Wednesday, July 01, 2009

Douche of the Month: A Continuing Series from MDOD

If you are a physician, you have probably read or heard about Dr. Atul Gawande’s New Yorker article concerning the escalating costs in medicine. This man has Obama’s ear and was a senior health policy advisor to the Clintons when they did such a great job with health care, so pay attention - here is a quick summary for those who have not read it:

Dr. G. visited the Texas town of McAllen to find out why it has the highest expenditure per Medicare patient in the country. After his visit, he concludes that certain doctors in McAllen are overutilizing services because of a profit motive; he makes a convincing argument that more procedures are performed and more tests are done because certain doctors treat patients like profit centers. He compares this model to the Mayo Clinic, a low Medicare expenditure hospital, which he characterizes as ‘patient centered’ and an institution that utilizes a ‘collaborative’ approach to care. Finally, he generalizes these lessons to medicine as a whole: Entrepreneurial physicians are bad; collaboration and holding hands while singing about world peace is good.

Read the article. It takes about 15 minutes. He is a good writer and he makes a compelling case. All that said, I think he is a douchebag. Read on:

First: why are physicians talking about this article so intently? Well, my observation is that there is a large cohort of MDs who are real self-flagellators. For example, they actually are upset that a physician organization will look after the financial interests of doctors as a primary goal. Yes, there should be (and there are) doctor groups that have patient care, education, medical research etc. as primary focuses. But to actively oppose an organization that supports your financial interests points to an underlying psychopathology that was likely acquired at UC Berkeley and a guilt complex that would make the Catholic Church proud. Outright greed and patient ‘churning’ for cash is obviously bad; trying to build a financially successful medical business, to me, seems like a good thing. The Physician Guilt / Self-Hatred Complex compels these docs to confuse and equate these two very different things.

That brings me to Dr. Gawande - his CV reads like something any baby-boomer parent would jerk-off into a bowl of corn flakes over: Associate Professor of surgery at Harvard, a graduate of Oxford and Stanford with an M.D. from Harvard Medical School. Unfortunately, even the most impressive credentials do not stop one from being a douche-tard. How could this over-educated scientist make such a basic mistake: extrapolating a general conclusion via analysis of the outlier. That is, by focusing on the single most extreme example of Medicare overuse (McAllen, TX), where it is clear something rotten is going on, and then concluding that this somehow identifies the problem as a whole is just illogical idiocy. That brings me to my next point:

In life there are a few simple rules: 1. no ass-to-mouth; 2. you’ve got to fight for your right to party; and 3. when writing an article in a major print publication, do not use some lame personal anecdote related to your fucking kid falling down the stairs, going to the ER with a subdural hematoma, getting a CT scan, staying overnight, getting another CT in the morning, then concluding that this provides an excellent example of overutilization of CT scans because the kid lived. Tape these rules to your fridge so your children will read and live by them. Listen, dummy, if your experience had been that the second CT had provided evidence that the hemorrhage had progressed and your child’s life was saved because of “overutilization” would you draw the same conclusion? Uh, like, I don’t, like, think so, and, oh yeah, you can overutilize my teabag on your face, genius.

Lastly, like Jesus said “Those who live in glass houses should not throw stones at a prostitute, unless they have a lot of loaves and fishes”, or something like that. Gawande throws these stones from his glass temple at Harvard: for example, getting your gallbladder taken out at a Harvard hospital costs roughly DOUBLE what it costs in the community, with no differences in quality of outcomes. Yeah, that’s right: at Atul’s hospital, procedures are much more expensive, with no quality differences… why? You ask. Well, it’s because the Harvard hospitals (“non-profit” hospitals, by the way) act like a monopoly and force insurers to pay much more than they do elsewhere. So guess what, Atul the Fool: maybe you should point the finger at yourself and stop suckling at the teat of your predatory employer.

Hear my warning: this is the man who will make broad health policy decisions under this administration. I have said enough. I rock. Etothepi out.


  1. For a counter example, see Natasha Richardson.

    Nicely written. And, I'm not setting my bowl of cornflakes down ever again.

  2. By the way, I may have asked this before, but I think my memory is going. What is "evidence-based medicine"? I don't know why, but it makes me suspicious.

  3. Peggy: Evidence-based medicine = doctors making medical decisions based on which treatments have been shown to be most effective based on the evidence available, i.e. clinical studies.
    I learned this from a veterinarian I was dating. He had a rescued bulldog with one leg. He named her Peg. Really.

  4. Thanks! That sounded like some Obamacare term. I'm sure that was a very fine dog, btw. :)

  5. Burn...nicely put E. Maybe you should put that in an editorial for the NY Times. It'll never see the light of day but at least it'll ruin their morning.

  6. *swoon*

    Healthcare reform, ass-to-mouth, teabags, and parables all together in one post?

    Genius. Pure genius.

