Dear patients: My skill set no longer matches your needs

Dear patients: My skill set no longer matches your needs

Dear patients,

It has been a hard week. I wanted to take a moment to personally apologize for all that you have endured. As one who has witnessed your pains and struggles, I can only wince with each new passing hurdle you are forced to leap over. This business of disease and illness is not for the weak of heart (metaphorically, that is).

To the man stranded in the hospital with a pelvic fracture, I wanted to say I’m sorry. Contrary to what you have been told, it was not I who gave the order to make your admission an observation. In fact, I did just the opposite. I had clicked the full admission order while doing the requisite computer work after seeing you that first night in the hospital. But the next day, I received a call from a physician in a distant city who has been paid by the medical center to review such cases. Although he reluctantly admitted that he is a pediatrician who doesn’t even take care of adults, he has been given the power to interpret Medicare rules and has decided that you don’t qualify for inpatient status. Unfortunately it is of little interest to Medicare, or this physician, that you are non ambulatory and that your wife is to frail to lift you. If you want to go to a skilled facility to strengthen before returning home, you’ll have to pay for it yourself.

I’m sorry for the young woman I saw in the office crippled by pain caused by gastroesophageal reflux. I cannot explain why your insurance company has decided to deny my prescription for twice a day Prilosec. I am aware that they have always filled it in the past. I am also aware that you have now been out of medication for a week, and are in severe discomfort. It baffles the human mind to understand the foibles of prescription coverage. It would be impossible for the insurance company to know, as I do, that you had been hospitalized with these symptoms and only by using the medicine twice a day have you found relief. This is a secret that only you and I share.

I’m sorry to the middle aged man who unexpectedly suffered a life altering stroke. Unable to walk, I had great hope that a motorized wheel chair would give you the mobility and independence that had been cruelly taken from you. I filled out the paperwork as carefully as I knew how, but the request was denied. I know that the world is full of fraud and misuse, but surely even the most uneducated could see that you are a perfect candidate for such technology.

I guess I can only imagine the unendurable suffering to all of you caused by such indiscriminate shows of brute force by our medical system. I too suffer. Not, of course, like you. I ache from the depths of my being when the product of my life’s work is sour and impotent. I spent all those years learning how to become a healer, a secretary and insurance negotiator I am not.

My skill set no longer matches your needs.

Perhaps a lawyer would get you farther.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

Image credit: Shutterstock.com

Comments are moderated before they are published. Please read the comment policy.

  • buzzkillerjsmith

    The problem is that outside parties want to ration care, in part to increase their own profits, and have found ways to force us to take responsibility for their decision and suffer the fallout when their decisions cause harm. Nice work if you can get it.
    A beautiful example of this is the EHR fiasco. Pts will be hurt by bad health IT. The Sutter system in CA, Epic I think it was, went down for a whole day in the East Bay and docs and nurses were unable to get such infomation as allergies, medications, medical problems on their inpatients and ER patients. The cherry on top is that an administrator had previously threatened nurses with “progessive discipline” for not jockeying this soul-crushing piece of technofeces to her satisfaction. The Health Care Renewal blog has a nice piece on this.

    • LeoHolmMD

      For most EHRs: if they were planes, they would be grounded. (For all the six sigma fans out there).

    • EE Smith

      I still don’t know a single patient who, if asked what advance in healthcare they’d most like to see, and if asked what healthcare initiative they’d most like to see their government throw billions of taxpayer dollars at, would answer “Electronic Health Records, of course!”

    • querywoman

      Care is always rationed. Most people like to hold onto to their money, or spend it all for whatever they want.
      New medical inventions happen all the time, and I want them.
      I walk with a cane and ride the bus. I do walk half a mile to a mile quite a bit with a cane.
      I had a nurse practitioner who told me about those new mobility moving chairs, and how so many people want them. Of course, the patients loose their “tone” after relying on them. They are also to be used inside, not to go shopping.
      There are a lot of people demanding them who don’t need them, and companies wanting the profit. So that’s what really makes it hard for people to get them.
      I had cellulitis of the legs several years ago. I was released with a walker. I never used it. I told my doc that in my own home, I’ll crawl. I also told her I will never quit walking until I’m crawling.
      In a month, I was walking fine with a cane and getting stronger.
      Sometimes I take a cab when I get real close to home if I have a heavy load.

      • Suzi Q 38

        I borrowed a walker yesterday. I wanted to go to the movies with my friends, and my orthopedic surgeon did not issue me a walker or crutches. He did not want me to rely on them. He wanted me to exercise my knee.
        When I had had the other knee repaired 15 years ago, they sent me home in an immobilizing brace that was so stiff that my knee could not move.
        It is nice things have changed.
        i feel so much better today.
        To think I put up with this injury for the last year to avoid another surgery.

        • querywoman

          I think I’d rather crawl to the grocery store than use a Hoveround, but I’m not there yet.
          The month after I got out for the cellulitis, it sure did feel good to be able to walk more freely.
          Sometimes I get painful rashes on my feet, and I’m trying to go into a bad stage now. They can interfere with walking some. Then I do best to switch from open sandals to socks and closed shoes.
          I take the good days as I can.

  • FloxieHope

    I am so sorry to hear of the exasperation that you, and your patients, are experiencing in the medical system. As I recently saw in a FB meme, “The healthcare system involves neither health, nor care and it isn’t much of a system.” I appreciate you taking the time to acknowledge that and I hope that some change comes from your exasperation.

    I also hope that you, as a kind and compassionate person (you seem to be), are exasperated and disgusted by the damage that pharmaceuticals are doing to people. I was an incredibly healthy and active person until I took Cipro on my 32nd birthday. The following 20 months have involved an assault on my central, peripheral and autonomic nervous systems, as well as my connective tissues. More can be read about my story on my blog, floxiehope dot com. I am sure that if more doctors listened to their patients, pain like mine could be avoided.

    Or, perhaps, as you say, I don’t need a doctor, I need a lawyer.

    Thank you for your insightful post. It is excellent.

    • Kristy Sokoloski

      Have you seen the movie Escape Fire? I want to see it because I heard it was a pretty good movie. I am wanting to see it.

      • EE Smith

        It’s available to rent on iTunes, for $3.99 ($4.99 HD). I’ve queued it to watch this weekend!

      • LeoHolmMD

        Go to their website, there may be a screening near you in Sept.

    • Suzi Q 38

      if you need a lawyer, get one. If you wait to long, the statute of limitations runs out, depending on the state that you live.
      Make sure to have lots of money available, as these lawsuits are very expensive.
      I wish you good health from now on.

      • querywoman

        Ha! Suzi, you and I already discussed how a malpractice suit is almost an impossible dream.

        • Suzi Q 38

          You are so right.
          Yet the doctors complain about being sued “right and left.” It must be their particular state.
          In my state, it is tough.

  • sandyvc

    I think the problem is that in the US health care is a business. In most other developed nations it is a service. If you want to get rich as a doctor in Canada you have to move to the US. We have waiting lists but only when it is elective or not an emergency. The very idea that medicine is a place to get rich is anathema outside the US.

    • azmd

      The people getting rich in medicine these days are the executives for insurance companies, pharmaceutical companies, major shareholders of those companies, high-level hospital administrators and entrepreneurs who have left medical practice to open up medical-related businesses.

      Doctors can make good money by working inhuman hours, but that’s not the same as being rich.

      • Joe Williams

        Once again azmd, you say what I would have liked to say but you beat me to it with words I would not have found.

        • https://www.facebook.com/arobert6 Alice Robertson

          I believe you, but the Bureau of Labor statistics says the top earners are doctors. It’s a frustrating job but comparatively doctors are still doing well. It may not be the money maker some of your defrauding old colleagues made, but I think it’s a great career choice:
          1. Anesthesiologists $234,950
          2.Surgeons $231,550
          3.Obstetricians and Gynecologists $218,610
          4.Oral and Maxillofacial Surgeons $217,380
          5.Orthodontists $204,670
          6.Internists, Genera l$189,210
          7..Radiologists $184,650
          8.Pathologists $184,650
          9.Neurologists $184,650
          10.Allergists and Immunologists$184,650
          11.Urologists$184,650
          12.Preventive Medicine Physicians$184,650
          13.Ophthalmologists$184,650
          14.Hospitalists$184,650
          15.Physicians and Surgeons, All Other $184,650
          16.Sports Medicine Physicians $184,650
          17.Physical Medicine and Rehabilitation Physicians $184,650
          18.Nuclear Medicine Physicians $184,650
          19.Dermatologists $184,650
          20.Family and General Practitioners $177,330

          • Suzi Q 38

            While I agree that doctors get paid a lot, I think that they deserve it.
            This is why I get annoyed with the specialist that does not feel that h/she should return my phone call when it is important. I feel that the $350K or so a year should make up for the inconvenience.
            I don’t feel sorry for their lifestyle, but they have put in a lot of years and work long hours. They take huge risks and pay a huge personal price.
            Not to mention the student loans they have to repay.
            I suspect some of your salaries listed are low. In California, a radiologist is paid about double the amount above. Ditto for the neurologists, anesthesiologists, ob/gyn’s, pathologists, urologists, and surgeons.

            Maybe I am wrong.

          • https://www.facebook.com/arobert6 Alice Robertson

            Even when doctors had low student debt they complained. There is an old book from a very witty doctor that shares about his colleagues whining. If you ever see a copy grab it and have a good laugh. It’s called Kill As Few Patients As Possible. Which was the mantra he learned in med school while learning how to play a good game of golf….um and hang out at the mandatory country club! Ha! He really does talk that way. I shared it with a few of my younger doc friends who said they know it’s true, but gosh did he really have to be so out there, and they reminded me how things have changed. Indeed they have. I think younger doctors have a better vision of what they signed up for because some of the doctors who are over forty definitely feel this is not what they signed up for. Yet my one friend tells me he is broke while his wife tells all about their fantastic investments and how they use the interest they earn and hide money and he’s a lower end doctor (he posts here about the sorrows of his job). Sometimes I don’t know what or who to believe. Then you usually get a resident who will find this thread and it’s usually a gal or anonymous “Guest” complaining wildly that they are sick of people like me while all they are only making $40,000 a year……they are clueless that people reading that will consider them a spoiled child (I make $0 a year and that’s my choice).

          • Suzi Q 38

            You are so funny.
            Yes, I will grab the book, as I need a good laugh.

            With regard to your friend claiming to be broke and his wife claiming otherwise….spouses tend to brag a bit at times. The middle is closer to the truth, which means that they are probably doing fine.

            I like your posts.

          • https://www.facebook.com/arobert6 Alice Robertson

            That was so nice! Thank you! There is another older book but I had a procedure done and they gave me Fent and it was a bit too marvelous:) Trouble is I think it’s still in my system and need to flush it out because my brain is stuck. There are two books I wanted to give you the titles to. I think one is the older book that satirical and I think it’s called House of God. The other one is a touching novel about a female doctor who so desired to help others and to hell with the money. She was tired of mistreatment and apathy. She wrote a very touching book about finding the real way throw away patients needed treated and she found it (I think in New England?). Maybe someone else with a brain has the name. I am trying to finish the great book The Emperor of all Maladies because I deal with my daughter’s cancer and this book is all about that. It’s marvelous because of the sincerity of the author (something in the water in Boston with literary physicians like Gawanda, Groupman and this author. Residents at the Clinic talk about Boston like a Medical Mecca:) If I forget please remind me because I like to read caring physicians. It helps me trust them and when I was laying there with my bum in the air getting a Sacroiliac Joint Injection I was so vulnerable (obviously) but you realize the trust that is involved. I need to trust on a high level and despite the head doctor’s barking at the other doctors they were doing their job exceptionally well. Pain management gets some rough customers. They asked me where I get my cheerful disposition and I laughed. Gosh it’s a rough crowd for those doctors:)

          • Joe

            Alice, frankly I think YOU need to shut up and quit whining. You are so adamant and in need to prove your point. If it’s such a big deal, why didn’t YOU go to medical school? Then you could reap these rich rewards you insist we are all making. 12 years of school with no life. Several $100 in debt. Overhead to get started and keep going. Insurance, ongoing licensing requirements, continued time away from loved ones, reimbursements being cut to the point it costs as much or more just to process the claim as any reimbursement will be. Some of the specialties listed require extended residencies (10 years, in addition to 4 undergrad and 4 med school). Seriously, if you are not willing to put in the hard work, the long hours, and the uncountable sacrifices, you have no idea about what you are speaking.

          • disqus_z9d5lJX92l

            At least she’s not miserable, and doesn’t appear to hate her life. Unlike some here.

          • Joe

            LOL. I have the impression that she IS miserable! Putting a lot of effort into making her point about how unfair life is. Generally speaking, you get out what you put it :)

          • https://www.facebook.com/arobert6 Alice Robertson

            You have an axe to grind….keep grindin’ and being a denialist. It’s Friday ….go to the pub and have some fun with all that money you may be making.

          • Joe

            Well, obviously, Alice, you don’t know me, so whomever you THINK I am, you are incorrect. Please save yourself the anger and refrain from seeing me through this veil of someone you hold so much hate and anger for. I don’t drink. NEVER HAVE. I do not own an axe either; however, I suspect you may have a collection.

          • https://www.facebook.com/arobert6 Alice Robertson

            Ha! That was a cheeky joke…but you still consistently don’t get it. I would hate to depend on you for a diagnosis. I hope you don’t consistently miss your patients ailments amidst a strong dislike of humanity. There are anger managment sites I can refer you to:)

          • https://www.facebook.com/arobert6 Alice Robertson

            Oh yes one point I like to make is that I love our doctors. Some of them are exceptional. With a child with cancer it’s important we like our doctors and admire their sacrifice. Now you….wowwee….honestly you’re scary!”)

