Thursday, April 30, 2009

Doctoring Online

This is a very interesting concept. It's a service that allows you to mostly connect with your doctor online through video chat, IM, and email after an initial face-to-face office visit. I think it's a great idea for simple problems that people have that can be diagnosed over the phone or email. I think it breaks apart when a patient comes in with more complex problems or health issues, making a good physical exam necessary. Then you need an actual doctor's appointment, just like with any other private practice.

Thursday, April 23, 2009

Perspective on Costs

I hear arguments or complaints all the time about how we're denying so many people health care because "an insurance company won't pay for it" or "it's too expensive for them to cover it". For example, many times, patients and their families (and their doctors) will fight with insurance companies to get them a really expensive treatment or get an exception to get a certain patient a treatment that usually the insurance company would not approve, either because it's too expensive or isn't indicated. While I'm the last one to support the insurance companies and I think they could be doing a lot more to cut costs and provide more and better health care, I think that many people are lacking perspective about this topic.

I don't think anyone would disagree with the statement that the budget for healthcare is limited. We can't spend all the money we want to save everyone in the world. In the US I think this is often not understood well because we have a relatively wealthy country, but it 3rd world countries, like many in Africa, or in countries that have 3rd world elements (like India or China), this is readily apparent.

When someone or a group of patients can't get a treatment because it's too expensive, many people react with indignance and outrage. While I certainly understand this sentiment, and probably would feel it myself if I or one of my family were the patient, there's another side to the story... By providing that one patient (or group of patients) with that expensive treatment, you are essentially denying health care to another group of patients. Just take for example that a treatment costs $100,000 per patient to save their life. Of course you can't put a $ value on a life, but say that $100,000 could be spent on 100 other people to treat something else to save their lives. Or maybe to, say, treat their hypertension and prolong their lives for 20 years each. It's hard to say which is the right way to go, but personally, I think it should be spent for the greater good.

Tuesday, April 21, 2009


Personality plays a large role in many different careers - it's no difference in the medical world. If you have a good personality, patients often like you better and think you're a better doctor. Similarly, if other medical colleagues get along with you well, they usually think more highly of you as a clinician. This all leads to more referrals, by patients and doctors alike. I think personality is supremely important in a doctor, and certainly is part of being a good doctor - you don't want a clinician who is callous or unfeeling, or someone who does not deliver bad news well.

However, personality is not everything. I think many good clinicians often lack in the personality area, or at least the empathy/sympathy area simply because they are too busy. And unfortunately, many times patients will label them as bad doctors because they don't like their attitude or the way they present themselves. I think that's totally valid, but I also think sometimes patients may be losing out on very good care because they may be too demanding and not understanding enough of their doctors.

I think it's even worse when other medical professionals assume that someone is a good doctor just because they get along with them well, or that person has a good personality. I've met plenty of people who I like to hang out with, but who I don't necessarily thing are the best clinicians. I don't necessarily think they're horrible, or even bad, but some people think they're great because they are really easy and fun to get along with, and I just think they're ok clinicians. I think that first and foremost, a doctor has to be a good clinician (making good clinical decisions, etc) and then secondly, should be empathetic and have good relationships with his patients. If the doctor can do both well, then that's great, but the first characteristic is the most important.

Friday, April 17, 2009

Being a health care professional in bad economic times

One good thing (of many, I think) of being a doctor during bad economic times - you pretty much are guaranteed a job. Especially in this day and age, with more and more people living longer and longer, people will always need doctors and nurses, and other health care professionals. In fact, there's an increasing demand for them. I'm sure salaries may go down, and people may have to work (even) longer hours and care for more patients in a shorter amount of time, but at least they're usually not at danger for losing their jobs. At the worst, people may have to relocate or take less-than-ideal jobs or situations in order to keep their incomes flowing in.

It's a reassuring thought this year considering 2,000,000 people have lost their jobs so far in the U.S.

Friday, April 10, 2009

Hospital Closings

There are all these rumors flying around that Methodist Hospital in South Philly is closing. This is in addition to Northeastern Hospital in NE Philadelphia already closing! If Methodist Hospital closes, that will really put other hospitals in a difficult position. If the other city hospitals are anything like Pennsylvania Hospital, they're already overfilled with patients currently. How are they going to handle the load and stress of another hospital closing? It's a very sad state of affairs when hospitals have to close because they're losing money.