How to Polish a Turd

The medical system has been royally screwed up for a long time.  We agreed to Medicare, unlike dentists, and became beholden to the government.  We got bullied by insurance companies who made deals to “give” us money even though it is the patients’ money.  We agree to managed care and HMOs and capitated care as these same insurers kept driving the payments to us down.  We lost control over ordering tests, prescribing medications, and how to treat our patients. Physicians became Robodocs that no longer responded to patients’ needs but we were trained like Pavlov dogs to click boxes to appease the government and the insurers.  With the ACA came unproven (actually proven not to work) metrics that we were convinced by the AMA, AAFP, AAP, ACP and every other governing body to go along with.  They were wrong.  They created a massive turd and the only way to fix is to…..add more crap to the turd.  How about another person in the room who does the boxes and notes like scribes?  Just more overhead and more hurdles to the patient-physician relationship. How about prior authorizations?  How about narrow networking, where doctors are removed from working with patients they have known for years?  How about expensive EMRs that change all the time and get in the way of doing your job?  What’s next?  Patient experience officers:

Because of this paradigm shift in patients, many practices are implementing a new role within their organizations of a patient experience officer—a designated employee responsible for making sure the entire experience is in line with patients’ expectations.

Can you afford this?  No. As a doctor, I should be responsible for making sure the entire experience is in line with patients’ experiences.  That’s called being a business person. I do this as a DPC doc because if I don’t then I go out of business. This is the charade we call modern healthcare in America.  Because of insurance, patients don’t know the prices of anything and without skin in the game they don’t care.  That is starting to change with high deductibles but the only one saving money are the evil insurers.  So who pays for the scribes and now patient experience officers?  We all do.  This is another joke created by ivory tower geniuses who did a recent study showing “that a growing number of patients who leave their healthcare provider do so not because they aren’t satisfied with the level of care, but because of frustration with practice logistics—things like interactions with staff, scheduling hassles, wait times, and communication processes.”

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Why aren’t patients satisfied?  Because these same idiots crapped out this turd we all have to deal with and now they want us to polish it.  I have written about the turd polishers before and they are our representatives. It is time we just say ENOUGH to these idiots.  It is time for a revolution.  It is time for doctors, yes DOCTORS (MDs or DOs), to take back ownership of this mess and unwind it to start over.  DPC is a start but there is so much more. We are being replaced, ignored and devalued and unless we do something we will have no role left.  It is our choice to either be sheep led to slaughter or be leaders that fix this thing.

Tell me your thoughts on how we should do this because I am all ears.  We need a voice.  Leave your comments here.

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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] 

  4 comments for “How to Polish a Turd

  1. Ben
    May 8, 2018 at 10:41 am

    HMOs and others have made winners and losers of specialties.
    Primary care has suffered because they compete against “providers” with less training, who are not paid less, but instead everyone gets less.
    Specialties with monopolies like Anesthesia continue to make more and more. CRNA now make more than family practice. Anesthesia makes more than most surgeons with less residency, no business to run, easier hours and lifestyle. Why, because they have a monopoly and do not have to sign most contracts. Every year, the hourly rate is raised for non Medicare and Medicaid patients. They now get 4x Medicare, and thus feel Medicare underpays them. Everyone else gets 1.2 x Medicare and has overhead.
    Drug companies were bribed to pass the ACA and contributed heavily to politicians and now $40 drugs have increased to $40,000
    Since 60% of Americans, primarily voters for one party do not pay their health care, they dont care.
    Next year my Blue Cross went up its annual 15% and I am paying $25,000 for a family of three, not including deductible and copay. Thus it is really at least another 10% income tax putting me in a 60% marginal bracket.

    • S T E V E
      May 9, 2018 at 3:20 pm

      You can rub it all day but you can’t get shit to shine.

  2. Steve O'
    May 8, 2018 at 8:40 am

    I’m thrilled to hear medicine picking up the neo-militarization trend of calling anyone whom you wish to portray as having authority, “Officers.” I hope they have the little radios that they talk into on their chest. “Roger, Officer responding to a patient experience incident in Family Practice.” “Roger, taking practitioner into custody for a Patient Experience 101-34, Failure to Enjoy Visit.”

  3. Thomas Guastavino
    May 8, 2018 at 6:35 am

    Since the odds of physicians forming unions are slim to none, I have advocated for the “Micro-Strike”, a series of moves that any physician can make and is, in fact already happening. These include:
    1) Financial independence and eventual early retirement
    2) For primaries-DPC or concierage care
    3) For specialists- Super-specialization ( Develop unique and not easily replaceable skills)
    4) Avoidance of complex, difficult, high risk or uncooperative patienst
    5) Stay out of the emergency room
    6) Move toward low risk, simple, high volume care. Urgentcares come to mind
    By the time the government figures out what has happened, we will be back in control.

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