Friday, July 31, 2009

Our President, on Tonsillitis.

Obama made what, if he were Republican or white, would have been a HUGE GAFFE two days ago when he waxed poetic about tonsillitis and its treatment. He said that doctors, based on reimbursement for tonsillectomies versus reimbursement for treatment with antibiotics, often decide to do the tonsillectomy because it pays better.

IDIOT. The American College of Otolaryngologists issued a statement refuting this on sound medical principles that are well known for anyone within a howitzer shot of the medical game. Here is the Wall Street Journal opining on the gaffe, but here's the down low...

1. Obama is either lying or is a poorly informed, dangerous man.
2. Tonsillectomies are performed much more rarely today than 30 years ago.
3. The physician who refers you for tonsillectomy (usually a pediatrician) IS A DIFFERENT PHYSICIAN FROM THE ONE WHO DOES THE TONSILLECTOMY AND WILL NOT BE REIMBURSED AT ALL FOR THE PROCEDURE THEREFORE THERE IS NO MONETARY INDUCEMENT FOR THE PRIMARY PHYSICIAN TO CHOOSE THE PROCEDURE OVER TREATMENT WITH ANTIBIOTICS.
4. Surgeons in general over the last 30 years have gone from a 'heal with steel' mentality to a 'prove it to me with a scan' mentality before they will operate. Just the facts.
5. Obama here, is giving away his mentality, for he assumes that all people think as he does, in a completely mercenary fashion.
6. Obama is here accusing physicians of violating their Hippocratic Oath on a regular basis and for the worst of motives.

Why are none of you out there who are physicians MAD AS HELL, and why are you not SCREAMING FROM THE ROOFTOPS? Where are you AMA? Sold out didn't you? Gang? I think I know the answer, but I still believe that most of the answer is that you are silver-handcuff cowards.


23 comments:

  1. This is not related to your post at all, I am still so tired I doubt I could make sense of anything intelligent today, but I wanted to let you know I am home from the hospital. I wrote a quick post on my blog. And now I am going to sleep because apparently I lost a lot of blood in surgery and that makes people tired.

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  2. I wonder if the reason docs aren't publicly saying much is because they'd get in trouble from the AMA. I happened to have this very same conversation with my opthomologist yesterday, and he told me the AMA signed off on Obama's Ration Care Scam, but that individual docs are screaming, humping furious.

    Ironic considering there would probably be no need for the AMA anymore since they make their money off the coding - and there would be no more coding other than what Obama's henchmen dream up.

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  3. Medicare pays $233-$268 for a tonsillectomy depending on age and whether adenoids are also taken. This is the payment for the surgery as well as all f/u. You could do tonsillectomies all day and barely pay a typical offices overhead, let alone actually earn a living.

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  4. dear anon.,
    thank you for the info. not surprised. i mean, scraping the tonsils out of a patient is easy... what's the worst that could happen... a carptenter could do it... until he couldn't, and then there would be death, but death is not even bad anymore, i mean, we are getting ready to push our elderly off a cliff like so many lemmings and i think, if you were falling from a cliff, that if there were lots of other people falling that it wouldn't be that bad.

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  5. Wrong, wrong, wrong. Replace tonsils with ankle for this. It took many, I repeat MANY surgeon visits to finally find one who would perform an absolutely necessery hardware removal. The hardware is protruding through the skin so obviously a necessary procedure one would think, but no, no, no. Ive heard everything from the risks from anasthesia are to great (no history of an issue with anasthesia) to hardware NEVER comes out. Were O's theory correct, the first MD would have booked it.

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  6. Can I get a $4500 rebate on my new govt health insurance with lower premiums if I trade in an old person? You know, cash for clunkers--so old, inefficient and expensive to maintain compared to us younger folks. And do I get scrap value for granny in cash or is that applied to this year's deductible?

    --Karen

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  7. I think somebody needs the fifth case of strep in less than a year, with tonsils never going back to "normal" size and problems with apnea at night. Strep infections and tonsils probably aren't related. Sounds cosmetic, don't you think?

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  8. Everyone knows the real money's in sleep studies and Drug Rehab... In what other "Specialty" is a 28 day "Hospitalization" routine???
    And has anyone ever seen a NORMAL Sleep Study???

    Frank

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  9. Karen you are hilarious, thank you for that.

    Frank makes a good point.

    When was the last time you saw someone who stated they had a tonsiliectomy ? And don't get me going on strep, I really have never understood why a self limiting bacteria gets so much attention.

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  10. sleep study schedged for september.....cant wait to see what they get from the ins co.

