Speak to Me

The name of the conference is \”Putting Patients First.\”  So how can we have the audacity to say that we stand for patients without having patients on the panel?  Aren\’t we just going to beat the drum of our own self-interest but do it in the guise of speaking on the behalf of the patient?
The danger is there.

I won\’t pretend that I don\’t have some selfish reasons to enter the healthcare debate.  I make my living off the system and a seriously flawed plan could significantly decrease my income.  I don\’t want to earn less.  Is that selfish?  Of course it is!

So to make sure that I don\’t go too far in that direction and so that I don\’t have mistaken ideas of the patients\’ perspectives, I want to open the floor for discussion.  I want to hear from patients, doctors, patient advocates, economists, llamas, mascots, and anyone else with opinions on the subject.  I will only say what I believe, but I am very open to change what I believe, understanding that what I think is based on my own limited experience.

I am very happy that folks like Duncan Cross will be at the conference and e-Patient Dave and others are wanting to contribute their opinion (this post stemmed from a Twitter conversation with Dave and others).  This is what keeps us honest.  I do intend on representing patients and feel that I have a lot to contribute on this issue.  I see thousands of people each month and have a wide range of experience with people\’s problems with our system.  I really get angry when I see suffering as a result of the stupidity of our system; I have enough to deal with from the usual causes of suffering.  Our system is supposed to make things better, but it often does the opposite.

If you want to know where I come from, you can read the following:

  • Contrary to what you may hear, Medicare is highly flawed.  Dear Mr. President, Medicare Stinks
  • Healthcare is about doctor-patient interaction.  The system must maximize this.  The Oncoming Train.
  • Uninsured patients are a huge problem.  The UninsuredSince You Asked, The Uninsurable (3-Part)
  • We need to stop paying for what doesn\’t work.  Evidence
  • Not paying for unproven and/or ineffective treatments does not equal rationing.  Rationing
  • The current system makes docs decide between good care of patients and a better income.  All of us have compromised on this, and most of us feel very uncomfortable with that fact.  Temptation
  • The lack of communication within our system is killing people.  Blind Medicine
  • We can\’t leave decision-making to politicians and special interest groups.  We will all need healthcare at some point, and we need to shape reform based on people, not politics.  Radical Moderation
  • Those who represent us are not like us.  They won\’t be hurt if they make the system worse, and they don\’t really know what goes on in real life.  We need to advocate for ourselves.  Why Blogging Matters
  • Trusting the insurance industry to fix the problem is the pinnacle of stupidity.  Rabid Wolves
  • Primary Care is central to reform, but usually gets left out.  Can I Play?
  • Epileptic emu farmers from Canada sometimes fret over windmills.  Return of the Llamas

That\’s a lot of reading, I know.  Pick and choose.  The bottom-line is that I don\’t care how the system gets fixed; I just want that fix to be what is best for the patients I take care of – one that lets me take the best care of them possible.

What do YOU think I need to address when in Washington?  You don\’t have to agree with my opinions.  I want to know.

138 thoughts on “Speak to Me”

  1. The incentive for insurers to drop patients for short term gains in stock prices has to be removed. In practice, the only way this can be removed is with a strong public option. Patients need access to moderately expensive treatments (say the $15K a year a MS patient needs to stay healthy). If we get this, then we’ll avoid situations where failure to provide maintenance care leads to extreme, and extremely expensive, care once complications develop.

  2. The incentive for insurers to drop patients for short term gains in stock prices has to be removed. In practice, the only way this can be removed is with a strong public option. Patients need access to moderately expensive treatments (say the $15K a year a MS patient needs to stay healthy). If we get this, then we’ll avoid situations where failure to provide maintenance care leads to extreme, and extremely expensive, care once complications develop.

  3. Man, you’re quick. :–)
    To be clear, I wasn’t at all suggesting that “you” (collectively / generically) would be banging “your” own drum(s). My point was that discussing “putting X first,” is likely to go differently depending on whether there’s any X present in the discussion.

    I hope to read your slew of links later, but for the moment I’ll capture one item that arose just now in our tweetstream:

    If I were there, for one thing I’d ask the slated policy expert, Robert Goldberg of the Center for Medicine in the Public Interest (who SourceWatch says is a pharma front group), if he still feels as he said in January 2008: “Internet health searches are dangerous to public health” http://is.gd/1waKh. Gunther Eysenbach, organizer of the Medicine 2.0 conference (Toronto, September), did a multi-year study that found zero cases of “death by googling,” and I wonder how Goldberg would reconcile that, or if he feels differently now. (Eysenbach’s finding is reported in chapter 2 of the e-Patient White Paper http://is.gd/1wbJG. He’s no slouch; he’s also publisher of the Journal of Medical Internet Research.

    But that’s a side question; mostly I’d listen for the stated topic (clinical impact of health care reform, which in the title is equated with putting patients first). The description says ” Topics covered will include key barriers to health care quality, affordability, and access as well as the potential pitfalls of a new public plan and ways to fix the current system without investing billions in a new one” and I’d listen for ways to contribute to that discussion. So it’s hard to know in advance what I’d say.

    But let’s hear what others would want to have heard.

    It’s GREAT that you’re soliciting these comments. You ROCK. This is definitely not the same as being there, but it’s a great step in a great direction.

  4. Man, you’re quick. :–)
    To be clear, I wasn’t at all suggesting that “you” (collectively / generically) would be banging “your” own drum(s). My point was that discussing “putting X first,” is likely to go differently depending on whether there’s any X present in the discussion.

    I hope to read your slew of links later, but for the moment I’ll capture one item that arose just now in our tweetstream:

    If I were there, for one thing I’d ask the slated policy expert, Robert Goldberg of the Center for Medicine in the Public Interest (who SourceWatch says is a pharma front group), if he still feels as he said in January 2008: “Internet health searches are dangerous to public health” http://is.gd/1waKh. Gunther Eysenbach, organizer of the Medicine 2.0 conference (Toronto, September), did a multi-year study that found zero cases of “death by googling,” and I wonder how Goldberg would reconcile that, or if he feels differently now. (Eysenbach’s finding is reported in chapter 2 of the e-Patient White Paper http://is.gd/1wbJG. He’s no slouch; he’s also publisher of the Journal of Medical Internet Research.

    But that’s a side question; mostly I’d listen for the stated topic (clinical impact of health care reform, which in the title is equated with putting patients first). The description says ” Topics covered will include key barriers to health care quality, affordability, and access as well as the potential pitfalls of a new public plan and ways to fix the current system without investing billions in a new one” and I’d listen for ways to contribute to that discussion. So it’s hard to know in advance what I’d say.

    But let’s hear what others would want to have heard.

    It’s GREAT that you’re soliciting these comments. You ROCK. This is definitely not the same as being there, but it’s a great step in a great direction.

  5. Agree. I also think that getting them out of “managing care” is important. If they are simply insurance companies, then decisions are actuarial. As it stands, they can manipulate the “managing care” into maximizing profits. IT plays a vital role in this, as the only measure of care we have is through insurance claims. If we can directly measure care, we can know what we are spending. Until that happens, it will be very hard to save money.

  6. Agree. I also think that getting them out of “managing care” is important. If they are simply insurance companies, then decisions are actuarial. As it stands, they can manipulate the “managing care” into maximizing profits. IT plays a vital role in this, as the only measure of care we have is through insurance claims. If we can directly measure care, we can know what we are spending. Until that happens, it will be very hard to save money.

  7. It’s not too late for you to add patient(s) to the program. While I appreciate soliciting patient opinions, it would still be secondhand, and through a filter.
    I don’t think most doctors would appreciate or understand a patient-oriented conference on “Communicating With Our Doctors” that excluded doctors. Even if panel participants asked doctors to communicate their concerns to them directly, and the patients would then make sure the doctor’s concerns were well represented at the conference.

    Unfortunately, I think this is an example of exactly what the patient community — and patient advocates in particular — are struggling to overcome: the well-intentioned but ultimately misguided idea that what patients need, and how to put us first is something that can be figured out, decided and agreed upon by doctors…alone, and without input from actual patients themselves.

    And while I appreciate that doctors are, at times, themselves patients, they are not a good cross-section representation of the general community of patients, nor do they likely experience the medical system and medical professionals in the same way as a patient who is not a medical professional.

  8. But the reality of this–and why there is so much stink in Washington–is that everybody is going to have to give up things they currently benefit from. Patients need to give up the notion that they should always have access to extreme patients; family members need to give up the notion that loved ones will live forever; doctors are going to have to give up some pay, because the only way to do this is via a national system; insurers will have to give up some, though certainly not all, of their profits; hospitals will have to give up indigent care funding; and drug companies will have to give up the rarely used, but super expensive, drugs that only the most sick take.
    In return, people will get different things. Patients will be more employable, because any sort of national plan reduces differences in employer costs. Doctors will get to do their jobs again, and won’t have to spend half the day arguing with an actuary. Hospitals will get paid for far more of the services that they provide, and reduced bill collection costs. Insurers will get more customers, though they’ll be making far less per customer. Likewise, drug companies will get more users of maintenance medication.

    The point is no one is going to totally get their way if the big problems are actually addressed by Congress. The problem is that everyone is going off on a tangent and arguing against things they’d hate. And if the groups which are complaining succeed, reform basically fails.

  9. It’s not too late for you to add patient(s) to the program. While I appreciate soliciting patient opinions, it would still be secondhand, and through a filter.
    I don’t think most doctors would appreciate or understand a patient-oriented conference on “Communicating With Our Doctors” that excluded doctors. Even if panel participants asked doctors to communicate their concerns to them directly, and the patients would then make sure the doctor’s concerns were well represented at the conference.

    Unfortunately, I think this is an example of exactly what the patient community — and patient advocates in particular — are struggling to overcome: the well-intentioned but ultimately misguided idea that what patients need, and how to put us first is something that can be figured out, decided and agreed upon by doctors…alone, and without input from actual patients themselves.

    And while I appreciate that doctors are, at times, themselves patients, they are not a good cross-section representation of the general community of patients, nor do they likely experience the medical system and medical professionals in the same way as a patient who is not a medical professional.

  10. But the reality of this–and why there is so much stink in Washington–is that everybody is going to have to give up things they currently benefit from. Patients need to give up the notion that they should always have access to extreme patients; family members need to give up the notion that loved ones will live forever; doctors are going to have to give up some pay, because the only way to do this is via a national system; insurers will have to give up some, though certainly not all, of their profits; hospitals will have to give up indigent care funding; and drug companies will have to give up the rarely used, but super expensive, drugs that only the most sick take.
    In return, people will get different things. Patients will be more employable, because any sort of national plan reduces differences in employer costs. Doctors will get to do their jobs again, and won’t have to spend half the day arguing with an actuary. Hospitals will get paid for far more of the services that they provide, and reduced bill collection costs. Insurers will get more customers, though they’ll be making far less per customer. Likewise, drug companies will get more users of maintenance medication.

    The point is no one is going to totally get their way if the big problems are actually addressed by Congress. The problem is that everyone is going off on a tangent and arguing against things they’d hate. And if the groups which are complaining succeed, reform basically fails.

  11. Right. You’d be surprised at how much care that is paid for is not necessary. It’s more than people think. Feeding tubes are minor compared to doing cardiac caths and stents on these people. Every doc could probably contribute their list of incredible waste.

  12. Right. You’d be surprised at how much care that is paid for is not necessary. It’s more than people think. Feeding tubes are minor compared to doing cardiac caths and stents on these people. Every doc could probably contribute their list of incredible waste.

  13. I can’t seem to reply above. Feeding tubes cost much more than the $2,000 or so Medicare pays for the procedure. Assuming the patient lives in a nursing home, you’re looking at a total cost to the system of well over $100,000 for the feeding tube. Say a patient lives three years with a feeding tube when they’d otherwise die in three months. The feeding tube is costing the system an additional $137,500 in unneeded care which provides zero quality of life. Heck a patient might live 5 years, at a cost of a quarter of a million dollars to the system (usually Medicaid).

  14. The flip-side is that doctors see the experience of thousands of patients, while patients only know their own experience. Advocates tend to gather those who are hurt by the system. In some ways, docs have the best vantage point of all.
    That is not to say that the other voices are not of equal value. We need to work together, each giving our opinion and giving a combined perspective. It is the only way for hope of success. I look forward to seeing you in DC.

