Ana, I have never heard such ignorant garbage...

Email Print posted by pdowell 03/02/2008 09:46:48 PM EST

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Regarding Feb 29th Post-game show.

My husband and I are primary care doctors.  We were both astonished at your hateful ignorance displayed on the post-game show (2-29-08) regarding the medical profession in your commentary on the John Ritter case.  

I don't know all the details of the case (and I suspect, neither do you), but what I find incredibly disturbing is your argument that because some doctors somewhere have committed negligence, that therefore all doctors are always negligent anytime something bad happens.  

I do know that dissecting aneurysms are quite rare  (10 cases per million patients) compared with heart attacks (about 13% of patients presenting with chest pain), and at face value I don't find it unreasonable that people thought his chest pain was a heart attack.  Furthermore a thoracic aortic aneurysm is not something that would ever be picked up on a routine well-checkup.

Attitudes like yours are a part of the problem with healthcare costs today.  Many doctors order way more tests than necessary because in the case that something goes wrong, people like you always look to sue.  

Like Cenk said, doctors are just people trying to do their jobs like anybody else.  We are going to make mistakes.  It doesn't mean we don't care, or that we aren't trying, or that we are criminals.

 You do the medical profession and the progressive movement great disservice with your commentary.

 Pamela Dowell,MD

 Robert Irwin, MD

 

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Ana, I have never heard such ignorant garbage... | 24 comments (24 topical, 0 hidden)
Actually... (none / 0)
My mom had breast cancer for 10 years after being repeatedly misdiagnosed by the same doctor during her annual mammogram.  They told her it was a calcium deposit, and they said a biopsy wasn't necessary.  It was because the doctor did not want to do the extra test that she had the disease for so long.  Luckily another doctor came along in the facility, and finally decided that it was worth looking into.  Luckily the calcium deposit had not grown, and they were able to get the cancer into remission.  We all have exposure bias, but just because you are close to a doctor, it doesn't mean that there isn't a valid argument in there.  I have done some studies, and health costs have tripled in the last 30 years.  Coincidentally, doctors' pay scale has tripled in the past 30 years...hmmm

by chrisandyasemin on 03/02/2008 09:58:23 PM EST

Your Mother's Breast Cancer (none / 0)

I am glad your mother is doing well now and it is unfortunate that it took 10 years for a biopsy to be done.  Changes in previously stable breast calcium deposits are always a reason to perform further evaluation.

Having said that, I respectfully disagree that you are saying there is a valid argument in Ana's insistence that physicians should be sued for any bad outcome.

I am a 39 year old primary care internist, so I really had no control over the cost of healthcare for the last 30 years.  But to suggest that healthcare costs increased by such substantial amounts because of doctor salaries is ludicrous.

I made $90,000 last year. If I spend 30 minutes with a patient (70% of my office visits), I get paid $90. I hardly think that is excessive.

But I will tell you what is excessive: I have to cover my ass on a daily basis with unnecessary tests. I had a patient on Friday come into my office with "severe abdominal pain." I think she had a urinary tract infection.  However, everytime I touched her belly she acted like I was stabbing her so I sent her to the ER. And you know why I did that? Because I was thinking I didn't want to miss a dissecting aneurysm and get sued. Her workup, which included an expensive CAT-scan & lab tests revealed--wait for it--a urinary tract infection.

I see patients everyday that feel they need to see a doctor because they have been coughing for 2 days, or ask for an MRI of the brain because they have had a headache for 3.

Patients are living much longer than they did 30 years ago: that means more heart disease, diabetes, lung disease, and neurologic disease, like strokes, to treat.  And that care is expensive.

Americans need to realize that healthcare is costly for a number of reasons.  Are there some physicians who game the system? Yes. Do health insurance companies charge high-risk patients outrageous premiums? Yes. Do pharmaceutical companies charge outrageous prices for their drugs? Hell, yes. And do some patients insist on their doctors ordering unnecessary tests? You better believe it. 

 

 

by pdowell on 03/02/2008 10:32:09 PM EST

[ Parent ]
Mind if I vent? (none / 1)

Feel free to completely ignore this reply. It's not often that a doctor is within earshot and since you aren't my P.C. doc, I don't need to worry about dull needles for bitching.

$180 an hour? 1. It takes you 5 1/2 hours to clear what I do per month. Stop whining. 2. From what I've seen, you're undercharging. 3. Does it make you nuts to know that people playing doctors on TV bring home a HELLUVA lot more than real doctors?

