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.
105020cookie-checkI’m The Problem by Pat Conrad MD