  15. I can’t seem to reply above. Feeding tubes cost much more than the $2,000 or so Medicare pays for the procedure. Assuming the patient lives in a nursing home, you’re looking at a total cost to the system of well over $100,000 for the feeding tube. Say a patient lives three years with a feeding tube when they’d otherwise die in three months. The feeding tube is costing the system an additional $137,500 in unneeded care which provides zero quality of life. Heck a patient might live 5 years, at a cost of a quarter of a million dollars to the system (usually Medicaid).

  16. The flip-side is that doctors see the experience of thousands of patients, while patients only know their own experience. Advocates tend to gather those who are hurt by the system. In some ways, docs have the best vantage point of all.
    That is not to say that the other voices are not of equal value. We need to work together, each giving our opinion and giving a combined perspective. It is the only way for hope of success. I look forward to seeing you in DC.

  17. Yes. I am not saying feeding tubes aren’t a big deal at all. You ARE right on that. My point is that for every 1 feeding tube, there are 20 unnecessary cardiac caths. I had an alzheimer patient who was admitted and worked up for pulmonary embolus – CT scans, angiograms, ICU visit. Then there are the people with 20% lesions getting stents. M’care pays for them! Cardiologists, stent manufacturers, and drug companies love this. Hospitals make $$. It is simply wrong.
    We agree on this. I am just adding more insult to the injury.

  18. Yes. I am not saying feeding tubes aren’t a big deal at all. You ARE right on that. My point is that for every 1 feeding tube, there are 20 unnecessary cardiac caths. I had an alzheimer patient who was admitted and worked up for pulmonary embolus – CT scans, angiograms, ICU visit. Then there are the people with 20% lesions getting stents. M’care pays for them! Cardiologists, stent manufacturers, and drug companies love this. Hospitals make $$. It is simply wrong.
    We agree on this. I am just adding more insult to the injury.

  19. Everyone has an agenda, even professional patient advocates. We’re all fortunate as physicians and patients to have someone willing to take a day out of their practice to speak for every one of us.

  20. Everyone has an agenda, even professional patient advocates. We’re all fortunate as physicians and patients to have someone willing to take a day out of their practice to speak for every one of us.

  21. I believe that. I was in the ER stall once when a cardiac arrest patient came in next to me. She was 85, had a previous DNR order, which the nursing home convinced her family to change so “we can give her the care she needs.” So the EMTs revived her, the docs saved her, and prolonged her life all so the nursing home could rake in the dough.

  22. I believe that. I was in the ER stall once when a cardiac arrest patient came in next to me. She was 85, had a previous DNR order, which the nursing home convinced her family to change so “we can give her the care she needs.” So the EMTs revived her, the docs saved her, and prolonged her life all so the nursing home could rake in the dough.

  23. Doctors don’t see it all though. The patient who drops out because they can’t afford treatment just disappears. The doctors generally aren’t there when patients are in wrenching pain but debating going to the ER due to the bill. I can’t think of a single example I’ve heard of a doctor with a patient who dropped out calling the patient up at random and seeing if things are OK. There’s a temptation to say “things worked,” when in reality it might be a total failure.

  24. Doctors don’t see it all though. The patient who drops out because they can’t afford treatment just disappears. The doctors generally aren’t there when patients are in wrenching pain but debating going to the ER due to the bill. I can’t think of a single example I’ve heard of a doctor with a patient who dropped out calling the patient up at random and seeing if things are OK. There’s a temptation to say “things worked,” when in reality it might be a total failure.

  25. I love this dialog. I’m learning.
    What did we do before social media??

    We certainly didn’t connect and hear each other was much as we do now.

  26. I love this dialog. I’m learning.
    What did we do before social media??

    We certainly didn’t connect and hear each other was much as we do now.

  27. I replied to DrV’s great post about this http://is.gd/1wgeM … good discussion happening there, too. Excerpt:

    Somebody mentioned that many patient advocates arose out of being injured by the system one way or another. I wasn’t – my life was saved by great docs. I *love* great healthcare. My motivation isn’t to tear anything down, it’s to do what I can in my “free replay on life” to help all patients (including d-patients) get access to the best care they possibly can.

    That’s why I’m more than glad to be learning from this exchange. It ain’t about docs vs pts, in my view – it’s about participatory medicine, collaboration, partnership.

    In fact one of my first blog posts ever, after learning about e-patient movement, was “Don’t be a jerk to your partner.” (http://is.gd/1wg5i)

  28. I replied to DrV’s great post about this http://is.gd/1wgeM … good discussion happening there, too. Excerpt:

    Somebody mentioned that many patient advocates arose out of being injured by the system one way or another. I wasn’t – my life was saved by great docs. I *love* great healthcare. My motivation isn’t to tear anything down, it’s to do what I can in my “free replay on life” to help all patients (including d-patients) get access to the best care they possibly can.

    That’s why I’m more than glad to be learning from this exchange. It ain’t about docs vs pts, in my view – it’s about participatory medicine, collaboration, partnership.

    In fact one of my first blog posts ever, after learning about e-patient movement, was “Don’t be a jerk to your partner.” (http://is.gd/1wg5i)

  29. Looking at all these comments and those on my post, most sensible voices are those of Rob and e-patient Dave who agree that we all need to talk. We really are all on the same page.

  30. Looking at all these comments and those on my post, most sensible voices are those of Rob and e-patient Dave who agree that we all need to talk. We really are all on the same page.

  31. I actually thought of you when I wrote this and thought the same. The problem isn’t evil cardiologists, hospitals, and stent manufacturers, however, it is a system that rewards consumption. Insurance companies are not evil for wanting to maximize their profits; they are doing what their shareholders demand. The problem is in a system that is set up to reward consumption of resources. We get what we pay for.
    Knowing you did EP did help as well.

  32. I actually thought of you when I wrote this and thought the same. The problem isn’t evil cardiologists, hospitals, and stent manufacturers, however, it is a system that rewards consumption. Insurance companies are not evil for wanting to maximize their profits; they are doing what their shareholders demand. The problem is in a system that is set up to reward consumption of resources. We get what we pay for.
    Knowing you did EP did help as well.

  33. Kim of Emergiblog will be on the panel. Don’t feel bad that I have more jokes at the expense of llamas than nurses. However, you could say what YOUR concerns are…

  34. Kim of Emergiblog will be on the panel. Don’t feel bad that I have more jokes at the expense of llamas than nurses. However, you could say what YOUR concerns are…

  35. Hey Dr. Rob,You said you don’t know anyone who is happy with their current insurance. I gotta say – I’m fine with mine. Seriously. I have Independence Blue Cross, a PPO plan. The contract is basically clear as far as what they cover (though I’m sure it becomes more vague when you get into things that could be called experimental, such as advanced cancer treatments etc – I can’t speak to that) and while I think it sucks that it’s so expensive, at the same time, they do cover what they state they will cover at the rate that they claim they will cover it, and they do pay for expensive things like CT (my daughter had one when a large book fell on her head and caused a laceration with hematoma when she was 3 weeks old!) and MRI (I had one as part of a diagnostic workup for hip pain that lasted >1 yr) and emergency services (like when my husband almost cut his finger off with a bread knife) so I’m not liable for those costs. I can see whatever doctor I like – assuming he or she is taking patients. My biggest beef is I can’t find a generalist to save my life. My OB/GYN is sick of me asking him to handle my strep throat or my needing a rabies titer or my migraines. My husband doesn’t have any doctor to see. I just want a regular doctor to call when I or my husband is ill or has something going on. I can’t get one. It’s not the insurance – at least, it’s not MY insurance – all the docs accept my insurance – it’s just that there is no one in my neighborhood accepting new patients. Actually the one thing my insurance company did that pissed me off more than anything else was that they paid a fraudulent claim from the hospital where I had my kids. The hospital billed them for labor anesthesia, including IV catheterization, IV fluids, epidural anesthesia, etc etc – I had *none* of that. In fact, my doc had instructed the staff to leave me alone til I asked for help, and no one came in til I told I passing nurse the baby was coming now. The baby was then immediately born into the hands of a freaked out med student (ungloved). I saw the EOB and freaked out at what had been billed for and paid for. The insurance company told me they didn’t care, it had already been paid, it was too much trouble to try to get it back. THAT is what is wrong with the system!!

  36. Hey Dr. Rob,You said you don’t know anyone who is happy with their current insurance. I gotta say – I’m fine with mine. Seriously. I have Independence Blue Cross, a PPO plan. The contract is basically clear as far as what they cover (though I’m sure it becomes more vague when you get into things that could be called experimental, such as advanced cancer treatments etc – I can’t speak to that) and while I think it sucks that it’s so expensive, at the same time, they do cover what they state they will cover at the rate that they claim they will cover it, and they do pay for expensive things like CT (my daughter had one when a large book fell on her head and caused a laceration with hematoma when she was 3 weeks old!) and MRI (I had one as part of a diagnostic workup for hip pain that lasted >1 yr) and emergency services (like when my husband almost cut his finger off with a bread knife) so I’m not liable for those costs. I can see whatever doctor I like – assuming he or she is taking patients. My biggest beef is I can’t find a generalist to save my life. My OB/GYN is sick of me asking him to handle my strep throat or my needing a rabies titer or my migraines. My husband doesn’t have any doctor to see. I just want a regular doctor to call when I or my husband is ill or has something going on. I can’t get one. It’s not the insurance – at least, it’s not MY insurance – all the docs accept my insurance – it’s just that there is no one in my neighborhood accepting new patients. Actually the one thing my insurance company did that pissed me off more than anything else was that they paid a fraudulent claim from the hospital where I had my kids. The hospital billed them for labor anesthesia, including IV catheterization, IV fluids, epidural anesthesia, etc etc – I had *none* of that. In fact, my doc had instructed the staff to leave me alone til I asked for help, and no one came in til I told I passing nurse the baby was coming now. The baby was then immediately born into the hands of a freaked out med student (ungloved). I saw the EOB and freaked out at what had been billed for and paid for. The insurance company told me they didn’t care, it had already been paid, it was too much trouble to try to get it back. THAT is what is wrong with the system!!

  37. Just to be clear – the intent of the press conference was to give medical bloggers an opportunity to speak directly to politicians inside the beltway about their healthcare reform concerns. I invited medbloggers who have been the most outspoken about reform, and who have the largest reach – but sadly I couldn’t include as many people as I’d like due to budget constraints, etc.
    The conference needed a name – so as I thought about what medbloggers really wanted to communicate, it seemed to me that we cared most about putting our patients first, and that this message often got lost in the “who’s going to pay” arguments.

    The spirit of the conference is about expressing the need to preserve the patients’ right to choose (along with their providers’ advice and input) the best path for their care. It was never my intention to exclude patients from the conference in any way – patients and physicians/nurses are each others best allies, and we need to stick together!

    I will see if I can include a patient medblogger to add some balance – my apologies for any upset that this might have caused!

    Yours in the struggle for quality, affordable, healthcare for all,

    Val

  38. Just to be clear – the intent of the press conference was to give medical bloggers an opportunity to speak directly to politicians inside the beltway about their healthcare reform concerns. I invited medbloggers who have been the most outspoken about reform, and who have the largest reach – but sadly I couldn’t include as many people as I’d like due to budget constraints, etc.
    The conference needed a name – so as I thought about what medbloggers really wanted to communicate, it seemed to me that we cared most about putting our patients first, and that this message often got lost in the “who’s going to pay” arguments.

    The spirit of the conference is about expressing the need to preserve the patients’ right to choose (along with their providers’ advice and input) the best path for their care. It was never my intention to exclude patients from the conference in any way – patients and physicians/nurses are each others best allies, and we need to stick together!

    I will see if I can include a patient medblogger to add some balance – my apologies for any upset that this might have caused!

    Yours in the struggle for quality, affordable, healthcare for all,

    Val

  39. I don’t agree with the premise that somehow, information from patient advocates is “tainted” or less valuable in some way because we hear more from patients who have problems, versus those who have no complaints.
    When doctors sit down for a Morbidity and Mortality conference, they don’t talk about all the cases that went well and all the patients who were discharged without anything notable happening, and the routine successful surgeries. The idea is to learn from the mistakes, and to then apply what has been learned so that future mistakes can be avoided.