          • Joe

            Hmmm, you bust me for a made up name, then you admit that you yourself have not been transparent? Last I checked, Joe and any long form of that name are not remotely uncommon. So I am not who you thought I was. That is not my fault. Stop making assumptions. I really do not care what DLI published. Those are averages. That is not what ALL doctors make. Some make much more than those averages. Great for them. They have earned it. I have chosen to work with very low income demographics. I have also chosen not to play the insurance game. This means that much of the care I provide is gratis, written off. I happen to love what I do. I think it is important to give good care to everyone, despite their economic circumstances. I do take issue with folks who spend so much energy spouting off, when they have not put themselves through the same rigor. Knowing many doctors is not at all the same as being one, and by that, I mean being the type of person to sacrifice so much and work so hard. I still think you are unhappy in life.

          • https://www.facebook.com/arobert6 Alice Robertson

            What you want my life story and the names of the doctors I am friends with? Are you kidding? Someone who is anonymous comes here and with a made up name acts like an unprofessional jerk…takes every word as suspect…as literal…and then talks like they are a drop out with anger issues and you want taken seriously? My doctor friends will rarely post here because they are too busy (some are researchers who can communicate exceptionally well). They don’t believe in harming people emotionally or physically as you do. Honestly if you weren’t pulling such a hissy fit over your salary and begging for respect I wouldn’t believe you are a doctor.

          • Joe

            One last comment, because you are right, I am busy. I have not taken the time to read every comment on here, so perhaps I’ve missed some medical information that you shared. If so, my mistake. I am not having any kind of a ‘hissy fit’ as you put it about my salary or any other issue for that matter. I commented as I think it is important for folks to have the whole picture. The general public looks at the DLI dollars signs and screams, ‘OMG! My doctor is ripping me off!” The general public doesn’t grasp just what it takes in time, money and hard work invested. They do not grasp that out of this salary, you are taxed like everyone else, you are paying a house payment’s worth of student loan payments every month, etc. Neither am I begging for respect, or anything else, for that matter. Just sharing another aspect of reality. What does ring true consistently here are your rage, your disdain, and your assumptions about me. Like I said before, I sincerely wish for you to find happiness in life. If you think the flippant anger and rudeness you flail about here are happiness, you are sadly missing out on so much more in life. Further, you will notice that MOST FOLKS do not post full names on these sights. You would be wise to do the same thing. Take it or leave it, but if I had been the person you thought I was, and you pushed enough buttons…. Granted, I don’t know the Joe you thought I was, so I am guessing at a few things here, but by the way you keep addressing me, it leaves me concerned about who THAT guy is, and to be direct, people are just off their rockers these days, okay, so protect yourself. PLEASE.

          • https://www.facebook.com/arobert6 Alice Robertson

            Do you realize you just warned me about yourself?:) My rage about your salary? My husband makes more than you. I already shared about that earlier today.

          • Joe

            No, I was not warning you about myself. I think I was quite clear about that. Great that your husband makes more than me. I could not care less about what your husband makes. My point is that you should be careful to protect yourself. Period. Folks get too comfortable with the internet. And NO I don’t mean YOUR rage about my salary. I don’t believe you have any anger about that. As you stated before, you know what goes into it. I mean your rage in general. You have got to be the most angry person I have ever had any encounter with. With that, I again wish you well. I have work to get back to.

          • https://www.facebook.com/arobert6 Alice Robertson

            You work?:) Okay I’ll go with that!

          • Joe

            Finally, I don’t know what you mean about my wanting your doctors’ names. I made no such mention. As I said, I am glad that you like your doctors. The end.

          • Joe

            Also, I am glad that you love your doctors. Like all professions, some are good, some are great, some should find another profession. It is difficult to know if all of what you write is truth or hypothetical. If I gather correctly that you have a child with cancer, my heartfelt prayers are sent your way. It also makes your rage understandable. If not, why interject that comment? And somewhere in these comments you insult my diagnostic skills. You have never even met me, so how could you have such magical insights? Whatever is eating at you, I wish you well in resolving the issue, and I hope you eventually find peace and happiness in life.

          • https://www.facebook.com/arobert6 Alice Robertson

            I teach literature….I like words….I like dissemination…but if you knew me you would laugh at your analysis. I am soft spoken with a big sense of humor (from living in the UK…a sardonic humor). But you are entitled to your opinion but posting doctor’s salaries should never put a poster in this kind of firing range. Next time you want to rip someone up at least post under your real name. But thank you very much for your thoughts. My daughter was harmed by an ENT at Cleveland Clinic because he didn’t read the lab report (not once, but twice…and no I didn’t sue…and yes I felt like it. The slide didn’t have enough cells on it to test but a second opinion from a marvelous ENT saved her life). Because of the delay in treatment the cancer spread through her lymphs and we still deal with it (her spinal accessory nerve may need cut because of the location of the swollen lymphs we are heading back down for).

            Now if you want to see me as mad as hell at doctors go back about three years when I was posting here. Now…I embrace them….am grateful for them…extremely grateful…but not for one’s who post as your previous posts here are just because I posted your salary. Transparency is what your job is all about and your hissy fit only hurts your whole profession because it makes it look like you have something to hide.

            But, again…truly…thank you for your thoughts. I am grateful for the chance to express my own here.

          • Joe

            Oh geeze, I MUST reply one last time. THANK YOU for sharing this. I am truly sorry to hear about your daughter. That is awful. I hope she is soon to have a miraculous recovery. I have to believe in those things because (a) we are not able to answer everything with science, and (b) some days it is otherwise too difficult to see others suffering. Part of me is SADLY laughing right now, because in THIS post, I do see and hear your soft spoken and thoughtful nature. Until now, all I have heard is anger. I was not intending to rip you, I was attempting to put the other side out there. As YOU were not forthcoming, I did not know that you already know those things, and as I posted before, most of the public has no clue; however, I suspect you already know that as well. My name is Joe. If you don’t mind, I will be praying for your daughter and for your family. Have a good night.

          • https://www.facebook.com/arobert6 Alice Robertson

            Mind? If you can handle it I would cyber hug you! Wish you were not anonymous. And no for the record you never emailed me. Not sure where that came from. I imagine we amused a few people tonight:) Pleased to meet you Joe! Thank you!

          • Suzi Q 38

            It is nice to have a place for both parties to “vent.”

          • querywoman

            Joe, apparently you and Alice reached a modicum of peace. That’s good.
            I think you kneejerked a bit at first, but almost becoming friends is great! Some people never reach peace.

          • Suzi Q 38

            Alice just “tells it like it is.”
            I am glad to see that you understand a little more.
            What is this site for anyway, if not to give our honest opinions?
            The name “Joe” is better than using the name “guest.”

          • Suzi Q 38

            Your story about your daughter is so sad.
            I hope she is doing better.

            I have a very different story involving two of my doctors, but a bad outcome.

            It is sad that the unsuspecting patient could pick a highly ranked teaching hospital expecting the best care and get a couple of doctors that really don’t give a $#it.

            I am more careful now. The physicians know to be careful for themselves or their families when they get sick, but we regulars truly have no idea.

          • disqus_33eam3DSQz

            No I dont know that vague reference you are citing that and don’t plan on searching for it based on the zero details you gave me.

            We aren’t comparing wages to wages cause you are having your own private argument it seems comparing doc wages to others when everyone else is talking about the healthcare gdp and it is totally appropriate to compare take home pay for docs. I dont need to medical author from whatever irrelevant year cause I have a calculator.

            650k FTE practicing physicians (we leave residents out cause they make $8 an hour). Say 200k take home on average across the board after all the taxes are taken. Thats 130 billion and divide that by 2.7 trillion and you got 4.8%. These are rough but increasing the take home or number of FTE doesnt budge that number close to 20% which is BS or forbes 10% (corporate propaganda, please). One international article had it at 8% a few years ago but the GDP rose and it wast take home.

            Cutting the physicians salary doesnt give the auto worker his job back or increase someone else wages. I know people look to other people to blame or think that guy making more causes me to earn less, but you are looking at different industries and if they were the same not corporation is going to take one guys wages and increase another one. They put that in their pocket. And I dont give a crap about money, I am tired of people spouting off and obfuscating the issue. Why do I know your son has cancer? From reading 2 posts? People are trying to talk about this crap and you are like some munchausen case or by proxy coming to the internet with your sick kid rather than the ED. Respect other people trying to look at these issues and talkin out of your ass. This isnt about a docs salary, this undermines everybodys healthcare for the worse when profitability dictates treatment, research backing said treatment, tests, labs, insurance, yada yada. People are not getting treated properly to their detriment not because of a docs personal greed but because a corporation is governed by profit only and every aspect of healthcare is owned and operated by a corp. every form of labor suffers because of this: auto worker, doc, stripper. Its all labor to them and gets squeezed, but more than that physicians get turnsd into assmebly line workers where they no longer understand pathophysiology and treat people medically like they are going off a flow chart. Which is what they want, busy seeing lots of pts, ordering tests, writing rx, etc. That fuels the healthcare private interests, docs arent making out on this deal and like you can do youself can work for free and thats a whole 5% cut from the gdp

          • Suzi Q 38

            Alice is unable to respond right now, probably because she is sleeping. she will return later.

          • https://www.facebook.com/arobert6 Alice Robertson

            Yep! Suzi you seem like you are a really caring person and that’s a priceless quality. I mean that. You know there is a new book from an economist that shows that the countries that have such high poverty levels lack values. Like Africa they have rebels and rogues in government that hurt people. Or like Latin America dealing with slothfulness and even reps who are late for meetings proclaiming they needed a nap or whatever. I could go on and on, but we need to place an emphasis on virtues of honesty, responsibility, etc. and that starts with people like you who see that value. When that value is evident and clearly seen we then see true profitability, and so it is with doctors. The ones with experience and virtue probably don’t seek to defend their salaries, because they are living out the prototype that a patient’s heart so longs for in that relationship. It’s how we take the lessons in life, and then our knowledge the universities *can* place on the intellect and encapsulate them into something that is so valuable to mankind it’s appreciated in a way that words are almost inexpressable. There is a doctor of my daughter’s who became my friend and he would take her long hair and brush it to her back and look at her big scars then into her eyes and tell her she is a beautiful young woman. My eyes well up with tears when I think of his hands that were so caring and so skilled that he understood that she felt undesirable from the comments unwitting teens made about the scars (one of the funnier ones was a little fella at church who asked her, “When are you going to die?” It was on his mind so he asked…kids are cute that way). But that doctor is now the head of Plastic Surgery at UCSF and I have a forever type of love for this doctor (he knows all about it). He helped heal two hearts because he truly cared. Priceless…a virtue and long years of surrender to training produced someone everyone who knows him is impressed…even the billing lady said the moment she met him she knew he was, “Different from the other doctors.” He blessed me immeasurably and I miss him more than words than express.

          • Suzi Q 38

            Thank you, Alice.
            I had two physicians that were losers and dangerous for me.

            I had 6 others that were very good.

            The two that were really bad, I have complained to patient advocacy about. It is laughable that they give a $#it.

          • https://www.facebook.com/arobert6 Alice Robertson

            Yep, it’s about risk management and covering screw up doctor’s arse’s:) In general doctor’s personal code of ethics is protectionism about their own mistakes so they won’t rat on a colleague. They spend so much money and time getting to the point of making money they have a problem with anything (including a mistake with a patient) get in the way. It’s the driving force of medicine…money (as this thread surely showed). I live near a very good medical school, but the stories about arsehole med students abound. Most seem to come from upper income families or daddy is rich…..and they are bloody well boring to boot.

            Anyhoo……thank you Suzi! You are a gem. If you ever feel led please write to me privately and we can support each other (I just got a bad diagnosis and holy cow the misdiagnosises it took to get here are astounding) I am at: alicerobertson@ameritech.net

          • querywoman

            Over what period of time?

          • Suzi Q 38

            My treatment was about a year and a half.

          • Guest

            You need to learn to write in standard English. Doctors who can’t even communicate in basic standard English scare me.

          • https://www.facebook.com/arobert6 Alice Robertson

            Whoa! Slow down partner! Ha! This post is basically a type of “I am fed up” post, so it doesn’t encourage feedback nor communication. So I don’t know if you want me to go over all you shared or if you are just venting (I am leaning towards the ya da ya da verdict:) There are problems contained in your diatribe like not giving a crap about money then pleading your case…then your sharing about residents low hourly rate and leaving off the annual rate (elsewhere in this thread I think someone did share a bit more about this). Have you read the bestsellers by Dr. Atul Gawanda on residents and the pay/knowledge/experience scale? . If I am mistaken and you do want an exchange over what you shared I am willing to go there.

            You know what the bottomline is. The great docs are worth it plus more, and you know how they convince the public? By being what they were trained to be. That works in all professions. Good beauticians, mechanics, waitresses, on and on and on can broadcast their wages to their clients who will say they will come back and tip well because they feel the professional is “Worth it!” If doctors followed that line and just did a fine job your patients will figure you too are worth.

          • Joe

            I was making no joke. I was not being cheeky. I would love to know exactly which part of my comment you are referencing.

          • https://www.facebook.com/arobert6 Alice Robertson

            Well this is just downright stupid. Fine be anonymous and even make up a fake email and email me and I will bicker with you all you want…and at the end of the day your salary will still be the same as posted (or within range).

          • Joe

            I am seriously trying to end this conversation and end it politely. However, I must respond to this last comment. “Made up a fake name’” was ridiculous. Now you accuse me of making up a fake email and messaging you. Let me be VERY CLEAR: I have NOT (EVER) sent you an email, and I NEVER will send you an email. Please cease and desist with your badgering. I will respond no further.

          • querywoman

            You kept typing though you said you were trying to end it. Wow!

          • Suzi Q 38

            They shook hands and became friends later.

          • querywoman

            Yes, I made a similar comment about the two reaching a “modicum of peace.”

          • querywoman

            Maybe you need some alcohol. Or a huge vanilla milkshake!
            Joe, you read as angry to me. Alice has humor in her posts.

          • querywoman

            Bull hockey! Some people enjoy activism!

          • https://www.facebook.com/arobert6 Alice Robertson

            And after my last post I wish I knew you:)

          • https://www.facebook.com/arobert6 Alice Robertson

            LOL And you are just so filled joy and I’m not feelin’ the love! I am not going to shut up. But I’m thinkin’ I am bugging you with real facts that are bothersome. You may need to just deal with the fact that some people actually want the truth and you have just as much right to complain as anyone else. But you know what? I think I know you….

