Thursday, July 23, 2009

Presser continued....

I missed this. It was near the end of the press conference and I may have been distracted changing Little Buckeye's diapers. But Dr. Wes catches it. Here's our President:
We wanted to make sure that doctors are making decisions based on evidence, based on what works. That's not how it's happening right now. Doctors are forced to make decisions based on a fee payment schedule that's out there. So they're looking... if you come in with a sore throat or your child comes in with a sore throat, has repeated sore throats, a doctor may look at the reimbursement system and say to himself, "I'd make a lot more money if I took this kids tonsils out." Now that might be the right thing to do, but I'd rather have that doctor making those decisions based on whether you need your kids tonsils out or whether it might make more sense to change, uh, maybe they have allergies or something else that would make a difference. So part of what we want to do is free doctors, patients, hospitals to make decisions based on what's best for patient care.

Yeah, that's how the President of the United States thinks American doctors go about the business of medicine. They ask themselves--- "how can I make more money" when trying to make clinical decisions. Because, you know, he read this one article in the New Yorker about it a few weeks ago. That's a good enough reason to disparage the integrity of an entire profession right?

Just an irresponsible, off the cuff load of garbage....

31 comments:

platensimycin said...

Step outside the four walls of top-notched medicine centers,

that's not far from how things actually get done. Paperwork, phone calls; more paper, more phone calls. To whom? For what end?

John said...

He's got the right idea, just the wrong example.

Doctors could be a lot more efficient if they could do phone or email consults. They don't because they can't get paid for them.

How many procedures aren't done because of the amount of time doctors waste getting approval and reimbursement? If you have a choice between two treatments one of which you'll get reimbursed for and the other will be a paperwork nightmare, which one will you recommend?

Every other professional chooses the path of least resistance. I don't think doctors are any different.

Frank Drackman said...

Hmm and how much can we cut out (pun intended) of the health care pie if we nip the bud on all those useless Circumcisions??? They are "Elective" after all except for the occasional Pair of Phimoses...
Not sayin you wont be able to get your kids 4skin snipped, you'll just have to pay a Rabbi to do it...

Anonymous said...

It could be that Obama's statement was an attempt to promote GPs/FPs handling of stuff like (tonsillitis) without knee-jerk specialty handoff. However, why was it so difficult for him to articulate this? He ended up flipping-off doctors, and fueling mistrust. IDK. Has he flipped-off nurses yet? :o)

-SCNS

tom said...

Interesting that Obama expects physicians to practice within the framework of evidence-yet he need merely speak in anecdotes-proclaim "I am the President" and expect that to be sufficient debate.
Six months into this nightmare I see my taxes programed to rise, my purchasing power programed to fall, my investments eroded, my property values declined, and a President who believes foreign policy is based on apologies... apologies to people who decapitate Americans and stone/starve their own people to death!
Next I expect him to say "I should be happy in my work".
When will the media stop enabling this an when will America wakeup and say ENOUGH

I have never been a fan of Helen T, but loved her comment a couple of weeks ago "why are you trying to control us (press corps) so much? Her reward for asking this question-no more opportunities to question? Perhaps she needs to ask about how enchanting he has found the Whitehouse to be-that played well in a previous press conference.

Anonymous said...

"Doctors are forced to make decisions based on a fee payment schedule that's out there."

Seems to me very clear that Obama is criticizing the payment system, not doctors.

Certainly, he could have been clearer, but as a primary care doc who is not forced to choose between OVs and procedures, I'm not ticked off by what he says.

It really sounds like he's urging the leveling of the playing field between "cognitionists" and "proceduralists."

Buckeye Surgeon said...

Anon-
That's an imaginative interpretation. Read the words he said. Words and sentences (we ought to hope) have very direct meanings in public discourse. It isn't a Wordsworth poem that requires interpretation.

Very clearly he implies that doctors make decisions based on profit motives. The way he phrases it is extraordinarily disingenuous...i.e. docs are "forced" to make unethical, self-interested choices. That way he averts pissing off true believer docs (like yourself) who have already made their decisions on what they prefer he might have said....

