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Posts tagged patients

The question of how much money physicians should make has long been a provocative topic. Even about 250 years ago, pioneering economist Adam Smith summarized the prevailing tone when he wrote, “We trust our health to the physician… Such confidence could not safely be reposed in people of a very mean or low condition. Their reward must be such, therefore, as may give them that rank in the society which so important a trust requires.” (An Inquiry Into the Nature and Causes of the Wealth of Nations; 1776)

With today’s focus on the need to control US healthcare costs and boost the number of primary care physicians, physician payment again is in the limelight.

Physicians are clearly fighting to maintain the incomes they — often justifiably — feel they deserve and for which they have paid their dues. But it’s obvious that just about no one else in society is weeping over any potential decline in physician salaries.

Few experts think that US physicians overall are paid too little, especially compared with most American workers. Some say that US physician fees, income, and services overall are excessive, contributing to US medical spending that’s by far the highest per capita in the world. Others argue that certain types of specialists, such as radiologists and orthopedic surgeons, are paid too much, while others, such as family practice physicians, pediatricians, and geriatricians, are paid too little.

A growing number of experts argue that the prices that physicians and other providers charge need to be curbed, along with wasteful and inappropriate care. That could lead to reduced physician incomes — though no one wants to see the draconian Medicare sustainable growth rate cuts take effect.

However, many consider high physician incomes to be perfectly justified.

Another view is that the US free market more or less accurately determines how much money it takes to attract and keep talented people in medicine. In a country where the top 1% have an average pretax income of $380,000, not counting capital gains, while the median household income is about $50,000, these observers say that it takes the promise of high and secure earnings to convince the brightest young people to choose a career in medicine rather than the potentially more lucrative fields of finance, management, law, and lobbying.

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Ouch! Did you know one of the fastest ways to go broke in America is to go to the hospital. As a physician-in-training, I see a lot of patients with similar stories, but I have noticed that these days it seems like almost everyone has an outrageous hospital bill story to share, myself included.

It is getting to the point where most people are deathly afraid to go to the hospital. All the financial progress that you have made in recent years can literally be wiped out in just a matter of hours. For example, you are about to read about an Arizona woman that was recently charged $83,046 for a three hour hospital visit. How in the world is anyone supposed to pay a bill like that? I have a really hard time understanding why a visit to the doctor should ever be more than a couple hundred bucks or why a hospital stay should ever be more than a couple thousand dollars.

The outrageous cost of healthcare, and hospital bills in this country are a real pet peeve of mine. What makes all of this even more infuriating is that Medicare, Medicaid and the big insurance companies are often charged less than 10 percent of what the rest of us are billed for the same procedures.

There is a reason why 41 percent of all working age Americans are struggling with medical debt right now. It is because our health care system has become a giant money making machine.

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I currently have a patient who’s father is doing everything possible to avoid his children from being vaccinated? The father has never allowed the children to have ANY vaccinations of any kind, and claims to have legal documents stating his children are exempt due to religious reasons, as well as so he can avoid them from “being shot up with mercury and synthetic garbage only to be brain damaged” — I kind of felt insulted when the patients father said this, as he did not believe in me, or the healthcare industry.

A few months ago, I read an article in the Wall Street Journal, that stated 20 to 30% of physicians have reported kicking out patients from their practices because of vaccine refusal — I don’t think that this is the correct way to deal with things. I mean sure, I understand bringing an unvaccinated child to a pediatricians office can spread diseases to other children, and even be fatal to some — but we can’t just fire our patients. We have to show the strong evidence for vaccine safety, and educate them about the frightening consequences of infection with meningitis, hepatitis, measles, polio, and other vaccine preventable diseases.

As a physician-in-training — the only thing I can do is try to explain why I believe the children should be vaccinated, and educate the patients families on why vaccines are important, not just to them — but to the rest of population as well. 

