Cynical Doctors? Pedantic Doctors?

[Felzor]

Curious... are doctors in real life as cynical, biting, sharp-witted, and pedantic as the people on these forums? While members of online forums everywhere exhibit those qualities, I feel like SDN really "shines" in that regard. Of course I'm generalizing, but there seems to be an unusual amount of, say, correcting other people's grammar, OP basing, and cynical humor. And let's not forget the misogyny!

I realize these forums aren't Candy Land, but boy, it feels kind of oppressive sometimes... like I really need to choose my words carefully. Just wondering if anybody feels the same way. Thanks.

---

Members don't see this ad.

 

[Disko]

most doctors i know are rather elitist.

 

[Green Pirate]

Curious... are doctors in real life as cynical, biting, sharp-witted, and pedantic as the people on these forums? While members of online forums everywhere exhibit those qualities, I feel like SDN really "shines" in that regard. Of course I'm generalizing, but there seems to be an unusual amount of, say, correcting other people's grammar, OP basing, and cynical humor. And let's not forget the misogyny!

I realize these forums aren't Candy Land, but boy, it feels kind of oppressive sometimes... like I really need to choose my words carefully. Just wondering if anybody feels the same way. Thanks.

LOLOLOLLOOL U CAN'T SPELL "BASHING" LMAO.

general rule of thumb--don't take things too seriously around here (or anywhere, for that matter). Everyone's stressed for one reason or another

 

[senseiturtle]

what the hell is "pedantic" ?

Seems to be the word of the day. Should I be screaming and throwing my hands up ?

 

[univscience]

i've met my fair share.

 

[pennybridge]

there should be an entrance exam for the internet.

 

[Wanna_B_Scutty]

Curious... are doctors in real life as cynical

yes

biting

yes

sharp-witted

if only... from what I've seen, they lose their wit after having their souls consumed by residency

and pedantic as the people on these forums?

yes

And let's not forget the misogyny!

oh, there's plenty of male bashing, too.
----
As you can see, I'm working on my self-loathing early!

 

[Chargers]

I had the same feeling when I first posted here. Some of them here are or have this up their a

 

[estairella]

Curious... are doctors in real life as cynical, biting, sharp-witted, and pedantic as the people on these forums? While members of online forums everywhere exhibit those qualities, I feel like SDN really "shines" in that regard. Of course I'm generalizing, but there seems to be an unusual amount of, say, correcting other people's grammar, OP basing, and cynical humor. And let's not forget the misogyny!

I realize these forums aren't Candy Land, but boy, it feels kind of oppressive sometimes... like I really need to choose my words carefully. Just wondering if anybody feels the same way. Thanks.

It really depends on the threads you're reading. If you're going to URM threads, or whatever, of course you're going to get lots of that. If you go to whining threads, you'll get much of the same. A lot of the threads are helpful - if you have legitimate questions and you are open to what other people think.

Overall, I think it's no worse than other internet forums. Then again, I suppose it depends on what kind of forums you visit. Here at least, I'm the type of poster who will call you out if you're stupid, arrogant or incendiary (for some reason, they are often connected). Certainly there are some people here (see: mods) who will post a reasoned, well-mannered response to such posters. But if you've been on the internet long enough, you know "reasoned discourse" is rarely what these people are looking for. In general, it's more of a "my way or the highway" attitude. So there's no point in voicing my disapproval in any earnest way - it'll just fall on deaf ears. At least cynical humour is fun!

Remember: The Internet Is (NOT) Serious Business

 

[pennybridge]

I had the same feeling when I first posted here. Some of them here are or have this up their a

up their grille?

 

[Green Pirate]

I think I've fallen in love with pennybridge's wit tonight.

 

[pennybridge]

I think I've fallen in love with pennybridge's wit tonight.

it's the wit that attracts, and my antique hysteria machine that keeps you coming back for more.

 

[beauregard]

Today has been a dictionary-intensive day.

 

[pennybridge]

Today has been a dictionary.com-intensive day.

fixed

edit// paper dictionaries are for poor people

 

[HreComesTheSun]

Curious... are doctors in real life as cynical, biting, sharp-witted, and pedantic as the people on these forums? While members of online forums everywhere exhibit those qualities, I feel like SDN really "shines" in that regard. Of course I'm generalizing, but there seems to be an unusual amount of, say, correcting other people's grammar, OP basing, and cynical humor. And let's not forget the misogyny!

I realize these forums aren't Candy Land, but boy, it feels kind of oppressive sometimes... like I really need to choose my words carefully. Just wondering if anybody feels the same way. Thanks.

this will go away after about post 50

i can't believe i've wasted a whole day on sdn

 

[Green Pirate]

this will go away after about post 50

i can't believe i've wasted a whole day on sdn

disbelief will go away after post 200. regret and depression promptly follow reality's rude awakening.

 

[HreComesTheSun]

lol, i just snort-laughed

 

[kypdurron5]

If you think these threads are negative then check out http://www.medschoolhell.com and to a lesser degree http://pandabearmd.com/.