    Mistakes are being singled out for study in an M&M conference. It’s a filtering process that IDs problems, and looks for solutions.

    Patient advocates function in somewhat the same way. We of course do not just solicit/hear stories of problems, but frequently it does happen that we hear more about the negatives, and not the things that went right. We hear about things that are not working. And we hear it direct from the system’s customers.

    And when as patient advocates we hear the same complaints, time and again, about various aspects of the medication system, from hundreds, and even thousands of patients — that’s usually a good sign that some things are clearly not working.

    We hear all about problems with the health care system — from the macro level of health care as a whole, down to one-on-one communications problems between individual doctors and patients.

    Anyone can organize a conference however they want, as their prerogative. But the fact is, creating a “Putting Patients First” conference, and not including patients as an active, first-hand part of the discussion — makes the conference title rather oxymoronic.

  40. I don’t agree with the premise that somehow, information from patient advocates is “tainted” or less valuable in some way because we hear more from patients who have problems, versus those who have no complaints.
    When doctors sit down for a Morbidity and Mortality conference, they don’t talk about all the cases that went well and all the patients who were discharged without anything notable happening, and the routine successful surgeries. The idea is to learn from the mistakes, and to then apply what has been learned so that future mistakes can be avoided.

    Mistakes are being singled out for study in an M&M conference. It’s a filtering process that IDs problems, and looks for solutions.

    Patient advocates function in somewhat the same way. We of course do not just solicit/hear stories of problems, but frequently it does happen that we hear more about the negatives, and not the things that went right. We hear about things that are not working. And we hear it direct from the system’s customers.

    And when as patient advocates we hear the same complaints, time and again, about various aspects of the medication system, from hundreds, and even thousands of patients — that’s usually a good sign that some things are clearly not working.

    We hear all about problems with the health care system — from the macro level of health care as a whole, down to one-on-one communications problems between individual doctors and patients.

    Anyone can organize a conference however they want, as their prerogative. But the fact is, creating a “Putting Patients First” conference, and not including patients as an active, first-hand part of the discussion — makes the conference title rather oxymoronic.

  41. AMERICA’S NATIONAL HEALTHCARE EMERGENCY!
    It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

    STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

    We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

    And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

    Progressive democrats the Tri-Caucus and others should stand firm in their demand for a robust government-run public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

    Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

    In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

    If President Obama has to declare a NATIONAL STATE OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He’s doing a brilliant job.

    THIS IS THE BIG ONE!

    THE BATTLE OF GOOD Vs EVIL!

    Join the fight.

    Contact congress and your representatives NOW! AND SPREAD THE WORD!

    (http://action.firedoglake.com/page/s/publicoption) (http://www.actblue.com/page/healthcareheroes)

    God Bless You

    Jacksmith – WORKING CLASS

  42. OK, I put my foot in my mouth a little with that comment. It shows that I don’t understand patient advocates well.
    The bottom line, however, is that no single perspective gets the whole perspective. The whole of healthcare is the doctor/patient interaction. All of the perspectives are important.

  43. AMERICA’S NATIONAL HEALTHCARE EMERGENCY!
    It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

    STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

    We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

    And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

    Progressive democrats the Tri-Caucus and others should stand firm in their demand for a robust government-run public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

    Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

    In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

    If President Obama has to declare a NATIONAL STATE OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He’s doing a brilliant job.

    THIS IS THE BIG ONE!

    THE BATTLE OF GOOD Vs EVIL!

    Join the fight.

    Contact congress and your representatives NOW! AND SPREAD THE WORD!

    (http://action.firedoglake.com/page/s/publicoption) (http://www.actblue.com/page/healthcareheroes)

    God Bless You

    Jacksmith – WORKING CLASS

  44. OK, I put my foot in my mouth a little with that comment. It shows that I don’t understand patient advocates well.
    The bottom line, however, is that no single perspective gets the whole perspective. The whole of healthcare is the doctor/patient interaction. All of the perspectives are important.

  45. Duncan and Mary will be there. The dialogue is the most important thing. We have an opportunity we wouldn’t have had. Val deserves huge kudos for getting this going at all.
    Val, don’t see criticism as a sign that you dropped the ball. Yawns are a far worse thing to see. People are talking about this meeting A LOT. That is a good thing.

  46. Duncan and Mary will be there. The dialogue is the most important thing. We have an opportunity we wouldn’t have had. Val deserves huge kudos for getting this going at all.
    Val, don’t see criticism as a sign that you dropped the ball. Yawns are a far worse thing to see. People are talking about this meeting A LOT. That is a good thing.

  47. A previous commenter asked “Why can’t doctors just tell families that their loved one is very sick and going to die rather than offering the a la carte DNR/treatment menu?” Amen sister. I have long wondered this. I mean, intellectually, I think I know the answer. I think the answer is, doctors can’t/won’t refuse treatment, even if they think the treatment is not recommended, because for whatever reason, our legal system is set up such that to do so is to become the target of a lawsuit. As a practicing veterinarian, if I have a patient who is super-elderly (think 25 year old cat), in end-stage renal failure, with advanced hypertrophic cardiomyopathy, who is being managed with a carefully tailored cocktail of blood pressure meds, fluids, and dietary interventions on an outpatient basis, and who then presents with multicentric lymphoma and aspiration pneumonia (just for example), I personally feel extremely comfortable telling the owner “I understand you really want what’s best for Fluffy, and therefore no, I am not going to start chemotherapy and inpatient IV antibiotics, as much as you seem to want me to. Fluffy has reached the end of her life and it is time to let her go. I can offer palliative care, up to and including euthanasia, at this point. If you disagree with my recommendations, and want to pursue aggressive treatment despite the extremely poor prognosis, here are some phone numbers and you can feel free to call from the waiting room or parking lot while one of my nurses watches over Fluffy if you like, but I will not be continuing aggressive therapy. You can stay in the exam room with Fluffy and think about it for a bit if you like, too. I’m so sorry.”So, I have thought when I hear about these super-elderly people undergoing these absurdly futile procedures – why hasn’t some physician somewhere, or some ethics committee, or SOMETHING, stepped up to the plate and said “no. This is inhumane. We vowed to first do no harm. It is a harm to this 102 year old gentleman, who has congestive heart failure, renal failure, and moderately advanced dementia, to put in a feeding tube, or to hook him up to a ventilator while we try to get a grip on his pneumonia. We are advocating for our patients and fulfilling our oaths and if you, the family, insist he be treated, then find another physician because we are not doing it.” I do not think I could practice in a world where I could not be that kind of advocate for my own patients (though it seems to have been advancing on veterinarians – so far we can still exercise reason and adhere to our own code of ethics).

  48. A previous commenter asked “Why can’t doctors just tell families that their loved one is very sick and going to die rather than offering the a la carte DNR/treatment menu?” Amen sister. I have long wondered this. I mean, intellectually, I think I know the answer. I think the answer is, doctors can’t/won’t refuse treatment, even if they think the treatment is not recommended, because for whatever reason, our legal system is set up such that to do so is to become the target of a lawsuit. As a practicing veterinarian, if I have a patient who is super-elderly (think 25 year old cat), in end-stage renal failure, with advanced hypertrophic cardiomyopathy, who is being managed with a carefully tailored cocktail of blood pressure meds, fluids, and dietary interventions on an outpatient basis, and who then presents with multicentric lymphoma and aspiration pneumonia (just for example), I personally feel extremely comfortable telling the owner “I understand you really want what’s best for Fluffy, and therefore no, I am not going to start chemotherapy and inpatient IV antibiotics, as much as you seem to want me to. Fluffy has reached the end of her life and it is time to let her go. I can offer palliative care, up to and including euthanasia, at this point. If you disagree with my recommendations, and want to pursue aggressive treatment despite the extremely poor prognosis, here are some phone numbers and you can feel free to call from the waiting room or parking lot while one of my nurses watches over Fluffy if you like, but I will not be continuing aggressive therapy. You can stay in the exam room with Fluffy and think about it for a bit if you like, too. I’m so sorry.”So, I have thought when I hear about these super-elderly people undergoing these absurdly futile procedures – why hasn’t some physician somewhere, or some ethics committee, or SOMETHING, stepped up to the plate and said “no. This is inhumane. We vowed to first do no harm. It is a harm to this 102 year old gentleman, who has congestive heart failure, renal failure, and moderately advanced dementia, to put in a feeding tube, or to hook him up to a ventilator while we try to get a grip on his pneumonia. We are advocating for our patients and fulfilling our oaths and if you, the family, insist he be treated, then find another physician because we are not doing it.” I do not think I could practice in a world where I could not be that kind of advocate for my own patients (though it seems to have been advancing on veterinarians – so far we can still exercise reason and adhere to our own code of ethics).

  49. doc_rob,You are to be commended for your swift action to collaborate and lead others on this sensitive topic. I have no doubt your voice will be strong and steady and represent the many who follow you.

    Kathy Mackey
    @mkmackey

  50. doc_rob,You are to be commended for your swift action to collaborate and lead others on this sensitive topic. I have no doubt your voice will be strong and steady and represent the many who follow you.

    Kathy Mackey
    @mkmackey

  51. I think Rob summed it up perfectly. It’s not criticism. We patient advocates are simply making a bid for connection, interaction and inclusion.
    I will be there…

  52. I think Rob summed it up perfectly. It’s not criticism. We patient advocates are simply making a bid for connection, interaction and inclusion.
    I will be there…

  53. Val,
    As Rob suggests, my tweeting is what started this. You know my opinions on this stuff, and I hope this superb dialog (and my private note to you) illustrates that I try to engage and discuss, not *just* rant. (I do rant sometimes, and this started as something of a rant, but I guess the proof of the pudding is in what happens when people try to engage.

    Personally, I think the discussion here and on DrV is an instant classic – it’s going into my De.li.ci.ous heap. Good to see you here.

  54. Val,
    As Rob suggests, my tweeting is what started this. You know my opinions on this stuff, and I hope this superb dialog (and my private note to you) illustrates that I try to engage and discuss, not *just* rant. (I do rant sometimes, and this started as something of a rant, but I guess the proof of the pudding is in what happens when people try to engage.

    Personally, I think the discussion here and on DrV is an instant classic – it’s going into my De.li.ci.ous heap. Good to see you here.

  55. Yes. That is truly a story of a system that is messed up. I have always had a hard time with hospitals’ billing practices.

  56. Yes. That is truly a story of a system that is messed up. I have always had a hard time with hospitals’ billing practices.

  57. I’ve posted in a zillion places (ok, slight hyperbole) that this should never be an “us vs. them” debate. Dr. Val, I wanted you to know I really appreciate your response on this and Doctor V’s blog post. It really puts it all into perspective.
    As for a lot of other things I would say, others have said it marvelously. I don’t need to repeat them. The fact that both doctors and patients are so defensive speaks to a history of problems that are not totally of any one faction’s making. Sometimes we are dealt a lousy hand and have to figure a way to use it.

    Most of all, the dialogue is such a huge improvement from just a year ago. I don’t know if you can see it, but I can. When I step back to look, I have hope.

    Thank you all for the positive, good efforts.

  58. I’ve posted in a zillion places (ok, slight hyperbole) that this should never be an “us vs. them” debate. Dr. Val, I wanted you to know I really appreciate your response on this and Doctor V’s blog post. It really puts it all into perspective.
    As for a lot of other things I would say, others have said it marvelously. I don’t need to repeat them. The fact that both doctors and patients are so defensive speaks to a history of problems that are not totally of any one faction’s making. Sometimes we are dealt a lousy hand and have to figure a way to use it.

    Most of all, the dialogue is such a huge improvement from just a year ago. I don’t know if you can see it, but I can. When I step back to look, I have hope.

    Thank you all for the positive, good efforts.

  59. I think a fair few of Dr Rob’s links in this post are links to previous entries in this blog, so if you’ve been reading it for a year or so, there’s no specific need to chase them except as an aide memoire.

  60. I think a fair few of Dr Rob’s links in this post are links to previous entries in this blog, so if you’ve been reading it for a year or so, there’s no specific need to chase them except as an aide memoire.

  61. I see where you’re coming from having had a grandmother with pretty severe Alzheimer’s, and my father having been effectively bed/chair bound for the last year of his life.
    In point of fact, since my grandmother’s death, my family have all given consideration to circumstances where we would wish Do Not Recusitate and No Heroic Measures directives to be applied to our care. Something for which I was actually grateful when my father was admitted to hospital with pneumonia.

