More pontification than a 15 minute office visit
John Goodman had a nice blog post today. I typically enjoy reading his stuff and recommend it to my readers.
After reading his post linked to above, particularly the very last paragraph just above his signature, take a look at this MSNBC story.
Cheers,
…Sam
A while back I wrote a series of posts about health care reform and in one I mentioned the system in Singapore as one which we in the U.S. should look at as a good model to work from when considering ways to improve our own.
Well, today the Happy Hospitalist has a post which links to another article about the system they have in Singapore.
Give it a read and tell me what you think.
Today, I’d like to touch upon a subject that I think in some way affects us all. I’m talking about the continually unfolding disaster of substance abuse in this country.
As a physician, I see the effects of drug addiction and abuse on pretty much a daily basis. There is hardly a day goes by that I don’t have at least one person either come in to the clinic or call my nurse demanding I write a prescription for their favorite controlled substance. I typically politely decline.
The problem is certainly not confined to prescription medications either. Currently the big problem in this neck of the woods seems to be related to methamphetamine, though crack coccaine is pretty big around here too. None of this is meant to ignore other substances.
After a while, you sort of get a sixth sense about these folks and can usually spot them pretty easily. A lot of times, I can spot them before I even see them, simply from what is written in the chart, what their presenting complaint is and how it is worded.
The E.R. docs have an even greater exposure to this stuff than I do as a family medicine doc.
It doesn’t take long for most folks in the medical profession to become somewhat cynical towards these patients. Hang out with some doctors or nurses long enough and you’re almost certain to hear them complain about their latest drug-seeker, or that disruptive crack-head they saw the other day, etc.
I’m not immune to this either. The fact of the matter is that a lot of these patients genuinely are a disruptive pain-in-the-asses. They usually take up an inordinate amount of time trying to convince you to do something you’ve already told them you won’t. They are often quite rude, and often use foul, abusive, and occassionally threatening language.
It’s not hard to lose sight of the fact that in spite of all this, they are still people. Most of them have family who love them and are worried about them. Most of them have dreams and aspirations. Most of them did not spend their early childhood dreaming of someday being an addict.
I’m not some touchy-feely left-wing pansy trying to make excuses for them or condone their behavior. What they are doing is wrong. They need to stop. They need help. Unfortunately, they are not usually too interested in receiving any help. They usually just want that next hook-up.
What got me going on this subject today was something I read from a member of another internet forum I sometimes visit. The guy posting this put a different light on the addict than what we usually see.
His is a story that I felt should be shared. I asked his permission to post it here and he kindly gave it.
Here goes.
“ Truthfully, I do have some sympathy towards addicts. my only experience with a crackhead/crackwhore.. My ex-wife’s younger sister, she was 16 or 17 at the time, and my ex wasn’t my ex yet.
Sis was dating a slightly older guy, seemed pretty nice. Parents were parents, they weren’t pleased that she was dating, but that’s what having a daughter is all about. When they met him, he said all the right things.
A little dating, a little experimentation with drugs (pot, ecstasy) apparently resulted in her to going to a party with him and people that she didn’t know. He got her high, and then gave a her a little crack. Over the next few weeks, he gave her a little more and a little more. just led her down the trail to addiction. all free, nobody suspected a thing.
She got hooked, then he wanted her to pay for her habit. She emptied her piggy bank, she emptied her bank account, not enough. Small things disappeared around the in-laws house. They didn’t notice.
They noticed her change in behavior, she was irritable (okay, more irritable), she was defensive, she wasn’t home. They didn’t know yet that she quit her job. Joe Blow kept giving her crack (discounted prices). She was hooked.
She stole more, she gave away her car, parents reacted wrongly (tried to confine her to house, gated community), and then they kicked her out. Instantly regretted that, but then they couldn’t find her to bring her back and get her proper help. They didn’t yet realize what was going on, just attributed it to her going through some rebellious stage.
She had no more money, she had no access to money. Joe Blow became her pusher and her pimp. all of this in less than a month.
Parents found her, brought her home, tried to get her help. a week or two later, she emptied mom’s very expensive jewelry case (after breaking into a locked room) and disappeared again.
Two weeks later they found her again, , in this short period of time she went from a beautiful young woman to an emaciated, much older looking, worn-out person.
This time, they put her in a program, in a home.
I was there to see their anguish throughout the entire ordeal. I helped them search the streets, try to keep her company when she was home, visit her in the rehab center. She did manage to overcome her addiction, but afterwards she was devestated.
She knew what she had done, the whole family needed counselling (but they didn’t get it, which was surprising to me). The last that I heard from her, she had her life back under control and was going to college. But she was scared about how she’d react in new situations with less help. She did join NA and hopefully everything has gone well for her since.
So, I can feel sympathy for addicts. Sis and her family had everything, loving, close-knit family, very secure financially, and this still happened, and was hard as hell to reverse..”
Okay, I promised to address the 800 pound gorilla , known as the broken medical liability system in this post.
Regardless of what all the parasites who are currently getting fat off the current system will try to tell you, the civil liability system in this country is a disaster.
Anyone with half a brain and a lawnmower can see this.
A lawnmower?
Yep.
Okay, if you read Part 5 of this series outlining what I affectionately call The Dr. Sam Plan, you know that I promised to offer a quick blurb here in Part 6 about what I envision as a meaningful way to deal with the 800 pound gorilla, known as the medical liability crisis.
I’ll have to do that in Part 7 instead.
First however, I need to offer a brief little addendum to Part 5.
