Authentic Medicine Gazette

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

Blogs and Thoughts for November 16th to November 22nd, 2017

Here is what we had this past week:

  1. Give It Up, Christine Sinsky MD!
  2. ZDogg, Doc Vader and Dr. Peter Gallogly MD
  3. What Does Aetna’s CEO Think About Healthcare?
  4. Doctor Wants to Kill Netflix by Pat Conrad MD
  5. Ridiculous Study of the Week: Medicaid Payment
  6. Friday Funny: Which AAFP Ad is Real (or Realistic)?
  7. Quote of the Week: Pauline Kael

 

1. Give It Up, Christine Sinsky MD!

November 22, 2017

The funny thing about this blog is that we have touched on so many issues that the same ones and the same people keep coming again and again.  This is what Dr. Conrad wrote back last January:

Christine Sinsky, MD coauthored a 2015 Mayo study that found: physician burnout had risen 15% since 2011, to 54%. There was also a corresponding decline in reported satisfaction with work-life balance. Dr. Sinsky recognizes that this burnout rate is the result of increasing time spent documenting, EHR’s, and loss of control “to government regulators and third party payers.” And now for the fun part.

Sinsky says, “It’s a cumulative effect of well-intended efforts adding up to a burden of work that no one anticipated.” Well-intended by whom, exactly, the sellouts at the AMA? And why is any credit given for good intentions, when those of us on the receiving end of this garbage absolutely anticipated the results? In what sounds like a parody from the old Placebo Journal, “the AMA has created a series of online tutorials – which Sinsky calls “transformation toolkits”—designed to help practices operate more efficiently and enable physicians to gain more control over their workday. Many of the tutorials focus on ways doctors and practices can save time, such as renewing all of a patient’s medications once a year, or spreading documentation and data entry among members of a care team.” She suggests straight-faced that doctors “reengineer” their days to “create a lot more room in their day for enjoyment.”

Yeah, I laughed at this stuff too. That’s when I tried to find out who Christine Sinsky MD was.  Here is what I said:

So, who is Christine Sinsky? It turns out that she is a member of the Board of Trustees of the ABIM Foundation and a director of the American Board of Internal Medicine. This is the same organizations found to be corrupt by Wes Fisher MD. Interesting.  How is it that someone can be so high up in the the AMA, the ABIM and the ABIM Foundation? Is this one, big, good old “boys and girls” club?  What am I missing here?

Yup. She has made a ton of money off our backs (with things like the MOC) but now she wants to help us?  The newest joke of an attempt comes in Medical Economics’ article Fighting Burnout at Three Levels. In the piece, Sinsky states that physicians “highly resilient” as a group and emphasizes, “If this group is struggling, the environment must be particularly problematic.” Yeah, and YOU HELPED CREATE THIS ENVIRONMENT!!

Here are more of her delusional thoughts:

  • She believes that most primary care practices can save three to five hours of patient care every day by reengineering the way work is done.
  • For larger medical systems, she recommends their newest module, called the Organizational Foundation for Joy in Medicine, which makes plain that what’s good for physicians is good for the bottom line, as well: “A more engaged, satisfied workforce will provide better, safer, more compassionate care to patients, which will, in turn, reduce the total costs of care,” the module notes.
  • “This is a solvable problem. I wouldn’t be devoting my work life to this topic if I felt it was futile.” She believes that by pairing solid data that asks the question “Is this a wise use of the societal investment in the training of physicians?” with resources, tools and innovations like those at the AMA and others cropping up because “the medical community is at the breaking point,” will help advance the conversation.

Dr. Sinsky, you go ahead and keep devoting your work life to this topic. You say that only 20% of your weekly hours are devoted to patient care so go ahead and sit at your desk or go to meetings for the other 80% trying to rack your brains for the solution. You won’t find one unless you take my advice and take the government and the insurers out of the equation. Boop. It’s solved.  Until then you will continue to litter these throwaway magazines with your incredibly stupid ideas that continuously fail.  But I bet you don’t care because it keeps you in the position of AMA’s Vice President of Professional Satisfaction and your paycheck will be just fine.  How much?  Well, it turns out it is impossible to figure out.  See Dr. Wes’s newest blog. 

This whole thing (and Dr. Sinsky) stinks.

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2. ZDogg, Doc Vader and Dr. Peter Gallogly MD

Nov 21, 2017

“Doc Vader on Losing Your Temper in the ER.”

