MG came yesterday. She has some very odd ideas about what I've done for her. I admit that I have given her some good medical care. It has helped her. We've improved the quality of her life. She had great pain which we reduced, even after other physicians weren't able to. But my care wasn't extraordinary. I'm happy with it it. But it isn't one of the cases where I am so proud of how well I did from a medical standpoint. However, she has great gratitude. She thinks I have done great things for her.
We were discussing a new machine one of my colleagues has which I think is fantastic. I would love to have one, but it's beyond my reach. It's not a machine that we get reimbursed for. It absolutely should be. However, in the infinite medicare wisdom it's considered part of taking routine blood pressure (it's actually far from it). I was very shocked when she offered to split the cost with me.
I run a for-profit medical practice. Donations for non-profit medical clinics and hospitals are common. But donations for my practice are unheard of. Donations for any practice, I think, are unheard of. I've gotten some thank-you cards from time to time. I've even gotten a few little gifts from time to time. It's wonderful to know that some patients appreciate what I do.
Of course, I appreciate what I do. Even if no one ever said "Thank-you" this would be a good thing to do. That is because it is a great process. Actually, it's sort of a privilege to be able to do it. It's challenging, of course. But it's a good thing to do. It's a good endeavor. One can see directly how the work you're doing helps people. And there are times when you save lives and times when you do great things like make people in wheelchairs walk again. It's not an every day thing, but it's so much fun when you're a part of that.
This business of someone offering to help me buy a machine for the practice is entirely overwhelming. I'm not even sure I remember what I said. My wife asked me "What did you say?" I can't honestly say I know. Patients are surprising sometimes. People are nice. I like people. I like being a doctor. Sometimes the patients can give you strength in the face of what may seem like overwhelming challenges. It's actually a very rare day that I don't have at least a few patients who are grateful for their care and tell me. On the other hand, it's an extremely rare day (so far about once every fifteen years) that a patient offers to help me buy a machine that I can't afford!
Thursday, July 17, 2008
Tuesday, July 15, 2008
Sick Monday
It was a sick Monday. M who actually is doing fairly well told me that his wife had died. I didn't know it. She had been a patient of mine for about five years or so. She had severe spinal stenosis and back pain. She died from a stroke. He's very depressed about this. It's made his tremors worse. That's a tough patient. Dying isn't easy for families. It would be nice if there were a way to make people feel better, but there isn't.
Then AB came in with a new diagnosis of brain tumor. It's not a metastasis, it's a primary brain tumor: a "glioma". That's tough because he's going to die pretty soon. Probably in a couple of months. He's going to have progressive weakness and thinking trouble. The weakness is on the left side. It started about one month ago.
PF was also here. She has diabetes with such severe neuropathy (she's had it thirty years) that she can't walk anymore. She can't even transfer in and out of the wheelchair. I was hoping she had developed some treatable neuropathy issue, which happens. So she came in for nerve testing, but that's not what happened. So she just can't get herself in and out of the chair now.
And CM was a patient with a new diagnosis of Alzheimer's.
Some days there are just too many sick patients. It's an excess sickness load. It can make a doctor feel tired. The curious thing is that if I do a great job and someone is totally cured, I never see them again. Of course, it isn't me as much as the illness that people get. There are days when rare things happen. Rare things have to happen sometimes. They aren't often, but they can't be never either. Otherwise, rare things would never happen and they wouldn't be rare things. So there have to be rare days when there are "too many sick people". Of course, everyone I see is basically see is sick. Every once in a while I have a patient who comes in and says "I feel great. I don't know why I'm here I almost cancelled this appointment." But this isn't something that is frequent. I guess most of the patients who feel this way cancel their appointments.
So what's so good about the "too sick days"? I suppose they test my strength and build my character. But they are a reminder to make sure you stay honest. It's always possible for the diseases to get the best of us. You need to respect that things aren't always easy. It's not good to get into a "groove". If you aren't shaking it up, then something will come around to help you with the shaking. Shaking is an important piece of living. Otherwise, it's boring. That's why some people go out and climb up mountains. I think being a doctor is better so I don't climb up mountains. Besides, I'm not a fan of great heights.
Then AB came in with a new diagnosis of brain tumor. It's not a metastasis, it's a primary brain tumor: a "glioma". That's tough because he's going to die pretty soon. Probably in a couple of months. He's going to have progressive weakness and thinking trouble. The weakness is on the left side. It started about one month ago.
PF was also here. She has diabetes with such severe neuropathy (she's had it thirty years) that she can't walk anymore. She can't even transfer in and out of the wheelchair. I was hoping she had developed some treatable neuropathy issue, which happens. So she came in for nerve testing, but that's not what happened. So she just can't get herself in and out of the chair now.
And CM was a patient with a new diagnosis of Alzheimer's.