          • querywoman

            Joe, telling someone to shut up is mean. I do understand some of your points.
            But something I will never understand is how doctors with all the education can only do blood pressure and cholesterol screening and recommend cancer treatment.
            I’ve put a lot of hard work, long hours, sacrifice, and money into trying to manage chronic diseases. Why am I not being paid for having been a professional patient?
            Also, never forget that when you post this stuff about the expense and the training, many doctors live a lavish lifestyle.
            But there are other doctors who don’t buy eight bedroom, five bath homes, and $70,000 vehicles.

          • Ecnar

            Average cost of medical education is also in the 6 figures now, with many students ending up over $200,000 in dept. I teach at a midwest medical school and I see the huge dept students rack up every year. Would you like to make the equivalent of a house payment every month on your student loans? Every year, physicians pay is getting lowered. CEO’s of insurance companies are making millions at the same time. Then lets talk about malpractice insurance. An ob/gyn friend in town had her premiums raised to over $200,000 per year without a single case ever being files against her. Your right, doctors make average salaries above, we have to just so we can live from month to month try to give our families a little something.

          • https://www.facebook.com/arobert6 Alice Robertson

            Well you make about five times what your average patient makes, and that patient has bills and student loans. I have been paying student loans for about 15 years. And teachers will make less than a resident often with high student loans.

            Quite frankly if I were in charge the great doctors and teachers would make tons and tons of money. But that said the whining gets on our nerves because we mostly all have student debt for our kids or ourselves.

            My doctor friends are living exceptionally well and I applaud them. One just bought a $2 million house and another goes on fabulous vacations once a month (he’s an internist with bonuses from his ACO).

            It’s a wonderful career but when doctors whine so much amidst patients who are often on the edge of not having a car to drive next week, or because Obamacare has lost them ten hours a week of wages and their insurance they are going to scoff back at you.

            My husband chose a good career so we don’t struggle like most but we have a huge student debt load and six kids. My choices, my struggles and that’s really the bottomline. It’s just hard for the average patient to see that the medical profession is in the top tier of earning and still complaining.

          • Suzi Q 38

            My PCP lives is a very nice, but more modest neighborhood…..$700K or so….I don’t begrudge physicians or anyone else (like my mother) that luxury if they can afford it. Just don’t whine at the same time.

          • azmd

            You know, I just want to point out that you don’t often see doctors complain about their situation, because we’re socialized not to.

            However, we do feel that it’s important to speak out when we see people repeating the propaganda that is cleverly being disseminated by the insurance industry and by the government about how doctors’ compensation is driving the staggering costs of our healthcare system.

            That’s not a true statement, and I personally think that challenging it is important to do. It’s not whining, it’s an attempt to explain to everyone why it is that if we all jump on the “doctors are greedy and worthless, let’s micromanage them and punish them by making them do more work for less pay,” we will all be sorry 30 years down the road. Because by then, the profession will have been degraded to the point where our most bright and motivated kids won’t want to be doctors. When I am 80, I don’t want my doctors to be the people who weren’t smart enough to go to business school. But that’s where we are headed with all this doctor-bashing.

            I am a public employee so none of this really affects my own career. But because of people like you, I recently told my bright, humble and hard-working son, who would be a terrific doctor, that we would not pay for med school, although we are happy to help pay for any other graduate school.

          • https://www.facebook.com/arobert6 Alice Robertson

            Good on you that you can afford to pay for your son’s college.

            But you know what patients who are reading this wanna know? Why do doctors want the title of Suffering Saints?:) There are tons of people who would and will make great doctors. I do remember a thread here that was authored by an attorney challenging Kevin. The attorney wrote something about doctors being against malpractice suits until one of their family members are hurt by a doctor (their conviction suddenly changes). He said the thing is doctors are usually the first to weep on the witness stand. I’m sorry but it was a very funny analogy. When someone wondered why…. his answer was because they are coddled from youth. I didn’t agree with him, but thought about the stereotype your colleagues have created.

            I have lived with the single payer system I believe you desire? . Some patients feel the true threat is the government (I am in that camp) and some feel it’s doctor’s themselves . But it’s simply wonderful all sides can come here and rant. In yesteryear that wasn’t possible. So far things have changed for the better for patients, but I agree things may not keep going in a direction that isn’t desirable for anyone, but somehow I think doctors are going to keep on doing just fine. As you well know single payer systems are harmful to catastrophic care. I find it odd when doctor’s desire that system unless it’s a tendency towards their own paycheck? Because sadly that’s what all the whining here is about. The data…it’s what patients fight for and doctors avoid.

          • azmd

            My son is attending the state university on scholarship. The fact that we couldn’t afford to pay the fees at the private university he got into and wanted to attend is probably the biggest factor in my feeling emboldened to speak out about physician compensation. It was also a factor in my having encouraged him to choose a profession other than medicine.

            Again, no one is whining here. But when people make wrongheaded comments about greedy and overpaid doctors, I think something needs to be said.

          • https://www.facebook.com/arobert6 Alice Robertson

            Well that makes sense. My husband makes what an internist makes and I am grateful and we get
            all the remarks about income (it allowed me to quit my own bureaucratic job which was absolutely excellent as far as pay and benefits).. His salary is on that same list. I learned long ago one can protesth too much.

            This is for those who are fed up with me:) Yes I admit my posts may come off as snarky but I tend to stay in the game far too long because so many patients feel tread upon but refuse to go public with their opinions and frustrations. This board is important because it’s open to both patients and doctors, therefore, because I love words and communication because I have no dog in the fight I speak up. And my doctor friends have some very good howls at my dramatic antics via my writing. So I apologize if anyone is upset with me…it isn’t intended…it just seems like a fight for the truth with very different vantage points in the same arena.

          • Suzi Q 38

            It makes sense that your son goes to the state school, anyway. Quit bemoaning the fact that you could not afford the fancy, elite, snobby, private school. it is probably way too expensive per year compared with his scholarship at the state university.
            It makes perfect sense, and faced with the same predicament, physician parents or middle class parents, I wouldn’t have done it any other way.

            Our kids wanted to go to Columbia. They got in, but we sent them to in-state Berkeley instead.

            It just makes sense. It would have been even cheaper to send them to UC Irvine, or a Cal State school.

            We were able to pay for their undergrad cash, but told them that they were “on their own” for graduate school(s).

          • querywoman

            When it comes to law and medical schools, the public ones are the best and the hardest ones to enter. People want to end up owing lesser moeny.

          • Suzi Q 38

            Yes, I always thought a lot about the physicians that attended and graduated from our top public medical schools.

            I agree.

          • Suzi Q 38

            I know lawyers without jobs that are $200K in debt.

          • Joe

            Alice, do you have any clue the investment in time and money it takes to get to these positions? Student loans plus compounding interest. Overhead for an office. Also, their malpractice insurance is crazy expensive. The number of years of life they gave up to get there? Now, the raw numbers put them in a high tax bracket, but there is so much they are paying on.

          • https://www.facebook.com/arobert6 Alice Robertson

            Okay so Joe just made up this name (what so you could tell me off….how impressive to tell a real person off anonymously. What a class act!:) and you got your knickers in a twist and can’t read well. I travel in circles with doctors and am purposefully not transparent on that issue. I know about your investment and I know what others invested. Great! So you are all upset that the Dept. of Labor broadcast your annual salary and because I posted it well boo hoo hoo hoo. If you have a temper like that you probably chose the wrong career choice.

            If you are a doctor you are making good enough money to pay your loans. Now about getting a real life….hmmmm………that’s priceless but hey you can afford it!:)

          • Suzi Q 38

            At least you can afford the loans on your salaries.
            It still makes sense to become a physician if you are academically gifted and want to be a physician.
            Think of the nurses that want to attend Columbia for their MSN or NP. How much will they have to pay of their loans?

            How about the teacher that graduates from USC.
            What are h/her loans, and how much income does h/she have to pay off the $200K+ in loans for the 4-6 years of tuition plus living expenses???

            I could do the same for a lawyer (worse yet) and geologist.

            At least you are making enough money, provided that you haven’t overextended yourself on a huge home or cars, to pay the loans off faster.

            Physicians should pay them off at a furious pace, ASAP, to get them off their backs before they buy homes or their kids end up needing loans for college.

            At least they have choices with their salaries.

          • azmd

            I would like to point out that of the five specialties making >$200K on your list above, two of them are not medical specialties at all (orthdontists and oral surgeons are dentists, not MDs) and the rest are surgical and associated specialties, which means that people doing that work are routinely up all night working before a full day of work the following day.

            Can you name any other profession in which for the person’s entire career, they will work for 36 hours at a time on a weekly basis? The only other profession I can think of which has such grueling hours is investment banking, and those people typically make a minimum of $500K-$750K per year and frequently into the millions. The reason they don’t show up on the list above is because in finance, compensation is structured in the form of a relatively low salary, supplemented every year by a bonus which is a multiple of the salary.

            As for the rest of the list, all other specialties make less than $200K per year, which although it’s a reasonable income, does not, these days, allow one to comfortably put more than one child through college and graduate school while paying off one’s own substantial educational debt.

            However, I suppose we can keep on bashing doctors and throwing around numbers to show how well-paid they are and what great jobs they have and we can ignore the warnings coming increasingly loudly from medicine that it is a less and less attractive profession, and in 30 years we can all see what kind of doctors we end up with in our old age, I suspect that we will get what we pay for.

          • https://www.facebook.com/arobert6 Alice Robertson

            Who is bashing doctors? It’s just worrisome the way doctors want to whine, or justify, or even demean patients. It’s really worrisome to patients. It could be best if doctors go to the private boards they tend to like so much and whine because your colleagues make for much more interesting fodder.

          • azmd

            Saying that doctors are whining when they point out that many people in the healthcare industry are becoming quite rich, but most of them aren’t doctors, is not whining. It might be whining if we all went into medicine to become rich, but fortunately we didn’t.

            Also, not a single doctor here is demeaning patients in any conceivable way, in fact, the original post was entirely sympathetic to patients.

            And finally, I think you should know that you are currently in the physician section of KevinMD, so this is, in fact, the area of the blog which is intended for doctors to communicate with each other. If you find the communications here “worrisome” perhaps it would be more comfortable for you to concentrate on the Patient section of the blog.

          • https://www.facebook.com/arobert6 Alice Robertson

            Seriously? What can a poster say when it’s so blatantly obvious? At first I thought, “Is she kidding?” You know as well as I do this is a public board open to anyone, and that there are private doctor only boards for the doctors with no interest in patient’s opinions. They can post their bollocks without dealing with people with the audacity to post your salary, or who challenge, or wish you would just shut the hell up:)

            This is a general statement that uses a broad brush, but really? All of this shite from anonymous posters…hmm…..it’s probably better most patients don’t know what some doctors really think. Honestly, if some of my daughter’s doctors were trashing patients in the manner I have witnessed here under anonymity I would wonder if doctors are so hyper-sensitive they are fearful of disagreement…or does their very occupation create a type of “How dare you” thinking in a sub-set? It’s a curious and sort of dementing dilemma for patients.

            But ultimately we know that if a patient likes their doctor they aren’t likely to sue them, they will stick by them faithfully and enjoy a good relationship with them. But some doctor relationships are born out of necessity not desire on the patient’s part.

          • Suzi Q 38

            Some of the physician posters on this blog have truly been helpful. At least I know what they are thinking, good or bad.
            Before, I was so unsuspecting that I trusted them with my healthcare way too much.
            Now a doctor has to show me that he/she is a good and caring doctor before I trust h/her.

            I have realized that all doctors have varying degrees in attitude as well as clinical skills.

          • EmilyAnon

            “I think you should know that you are currently in the physician section of the blog which is intended for doctors to communicate with each other. ”

            But the post starts out with “Dear Patient”. That’s OK, you’re welcome here :-)

          • Dana

            #Zing.

          • Suzi Q 38

            I disagree. There are a few rude physicians that attempt to demean us. You just haven’t read the posts.
            I find it odd that physicians post on this type of board, yet do not want our true opinions.
            It is as if you only want the opinions that you want to hear.

          • querywoman

            I disagree that this blog, “is intended for doctors to communicate with each other.”
            I think Kevin Pho organizes his site into areas which mostly are about physicians, patients, policy, etc.

          • Suzi Q 38

            I know several people in investment banking and they do not make $500K-$750K a year. If you have found this to be true, please let me know where, so that I can get them to apply for a job there.

          • Elena

            Some people seem to be struggling so let me break it down for you…those salaries are not starting salaries that is what people are making once they hit the top of their career – you know – after 4 years of undergrad, 4 years of medical school, a potential 1 year of research, 3 years of residency (4 if you do a chief year) and then 1-3 years of fellowship….and that is just for the general internist, I won’t even get into other subspecialties. You are now $250,000 in debt from school. And those residency/fellowship years you are working 14-20 hour days, doing over night calls, working all holidays, with only 2 weeks vacation and 3 sick days. And guess how much you are making? About $40 – 70K depending on what city you are in. So lets go even deeper….assume that I am making $55K a year during my residency and I am working 16 hours a day for 348 days – that comes out to $9.87 per hour. (Federal minimum wage is $7.25.) Ok, so now I am at the top of my career and making that $150k a year and still I only get 2 weeks vacation and 3 sick days and I am for sure still working 16 hours per day (don’t forget those over night calls twice a week!) Now I make $26.93 per hour. Does that sound like too much money to pay for someone to listen to you complain about how you don’t take care of yourself and how, despite their every effort to “engage” you in your own care, you will still be noncompliant but find some way to blame it on the doc or to stay up all damn night and up date you on your dying loved one while they haven’t seen their own loved ones in weeks? Why don’t you tell me, if you were applying for that job, how much money per hour would you accept to be on your feet all day, never sleep, never eat, never see your family, still be able to pay off debt, rent, bills, and get no respect and be made to defend your career choice at every turn because people can’t seperate the actual people from the politics?