 

[Green Pirate]

lol, i just snort-laughed

ah. the internet snort laugh. a true testament to nerditude.

 

[8744]

If you think these threads are negative then check out http://www.medschoolhell.com and to a lesser degree http://pandabearmd.com/.

I am not not negative. Just realistic. Medicine is nowhere near the simultaneous, mutually gratifying orgasm that pre-meds on SDN think it to be.

 

[HumbleMD]

I'd admit that I'm quite cynical and acid-tongued on these forums. I don't think all of us will grow up to be House, MD, though. I for one, use the forums as an outlet for my cynicism and sarcasm, whereas back in the real world I'm normally a pretty cheery guy.

 

[Felzor]

Hah, maybe it's growing on me. Thanks for the replies.

 

[beauregard]

fixed

edit// paper dictionaries are for poor people

I prefer m-w.com

 

[beauregard]

I am not not negative. Just realistic. Medicine is nowhere near the simultaneous, mutually gratifying orgasm that pre-meds on SDN think it to be.

I like your blog.

 

[NickRiviera]

I like your blog.

If we're sharing opinions no one cares about, I don't like the blog. Panda thinks he has useful knowledge to disseminate in an attempt to show pre-meds how to be realistic. Also, he goes on long rants without adequate knowledge of said ranted topic. Read "Don't Just Do Something, Stand There: Part Three." If you know anything about how insurance works, you'll realize he doesn't and created quite a farce to prove his misinformed point.

 

[8744]

I don't rant. Sorry. You must have the wrong blog.

 

[Cirrus83]

If we're sharing opinions no one cares about, I don't like the blog. Panda thinks he has useful knowledge to disseminate in an attempt to show pre-meds how to be realistic. Also, he go on long rants without adequate knowledge of said ranted topic. Read "Don't Just Do Something, Stand There: Part Three." If you know anything about how insurance works, you'll realize he doesn't and created quite a farce to prove his misinformed point.

Whoa...I actually just went and read that (I don't read his blog) and...wow...
Forget about insurance, I think that rant goes off the track on just about everything it manages to mention. I'm not even sure if there was a point to the entire mess either.

Edit: Well, Panda posted the above post while I was typing this. So, if it's not a rant that might actually just make it worse, since a rant would better account for the raving madness that comes through, lol.

 

[8744]

Whoa...I actually just went and read that (I don't read his blog) and...wow...
Forget about insurance, I think that rant goes off the track on just about everything it manages to mention. I'm not even sure if there was a point to the entire mess either.

Edit: Well, Panda posted the above post while I was typing this. So, if it's not a rant that might actually just make it worse, since a rant would better account for the raving madness that comes through, lol.

With what, exactly, do you disagree? I think you are just so conditioned to respond in a certain way that you are unwilling to think about things from a different perspective. I want you to point to one thing in my article that is not mostly true for most people (which is mostly the point) and why most people allow themselves to be stampeded by something that to most of them is not even a problem.

Whoa. "Insurance is to ameliorate the financial consequences of rare but catastrophic events." Heavy stuff? Hard to understand? Untrue? What?

"Most people who pay $15,000 per year for comprehensive coverage would come out ahead most of the time if they decided to keep the money and pay for their health expenses out of pocket." Oooh. That Panda is telling lies!

The other subtext, which might not have been clear but which you should know instinctively if you have had your eyes open, is that there is no utopia and no possibility of one either. I neither propose nor promise that the lame shall walk, the blind shall see, the lion will lay with the lamb and all will be goodness and light forever and ever amen in our health care system. We are always going to have a lazy, unhealthy, uninterested, and completely passive patients and no amount of cajolin' and bribin' is going to make them svelte and glowing. People are going to get old and die. Some will die of natural old age and some will die horrible deaths from things that only personal responsibility could have saved them from and we are going to pay for every man-jack one of them through the nose.

 

[NickRiviera]

Curious... are doctors in real life as cynical, biting, sharp-witted, and pedantic as the people on these forums? While members of online forums everywhere exhibit those qualities, I feel like SDN really "shines" in that regard. Of course I'm generalizing, but there seems to be an unusual amount of, say, correcting other people's grammar, OP basing, and cynical humor. And let's not forget the misogyny!

I realize these forums aren't Candy Land, but boy, it feels kind of oppressive sometimes... like I really need to choose my words carefully. Just wondering if anybody feels the same way. Thanks.

I think this is situation dependent. Here, people are mostly anonymous, so they can say anything without repercussion really. If you attend a conference for physicians, like an annual surgery convention, you'll hear physicians being a bit more tactful yet still ripping on each other. In that situation, they want to appear intelligent and professional so their views are taken seriously, but at the same time it might not matter what certain physicians think. Then take a situation where physicians are working closely together, like at a hospital. If you are as biting and sharp-witted there, it could affect your job. Other people might not refer to you, you could be deemed difficult to work with, put at the top of the "next-to-go" list, etc. Physicians hopefully are as tactful and diplomatic as possible in these situations so as not to get a bad rap. If someone says something mean or something you completely disagree with, you might just have to smile and nod or say "I respect your opinion" and more on. Here, on SDN, all stops are pulled.

