Authentic Medicine Gazette

Enjoy our most current issue of the most popular medical e-newsletter on the internet.

Blogs and Thoughts for May 18th to May 24th:

Here is what we had this past week

  1. How Times Have Changed by Steven Mussey MD
  2. The Derm Response
  3. UnitedHealth Outdoctors The Government
  4. That’s More Like It by Pat Conrad MD
  5. Rookie Move by Pat Conrad MD
  6. The One Minute Doctor
  7. Quote of the Week: Earl Nightingale

 

1. How Times Have Changed by Steven Mussey MD

May 24th, 2017

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2. The Derm Response

May 23rd, 2017

I recently did a review of a ridiculous study and you can see it here.  After mocking it I said this:

I guess when you make so much money you have to find a way to distract people from being too critical?  How? First up, throw the evil sun at them.  If that fails then you create a new prejudice. All we need now is a law to stop any movie from depicting someone who is “integumentary challenged”.  (I made that term up.  Do you like it?)

Before anyone thinks I am too insensitive let me summarize my thoughts on this:

  1. Humans are not perfect and we all have our blemishes.

  2. We all don’t need a personal dermatologist to see us to fix every blemish.

  3. ALL sun is not evil.

  4. This study is ridiculous.

  5. Dermatologists make too much money.

Was I too harsh?  Maybe.  Is it true? You decide. (You will notice that I never mentioned their value, their intelligence, or their work ethic).

Well, the dermatologists struck back and treated me as if I committed a hate crime.   Please read the above again and then see if the following comments were warranted. All are real and from dermatologists who felt they needed to say this:

  1. “Don’t be bitter because of your poor performance in medical school. Had you worked harder you could have been a happy dermatologist, not a miserably envious PCP.”
  2. “Trial lawyers get paid over 1.5 million on average too…And your field makes 300-350,000 with a full time schedule of 14 days a month so what’s your point you guys get way more time off than anyone and are grossly over paid for running a bunch of test in the ER that insurance companies have to dish out lots more money for driving everyone else’s health care cost to the moon. All my primary doctors call me up and I get their patients in the day of we make room for our schedule in my office for emergencies. The reason why you can’t get your patients in is bc of you, you sound like the biggest jerk who blames everyone else for their unhappiness while looking at other specialty journals you wish you got into but didn’t have the grades or the good standing in medical school.”
  3. “Doug your full of shit, punch biopsies free etc. yea they are free because your charging patients a monthly recurring fee regardless of if they need your services that month. You are charging each patient 900 a year. When they see a dermatologist they get charged for appropriate care. I bet you don’t even know what to do with your biopsy results and then you send to Derm. Hahah next time around get a better step 1 score and do what you really wanted to do in life and stop hating! Your ego really shows AKA “the king of medicine” And stop doing biopsies when you don’t even know what your looking for!”
  4. “Wow. Who are you? An offensive ass. I am a dermatologist and dermatopathologist in private practice. I do not practice cosmetology- that is a joke. Do you say the same of plastic surgeons who choose to practice cosmetic surgery only? I doubt it. Yes, I help patients with treating their disfiguring acne scars and birthmarks. Primarily though, I see complex medical dermatology patients, manage autoimmune blistering skin conditions and other severe dermatoses and prescribe many immunosuppressants. I diagnose and treat skin cancers much earlier than any other specialty. Last year, I diagnosed a systemic aggressive lymphoma in a pregnant woman that everyone else missed for six months and she nearly died. Two weeks ago I saw a patient with unrecognized gangene of the penis due to warfarin-induced necrosis that had been treated for 2 months by his PMD for an “infection” and had to undergo penectomy. These are just many examples of what I and many dermatologists do each day. Many of my referring MDs have my cell phone and I will work in patients for them. I am so sick and tired of dermatologists getting no respect from other specialties. Wait until you or a family member gets a crazy skin condition, develops melanoma or another skin cancer and needs our help to get them better. I am damn good at what I do. I see a lot of patients in day due to demand and that is why I might make more money than some, but not all, primary care docs. Demonizing another specialty is pathetic. You’re just a troll. If I was a patient looking for a PMD I would stay far away from you. There’s something called karma- watch out, Doug.”
  5. “Wow Doug you sound really super bitter. That first line, “who cares what you resent?” just reeks of resentment. Also, you’re kind of an ass. Maybe not kind of, really an ass. You took the time to write this piece and mock one of the most competitive specialties in medicine. More importantly, you’re quite out of touch with reality. I can’t tell if you’ve just had interactions with bad physicians or if you’re delusional, but something’s off. If you’d like your patients to have sub-par care then great, get rid of dermatologists altogether. Take care of all their skin problems yourself. See how happy your patients are when you can’t figure out their rashes, can’t clear their acne (yes, acne is important, anyone who’s ever been a teenager will tell you), can’t stop them from losing their hair, can’t catch their skin cancer at an early stage so they can live, can’t put together a complicated pathology report with an unusual rash to come up with a life changing diagnosis, can’t tell the difference between neonatal lupus and seborrheic dermatitis (yes, that happened), can’t tell the difference between a wart on the foot and fungating melanoma (yes, that happened), etc etc. You’ve clearly never seen a dermatology textbook (try opening one! I recommend you start with Bolognia) and since you clearly have no idea what the majority of dermatologists do all day, you have no space to talk, let alone insult and ridicule. Do we also freeze warts and inject pimples and Botox and yada yada? Yeah, we do, that’s our job, comes with the territory. We are all physicians and we all have our corner of medicine. You couldn’t do my job. Quit complaining about it, because you sound pathetic.”
  6. “Oh Doug! You are such a saint! If only the rest of the world were so righteous and selfless the world would be perfect. You have masterfully proven the point that you are superior to other doctors because you do things for free. Capitalism is so bad!! Gosh golly. If everyone would just do stuff for free then they too would be justified in whining about how everyone else makes too much money. Then everything would be as peachy as it is Venezuela.(To the rest of the primary care guys reading this, I think you should get paid more than you do. I respect your work and I think it goes under compensated. Farrago though, I think he should make less so he can be more justified in his complaining here. His sense of moral superiority…. THAT is what he gets to have instead of payment)”
  7. “Many of us don’t do cosmetology that’s an aesthetician. I personally practice general dermatology taking melanomas out, putting my psoriasis patients on biological and Mohs surgery on skin cancer patient most of which are VA patients that have served our country. If you guys feel we are useless and don’t see “real cases” than why don’t you guys start seeing dermatology patients instead of texting us pictures and calling us since most doctors have never had even one month of dermatology since it’s not required. Or better yet let Dr Google be your new dermatologist. I resent this physician shaming that is in this article. This should never be done to another physician or a speciality group in public or on paper. We already have enough people against us physician trying to pay off our loans, trying to get insurances to cooperate so patients can get the medications they need, people stealing from our offices and frustrated patients. This energy should be better spent on tackling getting better care to our patients.”
  8. “He’s an idiot masquerading as an writer. Can’t believe I wasted my time reading his envious, uneducated post.”

I am not going to even reply to these comments and sent them right to the trash section.  After a few days I changed my mind and felt they need to be seen.  I welcome your response to this.  But before you do please take a look at this article entitled “Elephant in the room of dermatology” by Dr. Brett Coldiron where he states the following:

“The honest ones in private practice, however, say, “Man, I make $200,000 a year off my PA while I am off.” The honest academics say, “Listen, I work in a gulag, and I would never be able to travel if my nurses didn’t see my patients.” Time is money, and the academic who gets an extra 10 hours a week out of clinic is benefiting as much as the guy who makes $200,000 a year.”

Dr. Coldiron, by the way, was past-president of the American Academy of Dermatology.

Making $200K off your PA while you’re off?  Family docs don’t make this themselves in a year.  Does anyone else see something wrong with this?  I understand that not all derms do this but the fact remains that the average dermatologist makes double what a primary care doctor makes. 

I think it is fair game to question a procedure based payment system that results in a disparity between  dermatology and family medicine by a ratio of 2 to 1.   If that makes me bitter, offensive, self-righteous or an idiot then so be it.

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COMMENT HERE

3. UnitedHealth Outdoctors The Government

May 22nd, 2017

The Justice Department on Tuesday has accused UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans. They are alleging “that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved.” How does this happen?  Well, Medicare pays the health plans using a complex formula called a risk score, which is supposed to pay higher rates for sicker patients than for people in good health. It seems UnitedHealth repeatedly ignored findings from its own auditors that risk scores were often inflated.