          • querywoman

            Where I live, I have known engineers and programmers who work those kind of hours for years. Their profession has no glamour.
            No, I am not saying their suffering is more or less than yours.
            I’d really like to see all professionals covered by hourly overtime laws, or something!
            The overwork madness in the upper middle class is horrible!

          • Suzi Q 38

            Thank you for your detailed explanation.
            I like your post because it gives us patients a glimpse into what your life was like before you started treating us patients after finishing school.

            I thought that residency was still a requirement to practice in the U.S. as a physician.
            Please educate me…is that the same work as an intern? If so, I would consider this is not a only a job, but a learning experience. In this country, it is sad that they pay so little. It is what it is, unless doctors change it.
            Fellowship….is that mandatory? I don’t think so, but many physicians make this leap and sacrifice in order to make more money during their career.
            This is an individual career choice for some.

            Are you a specialist only making $150K a year after your fellowship? If so, that is the unfortunate exception, rather than the norm.

            Can you find another job that pays more?

            You life sounds difficult at best. Frustrating.
            Time to take a deep breath and change it somehow. There are ways to make it better.

            As far as your patients, we sometimes are a lost cause, but some of us are responsive.

            I was nearing 190 pounds at 5’6″ and had borderline diabetes, HBP, high cholesterol and asthma. My doctor who is from another country had no social graces (his culture was very different and he probably was having a bad day)
            told me that I was “waaay to fat.” If I kept this weight up, I was going to die.
            I looked at him, and he was angry, he was not being funny or witty. He was sweating and gripping the BP cuff pump thingy like I had never seen him do before. It was as if he had transferred his anger at my non-compliance to that pump.

            Anyway, I told him that I would try to lose the weight. I worked hard at it, and I went to the gym. I monitored what I ate with “My fitness pal dot com.” I learned how to eat better, and notified my family that we were eating healthier.

            I lost about 40 pounds. My BP and cholesterol was much lower. My blood sugar levels improved. My asthma disappeared.

            I try to tell my obese relatives what the secret is, but they love their food and hate exercise.

            As far as all the other stuff, some people have no heart and don’t see their relatives. Why do you have to call them at night? Let them call you during business hours.

            If you are not seeing your family and want to, get a different job.

    • Trina

      But that has nothing to do with this post. In countries with socialized medicine, the doctor is still over-ruled by the payor, it’s just that the payor is the government and not an insurance company.

      A doctor might want his patient to get this or that drug; or to be referred to this or that specialist; or to be admitted to hospital for this or that; but if the government bureaucracy doesn’t agree, she won’t be allowed to. I have a friend working in Australia, and she wanted to see a gynaecologist for her pap smear and some other “female issues”, but her GP wasn’t able to write her a referral. There are also patients in the UK whose doctor might want them to have certain chemo drugs, but NICE has decided they’re not cost-effective enough for that particular patient in that particular stage of life.

      Rationing happens everywhere, because everywhere SOMEONE pays the healthcare bills, and that someone does not have unlimited $$.

      • querywoman

        Yeah. a pap smear is an example of something easy to get in the US because it is profitable.

        • Dana

          It’s easy to get in Australia too, but it’s your GP who does it. It’s your GP who does 99% of everything. You have to get special permission to be referred to a specialist, and there needs to be an actual medical reason why your GP can’t do what you’re wanting done. Maybe that’s how they keep costs down — and maybe that’s why GPs are still a highly respected and utilised group there.

          • querywoman

            Years ago, when Kaiser was in Texas, they did not refer me to a gynecologist for a menstruation disorder, nor did the family doc do a physical that included “down there.”
            No, it was a mental problem.

    • querywoman

      Everything is really a business. Nonprofits in the US turn over lots of money.

  • edpullenmd

    Unlike the stories above I most often find that the primary intent of the insurance blockades is to delay access to care so that payment is delayed, and to deny care to those unwilling to fight for it. Sometimes I cannot get the desired drug approved but most of the time a good alternative is available. It’s just the hassle factor

    • buzzkillerjsmith

      The insurance cos are arguing with the ump. You’ll lose but you’ll soften him up for the next time.

    • Trina

      Try getting a drug for your patient that is not on the NHS list (UK) or PBS list (Australia). It’s as much or more of a hassle than dealing with insurance companies here.

    • querywoman

      And to let insurance money sit in the bank and draw insurance.

  • Gibbon1

    One thing that comes across to me is that a bunch of the fighting over Obama care was between segments of the health insurance market.

    Employer based care seems great until you try ans get treatments approved, then you find the truth. They have two strategies for making money. First refuse to pay and hope the patient pays out of pocket in order to avoid having their credit rating dinged. This shows up as inexplicable denials of diagnostic tests, drugs, or doctor payment,

    If a patient develops a chronic or serious condition, then the strategy is to delay treatment and hope the patient loses their job and insurance. Any delay in paying saves them money.

    • Trina

      I agree that coupling health insurance to employment is ridiculous. We don’t expect our bosses to pay our car or home insurance, it shouldn’t be the norm that they pay for their employees’ health insurance either. Everyone should be buying their own policies out on the open market, with subsidies given to the poor to allow them to do the same.

  • Green Solution Collective

    Your a very good doctor and that’s all that matters. It’s thoughtful of you to apologize to those patients. But it’s really out of your hands when it comes to insurance. We all know you did your job. Thanks and more power.

  • guest

    Are these actual cases? It’s hard to believe that an insurance company or even the patient cannot afford generic omeprazole (prilosec) unless they are indigent.

    • EE Smith

      It’s true that generic omeprazole is very cheap, I get mine off Amazon. It’s interesting to see how the price plummeted after it stopped being “prescription only”. Once insurance, and thus “other peoples’ money”, stopped propping up the price, and there was some real competition introduced and a real price signal given, it came right down in price.

  • guest

    What is jaw dropping is how dialysis centers are booming (NYTimes yesterday front page) yet again according to the article, it matches the business needs–not the patients. An army of lobbyists have transcended Washington DC just as the recent laws were passed and ready to take effect. It looks like the same Congressman that passed the law to decrease Medicare expenditures are now working on undoing it.

    • querywoman

      Yes, and dialysis is routine and something doctors already know how to do.

  • https://www.facebook.com/arobert6 Alice Robertson

    The point you are making is good, but personally I don’t see how keeping this patient would be helpful to anyone other than the hospital. Why can’t you tell your patient to get OTC Prilosec like our doctors tell us (that’s why insurers deny coverage. But Medicaid patients particularly love scripts because it saves them from having to purchase the drug OTC with their own money instead of taxpayers paying for the script with no copay for them? Maybe that’s a bigger injustice than your examples?). I have a cracked pelvis and a hospital stay can’t help and neither can a lawyer. That’s a myth doctors like to perpetuate. Lawsuits are down, malpractice lawyers are often not taking on cases and if they win they are often aren’t paid (it’s the risk management of hospital systems that are paid to be vultures to protect doctors from people who pick up the mistakes you can often hide. It’s a job title I would never tell anyone if I worked for risk management. I would rather say I worked for the Mafia).

    It’s simply a reality, and the article left off bonuses your colleagues feed on (often at the patient’s expense and sometimes rightfully so. I am out thousands in insurance denials from cancer treatment and it’s a moonlighting doctor who does this from home at night). The ACO’s are doing really well keeping patients out of hospital and avoiding costly tests. And the doctors involved are enjoying higher income from their HMO mindsets.

    I tend to think your colleagues have found ways to moonlight and we really don’t know just how helpful or harmful it will be to the patients, we just know someone somewhere is making more money.

    Every denial or overtreatment has money to be gained or lost and a doctor behind it. If they save money they get bonuses, if they spend money they make less.

    You may be a pawn in the healthcare game but it’s a pawn your colleagues created.

  • Suzi Q 38

    Dr. Grumet,
    I KNOW it is not your fault.
    You have tried and therefore can only do so much.
    My PCP sometimes does not attempt to get the necessary tests I need because he thinks that my insurance will deny his request, and he is right.
    All I can do is ask you and other doctors to keep advocating for us.
    When the insurance company refused my doctor’s request for an MRI on my knee, I wanted to know WHO said “no.” I told the secretary that I had gone through 6 months of physical therapy. My right leg was swollen and sore. The CT scan and ultrasound ruled out a more sinister diagnosis.
    since I wanted the MRI first, why wasn’t that given? It would have saved a year of pain, physical therapy, and other unnecessary tests.

    I offered to call the insurance company myself, as I have done so several times in the past. There is nothing like the patient h/herself explaining what is needed and why h/she needs it. I answered every question they had, and I knew every answer.

    After speaking to me, they finally approved my MRI. The MRI showed quite a bit of mechanical damage, that could not be resolved with rest and/or PT. I needed arthoscopic surgery.

    If your patient is too old or too sick, there must be a family member that can help. If they still deny it, there is nothing else that can be done, other than the threat of obtaining a lawyer.

    I told one insurance company that I was getting the test done anyway, and if they refused to pay, I would take them to small claims or regular court (the MRI at the time for my left knee was about $1,100.00). I told them that I was going to experiment with all of this insurance BS.

    If nothing was wrong with my knee, they win. I would have to “eat” the $1,100.00. If stuff was wrong with my knee, I would not only sue for the $1,100.00 and probably get it back, but I would do something “lame” and ask for the pain and suffering that I had endured for 6 months or so. I truly doubted that I would be awarded any pain and suffering “pay.”

    I told them that I already had retained a lawyer for my FIL who was being denied in hospital rehabilitative care after his stroke, so to add my dilemma was not a big deal. I also told them that I would also ask for my lawyer’s fees, since, in my view, they were “denying me care.”

    The next think I knew, my MRI was approved.
    I also got FIL (72) a 6 week stay at a premier rehabilitative hospital when his stay was previously denied. I just pulled out the “lawyer card.”
    You have to mean it, though.

  • Trina

    There’s still rationing in socialized medicine, and doctors don’t always get what they want in the way of patient care. It’s just that it’s a government agent doing the turning down, instead of an insurance agent.

    • Dimitri Drekonja

      Sure, there is rationing in all health care. But dealing with a single-payer, vs. 1,500 separate private insurers, makes it a lot easier. Also, unlike places like my hometown UnitedHealth, the head of a public-option insurance program would not receive 30 million a year– all of which comes out of premiums. I’d rather not pay 1,500 CEOS, and presidents, and VPs, etc, all of which essentially duplicate their efforts.

      Finally– note that single-payer is not socialized medicine. Socialized medicine is government owned hospitals, staffed by government employees. Like the British NHS, or our VA. Single payer is a public mechanism whereby private hospitals, clinics, and providers are free to compete with one another and offer care however they please– but instead of sending bills to hundreds of different insurers, they just send the bills to one.

      • Trina

        “I’d rather not pay 1,500 CEOS, and presidents, and VPs, etc, all of which essentially duplicate their efforts.”

        Instead you’re happy to pay the >1.8 million NHS workers, bureaucrats and functionaries, fewer than half of whom have any medical qualifications? [And that's for a population much smaller than that of the US -- we'd need approximately 6 times as many].

        • Dimitri Drekonja

          We already have all of those– they just work for the 1500 private insurers. Eliminating the duplication would free up some of those workers to actually provide direct patient care. Currently, every doctor’s office (and hospital, anf rehab center, etc) has to have a staff capable of dealing with the innumerable different policies, forms, computer systems, etc, utilized by all of those companies. Thus the need for even more bureaucrats and intermediaries. It’s a lot simpler to bill one agency, under one set of rules, than it is to bill 1500, each with their own take on how their forms have to be filled out. Proof is in the pudding– we spend more than all other countries per capita, with most of the excess in administrative costs. And yet we do worse in almost all aspects of care.

          • querywoman

            Conservatives love privatizing services. In Texas, Lockheed Martin got their grubby fingers into the Texas Workforce Commission and botched it badly, and got terminated.
            Efforts to privatize Texas welfare also failed.
            The IRS has horrid problems with private contractors trashing returns, etc.

    • querywoman

      All medical anywhere is rationed. Plus, you get treated for illnesses with which doctors are familiar.
      There are many illnesses that have never received much attention.

  • guest

    somehow this turning into a discussion about the salaries of doctors rather than about the healthcare system rationing. I am not convinced that doctors salaries are the central problem here.

    In a way the more that we are spending on procedures, blockbuster meds and medical devices, the less there is for “mundane” primary care needs.

    There is a fixed amount of money. An example would be medicare. If the money is being used for stents or dialysis-whether medically necessary or not–care is rationed in other areas. The problem I see is that there is not a match of patients needs in either scenario. If there are lobbyists trying to fund dialysis centers than that is what is driving the success of the centers-not pt needs either.

    • https://www.facebook.com/arobert6 Alice Robertson

      Having a peripheral discussion is pertinent in healthcare where doctors salaries are 20% of the cost. I certainly wouldn’t suggest paying them less, but in context let’s say a doctor wants to buy a car and they start to complain about the salary of um maybe an auto worker. That salary is 10% of the cost of the car and those workers have taken bigtime cuts. So when what I consider naive or ambitious doctors recommend single payer or socialized medicine you have to wonder. If they are an internist or PCP they may very well make more money in that system, while other specialties will make less. That means catastrophic care is harmed while the more mundane is taken care of well. With all these anonymous posters it’s really hard to know who has an agenda to get paid more (or more regularly) and who has an agenda of actually helping the public get good catastrophic care.

      • Suzi Q 38

        Alice, I don’t listen much to the posters that use the name “guest.” There are far too many different people that use the “generic” name (guest). If they can’t even get creative and find a fake name to use consistently, I consider them “trolls” when they get too unreasonable.

        • https://www.facebook.com/arobert6 Alice Robertson

          Suzi thank you for taking the time to encourage me. I appreciate your words very much!

