How to lose friends and win enemies

And here we have a couple of nice neat bullet-shaped packages given out by a self anointed nerd antisocial MD PhD who has developed drscore.com, a website where doctors are scored and rated by patients and/or peers.  These are tips to APPEAR more empathic. Not to actually become empathic, heaven forbid. You just have to look like it...sick sad world...

• If there’s no parking for the patient when they arrive for their appointment, they think you don’t care about them. So you’ve got to have a good parking situation.
• If the staff is rude when the patient calls to make an appointment, they think you don’t care about them.

Other ways of interacting with patients that convey empathy:

• I schedule a lot of patients per unit time so I run to the door of the room and when I get there, I stop. I open the door really slowly so patients will think, “Oh, he’s in no hurry,” which is part of being perceived as caring.
• I make a big deal of using the alcohol on the wall to cleanse my hands, because when they get in the car and drive home and they’re listening to a spot on National Public Radio talking about doctors who don’t wash their hands, I want them to remember that, “Dr. Feldman used that alcohol and protected me because he’s a caring doctor.”
• I try to sit down, look patients in the eye, shake hands and introduce myself to everybody in the room.
• I try to connect with patients and establish rapport

- See more at: http://dermatologytimes.modernmedicine.com/dermatology-times/news/takeaway-how-positively-influence-patient-adherence#comment-5544

Does this guy think everybody is a 5 year old with such superficial (and creepy) observations such as "the doctor cares about me because I used the hand sanitizer". Most people are too sick, tired, dazed to notice. Also, hand sanitizer tends to be 99% alcohol and is highly flammable, thus not recommended if you're goig to use heat generating devices on a patient. Old fashioned soap and water first and ALWAYS you knob!!!!

Data mining is nothing new. It's become a forced issue in medicine because data is seen as the gateway to everything--patient volumes, scheduling, payments, procedures, the daily flow of work.
Doctors have time-limited board certifications. In essence this is a good thing, to ensure that physicians maintain high standards and excellence in their fields by continually self-education and training, because medicine is an ever changing and advancing beast that requires life long study. I became board certified in 1998 and then I re-certified with additional at-home independent study and testing--which was quite lengthy--in 2008. However, in the past 5 years or so, Maintenance of Certification, or MOC, has become linked with endless self assessments on patient safety, patient communication, peer review, and patient/customer surveys which must be filled out and then analyzed by a third party in order for the physician to maintain board certification.
Sort of how you get online surveys from hotels or stores after you purchase something? The same thing is happening in medicine. How happy or glowing would a survey be from a patient who had to go on water only for 48hrs due to pancreatitis? Or a patient with cognitive dysfunction post-stroke? Silly rabbit, tricks are for kids. It doesn't matter. Give the patient a lollipop or a small token of gratitude and they'll be happy to fill out a survey.
The patient, or the peer/colleague filling out surveys, isn't asked about the correct diagnosis or treatment. The surveys' content hinges around the customer service experience-- the "pleasingness" of office decor, the friendliness and responsiveness of staff, the accessibility of parking, the phone call to the office to make the initial appointment, and even whether the electronic health record meshes well with the colleague's electronic health record, or inter-operability of electronic technology.
I recently filled out a survey for a colleague wishing to maintain board certification. I kept a copy for my records. The survey asked me to rate the friendliness of the office staff, how well was I able to get referrals from the doctors, the overall ease and convenience for patients to see that doctor--i.e. location, parking, payment policies (!). How the fudge is this relevant to the medical service provided? What about doctors in downtown New York or Miami, where there is zero parking? How about doctors that don't participate in any 3rd party payors, are they to be penalized for going cash only? BY THE AMERICAN BOARDS OF SPECIALTIES???
Silly rabbit, we have fallen down the hole.

Jihad on doctors

CMS has released the Medicare payments made to doctors in 2012. This will be an annual update henceforth. We're talking the name, address, billed charges, and paid amounts to over 800,000 US physicians on a government website. The reason is to help "track fraud and provide clarity on physician charges". Already lots of media noise has been made about the lone ophthalmologist posting millions of earnings, some doctor injecting every old retiree in south Florida with macular degeneration and getting paid $21 million--at some point, aren't there any brakes on the payouts? And if there aren't any brakes, and the work is being legitimately performed, who are they to "out" this doctor in this fashion?

Oh, the Sherman anti trust act muzzles how we can discuss fees, but then this is posted publicly?

Is there any HIPPA protections for the physician? Of course not.

In return, here's what I want:

1. The name, address, and W-2 or 1099 earnings of every government employee, "civil servant", politician, etc. posted as a searchable icon on the .gov server.
2. The name, address and amount of federal subsidy given to healthcare.gov subsidy recipients. I must know what the patient I'm treating got from the feds, and how much. If they must know what I got, then it's a 2-way street.

3. The actual federal pay-out given to all the banks, with the breakdown of how federal monies have been distributed to all the government contracts, corporations and CIA informants.

It's the attack on doctors to blackmail and destroy us so they can put RNP's and PA's in charge of patient care. I will be filled with schadenfreude after I'm filled with rage.

