The Truth About Doctors



One of the advantages of being home sick for a month is that you get to see a lot of doctors.  I got to hang out in doctor's offices so much in January that it was almost as though I was working in one.  By spending so much time there I got to listen in on conversations between the staff and see how things really work.

This is my last week off from work.  Next Monday I get to go back to the office and put my repaired knee back to good use.  That's OK, because after a while even being home from the job gets to become boring. 

That's not to say that the last five weeks have been a complete waste. I got to do stuff I wouldn't otherwise have time for, such as frequently working on my blog.  I also got to hang out in a lot of different medical offices and listen in on the shop talk.  It's amazing what you can pick up by listening and observing.

When I went to the pulminologist on Tuesday, the place was packed.  I mean there was standing room only.  I asked one of the nurses what was up when I finally got in the back and she said that the people were all changing their appointments from Wednesday to Tuesday because they wanted to beat the ice storm.  New Jerseyians in general and the sick and elderly in particular are terrified by inclement weather.  I mean nothing either packs a supermarket or clears out a doctor's office like a New Jersey snowstorm.

I then got to see the doctor and got to discuss the results of my lung lavage.  He had to call the lab because they sent him the wrong report, without the information he was looking for.  When he got the results, it was just that I have simple chronic bronchitis which is a buildup of mucus in the lungs which gives you a chronic cough.  Nothing to worry about.  His solution:  he will order a nebulizer, which is a machine which pumps a medicated mist into the lungs.  He says that will clear out the mucus and make it easier to breathe.

What is going on?  Back when I was a kid, my family doctor told my mother that I had chronic bronchitis and was prone to getting something called the croup.  His test was simple.  Get out the stethoscope and listen to the lungs.  His remedy was to just put up with it,  Nothing really can be done, but you can take some cough medicine if the problem gets bad.

I went through life like this until I started coughing like I belong on a lung ward and my supervisor sent me to the doctor to bring back a note on what he could do about the problem.  My primary doctor sent me to a pulminologist.  I been to a few of them and also to ear, nose and throat doctors about the same thing over the course of my lifetime and no definitive answers.

So now I have been going to the same lung doctor for about four years and I still cough.  He came to the same conclusion that the old coot that my mother took me to when I was a kid came to.  The old guy was old in the early 1960s which means he graduated from medical school around 1910 or 1920.  And he came to the same conclusion that the modern specialist, with all his fancy tests and equipment came to.

Its just that it took the specialist about four years and perhaps $20,000 to get there.

Fact is that medicine is a business, and modern doctors are out to make money, plain and simple.  Can't blame the doctor.  He went to school for many years and has a lot of overhead because he has to rent the office and pay his staff and buy all the equipment.  You have a different agenda.  You just want your problem fixed.  You really don't care what it costs, after all it is all just insurance money.  You don't mind undergoing all those tests.  The insurance company is paying for them.  The inconvenience and discomfort many be worth it if modern science can assist the doctor in providing a solution.

But in many cases you don't get much real relief.  However, the doctor makes a lot of money.  Ever notice that when you go to see a specialist, you always have some condition that his speciality is qualified to fix.  I went to an ear, nose and throat doctor about the cough.  He wanted to operate on my nose to repair my deviated septum and open up my nasal cavity to get rid of my post nasal drip.  My lung doctor says my throat is clear and I don't have post nasal drip, but I do have sleep apnea and required sleep studies and a CPAP machine from a company affiliated with his practice.  It also looks like I can use a nebulizer from the same company, put probably will have the same problems afterward.

Fact is, doctors don't want to cure you.  If they did, you wouldn't come back.  What they want to do is manage your condition, so you get some relief, but still need their services for life.  Then you keep coming back again and again forever.

The tendency of specialists to want to fix almost any problem with some solution within their speciality so they can make money off you is why managed care health plans require you to get a referral from your primary doctor before going to a specialist.  The primary's job is not to cure you, but to make an unbiased guess on what condition you have so they can send you to the right doctor.  That way, you don't get the fellow in the picture above trying to fix you up.

This leads me to the second problem, which is insurance companies.  Private insurance companies should not be in the health insurance business at all because they have a conflict of interest.  The less care they provide, the more money they make.  Not good for you and not very good medicine.

One way insurance companies can save money is to cut reimbursement rates, or what they pay doctors for treatment.  That is a big problem in the physical therapy business because it interferes with their ability to provide decent care.  The therapy place bills at top dollar, but the insurance company doesn't pay that.  They pay what they want to.  Each company is different.  Horizon Blue Cross  managed care plans are notoriously bad payers.  Aetna is somewhere in the middle.  Blue Cross Traditional Plan is the best, closely matched by traditional Medicare.

One gimmick insurance companies have in the physical therapy business is they pay their full rate for the first exercise, three-quarters for the second, one half for the third, one-quarter for the fourth and nothing for the fifth exercise.  Some companies will also only pay for therapy to one body part each day, so if two parts are injured, you have to go to therapy on alternate days, one part or each day.  Stupid perhaps, but true.

Doctors have a way of fighting back against these tactics.  You pay me less per patient and each patient gets less time.  We'll keep up our revenue by pushing people through like cattle.  My therapy place so far has resisted this trend.  I get a full two hours per session.  But they say it is happening elsewhere.  They bill the same, but some places only do a half hour per patient.  Now you know why your doctor is giving you the impression of rushing you out of his office.  This makes it hard for him to figure out what is wrong with you.

Isn't the American healthcare system great!  Very expensive and not always very good.

Personally, I'd rather try to stay healthy in the first place by eating right and going to the gym.