      • disqus_33eam3DSQz

        Uh 20% where did you get that horribly inflated number? Try more single digits like 5% if you count the taxes a physician pays as a wage worker vs capital gains. 6% maybe and less than any other industrialized country on physicians as a % of gdp. So no a peripheral discussion means nothing as doctors could be work for free and our healthcare gdp would be basically the same. So try again, whats your job? And the labor doesnt cost the healthcare industry as it earns its own wages and the wages and profits for the other 94% of the 2.6 trillion healthcare gdp pie. They disappear and no one is there to order the crap that gets everyone else paid
        People shouldnt be undermining and arguing for less wages for people who work for a living. How about the guy on wall st who does nothing but makes bank. Why dont you worry about his “wages”. I am moving to australia and not dealing with this BS, this place will just be crap docs

        • https://www.facebook.com/arobert6 Alice Robertson

          No you are wrong on the 5%. There is a literary medical doctor author and he wrote a good article on this site asking if lowering doctor’s salaries would help with healthcare. He had what facts he could find on it. It’s a good read. I, personally, don’t think it would help that much and once again I will say it in rote that I don’t want doctors to make less (I am sorely tempted to just write it a hundred times and post it for those who catch on later than most:) but there is much disagreement about this. I *think* the figure came from the excellent TIME magazine article with the accompanying front cover that lit up the internet. But 5% is a figure I have never read and I am a political/medical junkie. Sometimes the more doctors protest the more that comes out worthy of discussion and assessment. If you can’t find it I will look for it, but it’s out there. I just read it again this week. Admittedly Forbes only uses your take home pay and uses the 10% figure, but that’s not a fair analogy because we compare wages to wages and that means annual salary comparisons not what the doctor has to spend. The Forbes article tries to dispell what they consider a myth that doctors and all they do adds up to 80 of the spending in healthcare.

          There is an interesting article at the Wall Street Journal (one of my favorite reads). I won’t put the URL because it gets lost but the title is:

          The Experts: How Should Physician Pay Be Changed?

          I already said a few times on this board I gave up a lucrative career. It would be so helpful to the readers not to have to wade through the mucky mire of innuendo in an effort to prove a truthsayer wrong (it’s impossible if the reader has a critical eye).

          Who wants doctors to make less? Maybe some of the anonymous posters should change their names to, Dr. Sniffles!:) But keep on protesting because I have loads of energy and like debate.

          • https://www.facebook.com/arobert6 Alice Robertson

            Sorry Disqus I should have added something. In this thread I said I earn zero dollars annually, but I have student debt and six kids, but you specifically asked what I do for a job. I volunteer at a conservative think tank that is fighting against Obamacare. Then I volunteer in the inner city ghetto with my kids.

          • karen3

            And with doing that, you should be making huge bucks, because those are all very valuable activities.

          • Suzi Q 38

            I agree.

          • https://www.facebook.com/arobert6 Alice Robertson

            Hey thanks gals! But I gotta laugh that someone took the time to “Dislike” Suzi’s comment! See your only valuable if you went to med school and come online and torment naysayers! Ha!

          • Jason Simpson

            “Admittedly Forbes only uses your take home pay and uses the 10% figure, but that’s not a fair analogy because we compare wages to wages and that means annual salary comparisons not what the doctor has to spend”

            It is ABSOLUTELY a fair comparison. 20 percent of total healthcare spending goes to doctors, but only half of that actually goes into doctor’s pockets. The rest of it is spent on nursing salaries, clinic utilities, malpractice and other “overhead” costs.

          • https://www.facebook.com/arobert6 Alice Robertson

            Not if you read what I was saying. One can’t compare my annual gross salary to a doctor’s take home salary. That was my point. But there is data on the 20% figure and at least you made an effort.

            Now admittedly you made more sense than Doc Disqus:)

          • https://www.facebook.com/arobert6 Alice Robertson

            I was busy when I posted earlier but this is disingenuous. Are you actually trying to say that 20% goes to a doctor and he gets a bit of take home because he is paying all those bills from his 20%. Oh bollocks! Let’s start a movement to help these poor struggling doctors pay their bills!

        • morebuzzkills

          I will piggy back on this comment to help the readers. One must also consider the talent pool from which American physicians must be recruited. Assuming that most physicians are probably bright enough to also work on Wall Street, one could make the theoretical (notice the word theoretical) argument that American physicians are underpaid. Alice is correct that the 20% number does get thrown around in popular internet articles. However, one must always remember that there is more than meets the eye when it comes to numbers on the internet. Tampering with this number would not solve the cost crisis. Of this 20%, about half is absorbed by practice expenses (filing insurance for patients is incredibly expensive), malpractice premiums, etc. This number also EXCLUDES medical school and college debt. Let’s say we manage to cut physician salaries by 20%…GREAT! We have now reduced total health spending by an underwhelming 2%…and demoralized an entire workforce. That’s like pissing in the Atlantic Ocean and calling it a success.

          • karen3

            Most doctors are not bright enough to work on wall street. in fact, in the financial world, there is a term called a doctors and dentist deal — which is a scam that relies on self-perceived grandiosity to remove much money from said person. doctors and dentists are favorite victims of con artists because of the mismatch in perceived capability and actual capability.

            But even more so, just because you are smart enough to do something doesn’t mean that something has to be well paid. I would bet that the world’s top expert in long lost languages is pretty bright and also gets paid squadoosh.

            The real driver is economic value. When half of diagnosis are wrong, and medical harm is rife, that is a huge drag on the value equation.

          • querywoman

            Wall Street requires a different type of intellectual skill.
            Doctors are known for making lousy investments, etc.

          • morebuzzkills

            Most physicians are definitely intellectually capable of working on Wall Street. That doesn’t mean doctors make good investments…they are not trained in investing (also most people who are trained in investing don’t make good investments, but we’ll save that for another day). Furthermore, equating physicians with the world’s top expert in long lost languages is irrelevant. Lost languages involve soft skills, medicine involves technical skills.

            You’re definitely right that the medical field is not immune to harm or misdiagnoses…it does involve humans, after all. However, I would love to see where you found that half of all diagnosEs are wrong and that medical harm is “rife.” Have you ever had a broken bone, a heart attack, or perhaps you have had the misfortune of a chronic condition such as diabetes? I’m not sure whether the millions who have had these maladies befall them would agree with your subjective statement about the medical field.

            Finally, let’s also examine your statement about economic value. If economic value was the true driver, why did Wall Street investment bankers make tons of money during the crash of 2008? On the opposite end of the spectrum, why aren’t teachers the most well-paid professionals in our society. After all, they have the potential to add more economic value than perhaps any other profession. I think you’re sort of missing the economic value boat on this one, unfortunately.

          • https://www.facebook.com/arobert6 Alice Robertson

            Um…interesting name there!:) Walll Street isn’t about smarts it’s about risk. So physicians supposedly being smart enough is a bad analogy. Physicians are highly motivated and ambitious. It takes determination to get through med school. And some of them weren’t great students just great MCAT scores. I think under the right circumstances and with the right amount of money, etc. one can become a physician. But what we want is a way to select good and caring physicians. But the heart isn’t an atom…it’s intangible…same as our thoughts and intellect. So we all live and learn and are the better for it.

          • morebuzzkills

            I said most doctors are intellectually capable of working on Wall Street. I maintain this to be true. This is not saying that a doctor who has been practicing medicine for 20 years could walk on to Wall Street and become the next Warren Buffet. Both disciplines involve considerable training. Investment is about risk management. The best investors are the ones that best manage risk. Risk management is also essential in medicine. Almost every drug and every surgery performed involves considerable risk. Some of the best critical care docs are the ones who best manage and explain risk. You are correct that getting through medical school requires considerable discipline…but so does investing. You can further appreciate the similarities between the two disciplines when you employ some of the soft skills that user karen3 commented on: where do you think terms like ‘financial health’ and ‘ailing portfolio’ come from? It would be wonderful to always select good and caring physicians…but unfortunately there is an economic consideration that goes along with deciding to pursue medicine as a career. If that is taken away, the medical field will lose a lot of bright minds. As frustrating as it is, that’s just the way the world works.

          • https://www.facebook.com/arobert6 Alice Robertson

            And that makes you not only one of the more honest doctor posts on this thread, but one of the better thought through. You are willing to show both the bright and dark side of medicine… the reality of the rewards and sacrifices that not only you, but future patients will appreciate if you can stay away from curmudgeon mode.

            I don’t know….I hang out at Cleveland Clinic far more than I ever desired to (I was thrust into a medicinal labyrinth and continue on the cancer carousel and want off so very badly), but I have to say some of the doctors are simply outstanding while most are a bit ho hum and yet I am at one of the best institutions in the world where a residency is a nightmare to obtain (I think you have to score in something like the top 90% to get in there).

            Anyhoo…..just so ya’ know….you did well! Ha! (Not that you care, but still……….:)

          • morebuzzkills

            I don’t think this is who you think it is. I’m about half the age of buzzkiller and about 1/4 as bitter. Either way, thanks for the comments and best of luck with the cancer treatments. Cleveland Clinic is an excellent institution. Even the best institutions will have some medical professionals who are sub-par. Keep up your dedication to medicine/politics.

          • https://www.facebook.com/arobert6 Alice Robertson

            Ha ha! Oh no I hope he doesn’t see your response!

            But…No, I knew it wasn’t buzzkill because your writing styles are different. You are more forthcoming:) I teased him last week about how good he looks for his age because he has already said he has been in the game for close to 30 years (and he has the same blue gravitar you do:) Admittedly, you have a level head and will do well with your posts here. And kudos to you for staying in the game until the end of the thread. Few doctors do that. They like to open the door and yell in at the patients then carry on to the next thread as if nothing happened (they start out polite, get irritated and leave in the huffs). They only stay for as long as it feels good to them. So anyone who reads both of your posts will know the difference.

            Thank you for your encouragement (and giggle:)!

          • https://www.facebook.com/arobert6 Alice Robertson

            I missed this post but upon reading it I am leaning towards thinking you did a good job with it. By-the-way about your post about medical errors. Please Jason don’t consider this concrete, but as I stated I am medical/political junkie and I believe I read that the mistakes by doctors run at about 20% also but most are inane (I believe the NIH has a link to a page on how errors happen and, of course, doctors know all of what I am going to say because they use trump cards and choose doctors very wisely and get special treatment which I tend to think is exactly what I would do. No one takes lesser care on purpose if it’s life threatening). And the facts remain that even out of the thousands that are killed by medical errors each year even if a doctor kills a patient the risk of getting sued is not as high as doctors or insurers want us to think.

    • querywoman

      Money, whatever, there are no things like medical equipment being invented all the time. The patients want them, and the insurance companies want to hang onto money.

  • querywoman

    The only problem I have with this post is the title.
    Most doctors are lousy bureaucrats, and paperwork is not their specialty, but you can’t get patients to realize that. All insurance companies have appeal processes, but the patient seems to think you are the miracle worker.
    The patient should go to a public or church hospital with a social worker.
    I no longer need this kind of help, but I have a BA in English and was a long time government worker.
    I used to write my own letters for stuff like reasonable accommodations or employment-related work needs, then the doctors would put it on their stationery.

    • https://www.facebook.com/arobert6 Alice Robertson

      This is good advice with one more to add….be patient if you go but if you wait it out your time is well compensated. We know someone who waited four hours but got $1000 bill completely wrote off. He was ecstatic and said that equaled $250 an hour for his wait.

      • querywoman

        It’s not that hard to get write offs. Regardless of what charges are, there’s only a little amount of money most people can pay.
        Like, I’m not sure the recent increase in interest on student loans will actually make monthly loan payments go up and increase the funds going into the federal kitty.

        • meyati

          @querywoman-I’m an English major that taught math. No the monthly student loan payments do not go up because of increased interest. Less money is applied toward the principle, so the former student has to make many more payments.
          The extra interest money will go into the federal kitty, while the former student pays and pays. It’s sort of like buying a car or a house, you don’t expect the interest rates to go up on you. I know there is a difference as a student loan interest rate isn’t finalized until the exit counseling at graduation, where a mortgage or vehicle purchase is finalized before you get the keys. I owe $45,000, pay extra, am ahead on payments-told each month that I owe a different amount for the monthly payment. One month I’m told I owe $300 for the minimum payment, the next month I owe $150. I pay what I pay-I have been contacted that I do not need to pay more or as much as I do. I still pay what I pay. I ask them if it is illegal to pay more than the minimum amount. Sallie Mae was paid off early. Now I just have AES-I sign every petition that I can about student loans.

          • querywoman

            I have a BA in English, and I couldn’t get any student aid. I do have a year of grad school, and a loan for that. I’m on disability, and could take a disability forgiveness, but I don’t want one.
            That would make it hard to get another loan.
            I ran out of my deferments and for forbearances, so now I am in an Income Based Deferment plan. My current payment is ZERO.
            In a few years, I’ll start drawing a government pensions as well as my SS. Then I might have a student loan payment of $45 to $60 month. No problem!
            Then, 25 years after I took out the loan, the lender could issue me a statement for forgiven debt, which is taxable. I’ve worked for the IRS. I can work out a payment plan, if I do that.
            Or, I can take six semesters hours in fall or spring, just one term, and three semesters in summer at a community college, and basically defer my student loan forever.
            The people who get in trouble over student loans have had umpteen warnings and letters.

  • disqus_33eam3DSQz

    EHR will tapped by all the corporations who currently cause our healthcare costs to balloon: pharm, med devices, insurance, drug delivery etc

    They used to have to buy doc rx habits from pharmacies but now they can get it for free in the context of a more complete patient scenario, insurance with this info can make or break themselves, etc etc

    Early info is what drives the speculation of our stock market. This info will allow lawmakers to better avoid paying out for the social services we paid in for.

    They stole you cell phone data, you think for a second that this crap wont be on an NSA server they were saving especially for this? Dont be a sucker, hippa means dick to them when the spy domestically allowed by our president for terrorist nonsense

    Companies can market more directly and effectively their treatment products to patients and docs. They see the health conditions of a community they can walk sell their BS

    And the hospital corporation now owning the private office for referrals is the very argument that would not allow physicians to unionize because of self referrals and price fixing.

    They have literally made an assembly line for peoples disease. Outpatient to hospital to rehab/nursing.

