Indentured

Here is a link to video news reports about a physician who won’t see obese patients.  She claims it puts here staff’s health in jeopardy. Fine.  By the way, I love how the news people are aghast at the whole incident.  Though I think it is a ridiculous rule of hers, I still stand behind her. Why?  Because it is a free country and physicians are not indentured servants.    The truth is that as government red tape grows, we may see a lot more doctors pushing back.  With all the unproven and bogus quality indicators coming down the pike, many physicians may balk at seeing noncompliant patients.   They don’t want to look bad because some of their patients basically brush their teeth with butter.  With the present administration NOT fixing the payment system to Medicare then there is also a good chance physicians will balk at seeing the elderly as well.    How do you fix this issue?  Well, you have two choices.  You can fix the problems to our system and the let the free market work its way out or you can hold physicians hostage by putting their licenses at risk.    The latter, by the way, is what Massachusetts is doing.   You know them, they are the only state that is a mini lab for the Affordable Healthcare Act.  See below from a previous post:

Under the plan, all Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure—that is, permission to practice. They’ll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics.

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] 

  8 comments for “Indentured

  1. Bill
    August 31, 2012 at 11:49 pm

    hey folks, please don’t oversimplify difficult issues. there is not just a simple choice between 2 options. If you think that healthcare is a “freemarket” system, please think again and look at your old economics 101 textbook. or if you beleive that a free market would efficiently and equitably solve the problems ask yourself to name a good example of when that happened.
    Healthcare is different. people see a doctor because they are sick / ill. to the extent that the person is, in some way, responsible for their illness adds another factor into the treatment.
    If the only peoople you are going to treat are the “good” ones, how do you decide what qualifies as “bad” ? smoking ? eating ? drinking ? illicit / unsafe / promiscuous sex habits ? that’s an awful lot of people you have just cut loose from medical care.
    BTW, I support the right of the doctor to “dump” a patient, when there are alternatives avaiilable. but if you are the only doc in a 30 mile radius to serve a 67 yr old, diabetic smoker who doesn’t drive you may just have to suck it up and do your best. and I don’t like the idea of penalizing you for something beyond your control
    If you are a Public defender attorney, you can’t pick just the innocent to represent. you do your best with the hand you are dealt.

    • September 1, 2012 at 2:28 am

      Bill, you make some thoughtful points. But isn’t what we see now not doctors, but government and/ or insurance companies deciding what are the “bad habits”? And if that is so, then they apply economic force to the doctor to agree with them, co-opting the doctor’s judgement and reputation. The problem here is we are given the responsibility, but not the control. Now THAT is inequitable.

    • Kurt
      September 4, 2012 at 2:02 pm

      The issue is that physicians and hospitals are soon going to be penalized for patient’s poor behavior. How? Hospitals are going to be screwed for 30 day readmissions for the same problem. Physicians “pay for performance” is going to screw them for non-compliant patients.
      Listen, if people were listening to medical community we wouldn’t be in the midst of an obesity epidemic now would we?
      If I am going to be penalize for patient’s poor behavior/non-compliance, I (and others) will chose who we treat in long term
      healthcare relationships. The attitude of “doing the best with what you got” is going to cost us soon.
      I’m not going to “suck it up” if I don’t get paid and I can’t pay the overhead.

  2. Pat
    August 29, 2012 at 11:59 am

    Medicare is a bi-partisan FAILURE. It presumes that certain population has a right to care, and in that presumption, places more value on them than on those paying the bill. The seniors pay for care? The hell they do – they pay a smal fraction of costs that are grossly inflated through unrestrained demand, bueareaucratic overlay, and a DELAY – not eradication! – of eventual end-of-life costs. Neither the elderly, the poor, nor any other demographic should be able to use government force as their surrogate to incrementally enslave anyone. Dammit!

  3. Kurt
    August 29, 2012 at 10:18 am

    I don’t blame her. I know docs who refuse to have smokers as regular patients. My philosophy has always been, “Do the best I can with what I got.” If the patient listens to me for instance, then they reap the benefit of lower cholesterol and lower risk of heart attack and stroke. If they elect not to, I try to pick up the pieces.
    Now that it’s going to “cost me” to deal with these people who, by the way are the majority, I and I bet others are going to be selective as to who they take on as patients. A lot of stupid people just can’t grasp what “good health” means so they keep destroying themselves and the rest of us pay for it.
    The situation is NOT going to change in this country until there is financial incentive for patients to do the right thing ie. much less insurance premiums for healthy behavior. It also should apply to a diabetic or other chronic disease sufferer who takes good care of themself. Those folks still get financially screwed even if they have great glyco’s,lipids and control disease parameters.
    BTW, good primary care docs are leaving and are not being replenished. With the current situation, all primary care will be administered by NP’s and PA’s in the future. Oh, they’ll probably unionize and not take the “shit” that the docs are currently taking
    who do primary care.

  4. Pat Nagle
    August 29, 2012 at 9:10 am

    So the present administration is responsible for Medicare problems, despite the GOP-dominated Congress’ heroic efforts to come up with sensible alternatives? Give me a break! And the “free market” will magically work its unproven wonders and all will be well? You’re right in one way: before social security/Medicare/Medicaid/union-inspired employee health plans, the free market made sure there weren’t too many elderly people clogging up doctors’ offices.

    • Craig
      August 29, 2012 at 12:28 pm

      Old way: See patient. Plead for her to do mammogram. She doesn’t want to for whatever reason. Get paid so I can pay the staff, electricity, and rent on the building for the time she took up in the office.

      New Way: See Patient. Plead the same. She doesn’t get mammogram, and my quality indicators fall below 80% and my “P4P’ quality care payment falls, and I can’t pay the staff or the rent.

      Paradigm shift: Fire noncompliant patient

      Refuses colon cancer screening: See above.
      Refuses statin to get cholesterol at nationally acceptable goal: See above
      Refuses insulin to reduce Hgb A1c under 8%: See above.

      Every other Quality Metric which acts to reduce my reimbursement even though I’m busting my butt, trying my best: See above.

      • Kelli
        August 29, 2012 at 3:08 pm

        Amen.

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