From: km@speedy.cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: Do Doctors Give a Damn? The Other Health Care Crisis
Date: 27 Aug 92 22:11:29 GMT
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Organization: Computer Science Dept., University of Pittsburgh

In article <geavNhi00iUxQ3P258@andrew.cmu.edu> lc2b+@andrew.cmu.edu (Lawrence Curcio) writes:
>The physicians' lobby has made non-physician providers a joke. If you
>can see a NPP without first seeing a doc, then the NPP functions
>primarily as referral service for docs, and you wind up paying *more*
>money. Indeed, the NPP makes it possible for physicians to specialize
>more rigidly, and to charge higher fees, because the generalist isn't
>one of the club. On the other hand, if you can't see the NPP first, you
>have to pay off the doc to do so. Either way, the doc takes his/her cut. 
                                               ^^^ ^^^ ^^^^^ ^^^^^^^ ^^^
An excellent view of patient "consumerism" which unfortuantely is
shared by operators of HMOs in many cases: the patient is after a
product (tests and procedures) and the doctor is merely a necessary
evil in the process. You should be encouraged by the development of
"practice guidelines" which will effectively elliminate primary
care physicians within the next ten to fifteen years: all workups
will proceed by computer-run protocol, with data input from a 
technician, or the patient. The only need for physicians will be
to perform procedures. People interested in working with patients
and solving problems need not apply to medical school, as there
will be no use for them.

If this is your view of doctors and medicine, I am sorry. Perhaps
you have had some bad experiences with individual physicians. It
is probably not going to be possible for me to convince you that
the majority of physicians are very hard working people who try to
provide good care for their patients. 

Yes, we like to make a good living, and we don't see why we should
be alone among the professions in shunning this. Our initial incomes
during internship and residency are quite low, and we end up
entering the work force several years after most of our peers, with
fairly large debt. That doesn't make us all rich bandits. If you
need to know, I make $119K a year. That is with ten years seniority
and a chief's position in the VA. I am comfortable but not rich,
and money is not the focus of my existence. When I go to the
grocery store I watch prices and look for sales just like everyone
else. And when I go to buy something major, I make certain the
salesman doesn't find out I'm a doctor, because the price automatically
goes up in many cases if this happens.

>I would have to argue that insulation of the consumer by insurance is
>not the problem, but rather a bad fix of the real problem: not enough
>bargaining power in the medical marketplace on the part of the consumer.
>Insurance simply takes the consumer out of the economic decision loop.

This is simply not true: the patient has ALL the bargaining power,
because he or she doesn't have to pay in many cases. Do you have
any idea of how many people with simply tension headaches get
CT scans because they DEMAND them from their doctors? If they had to
pay even $50 towards the cost in many cases, they might listen to
their doctors explain why the CT isn't always necessary. People equate
tests and procedures with medical care, and this is sad. If you go
to the doctor and come back "empty-handed" (no tests, no prescriptions),
then the implication is that you should not have gone. The fact that
many things in medicine can be handled with a decent (long) history
and physical exam, some inexpensive tests if necessary, and some
medical deduction, appears to be totally lost on the new consumerists.

Medicine is dying a slow death, but I am sure that people like you
will hasten its demise.

 -km