8. Ridiculous Study of the Month

The British Medical Journal reports that depressed medical residents make six more times the medication errors than non-depressed residents.   This study  looked at 123 pediatric residents who wrote for a total of 6,078 orders.  There were 45 total errors found.  As stated, most of them came from the 20% who were depressed.  The study also found that 74% were burned out.   An article in the American Medical News discussing this study reinforces the need to “humanize” training and watch out for these residents’ mental health.  Little secret: residency sucks.  These docs-in-training work ridiculous hours and not just because it helps them become better docs.  They work these hours because the big hospitals depend on them to do the job and pay them next to nothing.  If they had to get board certified docs to cover the patients the system would be more broke then it is; impossible as that may seem. 

Besides, I am not buying that only 20% were depressed.   I will bet you that if you continually check on these residents, the majority would be depressed at one time or another over a year’s time.  It depends a lot on the rotation you are on.  I will bet you the suicide rate, unlike in the rate in the depressed lay public, is lower because these residents see a light at the end of the tunnel.  I just want to be the first to formally tell that residents that I am sorry.  That light they are working towards is slowly dimming and may go out soon. 

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

Cutting the cost of Medical care

Each time the insurance industry and the government talk of cutting the cost of medical care the primary target is always the physician. Located at the base of the chain of medical care cost and the smallest contributing factor is the physician. The image of the affluent physician is imprinted firmly on the mind of the public and legislatures. This image is as obsolete as the Studebaker. Although a few specialties have withstood the financial forces the family physician and the internist have almost always been impacted disproportionately.  

The result of this policy has been a major factor in the overall cost of medical care. Primary care providers no longer provide care for emergencies or care for patients after office hours. The impact on Emergency room care is tremendous with an even greater impact on medical care cost. If someone were truly interested in cutting medical care costs it would probably best to increase the compensation of primary care providers. 

This would help stem the flow of physicians to higher paying specialties or specialties that operate on a cash only basis. Rewarding the primary care physicians for keeping patients out of the emergency room would be a good investment and provide a good return on the money invested. 

Global fees as utilized by Medicare need to be reevaluated to keep hospitals from gaming the system by discharging many patients too soon and sending them to nursing homes where they stay too long and often fail to get proper follow-up care. 

Some day the forces that affect our medical care will learn that “good care” is cheaper than “mismanaged care”.  

10. Bacharach’s Beliefs Part II

Physicians Are Beset By New Problems

It was only a few years ago that physicians were bombarded with offers of credit. New car salesmen salivated when a physician entered their showroom. Real estate agents saw dollar signs floating in their direction as soon as they got the first telephone call from a "rich doctor".  Managed care has fixed not only medical care it has also placed physicians in a position that they were not prepared for. Once physicians had survived the poverty inflicted by college, medical school and residency, they felt they were entitled to a few years of greater affluence. In today's environment in the Sacramento area this is not the case. No longer are the banks anxious to lend money to doctors; they are reluctant to lend anything to people in such a precarious financial position. The situation has changed to such an extent that the California Medical Association now offers advice to physicians as well as IPA's who are headed for bankruptcy.

Pecuniary insufficiency is not a new state of affairs for physicians. In the nineteenth century and earlier many physicians changed occupations, or found other activities that were more lucrative. One physician in Placer County was known for his plum orchard that netted him more than his salary as county physician. I suppose the dictum that in order to practice medicine it is advisable to marry a rich wife is once again valid. (In today's environment a wife with a good income would be an acceptable substitute.) If you are contemplating bankruptcy in the immediate future you can contact CMA on the Internet for advice.

A couple of years ago I attended the 50th reunion of my medical school class. My classmates and I were all survivors of the "Diamond Age of Medicine". All of them had practiced general medicine or a specialty for many years. Most were retired. None of them had become rich by any standard, but all were able to live fairly comfortably if they were not too extravagant. I have often wondered where the "rich doctors" are; while I have known many who lived above their means, the only ones who were wealthy started out that way or invested in something that prospered more than their medical practice. One of my classmates spent his entire career in Korea as a medical missionary, his ability to live in retirement was about the same as those who had stayed at home and "prospered" in the practice of medicine.

