From: Steven B. Harris <sbharris@ix.netcom.com@ix.netcom.com>
Newsgroups: rec.scuba,sci.med
Subject: Re: doctors (was: The Christmas Wish List So Far)
Date: Mon, 23 Oct 2000 05:49:24 GMT

In article <sv7hspgocrgh8c@corp.supernews.com>,
	"Angelmoon" <computer.goddess@exite.com> wrote:

>I've been away a while (crappy medical care) so please do not take this
>as any kind of insult.  Are you a people doctor?  If so, which state.
>I'd love to have a doctor who actually LISTENS to the patient.  :)



I am a people doctor. I do try to listen to the patient, but at medicare
rates, I would go flat broke doing much of this, if I didn't work at a
teaching institution.

Be advised that the fat has been trimmed from medical care by the
weenies who crunch numbers, and much of the fat which got trimmed is the
time you spend talking to your doctor. The reason for this is that it's
hard to document what you, the doctor, are doing, when you're shooting
the shit with your patient. You may be getting to know then well enough
to have some idea whether or not a given complaint from this particular
person merits $1500 bucks worth of tests or not, but it's hard to prove
that. And if you can't prove it (ie, you haven't dictated every thought
process, including subconsious ones) you can't charge 3rd party payers
for doing it. Because they won't pay. They will, however, pay for MRI
scans, because it's all documented and they have little choice. So now
your doctor just orders the MRI scan instead. Sorry.

All this is part of the general increase in unforgivingness in the
world. In medicine, you can blame third party payers (both private and
the Feds) and socialization, but that's only part of it.  The other part
of the story is the rise of the electronic computer, which is a major
source of the "lack of slack" (nod to Reverend Dobbs) which you see in
the world today. And not only in medicine.

But that's another essay.  Sorry about your medical care. Wish I could
help, but better minds than mine have utterly failed at fixing the
problem. Let me put it another way. Ultimately your doctor doesn't want
to talk to you for as long as you want to talk, because at several times
parked taxi rates, you're not willing to foot the bill. And NOW, a
computer is watching to make sure you *do* foot the bill for that time.
Lawyers long ago fixed this problem with their clients. Doctors have
been way too nice about it for way too long. But the *(&%ing machines
and the *(&%ing accountants have now fixed that, and here we are.

SBH

From: Steven B. Harris <sbharris@ix.netcom.com@ix.netcom.com>
Newsgroups: rec.scuba,sci.med
Subject: Re: doctors (was: The Christmas Wish List So Far)
Date: Mon, 23 Oct 2000 20:51:15 GMT

In article <8t1k6p$1tf$1@nnrp1.deja.com>,
	mjblackmd@my-deja.com wrote:

>Heh, heh, heh...do I sense a tad bit of disillusionment with the
>system, SBH?

You can't be disillusioned if you never had any expectations to begin
with. If you count the entire medical system as "the system," then I'm
not so much disillusioned as outraged.  It's not the same system as it
was in 1978 when I decided to join it. After I spent a decade of my life
getting into it, they changed the rules....!

Not that there's not enough blame to go around.  Doctors spent their way
into this mess, and now it bites them on the ass. I saw a license plate
on a very expensive car in Long Beach CA in 1983 that said "EGD PRN".
And that's about the way it was, then. Eventually the public found out
what that kind of thing meant. My problem is that the generation of
doctors who broke the system are (by and large) not the ones getting
hurt by the result.