Washing Tons for Boggers

Oops.  I meant Washington\’s for Bloggers. Here are my personal musings about my trip.  I\’ll talk about the actual content of the conference in another post.
Got back from DC last night around midnight.  My flight back (although delayed) was not as eventful as my trip up to Washington.  I was supposed to have dinner with a \”who\’s who\” group of medical bloggers on Thursday night.  I got to the airport without problems and waited for the plane to load.  In the \”famous last words\” department, I made the following tweet:

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(It was 5:17, by the way)

I gave the ticket to the woman at the gate and as she scanned it, the scanner made an angry sound.  \”You don\’t have a seat.\” she told me.  \”You are number 51 and there are only 50 seats on the jet.\”

I was a victim of rationing.

I got to DC six hours later, after more delays from thunderstorms and \”mechanical problems.\”  I finally arrived at the hotel and met up with Dr. Val at 11:30 PM.   We went back to the private room announced my arrival.  I was greeted by a group of people who almost seemed more interested in recounting their incredible dinner than meeting me.  I was reminded of my misfortune in missing this dinner many times after that.  Many, many times.

In truth, I was greeted with a very warm welcome.  It amazed me at how these people who I had never met in person were already good friends.  That has always been my experience with other bloggers – there is no work needed to get to know them.  There are very few surprises either – they all acted as I expected them to.  I like these people.  I really like these people.

I\’ve already posted about the people on the panels:

  • Kevin Pho (You may call him Lord Kevin) – Brilliant, very insightful, says a lot in a few words.
  • Allen Dappen – Has a practice that allows for house calls (a REAL house call doctor) and extra time with patients.
  • Valerie Tinley – Allen\’s nurse practitioner.  Has English accent, so sounded the smartest of anyone.
  • Kim McAllister – Emergiblog blogger and queen of Change of Shift.  Feisty as expected.
  • Wes Fisher – Dr. Wes – he and I came up with a new form of tele-medicine.  Bright and has good sense of humor.
  • Richard Fogoros – Covert Rationing blogger – used some words the rest of us had to look up.  Brilliant, but not cocky.
  • Jim Herndon – Big-Wig in orthopedic circles (I am told), but you wouldn\’t know it from talking to him.  Listens as well as he talks.

The moderator was Ria Blakey, who was extremely good at her job, making us feel very comfortable.  Handled a couple of raving lunatics in the audience with grace.

I also got to meet:

  • Edwin Leap – OK, I met him before, but he still is beyond nice.
  • Kerri Morrone Sparling – Six Until Me diabetes blogger.  Very nice, but didn\’t let me get away with saying stupid doctor things.
  • Evan Falchuk – New blogger for me.  He\’s a lawyer who is on the good team.  Great sense of humor.  Got my jokes faster than anyone.  Poor guy.
  • Val\’s sister – Has a name, but I will allow her to hide in the shadows.  Doesn\’t look anything like Val.  Lives with Dutch People.
  • Duncan Cross – Recoiled when I called him a rabble-rouser.  He doesn\’t do it to raise a fuss; he does it because he has convictions.  I know that.  I meant it as a compliment.
  • Lisa Emrich – Brass and Ivory patient blogger.  Has lots of illnesses but doesn\’t seem to let it show.
  • Mother Jones, RN – She gave me a hug.  She is that kind of person.

There were also a couple of looneys in the audience (as I mentioned).  They made a very good case for universal mental health coverage.

I didn\’t meet the giant inflatable Santa.  That was a blatant case of false advertising.  The children were weeping.

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Val also promised I could meet Oprah.  No dice on that one either.

It was nice to meet everyone.  I hope I didn\’t leave anyone out.  Let\’s do it again soon!

53 thoughts on “Washing Tons for Boggers”

  1. It was great to have you with us, Dr. Rob! Sorry about Oprah – she and I had a falling out after she offered Jenny McCarthy a TV show on her network. The Secret was bad enough – but encouraging moms not to vaccinate their kids is beyond the pale!

  2. It was great to have you with us, Dr. Rob! Sorry about Oprah – she and I had a falling out after she offered Jenny McCarthy a TV show on her network. The Secret was bad enough – but encouraging moms not to vaccinate their kids is beyond the pale!

