Thursday, June 21, 2007


Here is the future of medicine, 6 degrees of Kevin Bacon style:

1. Universal health care becomes law, is deemed a "right", and government becomes even more involved.

2. More people pour into the system, be it clinics or ED's, because it is "free", even though it really is already "free" to due unfunded federal mandates.

3. The increased govt. oversight leads to more paperwork, more QA bullshit, more pneumonia, CHF protocols, such that the actual number of patients that can be seen by each provider per hour or shift goes DOWN.

4. Fewer persons desire to spend a majority of their lives studying, training, and SUFFERING, to treat patients who consider them only a drone government worker who is obliged to see them no matter what, thus decreasing the pool of providers even further. I know if my children show an interest, they will quickly be steered in another direction.

5. The upper middle class and wealthy will continue to get excellent health care in a timely manner (which they should have the right to do), due to the exodus of the smart and financially savvy doctors going into "private practice" to see their own patients (ahh, the good old days). This is how it is in Great Britain. Trust me, I lived their for several months. The discrepancy in good care and "cattle care" is pretty profound.

6. This brings us to even more persons overloading an already burdened system, seeing providers who are disgruntled that they even chose this profession because they are doing more paperwork than medicine while govt. overseers are breathing down their necks. Imagine the post office line, but with people bleeding, vomiting, and sharing stories about their genital warts.
You get the picture.

7. Kevin Bacon (I had to end with him)

Before all you bleeding hearts say "You should do it for the love of it, etc etc ", this job sucks (ED work, shifts, nights, drunks) and most people DO do it for the desire to care for others, and also to provide a decent living for their families. At least in the beginning. But I am sure even Mother Teresa every now and then said to herself "Come on people, enough is enough." Well, maybe she didn't, but I am.


  1. where do i go to take care of rich people? i could be paris hilton's gynecologist but i'd have to find an extra large speculum.

  2. as you know i am a huge kevin bacon fan. 'animal house' was one of the funniest movies of all time, even in subtitles.

  3. 911doc: Never mind the speculum; just get the jaws of life. That might work.

  4. (Okay, I am falling out of my chair laughing at 911 doc's comment, hee hee!) Mr. Shrodingers Cat: (And everybody knew I'd bite on this one, right?)

    And here it is: Sir, You are correct in almost everything you said. (Especially when you said the job sucks---I am a diagnosed ER trauma nurse "burn-out" so I feel your pain...)


    BUT...sir, I think you are right EXCEPT for a couple small things.

    Which is...I don't think universal health would be a bad thing, because:

    1) I don't think universal health would be a system which would make things "worse"--- because I think there is a finite number of people right now who "abuse the system" currently in place.

    2) Also, I have faith in humanity and those "who would be doctors". There will still be doctors who do it because they want to, no matter the pay, no matter the frustrations, no matter the "vomiters" and those with "genital warts" (as you put it).

    3) Logic shows us that ANY system can be abused, no matter what. Free, not free, partial payments, whatever. There are always those who get around the loopholes. (Which takes us back to my number 1.)

    4) And about kids who are thinking of going into medicine but possibly being discouraged by the current system: It's like the Peace Corps. Many will STILL do it. And some will do it ESPECIALLY if it's a lower-paying, "noble" job. Some will simply do it in order to be the ones who cater to the rich people. I think we'll have the SAME number of docs we always have had....

    5) How do you know what Mother Theresa thought? I used to live in India. I heard (from Indians) that she thought this: "Oh, there's so many...I've got to work harder...")

    Feel free to disagree with me. Please know that I respect your opinions greatly and that I am not trying to start a brouhaha.

  5. There's a reason that Mother Teresa is in line for sainthood and that I will never be. It's that she could put up with all of it with out complaining, and I don't think that I necessarily will. She threw down her life in the service of the poor and sick and dying, expecting the repayment of Heaven. We're throwing down a couple hundred thousand bucks and expecting to break even and maybe even pay for our kid's to go to college.

    Completely different contexts, though she did make a vow of poverty to her employer (The Church), which is pretty much the same promise us soon-to-be physicians are looking at making to the US government...

  6. Agnes Gonxha Bojaxhiu (I refuse to call her 'Mother' Theresa) did what she did because of a belief in a mythical afterlife. Some of us don't believe in magic and the Easter Bunny.

    BRN, I believe that you have a basic misunderstanding about human nature: If I am shit on, disrespected, poorly paid, treated like a free care gov't worker - I'm simply not going to do it. Yes, I want to care for people, but I can certainly do it in other contexts besides a medical system that doesn't respond to basic human incentives.

    Altruism is not necessarily a good thing. It puts the altruistic in a position of weakness that basic human nature recognizes and will abuse. This is exactly what the gov't wants to do to Docs: "Hey, look, these guys will work even if we fuck them - let's get to the fucking!!!".

    12 years of training, terrible schedules, sacrificing free and family time and marginal pay won't cut it. Docs will 'cut and run'. And guess what, your reward won't be in Heaven - you will rot in the ground just like Agnes is doing now - so don't make that your motivation. It ceratainly isn't mine.

