to emedicine and google, and of course my EM training), and am capable and qualified to repair them as an ER doctor. But, I wasn't in the ER...and the repair seemed like it would take too long in the clinic setting. Besides, I didn't want to do it wrong, and have this guy sue me because a hematoma subsequently developed and caused a cauliflower ear for his lack of follow-up (as is typical of the innercity patient population). So, I did what every clinic doc does when they don't want to deal with a particular patient....I told him to go to the ER.

He *really* didn't want to go to the ER.

I explained the complexity of his wound, the possibility of hematoma, and the close f/u that would be indicated. I told him that there may be complications...and I, basically, didn't want to take the risk. The risk that he didn't fully understand the repercussions of improperly managing this type injury. The follow-up, the wound care, and the possibly that cosmetic appearance may be suboptimal despite perfect medical treatment. (Sometimes getting patients to understand that it wasn't *you* who dropped the 2x4 on their ear causing the damage, but rather their lawsuit anger should be directed toward the perpetrator...is a difficult task if complications develop).

He listened, and expressed understanding. Then he said "doctor, I don't care how it looks when you're done...and I don't care if I have to deal with complications; as long as you do your best, I will be happy. Please try, I don't want to go to the ER...especially if you can fix it." (hmmm...can I get that in writing? Does that count as informed consent? Will that hold up in court?).

So, the doctor in me...that part who doesn't want to base every medical decision I make on what's defensible in court, but rather do what's best (and within my capacity) for people...over took me.

I repaired his ear. And it looked nice. Tiny 6-0 sutures, all neat and tight (but not too tight). No hematoma.

I told him he'd better *better* come back the very next day!! I even gave him my direct line to call me when he arrives out to triage...as to avoid waiting (to encourage him to actually return). When he arrived, he started to check in. When he realized that there were no "short-cuts" despite the fact I told him there would be...he decided to call the number I'd given him. I arrived out to triage as he was being sent to registration. I stopped him, removed the dressing, and looked at my work his ear. Still great, no hematoma. (I did document this "visit"...but, of course, I not sure if "it'll count" since the patient didn't register). But, more than anything I felt better about doing the procedure. And the patient knew I really cared about not getting sued his injury.

After my short hallway reexamination....he handed me a gift basket from him and his family saying "thank you for being a great doctor; for going beyond what's able to be documented despite our current sue happy population, and treating me with respect."

You are welcome, Sir!!

Sometimes we are allowed to just be doctors!!

8.17.2007

New/Rich vs. Inadequate/Poor

With regard to public hospitals undertreating patients forcing private hospitals to do their "dirty work" per Dr. Rangel...

"When they treat charity cases the cost is passed on to the insured patients in the form of higher premiums or deductibles or to the tax payers who pay into Medicare and Medicaid.

The obvious answer would be to improve the capacity of the local public hospital to meet the needs of the community. So how are they planning on doing this? By spending millions on building massive new multi-story children’s hospitals, while their main hospital buildings remain ageing and overcrowded. Huh?"



LIKEWISE....

While UCLA builds a brand spanking new hospital in Santa Monica...
- an upper class population who can, on average, easily afford healthcare, and really....doesn't *need* additional facilities in their rich neighborhoods....

The steady pace of construction is transforming UCLA's hospitals into the impressive buildings that will begin opening in 2007. The four hospitals that comprise UCLA Health System - Ronald Reagan UCLA Medical Center, Mattel Children's Hospital UCLA, Resnick Neuropsychiatric Hospital at UCLA, and Santa Monica-UCLA Medical Center and Orthopaedic Hospital - are being renovated or rebuilt to better serve the health needs of our community and beyond.

[The new hospital will boast will] a new Birthing Center and 16-bassinet Neonatal Intensive Care Unit.
Cutting-edge medical equipment and integrated communication technology.
A new Critical Care Unit with state-of-the-art medical equipment and 360-degree access to patients.
Six new, state-of-the-art operating rooms.
Patient rooms featuring family space and comfortable sleep chairs for rooming-in.
A new cafeteria with outdoor and indoor seating areas.



The areas in most dire need of such facilities...lose them

County officials announced King-Harbor's impending closure Friday afternoon, shortly after the federal government said it would pull the hospital's funding because it was chronically unable to meet minimum patient care standards. The emergency room was closed within hours because it did not have enough nursing staff to safely care for patients. Inpatient units will be closed within two weeks as patients are discharged or transferred to other hospitals.


You're not alone!! I hear you, and I am observing the exact same thing here in Cali.
Such is the way of the world...I guess.

