As I sat down and closed my eyes to block out the office, I drifted off into a daydream of scantily clad physicians and nurses cavorting through the ER. Each had a perfect body and sported a distant dreamy look as they passed one another in the hallway.
by Mark Plaster, MD
When you schedule a dentist appointment for the morning after a long night shift, you run a risk. If the dentist uses nitrous oxide, you will drift off into a deep pleasant sleep and not even remember the appointment. That’s the best scenario. But if he doesn’t, you can descend into the maze of Matrix (for the younger dreamer) or the torture chamber of Marathon Man (for us old Dustin Hoffman fans). This was a new dentist for me and I soon found out he didn’t have nitrous.
As I settled into Trendelenburg position in the chair, I closed my eyes and tried to block out the high pitched whine of the ultrasonic tool. High up in the corner of the room there was a TV softly injecting the days news stories into my subconscious.
“We have with us this morning Dr…” I focused on the water filling up in my hypopharynx. The suction tip hooked over the corner of my mouth wasn’t quite getting to the water and I was beginning to feel like I was drowning. “After the way this company has used sexploitation to sell their products to young people,” the doctor on the TV said, “I think this $10 million dollar gift is simply a way for them to try and ingratiate themselves in the public eye.”
“So, are you saying,” the reporter probed, “that the hospital should return the $10 million dollar gift to Abercrombie & Fitch or do you think that they just shouldn’t name the emergency room after the company?” Suddenly the words Abercrombie & Fitch, $10 million gift and emergency room pierced the fog of my mind.
“id thay thay Athercothie and Fiths?” I almost shouted as I flailed my way to the upright position. In my light blue scrubs I resembled a big blue marlin trying to shake the hook from my mouth.
“Dr. Plaster,” the hygienist drew back startled. “You’ve got the suction catheter stuck to your tongue.”
“Dr. Plaster,” the hygienist drew back startled. “You’ve got the suction catheter stuck to your tongue.”
I yanked the leech out of my mouth. “Did they say Abercrombie & Fitch gave $10 million dollars to get their name on an ER?”
“Uh, yeah, I think that’s right,” she said. “I wasn’t really listening.”
“That’s brilliant!” I murmured as I gazed off into a picture of the future.
Uh, doctor,” she said apologetically. “Do you mind sitting down? I’m almost finished here.”
“Oh, yeah,” I mumbled. As I sat down and closed my eyes to block out the office, I drifted off into a daydream of scantily clad physicians and nurses cavorting through the ER. Each had a perfect body and sported a distant dreamy look as they passed one another in the hall.
“What did they give you back there?” my wife asked as I met her in the waiting room. “You’ve got a goofy grin like they loaded you up with some drugs.”
“You won’t believe what I just heard,” I said excitedly. “Abercrombie & Fitch is giving some hospital $10 million bucks to get their name on the ER. Wouldn’t that be cool if our ER could do something like that?”
“Oh my gosh,” my wife groaned. “You’re having one of your ‘Walter Mitty’ moments again. Don’t tell me. You think the ER could become one big Abercrombie & Fitch commercial.” I hate it when she reads my mind.
“Really,” I argued with a commercial glint in my eye. “Think about it. If we opened up the ER to advertising, we could make a fortune. We wouldn’t have to worry about collecting from the patients. Heck, we could all have our own sponsor.
“Hey, Michelle could be sponsored by Victoria’s Secret and I’m sure Bob could get a contract with Anheuser-Busch. Think of all the millions the drug companies spend on TV advertising. If they sponsored a doctor, think how much more ‘bang-for-the-buck’ that is.”
“Oh, yeah,” she mocked, “you could be sponsored by Viagra.”
“There’s no reason to get ugly,” I pouted. “You have to admit it’s an idea that has merit. Everybody is advertising something. The other day I read an article online that Ron sent to the paper that described the damage that lawyers were doing to health care system. Right next to the article was an advertisement for a malpractice attorney.”
“You’re kidding me, right? You can’t be serious about all this. You better let me drive home. Your drugs haven’t worn off yet.”
“Seriously,” I argued. “I’m as sober as a rock. If an advertiser can be on the outside of the hospital, why can’t they be on the inside? And if a hospital can benefit from putting a commercial advertiser on its building, why can’t a doctor benefit from putting a commercial advertiser on his body?”
“Are you suggesting that doctors should look like NASCAR drivers?”
