This is why medicine has a MASSIVE public relations problem, and why there really isn't much sympathy out there for us.
physicians have a PR problem because joe blow on the street all thinks we're millionaires. he believes that we all make a $1M+ per year. he believes that every time you go to the hospital, the doctor should pinpoint your exact diagnosis within 5 mins of meeting him. and, that no matter what the problem is, he should be able to walk out of that hospital cured. anything less is malpractice. that's the PR problem.
We SHOULD be advocating for equal access to health care for all Americans, but instead some of you are cheering that John Edwards' wife has incurable cancer... Yikes.
i'm not cheering for john edward's wife's diagnosis. i'm saying that we have a right to refuse who we treat electively, and i wouldn't give anesthesia to john edwards. this has little to do with his wife.
and, for the EMTALA regulations (which is what all of this "universal care" stuff is predicated on), no where does it say that everyone deserves the "gold standard" of care if they can't pay. we often provide this regardless. our mistake.
don't confuse the issues here. we can pick and choose our patients (well, not exactly as anesthesiologists). i shouldn't be responsible for the person who smokes for 40 years, has a bmi>40 and a ton of co-morbidities when they come to the hospital, say "fix me", get tens of thousands of dollars of care, get discharged because the DRG has expired, don't pay their share, and then show-up on the doorstep again 2 weeks later with the same exact problem. now, don't forget that same person can sue you at any time for any reason. they'll hire a contingency lawyer at no cost to them, and go on a fishing expedition regardless whether or not there's any merit (pre-marriage i briefly dated a girl who worked for such a plaintiff's attorney). there were no repercussions to this guy. most insurance companies would just pay a nuisance fee to make it go away. rarely, he'd have a legitimate case. (yes, there are a few, rare bad doctors out there. i do realize that too.)
you gotta ask yourself when are we actually going to effectively deal with this problem and how. because, there are a hell of a lot more people like this in the world with each passing day. the population is getting older and sicker. insurance companies are trying to cut reimbursements. everyone is squeezing the physician, part of which is based on the mixed-message PR we get in the lay media (saint vs. demon) and the perception that we're deep pockets. we either geniuses or idiots in the public's mind - no in between. and, i blame a lot of that on shows like datline nbc and the like. the media only tells the sexy stories, and they never tell the whole story.
everyone is looking for someone else to blame for their problems, be it the hospital or the physician. and, even if a lawsuit is completely bogus, often your insurance company will settle it out of court just to save costs. the system is broken. it's easy to blame the doctor. and, chances are it'll work regardless of merit.
i (as every physician should) treat all of my patients to the best of my training and ability. this includes the 4 a.m. gang banger i took to the OR about a month ago who told me post-op (paraphrasing without the expletives) that i "suck" as a doctor because he's permanently paralyzed from the waist down. did i shoot him in the spine? did i even perform the surgery? did i have a choice about dragging my ass out of bed and taking him to the OR for 3 hours in the middle of the night? no, i did my duty and we saved the guy's life. do you think we'll see a nickel of the probably $20k it took to patch him back together? take a guess. better yet, guess who's REALLY going to pay for that surgery. but, what's the real point of trying to explain all this to this idiot. instead, i'm just waiting for the subpoena. (and, you should see the note that i left in that chart... some of my finest work.)
as a profession, we gotta toughen up. at some point, though, we're going to have to start saying, "you need to pay a retainer or i'm not going to treat you." nothing changes until we convince the public that they have to take responsibility for their own health. and, the only way you can do this is by the "carrot and stick" approach, people need to be penalized for
abuse (yes, it's abuse) of the medical system and rewarded for taking care of themselves. right now, we have almost a marxist healthcare delivery model where everyone gets penalized. it's a herd mentality that just isn't working, and companies hire more and more administrators to force us to cut costs on our side - how do you think those administrators are paid? (i know; i used to work for one!) and now, the governator wants us to take money from our own pocket to pay for "universal" healthcare in california? why ANYONE would consider practising there is beyond me.
the bottom line: problem right now is, people erroneously believe their skyrocketing insurance premiums go straight into our pockets. the real education starts with making them realize that nothing could be further from the truth.