Ex-Practitioner

Here is a nice piece from the Wall Street Journal.   For those that can’t read the link, here are some highlights:

  • But never have I seen so many good intentions leading irreversibly to hell.
  • A number of lean years passed before I could build a robust practice. Yet the experience was exactly what I—and I think many of my colleagues—sought: a personal, direct and unimpeded relationship between me and those who chose to become my patients
  • But treating patients without insurance meant that I had to give my acute attention to the price of every medical intervention. The costs could have a direct and painful impact on a family’s budget. So I had to know the prices for most of the medications I prescribed and of most of the tests I might order. I learned to play for time by waiting, when it was safe to, before ordering an X-ray or a test—and to substitute less-expensive medications for more costly ones wherever possible.
  • Then, in the mid-1970s, things changed, and we became enlightened. Third parties, typically the insurance companies, were interpolated between the physician and the patient. Some of the consequences were unfortunate.
  • Patients knew that any suggestions I might make would have negligible consequences for their own budgets, so “more” became the expectation. A sense of entitlement developed. Why would the doctor hesitate to do some procedure, or hesitate to request a test? Everything was already paid for.
  • This mistrust heightened—and became rational—when “prepaid” group practices became more prevalent. Physician compensation is tied to “efficiencies,” which means reducing the outlays and costs to the group (translation: skimp where possible) and thus generating for internal distribution a larger share of the prepaid premiums.
  • Second opinions proliferated, upping the costs. Patients could get two opinions for the same price: near zero. I could acquire additional knowledge from the feedback of the consultant and was better positioned should some legal controversy arise. One underexamined aspect of defensive medicine is those excessive referrals to diminish responsibility.
  • “Preventive care” became the touchstone. The concept is obvious, but the evidence for its value, and especially its potential for savings, is rarely conclusive.Insurance relationships drove practice relationships. Patients were more likely to come to me because their insurance told them to, and more likely to leave, despite our congeniality, because their insurance required it. Thus our dealings were less personally rewarding, for my patients and for me.When it became increasingly difficult to work according to my principles, I closed my practice, first joining a “prepaid” group for 15 years, and then leaving patient care altogether.
  • As more physicians leave active practice, it must be appreciated that a focus on the economics of health care is not the only, and perhaps not even the most important, reason for their disillusionment. The glow of the personal relationship one might have with one’s patients is being extinguished.
  • Who is better suited than the patient to assess the value to him of the proposed treatment? Kathleen Sebelius? You gotta be kidding.
  • There is no shortage of evidence. ObamaCare will, deliberately and by design, destroy what—while imperfect—has served very well. We have gotten to this point after years of good intentions making bad problems worse. To double down on the very therapy that has brought the system to its present sorry pass is a toe-ticket to the morgue.
  • Dr. Marsh now raises Christmas trees in Ipswich, Mass.

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] 

  5 comments for “Ex-Practitioner

  1. April 17, 2013 at 12:03 pm

    So we replaced a horrible system with an arguably worse one… Big deal. Our per capita expense on health care is miles more than that of the next closest country. The question is not whether the Affordable Care Act is better, but whether it is a framwork which can be worked on to be better. Under the previous system, there was no way for health care to go other than “worse”. There is no reason we can’t cut our health care costs to, say, those of France or Germany…if we elect any politicians with the will to serve the needs of the PEOPLE.

    • Doug Farrago
      April 17, 2013 at 12:33 pm

      I will add that we need to change the culture of our people. Americans want what they want, they want it immediately, and they want it for free. Other cultures, like the ones you mentioned, are not like that. Add to this that 80% of all medical problems are from behavioral causes and you can see that maybe a variation of what Kennedy said was right (my version):

      “Ask not what you’re doctor can do for you but what you can do for yourself!”

    • Pat
      April 18, 2013 at 4:06 pm

      The biggest problem with the previous system has been GOVERNMENT. You would fix that with – of course – more GOVERNMENT. Underlying your desires with ” the needs of the people” makes whatever come the result of and subject to mob whims. Medicine was supposed to be about the individual – by making it a right and a utility, you reduce the patient to a raw material for processing. If you doubt that, look at the standard way government patients i.e. Medicare/medicaid are manipulated for the bottom lines of hospitals and yes, doctors.

      The “Affordable Care” Act, sure the most ironically ever named, is a sad joke on its own recipients, As this accelerates into the permanent sewer of nationalized care, the laughter you hear will be mine.

  2. Scott Miller, MD
    April 17, 2013 at 11:48 am

    Just wait until Dr. Marsh gets sued for calving a Christmas tree that developed the blight!

  3. Pat
    April 13, 2013 at 1:06 pm

    I’m envious. At least now he’s doing honest work.

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