The subsidizing of medical education is something that needs to be looked at seriously at this time. Physicians starting our burdened with debt, subject to the parsimonious fees offered for their services are ill equipped to pay several thousand dollars a month for their education which placed them in such severe financial straits. Many years ago Harry Warren wrote a song called "Brother Can You Spare a Dime"; even during the depression he did not have physicians in mind.

The field of medicine continues to offer a profession in which we can take personal; satisfaction, - remuneration is another matter.

11.  But It Isn’t All About Saving Money?

There has been a lot of hullabaloo about a recent Dutch Study published in the Public Library of Science Medicine journal which basically shows that if you live longer than you cost the health system more.  The researchers found that from age 20 to 56, obese people racked up the most expensive health costs but because both the smokers and the obese people died sooner than the healthy group, it actually cost less to treat these groups in the long run. 

I am not sure what the dilemma is?  As physicians, our job is to consult with patients and give them advice and possible treatment to become as healthy as they can.  This may add years to their lives which will actually cost the healthcare system more.  But that shouldn’t be our concern.  What we aim to do is increase the quality of their lives.  We are treating people and not numbers.   The numbers are left for the bean counters and politicians who really don’t care for the people like we doctors do. That is where we separate.

Preventive care is a good thing.  It is not, unfortunately, proven to be a cheap thing.  I think this study reinforces the notion that an individual should have a choice on how they want to take care of themselves.  Instead of the pressure of those bean counters pushing us to get a patients labs to look good in order to “save the system money” or to make their published data look good, we can now let patients decide for themselves if they want our help.  If not, we shouldn’t force it upon them in the name of prevention or “pay-for-performance”. 

12.  Must Be Worth It

In the early days of electronic medical records, I remember hearing about a entrepreneurial physician who created a very cheap product.  He hired some salespeople to answer the phones and advertised it for $19.99.  No one called.  He then raised the prices to $199 and got a few calls.  Instead of giving up, he raised the price to $1999 almost as a joke. He had to hire more staff to answer the calls as the phone was ringing off the hook.  It was the same product.

To be honest, one of my medical partners told me this story and I am not sure if it is an urban legend.  The fact that people perceive products as being better if they cost more, however, is a proven fact. I read so many books on this subject (Influence, Tipping Point, etc) that I don’t even question it.  It seems that for medication, this concept was never studied.  Well, now it has been.

Researchers at MIT found that a $2.50 placebo pill reduced pain much more effectively than the exact placebo that costs just ten cents.  The study appears in JAMA and shows exactly what a lot of doctors have known all along; the cost of a drug influences the perceived effectiveness by patients.  This is why the COX-2 inhibitors (Celebrex, Vioxx) sold so well even though they never were shown to work any better than OTC ibuprofen.  Patients used to swear to me how much better it was than advil or Aleve and I couldn’t dissuade them.  Here is the question I now have: why did it take science so long to prove this fact when Big Pharma knew it all along?  Let’s just hope science can next study how to market cheap generics more effectively or Medicare D will surely bankrupt us all soon

13. Lick This

Speaking of brilliant marketing techniques, I have to tell you about the new lickable ads that will be going into some magazines like People. It was featured recently in the Wall Street Journal.  For example, the Welch’s grape juice ad will have sticker that is easily peeled off to lick and therefore taste the product.  I am assuming the part that doesn’t come off really doesn’t have a taste.  Since the consumer is to throw away the sticker (it can’t be reattached) then, according to the marketers, there will be no cross-licking going on.  Yeah, right.  How many people are going to figure this out or get the urge to just sneak in a lick in a doctor’s waiting room?  We all know that a lot will.  Now that is really hygienic for a medical office, isn’t it? 

On a side note, I have contacted these marketers to help me put these lickable ads into my Placebo Journal.  Unfortunately, they stated they have no idea how to do “Chlamydia” or “Abscess” flavors. 

14. Feedback About The Placebo Gazette

I WANT TO KNOW WHAT YOU THINK.  Please go below and post your thoughts under the WRITE A REVIEW section.  You can also see some one of these articles on our blog:

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

Doug

King of Medicine