The lawsuit cites more than a dozen examples of undocumented medical conditions, from chronic hepatitis to spinal cord injuries. At one medical group, auditors reviewed records of 126 patients diagnosed with spinal injuries. Only two were verified, according to the complaint.

It never ceases to amaze me how greedy these insurers are.  They do NOT lose money.  Sure they got a little squeezed by the ACA but they had exit guarantees that made the move less risky.  Add to this that they raised ALL the rates outside of the exchange and they won big. You can see their profits and their stock prices if you don’t believe me. But that wasn’t enough. They had to cheat even more by making patients “sicker” then they are or by making up diagnoses when they needed to.

I guarantee they pay a minimal fine for this when it is all said and done.  And the taxpayers will lose again.

COMMENT HERE

4. That’s More Like It by Pat Conrad MD

May 21st, 2017

And then…

Miss USA is getting her mind right, courtesy of the mob.  After saying during her title-winning pageant answer that health care is a “privilege,” she was scorched for such a horrible slight to humankind.  She has since clarified:  “I am privileged to have health care and I do believe that it should be a right,” McCullough said on “Good Morning America,” adding, “I hope and pray moving forward that health care is a right for all worldwide.”

Now your talking girlfriend!  That’s what Whoopi and Joy and the studio full of intellectuals at “The View” want to hear.  Honestly, it wouldn’t hurt if you could go on “Live with Kelly and Ryan” and mention that you know, doctors do make an awful lot of money, and maybe they should…well, that comes with practice.

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We’ll know you have total commitment when Congress asks you to testify about the worsening health care crisis on which you will by then have been deemed an expert on the basis of your acceptably compassionate views. 

The important thing is to never stop feeling, and never allow that rational nuclear chemistry-trained intellect of yours to interfere with giving the people, the important, beautiful people, what they need to hear.  Don’t worry about Aetna bailing on ObamaCare, or the millions of families pushed to the margins because they voted for health care to be more of a right, or the 20 trillion debt and what a real economic collapse will look like when the hospitals can’t even get normal saline.  Because if you do, that nasty little bug that Kahn put in your ear via Twitter will start chewing on your brain, and the screaming will return.

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5. Rookie Move by Pat Conrad MD

May 20th, 2017

Ooooh, she didn’t read the script!  Everybody knows there are acceptable opinions, and there are rude, nasty, ugly points of view that will get you blasted from fashionable circles quicker than you can say “personal responsibility.”

Kara McCullough is a 26 year-old daughter of a U.S. Marine, a graduate of South Carolina State University with a B.S. in Chemistry and radiochemistry, member of multiple honorary societies, and a scientist working for the Nuclear Regulatory Commission’s Office of Nuclear Security and Incident Response.  And not to be sexist, but she is a total bombshell and as Miss D.C. just took the crown for Miss USA.  She is also an idiot.

“Miss DC was my fav but … not after that answer,” wrote one Twitter user, and justifiably so.  Poor dimwitted Miss McCullough, when asked during the pageant whether she thinks that affordable health care for all U.S. citizens is a right or a privilege, said, …sigh… “I’m definitely going to say it’s a privilege.”

“As a government employee, I’m granted health care and I see firsthand that for one to have health care, you need to have jobs, so therefore we need to continue to cultivate this environment so that we’re given the opportunities to have health care as well as jobs for all Americans worldwide,” said the silly girl.  Kara that is no way to get invited on “Ellen!”  You know good and well that your dad’s service, your parents’ efforts in raising you, and all of your hard work have nothing to do with the good health you apparently enjoy at the expense of others.  And don’t think being black is any excuse, noooo ma’am!  You should know your place as assigned by the popular media and deep Twitter thinkers like the one who said, ” “Well I guess poor people don’t deserve health care because the new Miss USA said it was a privilege.” Okay, so you didn’t actually SAY poor people don’t deserve health care, but we can all read between the lines, can’t we?  How can you hold your head up and look the cast of “The Today Show” in the eye if you can’t demonstrate more obvious compassion, even if it means a little less reason?