8.11.2007

Regular School....

Is it me, or has public primary school drastically changed since the early 80s when I was in kindergarten?

I eagerly awaited the day I could sign my child up for *free school*. After paying an obscene amount of money to private preschools, I was excited to actually have my tax dollar working for me in this way.

A'las, kindergarten this year...public, and up the street. I am of the mindset that public school is fine for most students. I went to public school...yadda, yadda, yadda. More diversity, more interaction with real life people. I believe it's easier to be a big fish in a little pond, so the fact that the school is 'average' could be a great thing for my kid. And, studies show that 'average' middle class kids, who attend 'average' schools, do just as well as similar 'average middle class' kids at great schools (whatever those are). Also, I've seen my share of the rich spoiled Paris Hiltons, to know that many of those expensive, pricey private high schools are full of cocaine, fast cars, and complete disregard for humankind at large. I've seen plenty of kids come into the ER intoxicated, high, raped, "suicidal", or all botoxed up with perfect make-up to boot, at age 16, from these well-to-do schools. My kid has a Diva personality, and she doesn't need any coaching in that area.

So, we went to the local public school. It was okay, I guess. But, it didn't seem as though the kids were well supervised. My kid is an escape artist, and she isn't always a great listener. It's important to know your kid, and in doing so, attempt to create an environment that they'll thrive in. Well, free play (whether planned, as in montessori or other 'child based' methods of teaching; or by default, as in lack of supervision by disinterested minimum wage earning staff on the playground) isn't a great environment for my little girl. Strike 1.

Then, they get out at noon. "School" is from 9a-12p. That's crazy. What is she supposed to do the rest of the day? Play on the playground....with the unsupervising supervisor. Strike 2.

What do they learn in kindergarten?
letters, numbers, frog cycles...

When do they learn to read?
First grade? You've got to be kidding me. I knew how to read and write sentences in kindergarten. I actually remember my teacher and everything. I expect that she'll learn how to read in kindergarten (actually I kinda think she should already know how to read).

I spoke with local parents, all whom agree that the local schools are unable to keep the reading ready kids advancing as a result of the....other kids. Those kids who don't know English, or are just stupid.

I don't want my child to stagnate waiting for Spanish speaking kids to learn English (unless my kid is learning Spanish simultaneously). Otherwise, my kid is getting the short end of the stick in this deal...and it's my duty to try and address these issues as her mother. As they are still learning (a very valuable skill), my kid is acting out, playing candyland, and waiting....
...and in the end, she's gained nothing. Strike 3.

So....she's going to private/christian kindergarten this fall. This school is the closest thing to a 'regular school' I've discovered in our 5 year search. They 'pledge allegiance to the flag.' They learn songs and dance. They learn about morals and friendship, love and obedience. It's okay for parents to spank (gasp) if deemed necessary. And....She's *learning practical things at school*...like reading, and math. Strangely, the Christian school has allowed us more freedom of expression than the public school or private, liberal preschools. The Christian School has been the most tolerant, and accepting of our family, our values and beliefs. It's amazing. Sometimes is seems the crazy right-winged republicans have taken ownership of Christianity. I am a Christian, and it's nice to see that there are Christians who actually do WJD (do what Jesus did).

After years of being forced to sit through church as a kid....and then marrying a guy who works in a world where anything Christian is typically anything but, it's refreshing to experience Christianity from this different perspective.

We have come full circle....back to our 'regular school.' No bullshit Montessori, or 'let the kids do whatever the hell they want child-based'. No learning about frogs and roaches in lieu of letters and numbers. No purple haired, flip-flop wearing, 35 yo single, childless, "teacher" with a PhD acting holier-than-thou because I think watching TV is okay, and my child eats Oreos. A regular school. With little desks. Where children raise their hands, and call teachers by their last names.

Ahhhh....finally....after 5 years!!
REGULAR SCHOOL!!

Play-based/Montessori Preschool - Kids gone wild!!


The new trend in preschool is (apparently) 'play-based/child-based', montessori "free play". I believe that kids learn alot via creative play and experimentation....but these new-age schools take it to an entirely different level. My daughter is a very intelligent, wide-eyed, out-going, lively spirit (putting it nicely). She has this preference for 'experimentation' rather than 'observation' (which is obviously, not always a good thing....and at age 4, it's *usually* not a good thing).

Anyway, when we started our tireless search for the perfect pre-pre-school at age 18 months, we realized that this was *serious business.* As we started investigating the various 'teaching techniques' and 'theories'....we came to the conclusion that...

