This topic contains 25 replies, has 9 voices, and was last updated by sweettsunade 2 months, 3 weeks ago. This post has been viewed 921 times
- December 14, 2017 at 10:32 am #4160
Speaking of, I should really do something about that unprotected contact page. We’ve already had spam come thru it, and I worry about people using it to fuzz the db. Since we are getting off topic here, should I fork this into a separate security/laughing at the idea of Putin trying to hack us topic?
My current jam: Anathema - SpringfieldDecember 14, 2017 at 11:54 am #4164
@TheRabbitKing The less bots the better. LoL
It may very well happen, I do Love CO.
Back in ’06 or maybe ’07, I spent 3 months in Gunnison, CO snowboarding Crested Butte a few times a week, working 30 hrs a week in a computer store. It was the closest to full time work I’ve ever managed actually. It also was a really good experience, I’d snowboarded here and in MI a bit, for years but had never ridden real Mt’s. By the time I left I was getting very comfortable with the Mt.
Haven’t snowboarded there since, but intending to get out there next month if I can swing it.
If I have an injury, like my knee hurts or I’ve got swellbow, or a wrist issue, I’ll wear a pad or two.
The helmet goes on at times, usually at deeper depths, I always wear one when riding my bike anymore.December 16, 2017 at 4:18 am #4179
Engi, You are absolutely right about drug development. Frankly pharmaceutical companies spend more on marketing than research. And, Jazz was on the verge of bankruptcy prior to Xyrem. They get pretty much their entire 1b in revenue from Xyrem, a drug that’s dirt cheap and been around since the 1800s. It’s actually not even a drug. It’s just GHB, which is naturally produced in the body in small quantities. Used to be OTC lol.
I should complain to my former high school classmate; he’s an accountant for Jazz Pharmaceuticals, making a pretty penny from what I heard the last time I ran into him at a highfalutin wine-tasting event in the big city. XD It’s entertaining to me that their blockbuster drug is simply GHB. But hey, it’s worked marvelously for them, and they have another drug in the pipeline now, I think?
Also, thank you for disabling the captcha…that was driving me nuts whenever I had to log in.December 27, 2017 at 8:33 pm #4298
@Sk8aplexy and others whose comments followed…
All I can say is that I was laughing so hard when I read through some of those posts that I was very glad that I was sitting down at the time. Sk8te, you are to be commended for maintaining any composure at all when you were having those couple of conversations.
Great idea on the original post!May 17, 2018 at 7:12 pm #5676
In our classic style, this thread went way off topic, haha. To get back on topic:
Given the recent news of physician burnout and even more tragically suicides, I’d encourage everyone to understand they are under an immense amount of pressure today. I’d also strongly encourage you to take 15 minutes to write a note/letter if you have a physician that’s helped you get diagnosed, gone above and beyond, and so on. I did and it really did mean more to him and his office than any payment. Physicians rarely receive a written letter thanking them and they often keep them for life. I’m happy to upload my letter if anyone needs any ideas on what to write. A written thank you carries a lot more weight than a verbal one. I owe most of my success and quality of life to my sleep doctor, who took the time to listen and followed up to make sure I had the best treatment possible.
@purpley I’m curious about your opinion on the physician situation if you care to share! I never know if it’s more media hype or reality but as someone in the service industry, I definitely know how taxing it can be. I’ve had a few clients with a controversial condition (begins with an f) on three opiods and I about lost my mind. No clue how you folks do it!May 18, 2018 at 8:46 am #5695
@purpley I’m curious about your opinion on the physician situation if you care to share! I never know if it’s more media hype or reality but as someone in the service industry, I definitely know how taxing it can be. I’ve had a few clients with a controversial condition (begins with an f) on three opiods and I about lost my mind. No clue how you folks do it!
