Underpiad family practitioner in upstate New York

Get the blood work done, pick up my Rxs and get on my way.

I end up doing what I want to anyway, but I don’t tell Dr. F. this.

I pretend she’s smart.

That takes alot of pretending on my part.

1. The majority of people are more interested in the advice of a specialist. This is an American malaise of always wanting the best thing. “Not only do I want to see an oncologist, I want to see the best melanoma oncologist in the country, that’s why I came to see you,…”

2. People veiw healthcare as a commodity, not as a luxury. People buy insurance (the proxy for the price they pay for their doctors) by price, not by quality. For those of you who get your insurance through your employer, remember, you have the option of buying it outside of your employer, or writing your congressman and asking them to change the tax incentives offerred to business for medical care.

3. Most people are takers, not givers. If someone sees that they have the opportunity to speak to a caring person about a problem, not only will they talk to them about the 2-3 most important things, but they will continue to talk and completely dilute the crux of their problem. Most people are like dogs who are left with a bag of dog food while their owners are away. They’ll eat the entire thing at the first sitting. If asked to “name the thing that is bothering you the most”, people become upset as they feel they have already prepaid for their doctors time. Patient caring doctors are abused because of their altruism. (and as a result are paid less as a reward for their kindness)

4. The government and medical oligarchy has made up a system where doctors who deal with only one problem are paid MORE than doctors who deal with the big picture. Why would physician’s not follow financial incentives like everyone else.

5. Physician’s are paid by the “piece”, not by the hour. If you are paid by the piece, you hurry. If you are paid by the hour, you linger. (notice your waiter and the highway repairmen if you doubt me)

6. Hospital’s cater to supersubspecialists, often luring them with signing bonuses, subsidized rents, etc. The flip side is that up until recently, hospitals viewed PCPs as business referrals and little else.

So let’s recap what we’ve learned about the person who is willing to look at the big picture and take care of the whole patient:

1. They aren’t valued by the patient
2. They aren’t valued by the government
3. They aren’t valued by the medical establishment
4. They aren’t valued by the hospital
5. They make less than everyone else
6. They are expected to be the quarterback for all of the patient’s problems and if something is missed as with Mr. Kling, it is the fault of the big picture guy

Who would want this job? No one. Anyone who isn’t a complete martyr spends one year doing this and either becomes an alcoholic or changes their job. What is crazy is that things are getting worse for this kind of doctor and no one who can change things cares.

I would like a free lunch. Delivered everyday with alacrity by the most intelligent hardworking segment of our society. But there is no such thing as a free lunch. Either for me or anyone else as long as people continue to have the freedom to choose how they make money and spend their work years.
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And somehow he says the reason for this is because of Medicare, and specifically because Medicare is pure “evil.” How that has anything to do with evaluating cellulitis has me guessing. Does he imagine that if Medicare paid more for a visit, the x-ray would not have been thought necessary? Interesting, but not convincing. But what do I know, I’m just a specialist.

So you get what you get.

In other news can we get a Celebration thread for John Edwards dropping out, Kevin. I’m as giddy as a little school girl.

Graduates avoid those “hands-on” fields like geriatrics because they pay badly and for those who must be responsible for paying off their educational costs and everything else, bad pay is a non-starter. Maybe the Ohmeda machine is blocking your view of what goes on outside the hospital doors. Medical practice certainly is a business, and like any other business needs to pay its bills.

They may think Medicare is great and generally “free.” In reality they have been irreversibly and unwillingly dumped into a third rate health plan that doctors avoid like the plague.

Suckers!

Ed Sodaro MD