 

[Cirrus83]

With what, exactly, do you disagree? I think you are just so conditioned to respond in a certain way that you are unwilling to think about things from a different perspective. I want you to point to one thing in my article that is not mostly true for most people (which is mostly the point) and why most people allow themselves to be stampeded by something that to most of them is not even a problem.

Whoa. "Insurance is to ameliorate the financial consequences of rare but catastrophic events." Heavy stuff? Hard to understand? Untrue? What?

Err...right, that wasn't even what I found problematic, but since you bring it up...
1) You completely ignore the fact that insurers also act as your bargaining middle-man with hospitals, the same hospitals that'll charge an uninsured patient who can afford to pay several times more than an insured patient whose insurance won't cover that particular procedure or stay, because the insurance company will still step in to negotiate a rate for you. So quite frankly, someone without insurance has no bargaining chips on the table against hospitals, and when you're horribly sick you're not exactly super focused on bargaining with them before you let them treat you. Insurance companies on the other hand, have actual leverage due to the number of people they cover. Where's your solution for this?

2) You proclaim that health insurance is a ponzi scheme where the extremely sick are draining a large portion of the money. Fine, so is your solution that the extremely sick should just go die? Oh, sorry, you have a chronic genetic illness, guess you're screwed because you can't afford to pay for all the meds and care you'll need to survive. And before you respond that you'd let the government handle these situations, your own blog says "The money is going to come out of somebody's pocket and it's not going to be the government which has no pockets, just hands to grab from one to give to another", so even if the government helped out there it'd still end up draining our money. So I guess the extremely sick are simply SOL in Panda Bear land eh? Great solution to our healthcare cost issue: let the sick people die. Wow, I wonder why no politicians want to suggest this BRILLIANT idea. It's SO SIMPLE!

3) "Not only do they hold the people in contempt thinking them incapable of planning for their own future but the money tied up in these accounts and owned by citizens is just another chunk of money that cannot be stuffed into the voracious maw of the political influence machine." Considering how little most Americans have saved for retirement, I'd say that there's plenty of evidence that people actually are pretty incapable of planning such things. Just because you're using evil sounding language like "in contempt" doesn't mean that people would actually have a friggin' clue how to plan for anything.

4)

As for the poor, well, we live in a society that is both opportunistic and compassionate. It would be demoralizing to our nation to have the disparities of medical access so wide that the poor and ignorant suffer or die from conditions that those who can think and plan ahead easily eacape. We will, unfortunately, always need to give medical care as charity. But the key here is that primary care is no bargain. The connection between good health and acccess to primary care is tenuous. The factors which contribute to poverty and ignorance also contribute to poor health and we have been fighting those since the Johnson Administration with little or no success. Bad health in the poor is mostly a the result of social problems which have shown a surprising resistance to huge doses of federal dollars. Dumping even more money onto the poor is mostly the same as trying to treat a disease with an antibiotic to which it is resistant. Staph Aureus laughs at your ineffectual pennicilin. The poor will laugh and ignore your ineffectual primary care.

Wow, that entire paragraph is supposedly not a rant, but and yet it actually suggests no actual solution to anything it mentions. So what is it exactly?

5)

What the poor need is the same as everybody else. Major medical insurance for which, if it absolutley must, the goverenment can pay. We certainly pay enough to support the poor now. May as well spend it where it will be effective, that is, on management of the acute health problems that people who don't think and plan ahead are going to get no matter what we do. To hell with it.

Wow, I think you just came up with Medicaid as your solution in this paragraph.

6)

There are many conflicting forces in medical care, each one trying to stiff the other with the bill. The insurance companies want to pay as little in claims as possible which is understandable given the nature of their business. The medical industry, from physicians to the lady mopping the hospital floors, would like to get paid fairly for their services. The government wrings its hands at the cost but at the same time would like as many people dependent on government as possible. The people want all the medical care they can eat but they want somebody else to pay for it.

Nobody else can pay for it unless we become a nation with a government whose sole function is to provide health and other benefits to a universal dependency class in some decaying freeloader heaven.

More "not a rant" paragraphs which seem to serve the purpose mostly of whining about how the people are evil and the government is out to try and make us all their dependents, oh, and universal healthcare will lead to doomed freeloader heaven. Yes, that's quite the well laid out and persuasive argument there, clearly not at all a rant.

Good thing the very concept of getting an MPH probably makes your blood curdle, because if you turned in this kind of nonsensical crap for your papers even the most right-wing professor would have a hard time not flunking you. Believe it or not, public health professors aren't all just huge fans of universal healthcare (gasp!), but even the most ardent opponents of universal healthcare would find your strategy of blaming the sick and poor and expecting people to just properly manage their healthcare money pretty ridiculous (Oh, pray tell, what is your solution for when someone doesn't actually manage their healthcare money correctly? Go die? File for bankruptcy?)