Check the box

Franz Kafka wrote about the horrors of bureaucracy nearly 100 years ago. I remember as a student reading his works and getting totally depressed. The world can't possibly be so bad, so corrupt, so full of hateful, lazy people.
He was right. It is.
I was urged to "join in" and get a free software program so that I can partake of an idiotic scheme called meaningful use. The Medicare people have decided that having physicians enter the data for them is much better than them having to pore over data that already exists. And gee, we don't have to pay them for this work, we can dock 2-5% from their pay, in increments over the next 5 years so they won't notice, if they DON'T do it.
The free programs seem all nice, but they're free because they depend on doctors becoming their product, and then you get targeted advertising so they can pay for the scheme. Then later on, they will start charging you for their services.
I'm sick of being victimized and assaulted.
So I'm saying no to this and I'm choosing to be a doctor and care for patients.
I don't have all the time in the world to jump through every artificial hoop. I'm a human being, with a family, with physical and emotional needs, with pressures, with foibles. I'm not perfect. But I won't compromise where I know my talent lies, and I won't cut time away from being a caring compassionate doctor to click through the program to check a bunch of boxes that mean nothing to me.
A patient got married, I sent flowers. A patient's husband died, I hand wrote a letter of condolences. This must continue, or the fabric of humanity will disappear, and it'll become the Paleolithic.

I recently saw a colleague that I hadn't seen in 2 years. He has gained about 50 lbs, gone grey, and was running around his office with a laptop to enter the data and the assistant to room and gather the patients up. I felt so sorry for him. He's imploding. This man went to Harvard, Yale, is a talented surgeon...it doesn't matter. The box must be checked or his livelihood and his family are threatened.

Then I have to witness the brazen bureaucrat telling me what to do. YOU WORK FOR ME.
Read here for some acid producing stuff.

I'm off to fight the man.

Insurance network managers suck gluteii maximii

Brutal phone interaction from a network management drone from a state insurance plan. I never received a certain contract, instead I received my termination letter effective in 90 days. WHISKEY TANGO FOXTROT?????? -- lots of corporate finger pointing led to actually blaming the victim, me. My office hours aren't long enough, I'm not accepting new patients, there was never anyone answering the phone in August....yadda yadda yadda. I was furious at being made to defend my practice and my business, is it in the contract how I should run my business? Needless to say this bureaucrat had the pondering droning voice of an elder in the Charlie Brown cartoons--woah woah woah woah woah waonhhhhhh.....I pointed out to her that they're the ones who don't publish their phone numbers, they have a byzantine voicemail system where I can't get through to a voicemailbox, much less a human, and they're telling me I'm AWOL. The pot is calling the kettle black.
My reaction to all of this is as follows. Let the chips fall where they may. If I get kicked off a network it's actually a blessed thing, less crap to deal with and more time to spend with actual patients, no need to deal with the harassing bureaucracy.
I'm not filling out any more surveys, I'm not having patients fill out surveys, I'm done.

It's bad and it's going to get worse, YAY!

As a physician, I hear all the intimate details of my patients' lives, whether I want to or not. The hot topic has been their cancelled insurance plans and what other insurance do I take. Also on the agenda-- the doctor "de-selections" from Medicare Advantage by AARP/United Healthcare "products" or plans.

People are seriously angry and scared. They won't go on to the abysmal healthcare.gov website for fear of having all of their data hacked. Click here to read something that has been given 3 minutes of media time, but it is devastating testimony, and the public, smarter than one would think, is aware.

I myself tried to get onto the website to find out, as a physician, what plans are on the Florida exchange. I can't, I keep getting the error message. I am completely unaware and have no way to access the info, because no government agency has communicated with A SINGLE DOCTOR in the USA as to what the nuts and bolts of this mess contains. I don't know, and can't get, info on plans, fee schedules, etc.

You might think the AMerican Medical Association would have some information on this, since they so steadfastly supported PPACA in 2009. Take a quick look at the home page of the
website and there is ZERO info on Obamacare or the doctor deselections from insurance plans. Just some platitude about how great we are and how the Medicare SGR formula needs fixin', the same tired story for the past decade.

Therefore in planning a business strategy for 2014, which is about 45 days away if one considers the Thanksgiving and Christmas closures, I must seriously plan to NOT accept new patients. I cannot enter a world where I have no data, no info, no knowledge of how to navigate. One cannot conduct business blindly. One cannot do as the clowns in DC have done, with zero prepping and zero oversight, and accept a destructive product.

I do see this whole thing imploding in short order.

The only silver lining I see is that the anesthetized horde that believed in hope, change, and that government can decide and orchestrate their lives for them...suddenly they've woken up to the fact that the failed parable of Obamacare has hit them in the wallet, hit them in their ability to even continue to see their doctors, even if they were already insured--and they are unhappy and don't want this at all. I can't see how the president can govern if the people aren't with him, at all.

He can spout what he wants from Mt. Olympus but it makes not one iota of difference. The law stands. And it's crumbling. Inept, incompetent, a horrendous thing. People will suffer medical morbidities from this botched thing--cancelled plans beginning in 2014 and not continuing to see their doctors or get their prescriptions-- and the politicos will have blood on their hands. I hope someone tracks mortality and morbidity from this when it fully kicks in on Jan 1, 2014.

wow they're all flip flopping

I have a chronic huge-ass migraine from all of this Obamacare dreck. What I'm especially fond of, and what I won't forget, is the loud singing and praising that was happening for 4 years. Now that the product is a piece of crap, the public figures are retracting.

Patients are in a tizzy, the country is in a tizzy, the let down is enormous. The president lied--gasp, horror--can you all seriously have such crooked pseudo individuals as your object of idolatry?

Hilarious juxtaposition from the CEO of Starbucks, here is what he praised on Sept 16, 2013, 2 weeks before the catastrophic roll out on Oct 1.

Now let's read what he has to say, one month after the spectacular failure.

The hearings say just you wait, things will improve and get fixed. It's too late. There's a bad collective taste in America's mouth, and left or right, people still abhor blatant liars.