Anybody else surprised at how little doctors know about healthcare?

[CCmetal94]

Obviously, some doctors know an immense amount about healthcare, and I'll preface by saying I don't know crap about healthcare really either. But i've been scribing for over a year and given the recent changes in healthcare It has been brought up in conversation multiple times. From my experience, most of the doctors claim to not really care or not know much other than the basics you'd learn from your local news broadcast. I was pretty surprised by this.

Another small trend i've noticed is that it's mostly older docs that are optimistic about the AHCA, but all the residents at my hospital hate it.

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[CCmetal94]

Practitioners of any profession may be experts in their particular piece of the field without having a good knowledge of how the a;; pieces of a complex system really work in detail. For example, a baseball pitcher has a different knowledge base and view than the general manager of the team. This may be especially true for physicians for two reasons. First, their time, energy and focus is taken up by the medical knowledge they need as a good deal by the non medical paperwork needed to document and bill for all that. Second, healthcare as a "system" is extremely complex with practitioners/physician establishment, hospitals, insurance companies, and government policy.

That's a helpful analogy. It seems like a lot of the general public (including myself until recently) thinks doctors are healthcare experts though. My family constantly uses quotes they heard from their doctor as evidence that (insert healthcare claim here) is true or false.

 

[Eurus_Holmes]

Obviously, some doctors know an immense amount about healthcare, and I'll preface by saying I don't know crap about healthcare really either. But i've been scribing for over a year and given the recent changes in healthcare It has been brought up in conversation multiple times. From my experience, most of the doctors claim to not really care or not know much other than the basics you'd learn from your local news broadcast. I was pretty surprised by this.

Another small trend i've noticed is that it's mostly older docs that are optimistic about the AHCA, but all the residents at my hospital hate it.

Can you elaborate on aspects of the AHCA that those older doctors think warrant optimism? Did they read the bill? Or maybe it's the amazing CBO score?

 

[gyngyn]

That's a helpful analogy. It seems like a lot of the general public (including myself until recently) thinks doctors are healthcare experts though. My family constantly uses quotes they heard from their doctor as evidence that (insert healthcare claim here) is true or false.

Even physicians can have unfounded opinions on matters outside of their area of expertise.
Hopefully, their medical advice is well-supported, though.

 

[CCmetal94]

Can you elaborate on aspects of the AHCA that those older doctors think warrant optimism? Did they read the bill? Or maybe it's the amazing CBO score?

Well, I work in the rural midwest so a lot of the old docs here are hardline conservative/trump supporters. So it very well may be just a partisan thing. They have not specified other than the vague "it's a disaster" trope.

 

[CCmetal94]

Even physicians can have unfounded opinions on matters outside of their area of expertise.
Hopefully, their medical advice is well-supported, though.

I've definitely become more aware of this fact over the past year. It's interesting how the mind can be partisioned, even with intillectuals. I've heard some docs use criticisms that a simple google search would debunk in seconds (death spiral, unconstitutionality of the ACA, congress being exempt from the ACA etc.), but still hold scientific evidence in high regard in terms of their medical advice.

 

[Goro]

Obviously, some doctors know an immense amount about healthcare, and I'll preface by saying I don't know crap about healthcare really either. But i've been scribing for over a year and given the recent changes in healthcare It has been brought up in conversation multiple times. From my experience, most of the doctors claim to not really care or not know much other than the basics you'd learn from your local news broadcast. I was pretty surprised by this.

Another small trend i've noticed is that it's mostly older docs that are optimistic about the AHCA, but all the residents at my hospital hate it.

Medicine is a team sport now.

 

[Tenk]

I've definitely become more aware of this fact over the past year. It's interesting how the mind can be partisioned, even with intillectuals. I've heard some docs use criticisms that a simple google search would debunk in seconds (death spiral, unconstitutionality of the ACA, congress being exempt from the ACA etc.), but still hold scientific evidence in high regard in terms of their medical advice.

I'm all for healthcare reform but the ACA was terrible. Like EMTALA it shifted the responsibility away from the entire population and was basically an unfunded mandate for employers as EMTALA is for hospitals. In addition it failed to do the one thing it was supposed to do: shift care from the EDs into outpatient clinics. Multiple scientific studies have shown it did the opposite as ED visits have increased at a rate not reflective of the US population growth. I have seen tons of people come to the ED after it was implemented all with the same story: "well I got insurance now so I want to get checked out..." ask any ED doc and they will tell you the same story. I don't have an answer to drive down healthcare costs but I'll tell you it sure as hell is not coming to see me. My job is to make sure you don't die, not do primary care.