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  11. c., 20 years ago, I insisted on having the screws removed from an ORIF and the surgeon finally relented (we knew each other). He took me into a training room, with no anesthesia, except for local xylocaine, and had a med student do the removal while we all chatted. She had terrible trouble getting a grip into the screw heads and getting enough torque on them, as I bled away and we all chatted.

    Eventually, the xylocaine was gone and I was feeling everything she did. Just OW! The doc? He said, "That's funny, I don't feel a thing!" Bastard! They got them out and I am glad we did it. However, the doc really thought this effort was unnecessary and, to this day, I still disagree.

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  12. Hope you're up and feeling better quick Radgirl!

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  13. The AMA and Wal-Mart are in the crib with the Obama admin. I'm convinced that Wal-Mart collapsed when Obama's goons said they wouldn't press for unionization of all Wal-Mart employees if Wal-Mart came out for obamacare.

    Extortion pure & simple. What's AMA's reason?

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  14. CJ - When I find an orthopod who has hardware and disagrees on removal I may listen to his/her reasoning. However, so far none of them have had hardware and everyone I know who has had a stabalizing plate installed, had it removed at some point. Granted, I am doing it at the earlist possible point because several of the screws are backing out but I would have done it anyway.

    There was an article in a medical journal about a guy in a socialized medicine country who wanted the surgery. As an elective procedure he was placed on a list to wait. During his wait he decided to take it upon himself to do the removal and took a packet knife, allen wrench and a needle and thread into the shower. He cut, got I believe 5 of the 6 screws out but the last one wouldnt budge so he ended up in the ER (ED - WC) then up to the OR for his much anticipated surgery.

    I cant imagine having a seven inch stabalizing plate and seven screws in my ankle for all of eternity. The pain alone is a constant reminder and the two sticking out of the skin are very attractive.

    There will be full on anasthesia Michael Jackson Style for this most auspicious occasion. Not only am I allergic to thesite of blood, the noise will send me into an anxiety induced tailspin. Youre a way better person for going local. Crazy, but perhaps better ;)

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  15. C, I'd stay away from the Michael Jackson anesthesia technique... Propofol doesn't have any analgesic properties, only amnestic..

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  16. Hey Frank,

    Answer me this....is the point of Propofol to induce amnesia so the patient doesnt remember anything during surgery? If so, what would be the point of MJ's usage? If he was insistant on using a anasthetic to sleep, isnt there a better choice?

    Oh, and my comment regarding MJ sleep, if it slipped away was merely sarcastic.

    Best,

    C.

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  17. I'm a docotor at a public hospital and I agree with you all here. A few points that most people but especially the politcians do not understand:

    The AMA does not represent even a majority of physicians. They have no power except as a lobbying group, but docs don't have to join nor do we have to follow their position - it's not like a union.

    Most surgeons/pediatricians I know do not practice unnecessary procedures. There is an incredible amount of scrutiny from the insurance companies, the government and the hospital administration to prevent this. There are significant penalties for any unnecessary procedures. Hospital administrators are NOT the doctors' friends - they are often at odds with what the medical team wants to do and how long to keep a patient.

    Not all physicians are paid directly from their billing. I and many of my colleagues are paid a flat salary and we do not see any direct payment from our billing so the idea of kickbacks and extra billing to line our pockets here is laughable and nearly impossible. Our billing is collected and kept by the hospital and medical school to support in part our salaries which while comfortable are well below our colleagues in private practice. in fact one of our residents just graduated and took a positon with a very busy private practice. His starting salary (which can be augmented by billing since it is a private group) is $10,000 more per year than my CURRENT salary after 14 years at the public hospital.

    So, yes, Obama either doesn't know or doesn't care to know the true complexities of the system.

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  18. Problem with salaried/hourly positions is you get paid less per patient the more patients you see... I know when I see 2 patients per shift I do better work than when its 32... What resident hasn't enjoyed that sweet feeling when you finish a call with only a few admissions and the guy taking over gets 8 in the first 10 minutes???

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  19. So the phrase 'heel with steel.' Most satisfactory.

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  20. I am so F-ing sick to death of hearing folks talk like Doctors commit atrocities to humanity every day in order to get to their T-time. I know some of my Docs don't play golf!

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  21. Obama claims the personal ethics of a doctor. He is going to fix an ailing society out of the goodness of his heart.

    He looks at doctors and is immediately suspicious. He believes that they have the ethics of a politician.

    Andrew_M_Garland
    EasyOpinions

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  22. Silly doctor
    Do you not realize that the referring doctor and the one who does the procedure are in cahoots?
    Clear as day to today's insightful conspiracy theorists-
    AMA no longer represents doctors the way AARP no longer represents the interests of seniors. The organizations carelessly let themselves be subsumed from within-

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