  3. Maureen Kane R.N.

    I just have a question for you. Is there a dearth of bloggers/web sites regarding insurance companies? Are there not any persons out there trying to show the good side of these things? Yes, there are good sides, believe it or not.
    I see no one in your list who fits that bill and I find no one when I prowl around the net either.
    Thoughts? Thanks. Maureen
    ( my spelling gets as bad as my grammer!)

  4. Maureen Kane R.N.

    I just have a question for you. Is there a dearth of bloggers/web sites regarding insurance companies? Are there not any persons out there trying to show the good side of these things? Yes, there are good sides, believe it or not.
    I see no one in your list who fits that bill and I find no one when I prowl around the net either.
    Thoughts? Thanks. Maureen
    ( my spelling gets as bad as my grammer!)

  5. I guess medical people generally think bad thoughts about insurance companies. They do some good, but so did communism in Russia. The lack of people saying good things and defending insurance companies is pretty damning in and of itself. I personally would defend big Pharma before I defended the insurance companies. Costs have gone up while our reimbursement has gone down. Where has the money gone? Watch this video if you have doubts. Do I think they are evil? No, I actually don’t. But I do think we are foolish to let them manage the money of healthcare.

  6. I guess medical people generally think bad thoughts about insurance companies. They do some good, but so did communism in Russia. The lack of people saying good things and defending insurance companies is pretty damning in and of itself. I personally would defend big Pharma before I defended the insurance companies. Costs have gone up while our reimbursement has gone down. Where has the money gone? Watch this video if you have doubts. Do I think they are evil? No, I actually don’t. But I do think we are foolish to let them manage the money of healthcare.

  7. Oh, how you hurt my head Dr. Rob… In your post “Radical Moderation” on June 10, 2009 you argued and appeared to support what “some would scream [as] ‘rationing’”, now you state above “I was a victim of rationing”.
    If you felt put out (my interpretation) from rationing, as it appears you were– then why does it appear you discount others when they “scream rationing” and may feel victimized if you try to limit diagnostic and medical procedures– seemingly labeling them worthless and a waste of money?

  8. Oh, how you hurt my head Dr. Rob… In your post “Radical Moderation” on June 10, 2009 you argued and appeared to support what “some would scream [as] ‘rationing’”, now you state above “I was a victim of rationing”.
    If you felt put out (my interpretation) from rationing, as it appears you were– then why does it appear you discount others when they “scream rationing” and may feel victimized if you try to limit diagnostic and medical procedures– seemingly labeling them worthless and a waste of money?

  9. My, hats off with a slight bow to Kerri Morrone Sparling – Six Until Me diabetes blogger.You state she is “very nice, but didn’t let me get away with saying stupid doctor things”.
    If my interpretation is correct and I hope it is– she called on you to stop calling people stupid. My kudos to her, she is trying to help you Dr. Rob and you should listen.

  10. My, hats off with a slight bow to Kerri Morrone Sparling – Six Until Me diabetes blogger.You state she is “very nice, but didn’t let me get away with saying stupid doctor things”.
    If my interpretation is correct and I hope it is– she called on you to stop calling people stupid. My kudos to her, she is trying to help you Dr. Rob and you should listen.

  11. Maureen,You are right, and yes there are VERY good things out there, I believe you. The issue here is that this blog doesn’t seem to want to give those sides. It has its agenda, it is bias and you will not get all the information here. It’s one reason I am here now…

    My first post to a blog was here in another area just days ago– it is the ‘narrowness’ (not to mention the name calling by Dr. Rod) of the viewpoints I found offensive. It will bring me back again and again to ‘out’ the flaming moderate that claims to be standing in the middle offending both side as little more than a fear monger pushing an agenda that he feels is right for everyone.

    Also, spelling is no sign of how intelligent you are—don’t knock yourself for it. If it bothers you, please read http://www.aihorizon.com/essays/generalai/rj_quest.htm It’s the questions we ask that are important, for without the questions, there would not be the answers.

  12. Maureen,You are right, and yes there are VERY good things out there, I believe you. The issue here is that this blog doesn’t seem to want to give those sides. It has its agenda, it is bias and you will not get all the information here. It’s one reason I am here now…

    My first post to a blog was here in another area just days ago– it is the ‘narrowness’ (not to mention the name calling by Dr. Rod) of the viewpoints I found offensive. It will bring me back again and again to ‘out’ the flaming moderate that claims to be standing in the middle offending both side as little more than a fear monger pushing an agenda that he feels is right for everyone.

