I’m The Problem by Pat Conrad MD

“Dude, go have a scotch and stop bitchin’,” our administrative coordinator counseled.  I replied, “Hell no, that is the column I’m gonna write tonight.  With bourbon.”
While Bernie and the AAFP – worst rock group name ever? – work to commit medical economic alchemy and conjure up free health care for everyone, I’ve had the opportunity to be reminded, and then to remind you, of an important prominence dominating today’s medical landscape.
Often we read in medical journals, vapid lay press feel-goods more fit for “Good Morning America,” or even hear from respected physicians that patients really do trust their doctors, and look to them for advice and reassurance during these pre-single payer times of turbulence.
My only goal here today is to get you Dear Reader to agree with me on a single, simple point:  patients do NOT trust their doctors, and never will.  Those days are gone.
Why, you ask, do I have to be the dark shadow of dread on a site dedicated to the healing arts and nobility of the human spirit?  Because it needs to be said, and good luck ever reading this on Medscape or Family Practice News.  Nope, there are no links here; this is pure opinion, with a side of venom that you can add to taste.
Patients look in my eyes and yours when the S-T segments are “tombstoning,” when a child can’t stop vomiting, and when I’m removing a fishhook from an eyelid (true story).  But they do not trust you and have the lawyers to prove it.  Hospitals do not trust you to even wash your hands, and they have all sorts of unproductive observers, surveyors, quantifying specialists, and graders to prove so.  Big Insurance damn sure doesn’t trust you:  a proper chart note should read, “Mrs. Smith, <date>, Cough x 1 week.  Smoker.  Exam consistent w/ bronchitis.  Z-pak, follow up PRN.”  DONE!  If you graduated residency, and passed  a board exam, it should be expected that you know how to diagnose a damn bronchitis, and assumed that you told Mrs. Smith not to smoke, because, well…YOU’RE A DOCTOR.  That’s what we do, right?  If her family history mattered, you would mention it.  And you – let’s be honest – don’t give a damn on this visit whether or not she has hyperlipidemia, or whether she feels threatened in her home.  I dare anyone out there to submit a chart note as brief as the one I’ve written, and get paid a dime for the visit.
A colleague in my group, a damn good doctor and fine fellow, countered my rantings by saying that insurance companies must have some way to determine the amount of work that was done.  Which makes my point, because clearly scheduling a patient, seeing them, putting the necessary, fluff-free facts on paper, isn’t good enough.  They receive a premium from the patient, who is free to complain to them if their paid agent – the doctor – gives lousy service.  So why does all this crap need to be written down, coded, parsed, retransmitted, and finally confirmed?
Get “MD” slapped on your forehead, and the bull’s eye of “Not Trusted” is immediately tattooed on your back.  All of Big Government medicine is built on the premise that physicians are thieves, and we got there because a lot of docs for a couple of decades cut very fat hogs indeed.  And yes, there have been many incredibly egregious, completely felonious abuses by scumbag doctors cheating the taxpayer.  But the very existence of a large government system, backed by apparently inexhaustible funds (hellooooo Greece), means there will always be a threat of fraud and theft.  And yet, more and more are clamoring for more government involvement in health care, which can only mean that whatever the idiot-in-the-street’s verbiage, they want Uncle Sugar to provide a “provider,” and probably for free.  Disagree?  Why then do we have a National Provider Identifier?  Why then do we need DEA numbers in each different state where we practice (given that it’s a federal agency)?  Why then do we have a National Practitioner Database?  (I’m personally in there 3 times, since malpractice lawyers trusted three separate vengeful families to buy them new beach houses.)
Like everyone else here, yes I too think there should be some sort of safety net for the working poor, the destitute, and those struck with catastrophic injuries or illnesses.  I would, however, NOT have a sclerotic central government program catering to the increasingly entitled elderly, and the overly-procreative semi-poor.  I would devolve all of that to the states where we are guaranteed to screw it up, but in less monumental, less permanent, and more fixable ways.  But what we have to acknowledge is that any such safety net will involve an attendant degree of distrust of those who check the weave.
As it stands, September in north Florida is glorious and radiant, where the locals can sniff a whiff of fall in the air at 85 degrees.  The days are precious and are to be used in joyful, productive ways.  And I wasted one of them driving from my rural area to an urban setting, and back again, to get a once-every-five-years fingerprinting for Medicaid  Will I get compensation for my burned away day?  “It’s the cost of doing business,” I hear some of you sneer.  Try that on a CPA that gets to bill hourly for anything.  Apparently the salt and sand alters fingerprints here in the Sunshine State, and Tallahassee needs to keep tabs on me.  Because for all the Medicaid junkies, falsely disabled, able-bodied & lazy, overly fertile, children with a runny nose and fever of 99.0, hypertensives who just “forgot their appointment,” chronically ill 300-pounders who show up at midnight in the ER to “get it checked out”…apparently, I’m the problem.  Just don’t tell me that society trusts me.  The picture above?  That’s my middle finger getting electronically printed.

