It’s Time To Fire Your Doctor?

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.

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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] 

  18 comments for “It’s Time To Fire Your Doctor?

  1. Mamadoc
    February 23, 2019 at 8:28 pm

    Wonder if he plans to take his appendix hisownself?

    • Frank J. Rubino MD
      February 25, 2019 at 7:42 pm

      He is clearly smart in his own mind, and I think he should.

  2. Doctor Bo
    February 23, 2019 at 10:26 am

    He brings to mind Osler’s quote, “A physician who treats himself has a fool for a patient.” Some things don’t change, although the thought might need to be broadened in its scope to include self-treatment of serious maladies by any individual, even self-promoting clueless douchebags.

  3. Bob Riley
    February 21, 2019 at 9:25 pm

    Dunning Kruger effect in action. I think it has become epidemic. Patients AND doctors are the victims of a medical industrial complex run amok.

  4. Frank J. Rubino MD
    February 21, 2019 at 7:41 pm

    Steve Jobs as smart as he was decided to treat his early pancreatic tumor himself with meditation and herbal remedies for 9 months until he realized they did not work. I am told it was a slower growing adenocarcinoma that was initially found accidentally with a CT Scan done for other reasons. 9 months later it was too late. Upper echelon IT people and MBA’s think that because they are smart in one small area of life , they are expert in everything. Hedge fund guys are the SOB’s of the world.

  5. Basia Jenkins MD
    February 21, 2019 at 5:59 am

    All that healthcare technology and distance medicine collapses and fails when you are truly , seriously ill and need a real highly experienced , exceptionally educated physician who will be your champion and advocate .
    Time counts , delays matter .
    Your physician will carry your burden of anguish and worry to determine what is wrong and all that needs to be done in correct order .
    With one phone call , that physician makes time for you .

    That relationship occurs over time .
    It’s called relationship building and networking in your business .
    You know you need certain contacts on speed dial .

  6. Peggy J Brown, MD
    February 21, 2019 at 12:30 am

    Is he planning to deliver his wife’s babies, too? Cookbook his way through an anaphylactic attack? Having a GI bleed or acute MI? Ask Dr. Google to fix that broken arm. What a nutcase.

  7. Craig
    February 21, 2019 at 12:16 am

    Andy Kessler is too egotistical and clueless to realize he is ignorant. If I was his doctor and read that, I would fire him. Every year I fire more patients from my practice. I started with one patient every two or three years and now I’m up to three patients per year. There is nothing that says you need to treat someone who is offensive to you and your specialty. Kick this Person* to the curb. As an example I have patients I have seen for viral conditions and then two or three days later they go to an urgent care where they get an antibiotic anyway. Increasingly, these Dr. shoppers then returned to me again after getting their antibiotic, now for a third visit demanding a “second round”. The great thing about our new electronic medical record is that I can see what they did and where they went. I have told a few patients that that is not how I practice medicine and that they are welcome to change doctors.

  8. Doctor Girl
    February 20, 2019 at 6:39 pm

    He should stop talking. No one would miss him.

  9. Allyagottadois
    February 20, 2019 at 1:49 pm

    This guy is clueless on so many accounts. Maybe the telehealth can console you on the loss of you husband. Hugs would be tough

  10. JRDO
    February 20, 2019 at 12:39 pm

    I wonder how many “gig-doctors” graduate from the top 25 medical schools.
    He is probably on a quixotic quest to find them.

  11. Gerard Mazza
    February 20, 2019 at 11:01 am

    I emailed the following to the author form the address listed on his website:

    Having practiced medicine for he past 32 years, I would like to address several inconsistencies in you recent article about medical care and costs. Regarding the cost of care, in our office we do free blood pressure checks and our insurance reimbursement for a Hemoglobin A1c is around $5 and $1.50 for a hemoglobin. I wish we could get reimbursements that were 1/100 of what you are suggesting.

    Even at my age, I still do embrace new technologies as I write to you on my iPad while wearing my Apple Watch. However technology in medicine requires medical knowledge and training in order to be interpreted correctly. EKG machines do give a computer interpretation, however these are very often incorrect or incomplete. The same goes for radiological studies, heart sounds, and many other aspects of medicine where a computer can help, but cannot make the final determination. It all goes back to the realizing that medicine is both an art and a science. Computers d not add the judgement aspect that is always needed.

    I do like the idea of telemedicine, but it is extremely limited in it’s scope. Patients sometimes message me with images and I can often make a diagnosis, but just as often I cannot. Later, when seeing the patient in person, the diagnosis is obvious. Also, what about all of the diagnoses that will be missed using telemedicine? I recall the girl wearing sandals who I saw for a common cold and noticed the melanoma on her foot, the previously undiagnosed diabetics who came in for unrelated issues, but had acetone on their breath, the “Strep smell”, the feel of a previously undetected cancerous nodule, the child I looked at while my nurse had her on the scale and I diagnosed epiglottis. How many of these would I have missed if I had been examining the patient on a video screen? The child, by the way, was immediately sent to the ER where proper treatment could be given and did well.

    While I agree that data is useful, there can be too much data. Getting data without an indication often gives false positive results which can lead to incorrect diagnoses and to many added unnecessary and often dangerous follow up diagnostic procedures. I have seen patients die from surgery when that surgery was later found to have been unnecessary due to a false positive test. I tell patients that no test is 100% accurate. All tests have false positive and false negative results. As far a a gastric pH monitor in a healthy individual? I think someone was scammed by a slick salesperson.

    • Steve O'
      February 20, 2019 at 2:21 pm

      A kind reply, but an intellectual appeal to a technology equivalent of a fanatic suicide bomber. His mindset is that of the Soviet persecution of the rich peasants or Mao’s Great Leap Forward. He is a thug.

  12. February 20, 2019 at 10:50 am

    I was also shocked when I saw this article. Unfortunately, it will likely take a collapse of the current system before we see real changes made. As more and more young physicians like myself exit our careers early, I hope the public begins to see what is truly happening with healthcare instead of what is being spoon fed to them through the media.

  13. PW
    February 20, 2019 at 10:03 am

    That’s OK. Pretty soon there won’t be enough of us around. You don’t miss your water til your well runs dry.

  14. Steve O'
    February 20, 2019 at 7:55 am

    I like the part of his article where he claims financial surety and responsibility for his giving healthcare advice. What, no? He’s not responsible for what he’s writing? Well, take him at the value of his word, then.
    The big money coming in healthcare is dumping the liability and responsibility onto the patient. Your baby is crying a lot and has a fever? Contact one of those GigDocs, and get some amoxicillin for her ear infection. Oops, meningitis? Mommy’s mistake. Time to fire your parent.

  15. Adriana
    February 20, 2019 at 7:50 am

    Brilliant post, Doug! And he is a douchebag that would never get DPC- I see lots of supplements in his future. That’s ok- natural selection I guess.

  16. Rick Singel
    February 20, 2019 at 6:52 am

    Saw this column when it appeared in the WSJ. My jaw dropped. So, why do we need journalists and newspapers?! All the “data” is on the web and we have the toys to retrieve it. Andy Kessler is an arrogant douchebag.

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