    Also, spelling is no sign of how intelligent you are—don’t knock yourself for it. If it bothers you, please read http://www.aihorizon.com/essays/generalai/rj_quest.htm It’s the questions we ask that are important, for without the questions, there would not be the answers.

  13. Watch the video when it comes out. It was an ironic statement I made, but true anyway. Rationing is when you say there are only x amount of things allowed and you are x+1, so you don’t get it. To say, however, that aggressive chemo for advanced metastatic melanoma should not be paid for, you are not rationing, but making a decision about what is covered and what is not. There IS a difference – one is withholding paying for something that has merit, but they just pulled the bad lottery ticket, the other is withholding paying for something that has questionable merit.
    Ironically, I was being left off of the plane I had legitimately paid for and had right to think I had a seat on was a good example of rationing.

  14. Watch the video when it comes out. It was an ironic statement I made, but true anyway. Rationing is when you say there are only x amount of things allowed and you are x+1, so you don’t get it. To say, however, that aggressive chemo for advanced metastatic melanoma should not be paid for, you are not rationing, but making a decision about what is covered and what is not. There IS a difference – one is withholding paying for something that has merit, but they just pulled the bad lottery ticket, the other is withholding paying for something that has questionable merit.
    Ironically, I was being left off of the plane I had legitimately paid for and had right to think I had a seat on was a good example of rationing.

  15. Uh, no. Perhaps I was jumping to conclusions and talking in a patronizing way (hint, hint).

  16. Uh, no. Perhaps I was jumping to conclusions and talking in a patronizing way (hint, hint).

  17. That’s why when we get calls in our office about parents questioning vaccinations, we always say, “Hey, if you wanna take the advice of some ex-Playboy Bunny who went to Google University and ‘cured’ her child of a genetic disorder over someone who went through countless years of med school, been president of numerous vaccination boards and has helped research them… we’re probably not the office for you.”

  18. That’s why when we get calls in our office about parents questioning vaccinations, we always say, “Hey, if you wanna take the advice of some ex-Playboy Bunny who went to Google University and ‘cured’ her child of a genetic disorder over someone who went through countless years of med school, been president of numerous vaccination boards and has helped research them… we’re probably not the office for you.”

  19. I will be sure to watch the video when it comes out, count on it. I also understand rationing, thank you. However, you have also changed your angle, before it was an unnecessary diagnostic procedure ordered by another doctor that was paid for. Now, it’s about chemo for advanced metastatic melanoma not being paid for. Money is finite too (remember x+1, x=money in this case and there is no more—business 101?), if you didn’t pay for the coverage it is not rationing but the contractual agreement between the parties that appears to have made the problem. The example is probably crap also, pulled from your ‘hat’. It appears oncology is out of your realm of ‘practice’ too Doctor. But yes, the case may have merit but this is a nation of laws, contracts (insurance policies are a contract) are at the very foundation of our legal system. Consumers must be aware of what they are paying for, always!
    Much like the video link above with the ex-insurance executive. He kept his mouth shut while he was getting paid as you probably did too, until now, as you look towards your financial future. Considering the recurring statement about your reduced reimbursement, it casts questions as to why you are coming out now. Is it for the good of the people or the good of your bank account? It is your arguments that have questionable merits in my opinion.

    As for your statement “Ironically, I was being left off of the plane I had legitimately paid for and had right to think I had a seat on was a good example of rationing”.

    Do you think your patients when making an appointment, feel they have a legitimate right to think they have their seat in your exam room with you there on time, when you have double or even triple booked the time slot? Making them wait as you did for the next opportunity to be serviced, are they victems too? I hope the irony is not lost here…

  20. I will be sure to watch the video when it comes out, count on it. I also understand rationing, thank you. However, you have also changed your angle, before it was an unnecessary diagnostic procedure ordered by another doctor that was paid for. Now, it’s about chemo for advanced metastatic melanoma not being paid for. Money is finite too (remember x+1, x=money in this case and there is no more—business 101?), if you didn’t pay for the coverage it is not rationing but the contractual agreement between the parties that appears to have made the problem. The example is probably crap also, pulled from your ‘hat’. It appears oncology is out of your realm of ‘practice’ too Doctor. But yes, the case may have merit but this is a nation of laws, contracts (insurance policies are a contract) are at the very foundation of our legal system. Consumers must be aware of what they are paying for, always!
    Much like the video link above with the ex-insurance executive. He kept his mouth shut while he was getting paid as you probably did too, until now, as you look towards your financial future. Considering the recurring statement about your reduced reimbursement, it casts questions as to why you are coming out now. Is it for the good of the people or the good of your bank account? It is your arguments that have questionable merits in my opinion.

