If physicians are “muggers” and co-conspirators in “taking money away from the rest of us”, then journalists and economists are pontificating parasites who produce no goods or services of any real value.

I don’t think either is true, but the recent attacks on physicians by economists Anne Case and Angus Deaton, and “media professional” Cynthia Weber Cascio, deserve to be called out. You could make a case for consigning them permanently, along with the anti-vaccination zealots, to a healthcare-free planet supplied with essential oils, mustard poultices, and leeches.

My real quarrel with them — and with the Washington Post, which published their comments — is that they have the courage of the non-combatants: the people who criticize but have no idea what it’s like to do a physician’s work. More about that in a moment.

Ms. Cascio was enraged by the bill from her general surgeon, who wasn’t in her insurance network at the time she needed an emergency appendectomy. She doesn’t care — and why would she? — that insurance companies increasingly won’t negotiate fair contracts, and it isn’t the surgeon’s fault that Maryland hasn’t passed a rational out-of-network payment law like New York’s, which should be the model for national legislation. She doesn’t care that Maryland’s malpractice insurance rates are high compared with other states, averaging more than $50,000 per year for general surgeons. She just wants to portray her surgeon as a villain.

The two economists are indignant that American physicians make more money than our European colleagues, though they don’t share our student loan debt burden or our huge administrative overhead for dealing with insurance companies. They resent that some American physicians are in the enviable “1%” of income earners. But do they have any real idea what physicians do every day?

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128 COMMENTS

Yes it is sad. I know a lot. We need to stop accepting insurance and unite and recover (fetch back) our lost dignity.

Gregory Craner

I was overhearing a conversation as the person was complaining about his anesthesia bill. "All he did was put me to sleep!" I could not contain myself and asked him if he woke up. When he said yes I told him anyone can put someone to sleep he was paying for the expertise to wake him up! I have read a lot about physician burnout and its relation to the increasing administrative and data keeping burdens. This is the first time I ...Read More

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As a newcomer to the Orthodox faith more than 20 years ago, I can still remember my first sight of the profusion of holy icons when I walked into an Orthodox church, and how foreign they seemed – severe yet serene, so different from the rotund Renaissance images of the infant Jesus and the Virgin Mary that fill non-Orthodox churches and decorate western Christmas cards.

After a day listening to the teaching of Kh. Randa Al Khoury Azar, a professional iconographer and a faculty member at the Antiochian House of Studies, I am delighted to have more insight into the deeper meaning of Orthodox icons and the scholarship that goes into their preparation and writing. She spoke at a retreat held recently at St. Simeon Orthodox Christian Church.

Kh. Randa began the day with an explanation of the purpose of icons in Orthodoxy. They are not to be worshipped, but venerated and honored. “Worship is for God, and only God,” Kh. Randa said. “Icons are a means of honoring God, his saints, and the holy angels. The honor that is given to the icon passes to its prototype.”

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Ramona

This is a wonderful article about icons, and is very enlightening to understand what it takes to write an icon. Thank you for sharing Dr. Karen!

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“Each man or woman is ill in his or her own way,” Dr. Abraham Verghese told the audience at the opening session of ANESTHESIOLOGY 2019, the annual meeting of the American Society of Anesthesiologists. In his address, titled “Humanistic Care in a Technological Age,” Dr. Verghese said, “What patients want is recognition from us that their illness is at least somewhat unique.”

Though we in anesthesiology have only limited time to see patients before the start of surgery, Dr. Verghese reassured listeners that this time has profound and immense value. He pointed out that there is “heightened drama around each patient” in the preoperative setting. “Everything you do matters so much,” he said. What patients look for are signs of good intentions and competence, and the key elements are simple: “the tone of voice, warmth, putting a hand on the patient.”

Dr. Verghese, a professor of internal medicine at Stanford University and the acclaimed author of novels including the best-selling Cutting for Stone, believes that patient dissatisfaction and physician burnout are the inevitable consequences of today’s data-driven healthcare system, where physicians seldom connect with patients on a personal level or perform a thoughtful, unhurried physical examination. “Our residents average 60 percent of their time on the medical record,” he said.

“It’s the ‘4000 clicks’ problem,” Dr. Verghese said, citing a study in which emergency room physicians averaged 4000 mouse clicks over a 10-hour shift, and spent 43 percent of their time on data entry but only 28 percent in direct patient contact.

