Enjoy our most current issue of the most popular medical e-newsletter on the internet.
Blogs and Thoughts for February 14th to February 20th, 2019
Here is what we had this past week:
Is It Time To Fire Your Doctor?
ARB Recall by Steven Mussey, M.D.
Parental Leave for Residents
This Sceptred Aisle by Pat Conrad MD
Ridiculous Study of the Week: Physical Activity in Sick People
Friday Funny: Marco…
Quote of the Week: Willy Wonka
- It’s Time To Fire Your Doctor?
February 20, 2019
I was just blown away when I read this article the Wall Street Journal. It is such a perfect example of the disrespect we physicians are getting. The title is It’s Time to Fire Your Doctor by Andy Kessler. Here is Andy’s bio:
Andy Kessler is the author of Inside View, a column he writes for The Wall Street Journal on technology and markets and where they intersect with culture. He is the author of several books including Wall Street Meat and Eat People. He used to design chips at Bell Labs before working on Wall Street for PaineWebber and Morgan Stanley and then as a founder of the hedge fund Velocity Capital.
So, obviously, he truly is qualified to give advice in this area, right? Here is a summary of his thoughts with mine in parenthesis:
- Let’s say you, like me, are one of the 20 million Americans who work for themselves—no boss, but also no corporate-tax deduction for health insurance. The smart move is to get a high-deductible insurance plan. Now it suddenly matters what doctors charge: $500 to take your blood pressure and bang your knee with a rubber hammer, $1,200 for a blood test that uses pennies worth of chemicals to tell you your hemoglobin levels are fine. Plus four months to get an appointment, and then the doctor asks you to fax an authorization. What? It’s 2019. It’s time to fire your doctor. (Dude, you just made the case for Direct Primary Care. Get a high deducible plan, pay the membership fee of $80, there is no cost for the BP check, $10 for the HbA1C test, and get in the same day with no extra office fee. DO SOME RESEARCH, ANDY!)
- He has a Fitbit, an Apple Watch, an Omron BP cuff, home labs through WellnessFX, a Beautyrest Sleeptracker and he is all set to fix himself. (I like toys too. It’s what you do with that information that counts, Andy. It’s like someone at home playing the Stockmarket on his computer and calling himself an expert.)
- When you do get sick, you still need to see a doctor—they have that prescription pad. But insurance companies tired of overpaying for five-minute doctor visits have begun setting up alternatives. Sutter Health runs walk-in clinics for $129 a visit. Online care is cheaper, so Anthem Blue Cross encourages customers to use LiveHealth, a videoconference platform, for $49. Aetna has a deal with Teladoc, a $4.5 billion public company, for $38 consultations. No pain meds, of course, but almost everything else. (Insurance companies are tired of overpaying for five-minute doctor visits? Dude, they caused the five-minute doctors visits! You just proved whose pocket you are in…the insurers. Then you extol their virtues. And your answer are walk in clinics that they want manned by LELTs. You get what you pay for.)
- Technology has moved so fast that several smartphone-based platforms now function like Uber for doctors: Doctor on Demand, PlushCare, Amwell and MeMD are cutting into primary care. These are gig-economy doctors who provide care on demand for, well, gig-economy workers and others without employer insurance coverage.(Go ahead and keep your “Gig Docs”, who don’t know you and will give you anything you want. I guarantee most of them suck and are just in it for the money. And why is it that tech people always think they are smarter than doctors and that tech will put us out of business?)
- Taking charge of your health care can be complicated and is not for everyone, but it’s doable for most. I’d stick with services that hire doctors from top 25 medical schools. (Oh, yes, you are so brilliant. The other medical schools are bad, I guess? Your tech is the answer to discover all your medical diseases but it can’t find another way to find better doctors?).
- For now, when you inevitably and repeatedly fill out the prescreening paperwork, specialists always ask for the name of your primary-care physician. I put down “Dr. Webb.” (What a disrespecting douche you are. A hedge fund guy, who never truly helped anyone else now belittles the most noble profession. Wow.)
- Data, data, data—the more the better. As I write this, I have a Fantastic Voyage-like capsule near my stomach transmitting pH levels. How cool is that? As this technology progresses, more tests and more capsules will fill databases with personalized information. (More data? How did the full body CT Scan fad go in the past? That was a lot of data. And a ton of false positives. Good luck with your pH monitor. That will tell you a lot. Actually, I can’t stop laughing as I write this.)
- The revolution is coming. But not from your doctor. (Uh, yeah, there is a revolution coming. It’s called Direct Primary Care, by DOCTORS, where we go back to the roots of our profession and give comprehensive, accessible and personalized care).
I am just amazed at the arrogance of some non physicians. People have no problem hammering what we do and then get offended when we defend ourselves. Whether it be these tech idiots or LELTs, somehow we have to be careful pointing out our years of training and education that separate us from them. Can we work together someday? Sure. But when you start out saying doctors are not needed, or we are just as good as them, then you are itching for a fight.
Lastly, Mr. Kessler, why do doctors go to other doctors if they are not needed? You would think we could just use all the tech and our training to remove our own doctor from the equation? We don’t because we are not that egotistical to think we can do it all. And we are not idiots.
2. ARB Recall by Steven Mussey, M.D.
February 12, 2019
This recall of the ARB’s (Angiotensin Receptor Blockers) is wreaking havoc on doctors and pharmacists. It started with Valsartan. So, we switched people to Losartan. Then Losartan was recalled. We tried Olmesartan but the insurance companies rejected the switch due to costs. We then tried Irbesartan, which worked… until the recall hit Irbesartan. Now, all three of the affordable drugs are unavailable. Uh… Oh, yeah! Telmisartan might work! Then, the stories came out: All the “sartans” are suspect!
