I recently read a blog with which I can partly agree. (http://thesystemmd.com/?p=778) I agree with the idea that what is “free” is often misused or overused. That socialized medicine ends up being rationed; I’ve seen that happen. I know that people on Medicaid use ERs as personal physicians due to the long lines. I know many people are on disability because they’re substance abusers, they can’t get or keep a job due to the addiction, & are often involved in criminal activities that keep their potential earnings very low once they’re released from prison. After all, once you’re convicted of a felony, you can’t generally become licensed, certified, or bonded, even if you were at one time a highly paid professional with a license. But addiction isn’t a disability like losing a leg or having a disease that impairs your mobility & function.
I also know that chronic disease is expensive. It seems to me the way to fix this is to find definitive treatments & cures. Instead, we blame the patients, claim the disease is imaginary – & if the patient’s female, we have a whole bunch of other sexist things on which to blame their illnesses.
But while I agree with some of the blogger’s points, I disagree partly with how poorly physicians are treated. Yes, in some cases, they are. I have 2 excellent physicians who earn every cent they get paid 3 times over. Yet, they’re treated just like the ones who don’t give a patient the time of day. Or give them 5 – 10 minutes, & blame “slow pay, no pay” insurance reimbursement practices & denials for the reason why they cram many more people into the waiting room than they can possibly care for.
Maybe if doctors listened, assessed, & quit blaming patients for their illnesses, they would actually earn what they get, like my physicians do. Instead, the perception that doctors get rich for being lazy is “proven” in the public mind repeatedly by some of the practices I have listed below in my response to that blog. Unless the blogger has dropped my comments, you’ll see them on the link above.
I don’t say the blog isn’t worthwhile or that there aren’t valid points. But there is a heck of a lot that, in my opinion, that blogger missed.
And I am tired of letting people get away with that without calling them on it, especially since I am sure they’ll have no hesitation on calling this female on things I’ve said with which they disagree heartily. So here we go with an expanded/edited version of my comments. Just in case…
I made several suggestions for why physicians are often seen as part of the problem, especially by women.
1. Physicians need to quit treating every illness for which they have no definitive tests, treatments, or cures, as if they are the fault of a lazy, good for nothing person who doesn’t want to work. Or that the patient isn’t ill but is instead a hysterical female. Or maybe, a “goldbricking” guy who doesn’t want to work. Or a malingering veteran of military action who wants to live on disability their entire life – and who had the unmitigated gall to enlist & serve in military action with which the physician disagrees.
Maybe some of us would like to, oh, WORK with at least fewer symptoms (preferably cured)? Maybe that’s why we keep “bothering” your Royal Highhandednesses? You know, you could treat us so we can work…what’s wrong with that option? And by treat, I don’t mean put us in mental hospitals or send us to shrinks. I mean find the physical problem & treat it.
Unless, that is, your MD degree is also “all in your head” & therefore not real?
2. Before you get on the admittedly large “behinds” of obese patients, consider some facts: There are people in 3rd world countries, who can’t find one meal a day, who are obese & diabetic. How do you get that their obesity is the cause of sitting on the sofa with chips, soda, & candy, watching cable or satellite TV? That being so, how about you find a REASONABLE cure for obesity? Try following the viral disease model for a while instead of ridiculing those researchers who do so. Maybe they’ve got something. Or the ones investigating gastric hormones (the pity in that is their new treatment is to excise the part of the stomach that creates the appetite/store food as fat hormone – but eliminating a hormone is not a good idea because it will cause an imbalance – that’s just common sense).
3. Consider how “sucky” current so-called “treatments” for obesity have proven. We have pills. One of them makes people leak stool. Isn’t that a lovely picture? Would YOU take that? Then there are the ones who were removed from the market only after years of absolute proof that they ruin the heart worse than obesity would. Lovely. What is this, get thin or die time?
Then there are the surgeries, again, “get thin or die” time. Oh, please…cut up your insides, cause massive dehydration & malnutrition that have to be treated with expensive supplements & special meals for years? Then, after 5 years of telling the public that we’re saving healthcare dollars because these people don’t have to take blood pressure pills that cost maybe $30 a month, or diabetes pills at about the same cost, we have people lining up for this. How about the truth- the cost of those supplements, the treatments for dehydration, the horrific morbidity (disease burden) – massive infections & seeping wounds that cost hundreds, sometimes thousands a month to treat, for example, plus sometimes IV tube feedings that cost hundreds a week, or even just the repeated hospital ER trips for fluids IV because the patient can’t keep food or drink down, can only drink an ounce at a time anyway, because they can’t stop throwing up & having diarrhea? This exceeds by far the miniscule savings for blood pressure pills & oral antidiabetic pills. And since joint replacements are going to be needed anyway, don’t even think to count that in the “savings” column. So far, the balance sheet is very much in the red.
