Healthcare Going To The Dogs

Here is the kind of orientation video that hospital administrators are now showing to their employees.   There is a longer video of it here:

As one of my readers said (who sent this in):

  • These all seem to be systems failures at a corporate hospital run by people not involved in the care of the patients.
  • It seems the cash-based model run by the veterinarian allows her to hire and retain staff with the right attitudes who are happy to work in a pleasant work environment
  • That call back by the vet was a nice touch, is the hospital going to pay the doctors’ additional hours to do the same or are you just sticking to your guns on the hourly/annual wage with no unapproved “overtime”?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “Healthcare Going To The Dogs

  1. mamadoc
    May 17, 2012 at 8:57 pm

    This is a hardy perinneal….they showed this at our malpractice “education” seminar put on but our insurer back in the 1990’s. Just as lame now as then, though

    • Melinda
      May 21, 2012 at 7:50 pm

      I am a veterinarian and practice owner, and I am also a patient who has experienced multiple significant health problems in the past 15 years, plus I am medical proxy for 4 other people. I have spent long sessions in various ERs 11 times in the past 10 months. I make an awful lot of comparisons between human and veterinary medicine, and overall, I see a lot of truth in the video.

      Human medicine has it best in the greater availability of diagnostic testing and specialists to focus on specific categories of problems. It drastically falls short in convenience and coordination of care between multiple doctors.

      When I see a sick animal patient, I can take x-rays, draw blood on site and run CBC, chem panel, UA, and many other tests within an hour, hospitalize on site, start an IV line, administer medications, perform surgery, place a splint, and send home medications with the patient. If laboratory tests are sent out, I call the pet owner the next day with results and recommendations. Multiple things can be done at one time, too: if a patient is in for a cystotomy, for example, while the pet is under anesthesia we can also remove a skin tumor, do dental cleaning and extractions, and many other secondary procedures.

      For a human patient, being sick is a full-time job. Your doctor orders labwork, x-rays, and other tests, refers you to a couple different specialists, and starts you on medication. You go to the pharmacy on the way home and call 3 to 4 other places to make separate appointments for it all, and it generally will take weeks to get through it all. At multiple places you have to go through registration and medical history paperwork, insurance, separate copays, and HIPAA regulations, as well as be sure reports are sent to every doctor. They don’t call you with results–they tell you to call them in a week, and when you do, the tests are often not yet back, or someone other than the doctor just tells you everything was normal. Then each doctor only helps with his/her specialty area, requiring follow-up with each of them.

      2 examples: I had an ovarian cyst for 2 years that suddenly grew last June, leaked, then ruptured and caused hospitalization with peritonitis also affecting urinary functions, and in the process it was recognized that I had a femoral hernia, which was then repaired last August. After reasonable recovery, abdominal pain and bowel function have worsened. This has taken multiple visits with my primary, my OBGYN, my Gastroenterologist, and my surgeon, and has included repeated bloodwork, 2 CT scans, multiple abdominal and transvaginal ultrasounds, upper and lower GI studies, colonoscopy, and 5 ER visits for pain and inability to pass stool. There is still no diagnosis. Nobody deals with the abdomen as a whole except the ER. It amazes me that when I call one of the doctors because I am not doing well, there is no concern about the fact that the next step will take weeks to get to the person/place I need. The attitude is, “if you can’t wait, go to the ER.” I’d much rather not wait until the problem becomes an emergency, but I’ve been trying to deal with this almost a year now, trying to function as a veterinarian, practice owner, and other important roles. Life can’t just stop while you wait for a specialist who can get you in 2 months from now….

      2nd example: a friend was systemically poisoned 6 years ago during treatment for minor injuries from a car accident and is severely disabled with full body pain and weakness. Working diagnoses include mitochondrial dysfunction, peripheral neuropathy, autonomic neuropathy, bowel dysmotility, TMJ dysfunction, possible Complex Regional Pain Syndrome, hypothyroidism, secondary opportunistic bacterial and fungal infections of the skin, sinuses and GI tract, chronic dehydration, carpal tunnel syndrome, and now multiple food allergies including celiac, eggs, dairy, meat, and tomatoes. She is unable to drive, do her own laundry, requires oxygen at night, needs all surfaces plushly padded due to pain, and needs to spend the entire day after any appointments in bed to recover from the exertion of just going.

      She is expected to maintain regular appointments with a primary, a rheumatologist, a neurologist, a dermatologist, an ENT, a gastroenterologist, a pain management specialist, an IV infusion center, a dental specialist, a psychotherapist, go for frequent lab tests and diagnostics, and go to physical and occupational therapy 1-2 times weekly. Further, she has to keep track of what Medicare and Medicaid cover, and various programs are in conflict with each other such that if she gets something as in-home care, she can’t get out-patient services for something else. In order to manage it all with no family, she has an aide twice weekly to drive her around and do her laundry, and is forbidden to change his schedule even if she is too sick to function or if a doctor is only in on certain days. Her doctors are forever having to rearranged things and re-write scripts with various diagnostic codes, and she is constantly having to troubleshoot errors and conflicts. She struggles to stay out of a nursing home, for there she would get no rest nor adequate needed padding and foam, the lack of which rapidly intensifies her pain.

      On the good side, human medicine is able to address all of these major needs in detail. But on the bad side, the patient has to run to how many different places to have it all done? A healthy person would have great difficulty doing all of this–how is a sick person supposed to manage all of this running around and making so many arrangements?

      Veterinary medicine does have specialists, but they generally see the patient within a week of referral. Surgeries can usually be scheduled within 1-2 weeks of when they are recommended. For most purposes, veterinary care is well-expedited and convenient. For humans, significant health problems often become an even bigger ordeal to deal with them.

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