Letter to the Editor on Health Care

 Posted by on 6 February 2007 at 6:53 am  Health Care
Feb 062007

Last week, I wrote a letter to the editor for the Rocky Mountain News responding to Paul Campos’ column on “myths” about American healthcare. It was published in full on the web, albeit apparently not in the print version. Here it is:

Paul Campos (“Our Sickly Healthcare,” Jan 30) notes the enormous influence of the government on America’s ailing market for medical care. Yet he misses the obvious: government meddling is the fundamental source of those ills. His proposal for more government-controlled medicine–for socialized medicine–would be a disaster for medical providers and patients alike.

Already, government bureaucrats set prices by arbitrary fiat via the Medicare system, then overwhelm doctors with paperwork and regulations. Already, consumers are encouraged to pursue medical care without regard for cost, thanks to tax laws encouraging employers to provide medical insurance for even routine expenses. Already, taxpayers are burdened with the cost of ever-growing medical entitlement programs. Already, FDA regulations drive up the cost of life-saving drugs and prevent doctors from prescribing drugs known to be safe. The result of that government meddling is an expensive bureaucratic labyrinth that prevents healthcare providers–doctors, nurses, drug companies, hospitals, clinics–from providing the best medical care for the patient’s dollar.

The solution to these problems is not more paternalistic government regulations, bureaucracy, and entitlements. It is to allow–and require–people to take personal responsibility for their own health by separating medicine and state.

Diana Hsieh

I was pretty pleased with the letter, particularly with the fact that it didn’t take me too long to write. (RMN allows comments on letters; so please post away!)

The forces of socialism are gearing up to impose government-controlled medicine on Colorado, so I expect to be writing more on this topic over the next year and a half. (I’ll say more about all that later.)

Socialist Medicine

 Posted by on 30 August 2006 at 12:12 pm  Health Care
Aug 302006

Paul just sent me the following:

The California legislature has approved a bill to mandate universal (state-run) health care in [California]; eliminating private insurance. We’ll see if Schwarzenegger vetoes this one.


“On a largely party-line 43-30 vote, the Assembly approved a bill by state Sen. Sheila Kuehl, D-Santa Monica, that would eliminate private medical insurance plans and establish a statewide health insurance system that would provide coverage to all Californians. The state Senate has already approved the plan once and is expected this week to approve changes that the Assembly made to the bill.”

Holy socialism! I’m glad that Paul isn’t practicing medicine in California any longer, because he certainly wouldn’t practice under such a system.

As for the likelihood of a veto, the article also reports, “Schwarzenegger’s office said it had no official position on the bill. The governor has said he would propose solutions to the state’s health care crisis in his State of the State address next January if he is re-elected.”

Tasteless Medical Slang

 Posted by on 6 August 2006 at 7:20 pm  Health Care
Aug 062006

After a busy weekend on call at our Level 1 Trauma Center, I thought I’d post some examples of classic medical slang. Here’s a related list, with a more UK flavor. And of course, there’s a Wikipedia entry. Most of these terms are never used in front of patients, for obvious reasons.

Angel lust: a male corpse with an erection (not uncommon). Is also sometimes used to mean death that occurred during intercourse.
BFH: Brat From Hell, usually accompanied by PFH, i.e., Parent(s) from Hell
Bobbing for apples: unblocking a badly constipated patient with one’s finger
Bury the Hatchet: accidently leave a surgical instrument inside a patient.
Code brown: Incontinence-related emergency
DBI: Dirtbag index, which is calculated by the number of tattoos on the body multiplied by number of recentmissing teeth, to estimate days without a bath
Donorcycle: motorbike, the biggest cause of donated organs!
FTF: Failure to fly, for attempted suicide victims
GPO: Good for Parts Only
Journal Of Anecdotal Medicine: The source to quote for less than evidence-based medical facts
N=1 trial: Polite term for experimenting on a patient
Neuro-fecal Syndrome: S**t for brains
Organ recital: A hypochondriac’s medical history
O-sign: Found on the very sick patient who lies with mouth open. Precedes Q-sign
Q-sign: Following the O-sign, it’s when the terminal patient’s tongue hangs out of their open mouth
Rule of five: If more than five orifices are obscured by plastic tubing then the patient’s condition is critical
TFBUNDY: Totally f*cked but unfortunately not dead yet. Best avoided in the medical notes
TUBE: Totally unnecessary breast examination
UBI: Unexplained beer injury, for all those hungover people on Sunday mornings with black eyes or swollen knees and no idea how they’d got them
Whopper with cheese: Fat woman with yeast infection

Although this sounds suspiciously like an urban legend, there is a supposedly true story of one doctor who had scribbled TTFO (“Told To F*** Off”) in a patient’s chart. When the case later went to trial, the doctor was asked by the judge what the acronym meant, and luckily for him he had the presence of mind to say: “To take fluids orally”.