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Kara, you might be an accomplished scientist, but you weren’t there with us in the auditorium that first week in medical school, when we started getting the script on acceptable opinions.  Most of the academics that first week told us that everyone deserved the same level of care no matter what, and they had left the slapdash economics of the private clinic for the sureties of academic medicine, sovereign immunity, and tenure to prove it.  We were told further on rounds during third year that the crack mother delivering lucky baby #7, and the 350 lb. smoker on food stamps going blind from diabetes all deserved the very best care the taxpayer could render, and got more of the same during the interminable days of residency.  If you had sweated out those board exams and med school loans, you might know that the actual privilege is to dole out free care to those who think they somehow earned it without actually doing the work or paying any of the freight.  Health care a privilege??  How will you ever get any audience applause on The Late Show with an attitude like that?

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6. The One Minute Doctor

May 19th, 2017

From the late, great Placebo Journal

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7. Quote of the Week: Earl Nightingale

May 18th, 2017

“We become what we think about most of the time, and that’s the strangest secret.”

Earl Nightingale

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Comment Here

 

UNTIL NEXT TIME, KEEP SMILING, KEEP LAUGHING AND KEEP OUT OF THE SAMPLE CLOSET!

Douglas Farrago MD

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  74 comments for “Authentic Medicine Gazette

  1. Dennis Kabasan
    April 27, 2017 at 10:23 am

    Doug,
    I ordered the Cryohelmet for my sixteen year old daughter, who sustained a concussion, with brief loc, after being struck in the forehead by a soccer ball, in a school match, two weeks ago. She’s been wearing the helmet, as recommended, one hour at a time, since it arrived three days ago. Her pediatrician is following her. She only tolerates a few classes each day, d/t frontal and temporal headaches and extreme tiredness. Sleep helps her. Is there any benefit to longer wear-time? Thanks.

    0
    • Doug Farrago
      April 27, 2017 at 10:31 am

      See my email to you

      0
  2. April 12, 2017 at 2:52 pm

    For some reason, my version of Authentic Medicine is delivered with comments from 2011 and 2012.

    Any notion of what may be going on?

    Thanks.

    1+
    • Doug Farrago
      April 12, 2017 at 3:55 pm

      none

      0
  3. John Comis, DO
    May 30, 2012 at 11:34 am

    Please encourage the KOM to join his friends at QC13.

    7
    (…of the lemons)
    PS the healthcare system is so terrible it is beyond any further comment.
    Peace,
    John

    1+
    • Doug Farrago
      May 30, 2012 at 12:27 pm

      I will try.

      1+
    • au-digit
      January 26, 2017 at 3:33 pm

      The Bush you quote was #41.

      1+
  4. Gary Gaddis
    May 20, 2012 at 7:43 pm

    Regarding our Federal government, Centers for Medicare and Medicaid Services (CMS), Secretary of Health and Human Services Kathleen Sebelius, and the growing gap between CMS perceptions and reality, here is my sarcastic “Sound Bite” suitable for the brief attention span of our electronic news media:

    “Since the Department of Justice is headed by an attorney, and the leader of the Federal Reserve is an economist, then how is it logical that the Secretary of Health and Human Services is also headed by an attorney?”

    Does anyone else agree with me?

    4+
    • Kristina Berger MD
      May 21, 2012 at 7:31 am

      There are too few physicians in politics. Is it because we dont have the stomach for it, or another reason? I know if there were more of us as policy makers, the healthcare system in this country would improve greatly.

      1+
      • Simon Cummings
        May 23, 2012 at 8:59 am

        My vote is for Doug and not the type of physician represented by the Cardiologist who told me that he wasn’t interested in cardiac rehabilitation cos there’s no money in it!

        2+
    • Judy
      May 24, 2012 at 8:58 pm

      No, I think that it is correct for a lawyer to head the Department of Health & Human Services. Only a lawyer can read the volumes of crap they put out as regulations and find a loophole way to still make a living; only a lawyer can repeatedly find a way to let someone die and it be due to no fault attachable to him; only a lawyer can write voluminous policies that effectively help only a select few of his supporters and require the rest of the populace to pay for it except himself; and only a lawyer can sit passively by and provide no useful assistance to a group of sick, needy people but still require them to pay for his service. If you will think on these comments for a few minutes, you may change your opinion.