I'm not saying that I actually have an awesome solution to all our healthcare problems, but your hate-filled rants are about as counter-productive as possible. More or less your entire blog post is about how the poor and the sick are to blame, the government is out to make us all zombiefied dependents, universal healthcare will lead to the decay of our society (seriously dude?), the sick should go die, and maybe we should invent Medicaid for the poor (oh wait, I think we already implemented that part of your genius plan). Wow, who can possibly think that's a rant?

Oh and let me pre-emptively strike here: Inevitably, at some point, you will bring up the fact that you're not some pre-med or even a med student, so because you've actually been caring for patients you're now a healthcare policy expert who actually has a clue what he's talking about. Well, I'm sorry your experiences with the poor have made you uber-bitter about them, but that doesn't actually mean you suddenly have a clue about insurance or healthcare policy. It just makes you a bitter ranting blogger, and while sometimes your rants (at least the ones I've read on the forums) are sometimes quite entertaining, on this particular blog post it's just plain wrong.

P.S. To the OP, yes, but in real life they can only show off their sharp wits to those under them, like med students and residents (not nurses though, since that'll pretty quickly screw you over).

 

[8744]

Err...right, that wasn't even what I found problematic, but since you bring it up...
1) You completely ignore the fact that insurers also act as your bargaining middle-man with hospitals, the same hospitals that'll charge an uninsured patient who can afford to pay several times more than an insured patient whose insurance won't cover that particular procedure or stay, because the insurance company will still step in to negotiate a rate for you. So quite frankly, someone without insurance has no bargaining chips on the table against hospitals, and when you're horribly sick you're not exactly super focused on bargaining with them before you let them treat you. Insurance companies on the other hand, have actual leverage due to the number of people they cover. Where's your solution for this?

2) You proclaim that health insurance is a ponzi scheme where the extremely sick are draining a large portion of the money. Fine, so is your solution that the extremely sick should just go die? Oh, sorry, you have a chronic genetic illness, guess you're screwed because you can't afford to pay for all the meds and care you'll need to survive. And before you respond that you'd let the government handle these situations, your own blog says "The money is going to come out of somebody’s pocket and it’s not going to be the government which has no pockets, just hands to grab from one to give to another", so even if the government helped out there it'd still end up draining our money. So I guess the extremely sick are simply SOL in Panda Bear land eh? Great solution to our healthcare cost issue: let the sick people die. Wow, I wonder why no politicians want to suggest this BRILLIANT idea. It's SO SIMPLE!

3) "Not only do they hold the people in contempt thinking them incapable of planning for their own future but the money tied up in these accounts and owned by citizens is just another chunk of money that cannot be stuffed into the voracious maw of the political influence machine." Considering how little most Americans have saved for retirement, I'd say that there's plenty of evidence that people actually are pretty incapable of planning such things. Just because you're using evil sounding language like "in contempt" doesn't mean that people would actually have a friggin' clue how to plan for anything.

4)
Wow, that entire paragraph is supposedly not a rant, but and yet it actually suggests no actual solution to anything it mentions. So what is it exactly?

5)
Wow, I think you just came up with Medicaid as your solution in this paragraph.

6)

More "not a rant" paragraphs which seem to serve the purpose mostly of whining about how the people are evil and the government is out to try and make us all their dependents, oh, and universal healthcare will lead to doomed freeloader heaven. Yes, that's quite the well laid out and persuasive argument there, clearly not at all a rant.

Good thing the very concept of getting an MPH probably makes your blood curdle, because if you turned in this kind of nonsensical crap for your papers even the most right-wing professor would have a hard time not flunking you.

I'm not saying that I actually have an awesome solution to all our healthcare problems, but your hate-filled rants are about as counter-productive as possible. More or less your entire blog post is about how the poor and the sick are to blame, the government is out to make us all zombiefied dependents, universal healthcare will lead to the decay of our society (seriously dude?), the sick should go die, and maybe we should invent Medicaid for the poor (oh wait, I think we already implemented that part of your genius plan). Wow, who can possibly think that's just a rant.

And I repeat, this is mostly an emotional response on your part to the attack on your sacred cows. The thought that most people do not need comprehensive health insurance, even though true, for most people, has you completely unhinged to the point that you will lose sleep at 4:00AM to get it off your chest, so great is your fear that someone, somewhere, is going to read what I wrote and be influenced by it without your having tried to stamp 'em back into the box.

I also repeat that it is not a thesis but some general ideas hammered out while on call. You fill in the specifics and the policy wonkery. I'm telling you how things are.

I also don't think you know what a ponzi scheme is. You need to look it up.

As for people being incapable of saving for their retirement, medical care, or what have you, people do actually save 14 percent of their income every year in the form of a forced contribution to Social Security, another ponzi scheme. And everybody pays this, up to (and I could be wrong about the exact number) the first 90K or so of their income.