Why do doctors ignore their patients? Why is it that I can bring up the same annoying complaint visit after visit only to have the doctor react each time as if it's the first time they've heard about it?

Can you tell me why doctors have patients fill out forms saying what today's concern is? They never read them. What's the first thing a doctor says when they come in the room someone has been sitting. waiting in for 20 minutes? "So, what seems to be the problem?" or similar drivel. If I have to take the time to WRITE it, doctors should take the time to READ it.

Sorry, but you pushed a button with "But I will tell you what is excessive: I have to cover my ass on a daily basis with unnecessary tests." No. You don't. You can tell the patient that you don't feel it's necessary and if they would prefer to find a doctor who does think it's necessary, more power to 'em. You CHOOSE to take the easy way by ordering tests you fully know to be unnecessary. And then you blame the patient for higher costs.

You don't, by the way, own any stock in HMO's or big Pharma or anything like that, do you? Just wondering, because I can't help thinking that doctors who prescribe things that will somehow benefit the doctor financially are probably not acting in my best interest.

I saved the best for last. Well, best in a sarcastic, ironic sort of way...

"Americans need to realize that healthcare is costly for a number of reasons.  Are there some physicians who game the system? Yes. Do health insurance companies charge high-risk patients outrageous premiums? Yes. Do pharmaceutical companies charge outrageous prices for their drugs? Hell, yes. And do some patients insist on their doctors ordering unnecessary tests? You better believe it."

So that's "Yes, yes, yes" and "you better believe it."

So, I have to ask...what are you doing about it? What are doctors doing to stop their brethren who game the system? Which doctors are boycotting the insurance companies that they know are gouging their clients? When has the AMA come out and took a stand against big Pharma and their pricing structure? And when was the last time you told a patient to go fly a kite instead of ordering that unnecessary test?

If you're 39, you've been practicing for, what?, 15 years? NONE OF THIS SHIT IS NEW!! It was the same 15 years ago! Why do doctors remain silent about the abuses of the system? Too much at stake financially, perhaps? Afraid that if you buck the insurance industry doctors would have to go back to taking chickens as payment? Can't make a BMW payment with vegetables, now can you?

We need a single payer system. Yesterday. Take the fucking profit motive out. Ask yourself...what would Hippocrates do?


Whew! Thanks! I needed that. It was like a tonic.

Now, if only a lawyer or insurance company exec would wander in... 

by MedfordTim on 03/02/2008 11:46:09 PM EST

[ Parent ]
Amen Tim!!! (none / 1)
As a veteran teacher, it would take me 3 years to pull in on salary what they do in 1.

Thanks for venting many of our frustrations at this situation.

:)

by bobo1 on 03/03/2008 12:00:16 AM EST

[ Parent ]
Mind if I vent back? (none / 0)

I have to clarify a few points.

$180 an hour?

$180 per hour does not go into my pocket. I get $72 of that to take home. And no, my office is not inefficient. That is the usual overhead for any 2 doctor primary care practice. Look it up.

From what I've seen, you're undercharging.

That $90 for that visit is not what I charge. That is what the insurance company pays me whether I charge $105 or $300.

Does it make you nuts to know that people playing doctors on TV bring home a HELLUVA lot more than real doctors?

No, it doesn't make me nuts that actors make more  money than me. That's how it works. This society honors celebrity.

Why is it that I can bring up the same annoying complaint visit after visit only to have the doctor react each time as if it's the first time they've heard about it?

If you have physicians that are so clueless that they act as if they never heard you complain about your issues, then you need to get a new doctor.

Can you tell me why doctors have patients fill out forms saying what today's concern is?

I don't know why doctors have patients fill out those stupid forms. I am not one of them. When I opened my practice, I made it a point not to use them because I prefer to hear from the patients mouths and not read it off a paper.

You CHOOSE to take the easy way by ordering tests you fully know to be unnecessary. And then you blame the patient for higher costs.

There is a difference between an unncessary test and testing for a diagnosis that is low on the differential. The case that I initially wrote about is an example of the latter: if she hadn't been writhing around on the table like she was dying, I would have just sent her home with 3 days of antibiotics and thought nothing of it. However, ordering an MRI for someone who has had back pain for one week is unnecessary and I would never do it.

You don't, by the way, own any stock in HMO's or big Pharma or anything like that, do you? Just wondering, because I can't help thinking that doctors who prescribe things that will somehow benefit the doctor financially are probably not acting in my best interest. 

No, I don't own any stock. I prescribe what is best for the patient, or more accurately I prescribe what is best for the patient and what will be covered by the insurance--and I give generics a preference.