    I’m more worried about data elements being manipulated like labs and vitals falsely to give reason to admit a healthy person who gets tx they dont need, gets sick because, to the nursing home and dead in 6 months for nothing.

    There are so many ways you can sway things slightly to make a buck in it, keep a patiet longer if his insruance is paying or kick them out when they stop paying. Wow better labs and vitals, encouraging to discharge

    This isnt out of the realm, I mean our goverment uses bombs on people. They dont care people lost their no home. They allow 80% of world weapons to be made in the us

  • karen3

    Jason, a lawyer would not do better. We are still trying to get payment for my mother’s motorized wheelchair — paralyzed to T5, body wracked with rheumatoid arthritis. The hospital who killed her, while using her as a billing cow to the tune of nearly a million dollars, found by Medicare to have provided care that did not meet minimum professional standards — paid in full with not a quibble. The persons who made those decisions. Marilynn Tavenner and Patrick Conway. Personally.

    • Suzi Q 38

      I am so sorry for your loss, Karen 3.
      I am finding out that if you have a PPO insurance card, you could be at the end stages of pancreatic cancer with mets, and the doctors would encourage you to fight. They then would send all sorts of specialists out to see your loved one and charge the insurance companies all they want. Sad but true.

      It happened to our family too.

  • Suzi Q 38

    I am not sure that I want to go back for catastrophic hospital stays. Without the insurance negotiating the price for our hospital stay, the total price would triple. Most families would go bankrupt.

    • Dimitri Drekonja

      Since the US is the only country where medical bills are a major cause of bankruptcy, and the only country without universal coverage (hmm, what a coincidence), you’d have little to worry about. Medicare does not have any trouble negotiating rates as good as, or better, than private insurers

      • querywoman

        How does Medicare negotiate rates? Don’t they just say, “This is what you are getting for X procedure?” It’s always more than most patients could pay on their own.

        • Dimitri Drekonja

          They do what every other payer does– negotiate rates on what they will pay. They just can do it much better, since they are large and all hospitals/docs want their business– even though they negotiate lower rates than private insurers.

          • querywoman

            I discussed insurance bargaining with a therapist once. He said there’s no bargaining; it’s just take this rate or not.
            Who does get to bargain with the insurance companies?
            Many mysteries!

      • Suzi Q 38

        Good for Medicare. Unfortunately, I am not old enough for Medicare.

        • Dimitri Drekonja

          Another way many describe single-payer is “Medicare for all”– so if adopted, you wouldn’t have to wait for age 65.

          • https://www.facebook.com/arobert6 Alice Robertson

            And another way to describe is to die waiting.

          • Suzi Q 38

            Thank you for your explanation.

          • Jess

            Um, who’s going to pay for it? Medicare as it is is already almost insolvent.

  • elizabeth52

    This may be partly the result of “over-everything” in the system, unnecessary routine exams, over-screening, over-treating, over-diagnosis. The health system is full of the worried well, many of them coerced into the system, and day procedure and surgery full of perfectly healthy people dragged in by screening. (often inappropriate screening)

    If we followed the evidence and respected informed consent, we’d have more resources for those genuinely in need.

    Here in Australia we spend a huge amount on cervical screening, a rare cancer, which was always rare, by the way, and in natural decline before testing even started. We’ve also, ignored the evidence over decades and seriously over-screened, leading to enormous over-treatment rates.

    Now that means lots of women with damage to the cervix, more premature babies, more c-sections, high risk pregnancy/cervical cerclage…and the vicious and expensive cycle continues.

    Compare that to resources that go into the prevention of heart disease, the No. 1 killer for both sexes, and the crickets are chirping. Our priorities are skewed by politics, the pursuit of profits and by powerful pressure/lobby groups, often well-meaning, but often unaware of the evidence or influenced/funded by those with a commercial interest in screening.

    The States is now attempting to pull back on serious over-screening, that’s a good thing, but when people (especially women) have been led to believe their ovaries will explode without an annual rummage-around, it will be hard to convince them that less is better and in my opinion, no screening at all is often even better. I’ve declined breast and cervical screening, both informed decisions, and the hugely profitable annual well-woman exam for symptom-free women is not recommended here at any age. It’s of poor clinical value and far more likely to harm you, even lead to unnecessary surgery.

    American women have poorer outcomes despite these exams, more than twice the number of hysterectomies and oophorectomies and an intact never-treated cervix must be a rare thing in the States. (with annual testing from a very early age common until fairly recently, including the madness of testing those who’ve never been sexually active) It’s fairly rare here as well, most women my age (55) have had something “done” to their cervix and of course, some think they were saved, when almost all were simply over-treated.

    Breast screening is a concern as well, millions spent here too, powerful vested/commercial and political interests, (the pink ribbon juggernaut) yet the evidence is concerning. The Nordic Cochrane Institute, an independent medical research group, say about 50% of screen detected breast cancers are over-diagnosed and any benefit of screening is wiped out by those who die from lung cancer and heart attacks after treatments, so the risks exceed any benefit. The fall in the death rate is mostly about better treatments, not screening.
    So women need to take a close look at the evidence, thankfully, the NCI have produced an excellent summary of all of the evidence. (go to their website)

    It’s great more doctors are speaking up and challenging the more-of-everything and keep-it-coming brand of medicine.

    BUT, when you’ve been scaring people and telling whoppers for decades, it’s not easy to turn around, everyone shouts cost-cutting.
    I’m reminded of my female ancestors who didn’t have pap tests, mammograms, routine breast or pelvic exams and lived into their 80s and 90s, long, active and healthy lives and they only saw the family doctor for persistent and unusual symptoms.

    I think we have to get back to basics and ONLY add on the things that “actually” help us.

    • querywoman

      I thought Australian women were less likely to be coerced into paps and mammograms. In the US, women get a hard sell on these tests constantly.

      • elizabeth52

        Hi querywoman,

        Actual coercion stopped here about 15 years ago, it would be a foolish doctor who declined a woman the Pill because she refused a pap test. The doctor could find s/he ends up at the Medical Board.

        Screening though is never presented as a choice, something we can reasonably refuse, and there is no respect for informed consent. Balanced information is not provided to women, we’re just told we must or should screen. No mention is made that cervix cancer is rare and was always rare, that false positives and potentially harmful over-treatment/excess biopsies are common, made worse by serious over-screening.

        We also, don’t get honest information on the significance of HPV, currently HPV testing is only used to test women “after” treatments. (most is over-treatment) Of course, if protecting all women was the goal, we’d offer HPV PRIMARY testing (and HPV self-testing) and only offer pap tests to those aged 30 to 60 who are HPV+

        (The HPV test should stand alone as the primary test and not added to pap testing, which happens in the States, that just creates the most over-investigation)

        This would save more lives and take most women out of pap testing and harms way, over-treatment rates would plummet.

        Many in this country would not welcome that though, the huge profits made from excess have IMO, kept our program unchanged for decades, we’ve steadfastly ignored the evidence and better options for testing.

        I can’t see that changing, no-one challenges this program, our medical leaders and medical associations are silent on the subject. Most women have no clue they’re seriously over-screening or screening unnecessarily (they’d be HPV-) and that’s why so many women end up in day procedure. (and why we have so many “saved” women, when almost all have simply been over-treated)

        Our doctors also, get target payments for pap testing, for screening 70% of eligible patients. This potential conflict of interest is never mentioned to women. Attitudes and practices vary doctor to doctor, practice to practice, so it’s possible to doctor shop and find someone who’ll respect your screening decisions.

        So the situation here is not as bad as the States, but it’s not good either. I see non-evidence based screening (and the lack of respect for informed consent/consent) as great threats to our health and well-being.

        • querywoman

          I have only had a few Paps in the past 10 or 15 years. No mammogram. I have questioned Paps and mammograms for years.
          In the past year, I started researching and discovered the public is starting to question American docs for doing too many.
          The US government helps push mammograms; I’ve seen it.
          If Australia is like the US, heart disease is the main killer of women (and men,) and often overlooked in women. It is a genetic hereditary disease, not necessarily connected with diet, and most of us, if we live long enough, will die of heart problems.
          Lung cancer is the cancer that kills the most American women. Its incidence is also rapidly increasing in nonsmokers.
          Many American women’s mags get a lot of cigarette ads.

          • elizabeth52

            How did you manage that, querywoman?
            I have American colleagues who avoid US doctors and pick up the Pill in Hong Kong with just a blood pressure test. (the only clinical requirement, plus your medical history)

            They’ve given up on US doctors and consider women’s healthcare dangerous and driven by profits.

            I also, have many online American friends and some have been sacked by their doctors because they refuse screening or don’t want as much, (annual pap tests, for example) others haven’t seen a doctor for years because of the way women are treated in the consult room.

            It makes me despair, women “managing” their asthma or diabetes because of this absurd pressure to have completely unnecessary and unhelpful routine breast and pelvic exams or unwanted pap testing. If they were so concerned about one rare cancer, then they could simply offer HPV primary testing, almost all women are HPV- and not at risk. We don’t do that though, we go about screening to maximize risk and profits.
            This is not good for women’s health.

            I also, feel the tide is turning, more so in the States, UK and Europe, we’re slow to the awakening, but it’s starting. I think US women will see the Pill off script before we do…it’s been used to force women into harmful excess which, in my opinion, is unethical and perhaps, even culpable.
            Heart disease is the No. 1 killer of men and women here, yet we don’t hear much about it. Cervical and breast cancer are the pin-up cancers, they have the loudest lobby groups and of course, both programs are loaded with vested and political interests.

            Not many doctors ask us about heart disease, but rarely miss an opportunity to waste consult time on unwanted pap tests and mammograms.

            I’ve mentioned elsewhere on this forum, but this warped focus gives women a false impression, like the woman who proudly told me she never missed a pap test as she lit up another cigarette. A heavy smoker, but she believes cervical cancer is the greatest threat to her life (why wouldn’t see we hear about little else?)…little did she know lung cancer is a much more likely threat to her life. I think it’s bad medicine to peddle misinformation IMO, simply to create a great business model.
            I rejected pap tests over 30 years ago and more recently declined breast screening. I think more and more women are starting to see holes in the screening “story” and now see screening as a choice, not a mandate or law. As fewer women turn up for these tests or set their own screening agenda, we’ll see things change, I think it’ll be the catalyst for change. Controlling women has always been a priority to funnel us into screening and excess, that’s finally starting to unravel…a very positive thing.

          • https://www.facebook.com/arobert6 Alice Robertson

            Elizabeth? I am curious what country you live in? Querywoman is right that the guidelines changed for women with a clear test to every five years instead of the old standard of three years. I remember years ago on Larry King two cancer specialists said if we could ban cigarettes we could close something like a third of the hospitals. Well smoking is down and business is up so it was more than just cigarettes, and plus that patients tend to like tests. We lean on horror stories for our preventative medicine instead of taking care of ourselves and depriving ourselves of feel goodness:) Yet, some like my daughter get cancer from xray equipment. Nothing is ironclad and life isn’t fair. We have over-relied on medicine to save us. But gosh it’s hard to find the truth in medicine.

          • querywoman

            And lung cancer increases all the time, in nonsmokers, and moreso in women than men!

          • elizabeth52

            Hi Alice,
            I’m Australian, our program is for sexually active women and calls for 2 yearly testing from 18 to age 70.

            It’s bad medical advice that sends huge numbers into day procedure for excess biopsies and over-treatment. No one talks about that ugly fact and there is very little research into the harms of over-treatment. These programs and the Government tend not to fund anything that might put women off screening.

            Our program is finally under review, but in my opinion, it’s been an exercise in stalling, the evidence has been clear for decades, why do we need another couple of years to consider the evidence?
            It’s great America has wound back it’s screening recommendations, but I understand that many women still face pressure and coercion in the consult room to not only screen, but over-screen. Some of your doctors are still pushing annual testing and still insist on annual routine pelvic and breast exams. Thankfully, the latter are not recommended here, I’d have refused them anyway. It also, seems harder to change your doctor, we can doctor-shop.

            I think many women are manipulated and misled into testing. We have a new program here using celebrities to get women into breast screening. I don’t take medical advice from celebrities, I act on my assessment of the evidence and my risk profile. They’ve asked women to, “Give a Reason” online why they screen”, “hashtag your loved ones if they’re the reason you screen”…all designed to pressure women into testing.
            It would never occur to them to give women the evidence (the NCI summary) and allow us to make our own informed decision, that would never do. The program must be protected, not women.
            I couldn’t agree more…we do lean on horror or survivor stories and neglect our overall health, lulled into a false sense of security.

            I actually went to a conference on evidence based medicine this year. It’s the easiest way to speak to doctors who are equally concerned about screening, over-diagnosis, over-treatment etc. It was an eye-opener and one of the best decisions I made for my future health.

            So sorry to hear about your daughter.
            I hear that some US women are getting small breast cancers, some suspect it’s because they’ve been horribly over-screened for breast cancer, having annual or 2 yearly mammograms from their mid 30′s or so. That’s a lot of radiation and compression of delicate breast tissue.
            It is hard to find the truth/evidence, but it’s definitely worth our time to look for it.
            Your Dr Gilbert Welch is one to watch, his books are very informative.

