Showing posts with label Is the public this naive? Doctors losing PR battle. Show all posts
Showing posts with label Is the public this naive? Doctors losing PR battle. Show all posts

Monday, December 19, 2016

NAFTA For Doctors

Okay, this is one of the crazier ideas I've read in awhile. Dean Baker, co-director of the Center for Economic and Policy Research, laments in the LA Times that doctors make too much money. He bemoans that the North American Free Trade Agreement has decimated the ranks of blue collar and factory workers here in the U.S. because the treaty allowed corporations to use cheap labor outside the country to lower their costs. In a fit of inspiration, Mr. Baker asks why we can't do the same thing to doctors. Why can't we allow cheap foreign medical graduates to flood the American landscape to lower healthcare costs?

As the writer sees it, there are several good reasons to promote this plan. It's unfair to discriminate against perfectly well trained doctors from foreign countries to practice here. If it wasn't for the protectionist practices of our medical organizations, these fine young doctors would be here already taking care of the unmet needs of millions of patients. Why must the only way to practice medicine here is through an American residency program?

Then there is the awful amount of money physicians make in the U.S. We make twice as much money as other doctors in First World countries. The way to lower our incomes and promote income equality is to bring in competition. A two for one special. Anybody who argues otherwise is not a true believer of fair trade practices. These discriminatory policies cost the country $100 billion in higher labor costs. Imagine the savings if foreign doctors were allowed to see patients for a fraction of what American doctors charge.

He believes that the only downside to his plan is that this would cause a severe brain drain to other countries. All their smart doctors will clamor to our shores to set up shop, causing their native countries to lose healthcare access. His solution to this problem? Taxes of course. He would tax the incomes of these foreign doctors and return the money to their home countries so they can train even more doctors, who of course will want to come here to work too.

I don't even know where to begin to comment about this asinine idea. It hits all the liberal ideologies about taxes, income inequality, protectionism, and racial discrimination. All I can say to Mr. Baker is that there are plenty of doctors just south of the border that he can go see. Let him put his money where his mouth is and take his family's health needs to Tijuana or Ciudad Juarez. He will then be doing his part improving the healthcare system of this country by decreasing its burden by one family and improving the livelihoods of the Mexican doctors and nurses. Somehow, like most limousine liberals, I doubt he will follow his own prescription.

Friday, May 6, 2016

Celebrating Nurses Week

It is good to be a nurse. As Nurses Week winds down, I want to show you how much our hospital LOVES our nurses. Compared to the pathetic tray of bagels the facility offered physicians for Doctor's Day, this is what the nurses got for lunch, just today.

Nothing like an all you can eat taco bar as a term of endearment. And this was only in one unit in the hospital. All the other units got similar lunch buffets. Oh yes, our hospital just adores our nurses. If you feed the ones you love, then we absolutely revere our RN's. This is what our nurses got yesterday.

We just love to keep our nurses fat and happy. Apparently it must be much harder to retain or acquire new nurses than it is to keep doctors placated. Besides these two examples, another day they received a full English breakfast buffet with all the cholesterol and salt the hospital cafeteria could possibly unload on our nursing staff. The nurses also received free tote bags and other swag with the hospital's logo on it just so they will remember who is treating them so royally.

Why become a doctor and get taken for granted when one can become an RN in half the time and one third the cost and actually get some appreciation at work?
Our sad Doctor's Day bagels.

Saturday, August 1, 2009

Is the public this naive?

In today's Wall Street Journal, there is an article titled "Imagine Doctors, Patients Talking" that demonstrates the naivete of the public, or at least this journalist, on the doctor-patient relationship. The article implies that it is the doctor that is the sole reason for driving up health care costs.

It starts out with advocating more "intimate" office visits with your doctor, like having a dinner conversation. Sure it would be great to spend two hours with each of your patients to discuss their health care but if the new health care bill is allowing more patients to visit their doctors while lowering payments to doctors, those dinner conversations will instead become more like a drive through at the In N Out.

Then the article leads with snarky remarks like "If there's a history of mutual honesty and transparency" and "Doctors should be forthcoming about discussing the alternatives." I would say that in most if not nearly all less-than-honest relationships with patients, it is the patient that lies to the doctor. "Doctor, I'm agonizing. I need more pain meds." "Doctor, I don't have enough money to feed my children. I can't make the copay." "Of course I take all my meds as prescribed doctor but I still can't get my blood pressure (glucose level, acid reflux, INR, etc.) under control." So the writer is implying that doctors are not honest with their patients about available treatments. Has the writer ever heard of informed consents? Before starting any treatments, virtually all doctors discuss the medical plan along with alternatives. We physicians have not dictated to patients their health plans for at least the last twenty years.

Then we get to the laughably ridiculous line "In exchange, patients should signal that they don't necessarily want to act on all the possibilities." Are you kidding me? How many times have I seen patients or their family say "I want everything possible done." I've seen 95 year old demented patients get gastrostomy tubes placed because the family wants everything done. I've seen the whole blood bank transfused into exsanguinating cirrhotic Child-Pugh C patients because the family wants everything done. Walk into the ICU in any hospital and you'll find patients on multiple pressors, ventilated, with feeding tubes and on dialysis long past what is medically indicated because the family wants everything done.

The problem of course is that patients don't know or don't care about the costs of these treatments because somebody else is paying for it. The article states "patients may welcome these developments as they watch their wallets" but that is precisely the problem, the patients and families don't. Most people have insurance through their employer or the government so somebody else is paying for all this. If they had to pay for the real cost of medical treatment, like in Britain where dialysis is out of pocket after age fifty and transplants after age 55, we wouldn't have so much needlessly aggressive care. But of course that would be cruel to the "most vulnerable" people in society.

The article ends by saying it is the doctors who need to upgrade their communication skills to better inform their naive easily impressionable patients. And the patients should have bias free information to make an informed decision. Hello. Patients already have that. But medical care is a very emotional decision. If you read the entire text of Harrison's to these patients, they would still want what they want, regardless of the logic and price of the treatment. No wonder doctors are leaving the AMA in droves. If they can't educate the public about what's really going on, the public will just keep squeezing the doctors until we are all just slave labor for the government. But we doctors are not supposed to say the truth. We're supposed to be all about compassion, treating each and every patient regardless of the physical, emotional, and fiscal tolls on ourselves. Otherwise we're bad greedy doctors who only care about money.