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Mike

Dr. Sibert, For some reason your contact tab is not working. I'm a pediatric dentist based in the Bay Area, California. I was inspired by your article "PEDIATRIC DENTAL ANESTHESIA: THE DENTAL BOARD GETS IT WRONG." I am planning to join organizational dentistry and advocate for a change in pediatric anesthesia, as oral conscious sedation poses a risk without proper training and I'm concerned about the public's attitude towards my profession. If parents don't trust pediatric dentists, then many children won't receive the care they need at ...Read More

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The Hahnemann Disaster

Though the news at first stayed local in Philadelphia and the northeast, it’s gaining traction nationwide. ZDoggMD is on it. Bernie Sanders held a rally.

What happened? The venerable Hahnemann University Hospital, the main teaching hospital for Drexel University College of Medicine in Philadelphia, is bankrupt and will soon close its doors after more than 170 years as a safety-net hospital serving inner city patients.

Why should we care? After all, there are other teaching hospitals in the immediate area with capacity to absorb the patients, and they had several months’ warning to prepare.

We should care for many reasons, but I’ll start with the plight of the 570 residents and fellows who are being displaced from their jobs. Getting a residency position in the first place is a perilous process – there aren’t enough spots for all the graduating medical students who want them. Only 79% of the more than 38,000 applicants in 2019 snagged a first-year or internship position in a residency program.

So the Hahnemann residents – the “Orphans from HUH”, as they’ve started to call themselves – are scrambling on their own to find new jobs at a time when most residents are thankfully settling in to the new academic year. There’s no organized program to help them.

Even for the residents who’ve already found new positions, there are other boulders in the road. To begin with, they haven’t been released yet. They can’t start their new jobs and the Medicare funding for their positions is still tied up in bankruptcy court.

They’re still at work, wandering around a nearly empty Hahnemann with only a handful of patients left. The ER isn’t admitting any new patients and will shut down completely on August 16. The labor-and-delivery ward has closed. The new interns aren’t gaining any real experience and will be lagging behind their peers wherever they go.

“Doctors have been writing notes to update plans of care and people have come in as part of the liquidation to take away their computers,” a third-year internal medicine resident named Tom Sibert, MD, told Medscape reporter Marcia Frelick last week.

Tom Sibert? Any relation? Why yes; he’s my son. You can understand, I’m sure, why I went into full-blown mama lion fury when the Hahnemann situation blew up, and why I was beside myself with worry until he locked in an acceptance to an excellent program where he’ll finish his training.

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Dawn Brockman

Anita Cherry, how exactly does Medicare for all help anyone with 120,000 too few physicians? No the answers aren’t in Medicare for All. The answers are in marginally higher Medicare payroll taxes and Premiums, and funding residency programs.
How about Medicare for all with realignment of payment. Anita Cherry

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When adjectives obfuscate

A few years ago, at the misguided recommendation of a public relations consultant, many of us in America started referring to ourselves as “physician anesthesiologists”. That was a silly move. The term is cumbersome and does not flow trippingly on the tongue. It is also redundant. You don’t hear our colleagues referring to themselves as “physician cardiologists” or “physician urologists”.

There was never any need of an adjective to modify “anesthesiologist”.

Anesthesiology is a medical specialty, practiced by physicians who have completed residency training in anesthesiology. To become board-certified, we undergo a rigorous examination program conducted by the American Board of Anesthesiology.

In England, comparably trained physicians are called “anaesthetists”. In England, they also refer to their subway system as “the underground”, and to the hood of the car as the “bonnet”. It’s confusing, but we muddle through.

The term “nurse anesthesiologist” is an oxymoron.

I’m all done with the term “physician anesthesiologist”. I am the immediate past president of the California Society of Anesthesiologists, and a 30+ year member of the American Society of Anesthesiologists. I am a physician who is immensely proud to practice anesthesiology. My patients know I am a physician because I make it clear to them when I introduce myself and give them my business card.

Dr. Virginia Apgar was an anesthesiologist. It is an honor to follow in her footsteps, even if most of us will never match her achievements. That is all.

8 COMMENTS

Stephen

Throughout my career I have had the opportunity to work with many wonderful and talented CRNAs. They referred to themselves as anesthetist, nurse anesthetist, or CRNA. They referred to me as Doctor or anesthesiologist. Recently, a newly minted CRNA informed the staff that she was a doctor(DNP), wanted to be addressed by that title, and wanted the truth spoken to everyone including patients. I will not hide from the truth; told her she can tell patients she a Doctor of Nursing Practice--not medicine--and the ...Read More

Nancy

I don't know about the different (and proper) terms for the medical professionals who administer & monitor anesthesia in all its forms, but I'm thankful for the training & skills of those who help comfortably prepare their patients for medical procedures ranging from the diagnostic to major surgery. I well remember the awful gas I was given around 1969, to sedate me for teeth extraction in preparation of getting braces within the next several months or year. That must have been ether? It was ...Read More

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