So, I have to ask...what are you doing about it? What are doctors doing to stop their brethren who game the system?  

I don't personally know any doctors who are scammers, but if I did, I would turn them in.

Which doctors are boycotting the insurance companies that they know are gouging their clients?

I am one of those physicians who "boycotts" the insurance companies if I feel they are unfair to either me or my patients. I accept a total of 3 health insurances in my practice: Blue Cross, Medicare and HealthNet. I dropped United & Aetna 4 and 6 years ago, respectively.

When has the AMA come out and took a stand against big Pharma and their pricing structure?

I am not a member of AMA because they are too Republican for me.

And when was the last time you told a patient to go fly a kite instead of ordering that unnecessary test?

I reviewed my schedule from last week. On Friday, I had a patient come in with ankle pain. After talking it over with her and explaining the anatomy of the foot, I was able to tell her that based on her exam she had a tendonitis of a particular tendon and an MRI was not necessary to make the diagnosis. Also on Friday, I had a patient come in with the flu and insisted I check a nasal swab for influenza. I told her I wasn't going to do it because I was treating her for the flu regardless of what the test would say. On Thursday, I had a patient ask me to have an MRI because she was dizzy for the last week. After talking to her & cleaning out her ears, I found out her dizziness was probably because of her ear infection. However, will I order an MRI if the dizziness persists for a month and the infection has cleared? Yeah, I will.

If you're 39, you've been practicing for, what?, 15 years?  I have been practicing for 7 years.

After college, I worked in a hospital lab as a medical technologist for 2 years, went to medical school for 4 years, did residency for 3 years, and then waited a year for the building to be built so I could open my practice. 

NONE OF THIS SHIT IS NEW!! It was the same 15 years ago! Why do doctors remain silent about the abuses of the system? Too much at stake financially, perhaps? 

Not all doctors remain silent. There are just not many of us out there who will buck the system. And yes, there is something at stake financially. Not many people are going to go to school for that many years, have loans that are outrageous (I went to a state medical school and my loans were $100,000), and then think it is okay to work for $90,000 a year.

Afraid that if you buck the insurance industry doctors would have to go back to taking chickens as payment?

Actually, I could go for a bartering system. A little organic meat for that office visit?

We need a single payer system. Yesterday. Take the fucking profit motive out.

Fine with me, but then don't expect me to pay my own rent & give my employees raises every year if money doesn't matter.

 

 

by pdowell on 03/03/2008 10:49:30 AM EST

[ Parent ]
There now (none / 0)

We BOTH feel better!

by MedfordTim on 03/03/2008 11:35:56 AM EST

[ Parent ]
Here's my prescription (none / 1)

Make 2 angry messageboard posts and call me in the morning. 

 

(and more cowbell!) 

by schmoab on 03/03/2008 12:01:53 PM EST

[ Parent ]
Thanks for your vent... (none / 0)
If I may, I have a few questions when it comes to the political side of medicine...

Do you think that most people in this country who go to medical school do so to genuinely help people or just to make Doctor's money?

Who else can change the insurance/medical problems other than the doctors or the government itself? Can a change come from the outside in this case?

Is the systemn we currently have in place the reason we have what many consider "the best care in the world?"

Is there anything short of publicly financed and run clinics that would take the money out of the Rich Corporate hands and place it with the people?

I appreciate any response from all on these questions. All of this talk about single payer/socialized medicine should raise these sorts of issues!

Thanks

by bobo1 on 03/03/2008 02:23:04 PM EST

[ Parent ]
The Real Issue Here (none / 0)
Dr. Dowell, I'm glad you laid out the realities of medical costs here. Most people think that we actually take home that $180 per hour! I have to say that we nurses don't get sued as often and, in reality, it's usually because attorneys don't go after us, since we don't have deep pockets and their % of the settlement won't be worth their time or trouble. We all know bad stuff happens as Cenk said so sensibly in the discussion. Even when we do everything right, people get sick and sometimes die too soon and it's usually not anyone's fault. Most doctors and nurses care deeply about their patients. We all know we are not perfect and we try hard to police our ranks, much more often than people realize.
 
But with all that said, the real issue is that, although we squabble about all the money, we are, all of us, patients and caregivers, slaves to for-profit insurance companies. The execs of these companies make more money every year than most of us will ever dream about in our lifetimes. And all of this money comes from the backs fo the sick. The immorality of this is astonishing to me.  None of us is immune from this central problem, whether on the giving or receiving end of care..we are all paying more and getting less.
 