Actually, patients aren’t the problem. Of course I don’t love all my patients any more than you love all your clients or a baker loves all of his or her customers, but I love practicing medicine — trying to figure out what’s wrong with someone and how I can make it better — no matter who I’m treating. Burnout doesn’t come from patients. It comes from two things in my book, and the first is the lack of even minimum universal healthcare, so that we have nowhere to refer patients where they can get a follow-up appointment in less than a month, and patients keep returning to the hospital because they simply can’t get follow-up care, or afford their medications. When I say “we” I mean essentially all branches of medicine other than the emergency room, for patients without private insurance. Medicaid/Medicare accessibility to follow-up care varies by specialty and location; people without insurance have even fewer choices. And I work in a major metropolitan area where there are plenty of doctors; in rural areas the situation is even more dire. The perception that whatever you do won’t make a difference is a major factor in burnout, in any line of work.
The second reason? Bureaucrats and systems that force doctors to do more and more paperwork and spend less and less time seeing patients. For example, I work in a hospital, and in the “good old days” I’d see a patient, scribble a note in their chart (once I found where the last person had left the chart, since it was never in the chart rack), and move on to the next person. The hospital had billing folks who took care of the business end of things, and my notes were written to convey important information to other doctors caring for the patient, no more and no less. Now? Now, I see a patient, I have to type a note into an electronic medical record, that note has to be in a specific format to meet specific billing criteria whether or not it’s useful for other doctors to see, and at the end of the day, I have to do the billing myself: I “code” each note — choose the specific type of service provided, diagnostic codes, and level of complexity — and submit it to the billing department. Some of the same people who used to code these notes themselves now have jobs as auditors, checking random samples of our billing and telling us if we’re doing it wrong. I now spend more time writing notes and billing than I do seeing patients.
Now if you’re thinking this seems foolish — after all, why have your highly-paid doctors doing billing instead of someone they can pay much less per hour — you have to realize, it’s not like they decided to have us do billing instead of seeing patients. They simply tacked it onto what we were already doing and fired a lot of billing people. Other than ED docs, this isn’t shift work, with a set quitting time, so there’s been a gradual creep into home life, and it happened very insidiously. After all, if the medical record is electronic, you can enter notes from anywhere — you don’t have to physically be in the hospital. Same thing with billing. So now we’re seeing the same number of patients as we ever were, if not more — after all, everything’s about efficiency these days, right? — and we’re taking work home with us.
Meanwhile, doctors are getting blamed for the rising cost of healthcare when their salaries haven’t risen disproportionately — my mother’s a doctor and I figured out that my salary now is actually the equivalent of one slightly lower than hers was at my age, taking inflation into account. What’s rising disproportionately are the costs of medications — like Xyrem! — and the rising number of medical procedures which use expensive devices (like meds, the prices of artificial hips and so on have gone up as well), with those costs magnified now that the population is getting older. If the federal government could negotiate drug prices for Medicare/Medicaid patients, you’d see immediate improvement.
OK…that was a bit of a rant. But like I said, in my case at least and that of most doctors I know, it’s not the patient care which causes burnout — it’s everything else."Even a soul submerged in sleep is hard at work and helps make something of the world."
― Heraclitus, FragmentsMay 18, 2018 at 5:08 pm #5700
@purpley Yikes, that sounds awful. I don’t even want to think about what that does to your earnings per hour compared to your mother since it’s not like you get paid extra on a salary. It’s bullshit they are doing that to physicians. Of course physicians get blamed for everything, particularly costs. Patients don’t interact with pharmaceutical companies or the managers.