    JTP, MD (internal med doc)

  7. But Mr. (or Ms.) Anonymous:

    If you want to go down that road, is there ANY job in this world in which the recipients of services say "thank" you? And do any of us workers get a "thank you" from our employers, the government, IRS, or whatver? Do any of us get a ticker tape parade? NO, we don't. And we're not promised it when in school.

    I don't see librarians, teachers, rocket scientists, dentists, trash collectors, post deliverers, or ANYBODY getting thanked for their services.

    So, with your logic---why work at all? The only promise of "rewards" we have is Jesus' promise from the Bible that we'll get our reward in Heaven. But then, that belief requires belief in Jesus' saving of us on the Cross.

    Meeaning that such belief would require, as you say say, "sacrificing ourself for a myth"--- for nothing, according to you, since you don't "believe".

    Okay, I'm one who DOES believe in what you call the "myth".

    But, that said ...I don't do what I do simply because of that "promise" from God. I don't know why, but I think I do what I do for the love of my fellow man.

    So here's a big monkey wrench to throw into your philosphy: I enjoy helping others (patients) whether I get paid big by my employer or rewarded in the "afterlife"---whichever you want to call it, altruism or a "myth".

    I truly feel sympathy and compassion for the sick and downtrodden. I've been in their shoes myself, more than you could ever know. I love them and I will sit proudly with them in any ER waiting room, waiting for the ER doc who will come and sneer at us....

    P.S. What? There is no Easter Bunny? Dang. Please don't tell me that there's no Santa Clause....

  8. Sorry, No Santa Clause. Probably a Santa Claus, though, unless you meant the movie.

    You are obviously one of those 'self-sacrificers'. Great! Get ready to get abused because now I know you won't stand up for yourself. It's all in the name of 'patient care' and 'compassion', mind you. You may not realize it, but you are ruining the system by allowing yourself to be used and abused by your employers. Sad.

    I don't care about being 'thanked' - but I and 99.99% of humanity do respond to incentives. There are alot of ways to do good in this world besides medicine. I won't be guilted into providing care for free while a gov't pawn tells me how to practice. You don't hold a monopoly on compassion - I and alot of docs do it every day - but I AM willing to stand up for myself. Don't get sucked in by the philosophy of altruism - you will get stomped and noone gains from that.

    JTP (good call, I am a Ms.)

  9. (Well, dadgum. I hope Santa Claus doesn't remember that I spelled his name wrong at Christmas....I'm hoping for a laptop....)

    And Ms. JTP "anonymous": I'll admit it-- You are correct in everything that you say.

  10. I also lived in the UK for quite some time and had a fair amount of interaction with the NHS. I was impressed just because the care I would have gotten in the states at my uni was "cattle" medicine. It was great for a poor student in a foriegn country but you have some excellent points. I don't think America will ever adopt a system like the British simply because of the heterogenous and much larger and difficult to treat population of the US not to mention pharm companies that lobby to maintain the status quo.

  11. Dear Mr. Medical Serf,

    If the pharm companies in the US don't provide the new drugs to maintain the status quo, then the gummint can just step in and provide all those new drugs that you'll need in your future practice. It's not your sparkling personality that will be curing all your future patients!

    The FDA and the rest of the gummint will come up with all those new drugs, as soon as they start on that dang fence!

  12. If Hillary gets her way, private practice won't be legal, at least that was hte plan last time.

    Whoever is elected, within a generation I expect to see the better doctors building new hospitals in places like The Netherlands Dutch Antilles. Actually, I think the better medical schools will go too. Where else will they find anyone competent to teach?

  13. All good points and input. But it really comes down to the fact that whenever someone says "I'm from the government, and I'm here to help", run for the hills. This applies to medicine as well as just about everything else, except the military. Thank goodness for our men and women in uniform.

  14. So who's on first tonight? I'm sleepless in Podunk.....

  15. I'm not a demigod, but merely a lowly nurse who paid big money to work weekends, offshifts, and holidays. I work hard and have mounds of paperwork that seem endless. The paperwork takes me away from my patients more and more each day. And yes, I probably don't get paid as much as I should, and yes, the public at large calls me names, tries to takes swats at me, and yells at me because they are too afraid to yell at the doctors. Yes, I get angry, yes I get discouraged, and yes, I wish I could yell back. But then.... one patient, one soul looks up at me with eyes so meaningful, so full of thanks, so full of gratitude; a smile that could stop a battleship in it's tracks. And that........that one "smile," that one "thank you," that one look of "I'm so glad you are who you are," makes it all worthwhile. It makes it so much better than a paycheck....but I do like the paycheck too.

  16. If that is your opinion, how do you think people do it in Europe, where most healthcare is government-funded? Also, I have the feeling that people already are either looking at you as a drone/as customer service or on the other end of the spectrum, a money-sucking villain. Damned if you do...

  17. I am sure they some/most do view me and other ED docs that way, at least until we stick a chest tube in them to save their life. Amazing how views change then. As far as the money, I make no apologies for any of the money I make. Hell, even if they doubled my salary, I still wouldn't think it was enough, based on the sacrifice of time/study/time away from family/ working nights/shortening life span due to rotating shift work... I could go on. But at this point I'll just continue to stamp out disease and retire as early as financially possible. As for the Europeans, obviously the French have that emergency transport thing down. Just ask Lady Diana.