 

[sullen-burger]

I'm all for healthcare reform but the ACA was terrible. Like EMTALA it shifted the responsibility away from the entire population and was basically an unfunded mandate for employers as EMTALA is for hospitals. In addition it failed to do the one thing it was supposed to do: shift care from the EDs into outpatient clinics. Multiple scientific studies have shown it did the opposite as ED visits have increased at a rate not reflective of the US population growth. I have seen tons of people come to the ED after it was implemented all with the same story: "well I got insurance now so I want to get checked out..." ask any ED doc and they will tell you the same story. I don't have an answer to drive down healthcare costs but I'll tell you it sure as hell is not coming to see me. My job is to make sure you don't die, not do primary care.

I know you just said you don't have an answer but before you leave, what do you think about a single payer system?

 

[Eurus_Holmes]

I'm all for healthcare reform but the ACA was terrible. Like EMTALA it shifted the responsibility away from the entire population and was basically an unfunded mandate for employers as EMTALA is for hospitals. In addition it failed to do the one thing it was supposed to do: shift care from the EDs into outpatient clinics. Multiple scientific studies have shown it did the opposite as ED visits have increased at a rate not reflective of the US population growth. I have seen tons of people come to the ED after it was implemented all with the same story: "well I got insurance now so I want to get checked out..." ask any ED doc and they will tell you the same story. I don't have an answer to drive down healthcare costs but I'll tell you it sure as hell is not coming to see me. My job is to make sure you don't die, not do primary care.

I think "well I got insurance now so I want to get checked out..." is better than "I don't have insurance so I'll stay home and hope my symptoms magically disappear...". Yes, there is an annoying number of people who go to the ED for benign reasons; but is this sudden increase you describe due to the ACA being terrible or is this what happens when marginalized group with little to no access to healthcare finally have the means to see a doctor without bankrupting themselves.

No the ACA is not perfect, but it did succeed in increasing coverage for millions of Americans ( I think that's the one think most agree it was supposed to do). Higher premiums, people who make too much for subsidies and too little to pay for insurance themselves, that type of stuff can be fixed...But here's the kicker, if you (a very general you..) don't help to improve a laudable but incomplete solution, you don't get to watch it struggle and say "ha I told you so.." We can do good better but the ACHA doesn't even attempt to do good..unless you're young, healthy, wealthy or without preexisting conditions.

 

[Tenk]

I know you just said you don't have an answer but before you leave, what do you think about a single payer system?

Sure why not. That's not the problem though. There are four major problems with the health care system of the US that need fixed:

1) Malpractice reform. This is a no brainer. I should not be able to be sued three times for a single case. Yup, I can be sued for an EMTALA violation, a malpractice claim and people can even file a civil suit against me. Yay lawsuits! Our entire nation is so built on litigation that the only way I see this changing is with caps on litigation that many states already have although I am not sure if they apply to EMTALA and civil suits, doubtful.

2) "Just go to the ED mentality." This drives up healthcare costs and allows PCPs to become lazy. When patients see how effective the ED is at getting things done, guess what, they come back! We have tons of people come to the ED just because they know it will be faster and more efficient. Outpatient needs to get up to our level.

3) Where the money goes. Think of all healthcare expenditures as a pool of water and everyone goes up to the same pool. Right now our country has a lot of unnecessary players coming to that pool: malpractice, insurance companies, hospital admin, etc. The money needs to stick to the hospitals, workers, clinics and patients, not make MBAs rich.

4) Lack of self responsibility in our patients. Good luck with this one... Getting people to stop smoking, have a decent diet and exercise more would save more lives than any other medical intervention ever.

You fix those four things and our costs will plummet and I may even have a hard time finding a job.

 

[Tenk]

I think "well I got insurance now so I want to get checked out..." is better than "I don't have insurance so I'll stay home and hope my symptoms magically disappear...". Yes, there is an annoying number of people who go to the ED for benign reasons; but is this sudden increase you describe due to the ACA being terrible or is this what happens when marginalized group with little to no access to healthcare finally have the means to see a doctor without bankrupting themselves.