    [Change of Subject]
    As far as I can see, this blog only allows 4 levels of nesting, which is usually adequate for it.

  62. I see where you’re coming from having had a grandmother with pretty severe Alzheimer’s, and my father having been effectively bed/chair bound for the last year of his life.
    In point of fact, since my grandmother’s death, my family have all given consideration to circumstances where we would wish Do Not Recusitate and No Heroic Measures directives to be applied to our care. Something for which I was actually grateful when my father was admitted to hospital with pneumonia.

    [Change of Subject]
    As far as I can see, this blog only allows 4 levels of nesting, which is usually adequate for it.

  63. I am a nurse. I can hardly afford to pay for my health insurance “benefit” (I carry my family of four on my insurance), much less afford to actually go to the doctor when I am sick, that is, if I had a doctor. There is something wrong with the fact that I work at a major medical center, pay over $400 a month for my insurance (please explain why it is called an employee “benefit”) yet can’t afford medical/dental/mental health treatment when I (or my family) need it. Physicians extend “professional courtesy” to each other but not to the nurses who make them look good and actually can’t afford to pay. There is also something wrong with the fact that getting a massage or hiring a cleaning service costs more than three times what I make per hour (and I’ve been a nurse for ten years). Nobody dies if my house isn’t spotless or my massage isn’t that great. But I can easily kill someone with a medication error or lapse in judgment. I face a very real risk of exposure (to deadly diseases) every time I show up for work. I am not fairly compensated. I have heard that the biggest part of any hospital budget goes to nursing. Without nurses, you have a clinic, not a hospital. However, society in general and the health care system in particular does not value nurses. When I have a doctor (or family member of a doctor) as a patient, she gets VIP treatment. When I have a nurse as a patient, doctors neither make special efforts nor offer extra attention/concern. It is nothing short of humiliating.
    Docs study hard, work hard and deserve to make a lot of money. But how much is enough? The amount of money doctors make is outrageous compared to the time/effort they give to patients. Doctors could make a little less money and still be doing quite well.

    Most of the patients I care for in the MICU of my major medical research/teaching hospital have no insurance and cannot pay. People who cannot pay deserve the best medicine has to offer, just like people who can pay and at my hospital, they get it. However, we waste hundreds of thousands of dollars in medical care every month doing things like keeping 91 year old patients alive on ventilators, pressors, continuous dialysis, multiple scans/labs/procedures/treatments. And guess what? They almost always end up dying anyway. And those who live generally die within one (qualitatively poor) year. “Do everything” is the common refrain in my ICU. Nobody likes to hear the word “futile.” But what is wrong with our society that we cannot accept death as a natural part of life? Why can’t doctors just tell families that their loved one is very sick and going to die rather than offering the a la carte DNR/treatment menu? Part of the problem is that Americans have way too much religion and way too little science. Part of the problem is the consumer model of medicine that this country has adopted. But the core of the problem, I think, lies in the physician’s fear of a lawsuit (and perhaps in her fear of failure as well).

    Insurance companies are nothing short of criminal. We need universal (government sponsored) health care. I don’t care what it takes to get there. Don’t tell me there isn’t enough money. The money just needs to be spent differently (think war in Iraq). People are dying preventable deaths. And guess what? We’re *already* paying taxes for health care coverage. Wouldn’t it be nice to get some of what we pay for?

  64. I am a nurse. I can hardly afford to pay for my health insurance “benefit” (I carry my family of four on my insurance), much less afford to actually go to the doctor when I am sick, that is, if I had a doctor. There is something wrong with the fact that I work at a major medical center, pay over $400 a month for my insurance (please explain why it is called an employee “benefit”) yet can’t afford medical/dental/mental health treatment when I (or my family) need it. Physicians extend “professional courtesy” to each other but not to the nurses who make them look good and actually can’t afford to pay. There is also something wrong with the fact that getting a massage or hiring a cleaning service costs more than three times what I make per hour (and I’ve been a nurse for ten years). Nobody dies if my house isn’t spotless or my massage isn’t that great. But I can easily kill someone with a medication error or lapse in judgment. I face a very real risk of exposure (to deadly diseases) every time I show up for work. I am not fairly compensated. I have heard that the biggest part of any hospital budget goes to nursing. Without nurses, you have a clinic, not a hospital. However, society in general and the health care system in particular does not value nurses. When I have a doctor (or family member of a doctor) as a patient, she gets VIP treatment. When I have a nurse as a patient, doctors neither make special efforts nor offer extra attention/concern. It is nothing short of humiliating.
    Docs study hard, work hard and deserve to make a lot of money. But how much is enough? The amount of money doctors make is outrageous compared to the time/effort they give to patients. Doctors could make a little less money and still be doing quite well.

    Most of the patients I care for in the MICU of my major medical research/teaching hospital have no insurance and cannot pay. People who cannot pay deserve the best medicine has to offer, just like people who can pay and at my hospital, they get it. However, we waste hundreds of thousands of dollars in medical care every month doing things like keeping 91 year old patients alive on ventilators, pressors, continuous dialysis, multiple scans/labs/procedures/treatments. And guess what? They almost always end up dying anyway. And those who live generally die within one (qualitatively poor) year. “Do everything” is the common refrain in my ICU. Nobody likes to hear the word “futile.” But what is wrong with our society that we cannot accept death as a natural part of life? Why can’t doctors just tell families that their loved one is very sick and going to die rather than offering the a la carte DNR/treatment menu? Part of the problem is that Americans have way too much religion and way too little science. Part of the problem is the consumer model of medicine that this country has adopted. But the core of the problem, I think, lies in the physician’s fear of a lawsuit (and perhaps in her fear of failure as well).

    Insurance companies are nothing short of criminal. We need universal (government sponsored) health care. I don’t care what it takes to get there. Don’t tell me there isn’t enough money. The money just needs to be spent differently (think war in Iraq). People are dying preventable deaths. And guess what? We’re *already* paying taxes for health care coverage. Wouldn’t it be nice to get some of what we pay for?

  65. I’m working on health literacy research at this very moment as it relates to primary healthcare and I can tell you from research but also from personal experience that the main problem I see is that clinicians (nurses, doctors, lab techs, rt’s, etc.) assume that patient’s understand what you are saying to them. Most of the time, we don’t. Have you ever tried applying reading level scales to your informed consent forms and patient education materials? I have and most are at a 10th or 11th grade level. While that’s not an issue for me, it is for the majority of patients and caregivers who require a reading level of 5th to 8th grade. And let’s not even begin to talk about font size! So, here’s an easy start to patient comprehension and compliance… really review your materials and resources for clarity. Have a patient-friend read them before you use them in your office. There’s some really great Word-Substitution websites too if need help.
    I’m also working on cultural compentancy requirements (coming soon from a Joint Commission standard soon…) which is fasinating stuff for me (I have a degree in anthropology) and hopefully will sink in to most that it’s not just about language barriers but how and why’s of bad and good communication. There’s a lot to learn…

  66. I’m working on health literacy research at this very moment as it relates to primary healthcare and I can tell you from research but also from personal experience that the main problem I see is that clinicians (nurses, doctors, lab techs, rt’s, etc.) assume that patient’s understand what you are saying to them. Most of the time, we don’t. Have you ever tried applying reading level scales to your informed consent forms and patient education materials? I have and most are at a 10th or 11th grade level. While that’s not an issue for me, it is for the majority of patients and caregivers who require a reading level of 5th to 8th grade. And let’s not even begin to talk about font size! So, here’s an easy start to patient comprehension and compliance… really review your materials and resources for clarity. Have a patient-friend read them before you use them in your office. There’s some really great Word-Substitution websites too if need help.
    I’m also working on cultural compentancy requirements (coming soon from a Joint Commission standard soon…) which is fasinating stuff for me (I have a degree in anthropology) and hopefully will sink in to most that it’s not just about language barriers but how and why’s of bad and good communication. There’s a lot to learn…

  67. Rob,
    Too often the patient community is left out in discussions of health care reform and it’s time for a change. As luck would have it, this Friday’s bloggers event has the identical name as a National Health Council (NHC) campaign dedicated to Putting Patients First in health care. Made up of more than 100 national health-related organizations, the NHC’s core membership includes 50 of the nation’s leading patient advocacy organizations.

    Our Campaign to Put Patients Firstis a nationwide initiative dedicated to mobilizing people with chronic diseases and disabilities to achieve effective and affordable health care – health care that meets their personal needs and goals. The Campaign is focused on 5 core principles for Putting Patients First ® which will guide our efforts to improve health care in this country.

    We encourage you to check out more information on the Campaign to Put Patients First . We truly believe that it will be the united patient voice that makes a difference in this year’s health care reform debate. In the spirit of this Campaign and in an effort to represent the patient community, the NHC will be attending this bloggers event.

  68. Rob,
    Too often the patient community is left out in discussions of health care reform and it’s time for a change. As luck would have it, this Friday’s bloggers event has the identical name as a National Health Council (NHC) campaign dedicated to Putting Patients First in health care. Made up of more than 100 national health-related organizations, the NHC’s core membership includes 50 of the nation’s leading patient advocacy organizations.

    Our Campaign to Put Patients Firstis a nationwide initiative dedicated to mobilizing people with chronic diseases and disabilities to achieve effective and affordable health care – health care that meets their personal needs and goals. The Campaign is focused on 5 core principles for Putting Patients First ® which will guide our efforts to improve health care in this country.

    We encourage you to check out more information on the Campaign to Put Patients First . We truly believe that it will be the united patient voice that makes a difference in this year’s health care reform debate. In the spirit of this Campaign and in an effort to represent the patient community, the NHC will be attending this bloggers event.

  69. I can’t disagree, although it saddens me to think that this truly is the majority of doctors. There is a degree to which medical professionals need to distance themselves, but the “punch the clock” mentality is really harmful. It is hard to hear the superlatives used (words like “offer ZERO information to their patients”), and I do think most doctors take offense to this. We all know there are idiots, and we all know that each of us carries our own degree of idiocy, but ALL of us are not TOTAL idiots.
    I consider myself a patient-oriented doctor, and I see my patients with affection and sympathy. My personal perspective is unique in this discussion – understanding both sides. I think the key to the entire discussion is to have folks who can understand (to a degree) two sides of the discussion. Instead of saying or implying that docs are idiots, patients are not worth listening to, or nurses are irrelevant, we need to compile perspectives and try to put together something that works.

    I fear that I pay for the sins of my predecessors and my selfish contemporaries. I will do my best.

    It is fun and easy to bash doctors, it seems. The transaction of healthcare is between healthcare professional and patient. Both sides of the equation are vital. Bash too hard and you may scare off those of us who give a damn.

  70. I can’t disagree, although it saddens me to think that this truly is the majority of doctors. There is a degree to which medical professionals need to distance themselves, but the “punch the clock” mentality is really harmful. It is hard to hear the superlatives used (words like “offer ZERO information to their patients”), and I do think most doctors take offense to this. We all know there are idiots, and we all know that each of us carries our own degree of idiocy, but ALL of us are not TOTAL idiots.
    I consider myself a patient-oriented doctor, and I see my patients with affection and sympathy. My personal perspective is unique in this discussion – understanding both sides. I think the key to the entire discussion is to have folks who can understand (to a degree) two sides of the discussion. Instead of saying or implying that docs are idiots, patients are not worth listening to, or nurses are irrelevant, we need to compile perspectives and try to put together something that works.

    I fear that I pay for the sins of my predecessors and my selfish contemporaries. I will do my best.

    It is fun and easy to bash doctors, it seems. The transaction of healthcare is between healthcare professional and patient. Both sides of the equation are vital. Bash too hard and you may scare off those of us who give a damn.

  71. Let me add that my “understanding” of my patients includes the fact that I don’t really understand them and need to listen to what they say and defer to them often. I don’t think that I can stand up and advocate for patients by myself. I think other voices are probably a lot more important. But there is a perspective on this that I do have that non-physicians do not.

  72. Let me add that my “understanding” of my patients includes the fact that I don’t really understand them and need to listen to what they say and defer to them often. I don’t think that I can stand up and advocate for patients by myself. I think other voices are probably a lot more important. But there is a perspective on this that I do have that non-physicians do not.