Insurance is a total mess in this country. It has effectively priced out self employed people. Most of my self employed attorney friends and I, can’t afford health insurance. If you make over something like 35k, last year it was $700 per month for a 6k deductible for one person in my state. And it seems to jump 50% or more each year. The least expensive thing for me as a cash payer is an appointment with my sleep doctor. I spend over $300 per month on medication, which is all generic. Even generic medication has skyrocketed in price. Tetracycline, a $3 medication in most countries is over $300 here. Non generics are even worse. Controlled release cyclobenzaprine (Amrix) is over 1k. I bet that took a lot of R&D to develop… yeah right.
xyrem was approved in 2002 as an orphan medication giving it market exclusivity for seven years. But because it takes years to challenge the bogus patents, when a generic manufacturer sues to be able to manufacture it, by the end of the yeas of litigation, they’ll settle with the generic manufacturer so the generic pharma company can be an authorized manufacturer rather than have the bogus patent shot down by the court. The generic company gives a kickback to the generic and the price remains absurd and the health insurance companies have to pay for it so the premiums skyrocket for everyone.
It’s funny, they never mention the EMRs influence on cost. My brother, who has a business degree, worked for Cerner for a year or so. They trained him for two weeks and sent him to hospitals to fix their program along with a bunch of other “trained” tech specialists. They were billing the hospital $250 an hour for each one and the hospitals just pay it.
If you were self-employed would that eliminate a lot of the crap you have to do? It’s sort of perplexing to me that physicians don’t seem to own their own practices anymore. Most of the ones I’ve met do much better financially. But admittedly I don’t understand the intricacies of your world.May 22, 2018 at 2:40 pm #5713
Sorry @jasonm, of course I wrote a long reply, got distracted by something else, and lost the reply. ARGH. Short version is that self-employed only eliminates the crap if you do an all self-pay practice. You print out statements for patients to submit to their insurance companies if they have out of network benefits, but you don’t have to deal with insurance companies directly. You do still have to make occasional phone calls or otherwise submit info to get medications approved, however. The problem with this model is that then you only treat patients who can afford to pay out of pocket, instead of treating anyone who needs help, which is what I like. In addition, this only works for outpatient practices, not inpatient work. Now, I could make a higher salary just by changing to a non-teaching hospital. But right now some of my day is taken up with teaching and supervising, and in a non-academic setting, I wouldn’t get that. So all in all, I’m OK where I am."Even a soul submerged in sleep is hard at work and helps make something of the world."
― Heraclitus, FragmentsMay 22, 2018 at 11:23 pm #5725
@purpley no worries, I’ve done that a few times as well. I was just curious if it was the management making life miserable or insurance itself. My sleep doctor works at a hospital, teaches, and seems to have his own business. Not sure how exactly that works but I don’t get billed by the hospital at all except when I had the sleep studies done. Just his office bills me for visits, even though his office is at the hospital’s physician’s building. He also has someone that specifically does insurance and prior authorizations. I guess because he’s the director of the sleep center, he has some sort of unusual control over his situation compared to most physicians.May 23, 2018 at 12:57 am #5730
I don’t really have anything to add, but I’m enjoying the look behind the scenes I’m getting from reading this discussion. As far as fixes for the healthcare industry, I know it gets really political and even lots of doctors disagree there, but I don’t think I’ve talked to a single MD that’s tried to tell me it isn’t broken, haha. Not that I’m a fan of his, but I was hoping Trump was going to make good on his promise to go after the pharma profiteering. Too bad what he actually announced was a nothingburger. But I guess that’s on me for getting my hopes up.
My current jam: Anathema - SpringfieldJune 27, 2019 at 1:20 am #10936
I hear that! My first sleep doc told me I just needed to lose weight and was very condescending. I live in a rural area so I didnt want to mess up what could be the only doc nearby who could help me. He joked about Narcolepsy my first appointment but never said or did anything with it again. He even refused to look at my journals and CPAP machine printouts. 1.5 years later I told my Primary I cant live like I was living and could she set me up with a new sleep study, and she did (hospital and clinic are 250 miles away)…. and guess what- they realized I had a problem and called me back for an MSLT right away. I got the diagnosis at the follow up and it has been great (not perfect, but better) because they didnt see me as just the person I am now- and I am sooooooo thankful! So many docs helped me get here, so many to thank, especially my Primary!
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