Some days there are just too many sick patients. It's an excess sickness load. It can make a doctor feel tired. The curious thing is that if I do a great job and someone is totally cured, I never see them again. Of course, it isn't me as much as the illness that people get. There are days when rare things happen. Rare things have to happen sometimes. They aren't often, but they can't be never either. Otherwise, rare things would never happen and they wouldn't be rare things. So there have to be rare days when there are "too many sick people". Of course, everyone I see is basically see is sick. Every once in a while I have a patient who comes in and says "I feel great. I don't know why I'm here I almost cancelled this appointment." But this isn't something that is frequent. I guess most of the patients who feel this way cancel their appointments.
So what's so good about the "too sick days"? I suppose they test my strength and build my character. But they are a reminder to make sure you stay honest. It's always possible for the diseases to get the best of us. You need to respect that things aren't always easy. It's not good to get into a "groove". If you aren't shaking it up, then something will come around to help you with the shaking. Shaking is an important piece of living. Otherwise, it's boring. That's why some people go out and climb up mountains. I think being a doctor is better so I don't climb up mountains. Besides, I'm not a fan of great heights.
Thursday, July 10, 2008
medicare - again
Yesterday the Senate passed legislation to prevent a decrease in medicare payments of 10.6% for physicians. A 10.6% decrease in PAYMENTS for my practice (overhead of 60% - which is fairly typical) would translate to a 75% loss in income.
The fight was between primarily Republicans backing the private insurance companies that handle medicare contracts (Medicare Advantage) and doctors (AMA). This time, AARP joined with the AMA because they were concerned about the possibility of decreased physician access.
I know two Internists who were going to stop taking new medicare patients (and still may) -- IN THIS TOWN! Others are considering retirement. Some are considering moving. I know many physicians who work in non-medicare saturated "markets" who already refuse to take medicare. The Mayo Clinic in Jacksonville doesn't take medicare.
Senator Kennedy showed up to vote for the doctors with a brain tumor. Nine republicans (including our not so illustrious Martinez) changed their votes due to too much voter pressure. Bush has vowed to veto this bill to protect his Insurance company friends. (Senator Frish as everyone remembers never had any conflict of interest despite the fact that his family owns Columbia health care).
Things are really getting out of hand. There is a major health insurance crisis here. Right now, the doctors are suffering. I know Internists working 80 hours per week making $125,000. That's a lot of money. Still, it's $62,000/job (they're working two full jobs). A medicare follow up visit charge of moderate complexity is $80 while cleaning the dryer vent is $90. Pretty soon medicare patients are going to start to suffer. A 25% pay cut to these friends of mine would have meant that they were supposed to be paid $46,000 for a full time (40 hours/week) job. I suspect doctors would be leaving in droves under those circumstances. They would have to if they have families.
In January 2010, doctors are now "scheduled" for a 20% cut in pay, and this fight is going to played out all over again. We have had no raises and several "small" cuts (one was 5%) over the past decade while costs just keep going up. People are either retiring, leaving medicare, or looking for other work.
It's time for people to start fighting against the insurance companies. We should have seen this when they refused to pay for the damage that was done during hurricane Katrina.
The fight was between primarily Republicans backing the private insurance companies that handle medicare contracts (Medicare Advantage) and doctors (AMA). This time, AARP joined with the AMA because they were concerned about the possibility of decreased physician access.
I know two Internists who were going to stop taking new medicare patients (and still may) -- IN THIS TOWN! Others are considering retirement. Some are considering moving. I know many physicians who work in non-medicare saturated "markets" who already refuse to take medicare. The Mayo Clinic in Jacksonville doesn't take medicare.
Senator Kennedy showed up to vote for the doctors with a brain tumor. Nine republicans (including our not so illustrious Martinez) changed their votes due to too much voter pressure. Bush has vowed to veto this bill to protect his Insurance company friends. (Senator Frish as everyone remembers never had any conflict of interest despite the fact that his family owns Columbia health care).
Things are really getting out of hand. There is a major health insurance crisis here. Right now, the doctors are suffering. I know Internists working 80 hours per week making $125,000. That's a lot of money. Still, it's $62,000/job (they're working two full jobs). A medicare follow up visit charge of moderate complexity is $80 while cleaning the dryer vent is $90. Pretty soon medicare patients are going to start to suffer. A 25% pay cut to these friends of mine would have meant that they were supposed to be paid $46,000 for a full time (40 hours/week) job. I suspect doctors would be leaving in droves under those circumstances. They would have to if they have families.
In January 2010, doctors are now "scheduled" for a 20% cut in pay, and this fight is going to played out all over again. We have had no raises and several "small" cuts (one was 5%) over the past decade while costs just keep going up. People are either retiring, leaving medicare, or looking for other work.
It's time for people to start fighting against the insurance companies. We should have seen this when they refused to pay for the damage that was done during hurricane Katrina.
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