Most of the general public doesn't understand that we in health care are so incredibly overburdened by unecessary tasks, unnecessary tests, paperwork, insurance coding and billing, over-scheduling, understaffing, it goes on and on. And through it all we try so very hard to help people, most of whom are grateful and appreciative. We all know there are times when people should sue and times we should police our peers better. And of course there are those patients who walk in the door hostile, leave hostile, and will look for any reason to make a lot of money for trumped-up injuries.
 
We simply need to get health care out of the for-profit realm. We wouldn't expect our fire departments or libraries to be for-profit. Why should we tolerate such a basic social institution as healthcare to be a source of easy pickings for greedy financiers who need to refurbish their yachts every year?  All of us, patients and caregivers, have been "had" and been reduced to mangey dogs scrapping over bones when the real feast is being eaten by execs of Cigna, United Health Care, etc.

by Verified1 on 03/03/2008 02:54:14 AM EST

[ Parent ]
Agreed (none / 0)

This position comes closest to how I feel about it.  I have been more and more asking myself why health insurance should be a for-profit business.  What happens to people who are ditched by the insurance companies?  They go to the government and we end up paying.  We also pay through higher premiums and higher charges in the hospital and doctor's offices to subsidize those who are unable to pay.  No matter how you slice it, we end up paying, so why should people be collecting profit off of it when it is always finally the public that has to pick up the tab?  We need an organization that allows people to share the risk across the board without skimming 30 percent for profit.

by bfaul on 03/03/2008 05:02:56 PM EST

[ Parent ]
You're Amusing. (none / 0)
Your blogger attack is immature and uncalled for. I did not claim that all doctors are negligent. However, you are extremely wrong when you claim that negligence is not a wide-spread problem in the medical field. You can make whatever argument you want. I've experienced it first hand, and so have countless friends and family members. In fact, I've put together documentaries about women who have been misdiagnosed when they have serious illnesses. I can put it up on the website if you'd like.

"Many doctors order way more tests than necessary."

That's absolute bull.

I don't know what hospital you go to, but the numerous ones I've been to in Los Angeles don't even want to give me a damn ultrasound when I feel a massive egg-sized lump in my breast. What's the harm in performing an ultrasound? Oh...that's right...THE COST! Negligence, greed, corruption...all the infections of the medical field.

So what would you term John Ritter's death if "negligence" doesn't tickle your fancy? Let's be real here...and put your medical bias aside.

I'm not making a claim that doctors are horrible people. In fact, they are incredible people who save lives on a daily basis. But you are plain wrong when you enter your fantasy world and make assumptions that negligence isn't a problem. Ignorance portrays a lack of knowledge. As someone in the medical field, I would argue YOU'RE the ignorant one if you can't wrap your mind around the downfalls in the medical field.

by AnaKasparian on 03/02/2008 11:06:43 PM EST

Personally (none / 0)

I would be interested in seeing the documentary.  I work in the medical field as well, and I think you guys both have some valid points.

by Spencer on 03/02/2008 11:14:34 PM EST

[ Parent ]
There are pros and cons (none / 0)
with regard to testing too much vs too little.  Without really thinking through all of the pros and cons, my gut reaction is that I'd rather be safe than sorry (or dead).

I know there are plenty of people out there that are terrified if they catch a simple cold.

But I can also say from experience that it can be incredibly difficult to get certain (expensive) tests or procedures done.  And insurance companies make you jump through so many god damn hoops...it's pathetic.  But that's a whole other topic.

PS---Does anyone have a link to that study Cenk referenced (can't remember when...within the last few months?) where a huge percentage of doctors said they woudn't report a fellow doctor that was negligent?

(Keep in mind I haven't heard the segment that sparked this thread so I can't completely weigh in here)

by ihavenobias on 03/02/2008 11:17:35 PM EST

[ Parent ]
It breaks my heart.... (none / 0)

...to find out that Ana doesn't have anything better to do on a Sunday night than I do.

Sigh............

by MedfordTim on 03/02/2008 11:49:37 PM EST

[ Parent ]
Ha! I love it. (none / 0)

She should be out listening to Deep Dish or something.

I hope she eventually got that lump checked out though. 

by Spencer on 03/02/2008 11:52:58 PM EST

[ Parent ]
Hey, hey, hey... (none / 0)
I'm human too ; ) Plus one of our favorite interns sent me an email linking me to this blog...

by AnaKasparian on 03/03/2008 01:58:06 AM EST

[ Parent ]
It's not actually absolute bull at all. (none / 0)
ND's health center gives notoriously poor health care, and yet every time you come in for a checkup just for a cold and a sore throat, you get tested for strep and sometimes meningitis.

