Being a rainy and lazy day I had the time to scan through all three Sunday papers. Two articles were most disturbing.:
The first was a story about a house fire in Springfield which completely destroyed the house although the first unit arrived within minutes of the alarm. The problem was the truck had only a three man crew which made it difficult to get the hoses to the hydrants and to the fire. This is usually the work of a 5 man crew. Although other units from cooperating towns arrived within 6 to 10 minutes with additional personnel the fire had by that time was out of control.
The gist of the story is that with the budgetary crisis the crews on a firetruck are being reduced to an inefficient and unsafe level and departments have to rely on support from cooperating communities.
Has Plainfield's reduction in firemen reach that unsafe level? We know that more than one truck answers a call but the question seems to be more a matter of bodies than trucks.
The other was a first page story in the Times which addresses one of the changes in medical care which I find to be destroying the quality of care that we were used to. I would advise you to read it. In Part the article starts:
"Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy
DOYLESTOWN, Pa. — Alone with his psychiatrist, the patientconfided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help. But the psychiatrist, ********, stopped him and said “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate. Like many of the nation’s 48,000 psychiatrists, *****, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation. So ***** sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.
Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and Dr. Donald corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients."
I have frequently commented that under present insurance company fueled medicare and more so in the future the one essential element in patient care, personal touch, has been lost. No physician can afford to spend the 15-20 minutes talking with the patient that was the norm in my day. The doctor patient relationship was as important as the treatment and often impacted on individualizing care.; Now a days the patient is a case number and not a human. Within the next ten years all care will be "cook book recipe" and any deviation from protocol will subject the practitioner to penalties.
Why are these two unrelated subjects in the same posting? Because both represent the impact of trying to provide too many entitlements for a society that doesn't have the resources available. Therefore, corners are cut, and the quality of the ultimate service will be severely compromised. They are not unique we can find many more examples of societal deterioration.
We will be drifting into a two tier society, the oligarchy that has everything and the great underprivileged mass. Welcome to the Middle East.
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I don't know Old Doc, it seems that the only cadillac plans these days are those enjoyed by the government workers and the unions....what to do?
ReplyDeleteto Anon 3/7/11. 1:26PM:
ReplyDeleteHow dare those unions and government workers have better plans than the average ordinary American? What to do. Line them up; put them in camps; burn them to a crisp. Problem solved.
For those left, lets go back to the 60-80 hour work week with no time off, no minimum wage and if an employee wants to quit their job they will need there employers permission, oh, and while we are at it we'll bind them to the land that is after they have returned those Cadillacs of whatever ilk and then your benefits, health plan, etc will be the putative Cadillac plan’ and those newly improvised workers can bring you down to their level. You’ll enjoy racing them to the bottom.
Apres moi le deluge.
Some communities have VOLUNTEER fire departments!
ReplyDeleteI believe that all of Plainfield's trucks leave the station with four men plus an officer, the same as in New York City. I'll leave it to you whether Plainfield's needs are as complex and challenging as New York's.
ReplyDeleteThe psychiatrist story in the Times was infuriating. the doctor clearly stated that his goal was to work as efficiently as he could to make as much money as possible to retire in the style that he decided he deserved. My back of the envelope calculations using the figures quoted in the story say that he and his wife gross 400-500K per year. His expenses? How much could the rent be for an office over a dog groomer? His treatment decisions had nothing to do with healing but were driven by pure self-interest. I hope the article makes him a pariah in his community but I suspect that within his circle he'll become a martyr instead.
Our insurance rates are lower because Plainfield has a oaid fire department. Towns with volunteer fire department have a problem with a full complement being available all 24 hours.
ReplyDeleteMy point in the psychiatrist article was not how much money he was making but (a) he could no longer afford to spend 45 minutes per patient which in that specialty means one patient per hour. The verbal hands on care has been delegated to practitioners in disciplines that require less years of training. The same effect has happened in family care and internal medicine where the per patient visit reimbursement is low that again time can not be spent with a patient. Routine matters are delegated to nurse practitioners or physician's assistants. The doctor and patient have lost the knowledge gained by personal touch.
Fear not Anon 3/7/2011, 10:29PM:
ReplyDeleteModern technology will soon solve the problem of those ridiculous doctor salaries. The Internet, HD TV, 3D TV and inexpensive diagnostic tools will allow 90% of the doctor’s visits to be done online. Removing that barrier will allow insurance companies to shop world-wide for the lowest cost deliverer of that service. No more $250,000 per year domestic physician, now you’ll get $30,000 physician in India for example –full stop, no disrespect to Indian trained physicians intended. That should make you happy.
Saying that "he could no longer afford to spend 45 minutes per patient" is only true if the income from those patients doesn't come up to his expectations. If he lowered his income expectation he could still maker a comfortable income as was shown by the counter example of the talk therapist MD. At 68 he doesn't have the excuse of having to pay off his training, but maybe the shore house, the Lexii and the four private colleges. Those should not be the patients' problem.
ReplyDeleteNat, priceless. I had not entertained the possibility that now health care has become a business not an "art" it could be outsourced to a third world country. Perhaps we would get "Peggy".
ReplyDeleteAnon, you would deny an individual who had spent 12 years of hios post high school life learning his profession the right to have some personal amenities especially when some sivil service employees at his age have acquire4d two pensions based on the last year or two of their employment.
Incidentally,psychiatry/psychology can b e one of the most stressful callings in health care and the least rewarding financially.