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Thursday, April 9, 2015

What Doctors Really Think (Maybe You Don't Want to Know)


If you want to learn our deepest thoughts, join an internet physician forum. Medscape and Sermo host the largest, but dozens exist. They restrict membership to physicians, but any intelligent person can figure out how to join. Think carefully before trying, because you may not like what you find.   

Most forums divide posts into clinical and nonclinical. The clinical section discusses treatments, techniques, and difficult cases. I find these stimulating; many doctors know their stuff.

Nonclinical posts deal with running a practice, patients, colleagues, and politics -- mostly health reform. I pray they don’t represent a cross-section because most forum doctors – say 80 or 90 percent – are extremely conservative and obsessed with money. Also, they don’t much like patients, cash payers excepted. For insured patients their feelings are ambiguous; they seem to believe that using insurance is a sign of weakness; real men pay real money.

They detest anyone on welfare. One persistent theme is the prosperity of Medicaid patients. They arrive in Cadillacs, own Iphones, wear expensive clothes. Since accepting charity shows a flawed character, they are irresponsible, demanding, rude to staff, needy, fond of drugs. The single mothers make an appointment for one child but bring them all (to these doctors, a single mother is the patient from hell).

Paradise is a cash-only practice, no insurance accepted. These are impractical except in wealthy areas, but doctors love to chat about them. If you can’t sign onto a forum, google “concierge practice” for a creepy dose of these doctors’ heaven.

They hate health reform. They despise President Obama. They also hate insurance companies and malpractice lawyers, opinions I share. They see lawyers as Americans saw communists during the 1950s:  (1) evil and (2) much cleverer than we are. As an example of cleverness, lawyers bill for phone calls. It drives forum doctors crazy that they can’t do the same. “We’re running a business,” they argue. “We’re providing a service! We should charge for it. Sensible patients won’t object!”

They hate insurance because billing requires complex paperwork for less reimbursement than they’d like. Scores of carriers exist, all with different policies, exclusions, and requirements; sensible doctors pay a fulltime employee to handle billing.

Now and then a na├»ve doctor wanders onto these forums with the identical question. Why, instead of billing innumerable carriers, don’t we bill one: the government. It would be simpler and cheaper. Private carriers keep ten to forty percent of premiums as expenses; Medicare keeps five percent. This is called the “single payer” system. Some physicians but almost no Congressmen support it, and mentioning it on a forum is a red flag. The innocent doctor is probably stunned to read an avalanche of abuse.

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