Placebo Journal - Medical Humor With A Purpose

1. Symptoms Only

In a nice article by Rita Rubin in the USA Today it is revealed how Americans forgo preventive care when the money has to come out of their own pockets. This is a real issue and one that doctors have been battling with for a long time. It has been even more magnified in a recession. The bottom line is that human beings tend to only treat symptomatic diseases because they feel pain, dizziness or a headache. Things like colon cancer, high cholesterol or high blood pressure aren't felt and are minimized until bad things happen. I recently had a women blast me for trying to "dig up" problems on her as if I was a mechanic getting paid on commission. What I had dug up was skin cancer, very high cholesterol, and severe osteoporosis. She refused treatment for all of them. She subsequently fired me.

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2. Honk If You Love ERs

Press Ganey, a consultant for more than 10,000 health care facilities, put out their results of a ER survey and got the media all buzzing. It seems that patients don't mind waiting so long (average time is 4 hours and 3 minutes) as long as:

They are kept informed about delays
The staff cares about them as people
Their pain was controlled

ERs are responding by adding Walmart greeters, restaurant pagers that look like coasters, and inflatable children ball pits (using Vicodin instead of the plastic balls).

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3. Sign Of Things To Come?

A pending House bill introduced by Representative Robert Wexler, D-Fla., will attempt to address the nursing shortage by allowing 20,000 additional nurses to enter the U.S. each year for the next three years. This is supposed to be a temporary stop gap measure but this "importation" of foreign trained healthcare workers is not a new thing. Whether it passes or not will be questionable. I wonder, however, if that will be the government's answer for our primary care shortage?

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4. Placebo Journal Update

We are now putting together our August issue. If you have some stories to share then send them in. If you want something that is all humor and guaranteed to make you smile again then:

Placebo Television #18

6. What I've Been Saying

There is only one way to produce more primary care doctors. Money. You may want to throw prestige as another factor but that isn't tangible. The harsh reality is that the medical students of tomorrow need to know that they will be making a very good living. I am not saying that family doctors or internists are poor but to carry a $200,000 school loan burden while also being out of the workplace for 10 years for training while your friends having been making a living, you feel you are worth it. Money. Not big money like a neurosurgeon, either. Just more money. The Washington Post just put out an article Primary-Care Doctor Shortage May Undermine Reform Efforts. Duh. Please see Placebo Television #17. I love the example that the article put out about the disparity of procedure driven compensation and primary care. They compare a half-hour visit for $89.64 to your family doctor to the $422.90 paid for the colonoscopy done in the same time by a gastroenterologist. The specialists point out, in the article, that the colonoscopy "requires more equipment, specialized skills and higher malpractice premiums". Please. I know guys who run 30 scopes a day. The first one covered all the equipment and malpractice. As far as skill, the gastroenterologists have blocked FPs from doing colonoscopies even when they are trained to do it and because of lack of skill but because it is their turf. This is about money, plain and simple. Let's call it what it is and bump up the Medicare payment for cognitive services and lower the payment for all procedures just a smidgen. That will move the young ones in the primary care direction.

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Hilary Clinton will be having surgery soon for a fractured elbow after taking a tumble. After that it will be anywhere from six weeks to three months of physical therapy. I am sure she is in some pain and I wish her well in her recovery. That being said, I would like a full account of the medical bills for everything she has been through. I want transparency. From the first physician assessment of her injury to the xrays to the surgery and PT, I want a detailed account of the amount she was billed. Then, and more importantly, I want to know how much she is personally paying for. I want to know if she is going to be a great example for a "new healthcare system" or an example of people in government being treated differently than the people they represent.

Hilary Clinton sat on a wall,

Hilary Clinton had a great fall.

All the Goverment's doctors,

And one orthopedic surgeon,

Got paid a lot of money to put Hilary together again!

If you haven't heard, the over-the-counter nose spray called Zicam is being pulled because of side effects. This non-prescription product has no FDA oversight and 130 consumers have reported that they lost their sense of smell with it. As much as I love going to Whole Foods Market and enjoy supplements/vitamins, I do know that without some regulation of so-called natural products these types of problems will keep reoccurring. No matter if it is herbal or homeopathic, you are always at the mercy of the company who makes it. Victims of the the Zicam "olfactory debacle" can testify to that - and will do just that once the lawsuits start. On a side note, as reported in the NY Times, there is a whole new trend to create weight loss productions which work by manipulation of smell. For example, one product called Sensa tries to curb the appetite by blocking rather than enhancing smell. Human trials are underway but I have heard from a little birdy on the street about a new drug that may do that same thing and is now very, very cheap. It is called Zicam. Hey, if you can't smell lemons then you won't drink the lemonade.

Doug

King of Medicine