          • https://www.facebook.com/arobert6 Alice Robertson

            You know I think I may have asked you that before. Honestly I think since I had anesthetic a week ago my mind isn’t working well. Or maybe that’s just an excuse?:) With my daughter I was sitting in a Starbucks and we thought we saw someone we knew walking outside the store. We all turned and I looked with horror as I saw what looking like a marble growing out of her neck. I took her right in to an internist who said she found nothing. Refused to order an ultrasound. I bickered so much with her I decided to get another doctor involved. Finally she says she will order the ultrasound but if she were a betting man she would be they won’t find anything. It was found within a minute and I was told to get a biopsy. The ENT screwed up the biopsy and it arrived at the lab too dry to be biopsied. But the ENT didn’t read the labnotes so he dolt me, “Great new…no malignacies!” I was thrilled and he told u s to come back in six months. At the six month mark the tech pulled me aside and said I needed a new doctor. Huh? That’s all she said. I realized she saw something. I go back to the ENT and again he says I am an over reactive mom and to come back in a year. I went to the second doctor who did the biopsy right. Said it was cancer and had the lab notes in his hand that the first doctor never read. Pretty devastating new…we lost eight months which caused a spread. I tell this story often because I realize we are test crazy here in the states and the doctor was trying to teach me to not be over-reactive, but when you are certain you have seen something keep at it. It’s vital. So this is one of the horror stories people hate to hear. While I agree we are sorta radiating ourselves with CT scans, and too many ma mamograms, etc. if you feel something stick with it and most importantly get a copy of your tests. I was so sure the ENT had actually read the lab report I didn’t order a copy. Who could have known he would disregard reading the lab notes twice? It was actually his medical assistant who was reading the notes and he would ask her before he went into a patient’s room. He refused to use EMR’s and Cleveland Clinic leaves it up to the doctor to choose whether or not they will upload anything electronic. I hope that changes soon because most doctors do use them. It’s a nice feature and I realize many doctors really dislike them. Personally I think we should have Open Notes where we not only see the hard notes from lab reports, but the doctor’s notes about their thoughts about the exams and us. They are paid to do just that, and I feel certain doctors would want the notes of insurance adjusters, mechanics, architects, etc. who work for them.

            Do you have a type of Open Notes in Australis. In the UK the doctors use the EMR’s but the notes belong to the government and patients don’t have the access we do here. The government says you do, then you talk to patients and lawyers who say even going to court won’t assure your viewing your records.

          • elizabeth52

            Hi Alice,
            That’s so true, we know our bodies best, if we feel something isn’t right, pursue it, it might just save your life. I’m so sorry to hear about your daughter, it’s unbelievable those mistakes were made, no doubt making the treatment more difficult, given there was spread. I hope she’s okay now. You hear that sort of thing too often, there was a high profile case here, a child was given the all clear when he had cancer. The hospital changed the system after that tragedy, but all a bit late for that young patient.

            I agree that radiation over time can cause issues, that’s my belief anyway. It’s concerning that some women start having mammograms early and every year, by the time they’re 70 or 75, that’s a lot of radiation.

            The restrictions are frustrating, I was quizzed when I wanted cold and flu capsules last year, they’re kept behind the counter now (this was in Queensland) because some people are misusing the medication. I can understand tightening access, but not to the point where people with a real issue can’t get to it easily.

            I hope you find some pain relief and sorry to hear about your health issues. I guess that’s another of my concerns, if we didn’t waste so much money on well people, looking for problems, we’d have more to look after those who are actually sick or with a real health issue.

          • https://www.facebook.com/arobert6 Alice Robertson

            Oh yes, I wanted to add at the cancer symposium they emphasized strongly to wear a collar around your neck not only during dental xrays but mammograms. So I go for the mammogram and they say they don’t want you to wear the collar and discourage the use of them (it’s at Cleveland Clinic) but if I get another mammogram I will wear it. The truth is I struggle with the mammogram, but my mom’s breast cancer in her fifties was spotted on a mammogram and I am in my fifties. I worry that one day I will very much regret getting the mammograms as much as I regret the older xray equipment that gave my daughter cancer (I had no idea our orthodontist had a machine over 20 years old. I understand after about ten years the machines can leak and are not as safe).

          • querywoman

            The medical profession will always say that a mammogram, or any other Xray. has too low radiation to cause cancer.

          • https://www.facebook.com/arobert6 Alice Robertson

            Yeah well I remember reading that a little radiation isn’t harmful and that it’s even safe in fish. Well if that’s the case those doctors can meet me at the Nuclear Bar and we can share an Atomic Cocktail (a small one:) for good measure. *wink*

          • querywoman

            Throw in Ann Coulter, JD, who didn’t think radiation was all that bad after a recent Japanese disaster.

          • https://www.facebook.com/arobert6 Alice Robertson

            Wasn’t that something? I posted on her boards inviting her to the Nuclear Bar for that Atomic Cocktail but she didn’t show up. Wonder where she is getting her atomic fix she promoted?:)

          • Guest

            Maybe she’s flying in an airplane (very high background radiation exposure) to Colorado (two to three times the background radiation of other states).

          • querywoman

            Gee, Alice you have a lot of nerve. I’m getting off topic here, but Ann looks like a slut in her black dresses on that skinny bottom with her peroxided hair and wearing her cross. I’ve heard her talk on TV, and I seldom watch TV, about her black dresses. Bimbo!
            She’s a lawyer???
            She’s had a steady stream of public boyfriends too, and I really don’t believe she practices Christian abstinence with them!

          • John H.

            Ladies, this isn’t Facebook. M’kay?

          • querywoman

            Forgive me, John. I said I was getting off topic.

          • https://www.facebook.com/arobert6 Alice Robertson

            John must actually believe these boards are only for the serious types;) They are discussion boards and Disqus encourages just that. Radiation is a medical issue, so I can’t “M’kay” back at this point without knowing what future posts may contain. Although he was polite and I am very grateful for that. If it’s boring (and tons of posts are) we can delete and move on or just hit the “Dislike” that so many people on Disqus hit because it somehow makes them feel so much better (another medical issue. Wanna discuss narcissists, egotists, or anonymous sociopaths?) Ha!

            By-the-way I don’t know what I did that was nervy but it’s perfectly possibly. Ann Coulter is a bossy broad, but she’s smart whether she is immoral or not is something she can take up with God. But she did give up cigarettes…another medical topic:)

          • Guest

            Tell me again how many thousands of people died from radiation poisoning due to Fukushima? Oh, wait. It was zero.

          • https://www.facebook.com/arobert6 Alice Robertson

            If so then do you want to meet me for that small Atomic Cocktail? My daughter drank one to heal her cancer (the cancer that was caused by a nominal xray she got so she could get braces). The radiation didn’t work (we were told it had a 95% cure rate) and her cancer spread. So forgive me if I suffer radiation paranoia and disdain for those who pooh pooh it out of ignorance. You should read TIME magazine this week about the importance of water in a nuclear plant and what is spreading to their drinking water in the exact location you mention. Cancer from radiation takes awhile to show up. What do you think they walk out of the water surrounding that plant glowing? And then you can read what the 20 year mark does to a person who was radiated. My son is almost deaf from more useless bean radiation. So let’s see if some radiation can eradicate your smugness.

          • https://www.facebook.com/arobert6 Alice Robertson

            Thanks! I read something I haven’t verified but it said one CT scan would be like being 1.5 miles away from the target of an atomic bomb. The residual effect would still enter your body but you wouldn’t realize it (maybe even feel fortunate you escaped the bomb). But it builds up. It was a discussion about what happens when a nuclear plant is hit and what happens with all that radiation and how many years it takes to show the invisible harm. Pretty scary stuff after going through radiation caused cancer in your child. But it’s good the public is more informed, they just need to understand symptoms better. I just had two MRI’s and I really thought a lot about it (they did find three growths so at least I know why my sciatica nerve hurts…there is a growth on it). It took a year of pleading about pain to get the tests (an xray clued them in). I understand why they waited but it has been a painful year, and yet, until I am incontinent they won’t remove it so really….knowing about the cysts on my spine isn’t all that helpful to the pain it’s causing (just epidural cortisone shots that are temporal). Nothing seems concrete to me but thinking that nesson doctors and patients parts can be both helpful and harmful. Actually all that does seem concrete is my constant pain and now in my state of Ohio good luck getting pain pills. Because a tiny minority killed themselves by abusing scripts the whole state gets to suffer because we are all suspect narcotic seekers. Sigh!

          • querywoman

            Several years ago, an internist suggested I go to a gyn because she was having trouble with a Pap maybe due to a cervical dysplasia laser/cryosugery years before.
            I never went, and she has not asked again.
            I have always refused a mammogram. I pop back at them, “Show me the original study that says 1 in 9 women will get breast cancer. Our city has about 1 million people, more in the surrounding suburbs. I remind that approximately 40,000 women die of breast cancer every year in the US.” Then I ask them to explain the discrepancy.
            I asked for the original, “1 in 9 women will get breast cancer,” study years ago from official US government sources.

            I am still waiting for the study. I have not found it to exist anywhere!
            Then I pop back about my lifetime history of neglected illnesses.
            I am 57 now. In my thirties, two internists tried to pressure me into a mammogram. They were both pretty good treating doctors. Each doctor died shortly before age 50. He died of some kind of colon or stomach cancer. She died of ovarian cancer. Perhaps they intuited their own deaths!
            My beef with Paps and mammograms has always been the COERCION. That violates a principle of US law: innocent until proven guilty!
            I have seen stuff lately about the US government aggressively promoting mammograms.
            What some gullible fools don’t understand is that free or low cost mammograms and Pap smears feed the medical schools with guinea pigs to help new doctors get board certification!
            The coming of birth control in the US enabled and enriched US gynecologists. They used it as blackmail to get women in for annual exams.

  • Michael Rack

    Regarding the 20% figure: There are various estimates of how much of total healthcare spending physician salaries/pay consist of. The most common figure on the internet is 10%. I have also seen 8%. As others have mentioned, the 20% figure includes all revenue to physician practices. Much of the revenue goes to paying office staff, the receptionist, billing personnel, etc.

  • David Mokotoff

    Great piece. This is of course sad but true. As physicians we are now ruled by faceless bureaucrats, number crunchers, and obtuse outcome data bases.

  • meyati

    You forgot the hated pharmacy board for a hospital system based plan and insurance. I’d like to blow mine up. They need to get their brains ventilated, because their tight ties choked off the oxygen needed for logical thought. This extends to Medicare too. In the effort to save money, they rack up thousands of dollars in unneeded medical care and hospitalizations If people received proper medication, they could maintain their health in a reasonable manner. .

    I use- Armour Thyroid. My body cannot break down T4 into T3, when I take synthetic thyroid supplements. My physician is not in a 1940 time warp. He knows about synthroids. So do I, that’s why I know that they have a great negative effect. In May I had the privilege of discussing this with an HMO pharmacist, while they were drawing blood, connecting me to IVs, etc. She began the tedious lecture about Armour thyroid being unreliable. I rudely interrupted her and told her that I couldn’t handle synthroid-I become a raging lunatic that pounds things, my body shouldn’t have to deal with problems of not taking thyroid, etc.While I was in the hospital. I told her that my doctor and I aren’t in a time warp, and I don’t care to have another thyroid storm caused by pseudoephedrines. Cold medicines made me sick before my thyroid was diagnosed. It’s easy to avoid cold medicines as long as the pharmacy board stayed out of my prescription life.

    She asked how I had a thyroid storm. I told her the fruitcakes at the pharmacy board changed a script of pure antihistamine to one that had pseudoephedrine in it-of course the pharmacy went along with that to make more money. I was sicker than a dog and wished that I was dead. I called the pharmacy headquarters and they put me on a conference call with several departments. I told them that I had argued at the check out with 3 pharmacy staff this wasn’t the right med. They said it was, the producer just changed packaging, and pill shape.

    On the electronic chart- I saw the script order for what I normally took. Then a few days later, it was changed. The pharmacy told me there was a hold on the script for HMO review. As told by the pharmaceutical company, we went in and asked the local franchise, ‘Why is there a thyroid warning on the box?” I was told that it didn’t mean anything-I exploded- went back- and the company called me. I told them that. This pharmacy now has new people and a new head pharmacist.

    Then they decided to review the medical records for the GI clinic-and put a hold on refilling prescriptions until the review was over with. This is probably why the woman had their GERD medication stopped, and they ended up in the hospital. I kept rationing my IBS medicine- and I do self-pay for it. I was ready to go to the Er and get checked into the hospital. I called the GI clinic and the pharmacy 4 times a day. Finally a nurse told me about the review. I kept arguing that this med keeps me out of the ER. I self-pay-The medicine is not illegal- Why can’t a doctor write a script for it? Why does the HMO want me to be hospitalized? This was the second time I had that argument with the HMO.

    The pharmacy boards want to save pennies to say they reduced HMO costs, but they don’t care how much the patient suffers and how much it costs other departments. Let’s put some of the blame where it belongs- the pharmacy boards- PS, It starts with the Medicare formulary put out by their pharmacy board. They don’t care that thousands are spent on Urgent Care, in ERs, and hospitalizations, because they pinch pennies. The prescription of medication should be between a physician and patient. I think everyone is giving physicians a bum rap-and I’m not happy with mine right now.

    • querywoman

      Not sure I understand all this, but thyroid is quirky to treat. Years ago, a Kaiser quack dropped my med, at that time, Thyrolar from 3 to 2, and it spun me into agonizing PMS, which of course was just “depression.”
      I eventually went to endocrinologists, who manipulated my med in tiny increments, but I still ending up bleeding 15 days a month for 2 years, and they didn’t care, so I didn’t get to have babies.
      But Armour thyroid was not the answer for me! It apparently spun me into a subdiabetic state. Metformin for my diabetes would eventually help my cycles…PCOS! After I started insulin, my periods lightened and eventually disappeared in 6 months. I have never had any symptoms of menopause.
      I currently use Victoza, metformin, and Amaryl, and on .112 Synthroid.
      Thyroid is just so tricky, and every doctor is an expert at it! Next time I go to my endo, if I have time, I may ask if he ever prescribes Armour thyroid. The endos don’t tend to like it. But it’s cheaper and worth a try for some people!

  • petromccrum

    Great post. These problems, insurance denials are going to get worse.
    Many individuals do not comprehend these issues; until they are the ones on the receiving end of that denial. Sad, sad, sad!!

  • Richard Willner

    Jordan,

    Under the new Law, the physician who certifies the medical necessity for DME may also be liable if the independent third party does not dispense it.

    An additional thing to consider.