      1+
      • Bill
        June 4, 2012 at 9:22 pm

        Hey Doug ! I am a lawyer. never made more than $85K /year and spent my entire career in trenches helping people, most who did not have much money, with problems, many of them caused by their own bad decisions and choices. and I love your journal.
        Given the wide range of attitudes, opinions and incomes among doctors do you really want a politically-connected MD in charge ? maybe an orthopedist ? xoxo

        2+
        • Doug Farrago
          June 4, 2012 at 10:43 pm

          The description “politically-connected” should remove that person from contention immediately.

          3+
    • Jeff
      February 22, 2017 at 3:14 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      1+
    • Jeff Palmer
      February 22, 2017 at 3:16 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      0
    • John A Goldman, mD
      March 4, 2017 at 3:10 pm

      thank goodness in 2017 it is a physician

      1+
  5. Alan Levine
    May 9, 2012 at 9:03 am

    You have bemoaned our lowly position in hospitals, commenting how few recognized our contributions on Physician Recognition DAY. In what I feel is a further diminution of what we do, my hospital is now celebrating Nurse Recognition WEEK!!!! How far we have fallen………….

    1+
    • Doug Farrago
      May 9, 2012 at 2:53 pm

      I agree

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      • Jack Forbush
        May 23, 2012 at 12:10 pm

        Ditto

        0
    • Common Sense
      May 30, 2012 at 4:54 pm

      So you’re denigrating nurses in an attempt to rally support for your plight? It is just as easy to argue that since nurses spent 7 times more time with patients, theyre deserving of their week.

      Or, you know, we could all just stop getting butthurt over who has the longest display of solely symbolic “appreciation” and get back to working as the team we were intended to be.

      We’re your knights and you’re our Earls. There is nothing to be gained by making besouring diatribe. Be good to your staff and your patients and you’ll have more appreciation and recognition than your little heart can handle.

      0
      • Doug Farrago
        May 30, 2012 at 5:11 pm

        You really need to have read the thread completely before making that comment. Please check out the blogs on how Doctor’s Day has been totally dismissed. Maybe then you will understand how we feel. This is NOT about doctors against nurses. It really is about administrators.

        1+
      • Doug Farrago
        May 30, 2012 at 5:12 pm

        You missed the point on this. It is about Doctor’s Day being totally dismissed by administrators. Please read those blogs.

        0
        • Alan Levine
          May 31, 2012 at 8:56 am

          That was exactly my point. In recognition of out efforts several years ago my hospital–a level 3 teaching hospital–gave chocolate bars (small ones) to the docs. Nurses this year received flowers and other shows of appreciation.

          0
          • JoAnne Fox
            June 8, 2012 at 7:23 pm

            Acknowledgement of a job well done would have been nice. I got a scoop of hot cocoa mix, repackaged in a baggie, with a little note attached telling me how wonderful nurses are.

            0
  6. Doug Given
    April 25, 2012 at 5:29 pm

    What a screw job from the lovely IRS on the Mandate.

    1+
  7. Judy
    April 18, 2012 at 10:05 am

    think you should run for President, as long as you will continue to keep up this site after you win!

    1+
  8. Dave Hoffman
    February 29, 2012 at 11:20 am

    Great thoughts as always, Doug!

    Is there a way to start new comment threads each time you post a new entry?

    0
    • Doug Farrago
      February 29, 2012 at 12:31 pm

      Each entry is a blog and has their own comment section

      0
      • t mcglone
        April 4, 2012 at 8:25 pm

        Having “served” for 15 years, those are finely edited comments fit for civilian consumption .

        0
  9. February 29, 2012 at 8:53 am

    today’s (feb 28, 2012) gazette was one of your best. some might say that your gazette is merely entertainment. i however, enjoy the articles with their kernel of truth/fact at the center and your encouragement for us to critically examine the field of medicine that we are a part of. the top ten signs that a hospital stay isn’t going well is what we see all our careers. uphoric for gout patients who like beer and ujerky for cardiac patients and the statin report were particularly good reading. i don’t know how you find the time or energy to do this. i was usually totally exhausted by the middle to end of my workday. thanks again.

    0
    • Doug Farrago
      February 29, 2012 at 9:06 am

      thanks, dennis! I appreciate the feedback and I am truly flattered.