“Well, not exactly,” I said somewhat sheepishly. “But it wouldn’t hurt anybody to have a little commercial logo on my lab coat?” I shrugged waiting for her response. “Do you have any idea how much Nike pays Tiger Woods just to have their symbol displayed on his cap?”
“But you have a position of respect,” she said plaintively. “You can’t use that to hawk a product like some TV home shopping channel guy.”
“Hey, it’s a new age for medicine. You can see a nurse practitioner in a Wal-Mart who will prescribe a drug for you that is sold by her employer. But doctors and hospitals can’t own their own retail pharmacies. That would be a conflict of interest. Drug companies can spend millions to tell patients to ask their doctors about drugs they don’t need, but I can’t accept a sandwich from a drug rep while he tells me about his drug’s latest research. Medicine needs to move into the 21st century, baby.
“Besides, all that advertising money could go into lowering the patients’ cost of care.” I spoke as if my logic was water tight.
“But isn’t the cost of advertising one of the reasons that drug companies have had to raise their rates so astronomically on new drugs? And haven’t you always said that it is advertising that makes people want things that they don’t need and probably wouldn’t buy otherwise?” I hate it when she uses my own words. “Let’s go home and feed you so you can get some sleep. You’ll feel better when you wake up.”
I sulked over the breakfast table as I tried to come up with something to defeat my wife’s logic. Finally as I prepared for bed and threw on an old sweat shirt it came to me. Emblazoned across my chest was the word GAP.
“Look at me,” I yelled from the bedroom. “I’m a walking billboard. I’m wearing a huge advertisement for GAP. I bought this sweatshirt. But by all rights GAP should be paying me to wear it!”
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“Go to bed,” she shouted back from the kitchen. “I’ll go to the mailbox to see if you got any royalty checks.”
Mark Plaster, MD, Founder/Editor-in-Chief of Emergency Physicians Monthly
16 Comments
The point of this article is to discuss common reasons people cite to keep a mortgage rather than paying it off. The math, however, can be illogical. For example, it really isn’t fair to compare the PREtax stock market return in the first year to the POSTtax interest rate. But these are reasons I have heard in the media, the general population, and even financial advisors. So the next column will turn this reasoning on its head.
I think your writings are realy great. I look forward to seeing and reading them first after the paper comes. I wish many more of our people would have half of your coments and wisdom. Your series makes my day.
Would the more liberal, gracious people of Qatar accept a Jewish emergency physician?
Greg, Couldn’t agree more, although I think a lot physicians would like to do/order less.–Dan
I would not focus so much on the age of our population. Japan has an older population than the US, yet its health care costs are considerably less. The waste of our resources and disorganization of the system are the real culprits.
You are right on. Several yrs ago when my children were learning to drive I proposed that DL eligibility be linked to GPA and auto and oil companies be allowed to advertise and support education and schools by sponsorship of books, equipment, etc. Same could work in the ED: Auto makers advertising auto safety features in the trauma rooms; OCPs, condoms, planned parenthood and the churches in the pelvic rooms; toy companies in the peds rooms; wgt programs, gyms, personal trainers in the cardiac rooms. Advertisers wouldn’t even have to donate the department, just a room or a wall or a poster. Great Idea. People need something to read while they wait anyway.
Working too many long hours makes us dingy. It’s a joy to read your satire with its many complex underlying themes; considering sleep deprivation, the influence of commercialism in medicine, and even the weird effects of dental care.
UPMC has already had a Jewish physician work for us here in Doha and there did not seem to be any problems. Dr. Ginsberg was here and back to the US before I started so I did not observe this first hand. However, my partners report there were no problems at all. Qatar is one of the few Arab countries to recognize Israel and while there are strong opinions here about all things Jewish, (and Christian) the people are tolerant. The same holds for my working with the 3 Cuban doctors here. We take care of patients and leave the politics to the politicians.
I thoroughly enjoy your column.
We as physicians are placed in a very difficult position. On one hand we all want to maximize our profitability, rightly so, it is the American way. On the other hand if not counterbalanced by some sense of what is right and wrong it can lead to unbridled greed.Superimposed on that is the direct concern of patient’s expectations and medical liability. I am certain I order testing ,scans etc on patients for completely potentially low yield reasons. But here I am , I get paid alot of money for it , the patient expects it and if I do not do it and miss something I get sued for it. Then there is the other side of that coin, once in a while I actually find something that we can help them with. So even though I order five venous doppler studies for every one DVT I find . I still find some DVT’s and that is a good thing . Frankly I do not know the answer to this paradoxical situation. I do the best I can but I also make alot of money for doing it.
