tag:blogger.com,1999:blog-5883634615775822475.post7065564331017217304..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: Games People PlayGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger48125tag:blogger.com,1999:blog-5883634615775822475.post-56849511199855342432009-10-23T11:04:06.505-04:002009-10-23T11:04:06.505-04:00I wish you both a safe and happy Halloween.I wish you both a safe and happy Halloween.The Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-80758559737239414692009-10-23T10:59:20.667-04:002009-10-23T10:59:20.667-04:00I won't bother to argue with Happy. As someone...I won't bother to argue with Happy. As someone pointed out yesterday on another post:<br /><br />Don't wrestle with a pig in the mud: you get dirty and the pig enjoys it.Grumpy, M.D.https://www.blogger.com/profile/09858110332436246760noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-57098139080140883062009-10-23T10:57:52.137-04:002009-10-23T10:57:52.137-04:00"I take care of just about everything in the ...<i>"I take care of <b>just about everything</b> in the hospital everyday, in one way or another without subspecialty assistance. And my complication rates are 1/3 of the expected..."</i><br /><br />Arrogant + ignorant = happy. <br /><br />nuff'said.Science Marches On Departmentnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-76408775165406961382009-10-23T10:45:18.577-04:002009-10-23T10:45:18.577-04:00Arrogance? Nice. My comments are based on my 10...Arrogance? Nice. My comments are based on my 10 years of experience in working with neurologists in my community. In fact most neurologists have no interest in taking care of TIAs. To be dragged away from their office to "see another TIA". Why just the other day, I talked with a neurologist whom the ED had consulted for possible "stroke alert". When the ED determined they weren't a TPA candidate, we were asked to admit. I called the neurologist after my evaluation and told them I have it under control and they don't have to see. They said thanks.<br /><br />Exactly what do you think internists are capable of managing independently if not TIA? Honest question, since the thought of an internist not being able to manage TIA independently is rather hilarious.<br /><br />I take care of just about everything in the hospital everyday, in one way or another without subspecialty assistance. And my complication rates are 1/3 of the expected severity adjusted rates. My mortality rate is 1/2. And I save almost $2,000 per discharge compared to other internists. <br /><br />You can call me arrogant. I call it excellent care. And I have the data to back it up.The Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-90411747846969118122009-10-23T08:54:36.485-04:002009-10-23T08:54:36.485-04:00The Happy Hospitalist wrote "I never consult ...The Happy Hospitalist wrote "I never consult neurologists for TIAs"<br /><br />His arrogance is inexcusable. Better outcomes are associated, in general, with greater training and experience. Outcome in stroke across medical specialties is well-studied. See Neurology. 1998 v50(6):1669-78. The finding: "Evaluation by a neurologist is associated with better survival for most patients ..."Science Marches On Departmentnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-82680852904603493922009-10-22T21:47:19.497-04:002009-10-22T21:47:19.497-04:00K, you are like a blogging superhero -- ever alert...K, you are like a blogging superhero -- ever alert to Happy missteps in the blogosphere. ;-)DreamingTreehttps://www.blogger.com/profile/09911536074688347584noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-56115492363136827912009-10-22T17:31:11.505-04:002009-10-22T17:31:11.505-04:00Happy's management of TIAs: "Exercise and...Happy's management of TIAs: "Exercise and avoid McDonald's". He no need neurologist to tell patient run! 80% of strokes are preventable with diet and exercise, as he says...<br /><br />It's almost like he believes that stuff too.Nurse Khttps://www.blogger.com/profile/06408755992926959084noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-92921270187512352009-10-22T17:05:34.124-04:002009-10-22T17:05:34.124-04:00>>And many get into it to help people, and b...>>And many get into it to help people, and between student loans and family and life discover that it's not the financially solvent field it used to be, and then do anything desperately to make a buck.>><br /><br />This is the group I personally find most frightening.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-42869656048773272762009-10-22T16:10:07.865-04:002009-10-22T16:10:07.865-04:00Where's Nurse K when you need her?Where's Nurse K when you need her?DreamingTreehttps://www.blogger.com/profile/09911536074688347584noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-57907945817189145842009-10-22T15:44:14.272-04:002009-10-22T15:44:14.272-04:00If doctors get more money for not ordering stuff o...If doctors get more money for not ordering stuff on patients in the 1990's and that kind of care is bastard care, how about fee for service care were the neurologist only has to "order two EEG's a day to pay for my overhead".