  73. Stitch-
    Great comment, but here’s the problem from the doctor standpoint. When you say “Maybe communication courses should be a required part of CME license renewal” as a solution to your concerns, one more administrative hoop is thrust upon a doctor, which in turn, leads to less time with you. Please understand I am not saying doctors shouldn’t do a better job communicating with their patients, they should. But wouldn’t it be far better that patient’s be given the potential to switch doctors if the one they’re seeing stinks?

    Just sayin’.

  74. Stitch-
    Great comment, but here’s the problem from the doctor standpoint. When you say “Maybe communication courses should be a required part of CME license renewal” as a solution to your concerns, one more administrative hoop is thrust upon a doctor, which in turn, leads to less time with you. Please understand I am not saying doctors shouldn’t do a better job communicating with their patients, they should. But wouldn’t it be far better that patient’s be given the potential to switch doctors if the one they’re seeing stinks?

    Just sayin’.

  75. Trisha: That is a bit harsh, as I would hope the aims of doctor and patients are more aligned than that of insurance executive and doctor. Do you see us as the pariah that we see insurance execs?
    Your point is taken. A good analogy from my side is that of a social worker working with the poor. They may not know what it is to be poor, but having worked in it for years, their perspective is of value.

  76. Trisha: That is a bit harsh, as I would hope the aims of doctor and patients are more aligned than that of insurance executive and doctor. Do you see us as the pariah that we see insurance execs?
    Your point is taken. A good analogy from my side is that of a social worker working with the poor. They may not know what it is to be poor, but having worked in it for years, their perspective is of value.

  77. @Trisha, I’d not have a particular issue with having Dr Rob, Dr Val et al speak for me (if they had to; the point’s kind of moot in some ways because I don’t live in the USA), because they all seem to be motivated by the idea of a healthy population rather than annualised profits.

  78. @Trisha, I’d not have a particular issue with having Dr Rob, Dr Val et al speak for me (if they had to; the point’s kind of moot in some ways because I don’t live in the USA), because they all seem to be motivated by the idea of a healthy population rather than annualised profits.

  79. We’re out of nesting levels (Rob, how DO you do that with this blog?? This is so cool!) so I’ll reply to Trisha & Rob in parallel.
    YOU GUYS ROCK! This discussion is so information and light-shedding!

    Trisha’s point about many insurance execs being docs is, imo, legit; to me it shows that merely wearing a hat doesn’t ensure that one can be counted on to represent all who have that hat.

    But then Rob’s point about aligned motives, and his social worker metaphor, are so apt and valuable.

    Now here it gets nasty, IMO: given that point, what the hell is up with the event’s “policy expert” being that pharma front guy?? (See <a href="http://distractible.org/2009/07/12/speak-to-me/#comment-4504"earlier comment about CMPI.) What is up with that?? Whose aims is he aligned with? Putting patients first??? Reform?? “Medicine in the Public Interest”?? It’ll be interesting to see what he says about empowering patients and providers to get the job done.

  80. We’re out of nesting levels (Rob, how DO you do that with this blog?? This is so cool!) so I’ll reply to Trisha & Rob in parallel.
    YOU GUYS ROCK! This discussion is so information and light-shedding!

    Trisha’s point about many insurance execs being docs is, imo, legit; to me it shows that merely wearing a hat doesn’t ensure that one can be counted on to represent all who have that hat.

    But then Rob’s point about aligned motives, and his social worker metaphor, are so apt and valuable.

    Now here it gets nasty, IMO: given that point, what the hell is up with the event’s “policy expert” being that pharma front guy?? (See <a href="http://distractible.org/2009/07/12/speak-to-me/#comment-4504"earlier comment about CMPI.) What is up with that?? Whose aims is he aligned with? Putting patients first??? Reform?? “Medicine in the Public Interest”?? It’ll be interesting to see what he says about empowering patients and providers to get the job done.

  81. I feel I really have to say this: Doctors may sometimes be patients but they are not patients like everyone else.
    What do I mean? First there is medical knowledge… a basic understanding of how the body functions gives you a better grasp of what is going on with your health. You also get more respect from your provider… having M.D. after your name forces them to treat you differently. In most cases this is the way they should treat all patients, as equal partners in health care decisions, but it just doesn’t happen that way all the time.

    As an RN with a chronic debilitating illness who is active in an online community I constantly find myself re-explaining to my peers what SHOULD have been explained to them by their doctors but wasn’t… at least not in a way that was meaningful to them. And the bottom line is that most people don’t want to appear stupid to someone that socially has a status just short of “President” or “God”. I am also amazed at the number of cases where doctors do not discuss potential options with patients. They decide a course of treatment and offer ZERO information to their patient about alternatives.

    I know I have a terrible habit of oversimplifying things like this. However, the bottom line, sadly, is that a vast majority of doctors treat patients like they’re in the way of the doctor doing his/her job. And they are missing the point (no patient, no job), but a lot of these patients don’t have the option of going to another doctor. I don’t know how anything can change that, least of all a conference about patients that doesn’t include them.

    But then again, those doctors aren’t attending these conferences either.

    Maybe communication courses should be a required part of CME for license renewal.

  82. I feel I really have to say this: Doctors may sometimes be patients but they are not patients like everyone else.
    What do I mean? First there is medical knowledge… a basic understanding of how the body functions gives you a better grasp of what is going on with your health. You also get more respect from your provider… having M.D. after your name forces them to treat you differently. In most cases this is the way they should treat all patients, as equal partners in health care decisions, but it just doesn’t happen that way all the time.

    As an RN with a chronic debilitating illness who is active in an online community I constantly find myself re-explaining to my peers what SHOULD have been explained to them by their doctors but wasn’t… at least not in a way that was meaningful to them. And the bottom line is that most people don’t want to appear stupid to someone that socially has a status just short of “President” or “God”. I am also amazed at the number of cases where doctors do not discuss potential options with patients. They decide a course of treatment and offer ZERO information to their patient about alternatives.

    I know I have a terrible habit of oversimplifying things like this. However, the bottom line, sadly, is that a vast majority of doctors treat patients like they’re in the way of the doctor doing his/her job. And they are missing the point (no patient, no job), but a lot of these patients don’t have the option of going to another doctor. I don’t know how anything can change that, least of all a conference about patients that doesn’t include them.

    But then again, those doctors aren’t attending these conferences either.

    Maybe communication courses should be a required part of CME for license renewal.

  83. Wonderful, illuminating comment, Stitch. You’re my instant buddy for the way you clearly and rapidly added to the conversation with a perspective few of us could offer. Thanks.

  84. Wonderful, illuminating comment, Stitch. You’re my instant buddy for the way you clearly and rapidly added to the conversation with a perspective few of us could offer. Thanks.

  85. Yes! That IS the point! All perspectives are important.
    Rob and Dr. Val — here’s a way to understand it…. Would you want health insurance executives to speak for you? Many of them are doctors! Do you buy the idea that insurance executives are doctors, too? Therefore, they can represent your point of view? (Just like doctors are patients, too?)

    Of course not. That’s why it’s so important that all points of view be represented.

  86. Yes! That IS the point! All perspectives are important.
    Rob and Dr. Val — here’s a way to understand it…. Would you want health insurance executives to speak for you? Many of them are doctors! Do you buy the idea that insurance executives are doctors, too? Therefore, they can represent your point of view? (Just like doctors are patients, too?)

    Of course not. That’s why it’s so important that all points of view be represented.

  87. I actually just increased the level to 6. Not sure if that is good. The WordPress setting is “discussion” that allows nesting of replies.

  88. I actually just increased the level to 6. Not sure if that is good. The WordPress setting is “discussion” that allows nesting of replies.

  89. Dr. Rob,
    I was not trying to imply that anyone is an idiot. Honest. But I cannot tell you how many people I know personally whose doctors have made the choice not to give the patient an opportunity to participate actively in their healthcare. They seem to operate from a “Father knows best” place.

    The number of doctors in this world that are afraid to admit that they don’t know something frightens me. The doctor that is willing to say “I don’t know, but let’s find out” is the doctor that I want to work with.

    I look at healthcare as a science. Scientists are supposed to ask questions and look for answers… and be willing to abandon a belief system if that belief system is proven to be wrong. The bottom line is that some doctors are bad scientists.

    So yes, Dr. Wes, it would be better if patients were allowed to change their doctors. But I’d like to point you to people (although I recognize that that most people are not as complex as those of us with an uncommon illness) who have been to doctor after doctor that has used the same faulty reasoning and poor communication skills. Sadly, in so many cases, if a doctor can’t figure out the patient they fall back on blaming the patient. Just watch an episode or two of those “mystery diagnosis” type shows.

    And I could just as easily suggest that communication be added to medical school. But that’s not going to help for years to come. My CME suggestion is grasping at straws… how do we reach the masses?

    I’m not suggesting that we ADD to the number of CME’s required for license renewal. Rather I’m suggesting that a certain number of CME’s be required to come from that area.

    The bottom line is almost a personality issue. I dealt, personally, with a doctor that works at an institution that is thought of as the top research institution in this country. His bedside manner was nothing short of atrocious. He was the “don’t” list in patient care.

    When I called him on it, he insisted that he had done nothing wrong. I don’t know how to reach people like that. The nursing staff came to me one by one and applauded my efforts, apparently he’s famous for upsetting patients. But when you need something from your doctor, you just can’t do that.

    Dr. Rob… I’m quite certain you’re the good kind of doctor that we all wish we could have. And I’m sure if you think about it, you’ll realize that you have known some of the doctors that are type that I’m talking about.

    I’m lucky. I have a great primary care doctor that has left few stones unturned in my care. But even she acknowledges that among her peers there are doctors that I don’t want to see. I’m blessed in that she’s protected me from them. She’s a rare gem, and hopefully the medical students that she works with (as she’s at a university) take away a lot from their time with her.

    We all know the system is broken. In every profession there is bound to be someone that has a cash register where their heart belongs. Bless you for being a part of trying to fix it.

    You need AVERAGE people to be a part of changing it. People that aren’t afraid to say “I don’t know what that word means”. My guess for every doctor that fails to treat patients as a full partner in their healthcare (and honestly… how can anyone do that in 10-15 minutes?) , there are 100 patients that are afraid to say “I don’t understand”.

  90. Dr. Rob,
    I was not trying to imply that anyone is an idiot. Honest. But I cannot tell you how many people I know personally whose doctors have made the choice not to give the patient an opportunity to participate actively in their healthcare. They seem to operate from a “Father knows best” place.

    The number of doctors in this world that are afraid to admit that they don’t know something frightens me. The doctor that is willing to say “I don’t know, but let’s find out” is the doctor that I want to work with.

    I look at healthcare as a science. Scientists are supposed to ask questions and look for answers… and be willing to abandon a belief system if that belief system is proven to be wrong. The bottom line is that some doctors are bad scientists.

    So yes, Dr. Wes, it would be better if patients were allowed to change their doctors. But I’d like to point you to people (although I recognize that that most people are not as complex as those of us with an uncommon illness) who have been to doctor after doctor that has used the same faulty reasoning and poor communication skills. Sadly, in so many cases, if a doctor can’t figure out the patient they fall back on blaming the patient. Just watch an episode or two of those “mystery diagnosis” type shows.

    And I could just as easily suggest that communication be added to medical school. But that’s not going to help for years to come. My CME suggestion is grasping at straws… how do we reach the masses?

    I’m not suggesting that we ADD to the number of CME’s required for license renewal. Rather I’m suggesting that a certain number of CME’s be required to come from that area.

    The bottom line is almost a personality issue. I dealt, personally, with a doctor that works at an institution that is thought of as the top research institution in this country. His bedside manner was nothing short of atrocious. He was the “don’t” list in patient care.

    When I called him on it, he insisted that he had done nothing wrong. I don’t know how to reach people like that. The nursing staff came to me one by one and applauded my efforts, apparently he’s famous for upsetting patients. But when you need something from your doctor, you just can’t do that.

    Dr. Rob… I’m quite certain you’re the good kind of doctor that we all wish we could have. And I’m sure if you think about it, you’ll realize that you have known some of the doctors that are type that I’m talking about.

    I’m lucky. I have a great primary care doctor that has left few stones unturned in my care. But even she acknowledges that among her peers there are doctors that I don’t want to see. I’m blessed in that she’s protected me from them. She’s a rare gem, and hopefully the medical students that she works with (as she’s at a university) take away a lot from their time with her.