First off — vaccines have been so successful at eliminating childhood infections that parents no longer see these infections as a threat. Ironically, the very success of vaccines has allowed the anti-vaccine movement to sway so many people.

Now, let’s get down to the facts — vaccines do not cause autism, nor do the ingredients in vaccines — scientific studies involving hundreds of thousands of patients support these conclusions. 

Anti-vaccinations claims on the internet started when Andrew Wakefield published one small study of 12 patients, now retracted, which claimed a link between the MMR vaccine and autism. Investigations later revealed that he was paid a large sum of money to recruit patients for a lawsuit against vaccine makers, and that he did not reveal these payments to his co-authors or patients, and that he manipulated the data itself.

Ever since then the anti-vaccine movement has exploded and we have experienced multiple outbreaks of measles, mumps, and other illnesses linked directly to unvaccinated children.

If we’re going to avoid a return to the era when children routinely died from infections, we have to keep trying..

For medical school students, Benjamin Franklin’s ubiquitous remark about death and taxes is particularly apropos. But while taxes will come into play years down the road, death is usually introduced on the very first day in the form of the cadaver you meet in Gross Anatomy. Death becomes more consequential, however, the first time a patient whose care you are directly involved with dies. 

Perhaps you are part of the code team that tries unsuccessfully to revive him or her, or perhaps you simply find out about it after the fact. Either way, it is certain to happen. 

When a patient you have been looking after dies, many emotions may come into play. We as physicians-in-training are trained to cure patients and improve their quality of life and in this context, we may feel that we have failed when someone dies. Patients may often develop a closer bond with us than with other medical staff — as we are able to spend longer time with patients than our attending, and they may confide in us more than others.

That first death, may be difficult, and the only thing you can do is know where to go for help.

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It’s an intriguing story: a teenage girl confides in you that she’s thinking about having sex with her boyfriend. Then, her parents secretly disclose to you that she has a communicable disease but doesn’t know it. What do you do?

An article from The Hastings Center Report, reprinted with free access on Medscape, gives all the details in this case, along with expert commentary. To Tell or Not To Tell is a really fascinating read, and it offers the kind of ethical reasoning that may not be taught in formal medical training.

So, if you want to explore the “art” of medicine and enhance your own ability to navigate such tricky patient encounters, take your nose out of whatever else you’re reading — even if you’re studying for an exam — and read this exceptional article. If you have questions or comments about it, share your thoughts here.

I’m currently on my psychiatry rotation at a major hospital in Chicago, and I have come to learn, and understand that as you progress in your medical training and career, you will encounter many different types of patients who have a wide range of personality traits and circumstances. These individuals will be faced with depression, terminal illnesses, chronic pain, addiction, and other problems. Some of them will be kind and a joy to see; others will be angry, frustrating, and challenging.

As a physician, you will need to get along with almost everybody well enough to do your job and, at the same time, develop a decent reputation. Your mission, of course, is to assure that your patients receive the best medical care that you can deliver, in a nonjudgmental way, no matter what their personal characteristics are. How well you accomplish this mission will in large part determine the kind of physician you are.

By carefully considering your patients’ personality traits and circumstances, you’ll be able to provide compassionate as well as scientific care to your patients. Keeping in mind that people are much more complex than any one of these characteristics, you might consider the following “types” of patients…

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I had a patient came in today saying, “Hey doc.. I got a leaky deaky, could you repair it so I can get freaky?!” — I chuckled to myself, and told the patient they had nothing to worry about.

Did you know, over 13 million people in America suffer from various forms of overactive bladder (OAB).

So what exactly is OAB? Basically the bladder muscle (the detrusor) is relaxed in a normal individual, but as we age, stress, and as life hits us — the muscle tends to tighten up and contract. These involuntary bladder muscle contractions during the bladder filling phase cause this increased urgency — as they cannot be suppressed by the patient. But, no need to worry — these days, OAB is treated relatively easily and pain free via the use of anticholinergic agents.

I’ve seen this patient so many times!  Another reason to love the ED.