Overtesting and overdiagnosis... aren't, perhaps.  I, for one, prefer it when those taking care of me medically leave no stone unturned, and I really haven't ever had an experience in the other direction, with one glaring exception: FDNY (New York Fire Department) EMTs back home.  I used to be an EMT and they drill this into your head during training:

Always get their name.
Always get their complaint.
Always get their vitals -- HR and resps.
Always strap them into the bed and NEVER allow them to ride in a chair.

The only thing these guys did was make me walk down about 100 steps from my apartment (after I'd lost consciousness twice and told both them and the 911 dispatcher so), get my name and get my insurance information.

by jarett on 03/03/2008 02:20:24 AM EST

[ Parent ]
You were wronged (none / 0)

I guess California medicine is different than where I practice. If you had been my patient, there is no way I would have ignored the lump in your breast. I would have told you that it is most likely a cyst, but that you needed a mammogram, ultrasound, and probably a cyst aspiration (taking out the fluid and sending it to look for infection or cancer).

So I agree that the doctors who would not order those tests for you, were wrong and yes, negligent, in my opinion. 

As for saying that my blog was uncalled for and immature, I must say that I felt the same way about your comments as I was listening to the post-game show last night. I just felt such hatred in your tone, that I felt I had to respond.

For all I know, the docs in Mr. Ritter's case may have been completely incompetent. But until you have seen the medical facts, you can't say that a physician is negligent.  

by pdowell on 03/03/2008 10:59:18 AM EST

[ Parent ]
I just saw this in another article (none / 0)
and thought it was interesting:

"98,000 Americans die annually from medical errors, caused by bad physician handwriting, incomplete charts, or other "low-tech" problems."

by ihavenobias on 03/03/2008 12:42:13 PM EST

that's funny (none / 0)

"bad handwriting"

 

At least when they do amputations they've figured out they should mark the foot with a marker. 

by schmoab on 03/03/2008 01:00:41 PM EST

[ Parent ]
aiggh (none / 0)
I really want to post on this thread, but it becomes too personal and nasty.  put me on the "sleighted by doctors" side.  then add my brother and mother who have both been nearly killed through negligence.

by mathcore on 03/03/2008 01:22:11 PM EST

[ Parent ]
Tom is my favorite defender. (none / 1)
You should be my lawyer.

by AnaKasparian on 03/03/2008 02:58:42 PM EST

[ Parent ]
Making Excuses... (none / 1)

for others mistakes in your field only makes you an accessory to those mistakes. Frankly, Ritter wasn't even close to the worst case, his condition was one of those tricky ones that becomes hard to diaganose without a mind numbing number of tests. However, so many other mistakes are unforgivable. Cancer is so easily diagnosed and treated in most cases that there is in reality no excuse, and yet so many cancer patients die, not from a lack of diagnosis but from an obvious mis-diagnosis.

I've heard many doctors complain that they are overworked. Well their nurses and techs are even more overworked and make far fewer mistakes than them, and yet make a pitiful fraction of a doctors salary. And all the doctor has to do is refer the patient to the correct set of techs or nurses.

So please stop your self-pitying excuses for others in your field. Take some responibility.

by Telrich on 03/03/2008 01:31:52 PM EST

Suit Incidence (none / 0)
Telrich, Agree there are too many mistakes. Who wouldn't agree that mistakes in healthcare are terrifying? However, many things are unavoidable and just as many lawsuits are settled because it is less expensive for a malpractice insurer to settle a case than to take it to court if there is any doubt whatsoever that the suit may be lost. Settlements happen very often and details are usually confidential as a condition of the settlement.
 
I appreciate your advocacy for nurses. You're correct - I work very, very hard and don't get paid that much. But I wholeheartedly support each of Dr. Dowell's arguments and replies. I would hope it is true that we in the nursing profession make fewer errors, but I don't have any stats to support that. My suspicion is that we make as many errors, but aren't sued as often for two reasons. One is what I mentioned in my previous post...our pockets aren't deep enough for personal injury lawyers to bother suing us. And two is that, because of the nature of nursing, and the amount of time we spend with our patients, we have in many cases developed a closer and more trusting relationship with our patients and are, therefore, less likely to develop the type of adversarial relationship that can prompt a lawsuit.

by Verified1 on 03/04/2008 04:36:00 AM EST

[ Parent ]
Ana, I have never heard such ignorant garbage... | 24 comments (24 topical, 0 hidden)
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