Continue reading ‘A Plan For Intelligent Health Care Reform Part 6′
To recap parts 1-4, so far in this little series, I’ve just been laying some groundwork, pontificating sort of non-specifically about where I think the main problems lie with our health care system and where I think the direction of reform should go.
In a nutshell, I think the major problems boil down to a whole lot of interference with the traditional doctor-patient relationship from outside forces such as third party payers (government and insurance), bureaucratic regulating bodies, a civil liability system that seems to have been designed by Jackie Chiles, and other outside industries such as the pharmaceutical industry, compliance industries etc.
I have compared our health care system with our veterinary health care system and made the contention that the veterinary system is vastly superior in many areas primarily due to a relative lack of such interferences. I contend that it is because veterinarians operate in a nearly free market system where the relationship between the veterinarian and the patient/owner is a direct one, without third party payers or as much government, corporate, or civil liability interference and fears, veterinarians are much more responsive to the needs and demands of their clients and clients are much more responsible with the money when it is coming out of their own pocket. They are much less apt to make needless visits to the ER and demand expensive tests and medications when there is not some nebulous third party footing the bill.
I have also mentioned that within this relative laissez-faire environment there are also some problems that become apparent in the form of people’s too frequent inability or unwillingness to pursue appropriate medical intervention due to financial considerations.
With this post I intend to finally start delving in with some ideas for bringing all this stuff together to try to come up with some solutions for creating a plan for intelligent health care reform. Continue reading ‘A Plan for Intelligent Health Care Reform Part 5′
Okay folks, in part 3 of this series on my plan for intelligent health care reform, I promised to try and keep this 4th post a bit shorter. I will endeavour to do that.
Up till now, I’ve been basically pointing out problems with our health care system, and also ranting about all the horrible plans and ideas being floated out there in the mainstream media and political land to “fix” them.
Not to sound like a broken record, but if you haven’t read parts 1-3 in this series, please do so now so this one will make a bit more sense and be read in context.
Anyway, to bring folks up to speed since it’s been almost a week since my last post, this whole series owes it’s life to an editorial I read in the Journal of Family Practice in which the editor, Jeff Susman, outlines his pleasurable experience with taking his dog to the veterinarian.
Continue reading ‘A Plan for Intelligent Health Care Reform Part 4′
If you haven’t read A Plan for Intelligent Health Care Reform Part 1 and Part 2 yet, please read them first, before proceeding with this post.
Sorry for the delay in getting this 3rd post up folks. The blame for that lays partly with a surge in activity in my off-line life concomitant with my fighting a nasty cold. (Also, I’ve recently been helping my friend get her website and blog about bargain wine reviews up and running. Go check it out if you get a minute. She’s got a pretty nice site I think.)
This stupid virus and my busy life only receive part of the blame however, as the bulk of the reason for my delay boils down to simple inertia on my part. When trying to piece together this third post in my mind, I have quite frankly been a bit overwhelmed by the complexity.
Continue reading ‘A Plan For Intelligent Health Care Reform Part 3′
Okay, as promised in yesterdays post, A Plan For Intelligent Health Care Reform Part 1, today’s post will basically just be a cut and paste of the letter I sent to Dr. Susman in response to his editorial entitled, “What if it’s cancer?”. If you havent read the editorial, please do so before reading my letter below, as things will make a bit more sense that way.
Continue reading ‘A Plan For Intelligent Health Care Reform Part 2′
Like most physicians, I’m usually a fairly busy fella. That’s one of the big reasons that this blog is typically only updated a couple times a week, rather than daily (or even more frequently), like a lot of blogs.
When I’m not in the clinic seeing patients, or trying to navigate through the massive bureaucracy associated with that, I try to read the latest professional journals to keep up with the latest research etc., so I can practice the best medicine I can.
This past weekend was one of those moments and I sat down to read the latest issue of the Journal of Family Practice. I often like to read the editorials and letters to sort of get a feel for how others in the profession are thinking.
So, what does that have to do with health care reform?
Well, the editorial in this latest Journal was of particular interest to me, and in it I think I see the makings of a plan for intelligent health care reform for the U.S.
Continue reading ‘A Plan For Intelligent Health Care Reform Part 1.’
So, as I’m surfing the web earlier today, I happened upon the “Health & Healing” discussion forum at www.craigslist.com, which is basically a typical fun Internet free for all.
Lots of folks with lots of opinions on there.
Anyway, I came across one post from a user going by the name of “dlwhiz” that expressed the following.
“I need to find natural cures for high blood pressure. Anyone have a cure, pills are not working, they make me sick.”
There was of course a plethora of answers from all sorts of folks. These anonymous Internet posters offered all sorts of advice basically ranging from “Quit being so lazy, get some exercise!” to “Use some different medicines” to “Try these great herbal remedies!” (I’m paraphrasing here to capture the general tone of most of the posts…these aren’t actual verbatim quotes)
Some of the answers I read were better than others, but most of them had one glaringly huge flaw, one which as a physician I saw immediately and which I think most physicians would similarly pick up on immediately.
What was this horrible flaw?
Okay, the following is a totally political rant. If you aren’t interested in a bunch of political ranting about socialized medicine, or the problems with Medicare funding, etc, (which, by the way is probably indicative of sanity and common sense on your part) then you should probably skip this post as it will most likely just irritate you. There is nothing in it that is informative about any particular medical topic or anything. It is not categorized under the “How to stay healthy” or “Silly Fun Stuff” categories for a reason. Disclaimer over with now. If you read further, don’t say you weren’t warned.