But that's kind of the point. Nothing is expected of anybody in the form of individual responsibility, the only strong foundation on which to build a society. Philosophically, if you structure a society to encourage freeloading, freeloading is what you will get. The people may be ignorant but they're not stupid.

 

[Tired]

And I repeat, this is mostly an emotional response on your part to the attack on your sacred cows. The thought that most people do not need comprehensive health insurance, even though true, for most people, has you completely unhinged to the point that you will lose sleep at 4:00AM to get it off your chest, so great is your fear that someone, somewhere, is going to read what I wrote and be influenced by it without your having tried to stamp 'em back into the box.

So I'm guessing you opted out of your residency's health plan, and pay cash for your childrens' vaccinations?

 

[Tired]

Fine, so is your solution that the extremely sick should just go die? Oh, sorry, you have a chronic genetic illness, guess you're screwed because you can't afford to pay for all the meds and care you'll need to survive. And before you respond that you'd let the government handle these situations, your own blog says "The money is going to come out of somebody’s pocket and it’s not going to be the government which has no pockets, just hands to grab from one to give to another", so even if the government helped out there it'd still end up draining our money. So I guess the extremely sick are simply SOL in Panda Bear land eh? Great solution to our healthcare cost issue: let the sick people die. Wow, I wonder why no politicians want to suggest this BRILLIANT idea. It's SO SIMPLE!

You're missing the point. Major medical insurance (which Panda seems to say he supports in some form or another) isn't the issue, it's everything else. It's the 22-year old with a headache who demands a CT scan. It's the 34-year old with gastroenteritis who gets a cardiac workup so the ER doc can defend against lawsuits. It's the guy who gets his nose broken in a fight, and get a facial CT scan despite the fact that it changes nothing in his management.

People get all sorts of tests for non-emergent conditions. Part of the problem is defensive medicine. But the other half is that, when people aren't paying for what they're getting, of course they're going to take the CT scan or MRI that is "offered" to them, without really listening to whether or not it is needed. If non-emergent conditions were dealt with on a cash basis, the guy who twisted his ankle 20 minutes ago might actually listen when you explain why an x-ray really isn't necessary right this second. But if he doesn't have to pay a dime for the x-ray, what the hell does he care? He wants it, and (unfortunately) he's going to get it.

I don't know what field you're going in to, but at some point you should start asking yourself what level of free care you're going to be comfortable providing. I'm doing ortho, and I have to tell you, Panda's blog about "Would you come in for the drunk femur fracture?" really hit home. I suspect I would come in for that case, just because of the severity and immediacy of the injury. But what I won't do is a SLAP repair on the 25-year old who never bothered to get insurance and has no intention of paying me for my time.

And before you bring it up, no, I won't be doing elective cases on kids either, unless their parents pay up. I feel for kids, I do, but I'm not validating poor parenting by working for free.

 

[Cirrus83]

And I repeat, this is mostly an emotional response on your part to the attack on your sacred cows. The thought that most people do not need comprehensive health insurance, even though true, for most people, has you completely unhinged to the point that you will lose sleep at 4:00AM to get it off your chest, so great is your fear that someone, somewhere, is going to read what I wrote and be influenced by it without your having tried to stamp 'em back into the box.

lol I'm on SDN until the wee hours of the morning plenty of the time...and this isn't the only thread I've been posting in tonight. I'm probably more bored than usual though. But it's not an emotional response to anything. I do like how you manage to completely ignore any of my criticisms.

I also repeat that it is not a thesis but some general ideas hammered out while on call. You fill in the specifics and the policy wonkery. I'm telling you how things are.

No, unfortunately your idea that the very sickest people are the ones costing us all the money cannot actually be worked into a healthcare policy where other people don't shoulder the cost. And no, we're not going to make a policy where we simply let the very sickest people go die. Oh, and hard as though some people may have to work to pay their health insurance bills, I doubt you'd convince most of them to go let someone else die so they can save $50.

I also don't think you know what a ponzi scheme is. You need to look it up.

No, you obviously need to learn to read because I very clearly wrote "Fine" and accepted your proposition that it's a ponzi scheme.

As for people being incapable of saving for their retirement, medical care, or what have you, people do actually save 14 percent of their income every year in the form of a forced contribution to Social Security, another ponzi scheme. And everybody pays this, up to (and I could be wrong about the exact number) the first 90K or so of their income.

Wait...are you for forced ponzi schemes or against them? Seriously, I point out that people can't manage money on their own, and you point out that social security forces people to contribute money to let the government manage it for them. Do you even know which side you're arguing for anymore? If you're conceding that people suck at managing their own money, then what is there left to even talk about here? Or do you mean the government will instead lord over the money people contribute into their accounts and manage it for everyone? Oh and let's not forget how your solution also includes the government paying for the poor to be insured. Hmm...add in the government also helping to pay for the very chronically ill (because you had no solution for this) and that sounds an awful lot like...wow...I think you just came up with universal healthcare.

But that's kind of the point. Nothing is expected of anybody in the form of individual responsibility, the only strong foundation on which to build a society. Philosophically, if you structure a society to encourage freeloading, freeloading is what you will get. The people may be ignorant but they're not stupid.