How To Choose A Career In Medicine

 Posted by on 12 May 2006 at 12:00 am  Health Care
May 122006

This pretty much says it all. (Via Respectful Insolence.)

The Hippocratic Oath

 Posted by on 16 September 2005 at 1:00 am  Health Care
Sep 162005

It is commonly thought that doctors swear the Hippocratic Oath. However, Paul never swore to anything like this:

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Paul vaguely remembers swearing to this modern version upon graduating medical school instead:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Boy, is that ever a snoozer! Surely it’s no longer necessary for doctors to promise to forebear taking sexual advantage of the slaves in the houses of the patients they visit. (After all, what doctor makes house calls these days?!?) Still, an oath with a single inspirational purpose would be more appropriate than that disjointed list of nags.

Medical Education

 Posted by on 28 August 2005 at 9:15 pm  Health Care
Aug 282005

In the comments section, Marnie recently asked,

What is Paul’s specialty please? How many years out of school is he? Does he still recommend the business? [I start post-bac pre-med classes in 3 weeks.]

In response to Marnie’s questions:

1) My field is diagnostic radiology, with subspecialty interests in trauma/emergency radiology and orthopedic radiology.

2) My education consisted of 4-years college (i.e., pre-med), 4 years medical school, one year laboratory research at the NIH (National Institutes of Health) in Bethesda MD, 4 years residency in diagnostic radiology, and one year of additional clinical fellowship training in MRI (magnetic resonance imaging) with emphasis in advanced orthopedic radiology.

Since then, I’ve been in practice for 11 years, both as a faculty member at the Washington University School of Medicine in St. Louis (3 years) as well as 8 years of private practice (3 years in San Diego, and 5 years now in Denver.)

3) I still recommend the field provided that one finds the actual science and art of medicine interesting in their own right. In that case, the various b*llsh*t elements related to government regulations are tolerable, at least for the time being.

I personally find the field intellectually fascinating. Plus the technology is advancing at an exciting pace.

During my daily practice, I get to deal with people who are for the most part very rational (at least with respect to work), goal-directed, and efficacious. Most of my day is a constant use of reason (both induction and deduction), applied directly to issues of ultimate value, namely another person’s life. In terms of job satisfaction, it’s hard to beat this combination.

Since a lot of people don’t know exactly what a modern radiologist does, I thought I’d explain in a little bit more detail what I do and what I like about my job.

There’s nothing I enjoy more than solving a diagnostic mystery by taking a set of subtle and apparently disconnected findings from a patient’s x-rays, CAT scans, and MRI’s, and integrating them in order to arrive at a correct diagnosis.

Similarly, I enjoy performing invasive radiology procedures (so-called “interventional radiology”) where I use real-time x-ray imaging to guide a needle to a target within a patient’s body (avoiding all the critical nerves and blood vessels), in order to either perform a biopsy or deliver a dose of medication to exactly the right spot in as pain-free and safe a fashion as humanly possible.

Advances in imaging technology allow radiologists to perform procedures in the x-ray suite that 20 years ago would have required much riskier open surgery. Interventional radiology is like playing a video game, but where the stakes are much higher (as are the rewards).

Colorado is a very outdoors-oriented state, and hence a lot of people enjoy activities like skiing, snowboarding, mountain biking, rock-climing, etc. Hence, if you were to take a bad fall on the ski slopes at Aspen or Vail and hurt your knee, it would be me who would interpret your MRI scan and tell your orthopedic surgeon which structures were torn and which were ok.

Or if you were to get into a bad car accident in the middle of the night and were helicoptered to our Level 1 trauma hospital, it would be me who would read your emergency CAT scans and tell the trauma surgeons which organs were critically injured and needed immediate repair, which were less critically injured (and still needed attention, but not immediately), and which structures were ok.

I think I have one of the coolest jobs in the world. It was a long road to get to the point of being able to practice independently as full-fledged board-certified physician, but it was well worth it in the end.

Medicine is an extremely varied field, and there is a branch of medicine that should suit nearly any personality type. For instance, some people enjoy high-pressure specialities that require quick-decision making skills like trauma surgery, whereas other people like slower paced puzzle-solving fields like pediatric endocrinology. Some people enjoy fields with a lot of patient contact like family practice, others prefer fields with minimal patient contact like pathology. Hence, Marnie, you should be able find a field that suits your interests and temperament.

I wish you much success and happiness in your studies, Marnie. If you have any further questions about medical education, I’d be happy to answer them, either here or via e-mail.

Killing Us Not-So-Softly

 Posted by on 24 August 2005 at 8:17 am  Health Care
Aug 242005

I’m feeling a bit ill this morning. I’m not surprised, since I just read Malcolm Gladwell recent article advocating socialist medicine. Apparently, my husband should be sold into slavery so that a few idiots with rotting teeth can smile again.