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] 

  6 comments for “I’m The Problem by Pat Conrad MD

  1. Curtis
    September 27, 2017 at 9:50 pm

    WOW! Very well stated and on point.

  2. politovski
    September 25, 2017 at 11:24 pm

    wow. well said pat. channeling your inner dr. hendricks. i would totally agree that a system that hold us accountable for the actions of the patients is ludicrous and unsustainable….

  3. Sir Lance-a-Lot
    September 23, 2017 at 10:50 am

    I’d say you nailed it, Pat.

    Being fingerprinted like a criminal really tee’d me off back when I was a resident in NJ, too, but the truth is that we are all treated like criminals all the time (I can’t get into the med room to get a med without a nurse, because I’m likely to steal, right?).

    The sooner I’m out of this, the better.

  4. Steve O'
    September 23, 2017 at 9:52 am

    When an argument is started with the premise that a certain group is inherently wicked, immoral and criminal, what follows is intended to be propaganda.
    The last of the honest political questions died out in the 60’s and 70’s. If we could act like a republic, and ask questions such as – is there a way to have universal healthcare? What are the obstacles, and can they be conquered? it might be one thing.
    But nowadays, when passing one-line bills with no substance stands for victory of some sort, it is impossible to look to improving the future, and merely survive during the ebbing tide.
    America CANNOT have universal healthcare, because it lacks the ability to honestly coordinate and plan for it. Our self-government has fallen apart into screaming interest groups that demand the impossible.
    Ultimately, cultures and civilizations cannot exist without a moral structure. An honorable Floridian commented on this,

    Charley Reese:

    A free society promises many things, but uniformity of opinion is not one of them. Uniformity is a specialty of dictatorships. When Joe Stalin was alive, everybody who wanted to stay alive publicly agreed with him. The same was true of Saddam Hussein. Tacitus said of the Romans that they make a desert and call it peace. Dictators scare the bejeebers out of their people and call it agreement.

    All we Americans have to do is learn to disagree in a civil manner. That’s not easy for some folks. Some people can barely open their mouths or put pen to paper or keyboard to bytes without insults, bad names and bad words pouring forth. In extreme cases, it’s like experiencing a broken sewer pipe. It’s too bad, because some of these people might have some good points to make if they didn’t drown all their thoughts in vitriol.

    The intention is often to intimidate those who disagree with them. Nobody who claims to be an American should ever allow himself to be intimidated by anybody for any reason. To forfeit the right of free speech out of fear should be unacceptable in the United States. A million or more Americans didn’t give their lives so Americans could become sheep. It is especially shameful to be a sheep in America, because nothing bad is going to happen to you for speaking out. You may be slandered or questioned, but you won’t be tortured, shot or imprisoned.

    Today, as long as someone will point to a Designated Enemy and shrill invective at him/her, that’s all that the sheep need. What passed for a Presidential election was merely a choice of which flock the sheep wish to belong to.

    The “epidemic crisis of opioid addiction” is merely a ruse to collapse the individuality of the doctor into becoming a cog in the corporate medical system. Whether DPC will survive this onslaught, I can only hope. Given the “heartbreak of opiates,” the sheep will demand oversight for the renegade doctor who goes into homes and makes decisions without someone else’s approval and authorization.

    Sometimes I wonder if Muslims are so terrifying simply because they have their own different system of ethics that is not subject to the approval of Political Correctness. We assume that makes them all blood-drinking savages. Perhaps 99% is simply disobedient to what they are told to do at some level or another. It is interesting that of many separate outside groups of people, they seem to be especially thirsty for American residence and citizenship. Perhaps it is what we used to be that attracts them, as America has attracted many yearning to be free in the past. Consider it.

    Now in America, you can believe what you want and say what you want and do what you want, except not too much. “Too much” is defined by the leading entities and corporations and religions and movements. Like Robert E Lee? Don’t like him too much. Or anyone else who has been disapproved of.

    Doctors are on that list. If you like your doctor, you may like your doctor. Up until she/he disagrees with you, then sue him/her.

    The problem is not in the stars, but ourselves.

    • Jay Cooperman
      September 23, 2017 at 2:54 pm

      Agree, mostly. When did we start to think everyone had to agree with us? When did we begin to be so incensed with the result of an election that we would refuse to talk to, or feel justified in insulting anyone who voted for the other candidate? I guess it was around the same time we began to think we were guaranteed a healthy, happy life, and that it was someone else’s fault if things didn’t work out as we hoped.

      On the other hand, we do have ideals which make us a cohesive society. We should all be able to agree that slavery is evil and that a leader who tried to preserve the institution should not be revered publicly. The term “political correctness” suggests that there should be no reaction to freely expressed speech, when the notion of free speech does not guarantee a receptive audience.

    • Pat
      September 23, 2017 at 3:20 pm

      Oh but Muslims do have their own political correctness – kill infidels, and or refuse to condemn those who do. Before you worry that I oversimplify with outlier stereotypes, let me note that I await the greater Muslim community’s effective condemnation of mass murder and clitorectomies.
      Barbarians In one corner, and large compassionate states in another are both enemies of the free individual, who physicians once existed to support.

Comments are closed.