1) preschools, and preschool teachers, take themselves *way* too seriously; and 2) no one just offered *regular* school anymore. You know....regular. Where the kids sit in little desks, and raise their hand to go to the bathroom. Where the good kids get stars on their work...but only when they did good work!! Where everyone participated in the same activity, at the same time, and learned to *play together.*

It's amazing that *regular* preschool is so hard to come by. My kid has been in 5 pre-schools, and she's not even 5 yet. Let me tell you a couple of stories along our journey.

The Practical, Hood School - (TPHS)
At 18 months, we chose a preschool. Near the house, good hours, and reasonable price. All the things that matter most (especially to busy parents, one who's in an ER residency). I figured anything she learned would be more than she knew - even if it's how to socialize. As long as she was safe.....actually, I didn't care if she didn't learn a damn thing. The 'teacher' was an unemployed mom. It was a day-care center, but their standards weren't that high. But this teacher was absolutely wonderful. She was a mom with two school aged kids....and was looking to get back in the work force. She had a way with kids....and my daughter learned her entire alphabet, numbers, colors, shapes, and her speech developed wonderfully while under the care of this 'regular lady.' But, because the school was in the hood....there was an incident....and we had to withdraw....

....what do you expect to get for a resident's salary?

The Montessori School - TMS
The next school, I think we overcompensated a bit. My mom actually had to pitch in and help us afford this new Montessori school. There was an interview, and an entrance exam. You know...one of those schools. "I guess we'll have to go get her a little black skirt-suit for her interview" I joked as the DIRECTOR poured over the admissions process, the requirements, and recommendations. Needless to say, she didn't find my sarcasm the least bit funny.

This school was over $1000/mo. My kid was 2. That's insane. But, this school was beautiful. And all the rich kids went there. We jumped thru the hoops, got baby girl in, and were feeling good about ourselves.

After a couple of months, we realized that she wasn't 'doing new things' as frequently as before. When she was a TPHS student, she had new tricks all the time. A new letter/number...a new song. She'd come home knowing things (good things, educational things) that we didn't teach her (maybe she learned it from all the videos we sat her in front of...but I think it was the school). That was a great feeling....afterall, isn't that what school is supposed to be?

At TMS, she just kinda floated. She'd come home with her clothes on backwards, socks missing, bare foot. One time, after complaining that her "vagina hurt" (we use proper words for our body parts, thank you), I noticed she had no panties on under her shorts. Apparently she decided (*she decided*) she didn't want to wear them, and the teacher allowed her to disregard them. Now, I can be a free spirit, but a 2 year-old toddler playing in the sandbox with shorts on....*needs panties on*. When I discussed this matter with the DIRECTOR, she assured me that they'll make a greater effort to "suggest to my daughter that Mommy prefers she wears panties."

Suggest to her??? Mommy prefers???

Then, since I have a genius baby, they wanted to put her into a class with 3-6 year-olds. For the life of me, I can see no common interests between a 2.5 yo and a 6 yo. But, these 'preschool experts' assured me that this was 'the thing to do', good for my kid...good for the big kid, etc. We agreed, and my daughter hated it. She was always the youngest. She did not have a peer group. And asked (she actually asked in 2 year old speak) to be demoted. She said that she was only 2, and she wanted to be with other 2 year olds. (told you she's a genius).

Finally, at the year's end, she knew all about frog eggs, and volcano dust...but she still couldn't write a lower-case T. I know, I know, it's my responsibility to teach her...fill in the gaps, etc. But...I pay them (great money) to do school, to teach her at least the ABCs. If not that, than what? Certainly ABCs will serve her better in life than knowing the life cycle of a frog.

The third school was in Venice. Famous people took their kids to this school. A great school...came highly recommended. Was a free-for-all like all the rest, but at least they acknowledged that (just maybe) there are multiple "right ways" to teach children. Unfortunately, the left-winged liberal, schools sometimes (many times) were more intolerant of difference in thought than the republicans they accuse of being closed minded. This school, wasn't like that...the parents were, but the school director/teachers, were not. Of note, the teachers weren't 'experts' or 'degreed', just people who care, and loved kids.

The next school was the Super Expensive School, (SES), but had an infant program that could also take my then infant son (so both kids are together). On a side note: infant care is a whole nother odeal. By this time, I'm out of residency...but still can't afford the school - so my mom continued to help us out. Can you believe that as an EM attending, I couldn't afford childcare for my kids? Anyway, this school was $24,000/yr for both kids. But it was only 'in session' for 9 months. And there was a month long 'winter break'. Again, I'll emphasize that I took/take my kids to preschool because I need someone to watch them, when both me and my husband are at work. So all this "time off" was very difficult, and actually proved to be very expensive. Having to hire supplemental help, or taking days off....disaster.