Yes, individual responsibility, blah blah blah. Again, no actual solution, and yet more ranting about freeloading.

 

[Cirrus83]

You're missing the point. Major medical insurance (which Panda seems to say he supports in some form or another) isn't the issue, it's everything else. It's the 22-year old with a headache who demands a CT scan. It's the 34-year old with gastroenteritis who gets a cardiac workup so the ER doc can defend against lawsuits. It's the guy who gets his nose broken in a fight, and get a facial CT scan despite the fact that it changes nothing in his management.

People get all sorts of tests for non-emergent conditions. Part of the problem is defensive medicine. But the other half is that, when people aren't paying for what they're getting, of course they're going to take the CT scan or MRI that is "offered" to them, without really listening to whether or not it is needed. If non-emergent conditions were dealt with on a cash basis, the guy who twisted his ankle 20 minutes ago might actually listen when you explain why an x-ray really isn't necessary right this second. But if he doesn't have to pay a dime for the x-ray, what the hell does he care? He wants it, and (unfortunately) he's going to get it.

I don't know what field you're going in to, but at some point you should start asking yourself what level of free care you're going to be comfortable providing. I'm doing ortho, and I have to tell you, Panda's blog about "Would you come in for the drunk femur fracture?" really hit home. I suspect I would come in for that case, just because of the severity and immediacy of the injury. But what I won't do is a SLAP repair on the 25-year old who never bothered to get insurance and has no intention of paying me for my time.

And before you bring it up, no, I won't be doing elective cases on kids either, unless their parents pay up. I feel for kids, I do, but I'm not validating poor parenting by working for free.

No offense, but I think you're reading way too much of your own rationale into his blog post. For one thing, his post actually places blame on the very sick for the high cost of health insurance, while making no mention of defensive medicine. "It has to be this way because health insurance is a ponzi scheme with hordes of investors at the bottom of the pyramid paying the dividends of those at the top who are, in this case, the extremely sick and the uninsured."

By mentioning the ponzi scheme he's alluding that the whole thing is a scam where the very sick and the uninsured are the con-artists ripping us off. Now, the uninsured claim one may be able to defend, but it's more than a little absurd to suggest that our healthcare cost problems are because there are very sick people, since the only actual solution to his complaint would be to not burden the rest of the populace with the cost of their care, which is only possible by simply not giving them care (as any government solution would also burden the populace, which is Panda Bear's complaint).

I'm all for addressing the cost of defensive medicine, although I will say that defensive medicine itself isn't what's causing to the rapid rise in healthcare costs (since it's fairly obvious we haven't increased our use of defensive medicine anywhere near the levels that our healthcare costs have grown). It's definitely an area where we can trim costs though.

Anyways, I don't disagree that we should limit the unneccessary tests being ordered, but that's because I mostly don't disagree with your post. If you are suggesting however, that only having catastrophic coverage would solve our healthcare cost problems, again I'll point out that individual patients have no leverage whatsoever against hospitals, and hospitals can and DO charge patients far more than their negotiated rates with insurers. So while a patient will be less likely to demand random uneeded tests when paying out of pocket, it's not going to bring down their costs if the hospital charges them 400% what they charge insured patients for the same tests.

OK, now I am actually getting too tired to keep posting here, so I bid you all good day.

 

[Tired]

No offense, but I think you're reading way too much of your own rationale into his blog post. For one thing, his post actually places blame on the very sick for the high cost of health insurance, while making no mention of defensive medicine. "It has to be this way because health insurance is a ponzi scheme with hordes of investors at the bottom of the pyramid paying the dividends of those at the top who are, in this case, the extremely sick and the uninsured."

Well, there is something to be said about the inordinate expenses incurred by the elderly and close-to-death set. We do waste huge amounts money on expensive diagnostics for people who are, for all intents and purposes, basically already dead. In a perfect world it would be easy to say no to a lot of these people, but from a practical standpoint it is difficult to envision where to draw the line, what constitutes a life worth extending, who would make these decisions, etc.

You may be right, I may be reading too much into Panda's blog, I don't know. But I suspect that he is grapling with the same issues everyone else in medicine is: Who do we say no to, and how do we decide? His solution seems to be, "Give them what they pay for." For a lot of people this is heresy, but I'm actually a lot more sympathetic to this viewpoint than most. Something will need to be done eventually, and there is something mildly appealing about letting market forces decide who gets care, rather than government bureaucrats and politicians.

Don't get me wrong, I'm not endorsing his viewpoint (assuming I am reading him right; my appologies Dr. DevilDog, if I've failed to summarize accurately). But I do get it, and at least he doesn't have his head shoved in the sand, pretending that everyone can have everything and we should be happy "serving the community" while going into default on our loans.

 

[8744]

So I'm guessing you opted out of your residency's health plan, and pay cash for your childrens' vaccinations?