I’m quite serious about socialist medicine meaning the enslavement of doctors. If our government ever voted itself control over our health care, doctors would not be permitted to practice medicine except under the terms dictated by government bureaucrats. My husband would be told what treatments he could offer, what equipment he could buy, what fees he could charge, which patients he can or must accept, and so on. If any of his patients wanted to pay him more for some safe and effective treatment unacceptable to the government, he could not offer it. (He would be exploiting their need!) If too many doctors refuse to work under those conditions — as I know Paul would — the government could follow the lead of Pennsylvania by requiring doctors to ask for permission to quit, retire, or move to another state. Of course, some doctors would welcome socialist medicine, but such happy slaves are still slaves.

Given the well-known disasters of socialist medicine — like ever-rising costs, long waits for diagnosis and treatment, substantial lags in technology, treatments not offered, and so on — for an intellectual to pretend that “universal health care” would simply extend our high standard of medical care to all is inexcusable.

Certainly, much is wrong with our current health care system. Yet all the serious, chronic problems are rooted in our decades of government intervention. The government has substantially distorted the market with its massive regulatory schemes and ever-expanding welfare programs. For example, the unprecedented use of employer-provided health insurance to cover normal, expected medical expenses is a direct consequence of government wage freezes during World War II. For example, since insurance companies determine their payments based upon the arbitrary fee schedule of Medicare, doctors are paid very poorly for reading those all-important mammograms, even though they assume a huge malpractice risk in doing so. The solution to these kinds of problems is to eliminate the source government intervention, not to increase it.

My mood was slightly improved upon re-reading Leonard Peikoff’s excellent essay “Health Care is Not a Right“. Altruism, collectivism, and statism drive the engine of change for socialist medicine — and so the battle must be fought in moral terms. Economic arguments about the practical effects of socialist medicine are a helpful adjunct, but by themselves, they lapse into absurd irrelevance.

Canadian Health Care

 Posted by on 20 March 2005 at 8:00 am  Health Care
Mar 202005

This recent article on Canadian health care shows how badly things have deteriorated. Some choice excerpts:

A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: “If the person named on this computer-generated letter is deceased, please accept our sincere apologies.” …The patient wasn’t dead, according to the doctor who showed the letter to The Associated Press on condition of anonymity.

Americans who flock to Canada for cheap flu shots often come away impressed at the free and first-class medical care available to Canadians, rich or poor. But tell that to hospital administrators constantly having to cut staff for lack of funds, or to the mother whose teenager was advised she would have to wait up to three years for surgery to repair a torn knee ligament.

“It’s like somebody’s telling you that you can buy this car, and you’ve paid for the car, but you can’t have it right now,” said Jane Pelton. Rather than leave daughter Emily in pain and a knee brace, the Ottawa family opted to pay $3,300 for arthroscopic surgery at a private clinic in Vancouver, with no help from the government.

Defenders of the Canadian system call it the “most moral and most cost-effective health care system there is in the world”. As proof of its morality, they make the argument that it’s good because there’s no contamination by self-interest. The website for this group, Friends of Medicare, is very explicit on this point in their FAQ:

Why shouldn’t I be permitted to buy medical treatment for myself and my family?

The Moral Answer

Let’s turn the question around. If you can afford the treatment for your grandchild, but your neighbor cannot, what justification is there for denying your neighbor’s grandchild timely treatment? Is your sick grandchild more deserving of help than your neighbor’s grandchild? This gets to the heart of the moral question; and it gets to the heart of the basic value represented by our compassionate Canadian Medicare System. The basic principle is that a person has the right to the best medical care available regardless of ability to pay.

As appalling as the answer is, at least they are totally clear on the moral underpinnings of their policies, as well as the practical consequence – you should not be able to buy better health care than your neighbor, since it goes against the moral value of egalitarianism. One obvious corollary would be an eventual ban on people buying better food their their neighbors even if they can afford to do so, because there’s no justification for you to have something your neighbor can’t. It may seem far-fetched now, but so would the current position of the “Friends of Medicare” just a generation ago. (The FAQ also glosses over the fact that buying something for oneself is not the same as “denying” the same thing for your neighbor – this is just another example of the “fixed pie” fallacy in action.)

The article also details a number of bizarre unintended consequences caused by the perverse incentive system of Canadian health care. For example:

…That’s one way the system discourages the spread of private medicine — by limiting it to nonresidents. But it can have curious results, says [orthopedic surgeon Dr. Brian Day].

He tells of a patient who was informed by Ontario officials that since Ontario couldn’t help him, they would spend $35,000 to send him to the United States for surgery.

Day said his Vancouver clinic could have done it for $12,000 but the Ontario officials “do not philosophically support sending an individual to a nongovernment clinic in Canada.”

The rest of the article describes various Canadians’ desires to somehow reform the system, while retaining the egalitarian nature. Given the unsoundness of the underlying premise, all I can say is “Rotsa Ruck!”

Suffusion theme by Sayontan Sinha