Anyway, all the teachers at SES prided themselves on having advanced degrees in child development (or whatever). That's all fine and well, but it doesn't take a PhD to teach a 3 year old to count to 10. Can I just get you to teach her something practical? On more than on occasion the preschool teacher attempted to undermine me with my own kid. We (like everyone) have certain things that we allow our kids to do, and other things we'd rather have them not do. Sometimes it's arbitrary, but it's our decision. I don't like my kid sucking her thumb all day and night. I don't think it's healthy, and I think it hinders her socially. Also, there are long term consequences to deal with (that I'll be dealing with) if she's allowed to hang her thumb out of her mouth all day. Additionally, this daughter of mine would exclude herself from activities by default in lieu of sucking her thumb. So...we purchased thumbguards. They worked to at least cut back on the behavior, but the entire time, this "granola eating -kids can do whatever the hell they want" preschool criticized me/us. Then, tried to turn our kid on us. "Don't you think what your parents are doing is restrictive?" They'd ask her.

News flash. My job is in todder-land is almost wholly restrictive.

I was so pissed. I pay you in excess of 24 thousand dollars a year, for you to judge me? To place your values on me? To undermine my decisions with regard to my child? I don't think so. So I sent a nice, saucy email, and had a face-to-face discussion with all the teachers. I preempted their "we have PhDs and we think..." bullshit with -

"Let's keep this in perspective, shall we? You all are frikin *preschool* teachers!! Please don't give me medical advice unless you're physicians. Please don't offer childrearing advice if you don't have any children. And please don't assume you know how to raise my particular child better than me. Get over yourselves already."

That didn't go over well...
...and now she's at her 5th school.
-it's no wonder we have no control over our kids in this country...


8.10.2007

CMS pulls King Drew (Harbor...whatever) federal funds!!

King Lose it's federal funding - the Headline



This is huge. Thought I'd never see the day CMS actually...pulled funding from a public hospital. After years of threats....and appeals.


Effective immediately, the ER no longer accepts paramedic traffic. August 15th, all inpatient services end.


I wonder what happens to the ED? I hear they can't 'just close it' without proper community notice...per the Beilenson Act - "which requires public hearings whenever hospitals close or reduce services."


Anyway....seems like it's actually happening


What will the community do? What will Los Angeles do?
The only silver lining...if LAC and King manages to see patients and carry-on despite not having CMS blessing (afterall, we all agree that CMS and Joint commissions don't actually improve patient care, they just sit around and think of ways to justify their existence. New rules, new hoops, some that are quite detrimental on multiple levels, but I digress)....
....a new precedent will be set, and perhaps this absurdity of jumping thru all the dumb-ass hoops as required by 'the regulators' (CMS, joint commissions, insurance companies) will be no longer. Maybe LAC or the State of California will come up with it's own 'regulatory system' that's better, and is more beneficial to both patients and physicians. Then they can tell CMS to kiss their ass...and run things w/o the threat of an unannounced survey; concentrating on "real issues" and solving problems (because there are plenty of problems....obviously).

8.08.2007

Bitching and Complaining - Play the trump card already

Multiple blogs have had recent posts regarding proper physician compensation, medicare cuts, universal health care, and the difficulties practicing medicine today. (As not to hijack their comments section I thought I'd just create my own entry). Seems to me the solution is simple...and stated so concisely by anon1151 on kevin's blog:

The solution is simple. Don't take Medicare. Don't take Medicaid either. End of story. It always amazes me that docs bitterly complain about reductions in reimbursement from public and private payors, yet continue to take them year after year.I wonder- Are any of the docs on this board truly planning to dump Medicare if reimbursements decline? The answer is most likely none.As long as most docs are willing to take the cuts, they will keep reducing them. It's a race to the bottom, and we aren't even close to the end.Docs are trained to be so risk-averse, that they will take any cut for fear of losing even the most meager returns. In other words, get some balls or stop complaining.
posted by Anonymous : 11:51 AM

I have to say that...I agree.

Doesn't seem like a "complicated" or "difficult" situation at all. The physicians hold the trump card, and would rather bitch and whine than play it. Just say "no."

