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

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

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

9. Bacharach’s Beliefs by Ted Bacharach MD, retired

The Physician’s Public Image

Sometimes I feel physicians are having a rough go!!  The physician was once depicted as a dedicated individual who worked hard to take care of his patients. That of course was long ago before the changes brought about by the government, hospitals, HMO’s and insurance companies. These entities saw lots of money and they felt that is was all right for them to siphon off all that money being made by physicians. These organizations schemed that the best way to get a place of power at the table was to depict the physicians as greedy, wealthy and spending much of their time playing golf or engaging in other costly activities at the expense of the poor patient. Unfortunately doctors made to feel guilty quickly agreed to see more patients providing that their income could be maintained. Gradually over a period of time the physician’s income was eroded but at an unequal rate. The “heart” such an important romanticized organ was allotted more remuneration than some of the less important but still vital organs as the kidney, liver and brain etc. Unfortunately it is not possible to live without any of these organs but fixing hearts pays better than fixing kidneys as well as many other vital organs. The changes brought about resulted in unequal pay for physicians. Never really good team players physicians went their separate ways.  A disorganized profession who are unable to get together as a group to object met restrictions, loss of income, loss of control, imposed on them by many different entities. The AMA once a powerful organization became fragmented and lost many members, as did the County Medical Associations. The slogan “In unity there is strength” was eliminated from the medical profession’s way of thinking. In our present environment some of the following facts are evident:

1. Staff membership in hospitals has become a function of the hospital administrative staff.
2. Doctor must refer patients to the laboratory and specialist the HMO or insurance company designates.
3. Diagnostic codes are required for all patients.
4. Authorizations must be obtained for many diagnostic or therapeutic procedures. Often a difficult problem involving interaction with individuals whose only qualification for their position is that they know how to say “NO”.
5. Someone other than the physician determines the time allotted for each patient.  
6. The dedication and pride in their profession is rapidly destroyed by the factors affecting his or her ability to interact with their patients. The result is a desire for many to find other means of earning a living or retiring.
7. Patients are the final recipients of these changes, which do not bode well for their care in the event they get sick. Their only hope is to stay well until some draconian changes can be brought about. 

10. Celebrities

 

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

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

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

 11. Maria’s Media Spotlight by Maria Simbra MD, medical correspondent KDKA-TV in Pittsburgh

I want to introduce the newest member to our Placebo Gazette reporting team.  Dr. Maria Simbra is a leader in medical journalism and an award-winning medical correspondent for KDKA-TV, a CBS owned and operated station in Pittsburgh. She is also an assistant professor of neurology at the University of Pittsburgh Medical Center. To see her reports, go to KDKA.com, click on the word "Video" at the top of the large box (top right), open the drop down menu and click on "Health," look for the headlines mentioned above.  They're organized by date, the most recent reports up top.

She is also a really great person who I have spent a bunch of time talking to over the years at the AMA Medical Communicators Conference.  I think she will give a great perspective of physician who is also a mainstream news reporter. 

 

This week it was all about Virginia Tech. 

Post-traumatic Stress Disorder             

"Dealing with Tragedy can Be Difficult" 4/17/07

Main idea: Students will feel the psychological ramifications in the short and long-term. 

News to muse: Students cope by text messaging. 

Thought-provoking point: Interestingly, James Cox, the local university psychologist I interviewed, believed that by and large, the Virginia Tech students would simply get on with their lives.  Psychologically vulnerable students would be the ones with PTSD.

Gun Shot First Aid

            "Local Doctor Talks About Life-Saving Techniques" 4/18/07

Main idea: A student from the Pittsburgh area had the presence of mind to tie a tourniquet around his leg after being shot.

Important to note: Be sure the shooter is out of the area before lending assistance.

Contrary to popular belief: Tourniquets can be bad.  More than 10 minutes of no blood flow is unhealthy for an extremity.  Hold firm, direct pressure instead, and call for help, says emergency physician Fred Harchelroad. 

Lessons learned:  There can be medical tie-ins when the big story comes along.  Experts will say all kinds of things...sometimes even counter to how the piece is promoted.

12. Recommended Website

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

13. Feedback About The Placebo Gazette

All future feedback will be posted as reviews for each issue.  Please go below and post your thoughts under the WRITE A REVIEW section.

Until next time, keep smiling, keep laughing and keep out of the sample closet.

Doug

King of Medicine