Dear Setu: I have long known of your grasp and deep understanding of money matters. This article shows your real depth and ability to make a good and unbiased case for your subject thesis. I liked it a lot. Will look forward to reading next month’s column. Are you a regular columnist now? Is it just this or any other magazine also? Love to all in the family..
Keep your good insight spreding around..Sanatmama..
Dear Greg,
I agree with you that the only way to save medical care in this country is by allowing the free market to operate. I also agree with you that it is “insurance”, the third-party-payor system, that prevents this from happening.
The third-party-payor system leads to over-demand for medical care by making medical care artificially cheap for patients. At the same time, it causes under-supply by artificially holding down the rise in fees that would signal that more care is needed. This over-demand/under-supply then squeezes economically marginal seekers of care(the “uninsured”) out of the market altogether. In addition, the third-party-payor system introduces tremendous waste and inefficiency in the delivery of health care in the form of coding, billing, claims adjudication, arbitrary rule-making and regulation, and general bureaucratic overhead.
However, I disagree with your assertion that medical care cannot be delivered by the same market mechanisms that provide every other need and want to Americans in tremendous variety and abundance.
You say that patients will not be able to make choices about what health care to purchase because they will only be able to follow our advice, unquestioningly. When your car needs repair, do you simply tell the mechanic to “do whatever you think best” or do you ask how much the repair will cost, what are the alternatives, how much will the mechanic down the block charge, etc? The only reason patients don’t ask these kinds of perfectly appropriate questions about a proposed course of diagnosis or treatment is that they don’t care because they don’t pay. And when they do have to pay, believe me, they’ll ask. All of us every day make successful, meaningful decisions about the use and purchase of complex, technically advanced services and devices. There is no reason, especially with the good advice of a physician who is focused on the best interests of the patient, that people cannot make good decisions about their medical care. Furthermore, they will be healthier and better off for having taken that responsibility on themselves.
Your other argument against a market model is the “dependency ratio”. However, this problem will simply disappear when medicine is paid for by the patient rather than the taxpayer.
The third-party-payor system has been a disaster for patients and doctors. Expecting someone else to pay for your medical care is no more economically workable (or morally justifiable) than expecting someone else to pay for your groceries (let alone Cafe Des Artiste). No amount of tinkering, half measures, or wishful thinking will fix it. Nor should we expect ANY politician to do anything except confuse and pander to the public for votes. It is time to focus clear and rational thought on how to dismantle the system and transition to the market.
Did this law apply to On-call specialists who provided emergent care i.e. plastic surgeon who had to take pt. to surgery or treat in office the next day? And, if so, has the state’s ED’s seen an improvement in the specialist’s willingness to take call or their responsiveness. Have the specialists seen a decrease in their liability also?
In my position, I have daily interactions directly and through our other offices around the world, as we address the needs of both international expats and travelers. The industrial and financial worlds may be first class, but medicine lags seriously behind in many areas of the world. I have found that EPs around the globe strive to do the best with what they have, but the knowlege base is often lacking.
One of the major differences between diagnoses in the medically developed and underdeveloped countries is:
– In the developed world, doctors are often trying to find every possible diagnosis and treat it – we seek out the unusual and obscure and rejoice in finding it. This is a means to recognition and respect from our peers.
– In the undeveloped world, doctors are trying to make the most treatable diagnosis. Successful treatment is a means to recognition and respect from their patients, and their professional survival.
This is admittedly an overly simplistic summary of a highly complex situation. Over the past several weeks, I have been traveling throughout SE Asia ith my family, through countries with world class healthcare (Hong Kong, Thailand)as well as some of its worst (Vietnam and Nepal).
I am grateful for those who share their knowlege, as the Chinese proverb goes:
“Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime”
let me hear it from the horse’s mouth. . .
One of the biggest advantages of paying off your mortgage early is peace of mind. Once you’ve paid it off, you’ll wake up every morning and fall asleep every night knowing that the roof over your head is 100% yours. For many people, you can’t put a price on that sort of security. [url]http://www.prime-targeting.com[/url]
Beyond the comfort/security aspect, paying off your mortgage early is a bit like locking in a guaranteed investment return. For every dollar that you pay early, you’re “earning” the interest that you would’ve otherwise paid on it over the balance of the loan period. This sounds great, right? Well…