Another great one from Zubin.  Here he is protective of an ER doc who got a ton of crap from this video. When the whole story came out is wasn’t what it seems.

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3. What Does Aetna’s CEO Think About Healthcare?

Nov 20, 2017

Here is basically the whole article in Becker’s Hospital Review:

During a keynote discussion at a Financial Executives International conference in New York City Monday, Aetna CEO Mark Bertolini described healthcare as a “rat’s maze,” according to CFO.

Mr. Bertolini joined Johnson & Johnson CEO Alex Gorsky in a conversation about healthcare’s shifting reimbursement landscape. Aetna’s executive spoke about his frustrations with the complexity of healthcare.

“They [physicians] refer you here; then you get a test, and you don’t know how much it costs; and then you get a bill 30 days later and it’s got all this gobbledygook,” Mr. Bertolini told attendees.

He added, “Every time I sign up for my healthcare, I have someone else do it for me, because I just can’t take it. It’s too hard. It’s too confusing. It’s got to be easier,” CFO reports.

Now, why is he saying this?  Foor one, he is a smug idiot but obviously, he has another motive.  Digging into that CFO link above I found this:

In separate keynote discussions at a Financial Executives International conference in New York City on Monday, Mark Bertolini, the CEO of Aetna, and Alex Gorsky, his counterpart at Johnson & Johnson, argued that a key to fixing the U.S. health-care system would be to move away from health-care providers being paid for each procedure, office visit, or test they perform. Instead, the providers would receive a single fee for an entire “episode” of medical care, with the fee varied according to the quality of service provided.

It gets better:

Gorsky said that to make the Affordable Care Act more sustainable, it might help to “move from a health-care system right now that’s predicated on reimbursement for a particular procedure to one that’s focused more on an outcome or an episode of care.”

I wonder if we should pay for J&J products depending on their outcome? Or how paying Aetna’s premium depending on the quality of service you get from them?   Service and outcomes are important for doctors, too, but only when it’s a true free market.  Not the crap we have now.  And all the quality metric attempts have FAILED!!

Once again we let the idiots in the government or insurance industry, who created this mess, try to fix it.  They created the gobblygook!  They created the rat’s maze!  Bertolini whines about lack of transparency but his company negotiates different deals with hospitals and drug companies causing that lack of transparency.  He is an unbelievable hypocrite and a quick scan shows this is not the first time for him.

There is a better way and that is the free market plus DPC.  We just need to keep the insurers away and let them be used only for catastrophic issues.

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4. Doctor Wants to Kill Netflix by Pat Conrad MD

Nov 19, 2017

Hey, does this sound familiar?  Just up the road from King Doug in Lynchburg, another Direct Primary Care spark has flamed up in the region.  Dr. Maura McLaughlin has a DPC practice in Charlottesville, Virginia, “one of nearly 700 nationwide.”

Here is some info from her website:

“Ages 0-30 years: $30/month, discounted to $15/month if enrolled with a parent.  Ages 31 years and up: $60/month”

What does that get you?

Clinic visits for chronic and acute problems; reduced labs pricing; preventive care for adults and children, and GYN care; certain procedures “for cost of supplies ($20)”; nights and weekend physician access, and “Treatment over the phone when medically appropriate”; home visits for an additional fee (and free for newborns and hospital follow-ups).

And I just love this quote: “The model itself works sort of like Netflix,” Dr. McLaughlin says.  “They can use the services here as often as they need to.”

“Chuck Gulat isn’t rushed when he sees his primary care doctor. He comes as often as he wants, and doesn’t need insurance to pay for it … Patients like Gulat are still encouraged to carry a lower cost insurance plan to cover medical emergencies …  Gulat comes every three months for his high blood pressure and diabetes.  ‘Hands down, it’s made me physically healthier, and financially healthier.’  He’s now saving about $1,300 a year.”

The patient is happier and has more money in his pocket.  The doctor is happier, and doubtless giving better care (arguably a chicken-egg question, so feel free to debate).

I like Netflix.  I like convenience, and knowing exactly what I’m paying and exactly what I’m getting.  And I like competition, and knowing that I can discontinue something I don’t like.  I like choices.  Who could possibly argue against this?

“Critics, like Dr. Ed Weisbart with Physicians for a National Health Program”, that’s who.  Weisbart is quoted in the lead article wringing his hands over what he believes will be a growing shortage of primary care doctors, “since these [DPC] doctors see fewer patients.  Also, high deductible plans leave specialists uncovered.”