    As for your statement “Ironically, I was being left off of the plane I had legitimately paid for and had right to think I had a seat on was a good example of rationing”.

    Do you think your patients when making an appointment, feel they have a legitimate right to think they have their seat in your exam room with you there on time, when you have double or even triple booked the time slot? Making them wait as you did for the next opportunity to be serviced, are they victems too? I hope the irony is not lost here…

  21. What in the world did I do to make you so bitter? I never triple-book patients. I do my best to stay within my schedule, but sometimes I have to spend more time with patients and am late. My patients seem to understand. Why would you accuse me otherwise without knowing. Really. You are accusing me of things without knowing their truth. That is not at all reasonable. What’s the deal?
    You are throwing accusations and pretty bitter words at me. Do you know me that well? Why are you so angry? Really. What did I say that has made you speak with such anger? I am sorry if it something personal.

  22. What in the world did I do to make you so bitter? I never triple-book patients. I do my best to stay within my schedule, but sometimes I have to spend more time with patients and am late. My patients seem to understand. Why would you accuse me otherwise without knowing. Really. You are accusing me of things without knowing their truth. That is not at all reasonable. What’s the deal?
    You are throwing accusations and pretty bitter words at me. Do you know me that well? Why are you so angry? Really. What did I say that has made you speak with such anger? I am sorry if it something personal.

  23. I really was saying this because of your patronizing tone. Ask Kerri what she thinks of my attitude toward patients. I think she will have good things to say. I consider her a friend. I am sorry I got angry and responded in kind. Your comments were against me personally, which is not how people usually talk on this blog.
    I do get angry – much of it aimed at insurance companies. Why? I hope I make it clear that this is because of the harm they cause my patients. It’s not because of my income – I actually do just fine.

  24. I really was saying this because of your patronizing tone. Ask Kerri what she thinks of my attitude toward patients. I think she will have good things to say. I consider her a friend. I am sorry I got angry and responded in kind. Your comments were against me personally, which is not how people usually talk on this blog.
    I do get angry – much of it aimed at insurance companies. Why? I hope I make it clear that this is because of the harm they cause my patients. It’s not because of my income – I actually do just fine.

  25. Charlie, what axe do you have to grind here? You aren’t even making any sense. You just come here and blast away. What is the point of your vitriolic diatribe?

  26. Charlie, what axe do you have to grind here? You aren’t even making any sense. You just come here and blast away. What is the point of your vitriolic diatribe?

  27. It was great to meet you in person and a personable guy you are. Thanks for sharing your viewpoints here and in DC. Hey can I reserve the right to quote you – “Has lots of illnesses but doesn’t seem to let it show.” This is a great example of living with invisible illness, not always, well, so visible. LOL.

  28. It was great to meet you in person and a personable guy you are. Thanks for sharing your viewpoints here and in DC. Hey can I reserve the right to quote you – “Has lots of illnesses but doesn’t seem to let it show.” This is a great example of living with invisible illness, not always, well, so visible. LOL.

  29. Understood– no triple booking that’s good. Yet you had no denial of double booking—understood, some people just won’t show up, and some people need to be seen quickly, it pretty common. Some offices are even going ‘production based’ to keep up, with corporate Americas demands. Much like the airline that double booked your seat.
    The hostility you feel should not be new considering your statement “As a flaming moderate I get to offend people on all sides”. This is what you get when you try to offend, I too am sorry for being an ‘asshat’. But when you call peers, and others idiots, and stupid (these are offensive any way you say them) this is what you get, anger. I have many friends that have their MDs. Which would put them in the group you told to stop being “stupid”. They are all fortunate to also have their offices equipped with good implementations of EMR/PM systems to help improve the care for their patients, not to mention efficency. I also have friends that are implementing these systems. On certain things I think we agree, EMR is good, government and other institutions infringing upon a doctors ability to do their jobs, bad. But I don’t like your tactics, ‘to offend’ and I used the idea– again my apologies. What you did to make me appear so “bitter”? Please check your own word choice and ask yourself if I maybe justified.