I can't. They won't let me, or rather they will let me but they won't give me the money for it so there is no point opting out. It costs the hospital a good bit of money but it only costs me about 53 bucks a month which is like stealing...except I pay for it because the real cost is money that they could pay me. I would have done it in a heartbeat at Duke where the total cost of my health insurance, according to Duke anyways, (but it was kind of squirrely because they "self insured") was close to $11,000. In no way did we come close to this in actual expenses.

I also payed $350 per month for the privilege.

I looked into it. A decent major medical policy would have cost us a little more than $3000 per year.

 

[8744]

Well, there is something to be said about the inordinate expenses incurred by the elderly and close-to-death set. We do waste huge amounts money on expensive diagnostics for people who are, for all intents and purposes, basically already dead. In a perfect world it would be easy to say no to a lot of these people, but from a practical standpoint it is difficult to envision where to draw the line, what constitutes a life worth extending, who would make these decisions, etc.

You may be right, I may be reading too much into Panda's blog, I don't know. But I suspect that he is grapling with the same issues everyone else in medicine is: Who do we say no to, and how do we decide? His solution seems to be, "Give them what they pay for." For a lot of people this is heresy, but I'm actually a lot more sympathetic to this viewpoint than most. Something will need to be done eventually, and there is something mildly appealing about letting market forces decide who gets care, rather than government bureaucrats and politicians.

Don't get me wrong, I'm not endorsing his viewpoint (assuming I am reading him right; my appologies Dr. DevilDog, if I've failed to summarize accurately). But I do get it, and at least he doesn't have his head shoved in the sand, pretending that everyone can have everything and we should be happy "serving the community" while going into default on our loans.

Oh no, you hit all the high points. Cirrus need to to read Parts One and Two. It is a series, after all.

 

[8744]

No offense, but I think you're reading way too much of your own rationale into his blog post. For one thing, his post actually places blame on the very sick for the high cost of health insurance, while making no mention of defensive medicine. "It has to be this way because health insurance is a ponzi scheme with hordes of investors at the bottom of the pyramid paying the dividends of those at the top who are, in this case, the extremely sick and the uninsured."

By mentioning the ponzi scheme he's alluding that the whole thing is a scam where the very sick and the uninsured are the con-artists ripping us off. Now, the uninsured claim one may be able to defend, but it's more than a little absurd to suggest that our healthcare cost problems are because there are very sick people, since the only actual solution to his complaint would be to not burden the rest of the populace with the cost of their care, which is only possible by simply not giving them care (as any government solution would also burden the populace, which is Panda Bear's complaint).

I'm all for addressing the cost of defensive medicine, although I will say that defensive medicine itself isn't what's causing to the rapid rise in healthcare costs (since it's fairly obvious we haven't increased our use of defensive medicine anywhere near the levels that our healthcare costs have grown). It's definitely an area where we can trim costs though.

Anyways, I don't disagree that we should limit the unneccessary tests being ordered, but that's because I mostly don't disagree with your post. If you are suggesting however, that only having catastrophic coverage would solve our healthcare cost problems, again I'll point out that individual patients have no leverage whatsoever against hospitals, and hospitals can and DO charge patients far more than their negotiated rates with insurers. So while a patient will be less likely to demand random uneeded tests when paying out of pocket, it's not going to bring down their costs if the hospital charges them 400% what they charge insured patients for the same tests.

OK, now I am actually getting too tired to keep posting here, so I bid you all good day.

This is not obvious at all. Estimates of the cost of defensive medicine are sheer conjecture. It is almost impossible to measure. I believe, and this is just on my gut feeling so if you have a better gut I'm all..um...ears, that it is well more than half of everything we do.

 

[DocBR]

Philosophically, if you structure a society to encourage freeloading, freeloading is what you will get. The people may be ignorant but they're not stupid.

While I am not a physician (yet) I have seen this enough times to be slightly bitter about it. A few years ago I went to the ED in an ambulance, unfortunately for me in my haste to pass out and hit my head on a rock I forgot that I did not have my updated insurance card in my wallet. After getting to the hospital I was checked over briefly and placed in the hallway while they called my mother to go to my apartment and get my insurance information so that they could verify eligibility before doing whatever scan they needed to do. After all was said and done there was a 2 1/2 hour period before I was told my information was verified and I would be getting the scan.

About a year after that I began volunteering at the very same hospital; time and time again I would see some patients sidelined with fairly legitimate reasons for being in the ED while others with strep throat, sinus infections, migraines, etc were seen, prescribed and bounced out. The only difference between the two types of patients was one type looked like they could pay for insurance and thus were side lined if they did not have proof of coverage, and the other looked like they could not/would not and were expedited through.

What really irritates me about the situation is, I've gotten strep throat, and when I do I suffer through it until I can get in to see my primary care doc - but that is because I do not want to pay an extra 80$ copay at the ED.
But in the end, if you don't plan to pay your bill anyway, a cheratussin prescription on a Saturday at 6PM sounds a lot better than waiting until Monday to visit the free clinic.