    We all know the system is broken. In every profession there is bound to be someone that has a cash register where their heart belongs. Bless you for being a part of trying to fix it.

    You need AVERAGE people to be a part of changing it. People that aren’t afraid to say “I don’t know what that word means”. My guess for every doctor that fails to treat patients as a full partner in their healthcare (and honestly… how can anyone do that in 10-15 minutes?) , there are 100 patients that are afraid to say “I don’t understand”.

  91. > “I don’t know – let’s find out.”
    That’s exactly the phrasing that Dr. Danny Sands used in his talk at Health 2.0 Meets Ix in Boston this April: “In med school we’re trained to do [xyz], but we’re not taught how to say ‘I don’t know. Let’s find out.'”

    Needless to say, I like having him for a doc…

  92. > “I don’t know – let’s find out.”
    That’s exactly the phrasing that Dr. Danny Sands used in his talk at Health 2.0 Meets Ix in Boston this April: “In med school we’re trained to do [xyz], but we’re not taught how to say ‘I don’t know. Let’s find out.'”

    Needless to say, I like having him for a doc…

  93. Hello there,I’ve read your reference to “$15K a year for MS patient” in comments on a couple of blogs now. Just to put that in context, I’d like to inform you that the price tag on routine care for an MS patient far exceeds that amount. The negotiated discount rate for Copaxone, the MS drug I use, is currently $27,600 and keeps increasing each year.

    I did a little research and calculating to discover what exactly the costs were associated with basic medical care in one year. I wrote about it in a post: The Annual Cost of My Chronic Illnesses. The total price tag came to $55,413.

    Out of that $55,413, insurance discounted $8,927 and paid $11,895, and I paid $3739 in copays and uncovered costs. But what about the remaining $30,852? Since my insurance caps prescription coverage at $1500, I did not have coverage of the two most expensive MS-related drugs. I received assistance for one but had to go without for the other. This is just the financial story of one MS patient.

    BTW Dr. Rob, I live in the DC area and will be present for the medblogger event. I look forward to meeting those on the panel. See you there.

  94. Hello there,I’ve read your reference to “$15K a year for MS patient” in comments on a couple of blogs now. Just to put that in context, I’d like to inform you that the price tag on routine care for an MS patient far exceeds that amount. The negotiated discount rate for Copaxone, the MS drug I use, is currently $27,600 and keeps increasing each year.

    I did a little research and calculating to discover what exactly the costs were associated with basic medical care in one year. I wrote about it in a post: The Annual Cost of My Chronic Illnesses. The total price tag came to $55,413.

    Out of that $55,413, insurance discounted $8,927 and paid $11,895, and I paid $3739 in copays and uncovered costs. But what about the remaining $30,852? Since my insurance caps prescription coverage at $1500, I did not have coverage of the two most expensive MS-related drugs. I received assistance for one but had to go without for the other. This is just the financial story of one MS patient.

    BTW Dr. Rob, I live in the DC area and will be present for the medblogger event. I look forward to meeting those on the panel. See you there.

  95. I have always said that the measure of a good doctor is not what they know, it is if they know what they don’t know. If you don’t know your limitations, you are dangerous. I wouldn’t trust a doctor who couldn’t say “I don’t know.”
    A small correction: I see medicine as applied science, not science. We use science to make decisions, but many of the decisions are best guesses. Does the patient fit into x or y category? It’s very much a judgment call. We don’t experiment on our patients very much.

    Just a fine point.

  96. I have always said that the measure of a good doctor is not what they know, it is if they know what they don’t know. If you don’t know your limitations, you are dangerous. I wouldn’t trust a doctor who couldn’t say “I don’t know.”
    A small correction: I see medicine as applied science, not science. We use science to make decisions, but many of the decisions are best guesses. Does the patient fit into x or y category? It’s very much a judgment call. We don’t experiment on our patients very much.

    Just a fine point.

  97. Rob — you ask if the “health insurance executive is to doctor, as doctor is to patient” analogy is harsh. Yes and no.
    The analogy does not work for you at all. But I don’t think you realize how much of an enigma you are. You are only one physician among hundreds of thousands who just do not see the patient’s side nearly so clearly as you do.

    So I’ll stick with the analogy for the others — and tell you how much I appreciate the fact that you are as patient-focused and understanding as you are. As you well know, I’ve written publicly how much I appreciate that you “get it.” and I do.

  98. Rob — you ask if the “health insurance executive is to doctor, as doctor is to patient” analogy is harsh. Yes and no.
    The analogy does not work for you at all. But I don’t think you realize how much of an enigma you are. You are only one physician among hundreds of thousands who just do not see the patient’s side nearly so clearly as you do.

    So I’ll stick with the analogy for the others — and tell you how much I appreciate the fact that you are as patient-focused and understanding as you are. As you well know, I’ve written publicly how much I appreciate that you “get it.” and I do.

  99. Trisha: My point is that it is no way to endear yourself to doctors.
    You know, people say that I am an exception to the rule, but I would beg to differ. Most of the docs I know do give a damn, and most patients seem to think THEIR doc is OK. I think this broad stroke of docs as insensitive doofuses is not a constructive way to approach them. Yes, I know there are a lot of idiots out there in the doctor population; but I doubt it is more than the general population.

    My problem with all of this is that patients don’t like being talked down to by doctors, but it seems a lot of comments here and elsewhere are returning the favor. I know it is hyperbole to some extent, but it really is no way for people who want docs to engage patients to talk.

  100. Trisha: My point is that it is no way to endear yourself to doctors.
    You know, people say that I am an exception to the rule, but I would beg to differ. Most of the docs I know do give a damn, and most patients seem to think THEIR doc is OK. I think this broad stroke of docs as insensitive doofuses is not a constructive way to approach them. Yes, I know there are a lot of idiots out there in the doctor population; but I doubt it is more than the general population.

    My problem with all of this is that patients don’t like being talked down to by doctors, but it seems a lot of comments here and elsewhere are returning the favor. I know it is hyperbole to some extent, but it really is no way for people who want docs to engage patients to talk.

  101. Right, the “reply” is only nested 4 times. This is the first post this is a problem. Hah.
    Trisha: You are not the one I am really referring to about negative comments on docs. If you read other comments, they seem to imply pretty bad things about docs as a group.

    When I see people who are acting in ways I don’t understand (like someone who does drugs, cuts themself, or is bulimic) I look for the reasons they act that way. Too often people jump at a “moral” answer (they are “bad” people) and not look for reasons (such as a history of trauma or sexual abuse). It is comforting to us to think that we would not do things so bad, so saying the person is “bad” (unlike us) keeps us safe. But to really help, we have to understand that people get the way they are for reasons.

    The same thing can be said for all sides of this issue. Doctors behave like they do because of the system they are in. I speak mainly for primary care doctors, but I often have to bite my tongue when I read some stuff about “greedy doctors” and docs who “don’t care about patients” or “never listen.” These are rants to be sure, but they are not constructive toward engaging doctors – which is something the patient community needs to be doing. Don’t ignore our faults, and don’t deny there are bad docs; but if your goal is to fix things, engaging docs is the best route.

    If you don’t believe me, read the other comments on this. There are some very harsh things. Certainly equating docs/patients with insurance execs/docs is pretty much like saying patients think docs are evil (because docs HATE insurance execs). The analogy may be appropriate, but it still offends, so your point is lost on the listener.

    I REALLY offended a pharmacist with my previous rant on e-prescribing. I don’t think all pharmacists are idiots (only the one pharmacy gets it wrong), but if I want to engage pharmacists, ranting has to go on the back seat.

    Yes, social workers don’t understand what it is like to be poor, but they understand the culture of poverty in ways the poor do not, and anyone who wants a good picture on poverty should talk to them as well as talking to the poor. Both would be extremely valuable. That is my whole point.

    Thanks for engaging this discussion everyone! It is very valuable and I will probably distill the comments on this and make it into a post of its own.

  102. Right, the “reply” is only nested 4 times. This is the first post this is a problem. Hah.
    Trisha: You are not the one I am really referring to about negative comments on docs. If you read other comments, they seem to imply pretty bad things about docs as a group.

    When I see people who are acting in ways I don’t understand (like someone who does drugs, cuts themself, or is bulimic) I look for the reasons they act that way. Too often people jump at a “moral” answer (they are “bad” people) and not look for reasons (such as a history of trauma or sexual abuse). It is comforting to us to think that we would not do things so bad, so saying the person is “bad” (unlike us) keeps us safe. But to really help, we have to understand that people get the way they are for reasons.

    The same thing can be said for all sides of this issue. Doctors behave like they do because of the system they are in. I speak mainly for primary care doctors, but I often have to bite my tongue when I read some stuff about “greedy doctors” and docs who “don’t care about patients” or “never listen.” These are rants to be sure, but they are not constructive toward engaging doctors – which is something the patient community needs to be doing. Don’t ignore our faults, and don’t deny there are bad docs; but if your goal is to fix things, engaging docs is the best route.

    If you don’t believe me, read the other comments on this. There are some very harsh things. Certainly equating docs/patients with insurance execs/docs is pretty much like saying patients think docs are evil (because docs HATE insurance execs). The analogy may be appropriate, but it still offends, so your point is lost on the listener.

    I REALLY offended a pharmacist with my previous rant on e-prescribing. I don’t think all pharmacists are idiots (only the one pharmacy gets it wrong), but if I want to engage pharmacists, ranting has to go on the back seat.

    Yes, social workers don’t understand what it is like to be poor, but they understand the culture of poverty in ways the poor do not, and anyone who wants a good picture on poverty should talk to them as well as talking to the poor. Both would be extremely valuable. That is my whole point.

    Thanks for engaging this discussion everyone! It is very valuable and I will probably distill the comments on this and make it into a post of its own.

  103. You want comments/fodder. Here’s my stab.
    1) Doctors need to fix their billing systems. I have a chronic illness and I spend at least two hours per medical “event” (visit, test, etc.) straightening out the messed up billing by the medical providers. I am not going to buy that you all are blaming others when back room operations are so poor — this is why you have such horrendous overhead.
    2) Communicate. Here’s a story. Had surgery at a “world class” hospital last year. Electronic everything up the whatever. They forgot to tell me about post-operative complications and severe hyperthyroidism. Even though I called the doctor, patient advocacy, and eventually the hospital’s general counsel. Nobody could be bothered to read the records. Several ER visits later and a couple MONTHS, we get most (but not all) of it figured out. But by then I have had severe muscle wasting, probably need shoulder surgery and may not be able to because previously undisclosed heart complications now predominate, must be resolved, were exacerbated by the hyperthyroid and are now much harder to treat. Cost of the refusal of the entry level, $60k per year doctor to pick up the phone — easily $30k and a year on disability at $95k. The $125k and counting phone call that never happened. This includes play nice with others. Don’t be pissy with my other doctors or me expect to resolve disagreements between the two of you and I don’t care to see you fighting in front of me or through me.
    3) Doctors need to think more about schedule — not how many patients they think they can cram into their offices per day, but how quickly they can get to diagnosis and effective treatment. Doctors should have something that causes them bodily harm when footdragging. Illness begets illness. The faster you get the right dx and the right treatment, the less things will cost. So, if you have a many month, multi-visit plan to give yourself time to figure things out so that you can be “cautious” and “conservative”, you are probably already harming your patient, and often more than any treatment that you might prescribe. I guarantee you that almost every patient you see is judged in their job based on how well they accomplish a timely and cost-effective solution — and they will judge you the same. Think long and hard before you decide that its ok for them to stay sick for six months between visits and punting. Cycle time matters. If you are over your head, admit it.
    4) Patients expect specialists to know their stuff and that knowledge needs to be CURRENT — not what you learned in med school. This is probably one of the biggest gripes and biggest causes of the increasing distrust of the medical profession. It is not that tough to find out the basic side effects of meds online. It is not tough to find out what the basic standard of care is for most illnesses or to see the most recent medical journal articles. If a patient knows more than you about an illness based on ten minutes on the internet, guess what, they are not going to trust you or think well of you. Take the time to look up what you treat on the internet so that you don’t get scooped and consider your degree to be a rapidly depreciating asset, not some permanent seal of approval.
    5) Be organized and prepared. If you want a test redone in a month, have the lab slip ready and don’t make patients call you five times for it. Have your records be set up so that you can see the most recent test results. Ask the patient what they want to get accomplished in this visit up front.
    6) Treat me they way you would expect to be treated by other professionals who provide a service to you. Return phone calls. Be prompt. If an additional explanation is needed, provide it. If you don’t like to spend the time to fill out my disability paperwork, its fine to ask me to reimburse you for the time, but its not ok to do a crappy job on it or crab about it. If your medical plan doesn’t work for me because of other things that are going on with me, work with me to come up with a compromise — don’t get give a “take it or leave it cause you must have a problem if you are questioning me” attitude. If your lawyer did that to you, you would be unhappy and ignore him/her– so why do you think the attitude works with patients?
    7) Learn to apologize and foreswear BS. Doctors do not get sued because they make mistakes. They get sued because they were enough of a jerk that someone is willing to spend alot of time and alot of money (even contingency cases require the plaintiff to cover costs), to make sure that the doctor hears how perturbed they are with him or her. Which means that in general, the doctor had to have stepped on some toes or be perceived to have been pretty disingenuous somewhere along the way so that someone really feels that they have to let loose the big guns to get the doctor to pay attention. If you want to lessen litigation, be nicer, less manipulative, and more honest. Nice guys do win in this.
    8) We don’t want to hear your whining. When I see my accountant, I don’t want to hear him moaning about the pressures of tax season, his student loans, his mortgage, his car payment or his office management problems. While I am happy to hear some humility about what you don’t know about medicine, you do not increase my respect by blathering about your PERSONAL problems — it just makes you look like you can’t manage your life.
    9) Understand that at best, you can only have half of the solution to my medical issues. I live in my body and I am the only one who can say if things are right or not, and if not, what is wrong. All of the information that is in your brain that you studied so long for, can never be the whole answer. So you need to work with me if you are going to do a good job.