<br /><br />As one neurologist once told me. <br /><br />Fee for service that results in unnecessary care just as bad and that care is rampant. <br /><br />Even the neurologist has a car payment every now and then.<br /><br />By the way, any payment model that links length of stay to compensation is illegal. I doubt event the hospitalist knows what they were talking about.<br /><br />I never consult neurologists for TIAs. I find their care expensive and rarely helpful on most occasions. That's not to say they don't have something to offer every now and then. Just not that oftenThe Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-376096665756986132009-10-22T11:39:37.171-04:002009-10-22T11:39:37.171-04:00I'm starting to feel there are two kinds of do...I'm starting to feel there are two kinds of doctors in our country:<br />1. Those whom the system has defeated and who, to survive, have to resort to all these games to keep up, let alone stay ahead.<br />2. Those who are saying "I'm outta here" and are looking for other more sane ways to make a difference and a living!<br />I know I belong to the latter.<br />Have I missed any other kind?Philippa Kennealy MD MPH CPCC PCChttp://www.entrepreneurialmd.comnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-55386397097486882362009-10-21T23:15:21.913-04:002009-10-21T23:15:21.913-04:00Great that you hung up. More power to you!Great that you hung up. More power to you!MCTnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-74241611391208269202009-10-21T23:10:44.613-04:002009-10-21T23:10:44.613-04:00Wow, Dr.G could you get booked for a few days on t...Wow, Dr.G could you get booked for a few days on the senate floor and try to relay some of your insights to the men in power. I worked at one of the original HMO's in California and this kinda of "payment/bonus" plan just kills me. <br />I understand the docs needs for cash but just where does fall in the hypocratic oath he agreed to?<br /><br />Hanging up was the perfect answer.<br /><br />Once again, you are my hero.jamiegirlhttps://www.blogger.com/profile/17344722771631497384noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-37578108806948572352009-10-21T22:04:10.743-04:002009-10-21T22:04:10.743-04:00Thanks so much for posting this! Gives lots to thi...Thanks so much for posting this! Gives lots to think about--don't see an answer readily apparent. But, this is just wrong. Stick to your guns Dr. G!<br /> CPAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-3241605353091675242009-10-21T21:25:38.287-04:002009-10-21T21:25:38.287-04:00First off, I don't live in the States but in G...First off, I don't live in the States but in Germany so I am used to a very different health care system. And I sincerely hope I will never have to worry about having health insurance. I have never been in the position where I actually depended on a doctor for my life yet but many people have.<br />I think the system in the States as it is is really bad. Too many people are without insurance, too many people delay doctor's visits until they are really really really sick because they don't want to fork out the money until they absolutely have to (and then their treatment is much more expensive).<br />I also think that probably doctors are too interested in money. Of course doctors do great work (well, unless they're bad doctors), but I also think that the job of a doctor is not comparable to any other job and I think people know that (or should know that) when they sign up for it. Someone on another blog (a doctor) said basically that no one else would work without getting paid (normal office jobs for example), but I do think doctors have the moral obligation to help sick people and they know that (hello, Hypocratic oath). Their job often decides between life and death. Most people can't say that about their jobs. Of course they should get paid for it, but I don't think that's even up for debate anyway.<br />I also think it's a problem that doctors in the US start out with (hundreds of) thousands of debt due to medical school, another problem doctors here don't have. Money just matters too much right from the start. For everyone involved in this thing that is the healthcare system (patients, doctors, insurance companies). I cannot even imagine being in the position you described where you actually have to call an insurance company to ask whether a necessary treatment will be covered! Here, for public health insurance companies, we have a catalog of treatments that are always covered if medically indicated (the decision lies with the doctor). So if my doctor decided I needed an MRI for something, my insurance would pay, no questions asked. I would never even see a bill nor would the insurance be informed of my treatment until they get billed for it.