      0
  10. Angi Wall DO
    February 9, 2012 at 9:18 pm

    I’m with Doug on the dietary/diabetes. It’s not often you catch those guys looking good in a bikini and munching on carrots.

    0
  11. Dr. Veronica Friel
    January 25, 2012 at 4:20 pm

    More! More!! Doug, keep it coming!!!

    0
  12. Robert Bosl, MD
    January 25, 2012 at 1:27 pm

    Regarding relationship of AD & DM, and comment that DM is dietary–too simplistic and likely wrong. We know about dysmetabolic syndrome & PCOS etc. which is genetic, DMS causes weight gain and subsequent DM. Consider whether strong relationship of DM to increased risk of AD is also genetic predisposition to both rather than one causing the other.

    0
    • Doug Farrago
      January 25, 2012 at 2:06 pm

      100% disagree. Predisposition is not a certainty. How can you NOT think DM is dietary related?

      0
      • Robert Bosl, MD
        February 1, 2012 at 4:12 pm

        My earlier comment may have been oversimplified–just tried to point out that some legit. MD’s believe in insulin resistance as a cause of some obesity issues than the result thereof, and it is conceivable that the “insulin resistance gene” may also play a role in development of Alzheimer’s.

        0
    • Bridget Reidy
      March 8, 2012 at 6:49 am

      Ever consider the relationship between Alzheimer’s and diabetes might be iatrogenic brain damage from hypoglycemia? I’m always shocked at how lightly my patients consider the risk of it.

      0
      • March 16, 2012 at 12:13 am

        May I suggest that the dementia with chronic diabetes isn’t Alzheimer’s, it is more likely to be due to the vasculopathy that accompanies non-well controlled diabetes or elderly age + diabetes. So the relationship is between DEMENTIA and diabetes, not Alzheimer’s Disease and diabetes. The fact that most elderly diabetics are vasculopaths, and the recurring theme in medicine that the brain depends on a constant supply of glucose and oxygen to function well, and that vasculopathy impairs oxygen and glucose delivery, is much more plausible than recurrent hypoglycemia.

        0
  13. Scott Miller, MD
    January 25, 2012 at 12:34 pm

    I work in urgent care and when I get home at night I am too tired to exercise. I find that the exercise I get from going back and forth in order to finish the articles in your journal gives me the physical exercise I need to stay healthy and sane. Thanks, Doug! Could you get me a beer when you go to the kitchen?

    0
    • Doug Farrago
      January 25, 2012 at 2:08 pm

      You got it!

      0
  14. Allyagottadois
    January 18, 2012 at 8:55 am

    If I can print it out in its’ entirety, I can leave it casually around the hospital. Mailroom, Medical floors, ICU, ER, surgical suites, administrative offices, JACHO. Because All I’ve got to do is: everything everybody tells me to do.

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  15. Dr. Bill Ameen
    January 1, 2012 at 11:31 am

    Hey Dr. Doug,
    To start the new year right, this ticks me off! I was belatedly reading the 11/4/11 issue of THE WEEK, an article about the Top 1% wage-earners. It takes annual earnings of $516,000 to qualify. Guess what? One out of six of the Top 1% is “in medicine”…I suppose some could be CEO’s of Big Pharma, but I suspect a large number are like the pediatric surgeon who heads the AMA and lives overlooking Central Park, and probably every orthopedist. Sorry, but I believe that anybody who makes that kind of dough either 1) inherited it, 2) stole it, or, as with most surgeons, sports figures and actors, 3) was grossly overpaid (as by insurance companies).

    0
    • Doug Farrago
      January 1, 2012 at 12:32 pm

      agreed

      0
  16. bill lorentz
    December 28, 2011 at 11:25 am

    I am a recent professor emeritus from a well known university medical school. For a number of years I worked with administration as an associate chief of staff. We spent considerable time and effort reviewing patient satisfaction scores using a well known national company and were quite excited that ours were consistently higher than most othere and certainly higher than I thought was reasonable.
    Bottom line-we discovered that the administrator in charge of managing the satisfaction suvery was “doctoring” our results. When we changed over to a more honest effort our scores dropped significantly. However, no one in administration was happy with our new lower scores and the subsequent need to address the outcomes.