And no one is arguing that PCP docs need better remuneration. But the thrust of his reform "plan" is that doctors are greedy McAllen clones...You ought to be alarmed.

Trader Bob said...

I couldn't agree with you more. I'm not a physician and I think on the average physicians are the most intelligent people based on profession. The professions that are overly compensated in my ranking order are bankers, politicians, and lawyers. This government has run this country into the ground. A great American is where wealth is dispersed widely and we are free. We need a president that comes from the grass roots and outsde the control of the main stream media.

Trader Bob said...

Why are physicians defending themselves on the issue of being greedy. The bankers and the corporate lobbyists are the greedy ones. Why are we not auditing the federal reserve.

Anonymous said...

Buckeye,

Your interpretation could also be a bit far-stretched.

Perhaps it helps to compare this specific statement with any other statements he made regarding doctors, specialists and GPs alike. You would find it inconsistent to conclude that Obama sees all clinicians as profiteering low lives.

He did, after all, say "Doctors are forced to..." rather than "Doctors make decisions" - didn't he?

You ought NOT to be so alarmed.

Anonymous said...

We physicians are antagonistic and self-righteous/conscious, Trader Bob.

Frank Drackman said...

Ummmm Buckeye...........

Didn't you vote for this guy??


Good Job, elections have consequences...

Frank

Anonymous said...

Stop making remarks like "You ought to be alarmed."

1. You are making others sound like irrational airheads; it's just as condescending.

2. One's fear might not necessarily translate to anthers' - we are all old enough to perceive incoming threat.

3. What's up with this "true believer" nonsense? Is this a cult or religion we are discussing? Are you implying that those who have high hope in Obama's reform plan are in danger of being labeled of cult membership?

Now, how does it feel like to have your own words stretched beyond intended purposes?


(CENSOR this post if you like - it's fine with me either way.)

Anonymous said...

Buckeye,

Your interpretation could also be a bit far-stretched.

Perhaps it helps to compare this specific statement with any other statements he made regarding doctors, specialists and GPs alike. You would find it inconsistent to conclude that Obama sees all clinicians as profiteering low lives.

He did, after all, say "Doctors are forced to..." rather than "Doctors make decisions" - didn't he?

You ought NOT to be so alarmed.

Anonymous said...

There has been this sense that PCPs have been elevated to "Chosen One" status aside from leveling the playing field. One must be wary of the age old corporate trick of first showering you with compliments publicly, then giving you an elevation in status (amongst your peers), and then screwing you royally. Better get some game.

-SCNS

Kellie said...

arrgh.

Most of the time the kid with a sore throat goes to a FP/PCP who isn't going to do a tonsillectomy anyway. If they are sent to the ENT then they are likely to get the tonsillectomy because that's what they do.

As for the person who is saying their investments are down, mine have gone up in the past 4-6 months.

Trader Bob said...

Kellie wait and see if your investments are up in the next six months. Japan went through a similar economic scenario which started two decades of falling stock and real estate prices. The S&P 500 hit a bottom of 666 on March 6th of 2009. The market closed at roughly 980 today which is a 47% increase from the bottom. The market has to return 90% more to get back to the highs in October of 2007. I attached the Japanese Nikkei chart for your viewing enjoyment. The Nikkei topped at 40,000 in 1990 and is trading at roughly 10,000 20 years later. Japan went through a credit and real estate crisis very similar to what the US is going through now. Dollar cost averaging only makes sense if you believe the market will always go up. In a down trending market you will average a losing return.

http://2.bp.blogspot.com/_od7SxDkNKrI/Sl6XZ5Cia_I/AAAAAAAAADc/RzlLvw-Vxbg/s1600-h/%24nikk-monthly.png

Rogue Medic said...

Anonymous,


He did, after all, say "Doctors are forced to..." rather than "Doctors make decisions" - didn't he?

You ought NOT to be so alarmed.