    I hope to see less of the offensive side of this political issue in the future.

  30. Understood– no triple booking that’s good. Yet you had no denial of double booking—understood, some people just won’t show up, and some people need to be seen quickly, it pretty common. Some offices are even going ‘production based’ to keep up, with corporate Americas demands. Much like the airline that double booked your seat.
    The hostility you feel should not be new considering your statement “As a flaming moderate I get to offend people on all sides”. This is what you get when you try to offend, I too am sorry for being an ‘asshat’. But when you call peers, and others idiots, and stupid (these are offensive any way you say them) this is what you get, anger. I have many friends that have their MDs. Which would put them in the group you told to stop being “stupid”. They are all fortunate to also have their offices equipped with good implementations of EMR/PM systems to help improve the care for their patients, not to mention efficency. I also have friends that are implementing these systems. On certain things I think we agree, EMR is good, government and other institutions infringing upon a doctors ability to do their jobs, bad. But I don’t like your tactics, ‘to offend’ and I used the idea– again my apologies. What you did to make me appear so “bitter”? Please check your own word choice and ask yourself if I maybe justified.

    I hope to see less of the offensive side of this political issue in the future.

  31. I think I have made my point– if you did not follow it, I am sorry for being so obtuse.

  32. I think I have made my point– if you did not follow it, I am sorry for being so obtuse.

  33. OK. Thanks for the explanation.
    We do double-book, but only 1 per hour and it must be a simple (5 minute) medical problem. We found that this allowed people to get seen on the same day of their illness and the accessibility it offered was very much loved by our patients. My staff is good at determining simple from complex. Most of the time I stay fairly on-time.

    The purpose of that post was to rant a little at what I see as political games on the parts of politicos and the doctors standing by the sidelines doing nothing but gripe. A someone who is trying to put his voice out there for others to hear, it bothers me when my peers jump into political jargon instead of working on the problem itself. Yes, I get passionate about what I write. Your problem was that you read one of my strongest pieces early on. Really, I try to be even-handed and certainly try to listen to what others have to say (read the recent post “Speak to Me” and its comments as a good example).

    That, by the way, was the point of the meeting in DC. We had REAL doctors who take care of REAL patients making their voices heard.

    I will take choice of words into consideration, but if my passion spurs dialogue, then I suppose I’ve done what I wanted.

  34. OK. Thanks for the explanation.
    We do double-book, but only 1 per hour and it must be a simple (5 minute) medical problem. We found that this allowed people to get seen on the same day of their illness and the accessibility it offered was very much loved by our patients. My staff is good at determining simple from complex. Most of the time I stay fairly on-time.

    The purpose of that post was to rant a little at what I see as political games on the parts of politicos and the doctors standing by the sidelines doing nothing but gripe. A someone who is trying to put his voice out there for others to hear, it bothers me when my peers jump into political jargon instead of working on the problem itself. Yes, I get passionate about what I write. Your problem was that you read one of my strongest pieces early on. Really, I try to be even-handed and certainly try to listen to what others have to say (read the recent post “Speak to Me” and its comments as a good example).

    That, by the way, was the point of the meeting in DC. We had REAL doctors who take care of REAL patients making their voices heard.

    I will take choice of words into consideration, but if my passion spurs dialogue, then I suppose I’ve done what I wanted.

  35. Wow. What a hornet’s nest in here.
    For Charlie – I have no issues with Dr. Rob. He was a very entertaining and personable guy and honestly, as a patient advocate, I felt that he was a good voice to have on our side.

    And for Dr. Rob – I am nice. And I don’t care for stupid doctor things. Good calls on both fronts. 🙂

  36. Wow. What a hornet’s nest in here.
    For Charlie – I have no issues with Dr. Rob. He was a very entertaining and personable guy and honestly, as a patient advocate, I felt that he was a good voice to have on our side.