With regard to the threat that all docs will leave clinical medicine...
Why do physicians believe this? If you're a bad businessman in one field, what makes you think you'll be any better in another? Making money is making money, no matter what industry.
# posted by Anonymous : 8:41 AM

I agree with Anon841. If you're too weak, too chicken-shit to advocate for yourself, and your practice...your livelihood, what makes you think that (as a group) we'd be successful doing anything else?


-caveat-
I understand *individuals* leaving clinical medicine for one reason or another may be a great idea. And, sure, their lifestyle may improve...yadda, yadda, yadda. And, I constantly provide caveats to individuals, because, as an individual you're not quite as strong, you're more vulnerable, and really, can only bitch, complain, and try to motivate others to become angry enough, and fed up enough...to encourage others to do the same. When a certain threshold is met, change will follow. I know this, and am not suggesting that individual doctors jeopardize their (even suboptimal) situation and become a martyr at the expense of their families. That wouldn't be wise - and there is a better way.

However, for doctors as a group to think that either 1) an empty threat to leave clinical medicine, or 2) waiting for even a substantial number of docs to leave the bedside, are viable solutions...further demonstrates their, um...what's the word?...*stupidity*!!

I see docs take all kinds of shit from HMOs and 'regulators' for very self-serving reasons - like pensions, guaranteed income, or vacation/sick leave benefits. Doctors don't refrain from telling medicare to fuck off, or the HMOs to shove it because they're nice...altruistic...or care about poor people. The reasons are more self serving - so don't believe the hype. If these docs cared about *patients*...they'd advocate for themselves, which would benefit their patients (or vice versa...either way, it's better than what's currently taking place). The reasons they don't...are a topic for another post, and mostly due to the past/older generations (afterall, the newbies haven't been around long enough to create this problem), their greed, arrogance, and passive-aggressiveness. Their complacency, and disinterest in managing their own trade. Their lack of a unified voice, and failing to hold their societies accountable (or forming new ones that are worth a damn.)

Instead of bending over, and taking it in the ass keeping silent....doctors should just say*no*. When that day comes...things will change. Not a moment sooner. No one is going to make things better for doctors while they sit silently in the corner, accepting bullshit from the purse-holders!!

Play the damn trump card already...

8.04.2007





Hilarious....

....just *had* to add this (for no other reason than to simply keep track of it myself, and share with friends and family).




Older Generation of Docs


The older generation pretty much sold the rest of us out as they sucked up to "managed care" (the embodiment of "the pursuit of self-interest) in order to make sure that the retirement packages were secure, so this is left to the newbies.


Organized medicine wants you to be another cog in the wheel driving the revolving doors of of cheap medical labor and indentured servitude.It is far past the time medical students and residents were "armed" with more information.


Couldn't have said it better than Dr. Mary Johnson via KevinMD, regarding the Lucidicus Project.

8.02.2007

Chinese Cell Phones

Poisonous, deadly, cancer-causing, Chinese cell phones that catch fire and fry your brain while using them....

***
Dog and cat food ingredients made in China killed dozens of pets in the U.S. this year. Toxic Chinese cough syrup killed at least 94 people in Panama. Chinese tires sold in the U.S. spontaneously shredded on the freeway. "European" toys made in China and sold in the U.S. were made with poisonous metal. Jewelry made in China and sold in the U.S. was found to be made with "recycled" toxic "eWaste" -- the components of computers and other electronics. The list goes on and on.

Unlike, say, toothpaste, which you put in your mouth, cell phones seem safe enough. In reality, however, it's hard to make a safe cell phone. A typical cell phone contains heavy, toxic metals such as lead and beryllium, poisonous flame retardants like bromide and enough cadmium to contaminate thousands of gallons of water. It's difficult and expensive to use these ingredients without exposing the user to toxins.

Chinese news media reported recently (and vaguely) that inspectors in southern China found that about 80% of cell phone chargers failed to "pass tests," and a whopping 40% of the cell phone batteries for sale there fell "below standards."
Below whose standards. China's? Yikes!
***

....I'm telling you, it's just a matter of time before it is made public that those radioactive, electronic headsets cause some adverse pathology to humans....and their brains.

8.01.2007

Chinese Toys

Mattel, the maker of Barbie dolls and Hot Wheels cars, is recalling nearly one million toys in the United States today because the products are covered in lead paint.

According to Mattel, all the toys were made by a contract manufacturer in China.....

....factories in China have been sources of poisonous pet food sold in stores in the United States, dangerous car tires, and lead paint on the popular Thomas & Friends wooden toys.

Guess I'll toss all of our Elmos, Dora, and Barbie doll crap stuff into the trash can...or risk having dumb kids.

Maybe Legos are safer?