<br />I just started allergen immunotherapy which is probably the most expensive medical procedure I am undergoing in my entire life so far (well, in the long run), and all I pay is a copay of $15 on a $500 prescription (and I get two of those every 3-4 months for three years). This is a treatment generally covered by public health insurance so my doctor prescribed it and of course he did not have to ask my insurance about it. (This is in response to that post you wrote a while back about having to ask insurance companies for 'permission', I cannot believe the amount of time wasted on that by doctors and insurance companies day-in-day-out.)<br />This comment is a little all over the place, so I hope you can make sense of it anyway.Vivhttps://www.blogger.com/profile/16571250715197636482noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-40262043150649452562009-10-21T20:37:41.364-04:002009-10-21T20:37:41.364-04:00This is my first time commenting, and I want to st...This is my first time commenting, and I want to start by saying I LOVE your blog. You're absolutely hilarious. I'm a long time reader and have never commented before, but I felt compelled to comment now because of #5 on your list. My mother is a nurse manager and works at a hospital where there is no pay incentive to do such a thing, and even if there were I know she would never do that. While I don't disagree that there are some unethical nurse managers who do that, I would argue that the majority of them are forced to do it because they are understaffed and have no choice.a daughternoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-69542628332315246322009-10-21T18:48:21.142-04:002009-10-21T18:48:21.142-04:00Wow, that's really disturbing. I tend to be so...Wow, that's really disturbing. I tend to be somewhat idealistic in my expectation of how fellow professionals behave with respect to ethics, morals, doing the right thing... I'm really upset to hear about this.webhillhttps://www.blogger.com/profile/05938934194973454729noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-25639342689812081082009-10-21T18:45:04.594-04:002009-10-21T18:45:04.594-04:00How is pay for performance supposed to work betwee...How is pay for performance supposed to work between specialties? Seems to me as though the number of aspiring oncologists would undergo a drastic drop.Charleshttps://www.blogger.com/profile/04263878301793806625noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-51384541039048136552009-10-21T17:48:09.079-04:002009-10-21T17:48:09.079-04:00I wish something good could happen health-cover re...I wish something good could happen health-cover related for you all. The NHS isn't perfect, but it is always there.Fiznoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-19371425379063153532009-10-21T17:46:23.266-04:002009-10-21T17:46:23.266-04:00I'm late to the party....again....
So, Dr. Gr...I'm late to the party....again....<br /><br />So, Dr. Grumpy, thank you for this post....I just began Medical Assistant schooling and I am currently taking a class about medical office prodecure....we've been discussing all of the things it takes to run an medical practice...this blog post will be an excellent 'show and tell' in class on friday, as our teacher has been trying to educate us on how complicated things can be when trying to run a practice and be ethical and still make a living.<br /><br />I love this blog, I visit here everyday!<br /><br />♥<br />SAn Open Hearthttps://www.blogger.com/profile/01581361716412644419noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-62757150088223442512009-10-21T17:14:27.041-04:002009-10-21T17:14:27.041-04:00Glad you hung up on him!
Hope the health care fo...Glad you hung up on him! <br />Hope the health care for us turns around soon.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-74516821215193296562009-10-21T16:42:53.021-04:002009-10-21T16:42:53.021-04:00That's why I always refused to sign up for HMO...That's why I always refused to sign up for HMO's.Jenhttps://www.blogger.com/profile/12573262524755768643noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-73630503227329339002009-10-21T16:35:56.675-04:002009-10-21T16:35:56.675-04:00I am sooo glad you are posting about this!
Thank y...I am sooo glad you are posting about this!<br />Thank you thank you thank you!S3XinthePantryhttps://www.blogger.com/profile/11838007073775158370noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-59476782941097251862009-10-21T14:57:59.539-04:002009-10-21T14:57:59.539-04:00Livin in AmericaLivin in Americadannoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-39055378417337567532009-10-21T13:16:51.941-04:002009-10-21T13:16:51.941-04:00I'm not going to defend Dr. Hungry, but he is ...I'm not going to defend Dr. Hungry, but he is exhibiting perfectly normal and predictable human behavior in this situation. The basic problem is a system in which he is paid more for doing less. Can you think of any other profession in which this would even be considered?<br /><br />This is why I have always felt that payment systems like capitation and the one in this incident are fundamentally and unchangably unethical.Anonymousnoreply@blogger.com