    And for Dr. Rob – I am nice. And I don’t care for stupid doctor things. Good calls on both fronts. 🙂

  37. Maureen Kane R.N.

    Well, Charlie, Rob et al, my innocuous little question/comment sure opened a can of worms didn’t it? That being said, may I establish that:1. I have worked for a large national not-for-profit HMO for 18 years. Being integrally involved in UM ( yes, that dirty word Utilization Management) for 14 of those years years, I can assure you that ALL decisions to either approve or deny were based on either sound clinical criteria as reviewed by physicans OR the terms of the patient’s contract with us.
    2. The terms of a member’s contract are set ,in most cases, by the employer, not the insurance company. That is the tail that wags the dog. If the employer says’ exclude treatment x,y,z or we will take our 1,000 members elsewhere’ we then write the contract as asked. It is the employer who decides that a deductible will be $5,000 for a family and the out of pocket maximum will be an exorbitant $10,000: not the insurance company.
    3. The most stringent ( stingy?) of the employer groups are the self funded, as was the group who insured the young lady who died while trying to get a liver transplant. Transplants were excluded by the employer group, not the insurer. Self funded groups are not held accountable to any state laws/mandates regarding what to cover, only Federal laws. That is why employers like being self funded and you will see more and more employers adopt this method of payment.
    4. Wendell Potter has a lot in common with Michael Moore: a penchant for inflammatory statements that present one side without offering concrete facts to back them up. Please see http://www.forbes.com/2008/01/08/sarkisyan-cancer-insurance-biz-healthcare-cz_dw_0107cigna.html for another take on the Nataline Sarkisyan case.
    5. Care does need to be ‘managed’ as the health care dollar is indeed finite. A huge reason for the expense of health care= increased premiums= less people able to afford coverage is the fact that every person wants EVERYTHING done that is available, whether appropriate or not. And they want ultimate unlimited choice. And we all understand that. But it isn’t possible. Someone has to make the determination that certain treatments are not medically called for. Managed care took on that role and the rebellion against anyone telling a patient ‘ you don;t need that’ continue to this day.

    Thank you for listening. It seems I will have to start my own blog to advocate for the ‘dark side ‘ and offer some alternative to oftentimes unjustified ‘ insurance company bashing’.
    Maureen

  38. Maureen Kane R.N.

    Well, Charlie, Rob et al, my innocuous little question/comment sure opened a can of worms didn’t it? That being said, may I establish that:1. I have worked for a large national not-for-profit HMO for 18 years. Being integrally involved in UM ( yes, that dirty word Utilization Management) for 14 of those years years, I can assure you that ALL decisions to either approve or deny were based on either sound clinical criteria as reviewed by physicans OR the terms of the patient’s contract with us.
    2. The terms of a member’s contract are set ,in most cases, by the employer, not the insurance company. That is the tail that wags the dog. If the employer says’ exclude treatment x,y,z or we will take our 1,000 members elsewhere’ we then write the contract as asked. It is the employer who decides that a deductible will be $5,000 for a family and the out of pocket maximum will be an exorbitant $10,000: not the insurance company.
    3. The most stringent ( stingy?) of the employer groups are the self funded, as was the group who insured the young lady who died while trying to get a liver transplant. Transplants were excluded by the employer group, not the insurer. Self funded groups are not held accountable to any state laws/mandates regarding what to cover, only Federal laws. That is why employers like being self funded and you will see more and more employers adopt this method of payment.
    4. Wendell Potter has a lot in common with Michael Moore: a penchant for inflammatory statements that present one side without offering concrete facts to back them up. Please see http://www.forbes.com/2008/01/08/sarkisyan-cancer-insurance-biz-healthcare-cz_dw_0107cigna.html for another take on the Nataline Sarkisyan case.
    5. Care does need to be ‘managed’ as the health care dollar is indeed finite. A huge reason for the expense of health care= increased premiums= less people able to afford coverage is the fact that every person wants EVERYTHING done that is available, whether appropriate or not. And they want ultimate unlimited choice. And we all understand that. But it isn’t possible. Someone has to make the determination that certain treatments are not medically called for. Managed care took on that role and the rebellion against anyone telling a patient ‘ you don;t need that’ continue to this day.

    Thank you for listening. It seems I will have to start my own blog to advocate for the ‘dark side ‘ and offer some alternative to oftentimes unjustified ‘ insurance company bashing’.
    Maureen

  39. Please do voice your opinion. I will say that I have actually served on a formulary committee for an insurance company and know that these folks are not evil or bad people – they are doing what is best for their business. I have no problems with them doing that.
    My beef is not with the management of care – I agree 100% that care/cost has to be managed (I reiterated that multiple times in Washington). My problem is to put a for-profit company as the one to decide if money should be withheld. Even with very nice moral people at insurance companies, there still is a conflict of interest.