How about an option that doesn’t involve an expensive surgery which has good results for maybe 5 years, after which most of the doctors quit following these people? Those who do have found early osteoporosis, death of the cells in the hip joint (read: hip replacement), accelerated arthritis in all weight bearing joints (knee replacements, hip replacements, spinal fusions), & accelerated aging overall with resultant changes to the body’s organs (brain included). As their health goes down the toilet from rapid aging, what gets blamed Not the doctor, or the procedure. You see, you lose a max of 80% of your excess (not your total) body weight – and if you do the math for almost any weight, 80% loss usually means the patient’s still at least overweight, if not obese. Guess what THAT means? Yep. All that surgery & the patient’s still fat. And treated with the same disrespect with which they were treated before they had this “miracle” surgery. Not to mention, if insurance does pay for this 5 – 6 figure surgery & the complications, they also usually pay for the excess skin to be whacked off the belly at 10 figures’ cost. No place else but the belly, by the way - so the patient has all this heavy, excess skin hanging off their legs, arms, back, butt, etc. Attractive, huh? Unless you’ve got the cash for a lot of plastic surgery, you’re still gonna be ugly, so you’ll have to hide that now-thinner body so no one sees the droopy skin. So much for the beach…it’s gross, more so than the fat.
So the fat person gets less fat, spends about 5 yr. sick, spends the rest of their life aging prematurely, & probably dies earlier than they would from obesity.
But the doctors are making a fortune on this racket. No way are they going to kill the goose that lays the golden egg in favor of finding the real reason for obesity! Just keep blaming everything on “weak willed, lying, cheating fat people” & the weight. Belittle the patient. Eventually they will wear down & beg you to do the surgery. Then you can go ahead & force them to diet for 6 months, exercise & ruin their joints more, blame them for failure or else say they’ve lost enough to prove they really could lose weight if they’d do as they’re told. Have the insurer pay for expensive counseling from the people you recommend (a clear violation of anti-kickback rules disguised as collaborative practice), who will always say the patient’s OK psychologically so they get their “cut.” I’ve seen people who have borderline personality disorder, who should not qualify for the surgery, who’ve been given it & have made life miserable for all around them. There’s no change to the central problem there. Go ahead & let the counselors blame them & belittle them more if they’re mentally stable to start with, so you can prove they’re really mentally unstable (sure, by now they’ve been convinced they’re terrible humans & their only salvation lies in this drastic option). Then have your billing people get the insurance to cough up (knowing how much more you’re going to be able to charge for complications & getting rid of the belly skin). Put them in special “bariatric” units where people treat them nicely to their faces (for the tiny amount of time they can stand to be by the fat person), then laugh & make fun of them behind their backs. Ignore their complaints as “whining” until they come to the ER, nearly dead. Let’s not forget the free labor at home, provided by, usually, female family members – & the huge amount the insurance would have to pay if the person lived alone, for convalescent care. Blame them for their infections, vomiting, & diarrhea the same way you blamed them for the weight – obviously, they’re lying; obviously, they “cheated.” Yes, some did, but not all of them; most patients have one really bad bout of diarrhea or vomiting from disobeying the rules before they learn to do what they’re told. The only possible motive for obedience is the fear of being that sick again; they’re still going to be blamed for “cheating” when something goes wrong, so their motive can’t be pleasing the doctor. Don’t let anyone know that the dangers of a fat, malnourished weight loss surgery victim – yes, they’re victims – cause health problems that are far more expensive than the treatments the patient would get if they stayed obese. Keep that cost of healthcare high, and blame it on the problem instead of this half-baked “cure.”
And oh, yeah, make sure all those followup articles about weight loss surgery after 5 years are pulled unless they’re the ones who, rarely, support weight loss surgery instead of questioning it. I have seen more articles that question weight loss surgery claims disappear off Medscape than I care to think about.
4. Everyone says obesity causes diabetes. Well, I think it’s often the other way around; that diabetes does, in some cases, cause obesity, then manifests as a glucose metabolism disorder when what it causes (obesity) makes the body more dysfunctional. Here’s why: I know of a kid who was size slim, but in 1 year, without additional food intake or a reduction in activity, gained 2 sizes & went from slims to husky size. When he developed type I (not type 2, type 1) diabetes 6 yr later, the endocrinologist told his parents that he got diabetes that year he went up 2 sizes & from slim to husky in one year. That as the viral infection that triggered the autoimmune type 1 diabetes kept destroying his pancreas, it caused him to be unable to metabolize food & store it correctly, so he got fat. How about you follow THAT idea? What if type 1 AND type 2 diabetes cause obesity, not the other way around?
