Thursday, June 20, 2013

PARACHUTING IN CIRCLES

   Stream of consciousness tonight. Watched "The Hobbit" with the Young Padawan, the Cowboy, Blair Corbett of Ark of Hope fame, and Gimli, son of Gloin. The Cheshire Cat would pounce in and out of the viewing area while the Cowboy seemed to think that the chair and his bed were interchangeable living arrangements.
   Gandalf healed Thorin with prayer. In my practice, that occurred 10% of the time. Can I prove it? No. Prove I'm wrong.
   Angie once bragged that her brother was a great photographer because he had a lot of great photography equipment. I still won't let her live that one down. In photography as in medicine, there are paths of knowledge where critical factors overlap. My own father was a professional photographer. One of my best friends was the photographer extraordinaire Dan Harris. They both trained on high-tech equipment (the more they learned, the techier it became. Did I invent another word?).They could also take outdated equipment and playfully create works of art.
Using whatever equipment you have available and trying to make a diagnosis is similar. It CAN be done with the most expensive toys found in any hospital. Trust me, they won't be in your local clinic. It can also be done through listening to a patient carefully and doing a thorough physical examination. The use of extra tests usually serves to verify a good physician's suspicions. A bad physician will run batteries of tests to arrive at something, anything. There is an old saying in medicine that if you run enough tests, eventually you will find something abnormal.
Abnormal. What if there was a test that created "abnormals" that were ill-defined and vague. How do you interpret that and how do you treat that? Aurora Health Care in Southeast Wisconsin discovered how to do that AND make money doing it: http://m.jsonline.com/features/health/113541984.html?dc=smart&c=y&ua=blackberry. We heard of these tricks Aurora was pulling when an ostracized cardiologist came to our clinic and repeated to us what he saw with his own eyes. When he complained about it, he was let go unceremoniously and lives with the bitterness of knowing that there is no "Employer Retaliation" protection against whistleblowers in the state of Wisconsin. The state brags there is. Believe me, there isn't.
   I will be parachuting for the first time next week. No, I will not have a Golden Parachute like the ex-CEO of Aurora whose termination package amounted to more than $20 million. Ironically, the company stopped construction recently of one facility because they were $20 million behind in projected costs.
   So the take home message today is this: hospitals are not the hospitals our grandparents and even parents knew when they were younger. They are hospital systems and their bottom line is profit. Second in line, image. Third, helping people get better. A physician's and nurse's bottom line is making people better. Profit should come second. Sometimes job security or the security of a steady paycheck has more pull than pure profit. Sometimes profit wins but really, it is patient care.
   Say a prayer for me on the 23rd when I sky dive for the first time in my life. I hope my knees can take it.

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