 

[Depakote]

I am not not negative. Just realistic. Medicine is nowhere near the simultaneous, mutually gratifying orgasm that pre-meds on SDN think it to be.

I'll have you know that I'm only entering medicine for self-gratifying purposes.

 

[Eric Lindros]

No offense, but I think you're reading way too much of your own rationale into his blog post. For one thing, his post actually places blame on the very sick for the high cost of health insurance, while making no mention of defensive medicine. "It has to be this way because health insurance is a ponzi scheme with hordes of investors at the bottom of the pyramid paying the dividends of those at the top who are, in this case, the extremely sick and the uninsured."

By mentioning the ponzi scheme he's alluding that the whole thing is a scam where the very sick and the uninsured are the con-artists ripping us off. Now, the uninsured claim one may be able to defend, but it's more than a little absurd to suggest that our healthcare cost problems are because there are very sick people, since the only actual solution to his complaint would be to not burden the rest of the populace with the cost of their care, which is only possible by simply not giving them care (as any government solution would also burden the populace, which is Panda Bear's complaint).

I'm all for addressing the cost of defensive medicine, although I will say that defensive medicine itself isn't what's causing to the rapid rise in healthcare costs (since it's fairly obvious we haven't increased our use of defensive medicine anywhere near the levels that our healthcare costs have grown). It's definitely an area where we can trim costs though.

Anyways, I don't disagree that we should limit the unneccessary tests being ordered, but that's because I mostly don't disagree with your post. If you are suggesting however, that only having catastrophic coverage would solve our healthcare cost problems, again I'll point out that individual patients have no leverage whatsoever against hospitals, and hospitals can and DO charge patients far more than their negotiated rates with insurers. So while a patient will be less likely to demand random uneeded tests when paying out of pocket, it's not going to bring down their costs if the hospital charges them 400% what they charge insured patients for the same tests.

OK, now I am actually getting too tired to keep posting here, so I bid you all good day.

Are you even in med school yet? Assuming you aren't.....I'm not saying it doesn't give you the right to debate, but I think you are in a little over your head here. I find it funny that you are fighting so hard to defend a stance that you haven't even begun to experience.

If my assumptions are wrong, I apologize.

 

[Tired]

Are you even in med school yet? Assuming you aren't.....I'm not saying it doesn't give you the right to debate, but I think you are in a little over your head here. I find it funny that you are fighting so hard to defend a stance that you haven't even begun to experience.

I'll chime in and say that I don't think this makes any difference at all. Cirrus isn't arguing with Panda over factual issues that would be better clarified with further clinical experience. He is arguing public policy, which is fair domain for everyone, regardless of their level of experience. Assuming there is a general level of agreement on what is happening in medicine, I don't think a med student or resident is particularly better equiped to come up with solutions than a layperson.

 

[Eric Lindros]

Cirrus isn't arguing with Panda over factual issues that would be better clarified with further clinical experience. He is arguing public policy, which is fair domain for everyone, regardless of their level of experience.

I would argue that you cannot fully understand the scope of the situation unless you are actually experiencing it first-hand.

 

[Tired]

I would argue that you cannot fully understand the scope of the situation unless you are actually experiencing it first-hand.

Then students and residents should have no standing either, given our lack of involvement with the business side. Ditto for patients and other taxpayers. Even insurance company execs shouldn't have a say, given their lack of clinical experience.

 

[schooltill30]

Without even trying to broach the subject of healthcare costs, I'll just say that of the numerous doctors I have spoken to about their field, none of them were cynical, negative, or otherwise unsatisfied with medicine. I mean, I've been to doctors who weren't the cheeriest of people, but, hey, who said we have to be smiling and singing every day of our lives? Some people have bad days, weeks, months, etc.

 

[Tired]

I'll just say that of the numerous doctors I have spoken to about their field, none of them were cynical, negative, or otherwise unsatisfied with medicine.

Thanks for the morning laugh!

 

[schooltill30]

No, really, I'm serious. Nobody has been negative about it. I guess I got lucky...

 

[8744]

I think Cirrus is very intelligent, well-spoken, can justify and explain his opinons and is perfectly qualified to offer them. If he wants to comment on my blog he is welcome and nobody is going to be other than respectful (I enforce this) even if we disagree.

 

[MonkeyNuts!]

Curious... are doctors in real life as cynical, biting, sharp-witted, and pedantic as the people on these forums? While members of online forums everywhere exhibit those qualities, I feel like SDN really "shines" in that regard. Of course I'm generalizing, but there seems to be an unusual amount of, say, correcting other people's grammar, OP basing, and cynical humor. And let's not forget the misogyny!

I realize these forums aren't Candy Land, but boy, it feels kind of oppressive sometimes... like I really need to choose my words carefully. Just wondering if anybody feels the same way. Thanks.

You can't be serious... SDN is like one of the most passive and civil forums I've been on. Most people on here wouldn't last a day on Bullshido or Sherdog. They even have censors for curse words here. And the treatment of noobs here is like a stay at a five star hotel in Malibu.