  7. "Evidence-based medicine = doctors making medical decisions based on which treatments have been shown to be most effective..."

    So long intuition and creativity.

  8. Actually, I think evidence-based medicine is a safer bet, as I wouldn't want anyone getting all creative with my chemotherapy dosage or spinal surgery procedures.

  9. I remember a nurse I worked with who had a beautiful little girl with a Wilm's tumour. At the time the very upscale hospital were we worked treated these tumours with chemo. At the local "children's" hospital they were trying a new approach: surgical excision. The mom decided to stick with the "best practice" of chemo. That little girl suffered incredible side effects, and the outcome was not good. To this day surgical excision has led to an over 90% cure rate, and is the new "best practice."

    Innovation comes from creativity and intuition; new drugs are found this way as well.

    Safer is not always better

  10. F*ck yeah this guy is a douche over douche toast, sweet mercy what a retard, but I don't think he has Obama's ear. Congresses ear, yes, those bastards won't shut up about him, but I haven't heard Obamessaih use his name yet. Have you?
    As much as I disagree fiscally with the big O's policies; the guy loves America, and is not mentally retarded.

  11. This man has Obama’s ear

    That's a handful.

  12. Great post. Now with Minnajackoffsota putting Stuart Smalley in as a fillabuster proof vote (what is it with that dip shit state? First the terrorist, now this jack ass. I will never set foot in the land of a thousand fags) they will likely cram this down our throats, without consideration of the 84.5% of Americans with insurance. That's what the statist does. Takes a problem affecting a few, (if there is a problem) magnifies it, emotionalizes it, appeals to the activist, COMMUNITY ORGANIZER, or college kid, all with time on their hands, and leaves the rest to Katie fucking Couric to transmit it to the masses (read those who still watch the news) and eventually get them to believe that something NEEDS to be done NOW, and that GOVT is the one to do it. Unemployment under FDR was over 25% 7 YEARS into the great depression, yet the people kept eating the shit he was feeding them. Looks like we're still hungry for shit in America.

  13. "fags" in the previous post is used as a pejorative, not a direct slight to all the g & l readers of M.D.O.D.. However, due to political correctness there are almost no words that can be used anymore to describe aa large group or really stupid people without offending someone, so that one was chosen.

  14. Nightingale: A point well-taken. I think evidence and intuition both play their roles.

  15. There will be no place for intuition under a government plan.

  16. O loves America and isn't mentally retarded? What the fuck have you been smoking?

    Puff, puff and pass that shit to the Proffy, son.

  17. LOL! True. Won't salute a flag, bashes the country when he goes abroad, cozies up to thugs, has a domestic terrorist write his first book ... where exactly do you see the "love"? I'm not feeling it.

  18. Arthur Kling at EconLog.EconLib writes well on this:
    [edited] Political Economy is the science of obtaining and retaining power. The pollster, the fundraiser, and the media expert supply expertise to the operation. The public policy expert is for decoration. If you want to be an economic policy adviser, my advice is to learn how to put a good spin on the methods used by leading politicians to obtain power.

    Suppose you believe that regulators cannot possibly have the wisdom to direct human activity, and that politicians spending other people's money tend to choose unwisely. Keep those beliefs to yourself, if you want to get anywhere as a public policy adviser.

  19. Happy Independence Day!

    (And to you who work in the ER, I hope it is a quiet one!)

  20. "Won't salute a flag, bashes the country when he goes abroad, cozies up to thugs, has a domestic terrorist write his first book ..."

    Ugh. I just threw up a little in my mouth. Please watch less Fox News and help financial republicanism become exponentially more electable by never talking ever.

  21. Go ahead and do a projectile vomit. I own a gun and a Bible.

  22. What does owning a Bible have to do with any of this? By Old Testament standards, would you, PeggyU, have to be stoned to death for talking back ? Or do you just pick and choose what fits to your life?

    I don't like religion mixed in with my politics. Or medicine for that matter. Keep writin' like this, E. Loved every sentence. But the ass to mouth was a little rough.

  23. Alex Chesbro: Yeah, I probably would have managed to get myself stoned by now. I'm grateful to live where it isn't likely to happen. :) The reason I dragged that in there was because of the reaction to what I had said before. It seems I have just been labeled a reactionary (You know, Bible hugging and gun toting - isn't that the stereotype?) redneck. Maybe to some extent I am. It was assumed I watch Fox News.

    I believe, based on his history and recent actions, that Obama is a self serving politician who does not have the best interests of America at heart. Criticizing him is detrimental to republicanism? How?

    I actually don't watch Fox News (or much television at all, for that matter). I also don't know how you can neatly partition "religion" and politics or medicine. I doubt all of your patients do.

  24. PeggyU:

    What politician ISN'T self-serving? Do any of them have the best interests of America at heart, or only their/their party's version or view of America? I consider myself a Republican. But the GOP these days is fuckin' ridiculous. Pardon my language, but I can't say it any other way. I think criticism of any President, or anyone, is what makes this nation great, and can also bring about change. But it can't be done in the...way that it's been done in the recent past (no specifics, no worries).