“That opens the door to this huge range of medical problems, that fall in-between the catastrophe and primary care.”  So is Weisbart just another Stockholm-Syndrome, hapless family doc beaten into submission and lack of imagination by a crushing system?  Not exactly.

Weisbart is a nationally recognized advocate for single-payer health, who “now volunteers in a variety of safety-net clinics in the St. Louis area and is also assistant professor of clinical medicine at Washington University in St. Louis.”  Now a humble volunteer and academic, he once was once a practicing family doc for 20 years, just a simple, altruistic, if misguided remnant of a noble profession, right?  Not exactly.

In 2003 he left his practice “to become chief medical officer at Express Scripts, a Fortune 100 Company. After retiring from that position in 2010, he began organizing the St. Louis chapter of Physicians for a National Health Program, which he currently chairs.”

Whoa, whoa, let’s back up.  This expert on how other doctors should make a living himself RETIRED from a Fortune 100 company??   So the guy that advocates a system that will trap physicians into a greater web of government mandates, himself escaped from primary care to turn what I imagine was some pretty good coin, before returning to academia and the volunteer life.  But didn’t his time at Express Scripts reduce his availability as a primary care doc during a time of worsening shortage?

Yes Weisbart, if there is any good left in medicine, thinking physicians like Maura McLaughlin will add to the growing rolls of DPC practices, and definitely worsen the shortage of your preferred kind of primary care docs.  The McLaughlin’s and Farago’s of the world are increasing patient satisfaction, providing better care, and leading happier lives.   You Prof. Weisbart want doctors dragged back into a despair pit of increased workloads, flat wages, more meaningless administrative data gathering, anger, depression, and health commissars telling everyone what to do.

While Direct Primary Care is offering the next Netflix, you want to force us all to go back to watching PBS.

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5. Ridiculous Study of the Week: Medicaid Payment

Nov 18, 2017

You are not going to believe this but lower Medicaid fees are linked to scarcer primary care appointments.  Crazy, right?  It amazes me that they had to do a study to prove this.  The recent study alluded to, in JAMA Internal Medicine, found that “when the fees paid to healthcare providers by Medicaid go up, appointments with primary care doctors suddenly become more available to Medicaid beneficiaries – and the opposite happens when fees go down”.  You don’t say?  So is this saying that doctors are greedy?  I don’t think so.  I just think doctors feel they should be paid for their time and when the payment get’s so ridiculously then you are forcing them to give care for free. And they start pushing back.  It is all just basic human nature. Before you judge us let me ask you this: If you are not a doctor, would you enjoy being forced by the government to do something that loses you money?  I didn’t think so.

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6. Friday Funny: Which AAFP Ad is Real (or Realistic)?

Nov 17, 2017

So, which of these ads do you think is real? Which one is more realistic?  Feel free to send to the AAFP on my behalf.

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7. Quote of the Week: Pauline Kael

Nov 16, 2017

“Where there is a will, there is a way. If there is a chance in a million that you can do something, anything, to keep what you want from ending, do it. Pry the door open or, if need be, wedge your foot in that door and keep it open.”

Pauline Kael

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

Douglas Farrago MD

3+

  75 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.

    2+
    • 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?

    5+
    • 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.

      2+
      • 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+
        • Dr Bonz
          June 21, 2017 at 8:29 am

          Dear Bill.

          F*** You.

          Signed,

          An orthopedist.

          0
    • 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

      0
      • 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.

    0
  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.

      0
  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.

    0
  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.

    0
    • 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.

      0
      • Doug Farrago
        June 8, 2012 at 8:27 pm

        Hopefully you will find them in the future

        0
  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

      0
    • 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.

      1+
    • 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

    0
    • Doug Farrago
      December 7, 2011 at 10:08 am

      Ok, will work on it.
      Doug

      0
      • 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 >>>

        0
        • Doug Farrago
          December 8, 2011 at 3:31 am

          LOL. Will work on it

          0
          • 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?

            0
          • 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.

            0
          • 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.

            0
          • Doug Farrago
            December 15, 2011 at 11:25 am

            Done and done.

            0
          • 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.

            0
          • Doug Farrago
            January 11, 2012 at 7:54 am

            Thank you, Tom!

            0
          • 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.

            0
        • 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

          0
      • Ariel
        December 8, 2011 at 8:58 pm

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

        0
        • Sharon
          December 28, 2011 at 10:10 am

          I totally agree with Chris!

          0

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