No the ACA is not perfect, but it did succeed in increasing coverage for millions of Americans ( I think that's the one think most agree it was supposed to do). Higher premiums, people who make too much for subsidies and too little to pay for insurance themselves, that type of stuff can be fixed...But here's the kicker, if you (a very general you..) don't help to improve a laudable but incomplete solution, you don't get to watch it struggle and say "ha I told you so.." We can do good better but the ACHA doesn't even attempt to do good..unless you're young, healthy, wealthy or without preexisting conditions.

Except it bankrupts the entire country in its place. It is not cheap to see me. It is several hundred dollars for a toothache. The ACA did little to nothing to help reimburse PCPs and did nothing to filter people from the ED to the PCP. It did the opposite.

I do not provide good primary care. I provide good emergency care. I don't think like a PCP and I don't want to think like a PCP. Having people come see me out of convenience rather than work a little harder and wait a little longer is not better. It is far worse for the system and studies have also proven for the patient's long term health as well.

 

[JJRousseau]

Sure why not. That's not the problem though. There are four major problems with the health care system of the US that need fixed:

1) Malpractice reform. This is a no brainer. I should not be able to be sued three times for a single case. Yup, I can be sued for an EMTALA violation, a malpractice claim and people can even file a civil suit against me. Yay lawsuits! Our entire nation is so built on litigation that the only way I see this changing is with caps on litigation that many states already have although I am not sure if they apply to EMTALA and civil suits, doubtful.

2) "Just go to the ED mentality." This drives up healthcare costs and allows PCPs to become lazy. When patients see how effective the ED is at getting things done, guess what, they come back! We have tons of people come to the ED just because they know it will be faster and more efficient. Outpatient needs to get up to our level.

3) Where the money goes. Think of all healthcare expenditures as a pool of water and everyone goes up to the same pool. Right now our country has a lot of unnecessary players coming to that pool: malpractice, insurance companies, hospital admin, etc. The money needs to stick to the hospitals, workers, clinics and patients, not make MBAs rich.

4) Lack of self responsibility in our patients. Good luck with this one... Getting people to stop smoking, have a decent diet and exercise more would save more lives than any other medical intervention ever.

You fix those four things and our costs will plummet and I may even have a hard time finding a job.

I agree these are salient issues. The NHS in the U.K. fixes 1 and 3 handily. Taxes can help with 4 but it's a tough problem. National healthcare Tax deductions based on physical fitness exams and drug / tobacco tests ( no criminal action allowed) could do more. Problem 2 is really not solved by any current health providing system and needs some careful and clever thought. That said a move to an NHS system would mean the public would probably need to start paying for medical school tuition at the least... and of course a parallel private system with additional insurance would need to operate alongside it as it does in the U.K. They do have the cheapest healthcare in the world after all, and are not lacking in quality in any serious way.


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[JJRousseau]

Another thought, you could introduce fines for trying to use national insurance at emergency departments for non-emergency issues...


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[Tenk]

I agree these are salient issues. The NHS in the U.K. fixes 1 and 3 handily. Taxes can help with 4 but it's a tough problem. National healthcare Tax deductions based on physical fitness exams and drug / tobacco tests ( no criminal action allowed) could do more. Problem 2 is really not solved by any current health providing system and needs some careful and clever thought. That said a move to an NHS system would mean the public would probably need to start paying for medical school tuition at the least... and of course a parallel private system with additional insurance would need to operate alongside it as it does in the U.K. They do have the cheapest healthcare in the world after all, and are not lacking in quality in any serious way.


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2 can be solved with ease: co-pay of 50-100$ for non-emergent visits to the ED and complete tort reform on EMTALA lawsuits. Done.

 

[libertyyne]

Sure why not. That's not the problem though. There are four major problems with the health care system of the US that need fixed:

1) Malpractice reform. This is a no brainer. I should not be able to be sued three times for a single case. Yup, I can be sued for an EMTALA violation, a malpractice claim and people can even file a civil suit against me. Yay lawsuits! Our entire nation is so built on litigation that the only way I see this changing is with caps on litigation that many states already have although I am not sure if they apply to EMTALA and civil suits, doubtful.

2) "Just go to the ED mentality." This drives up healthcare costs and allows PCPs to become lazy. When patients see how effective the ED is at getting things done, guess what, they come back! We have tons of people come to the ED just because they know it will be faster and more efficient. Outpatient needs to get up to our level.