The use of such juvenile language is alarming. President Obama is supposed to be a thoughtful person. Claiming that doctors are forced to do things by money, while ignoring all other influences is alarming. Assuming that money is evil is not going to improve health care. There is much to improve about this country, but attacking people because of their profession, or because of their income, is no more fair than any other kind of stereotypical discrimination.

Anonymous said...

The incredibly detailed stats back up obama. You should look at the dartmouth atlas.

Put a sick man into the care of a few caring doctors and they'll soon relieve him of his wallet. Thanks to improved transparency the general public is beginning to understand this fact.

But of course, at the end of the day it is all the fault of malpractice lawyers. And Insurance guys on lear jets and other faceless bureaucrats. And Government. And patients expecting too much.

Anyone but the doctors.

Buckeye Surgeon said...

Anon-
The dartmouth atlas shows what exactly? At UCLA, the cost of care provided is twice as much as what you get at Mayo. But those UCLA docs are salaried, academic docs just like Mayo. So it obviously isn't just financial incentives. Your opinion, inflammatory and wrongheaded as it is, has unfortunately become prominent across the country due to shady circumstances. It's a political ballgame and the fractured physician voice is getting hosed....

BTW I don't see many docs (like Wellpoint/Aetna CEO's) pulling down 7 or even 8 fig salaries...

Frank Drackman said...

Buckeye,
I just do Locums Work and I make 8 figures.....
If you count the "Cents" column...

Frank

Anonymous said...

Geez, it just occurs to me

Why should any of these be your concern if you already live on 6+ fig salary (est.)?

Why should the uninsured or the lack-of-access be any of your concern? They probably rarely come across your life as it is. You guys oppose because the reform calls for higher tax on those with salary >$1M.

Silly me - i am clearly talking to the wrong crowd.

Buckeye Surgeon said...

Anon- Time to start trolling elsewhere. You ought to come watch me some weekend when I do thousands of dollars of free surgery on uninsured young people with appendicitis/free air. I don't get paid and if things don't go perfectly, there's a chance I may even get sued!

Now beat it.

Anonymous said...

And you wouldn't call that inflammatory?

It's not about your pay per se (free surgery you provide are admirable). It's about how you make the reform bill (and the support necessary to get it passed) sound like it's the stupidest thing you have ever heard. I presume it's because of the addition tax that will be used to materialize the reform; i wouldn't like it either. BUT does that warrant opposing the entire bill simply for the sake of opposing it?

The whole heath system is in very bad shape; you probably know that better than i do. If that puts me in your category of "ObamaCare Believers," then BITE IT!

(Please reconsider censoring my previous post; the TX & Medicare stats are important indicators.)

Anonymous said...

Hi buckeye, this is anon 7.25. I didn't write that second remark.

My point was that doctors blame everything on everybody else, and they still feel hard done by!

Don't see how that's trolling.

Anonymous said...

Selective censorship - interesting.

FYI, in Europe, government limits the amount an individual can sue his/her doctor for less-optimal procedural outcomes. With a gov-backed payment system, American insurance company would have less leverage to keep raising the cost of malpractice insurance (eg Ob/Gyn). Net result: less financial stress for the hospital resulting in better payment for doctors and hospital staff.

For whatever the reason - unless the reform bill genuinely sucks - please reconsider your opposition and its long-term ramification.

Anonymous said...

* 1/4 of Texans are without insurance.

* Medicare is projected to run dry by 2017.

-----------------------------

Appreciate it, doc.

Anonymous said...

My apologies for

indeed being inflammatory at times, Dr. Parks.

John said...

Over at Movin' Meat he had a perfect example of how the current system drives up costs because of misplaced incentives.

http://allbleedingstops.blogspot.com/2009/07/drawing-line.html

Emergency departments are required to accept all patients so an on-call doctor simply referred the patient to the ED rather than interrupt his weekend to see him.

Anonymous said...

That's your boy.

Anonymous said...

Medicare pays $233-$268 for a tonsillectomy depending on age and whether adenoids are also taken. This is the payment for the surgery as well as all f/u. You could do tonsillectomies all day and barely pay a typical offices overhead, let alone actually earn a living.