Monday, June 9, 2008


SICK AS A DOG: An article buried in the Advertiser’s business section today described yet another example of the absurd “only-in Hawai`i” process whereby money can be appropriated by the legislature, approved by the governor and yet the governor gets a second bite of the political apple by “not releasing” the funds.

We’ve been unable to find anther state or local jurisdiction where this anomaly of process occurs to this degree, although we would love to it hear if anyone has another example.

But that rant is for another day because the underlying issue is that the money that is not being released is to pay doctors who treat Medicaid, Medicare and state “Quest” program patients.

As bad as payments for regular medical services are these days the reimbursements for these patients are pitiful. At most times paying around $37 for an office visit they don’t pay for the lights and the nurses and office staff much less pay the doctor. And so many won’t take patients so covered and the ones who will take them are doing it as a community service, actually losing money on each patient seen.

Everyone wants to do something about the fact that doctors are leaving the state- and especially on the neighbor islands where specialists for the most part don’t exist- and though some have blamed it on “the trial lawyers” and malpractice settlements that’s really a red herring if compared to the often standard-setting low rates for the poor patients doctors see.

So some blame the doctors and some blame the lawyers and everyone blames the politicians. But no one looks at the real problem which can be seen over every bathroom sink in the state- the patients.

As a group and as people tend to do, patients- also known as sick people- fall into two classes: idiots and assholes or a combination of the two in differing ratios.

But the difference is that when it comes to what’s going on under their skin everyone is an expert even though they haven’t the foggiest idea as to what’s inside their outsides much less how it all works.

One of the prime reasons for this obstinate lack of knowledge is seen in the huge market for snake oil “alternative” mumbo-jumbo. And it keeps people ignorant with magical thinking and all sorts of “cures” for those who aren’t sick to begin with to fill the pockets of charlatans of all stripes. We gladly turn over our cash to these people but whenever we really get sick we run to the real doctors who use the state of the art treatments that at least have a prayer of helping those who need it.

And then we lie to the doctor and sit there seething at them for trying to find out what’s wrong with us because we know that it’s really our “aura” or the fact we “don’t love ourself enough” that is the true ailment... but we’ll see this silly doctor because, well, just because.

Could it be because what you were doing- which was essentially nothing- wasn’t working.

It seems that we all expect to live forever because despite the fact that we all know we’re going to get sick and die, somehow when the doctor can’t “cure” us it’s the doctor’s fault we’re sick or dying

“Well my cousin’s auntie had the same thing and she’s fine now and I went to my doctor and he didn’t make me fine so it’s my doctor’s fault- and I want a million dollars.”

Well first of all no one has “the same thing” as anyone else because each body is different as is the degree of health and of course knowledge of the individual. And second of all most wouldn’t know a kidney from a stomach much less what they do. And yet they curse these “stupid doctors” like immortality is their birthright.

A doctor can only do so much and most of the time it is the way a patient approaches their own health and health care that determines the outcome. But we complain that “doctors act like gods” and then go to them and assume they have god-like powers to heal us.

Half the time we lie to the doctor and then go off and don’t take the treatment the doctor gave us. Or we go to the phony doctors- the naturopathic and the implausible homeopathic for instance- and then wonder why we’re still sick. And when we’re finally doubled over and present at the hospital the real doctor can’t “cure” us even though we let this thing go because we programmed ourselves to reject “western medicine” or whatever pejorative we’ve heard from the quacks.

We’re looking for a witchdoctor even while going to the scientist. We even kill ourselves doing this such as the dozens of people we’ve known personally who, when they got cancer went to Mexico to have their blood boiled or got another of those no-treatment treatments. Then they got really sick because the cancer that was easily treatable has now taken over our whole body... And then of course they blame the real doctor because they couldn’t save them.

There is no subject that people know less about but actually somehow think we know more about than the actual anatomy and physiology of our own bodies. Forget patho physiology. How many people would know which is which if you put a kidney and a piece of muscle on a table.. much less a pancreas from a pineal gland... much less what they do, much less how they do it, much less what can go wrong with them, much less how to treat those anomalies we all suffer eventually.

One time in the distant past we were giving a back massage to someone and when we pushed hard on her shoulder she belched. And she actually said, in all seriousness ”oh, I guess I had an air pocket in my shoulder”. And this was an educated woman who took her health seriously.

What the heck do people think is under their skin- just a hodge-podge of bones muscles organs and blood that all somehow arrange and rearrange themselves to keep us breathing and eating?

That’s the way it is with “patients”- most of them don’t know what the aches and pains they have are so they ignore them and treat them as some magical process where if they ignore it- because they have no notion what it is- it will go away.

And when it doesn’t we go to the doctor and lie to them and tell them we don’t know where or how it started and have already decided that the very person they are desperate to have heal them is hell bent on killing or ignoring them.

For example there is virtually no one who has a serious heart attack (the “myocardial infarction” type) and needs by-pass surgery who didn’t have “chest pains” (known as angina) before the attack, usually many times over an extended period. But ask most and will say they never had any either because they didn’t want to admit it to themselves or because they didn’t know what angina feels like despite the valiant attempts to educate them.

And that’s who sits on juries who decide “malpractice”- patients. Yes of course there are lousy irresponsible and/or lazy doctors occasionally. But 99% of the cases in court are there because someone died or was permanently messed up when the doctor’s treatment was unsuccessful.

Capping the amount of a settlement isn’t the answer- it’s redefining what malpractice and negligence are and throwing out cases that don’t meet strict standards based, not on unrealistic expectations but on basic protocol.

Just because you didn’t get treatment B and chose treatment A and died doesn’t mean treatment B would have worked. And even if you can say it would have based on a post-mortem exam, it doesn’t mean the doctor made the wrong decisions should be sued because he or she- with your consent- chose another treatment.

Or even because their diagnosis wasn’t the best....especially when the patient falsely “presented”

And don’t give us that “I didn’t know what I was signing- it was all medical mumbo jumbo”. What the heck do you think we’re trying to tell you... learn something about what’s going on under your skin.

Yes, you’d be shocked to learn- if you listened- that it sometimes some treatments work, sometimes they don’t and doctors don’t always use the right one, not because they’re idiots but because the patient lied to them about what really hurts or just because it the treatment didn’t work- for whatever reason.

Being a doctor involves taking an educated guess, explaining to the patent their options, telling them which one they would recommend and doing it and THEN finding out what happens once they do.

But we patients are often too stupid to live and sometimes seem intent on proving it.


Anonymous said...

For once, we'll agree though your assessment that there are only "assholes and idiots" seems a bit narrow. You left out the 1% who seem to smile in the face of hell -- and I know a few.

The idea that non-economic damages need to be capped to stop "junk lawsuits" is just classic BUSHit.

Junk lawsuits -- those with no merit -- get settle for nuisance value because Insurers would rather write a check for $10K than spend $50K on legal fees. (Hopefully their success in dealing with bogus silicosis claims will end that practice.)

But lawsuits with serious punitive/non economic penalties are simply not junk suits. Juries don't just hand out $5 million judgments on a whim and if they do, they're overturned on appeal.

This BUSit is just a way to protect big insurers and those who've really really screwed up from getting the whacking they so richly deserved.

Not that I have a great deal of respect for some trial lawyers that invent claims and cheat to win, but the idea that those cases are killing American Health care is just Republican BUSHit.

Anonymous said...

Actually, junk suits usually settle for between 80 and 120 k.

Anonymous said...


And I know people that have $2 million legal bills in a fight over a business sale gone wrong. Even $80K is chump change when the lawyers get whirling at $350/hr and up.