3) Where the money goes. Think of all healthcare expenditures as a pool of water and everyone goes up to the same pool. Right now our country has a lot of unnecessary players coming to that pool: malpractice, insurance companies, hospital admin, etc. The money needs to stick to the hospitals, workers, clinics and patients, not make MBAs rich.

4) Lack of self responsibility in our patients. Good luck with this one... Getting people to stop smoking, have a decent diet and exercise more would save more lives than any other medical intervention ever.

You fix those four things and our costs will plummet and I may even have a hard time finding a job.

Just wanted to be pedantic about your Point 1. Texas has implemented pretty extensive tort reform. It has not changed the way medicine is practiced and nor has it reduced costs. And malpractice lawsuits are a category of civil lawsuits.

 

[Tenk]

Just wanted to be pedantic about your Point 1. Texas has implemented pretty extensive tort reform. It has not changed the way medicine is practiced and nor has it reduced costs. And malpractice lawsuits are a category of civil lawsuits.

Correct but also not correct.

While the way that providers practice has not drastically changed (this could take generations actually), the payout for malpractice cases has. Where do you think this money comes from? The sky? Magic? No, it's part of the healthcare pool. It's going from the pool into the wallets of the plaintiff and the plaintiff's attorney. In other countries they actually have a system that does not involve so many lawyers where if a screw up occurs, the hospital/doctor can say "yup we messed up" and then the person gets money as compensation. Again, we need to redirect the money to the people who matter: health care providers and patients.

You don't seem to understand what I meant. I can get sued for malpractice, win that case and then be sued personally as in the person sues me (not covered by malpractice) for damages. This can and does happen, albeit rare. This is why a lot of physicians are now incorporating themselves.

 

[libertyyne]

Correct but also not correct.

While the way that providers practice has not drastically changed (this could take generations actually), the payout for malpractice cases has. Where do you think this money comes from? The sky? Magic? No, it's part of the healthcare pool. It's going from the pool into the wallets of the plaintiff and the plaintiff's attorney. In other countries they actually have a system that does not involve so many lawyers where if a screw up occurs, the hospital/doctor can say "yup we messed up" and then the person gets money as compensation. Again, we need to redirect the money to the people who matter: health care providers and patients.

You don't seem to understand what I meant. I can get sued for malpractice, win that case and then be sued personally as in the person sues me (not covered by malpractice) for damages. This can and does happen, albeit rare. This is why a lot of physicians are now incorporating themselves.

The argument for tort reform is usually along the lines of "we practice defensive medicine because we dont want to get sued"
So one would think if tort reform actually occurs defensive medicine would stop being practiced. This is not the case. The argument that the cost of lawsuits gets incorporated into the cost of medical care might be valid, however those costs are peanuts compared to over-utilization and unnecessary testing/care.

IMHO, Proceduralists will keep on doing more procedures even if they are a of questionable efficacy as long as they continue to get paid to do them. Without reforming the way reimbursement is performed non of the national cost problems are going to be solved, hospitals and practices will just find better ways to game the system.

 

[Tenk]

The argument for tort reform is usually along the lines of "we practice defensive medicine because we dont want to get sued"
So one would think if tort reform actually occurs defensive medicine would stop being practiced. This is not the case. The argument that the cost of lawsuits gets incorporated into the cost of medical care might be valid, however those costs are peanuts compared to over-utilization and unnecessary testing/care.

IMHO, Proceduralists will keep on doing more procedures even if they are a of questionable efficacy as long as they continue to get paid to do them. Without reforming the way reimbursement is performed non of the national cost problems are going to be solved, hospitals and practices will just find better ways to game the system.

Sorry, department ramped up and I had to intubate some peeps.

Physician reimbursement is a small piece of the pie. CEOs dominate, physicians are smaller fry. We are not the cause of the several decade increase in costs. We aren't pocketing that money. CEOs/admin are.

You absolutely need to think about all that malpractice money because it comes out of your salary. Insurance companies/the government pay your salary. You pay for malpractice insurance which pays for the lawsuits. It is all interconnected. Until you have total national tort reform, I don't think you will see big changes because doctors shift and train in all places of the states, myself included and EMTALA lawsuits can be in the order of several million currently.

Obviously none of this crap matters because none of this is likely to change but it is frustrating with how much effort I put into this job when I see someone with far, far, far less education making 2x-3x my salary with a desk job telling me what I should and should not be doing. It's like wtf...?