    By the way, I don’t think that this list covers a single thing that is on the “big” political agenda.
    9)

  104. You want comments/fodder. Here’s my stab.
    1) Doctors need to fix their billing systems. I have a chronic illness and I spend at least two hours per medical “event” (visit, test, etc.) straightening out the messed up billing by the medical providers. I am not going to buy that you all are blaming others when back room operations are so poor — this is why you have such horrendous overhead.
    2) Communicate. Here’s a story. Had surgery at a “world class” hospital last year. Electronic everything up the whatever. They forgot to tell me about post-operative complications and severe hyperthyroidism. Even though I called the doctor, patient advocacy, and eventually the hospital’s general counsel. Nobody could be bothered to read the records. Several ER visits later and a couple MONTHS, we get most (but not all) of it figured out. But by then I have had severe muscle wasting, probably need shoulder surgery and may not be able to because previously undisclosed heart complications now predominate, must be resolved, were exacerbated by the hyperthyroid and are now much harder to treat. Cost of the refusal of the entry level, $60k per year doctor to pick up the phone — easily $30k and a year on disability at $95k. The $125k and counting phone call that never happened. This includes play nice with others. Don’t be pissy with my other doctors or me expect to resolve disagreements between the two of you and I don’t care to see you fighting in front of me or through me.
    3) Doctors need to think more about schedule — not how many patients they think they can cram into their offices per day, but how quickly they can get to diagnosis and effective treatment. Doctors should have something that causes them bodily harm when footdragging. Illness begets illness. The faster you get the right dx and the right treatment, the less things will cost. So, if you have a many month, multi-visit plan to give yourself time to figure things out so that you can be “cautious” and “conservative”, you are probably already harming your patient, and often more than any treatment that you might prescribe. I guarantee you that almost every patient you see is judged in their job based on how well they accomplish a timely and cost-effective solution — and they will judge you the same. Think long and hard before you decide that its ok for them to stay sick for six months between visits and punting. Cycle time matters. If you are over your head, admit it.
    4) Patients expect specialists to know their stuff and that knowledge needs to be CURRENT — not what you learned in med school. This is probably one of the biggest gripes and biggest causes of the increasing distrust of the medical profession. It is not that tough to find out the basic side effects of meds online. It is not tough to find out what the basic standard of care is for most illnesses or to see the most recent medical journal articles. If a patient knows more than you about an illness based on ten minutes on the internet, guess what, they are not going to trust you or think well of you. Take the time to look up what you treat on the internet so that you don’t get scooped and consider your degree to be a rapidly depreciating asset, not some permanent seal of approval.
    5) Be organized and prepared. If you want a test redone in a month, have the lab slip ready and don’t make patients call you five times for it. Have your records be set up so that you can see the most recent test results. Ask the patient what they want to get accomplished in this visit up front.
    6) Treat me they way you would expect to be treated by other professionals who provide a service to you. Return phone calls. Be prompt. If an additional explanation is needed, provide it. If you don’t like to spend the time to fill out my disability paperwork, its fine to ask me to reimburse you for the time, but its not ok to do a crappy job on it or crab about it. If your medical plan doesn’t work for me because of other things that are going on with me, work with me to come up with a compromise — don’t get give a “take it or leave it cause you must have a problem if you are questioning me” attitude. If your lawyer did that to you, you would be unhappy and ignore him/her– so why do you think the attitude works with patients?
    7) Learn to apologize and foreswear BS. Doctors do not get sued because they make mistakes. They get sued because they were enough of a jerk that someone is willing to spend alot of time and alot of money (even contingency cases require the plaintiff to cover costs), to make sure that the doctor hears how perturbed they are with him or her. Which means that in general, the doctor had to have stepped on some toes or be perceived to have been pretty disingenuous somewhere along the way so that someone really feels that they have to let loose the big guns to get the doctor to pay attention. If you want to lessen litigation, be nicer, less manipulative, and more honest. Nice guys do win in this.
    8) We don’t want to hear your whining. When I see my accountant, I don’t want to hear him moaning about the pressures of tax season, his student loans, his mortgage, his car payment or his office management problems. While I am happy to hear some humility about what you don’t know about medicine, you do not increase my respect by blathering about your PERSONAL problems — it just makes you look like you can’t manage your life.
    9) Understand that at best, you can only have half of the solution to my medical issues. I live in my body and I am the only one who can say if things are right or not, and if not, what is wrong. All of the information that is in your brain that you studied so long for, can never be the whole answer. So you need to work with me if you are going to do a good job.

    By the way, I don’t think that this list covers a single thing that is on the “big” political agenda.
    9)

  105. One more thing — I have read your list of suggestions and I agree that improving the care of the chronically ill is the low hanging fruit on controlling health care costs and improving health care in general.
    1) It is not necessary (or cost effective) for every single person in this country to have electronic health care records, but a patient oriented solution (starting with patient access to records) would allow chronically ill patients the ability to at least manage the information, and probably provides the biggest bang for the buck.
    2) For the chronically ill, reimbursing physician email and phone calls, in lieu of visits, would certainly reduce costs.
    3) For the chronically ill, reimbursement for regular (short) conference calls by consulting specialists and the pcp would undoubtedly reduce costs, especially in situations where the patient ends up using several visits to try to resolve dueling and inconsistent treatment plans. These could also be used to facilitate better diagnostics — having the X specialists in the room who have input into a diagnosis working together would also likely lower the number of round robin office office visits and allow for prioritization of tests, all of which are expensive. Having the patient on the conference call would be really appreciated by the patient.

  106. One more thing — I have read your list of suggestions and I agree that improving the care of the chronically ill is the low hanging fruit on controlling health care costs and improving health care in general.
    1) It is not necessary (or cost effective) for every single person in this country to have electronic health care records, but a patient oriented solution (starting with patient access to records) would allow chronically ill patients the ability to at least manage the information, and probably provides the biggest bang for the buck.
    2) For the chronically ill, reimbursing physician email and phone calls, in lieu of visits, would certainly reduce costs.
    3) For the chronically ill, reimbursement for regular (short) conference calls by consulting specialists and the pcp would undoubtedly reduce costs, especially in situations where the patient ends up using several visits to try to resolve dueling and inconsistent treatment plans. These could also be used to facilitate better diagnostics — having the X specialists in the room who have input into a diagnosis working together would also likely lower the number of round robin office office visits and allow for prioritization of tests, all of which are expensive. Having the patient on the conference call would be really appreciated by the patient.

  107. Hi Dr. Rob,Firstly, I’d like to say that I love reading your Blog, and the comments you leave on others. As a patient with a rare disease, it’s refreshing AND comforting to know that there is still good medicine being practiced.
    I think our healthcare is a mess! From Docs that are more interested in quantity not quality for financial reasons because Ins company’s are squeezing them, to Doc’s that are too conservative because of the opposite end of the medical financial burden, MALPRACTICE, and well Doc’s that are just ill-informed and simply don’t take as much pride in their work as others. It happens in every sector of work, not just the medical field. As patients we tend to think of Physicians as all knowing Gods, it just isn’t always the case. You can go to the garage and have work done on your car, and have a very knowledgeable person due the repairs correctly the first time around, or have a hack just suck every dime out of you until they find the real problem.
    As a Doctor you are facing a vast amount of issues regarding medicine; patients, insurance companies, and the government. As a patient with healthcare I say go to Congress and let’s force them to purchase their own insurance just like everyone else in the private sector of this country does. After all, they are only part time employees. When they and their loved ones are squeezed and forced and pushed like cattle through our health care system, then and only then will change become a real priority to them, and boy does there need to be a lot of change. Secondly, there needs to be more access to medical records between Doctor and Patient. I want, scratch that I need to be proactive in my healthcare and although I believe that it can be taken advantage of (what isn’t?) My opinion is that my test results belong to me too. I shouldn’t have to jump through hoops to obtain them, keep record of them, and research them.
    Thank you so much for opening up this topic for discussion.

  108. Hi Dr. Rob,Firstly, I’d like to say that I love reading your Blog, and the comments you leave on others. As a patient with a rare disease, it’s refreshing AND comforting to know that there is still good medicine being practiced.
    I think our healthcare is a mess! From Docs that are more interested in quantity not quality for financial reasons because Ins company’s are squeezing them, to Doc’s that are too conservative because of the opposite end of the medical financial burden, MALPRACTICE, and well Doc’s that are just ill-informed and simply don’t take as much pride in their work as others. It happens in every sector of work, not just the medical field. As patients we tend to think of Physicians as all knowing Gods, it just isn’t always the case. You can go to the garage and have work done on your car, and have a very knowledgeable person due the repairs correctly the first time around, or have a hack just suck every dime out of you until they find the real problem.
    As a Doctor you are facing a vast amount of issues regarding medicine; patients, insurance companies, and the government. As a patient with healthcare I say go to Congress and let’s force them to purchase their own insurance just like everyone else in the private sector of this country does. After all, they are only part time employees. When they and their loved ones are squeezed and forced and pushed like cattle through our health care system, then and only then will change become a real priority to them, and boy does there need to be a lot of change. Secondly, there needs to be more access to medical records between Doctor and Patient. I want, scratch that I need to be proactive in my healthcare and although I believe that it can be taken advantage of (what isn’t?) My opinion is that my test results belong to me too. I shouldn’t have to jump through hoops to obtain them, keep record of them, and research them.
    Thank you so much for opening up this topic for discussion.

  109. Thank you for taking time away from your office practice to do this. Hope my input isn’t too late (I had a great vacation) or too long. Here are some things that this patient would like to see addressed:
    Retain Insurance
    I want to be able to keep my insurance at a reasonable price. I don’t want to be forced onto a different plan (or dropped) when the insurance company stops making money off of me.

    Real Coverage
    For the most part, my insurance is good. However, some things are covered only in theory, not in reality. Example: according to my plan booklet, speech therapy is covered. Since many speech issues are developmental, therapists often recommend waiting until children reach age seven or eight to see if they outgrow the problem. I waited. And waited. Finally, our doctor wrote a referral. And I learned that there’s more to it than the plan book we received, and that the fine print (in a file in some obscure closet) says “only until age six.” This means that speech therapy for children is not really covered. At all. Insurers can write whatever they want in a policy, but they shouldn’t be able to claim they’re offering coverage for something when they really aren’t.

    Malpractice Reform
    I want my doctor to be free to do what is best without having the threat of a frivolous malpractice suit hanging over his head. If premiums for malpractice insurance weren’t so high, doctors would have more take-home pay without having to generate more income. When there is a physician shortage, obstacles such as this need to be addressed.