    That being said, I am mostly just jaded by living the past 15 years in a constant tug-of-war with them about what I want to do and what they say I can do. From the perspective of someone who is tries to be conservative with my ordering of tests and medications, the amount of exasperation I have had from insurance companies has truly made it hard for me to feel much in the way of good feelings toward them. I am sure they were right for denying me, but it just is exhausting to fight every day.

  40. Please do voice your opinion. I will say that I have actually served on a formulary committee for an insurance company and know that these folks are not evil or bad people – they are doing what is best for their business. I have no problems with them doing that.
    My beef is not with the management of care – I agree 100% that care/cost has to be managed (I reiterated that multiple times in Washington). My problem is to put a for-profit company as the one to decide if money should be withheld. Even with very nice moral people at insurance companies, there still is a conflict of interest.

    That being said, I am mostly just jaded by living the past 15 years in a constant tug-of-war with them about what I want to do and what they say I can do. From the perspective of someone who is tries to be conservative with my ordering of tests and medications, the amount of exasperation I have had from insurance companies has truly made it hard for me to feel much in the way of good feelings toward them. I am sure they were right for denying me, but it just is exhausting to fight every day.

  41. Kerri, Rod and everyone else here, I apologize for the “hornets nest”. It WAS hard to be such an @ss– please believe me. In fact the whole thing has left me empty, save some feelings of guilt.
    If I misunderstood the “stupid doctor” statment, it’s not the first time I have been wrong and I know it will not be the last.

    As Doc. Rob stated my “problem” was reading one of his most radical postings first. But it was not his ideas I disagreed with (mostly)– It was the delivery.

    I am now trying to edit my Masters Thesis down to a manageable size (it is about 120 pages.) It covers several different EMR systems, types of implementations, costs, ROI, efficiency, barriers and other associated issues.

    I hope this effort moves me away from being part of the problem (having stated no avenue for solution) and, I hope will help to answer some questions. But I fear it will take a few weeks to cut the meat from the bloated APA standards it adheres to.

    Again my apologies…

  42. Kerri, Rod and everyone else here, I apologize for the “hornets nest”. It WAS hard to be such an @ss– please believe me. In fact the whole thing has left me empty, save some feelings of guilt.
    If I misunderstood the “stupid doctor” statment, it’s not the first time I have been wrong and I know it will not be the last.

    As Doc. Rob stated my “problem” was reading one of his most radical postings first. But it was not his ideas I disagreed with (mostly)– It was the delivery.

    I am now trying to edit my Masters Thesis down to a manageable size (it is about 120 pages.) It covers several different EMR systems, types of implementations, costs, ROI, efficiency, barriers and other associated issues.

    I hope this effort moves me away from being part of the problem (having stated no avenue for solution) and, I hope will help to answer some questions. But I fear it will take a few weeks to cut the meat from the bloated APA standards it adheres to.

    Again my apologies…

  43. Charlie: If I can have a bad tone, you can as well. No problem at all. Thanks for apologizing.
    I am actually going to write a post coming up about the fact that I have been more angry and provocative than normal. You helped point that out (along with others’ comments). For contrast, read Monday’s physical exam post.

    Keep your head up. It is a good sign that you apologized and I hope you come back and whack me across the shins if I need it.

  44. Charlie: If I can have a bad tone, you can as well. No problem at all. Thanks for apologizing.
    I am actually going to write a post coming up about the fact that I have been more angry and provocative than normal. You helped point that out (along with others’ comments). For contrast, read Monday’s physical exam post.

    Keep your head up. It is a good sign that you apologized and I hope you come back and whack me across the shins if I need it.

  45. Maureen, I like this post… I would enjoy hearing more from you, blog on!

  46. Maureen, I like this post… I would enjoy hearing more from you, blog on!

  47. Maureen Kane R.N.

    Thanks Charlie. I will report out on the town hall meeting tomorrow with President Obama. He will be here in Ohio to discuss health car reform and I got 2 tickets. Can’t wait.

  48. Maureen Kane R.N.

    Thanks Charlie. I will report out on the town hall meeting tomorrow with President Obama. He will be here in Ohio to discuss health car reform and I got 2 tickets. Can’t wait.

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