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How Much Does A Colonoscopy Cost?

 One would think that a physician who earns his living billing patients would be conversant with the prices of his services. Not this doctor. I am queried periodically by patients asking how much I charge for a colonoscopy. Of course, every physician recognizes that this question is not phrased properly. It doesn’t matter what we charge; it’s what an insurance company determines we will be paid. I might believe that your colonoscopy was worth a thousand bucks, but those who pay the bill have a different sense of its value. Many ordinary folks think that we doctors can simply raise our prices to enrich ourselves. Physicians cannot do this. The hardware store and the supermarket can raise prices in response to rising overhead and market forces, but we physicians cannot. While I realize that the public does not sympathize with physicians who are lumped in with the 1%, a pejorative term popularized by the Occupy movement. The reality is that many private medical practices are struggling

The Plague of Unnecessary Antibiotics

With regard to antibiotics, physicians and the public have each been enablers of the other. Patients want them and we doctors supply them. There’s nothing evil about this arrangement. Antibiotics are one of medicine’s towering achievements and have saved millions of lives. Shouldn’t we prescribe them to patients who need them? Of course we should. But why do we prescribe them to patients who don’t? Before you race to the comment section to accuse me of being a self-righteous preacher, realize that throughout this blog, I have confessed my own mistakes and shortcomings, and will continue to do so. (Yes, many commenters have enthusiastically assisted me in this effort.) So, when I throw a stone at the medical profession, I am also in the line of fire. I have since the heady days of medical internship, been a conservative practitioner, preserving my soul even after completing training where medical overtreatment was worshiped. In medicine, less is so much more. I wish that more patie

Better Bedside Manners Heal Doctor-Patient Relationships

Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all.  We want them to be chimeras of Drs. House and Welby. But, is this possible? I can't say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was the overriding priority when I was in medical training. No points were awarded in our morning reports with the chief of medicine for holding a patient's hand during the night. Big win, however, if the intern could recite 14 causes of hypercalcemia.  The message was that 'hard medicine' is what really matters. Where's the bedside manners site?  The importance of bedside manners depends upon the specific medical circumstance at hand.  Good bedside manners may mean less if you are going to see a physician once for a procedure than it would if the doctor-patient relat

Accountable Care Organizations (ACOs) and Physicians: Are We Partners or Prey?

During my college years, we loved the album Bat Out of Hell by Meat Loaf. We would wail along with Meat Loaf as he screamed out his passionate interpretation of Paradise by the Dashboard Lights. Another memorable song on that album was Two out of Three Ain’t Bad, which offers an important lesson to those of us interested in health care reform. No, Meat Loaf was not a medical policy wonk who offered health care solutions via allegory in his ballads. It’s the song title that caught me as I read yet another article on accountable care organizations (ACOs). Take a look at this banal 3 word description. Accountable Care Organization These new organizations have much more to do with accountability and organization than they do with care . In other words, Two Out of Three Ain’t Bad. ACOs are another coercive mechanism to track and compare physicians using quality metrics that are far removed from true medical quality measurements. As practicing physicians understand, and government re

Secret Shoppers in the Doctor's Waiting Room- A Twist on Pay for Perfomance

Image Depicts Doctor'sWaiting Room Flow Plan On a prior posting, I opposed using secret shoppers to evaluation medical offices. I admit, however, that physicians’ office practices do need some healing. Patients who phone their doctor pray they will reach living breathing human beings, but often find themselves trapped in the expanding phone menu universe. Waiting room patient ‘flow’ can be stagnant. Getting medical records transferred, a reasonable and routine request, can test the mettle of even the most steeled and seasoned patients. Office staff, who are often multitasking machines, may be impatient with patients. I don’t need a secret shopper to make these diagnoses in my practice. We already know them and struggle to improve them. We have made progress where we could and tried to mitigate the damage when we couldn’t remedy a particular situation. Our most important resource of identifying our flaws is our patients. When they point out when we have missed the mark, they

Pay for Performance Attacks Medical Quality: Lincoln Lucks Out

Why does Pay for Performance (P4P) make most physicians reach for Maalox? I have devoted a good portion of this blog’s real estate to dismantling the fallacy that pay for performance improves medical quality. It’s easier to argue that this clumsy and robotic approach diminishes medical quality by incentivizing physicians and hospitals to game the system to maximize their quality scores. When an irritating high school student raises his hand and annoys the teacher with the inquiry, ‘is this gonna be on the test?, it is a forerunner of the concept of pay for performance. The Ivy League seeking student won’t study material that he knows won’t appear on the exam. Similarly, physicians and medical institutions will focus their attentions on achieving those outcomes that will be measured and graded, which might be at the expense of patients who ‘are not on the exam’. For example, if irritable bowel syndrome isn’t being measured, but GERD is, then will these patients be treated the same?

Supreme Court Upholds Obamacare: There's Order in the Court

President Obama enjoyed a towering victory days ago that I feel leaves the GOP reeling, although they are spinning the Supreme Court’s validation of Obamacare as a great gust of wind at their backs. While I would not have expected a different response from them, I fear that there is a developing wind that may blow them away in November. I offer this analysis as a tepid Romney supporter who will be voting more against Obama than I will be voting to support Romney. The phrase Obamacare is peppered throughout this blog. I was recently chastised by an unabashed whale-saving tree hugger that I should abandon this derisive term which detracts from my otherwise unvarnished objectivity. On the evening that the Supreme Court's decision was announced, I was watching CNN and its pontificating pundits. Various panelists were spewing forth verbal pabulum telling us benighted listeners what we were supposed to think. John King, the moderator, and many members of the spin squad all used the t