Presidential Election…What’s At Stake For The Physician???

Thus far, I have withheld my personal opinion on Obamacare. If you have spent time on over the past few weeks you likely had the chance to watch the Kaiser Video on Obamacare basics. If not, you can find it here: Kaiser Obamacare

So, now that you know the basics, let’s think about this seriously. The true goal of Obamacare was not to get health insurance for all, rather, it was to cut the deficit. It is important to realize that deficit reduction is just as important as providing insurance for all. When a government provides insurance for the poor and the elderly populations of a country, they end up footing the majority of a nation’s the health care bill. In order to continue doing so, deficit reduction is necessary. Providing health insurance for all is simply an attempt to optimize the nation’s preventive care which will be a significant financial burden initially, but in theory promises to save in the long run.

We as physicians must understand that the Affordable Care Act will NOT be the panacea for our nation’s healthcare ailments. Hopefully it will lead to cost savings with its preventive strategies, but what it comes down to is that we as health care professionals must take ownership of the problems we created. We have become greedy, scared, and lost our sense of altruism. These are the reasons healthcare costs inflate at alarming rates.

Doctors need to be thinkers! What happened to “the history and physical exam lead to 90% of diagnosis”. If that’s true, why do most patients get labs and tests ordered? Not every disease requires 10 laboratory tests, EKGs, and X-rays adding up to 10 thousand dollars for one emergency room visit. This is simply not practical and certainly not sustainable. Yes, I do understand the concept of malpractice and tort reform, but that is no excuse for us not to use our brains in caring for patients. We have adopted a rule out strategy meaning that we rule out all other diagnoses. Hickam’s dictum is replacing Occam’s Razor (Look these up if you don’t know them. Necessary to be a good physician) and costing our nation billions of dollars. THINK!!! Don’t let the tests think for you!

What is at stake for physicians in this election? Well for me it’s nothing. Obamacare or not, I’m taking care of my patients to the best of my ability. I am also minding my public responsibility to utilize resources appropriately and contribute to cost savings. So, to offer my thoughts, I support the Affordable Care Act as I think it will force the nation to address issues that have been overlooked for decades. But in the end, I certainly am not counting on it to solve our nation’s healthcare problems; I am counting on You. PONDER THAT!!!

2 thoughts on “Presidential Election…What’s At Stake For The Physician???

  1. Profile photo of Dr. Toyo TrenouDr. Toyo Trenou

    Dale, I agree that we as physicians need to take part in reducing the cost of healthcare in this country. But it would be hard to accomplish without a real liability tort reform. This is more true in the emergency setting. There are many factors that contribute to costly ER visits. The reality of an ER visit is far different from one of an office visit. As an EM resident, I learned early that most patients are either unreliable or have unreal expectations when they present to the department. Can I figure out emergencies from non emergent conditions for the most part by simply performing H&Ps. You better believe it. But as we all know, not all patients follow the text books. I found myself a couple time catching some badness (a cervical spine fracture and an early appendicitis on CTs, both in 2 older kids), which were not supported by the histories or physical exams. As ER physicians, we would have much ground to stand on if we did not order those CTs and ended up in front of a Jury of “our peers” (whose level of education would be at the 8th grade level). The PCPs also need to take on the responsibility of educating their patients as to when to go to the ED. They should also make a greater effort to see patients in the office instead of sending them to the ER for low acuity complaints. The Emergency Department is for EMERGENCIES; not cold, sore throat or ankle sprain.

  2. Profile photo of Dr. DanielDr. Daniel

    Great topic Dale.

    I agree that as physicians we do need to sharpen up on physical assessment skills and practice medicine in a more cost effective and efficient way but liability remains a huge barrier. In this age of technology, patient’s come to ERs and clinics with so much information (sometimes good but many times bad) and expectations from their doctors. It seems easy to reject some of their requests if you feel it is unnecessary and document why but the truth is if there is a shadow of a doubt it is hard not to cave in. Many doctors have sleepless nights wondering if they should have ordered “that test”.

    We spend a decade or so studying medicine but learn very little about the law. At the same time there are many professionals out there that know the law and spend their lives watching our decisions.

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