    Fair Pay
    I like my doctor, and I don’t want him to retire early or take a different job because he can’t make ends meet. I’d like my doctor to be fairly compensated for his services so that he stays in practice as long as possible.

    Most service providers (the electrician, the plumber, the housekeeper, the babysitter, the tutor) are paid an hourly rate for their labor. It is in their best interests to take the time to do my job right. Whether the job takes thirty minutes or two hours, they take as much time as is needed to get the job done, and bill accordingly. Another example is the legal profession. Attorneys bill by the hour – not just time spent with a client, but also for time spent working on behalf of a client.

    Medical services are the exception, and medical services suffer as a result. Doctors do not get paid for their time, but for the number of people they can see. Sometimes a simple medical issue could be thoroughly addressed in twenty minutes instead of fifteen, but doctors only get paid for it if they bring patients back for a second appointment rather than take the extra time to take care of the problem in a single office visit. By paying doctors for their time, they would be freed from the tyranny of running patients through exam rooms as if they were working on an assembly line. Patients would benefit by getting the time they really need, without the inconvenience of a second appointment.

    Fair pay would include compensating doctors for time spent on behalf of a patient, for things such as writing referrals, determining a treatment plan for complicated conditions, phone calls/emails, or jumping through insurance hoops for preapproval. If insurance companies knew they’d be billed for the amount of time it took the doctor to deal with them, would they respond differently?

    I realize that this topic typically comes from doctors, but it comes from patients, too. “You get what you pay for.” I am accustomed to paying for high quality work, firing people who provide poor service, and giving a bonus for a job well done. Yet when I read the EOB’s from my insurance company, I wonder how doctors can afford to run a practice on the reimbursement they receive.

    Confidentiality
    I want what transpires between me and my doctor to be confidential. It is not. The solution is not additional regulation, nor is it threat of punishment/fines for violations. The solution is to permit doctors to maintain confidentiality. Doctors are required to provide information to insurers, and insurers have demonstrated an appalling propensity for releasing medical information to employers. The system needs to be fixed so that doctors can be paid without releasing a diagnosis code (or any other information).

    A Level Playing Field
    I have no confidence that the politicians will do what is best for anyone, unless they have some skin in the game. “Separate but equal” doesn’t exist in civil rights, and it won’t exist in the healthcare world. Our senators, representatives, and president need to have the same plan that the rest of the country gets.

    Respect Good Doctors
    Give my doctor the freedom to do his job. I want my doctor to use his expertise to diagnose and treat me. My doctor should be able to order tests based on his medical judgment of what is needed, not based on the pre-approval of an outside source. I want a treatment plan based on what is most appropriate for my specific situation, not based on some cookie-cutter recommendations developed for the “average” patient.

    Responsible Use of My Tax Dollar
    Healthcare reform should include having a team of ER doctors rewrite the emergency access law. Why do I include this in what patients want? Because when my two-year-old falls on a big piece of metal and cuts a three-inch gash across his forehead, I don’t want to wait while the emergency doctor writes a non-emergency prescription for a Medicaid mom to get her kid some children’s Tylenol. The people who are most affected by the problems of the current law would have good ideas on how to fix it.

    I am willing to contribute taxes toward the healthcare of people who fall sick due to misfortune. I don’t want tax dollars to pay for treating people if they willfully make lifestyle choices that cause their own poor health. Someone who can find money for cigarettes can find money for their own lung cancer treatments. People who have been able to purchase enough food to weigh 400 pounds (not caused by a medical condition) can come up with their own money for insulin, heart medication, knee replacements, etc. I know doctors aren’t supposed to judge patients, but other patients do it all the time. Tell the politicians that making people live with the consequences of their actions will help keep costs down.

    Affordable Meds
    I want medication to be affordable. Actually, what I really want is a cure. Until a cure is discovered, I’ll make do with meds. My concern is that healthcare reform, done wrong, can result in companies being unwilling to develop new treatments. Pharmaceutical companies (like all businesses) need to earn a profit. Look at biologic response modifiers. Biosimilars (generic biologics) sound like a great idea to the person paying for these expensive drugs, but if the pharmaceutical companies decide there isn’t enough profit in these, we all lose. Reform needs to encourage research and the development of new treatments.

  110. Thank you for taking time away from your office practice to do this. Hope my input isn’t too late (I had a great vacation) or too long. Here are some things that this patient would like to see addressed:
    Retain Insurance
    I want to be able to keep my insurance at a reasonable price. I don’t want to be forced onto a different plan (or dropped) when the insurance company stops making money off of me.

    Real Coverage
    For the most part, my insurance is good. However, some things are covered only in theory, not in reality. Example: according to my plan booklet, speech therapy is covered. Since many speech issues are developmental, therapists often recommend waiting until children reach age seven or eight to see if they outgrow the problem. I waited. And waited. Finally, our doctor wrote a referral. And I learned that there’s more to it than the plan book we received, and that the fine print (in a file in some obscure closet) says “only until age six.” This means that speech therapy for children is not really covered. At all. Insurers can write whatever they want in a policy, but they shouldn’t be able to claim they’re offering coverage for something when they really aren’t.

    Malpractice Reform
    I want my doctor to be free to do what is best without having the threat of a frivolous malpractice suit hanging over his head. If premiums for malpractice insurance weren’t so high, doctors would have more take-home pay without having to generate more income. When there is a physician shortage, obstacles such as this need to be addressed.

    Fair Pay
    I like my doctor, and I don’t want him to retire early or take a different job because he can’t make ends meet. I’d like my doctor to be fairly compensated for his services so that he stays in practice as long as possible.

    Most service providers (the electrician, the plumber, the housekeeper, the babysitter, the tutor) are paid an hourly rate for their labor. It is in their best interests to take the time to do my job right. Whether the job takes thirty minutes or two hours, they take as much time as is needed to get the job done, and bill accordingly. Another example is the legal profession. Attorneys bill by the hour – not just time spent with a client, but also for time spent working on behalf of a client.

    Medical services are the exception, and medical services suffer as a result. Doctors do not get paid for their time, but for the number of people they can see. Sometimes a simple medical issue could be thoroughly addressed in twenty minutes instead of fifteen, but doctors only get paid for it if they bring patients back for a second appointment rather than take the extra time to take care of the problem in a single office visit. By paying doctors for their time, they would be freed from the tyranny of running patients through exam rooms as if they were working on an assembly line. Patients would benefit by getting the time they really need, without the inconvenience of a second appointment.

    Fair pay would include compensating doctors for time spent on behalf of a patient, for things such as writing referrals, determining a treatment plan for complicated conditions, phone calls/emails, or jumping through insurance hoops for preapproval. If insurance companies knew they’d be billed for the amount of time it took the doctor to deal with them, would they respond differently?

    I realize that this topic typically comes from doctors, but it comes from patients, too. “You get what you pay for.” I am accustomed to paying for high quality work, firing people who provide poor service, and giving a bonus for a job well done. Yet when I read the EOB’s from my insurance company, I wonder how doctors can afford to run a practice on the reimbursement they receive.

    Confidentiality
    I want what transpires between me and my doctor to be confidential. It is not. The solution is not additional regulation, nor is it threat of punishment/fines for violations. The solution is to permit doctors to maintain confidentiality. Doctors are required to provide information to insurers, and insurers have demonstrated an appalling propensity for releasing medical information to employers. The system needs to be fixed so that doctors can be paid without releasing a diagnosis code (or any other information).

    A Level Playing Field
    I have no confidence that the politicians will do what is best for anyone, unless they have some skin in the game. “Separate but equal” doesn’t exist in civil rights, and it won’t exist in the healthcare world. Our senators, representatives, and president need to have the same plan that the rest of the country gets.

    Respect Good Doctors
    Give my doctor the freedom to do his job. I want my doctor to use his expertise to diagnose and treat me. My doctor should be able to order tests based on his medical judgment of what is needed, not based on the pre-approval of an outside source. I want a treatment plan based on what is most appropriate for my specific situation, not based on some cookie-cutter recommendations developed for the “average” patient.

    Responsible Use of My Tax Dollar
    Healthcare reform should include having a team of ER doctors rewrite the emergency access law. Why do I include this in what patients want? Because when my two-year-old falls on a big piece of metal and cuts a three-inch gash across his forehead, I don’t want to wait while the emergency doctor writes a non-emergency prescription for a Medicaid mom to get her kid some children’s Tylenol. The people who are most affected by the problems of the current law would have good ideas on how to fix it.

    I am willing to contribute taxes toward the healthcare of people who fall sick due to misfortune. I don’t want tax dollars to pay for treating people if they willfully make lifestyle choices that cause their own poor health. Someone who can find money for cigarettes can find money for their own lung cancer treatments. People who have been able to purchase enough food to weigh 400 pounds (not caused by a medical condition) can come up with their own money for insulin, heart medication, knee replacements, etc. I know doctors aren’t supposed to judge patients, but other patients do it all the time. Tell the politicians that making people live with the consequences of their actions will help keep costs down.

    Affordable Meds
    I want medication to be affordable. Actually, what I really want is a cure. Until a cure is discovered, I’ll make do with meds. My concern is that healthcare reform, done wrong, can result in companies being unwilling to develop new treatments. Pharmaceutical companies (like all businesses) need to earn a profit. Look at biologic response modifiers. Biosimilars (generic biologics) sound like a great idea to the person paying for these expensive drugs, but if the pharmaceutical companies decide there isn’t enough profit in these, we all lose. Reform needs to encourage research and the development of new treatments.

  111. (For some reason there is no REPLY button after your post below – so this comment is a reply to that one.)
    Excuse me, Rob — but you are putting words in my mouth. You say, My problem with all of this is that patients don’t like being talked down to by doctors, but it seems a lot of comments here and elsewhere are returning the favor.

    I have not talked down to anyone! You are the one who used the terms “insensitive doofuses” and “idiots” – not me! And I certainly never said doctors didn’t give a damn.

    A doctor can be the most caring and effective practitioner on earth, but that is NOT the same thing as understanding a patient’s point of view.

    To use your metaphor, a social worker may do her job extremely well, but that doesn’t mean she truly understands what it’s like to be hungry, or live in a homeless shelter. I also think that to suggest she would understand, would be insulting to those who ARE hungry and who DO live in homeless shelters.

    You are an exception to the rule, not because you give a damn, but because you listen and engage. That means you understand a patient’s point of view better than most docs do. Even still — you have never (metaphorically) been hungry or lived in a homeless shelter.

    Back to what Mary said — all perspectives are important.

  112. (For some reason there is no REPLY button after your post below – so this comment is a reply to that one.)
    Excuse me, Rob — but you are putting words in my mouth. You say, My problem with all of this is that patients don’t like being talked down to by doctors, but it seems a lot of comments here and elsewhere are returning the favor.

    I have not talked down to anyone! You are the one who used the terms “insensitive doofuses” and “idiots” – not me! And I certainly never said doctors didn’t give a damn.

    A doctor can be the most caring and effective practitioner on earth, but that is NOT the same thing as understanding a patient’s point of view.

    To use your metaphor, a social worker may do her job extremely well, but that doesn’t mean she truly understands what it’s like to be hungry, or live in a homeless shelter. I also think that to suggest she would understand, would be insulting to those who ARE hungry and who DO live in homeless shelters.

    You are an exception to the rule, not because you give a damn, but because you listen and engage. That means you understand a patient’s point of view better than most docs do. Even still — you have never (metaphorically) been hungry or lived in a homeless shelter.

    Back to what Mary said — all perspectives are important.

  113. I’m wondering if something like our “Sale of Goods Act” should be applied to health insurance.
    Under the way this would apply, basically, anything that is diagnosed whilst you’re covered would still have to be covered until cured on the same basic terms. Certainly I think this could be made to stop insurers dropping patients who develop a disease, and over-riding a “this is only coverd until [age]” clause, when treatment normally only commences after that age.

  114. I’m wondering if something like our “Sale of Goods Act” should be applied to health insurance.
    Under the way this would apply, basically, anything that is diagnosed whilst you’re covered would still have to be covered until cured on the same basic terms. Certainly I think this could be made to stop insurers dropping patients who develop a disease, and over-riding a “this is only coverd until [age]” clause, when treatment normally only commences after that age.

Comments are closed.