5. While doctors are all so compassionate about HIV/AIDS (which only happened after a lot of lobbying to get that changed around, by the way – most of it by nurses uniting with families & patients), remember that, with the exception of needlestick transmission & tainted blood, former Pres. Reagan was right: This the most preventable disease in the world. I don’t suggest abusing HIV/AIDS patients. But how about if you stop abusing people who are fat, or who have things like chronic fatigue syndrome or fibromyalgia. of Gulf War Syndrome, as if they are lazy. Show them the same consideration.
6. Women are automatically labeled as hysterics because they come to see you BEFORE their conditions become serious, because unlike you men, we have to keep going; we can’t sit on our butts in bed or the recliner, whining about colds, expecting to be waited on hand & foot – often by a woman who’s taking cold medications, cough medications, etc., to keep going & serve YOU while she suffers through aches & pains. Hey, that’s OK for the children – but if you need that much care from Mom, wife, sister, girlfriend, then hand in your Adult License - & your “Guy Card.” You’re a bonafide sissy. If you can’t take care of yourself with a cold without whining & being waited on, you should not be able to control the TV programming, drive a car, drink alcohol, or vote.
This abuse of women – and it IS abuse - is the reason why you don’t see men in your physician practice until they’re seriously ill most of the time - unless the wife hassles them to come in. You have built in servants/nurses in the women in your lives & theirs. Instead of being grateful, you’re a bunch of sanctimonious, sexist pigs – the doctors being the worst. Even female physicians, who can afford someone to care for their kids & elders, act as if their fellow female professionals in the workplace owe it to the world to work full time, take care of the house, & nurse everyone in their families to keep healthcare costs down – & not seek care for their own illnesses. When we get sick & need our share of the care, we get the bill, but not the treatment. We’re expected to nurse ourselves. Hey, news flash: If we nurse ourselves & everyone else in the family, we end up with chronic illnesses from stress & overexposure to untreated pathogens.
Women might as well wait until the last minute like the men do, though; we’re not really going to get the care for which we’re billed (as is our insurance - fraudulently, I might add, since you’re not doing a thing for female patients most of the time). We won’t get care until we’re dead or nearly so - & that’s provided we’re even believed at that time!
No wonder you see slow pay/no pay. Women process the claims & they know what care those female patients likely are NOT getting.
Yes, there are a lot of guy caregivers. They’ll all tell you they’re way outnumbered by females. They also get a lot more help getting respite care than most women do.
7. Oh, while we’re at this: stop with the “hysterical mother” stuff when moms are worried about their kids. There are way too many tales out there of kids who died because their mothers were ignored or even accused of Munchausen’s by proxy in some cases. Or that we’re “enabling” kids to be sick so we can keep them dependent on us. PUH-LEEZE! Like we need more caregiving responsibilities? We’re already considered free healthcare for the entire system, from sick kids to sick spouses to elder care. The bill to the healthcare system if women refused to do all this caregiving would run in the billions of dollars. You all get a huge free ride from women. The least you could do is actually try to find out what’s wrong with our kids when we ask for help.
9. Here’s another revelation: Not everything that’s wrong with a woman is related to the phase of menstrual cycle from pre-menarchal to post-menopausal, either. I just love it when a doctor tells me I wouldn’t have bronchitis if I wasn’t having a period, or fat, or – believe it or not – doing too much caregiving or working too hard. Or if my parents hadn’t smoked (I never did, but when I was first diagnosed with 2nd hand smoke problems, I was called a liar for saying I never smoked).
10. The men & women of the military may or may not see combat, but they have joined to serve & are always at risk of being called up into battle. I don’t give a hoot if you agree with the conflict or not. If the conflict came to your fancy office door, or your upscale exurban home, you’d be glad to have them helping defend you. Their action in Iraq, you claim, is for oil – yep, the stuff you use to drive nearly 100 miles one way from your exurb in your big gas-guzzling SUV – the one that you have to have because you’re a doctor & the weather can’t be allowed to stop you from getting to work. Hence the Hummer or the Range Rover, Escalade, etc. But you too often treat vets like garbage, following the example of a lot of military doctors who’ll get in trouble if the servicemember gets disability. Especially if they get out & need medical help but can’t get a job – & thus have no insurance & no way to pay you much money except in small installments as they get something. Or else they’re forced into the ER, where you call them GOMERs (Get Out of My E R, for the uninitiated). Jobless rates for vets are double digits; they’re worse than the horrid rates of unemployment & underemployment among the disabled. For all they’ve given us, we can’t even give them a job, we blame them for the conflict, & we kick them when they’re down.
