Thursday, May 15, 2008

Clarence This is Stupid Stuff

Today I am reading Leavitt's Blog. As most MDs will recognize this name as gentleman who is the Head of HHS. I am not sure, but I believe this is a Cabinet Level Position, or at least on a level commensurate with the Head of a Major Federal Agency. I made a comment on his blog, and lo and behold it appeared. (moderated, too). In a land where "titles" and certificates, outcomes and credentials outweigh all other measures of intelligence, competence, and malpractice coverage I come to the table with merely an MD and Board Certification in a surgical specialty.

It took me 15 years post high school graduation (including involuntary military service in the Navy during Vietnam), which by the way turned out to be one of the most interesting and rewarding periods of my life, to get to a point where I paid real money to purchase a medical practice (now called medical business), which took another five years to pay off. Throughout a great deal of this time I was paying off my medical school loans.During residency I also moonlighted a great deal to support my family. I am one of those rare birds that actually used my general medical knowledge practicing family medicine and emergency medicine for four years prior to residency. Another time well spent where I learned to appreciate my specialty was actually a small niche in the scheme of health care.

In those days of early medicare and non existencey, a great deal of medical services were actually given away because it was possible to cost shift and absorb non paying patients, indigent patients in your practice without going bankrupt.

In today's real world the invention of "needs" to satisfy neurotic patients, such as refractive laser surgery, cosmetic botox, restylane injections, nip and tucks, fancy lasers for vein and skin treatments and other cosmetic surgery has allowed some primary care physicians and specialists to continue having an economically sound business model and also to allow them to continue to see Medicare/AND/OR Medicaid patients. Managed care also sucks off this since they do not pay enough to support medical and/or surgical care.

So cost shifting still takes place and it is what keeps the system running. Of course medicare nor other pencil pushers measure this....except those who deliver the care at their doorstep.

Medical practices now have " profit centers" pandering to the latest high visibility newsworthy procedure of the month and snake oil remedies.

To reiterate what Forrest Gump said "Stupid is what stupid does". The stupidity and lameness of it all is apparent ....However it is difficult to measure common sense there aren't any health insurance carriers, or government agencies that have set up a committee, or algorithm to measure common sense. Stupidity is apparent to the eyes of the beholder, and invention to serve a need, such as imaginary numbers, the square root of -1.

I also read Medinnovation Blog, written by Richard Reece MD who is a retired? pathologist who writes about medical economic issues ranging from primarycare challenges to physician IT, and Physician Culture. He is always a good read, and I wish he had a column in a highly visible medium such as the Wall Street Journal, a column in Time Magazine, or a Bill OReilly segment.

Mr OReilly should cover some health care subjects....if I hear anymore about Democratic primaries, I will surely vomit.

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