    0
  17. David Devonis
    December 16, 2011 at 11:17 am

    Impressed that a lot of teachers are reading this material. Your site is the Writing on the Wall. Keep it coming!

    0
    • Doug Farrago
      December 16, 2011 at 1:35 pm

      Thanks!
      Doug

      0
  18. Dr. Bill Ameen
    December 15, 2011 at 10:46 pm

    Hey Dr. Doug, Heard that due to droughts affecting the peanut crop the price of peanut butter will go up. There’s a worsening shortage of PCP’s, so guess what? They’re paying us less..and less…and less. Also, latest Medical Economics has lead article about MOC. I was gritting my teeth reading remembering when you published the ABIM chief’s salary at $600,000. I’m sure ABFP CEO’s isn’t far behind. Where are the studies showing MOC (or even boards) make any difference in our performance? Finally, get “The Parking Lot Movie” on DVD. It’s a hysterically funny documentary about the parking lot behind The Corner at U.Va that will remind you of your days there!

    0
    • Doug Farrago
      December 16, 2011 at 5:04 am

      Thanks for the great points, Bill! Will need to get that DVD, as well. On one of my first dates with my future wife she remembers me checking all over the ground for parking lot tickets that were cheaper than the one I had in my hand. I was a class act.

      0
    • Dr. Veronica Friel
      January 25, 2012 at 4:16 pm

      Peanut butter prices going up? At COSTCO, the price of the large-size Jiffy Peanut Butter remains the SAME – the large-size is simply 8 oz. smaller.

      0
    • Connie Severin
      February 8, 2012 at 1:06 pm

      Thanks so much for adding that bit about the movie. I just ordered it off Amazon. I worked at UVa Med Cen from 1980-1985 and remember the strip and the parking behind it (apparently pre-Farina days). I remember some sort of parking honor system and some lot Nazis from back then too, but obviously predating when this documentary is set. It was about the only parking within a mile of campus too, so finding any spot at all was a miracle. I’m looking forward to the video. Thanks for the heads up.

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  19. Mary K Freel
    December 9, 2011 at 7:08 am

    RE: Grading Dr. on patient performance. Can you grade me if I work in a factory stamping out parts? Absolutely!! If the part doesn’t meet specifications then I’ve failed. Can you grade me on my patient’s health performance? Absolutely not!! I can only control a small part of what goes into a patient’s health and as studies have shown patients often pay for the dr. advice and then do nothing or the opposite. What a wonderful world it would be if when the dr. told his patient to lose weight and quit smoking they went right out and did those things. I was a nurse for 22 years and a teacher for 10 and in both professions I was the one who got blamed for whatever didn’t go right–whether it was poor scores on tests and the patient not getting better faster. Until people take ownership in their own health and realize that they are the number one reason that their health doesn’t improve the overall health of this nation will not improve and so our health care costs will continue to rise.

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  20. Bridget Reidy MD
    December 8, 2011 at 10:44 pm

    I agree with the teacher and have always been suspicious of both of our “quality” grading.

    The recent issue of AMA News gave opinions of practicing docs on lots of little issues but NONE on their main article on why small practices (aren’t they usually run by docs?) aren’t getting EMR’s. Gee 15% more pay for 50% more work – why wouldn’t we bite? I wonder if it’s a censored rag. Thank you Doug for validating our voices.

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    • JoAnne Fox
      June 8, 2012 at 7:32 pm

      Where do you find doctor owned small practices?? Most everyone around here is owned by one of the two hospital systems, and one has the gall to proclaim itself “not for profit” – I guess if you don’t mention the wholly owned subsidiaries they don’t count.

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      • Doug Farrago
        June 8, 2012 at 8:27 pm

        Hopefully you will find them in the future

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  21. Pat Nagle
    December 7, 2011 at 11:45 am

    I enjoy your site. I appreciate your heartfelt concern for patients and your irritation at the “solutions” suggested/mandated by outsiders (e.g. politicians). What strikes me most of all are the similarities between the world of medicine and the world of education, in which I spent 40+ years, working from K-graduate schools.

    Although the history, dynamics, and focuses are different,
    healthcare and education get pushed around by folks who don’t know what the hell they’re talking about, from Presidents, Congresspeople, media, on up, and the bottom line is always the bottom line, not the needs of patients and students.