In summary, you doctors have a lot to answer for before you start kvetchingn about fee cuts & socialized medicine/heatlhcare as a right. You are part of the reason for high costs, but NOT BECAUSE OF FEES – because you refuse to listen, to treat people (especially women) as if they are human beings instead of some sort of slave workforce for your pleasure. You bill for work you don’t do, & excuse it on the basis of slow pay/no pay. Because of this, & because you’d rather blame people for being sick instead of figuring out why, you are raising the costs of medicine sky high. Everyone knows preventing problems costs less than solving them. Take care of it early instead of blaming & the cost of medicine will go down.
I’m going to be harsh here, but it needs to be said. Quit kissing up to the AIDS lobbyists. Don’t ignore this terrible disease, but how about some research for some OTHER diseases? There are a lot of them. Like, oh, cancer? Heart disease? Lupus? Rheumatoid arthritis? Alzheimer’s? Parkinson’s? ALL of these diseases have had research dollars cut for decades, rerouted to AIDS research when the disease is mostly preventable. And diseases that have gone from being rare to being very common (Chiari malformation, chronic fatigue syndrome, fibromyalgia, & others) can’t get funding at all, or get a few thousand when the disease toll is costing the world millions per country. All in lost productivity.
Also, for all you embryonic stem cell lobbyists out there: Adult stem cells have done far more to treat these diseases. At last count, adult stem cells had helped 80 diseases. Embryonic stem cells, worldwide, have yet to cure even one illness, let alone ease the course of the illness & improve a patient’s quality of life. You’re not just blaming the patients, focusing on just one disease to the exclusion of others, but you’re also fixated on embryonic stem cells (which have a far higher risk of cancer as a side effect) when adult stem cells have far more documented proof they work. Thus, again, you are delaying an avenue that might treat, even cure, some of these diseases. After all, if the patient’s cured, where do you get money in a pay for sickness economy?
You’re right, Dr. Blogger, we pay for sickness & not health, but until you doctors are more vested in finding cures instead of blaming patients & collecting endless fees for doing so (as opposed to research for cures & treatments if cures aren’t available), you won’t change that.
Good health is both a right & a responsibility. When the body malfunctions, illness occurs. Blame doesn’t help; research, treatment, cures, those are what will help reduce costs & restore health.
Here’s one that everyone should hate: Quit blaming patients for getting cancer. You can blame almost anything: that they lived in the wrong place, had the wrong type of job, ate the wrong kinds of foods, didn’t have the right hobbies, worked in the wrong industry, stayed too close to people who smoked, cared for people with radium needle implants, worked doing imaging in a healthcare facility, served on a ship with asbestos…Cancer is caused by being alive, for Pete’s sake; quit blaming the patient. I’m a nurse. I’ve worked in many areas of endeavor, including oncology; I got so sick of hearing patients blamed for cancer I was ready to choke most of the physicians (as well as some of my nursing colleagues who blindly parroted the doctors rather than setting them straight), so I moved to another specialty. Remember the definition of stress: when the desire to choke the living crap out of some idiot who richly deserves it is overridden by ethical considerations (or the desire to avoid prison). There, I heard people who ran marathons & ate a vegetarian diet blamed for familial hypercholesterolemia – called liars when they weighed maybe 140 lb at a height of 6 ft tall – accused of eating everything fried. I have seen people who eat french fried junk food who have a normal cholesterol, & while the medical community now claims to be “enlightened” about that, I still hear the occasional person I know who has all the right health habits, blamed as “cheating” on their low cholesterol diet. Why? Because doctors don’t really know why some people have high cholesterol on vegan diets while others have normal levels on french fried diets. It’s easier to blame the patient.
We all know about people who want to pig out, smoke (although the stench alone makes me wonder why), drink alcohol to excess (when it tastes horrid), use substances of abuse despite the risk of jail & disease – but we never ask why. We did find genes that are only in people with certain addictions, but that’s where it stopped. In other words, find the cause, then find the cure. And hopefully, test it so you don’t have to pull it a couple years later due to the death & disability the medication’s caused.
Because it’s easier to blame the patient.
Tags: AIDS, alcoholism, Alzheimer's, attitudes toward mothers, blaming the patient, cancer, children's healthcare, chronic illness, chronic pain, cost of not having female caregivers, diabetes, disability, drug addiction, ER used as a primary doctor, female caregiving, gastric hormones, Healthcare Costs, heatlchare rationing, HIV, hormones, lupus, Medicaid, methadone, military service, obesity, obesity medications, obesity treatments, Parkison's, preventive medicine, reimbursement, rheumatoid arthritis, sickle cell disease, slow pay/no pay, smoking, socialized medicine, substance abuse, undertreatment of pain, veterans, weight loss surgery, women and heatlhcare
