Tuesday, September 25, 2007


My wife recently took my 18 month old to a pediatric neurologist that was recommended by our pediatrician. I like our pediatrician. She’s very direct and “old school” and is highly competent. So I trust a recommendation from her.

She may be right, and this pediatric neurologist may be great. However, I would never know because my wife told me that she NEVER EVEN GOT TO SEE HIM!!! No, she saw the Nurse Practitioner (cue scary music). And then when my wife protested, the staff told her “Oh, don’t worry. The doctor will come in to see your child afterward”.

Well, that turned out to be a gigantic load of bird-plop! He wasn’t EVEN IN THE OFFICE!!!

I called the doctor himself to protest this shoddy treatment. He reassured me that his NP was his “partner” for six years, that the NP had published more papers than the doctor had, that the NP’s capabilities were superb.

I told him that, while all of this may be true, there was one indisputable fact: I know what kind of training (for the most part) a pediatric neurologist has received. I have NO FREAKING IDEA what kind of training a pediatric neurology NP has received. And what’s more, I really don’t care! I don’t care if the NP has written 100 papers, published in every major journal in the nation (well, actually that would be pretty cool).

Also, I object to his use of the word “partner”, as if his credentials were somehow equivalent with the NP’s. What is he thinking?

Look, I understand why NP’s exist. It’s an economic reality of office based practice. It increases the number of patients that can be seen. However, when it comes to a very specialized group of patients, especially nervous parents who obsess about their little one, for whom they’ve lost so much sleep (SO MUCH) in the last 18 months, I think an NP is not good enough. And shame on his staff for lying about his availability. (He states he was stuck at another hospital, which I understand. But the staff completely misled my wife).

I will never employ an NP to see my patients for me. End of story. Ditto for PA’s. They can draw blood, they can do post visit counseling, they can hold a patient’s hand.

But they aren’t doctors.

Sunday, September 16, 2007


There is a certain kind of blog poster that has been angering me. It’s the nuts on KevinMD that make the claim over and over that somehow I, and all doctors like me, are responsible for creating this system where insurance companies bilk doctors and patients, and that, after years of “doctor abuse” and “doctor fraud”, I am just now getting what I deserve.

What a complete load of garbage.

Just to clue all of these brilliant thinkers in, I completed residency training FIVE YEARS AGO!!! So the idea that somehow I am responsible for the current system is total crap. Does anyone think doctors made any substantial monetary gains in the last FIVE years? Or even the last FIFTEEN???

When I entered medical school, I had ideas about being a respected professional who could offer opinions and diagnoses to ease suffering, cure disease, and as my father told me “You won’t get rich, but you’ll never go hungry”. Well, truer words were never spoken my friends. I am not rich, and for the most part, I haven’t missed a meal (except on call of course). But I did manage to amass over ONE HUNDRED AND FIFTY THOUSAND DOLLARS IN DEBT!!!

So when I was slogging through Gross Anatomy and Physiology, according to the “just desserts” crowd, I should have KNOWN that HMO’s and insurances were perpetrating dwindling reimbursement on doctors and that Medicare was dropping their payments. I should have KNOWN that doctors in the 70’s and 80’s were doing unscrupulous things like putting pacemakers in dead people and charging for them (a fact told to me by an esteemed medical director who saw these things happen and did nothing to prevent it). I should have KNOWN to study these things just as hard as the Biochemistry and Microbiology and Pathology I thought I would need to be a good doctor.

After four years of school and three years of mind-numbing residency, I was, of course, desperate to find a job that would help me pay down this debt I had acquired. So I took the first job offered that paid well (I felt). According to the “just desserts” crowd I should have rejected all insurances, Medicare, etc, and just took cash only or raised my fees.

Well then, I just have one question… WHERE THE HELL AM I GOING TO FIND PATIENTS???

The people who make these statements are just clueless. And they blame doctors like myself for the way the system is. Just as you would blame me for slavery during the Civil War or I would blame Germans today for the Holocaust. It’s such a tired argument and serves no purpose, except to make the “just desserts” crowd feel better about blaming doctors for high health costs. They forgot that doctors become competent only through studying and hard work. The best doctors aren’t the most business savvy ones. They should ask themselves which doctor they want to see: the one who’s practice is booming because they’re making money hand-over-fist, or the one who paid attention in Path.

Tuesday, September 4, 2007


Anytime I watch the television news I get severe dyspepsia, but recently I had the misfortune of watching CNN headline news.

You see, CNN often has long boring stories about John Edwards’ haircuts, so sometimes I just want to hear the top stories before work. They’ve employed some Asian doofus named Richard Lui, who insists on peppering the headlines with “funny” comments. Hey, more power to ‘em.

But this is not why I exploded with rage.

After an obnoxious commercial for Aricept, Richard Lui returns with a shocking headline. His quote: “Lettuce could help wipe diabetes off the face of the map!”.

At this point, I’m pondering losing many of my patients to the “miracle” cure. I am awed at the possibility of curing an epidemic that plagues America and causes so much morbidity and mortality. I await Richard’s next words with razor-like attention.

He goes on to say that a study from the University of Central Florida is working with genetically modified lettuce AND… researchers are going to test it on humans to see if it affects insulin levels.” THE END!

Well, the weight of the headline is belied by the fact that the "report" is lacking in any substance. I’m not sure why I expected anything more from “CNN Headline News”, but the story was so misleading, that CNN and Ted Turner really ought to say a million Hail Marys and Our Fathers before they can even THINK about forgiveness. Mr. Lui doesn’t even make an effort to explain how this mutant lettuce has one damn thing to do WITH diabetes. It’s all left to the imagination, as if some aliens had left the recipe buried in Hanger 51.

Well, every obese diabetic who has a Devil Dog in one hand, and their insulin in the other just caaaaaaalm down. First of all, it’s only a potential cure for Type ONE diabetics, not Type TWO (the ones we see in the office). Apparently, Professor Henry Daniell at UCF has created a way to deliver insulin-producing genes that he is infusing into lettuce. He previously used tobacco plants and fed them to diabetic rats. (He’s going to give them a heart attack, I tell you…) You can read more about it here.

So good job Richard and your CNN brethren. Way to pump up the hopes of 20 million diabetics in America with your “psudo” news article. You really are true human excrement.