No one is communicating to the doctors! We’re out here on our own, trying to figure out how to keep blood pressures controlled without causing side effects or cancer!The FDA looks totally incompetent!
Big pharmacies look absurd with their letters to patients: “Your drug may… or may not be causing cancer. We’re not sure. Ask your doctor!” (Since when do doctors track lot numbers and generic manufacturers when they write for a medication?)
It is every hour of every day! Letters in the mail with lists of patients but no useful information! Calls and faxes from pharmacies and patients! Everyday, patients are coming in who have stopped ALL their medicine because they don’t want cancer.
This is insanity!
3. Parental Leave for Residents
February 18, 2019
I run the risk of pissing a lot of people off here but this study just gives me pause. Here is what it found:
Leave policies for residents who become new parents are uneven, oft-ignored by training boards, and provide less time off than similar policies for faculty physicians.
Though all 12 schools provided paid childbearing or family leave for faculty physicians, only 8 of the 15 did so for residents (JAMA. 2018 Dec 11;320[22)]:2372-4).
In programs that did provide leave, the average of 6.6 weeks of paid total maternity leave for residents was less than the 8.6 weeks faculty receive.
Okay, this is interesting. For one, I agree that there has to be some unpaid maternity leave for ALL schools. I get that. But who says that it has to be equal to the faculty? This is their full time job. This is their careers. The others are in training. They are residents. They are not equal. I know this sounds harsh in this politically correct climate but not everything has to be the same. Should a surgery resident in his third year get 8 weeks for a his first kid’s birth while the other seven residents get destroyed on their rotations? I know we are trying to be more kind to this situation but there is a bigger picture here. There is only a finite amount of residents doing a ton of work. It’s just not that simple. Residents are just not equal to faculty members. Am I being too harsh here? I would love your thoughts on this.
EDITOR’S NOTE: Obviously this hit a nerve. I want to point out a couple of things. One, see the second line in the paragraph above. “For one, I agree there has to be some unpaid maternity leave for ALL schools”. Ladies, I am on your side!!! My real question is whether residents, who are in training, are the same as faculty in the AMOUNT of time needed off. Should they be equal? Should they get the same pay? The same amount of vacation? The same days off for maternity leave? Or what about paternity leave? Is that different?
Lastly, are we at a point that a question can not be asked without being hammered? People now claim they lost respect for me. What? I openly asked for your thoughts. Can we do this in a civil manner?
(no more comments on this on. It’s all been said and there is no point)
4. This Sceptred Aisle by Pat Conrad MD
February 17, 2019
It’s sort of shooting low hanging fruit in a barrel, but is there ever a wrong time to make fun of production-line health care?
The land that brought us Monty Python and is now banning scary-looking knives is also an epoch leader in the “health care is a right” thought disorder, and as ever is short of cash. The United Kingdom National Health Service has overbooked and overworked their GP’s to the point that they are making plans for group visits, in groups of up to 15, and included in the new 10-year plan. Patient advocacy groups say that patients would feel “incredibly uncomfortable,” to which I say Thhhhhffffbbbpppptttttt! The taxpayers have felt incredibly uncomfortable for years funding this expenditure without end. And what about the GP’s? How exactly did a shortage occur, if they were trained and paid appropriately? Patients are getting more of the consequences of the public policy they have chosen since 1945, and they deserve these rewards.
“Doctors at the Royal College of GPs’ annual conference yesterday said the groups were a ‘fun and efficient’ way to carry out consultations with patients who shared the same conditions.” Which is proof that the AAFP has a branch office in London.
“Doctors using group consultations said they had proved far more efficient at dealing with a host of heath complaints, including arthritis, diabetes, obesity, and even treatment of erectile dysfunction.” Oh, I’ll bet! “Gladys, you’ve stuff down any more boiled kidney pie and you’ll weigh 3 stone more, priming yourself for the arthritis Beatrice keeps complaining about all the while refusing to exercise, and Gertrude here can’t get any wink-wink, nudge-nudge from ol’ Tom, who’s just joining us today because he can’t wake up his old fellow, isn’t that right Tom?”
“Under the system, patients will spend much of their time with a “facilitator” – a receptionist, clerk or healthcare assistant with a day’s training – who can point them to advice on their health condition, the conference was told.” That sounds familiar.
Okay, now everyone take a deep, calming breath before this next, realizing that it isn’t parody:
“GPs said patients were given forms telling them to respect confidentiality, and told: ‘What’s said in the room stays in the room; don’t go discussing it with the postman and his dog.’” By now Tom’s troubles have made it around the pub.
Before we laugh too hard, we should remember U.S. voters watched this mess unfold – and then instituted Medicare. We saw it get worse in Britain, and we expanded Medicaid. We have several decades of experience in embracing bad ideas incrementally without arguing against their central flaws. Which makes us dumber than people who habitually eat kidneys and deliberately watch soccer.
5. Ridiculous Study of the Week: Physical Activity in Sick People
February 16, 2019
Okay, so you are not going to believe this, but:
Participants with chronic disease undertook 9% or 61 minutes (95% confidence interval: 57.8–64.8) less moderate activity and 11% or 3 minutes (95% confidence interval: 2.7–3.3) less vigorous activity per week than individuals without chronic disease.
To be clear, it is not saying that those who exercise less may get more diseases. That would be interesting. No, this study says that people who are sicker undergo less moderate and vigorous exercise. No shit!
And that is why this is this week’s winner of of “Ridiculous Study of the Week”. Congratulations.
6. Friday Funny: Marco…
February 15, 2019
I did not make this up. It’s scraped from the Internet.
7. Quote of the Week: Willy Wonka
February 14, 2019
“A little nonsense, now and then, is relished by the wisest men.”