The chilling effect... on MDs
Heather Higgins ·
Aug 29, 2010 at 9:09pm
Suddenly, it is MUCH harder to find MDs and RNs who are willing to record calls about the health care legislation. With more and more physicians becoming employed by hospitals and large groups, fewer and fewer are willing to take a political stand for anything other than tort reform. Everyone it seems is afraid of getting fired or an IRS audit, or in some way adversely affecting their practice. One more reason why being dismissive about government control is to be cavalier about our liberty and the perils of intimidation.
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Jul '10
Re: The chilling effect... on MDs
Pediatrician:
"Does your mommy give you sweets a lot? Does she let you drink soda? Does Daddy have any guns at home? Does he smoke in the house? Now I'm going to show you a little doll...does Daddy ever touch you...here?"
Jun '10
Re: The chilling effect... on MDs
Heather, the best is yet to come if the US nationalizes medicine. In Canada chronic patients have difficulty getting a doctor’s appointment; it seems their GPs are too busy to see them. Chronic patients require more time and the visits result in little or no success, consequently, doctors tend not to want them as patients. Invariably, these patients end up at walk in clinics. The College of physicians and surgeons in this region has begun cracking down on the walk in clinics by forcing them to accept these chronics as patients when they supposedly have family doctors. Symptomatic of the problem is that hospitals now have doctors that are termed “Hospitalists”, these are doctors employed by a hospital to oversee the needs of patients that have no family doctor of record. In turn the doctors are restricted to a finite number of patient visits they can bill in a single day. Once they see more than the allotted number the medical services do not reimburse them. Perhaps the most alarming aspect is that the government now sets the billing rate per visit, which turns doctors’ salaries into a political football subject to class war sentiment.
Jul '10
Re: The chilling effect... on MDs
Kenneth is not kidding but, unfortunately, it's not only pediatricians who double as policemen now. At a recent visit to, my American, doctor it was: do you drink alcohol, do you smoke, would you step on the scale, do you feel safe in your home, how much sugar do you consume? My response was that none of this had anything to do with my problem, ear-ache. Perhaps each of us should take a firm stand on how far we can be pushed. As a Canadian I can tell you that whatever the joys socialized medicine, my personal habits or domestic safety were of no concern to my doctors. It is unfair to compare Obamacare to the Canadian system. Obamacare is shaping to be much, much worse
Jun '10
Re: The chilling effect... on MDs
I work with a lot of physicians and I surmise that they are less afraid of retribution than of simply appearing ignorant They are not much better informed than you or I about what's coming and the regulatory framework that really determines the implementation hasn't even begun to be developed. If they were to say to you what they say to me, you would hear real fear related to low reimbursement, ever more red-tape, interference with medical decision-making, fines or worse for running afoul of new regulations,inability to spend adequate time with patients, medical malpractice premiums can exceed their take-home and predatory trial lawyers. Many speak of plans to retire, change careers, and to limit or move practices to avoid a concentration of Medicare or Medicaid patients
May '10
Re: The chilling effect... on MDs
This business is going to change drastically, ObamaCare or not.
The two biggest adjustments will be to ambulance-chasing and to open up medical licensing to far more economical use of information technology. The primary care shortages will disappear- if (and only if) the rigid monopolies are broken.
Jun '10
Re: The chilling effect... on MDs
Duane Oyen: This business is going to change drastically, ObamaCare or not.
The two biggest adjustments will be to ambulance-chasing and to open up medical licensing to far more economical use of information technology. The primary care shortages will disappear- if (and only if) the rigid monopolies are broken. · Aug 30 at 8:45pm
Ambulance-chasing I get. Could you expand on the rest?
May '10
Re: The chilling effect... on MDs
Sure. Medicine, like any set of industrial or processing tasks, is complex in the aggregate and simple when broken down. In every other area of your life, unless regulatory processes interfere, managers break down larger tasks to simpler forms and delegate them to appropriate levels. The key is getting the levels right and not losing the system effects when buried in the component details. As we have learned more and more about physiology, the expertise has fragmented and deepened.
One hundred years ago, you had doctors and surgeons, descendants of Galen, and the medieval barber surgeons (who sawed off limbs during time of war). In the late 1800's, medical education was a mess, and a group of mostly Ivy League medical schools formed a cartel to freeze out the charlatans and bring some discipline to the profession. That is when the official term "MD" was created to describe "allopathic medicine" practitioners. A few years later, after much acrimony and even legal maneuvers, osteopathy was granted the same legal licensing status, and that is where we stand today- two kinds of doctors- MD and DO, who do virtually the same thing.
May '10
Re: The chilling effect... on MDs
But what they actually do is:
1) collect information, by asking, observing, via sensors, and auscultation (stethescope) and palpation (tactile).
2) process information
3) Make judgments and establish a response based on standardized algorithms; and the processing and algorithms are absolutely locked in most cases by standards of care necessary to avoid malpractice vulnerability.
For the most basic front-line needs- primary care- the doctor can almost literally be replaced by a computer a nurse or med assistant, and an air-inflatable jacket with some sensors embedded in it.
Cheaper nurses already do telephone triage, physicians assistants and certified nurse practitioners exercise standard protocols under MD supervision. This will accelerate significantly as cost pressures grow and as physicians settle in cities, leaving small towns and rural populations served by distance medicine. If you can see a patient cheaply over Skype, you can do so cheaply in the same town. I diagnosed and treated strep throat according to a stock protocol as a nursing student a dozen years ago.
The trade associations have thus far succeeded in quelling the competition. But in 20 years, physicians will either supervise 20 caregivers, consutling, referring, and reviewing exception charts, or specialize, handling complex cases.
Jun '10
Re: The chilling effect... on MDs
Thanks for the response. You may be right that the current guilds will have to be broken, but if physicians and nurses can control (and profit) from the technology by extending their reach and reducing their costs they may embrace it. Dr McCoy did keep possession of the Tricorder at all times.