    I do watch Fox News. For comedic reasons, actually..Bill O and Glenn Beck are hilarious. And Shep Smith is my favorite news anchor of these days ('we don't fucking torture' solidified my reason). But I usually include "beer-swilling" and "wifebeater-wearing" into my stereotypes of Rednecks, and the Union Jack usually flies over their house. But that's just me (the South WILL rise again {ha]).

    I also partition those things, because it's easier when you don't have to worry about a superstition -a grandfatherly santa figure in the clouds, hearing everyone, but answering no one- you can concentrate on the things that really matter.

    And I'm not a MD. I'm a copywriter in advertising. Sorry for always being long-winded, but this is one of the few blogs where people actually READ comments. So amazing.

    And Peggy...keep on truckin'. I always say (from those who've come before me)...I may not agree with what you say, but I'll fight to the death for your right to say it (as long as it doesn't affect anyone else's rights...and as long as those rights aren't retarded in themselves....friggin' PC this and PC that).

  25. Alex: Up until recently, I have not had such a visceral reaction to politicians. I think it is a combination of the current political players, recent events, and the slow growing perception that all aspects of our lives have become more government regulated.

    I've never been that interested in politics until I started really realizing that while I'm at work earning money to raise my family ... these people are busy deciding how much I can keep and what I can spend it on. The current president and most of our "representatives" horrify me. You look at the things they have done, and you wouldn't trust them to housesit, or to watch your kids or your wallet. And yet they direct the course of our lives.

    So you get out and vote and you try to get others to be aware of issues and be active in contacting their congresspeople. You think about running for an office yourself, because you have a vision of what it means to serve while useful, then step down ... but reality sinks in and you know that you can't afford to do it because you have a family to support. Besides, you're not that good at that sort of thing and your efforts would be better applied behind someone who has those leadership qualities. That's where you also realize that those people are very few and far between. The people you would like to see assume this mantle of responsibility ... is it fair to ask them to give up their livelihoods and their family time to fill the void?

    I would agree with you that the majority of politicians are self serving, and that this is no surprise. You have to put your ambitions ahead of everything else in order to secure a position. Republican or Democrat is really almost a nonissue. Look at the authors of this health bill, for example ... they're from all over the place, and this bill stinks. Just sit and think about the ramifications of this for a few minutes, and you just want to tear your hair out.

  26. eto',
    balls out post.

    dear alex,
    you seem confused.

  27. Alex, I enjoy a stereotype as much as the next guy. When that one guy in who actually fits it passes me by, I get a good laugh.

    I live in the heart of "redneck-ville", and you can have my gun and Bible when they're pried from my cold dead hands.

    I love Fox News because it's in the best interests of my blood pressure and my TV set. I know the news, and I can get the facts anywhere. I chose the editorial slant I prefer to hear. I believe that Fox does a better job of presenting the Left's argument than the other mainstream media sources do of presenting the Right's.

    As for flags.....I've seen only two Union Jacks flying within a 100 mile radius of my home. One is flying over an antique store, and the other flys over a golf course.

    If you meant the "Stars & Bars" or the "Confederate Battle Flag", you'll see a few of those but it isn't as common as Hollywood and non-Southerners would like for you to believe.

    If you and I went for a day of driving, we'd be lucky to find 25 such flags IF we were looking. I know only ONE person who displays the flag, and that person does so for reasons of Southern Pride. He has no racial intent (no matter what the "PC Police" which you decry would have you believe).

    The South rise again? I personally think it's an excellent idea. It's not that I'm not patriotic. It's not that I don't love the USA. It's that I see the USA evolving into a form of Government that I (and most Southerners) do not like. We don't like Washington trying to micro-Nanny-manage our lives and the lives of those around us. I generalize, of course. But as my kids would say (before I backhand them for speaking like this...) "I knows my peeps".

    There's always talk of Texas Secession. The arguments are based on Texas joining the Union by treaty as an independent nation. Right now, it sounds far-fetched, as does "The South will Rise Again", but I can't help but wonder what will happen if the Northeastern part & Pacific Coasts of the country continue to drag us to the left. Either the pendulum will swing back toward the right, or there will be a breaking point somewhere beyond which folks will no longer tolerate.

    The divisions in our country are very deep right now. As these divisions deepened under Bush ("the great uniter"), they are growing exponentially wider under Obama's promised healing of these divisions. I wonder if these divisions are as deep as any time since the Civil War?

    Just food for thought.

    Also, I can live with your stereotype of Southerners, but please include our willingness to help others, our friendly open disposition (usually), our fierce self-reliance, and our unwavering loyalty to our friends.

    I don't know what a copywriter is, but please try not to be so long-winded next time. I need all of the band width for my short, succinct posts!