    Your tirades against administrators parallel my feelings about the “consultants” and “foundations” who infest educational policymaking at every level. The last ones consulted are the frontline teachers and docs. And of course, the politicians and business moguls take no responsibility for the culture and economy they’ve helped create which lead to the problems in both areas.

    I don’t always agree with you (I’m adamantly for universal/single payer healthcare), but I appreciate your struggle. Keep up the good work.

    1+
    • Doug Farrago
      December 7, 2011 at 12:39 pm

      Thanks for some great feedback! And the similarities are eery.

      Doug

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    • Frank J. Rubino MD
      December 14, 2011 at 6:55 pm

      We do have much in common. “No child left behind” where the teacher is held responsible for the sucess of each and every child no mater how functional or dysfunctional is the child’s family.

      “Pay for performance” reguardless of how cooperative a patient is with diet & exercise and with their medication regimine for hypertension, diabetes etc.

      If one wants to make a lot of money in a short period of time, one should become a “consultant” to to school districts or to health care organizations. Expensive advice with out the responsibility. Charge a lot and then get out of town.

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    • pat nagle
      December 21, 2011 at 12:50 pm

      Pardon me for doubledipping, but I forgot to mention that no legislator/congressperson has ever begged to be put on merit pay/pay for performance. Obviously, legislating doesn’t lend itself to factory models of evaluation. So why do medicine and education? The things that count aren’t measurable, and the measurable things don’t count.

      1+
      • Judy
        January 4, 2012 at 9:26 am

        hey, Pat, hope you don’t have a patent on your last line! that is about to become my ‘signature statement’ on my sign-offs!

        2+
        • Richard W. Mondak
          March 28, 2012 at 1:56 pm

          I think several of us are going to “borrow” that line (of course we’ll give credit to whomever coined that phrase — whoever that is)

          1+
  22. John Chase
    December 7, 2011 at 9:11 am

    I would prefer your stories to run in their entirety rather than “read more”. Very irritating to have to go back and forth

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    • Doug Farrago
      December 7, 2011 at 10:08 am

      Ok, will work on it.
      Doug

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      • Greg Salard
        December 8, 2011 at 2:35 am

        I have to agree. Not only is it irritating, it can be confusing when you have to …

        Read More >>>

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        • Doug Farrago
          December 8, 2011 at 3:31 am

          LOL. Will work on it

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          • thea
            December 14, 2011 at 8:00 am

            Would like more written stories/blogs etc, do not have sound card on computer so can’t hear any of these videos..they kinda lose their punch without sound?

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          • Doug Farrago
            December 14, 2011 at 8:14 am

            Understandable. I had some videos done already and needed to get out a few extra this week. Won’t always be like that.

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          • Chris
            December 15, 2011 at 11:20 am

            Dear Doug,

            Not only do I want full articles on the page and written articles instead of videos, but I also want to have $100 deposited into my bank account each time I click onto your sight. And world peace.

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          • Doug Farrago
            December 15, 2011 at 11:25 am

            Done and done.

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          • tom walsh
            January 11, 2012 at 7:52 am

            These same people who can’t fathom going “back and forth” to read an article are the same ones who had difficulty with ‘butterfly” ballots in the 2000 elections in Florida.
            I have been enjoying your articles for quite a while and have no problems with the layout. Keep up the great work!! And, thanks.

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          • Doug Farrago
            January 11, 2012 at 7:54 am

            Thank you, Tom!

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          • Connie Severin
            February 8, 2012 at 1:09 pm

            Thanks for the new format! Jumping between responses and articles was a nuisance. I like being able to read everything in only one, maybe two spots at one read. It also makes it easier to check on new entries to the comments all at once, rather than having to check for each separate article.

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        • Richard W. Mondak
          February 22, 2012 at 12:21 pm

          I have a short attention span, so reading part of the article and assuming I know what is being stated is par for the course for me. I often shoot par – 36 on the first 5 or 6 holes – so why play more?

          I don’t mind procrastining to READ MORE>> later

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      • Ariel
        December 8, 2011 at 8:58 pm

        Agree with Mr. Chase. Thanks for looking into it!

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        • Sharon
          December 28, 2011 at 10:10 am

          I totally agree with Chris!

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