    Richard Willner
    The Center for Peer Review Justice
    info@PeerReview.org

  • redscarf

    Okay. So, Dr. Grumet: You’re an industry insider. Not that it’s the holy grail, but tell me what you did to promote the ACA when it first came out? If that didn’t go far enough for your taste, tell me what you did to argue in favor of a single-payer system? Tell me how you are currently fighting the concept of a hospital chargemaster and the unjust charges it costs patients and their insurers? Do you talk to your patients about what kind of charges that they or their insurer might face if you give them the treatment they require? DO YOU EVEN KNOW what sort of charges a patient or their insurer will face when you prescribe a test or treatment? The last time I was faced with a hospital bill for something insurance didn’t cover (pregnancy! like that can be separated from one’s overall health!), a doctor recommended a completely unnecessary test. I reluctantly agreed after getting my arm twisted a few times. I was quoted a price of $265. The bill came back for $2750. Thanks chargemaster! Doctors like to wash their hands of the cost of the treatment they recommend and prescribe, but patients have to live with it along with any health problems they have. If you’re not fighting the underlying causes of the high cost of care (inflated chargemaster prices, insurance underwriting, among many others), then stop complaining and do something about it.

    • querywoman

      I hope you didn’t pay that bill.

      • redscarf

        It took me four months of fighting – I had to get the hospital where the procedure was carried out to fight on my behalf against the hospital that the specialist came from, but in the end, I got a phone call one Saturday morning from the chief cardiologist of the second hospital admitting that the charges were “inappropriate” and he told me that I was only responsible for the originally quoted price of $265 (which was actually the chargemaster price of the fetal echocardiogram). The fetal echocardiogram (non-invasive, under 30 minute procedure) had been broken down into 7 separate procedures for maximum billing potential. I know it’s not the doctors who bill – at least in hospital settings – but they CANNOT wash their hands of what the financial wing of hospitals do – that includes both uninsured or underinsured patients AS WELL AS insured patients. Overcharging patients or their insurers is fraud and it costs us all.

        • querywoman

          Maybe we should carry tape recorders in medical situations. While I worked in public welfare, I consulted an attorney for some private business.
          I told him that my clients told me that the public hospital would turn them away without money (not supposed to do that) and one woman even told me they threatened to put her in jail if she didn’t pay. She wasn’t the lying type.
          My attorney said they should take a tape recorder with them!

  • Stephen Sutherland

    when a big faceless bureaucracy is paying the bill 3 things tend to occur (1) prices of everything go sky high — maximum charges are sent. (2) patient over use of the system and have less incentive to take care of their own health (3) denials and bureaucracy can also be absurd due to the size and facelessness of the system.
    This happens because nobody has any skin in the game – neither the hospitals, physicians nor patients. If the hospitals systems were themselves collecting the insurance from patients they would not let their surgeons and sub-specialists charge outrageous sums for 15 minute procedures. If physician groups collected insurance from patients they would maximize quality of care and view inpatient admissions as a failure. If the patient was paying on a monthly basis for their health care which might increase and decrease , they would optimize health and minimize unnecessary use of the system . We need to get a system that is closer to the payer and purchasers. Otherwise these problems of overcharging the system and mixed up reimbursements will continue . Free Market is the answer – with minimal regulations.

  • Bobbi Hopfensperger

    I have run into many insurance denials over the years as a patient and mother of 2. Most recently, my daughter with FAS, ADHD was denied continuing PT, OT and speech therapy stating that she had reached her maximum for the year (20 visits). She’s 7 (adopted at age 3 from Russia) and has been in OT, PT and speech therapy since age 5. She has made remarkable progress in those 2 years but there is still so much more that she could do. Denying her access to therapy Will, not might, but Will decrease her level of functioning as an adult and Will, not might, lead to losing the ground that she has worked so hard at gaining. Makes no sense to me as her mother what possible gain the insurance company would have in denying her therapy now when they will have to pay for residential group home when she is 18. Can someone explain that to me?

    • elizabeth52

      Bobbi,
      Have you tried speaking to the insurance company, occasionally they see reason if it ends up saving them money. My mother had a procedure recently and was going to be released from hospital early if she qualified for the Hospital in the Home scheme. This means a doctor or nurse (as required) visits you once a day in your home, in Mum’s case it was to stabilize her Warfarin levels, she had to stop taking it before the procedure. (Warfarin thins the blood to prevent clotting, but during surgery/procedures you could end up hemorrhaging so it must be stopped, getting the measures right again can be a slow process with daily injections and blood tests)

      Her private health insurance didn’t cover this service which meant Mum would have to stay on in a private hospital, a MUCH more expensive option for the insurance company. A couple of phone calls and they covered Mum for Hospital in the Home for 7 days…and have amended their cover to include that service. (up to a maximum of 7 visits per year, which would be enough for most patients)
      You have nothing to lose, I’d contact them.

      Hope things go well for your daughter into the future and she continues to make great progress.

  • Paige McDonald

    Thank you! Wonderful piece! A must share with my class!

  • querywoman

    Elizabeth52, that’s more of an answer on the 1-in-9 study than I have ever had.
    You should see how doctors react when I pop this stuff back at them. They can’t answer.
    The male doctor who tried to coerce me into a mammogram in my 30s asked me what he would have to do to persuade me to have one. I said present the original 1-in-9 study.
    The woman doctor who tried to coerce me into a mammogram in my 30s asked me, “Do you want to die?” I told her I was going to die.
    I have had a pelvic exam lying on a bed without stirrups while waiting for surgery on a skin lesion elsewhere.
    I opposed any women’s health organization like Susan G. Komen or Planned Parenthood which centers around cancer screening.
    I’ll check out the other site.

    • elizabeth52

      I think the behaviour of many so-called pro-women groups has been shameful. They have treated women in exactly the manner they screamed was unacceptable for years…telling women what to do and working with the profession, the program is the focus, not us.

      It also, infuriates me that we never get the evidence and left to make up our own minds, they use slogans, scare tactics “do you want to die?”.

      Dr Margaret McCartney, a Scottish GP, was brave enough to come out and say she doesn’t have pap tests and will be declining mammograms. Yet we don’t see the same reaction if a male doctor says he’s rejected screening. That’s his right. My husband rejected prostate screening, no drama, “it’s your decision”…how nice, how many women get that sort of treatment? He also, received real information on the risks and benefits of testing. There was no expectation he would just screen and it was just a question of intimidating or pressuring him.

      Real information is suppressed and women get a screening “story” or an order, Get Screened. Even the newspapers carry that over, “A shocking 40% of women don’t have pap tests” So, it implies all women should be screening, as we’re always being told, when in fact all screening is elective. Informed consent is what should matter, so it is irrelevant how many choose to screen or not, that’s our business, or should be.
      A pelvic exam when you were having a skin lesion removed…what? How on earth could that be justified? If that happened here, the Medical Board would ask the doctor to justify the exam, how was it a clinical requirement when the patient was having a skin lesion removed? I’d like to hear the answer.

      Yet the Medical Board overlooked for years the fact doctors were coercing women into pap testing to get the Pill. They’ve had to pick up their game after a number of high profile cases that showed them up badly and now some women go straight to the Police….so they have to play catch-up.

      I also, think many of these women’s health groups treat women disrespectfully, they also, give women bad medical advice. Informed consent, not for women.
      I’m also, suspicious of their funding, if you look deep enough you often find vested interests.

      • querywoman

        I don’t know why other women have not questioned the coercion into these screenings.
        Years ago, I went to some “skeptic” society meeting. I don’t remember what brought us to this point, but somebody mentioned that their skeptical doctor, Dr. Sawbones, would know more.

        I asked if they accepted a doctor’s word automatically, and then went into my bit about how there is no proof 1 in 9 women will get breast cancer. I was treated, politely, but like I was loony.
        As for Dr. Sawbones mentioned above, he’s all other the place, spouting off classic gynecology stuff, like most of his patients are satisfied with hysterectomy. Does he listen to them if they are not?
        Also, he blasted nonprescription progesterone cream, calling it quackery. It may be, but he went on to say that prescription premarin pills cost the same.
        They may cost the same, but you have to pay for a costly doc visit to get them, and risk getting sold up on all kinds of screening, and become cut up and altered, and on all kinds of other meds.
        I’d rather try the over-the-counter progesterone cream first!

        • elizabeth52

          Most/many women don’t question official recommendations, they trust the medical profession and even the Government. Also, everyone is on board with the screening “stories” so there is little real information getting to women, and the lack of respect for informed consent and even consent itself, is across the board.
          It’s only women who question or refuse this testing who see the inappropriate attitudes…this may prompt them to do some reading or some more reading.
          As it stands here and in the States (and in many other countries) women are given bad medical advice that can only risk their health and even cost lives. This is how the profession has treated their trust.
          Hopefully, we’ll see some justice for the huge number harmed by these programs.
          Some women will never believe the system was working against them, it would be too difficult, especially if they’ve lost some of their cervix and perhaps, a premature baby due to an incompetent cervix. (after an excess cone biopsy/over-treatment)
          I think doctors have misused their prescriptive powers to coerce women into testing, that negates all consent. The attitudes and conduct in women’s cancer screening reflects very poorly on the profession and shows they still view women very differently…fair game, just keep them in the dark, mislead them, and keep the profits rolling in.

          It’s shameful that we now have huge numbers of women who “think” they had cervical cancer. These women will carry this burden through life, it might affect their ability to get insurance and their daughters etc. will be urged to be vigilant. How could you trust or respect a profession that thinks all of that amounts to good healthcare? (good business perhaps, but not good medicine)

          As for hysterectomies, women are so often “told” how they should feel about all sorts of things, and ridiculed or dismissed if they feel differently. We see that in screening and in women’s “healthcare” generally. Many women report doctors speak down to them, over the top of them, dismiss them, even become aggressive if they don’t do as they’re told etc.

          I’d say sack any doctor who treats you this way and find a decent doctor, someone who views your health and well-being as their highest priority. It’s not easy, but they do exist, like truffles, you have to hunt for them, but it’s definitely worth the effort.

          I believe the well-woman exam is partly responsible for your high hysterectomy rates (Dr Carolyn Westhoff’s articles address this subject) American women have more than twice the number of women in countries that don’t perform routine pelvic exams and the same applies to oophorectomies.
          Using a gynecologist as your primary carer is a very bad idea, we are only referred to a gynecologist if we have symptoms or require their specialist services, some women use them for pre-natal care and delivery. (especially high risk pregnancies, multiple births etc.)

          I’ve listened to the medical profession mislead women for decades, so I’m very cautious with any of their advice and always do my own reading before accepting any of their recommendations or advice. That attitude has served me well over the years. Is this advice or recommendation really in MY best interests? 9 times out of 10 the answer is a clear NO.

          • querywoman

            We’re on the same wavelength. I got burned badly by an OB/gyn in my early 30s over a pap smear. He was a cancer phobic nutjob who couldn’t treat illness.
            I used to see a family doc who had delivered 1000 babies.
            I think gynecologists are a waste of time; their idea of a “physical exam” is a cancer prevention exam.
            More another time. I’m tired.

          • querywoman

            Premarin, aka horse p!ss, seems to have fallen out of favor some, but it’s still hucked on women.
            I know nothing about hot flashes. I never had a single symptom of menopause. I have a hellish menstrual history.
            I went on insulin at 43. My periods instantly became noncramping, and gradually lightened and mostly disappeared in 6 months.
            My endo didn’t know why insulin worked so well on my cycles, but I let her take credit for it.

  • Suzi Q 38

    I will have to say, though that one of those “ambulance chaser” type of law firm called me the other day. He got my phone number from a friend of mine who was a lawyer whose firm successfully sued a pharmaceutical company for the drug “V.”

    This lawyer had a class action suit going for the da Vinci surgery that I had had on my hysterectomy.
    He wanted me to join the lawsuit.

    I am not sure about stuff like this. I would have way too many concerns and questions for them to want me on the case, LOL.

    Other times, since my doctor was so complacent with me, and so obviously tried to delay my care after the surgery and adverse events, I think Why not?

    • querywoman

      I think I would join in the class action. I never heard of one for a medical malpractice issue.
      Re: the fax blitz. Just get a fax machine and start blitzing. I think US government offices have been forbidden from blocking fax numbers, due to the right of free speech.
      Fax issues bring up certain harassment laws. I don’t think it’s harassment just to state what happened. Anyway, it’s a civil issue. If they tried to get an injunction against you sending faxes, then they would really look bad. They’d have a public case in which you state your case. if they one an injunction, it would probably get overturned on appeal.
      Make faxes that short and sweet, so the person taking it off the fax will machine read it.

    • querywoman

      For a simple statement that could be handed out or faxed, I suggest something like this:

      Dr. SawHatchet did a DaVinci hysterectomy here in 20xx. Since then, I have suffered this and that disease, etc.

      No blame, not even a link. It’s implied that you are saying SawHatchet caused your problems. Short enough to be read! Then the human tendency to fill in the blanks would seed gossip!

      The institution would say your are harassing them! How is such a statement harassment?

      You could say something about not fully informed consent, but the more you say, you increase the risk of it not being read.

    • querywoman

      I researched Da Vinci surgery class action suits. Looks like a bunch of lawyers got their fingers in it. Seems like the electronic robot burned some insides and did not perform better than skilled human hands!

  • https://www.facebook.com/arobert6 Alice Robertson

    I think the internet is a better place to vent? If people care they go to google and put a doctor’s name in. The ratings sites don’t really capture their attention, but personal stories do. My friend was in risk management and uses the internet freely. Now that said I think it depends if the doctor’s mistake was true negligence. There are errors in medicine and most don’t end up with irreversible harm….but obviously some do….death is pretty irreversible. The differentiating is vital.

    But like abortion we have medicine being legislated to the nth degree. I wish it wasn’t necessary, but because a small percentage of doctors behaved badly they not only harmed patients but the whole profession. Thankfully, few doctors will do abortions and few do real long-lasting harm to patients. But, sadly, it took real harm and negligence to get us to the point we feel more empowered.

    I worry about patients becoming bullies. We need as much discernment as we demand from the doctors. My admiration for the good doctors is probably what will, ultimately, heal my fears of another medical mistake that haunts my mother’s heart.

    • querywoman

      I’ve always been too sick to do public protest. Most of us who have been screwed over the docs are!
      Sitting crosslegged on my living floor typing words fits my energy level. I shore do manage to p!ss off some people.