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If this is surprising to you, you don’t really understand the purpose of the “US healthcare system.” It’s designed to 1) employ extra people through inefficiency & 2) make some millionaires.
Not to “deliver health.”
How do I know this? Because that’s what it does.
@EricTopol
Not to “deliver health.”
How do I know this? Because that’s what it does.
@EricTopol
If you think a private health insurance company is part of some ideal free market economy, you are a true sucker.
It’s protection money. Like you pay to a local gangster to keep from getting beat up.
It’s protection money. Like you pay to a local gangster to keep from getting beat up.
People who think US government health care spending is not sustainable have clearly never looked at the budget for the Department of Defense.
Medicare pays for
1) complexity and
2) procedures
Thus, your hospital census and OR schedule today.
1) complexity and
2) procedures
Thus, your hospital census and OR schedule today.
A hospital with an open bed is overhead without revenue.
An inpatient (or OBS patient) receiving care in the ER is extra revenue despite a relatively fixed overhead.
Every hospital administrator in America prefers an overfilled hospital to under-filled.
An inpatient (or OBS patient) receiving care in the ER is extra revenue despite a relatively fixed overhead.
Every hospital administrator in America prefers an overfilled hospital to under-filled.
Worrying about the US government debt incurred from healthcare spending (like Republicans used to do) is silly. Your paycheck has your name on it. The debt doesn’t.
As long as taxes stay low you’ll never have to give it back.
We need you to spend it because economic indicators.
As long as taxes stay low you’ll never have to give it back.
We need you to spend it because economic indicators.
20 years ago I could see 25+ patients in a day. Now that takes 2 doctors. This inefficiency is intentional. Everyone likes having a nice doctor for a neighbor. Now you get 2!
Medicare and @CMSGov don’t pay for health. They pay for notes. So many of us spend half our days making good notes for them.
The system could be built far more efficiently but who wants to put a nice doctor out of a job?
The system could be built far more efficiently but who wants to put a nice doctor out of a job?
If you’ve been surprised by any of this you really haven’t been paying attention.
This next part may be a little surprising...
This next part may be a little surprising...
The doctoring I do is actually invisible this system. Unmeasured and uncompensated. It’s actually a volunteer job—a hobby—I do in between generating notes for coders.
This used to bother me but I enjoy being subversive.
This used to bother me but I enjoy being subversive.
It’s fun to do the right thing and minister to the sick according to some ancient tradition and calling while I am supposed to be competing a 12 point review of systems and drawing a family tree.
I like doing this while I am supposed to be doing that.
#subversive.
I like doing this while I am supposed to be doing that.
#subversive.
While I document the necessary criteria for acute hypoxemic respiratory failure I also sit in a chair with the old fella and ask him to tell me a story.
Medicare never needs to know. There is no place to document this human connection. They couldn’t handle the truth anyway.
Medicare never needs to know. There is no place to document this human connection. They couldn’t handle the truth anyway.
In summary, I don’t doctor within the US healthcare system. I doctor in spite of it.
I generate a lengthy problem list to be thorough and reflect the complexity of the patient I am caring for.
Simultaneously I remove problems because patients want to leave with fewer not more.
I generate a lengthy problem list to be thorough and reflect the complexity of the patient I am caring for.
Simultaneously I remove problems because patients want to leave with fewer not more.
