Mad About Medicine: Welcome to Mad About Medicine

Welcome.

Into my second decade in the practice of medicine I feel that I have gone through a whirlwind of Orthopaedic and Medical Progeria. When I started my training in 1985, American Medicine was in its heyday. Then someone decided something was wrong. Something needed to be fixed so we all screwed with it. Well, as Peter Finch so eloquently said in the movie NETWORK- "I am mad as hell and I'm not going to take it anymore."

When I went into practice in 1991 here is what happened to me:

1991 to 1991: Joined a joint replacement only private practice. Problem- one month before I got there, the major surgeon of the three decided to leave suddenly, destroying the practice. I left 4 months later after seeing three reasonable surgeons yell at each other, spend more money in legal fees than the gross national product of the Congo, and even have pushing fights in the operating room. Needless to say- I moved on.

1991: Consulted to US Healthcare on Orthopaedic Utilization issues- Little did I know at the time that they were the company from hell.

1991-1995: I joint Kaiser Permanente in NY. Eventually I was the Chief of Adult Reconstructive Orthopaedic Surgery (a dubious, small title) and the Director of Resource Management in the Northeast region. Due to a mass lobotomy of the entire health plan I won the 1995 Vohs Award for Quality. This is the most prestigious award at Kaiser Permanente.

I say that line about the mass lobotomy because in the history of the award only Pediatrics, Cardiology, Cancer, and Epidemiology have ever won. Chalk one up for the Orthopods! I actually liked Kaiser a ton. To this day I still feel it is a strong a persuasive medical model. The problem is that all the imitators calling themselves HMO's have totally bastardized Kaiser's version of a good idea. More on this in later posts.

1995-2000: I rolled the Orthopaedic Department at Kaiser into a large Orthopaedic subspecialty group. Good idea. poorly executed. Never counted on 2 things. Kaiser would eventually leave NY. Disagreements among partners. In 2000-2001, 3 of us left the group, for different but exactly the same reasons. I then decided to really do something totally radical. I went into a solo Orthopaedic practice in the most competitive suburb, overlooking the most competitive city, in the most competitive country in the history of mankind. As George Burns would have said- If I woke up in the morning and saw that my name was not in the obituaries I knew it would be a good day. I saw 4 patients on my first day with 3 staff members and debt from a loan from the bank.

Fast Forward.........

Five years later, possibly due to the fact that I love medicine and surgery- (I really am "mad about medicine") and partially due to factors beyond the major capabilities of my active brainstem - here are the facts:

Last year I took an associate in the practice
The year prior to bringing him on I personally saw over 5,500 office visits and performed nearly 300 major Orthopaedic cases
My office became totally paperless and digital (in 2000) and I lecture around the world about this. (Along the way I was involved in the development of medical multimedia and Medscape- starting a web site called Bone Home that was bought out by Medscape and became Medscape Orthopaedics with me as the Executive Medical Director- another dubious title...)
I am a minimally invasive surgery evangelist, do more joint replacements than anyone in my hospital- and my hospital does the #1 in the county
I open my office for any kid with any injury 24/7, I don't mind seeing back pain. I do house calls some times.
My patients get my cell phone number
No one is wishy-washy about what I do- hate or love- black and white- no one in the gray.

Here is how I feel about all this:

I hate insurance companies with a passion- they produce no products, but they print money on our fear
I like drug companies- they actually produce products that help us. So they make a lot of money- welcome to America...
Stem cell research needs to be done aggressively- I actually don't like chronic destructive diseases.
I voted for Bill Clinton twice, Al Gore once, and George W. Bush the last time. Edwards was a medical malpractice attorney and they are the lowest form of life. Couldn't pull that switch.
Everyone should have healthcare. Everyone needs to pay something.
Everyone thinks it's the poor that are the problem. That's a lot of medical crap. They have problems, they are not the problem. The problem is that insurance companies are pulling so much profit out of medicine there is nothing left for anyone even to get a thermometer up where the sun don't shine.
Also, when did the government start to suddenly care about people and healthcare? Your Senator and Congressman have no interest in the state of healthcare. They pander to insurance and other lobbyists and people that give thm large amounts of money. In the end, all they do is vote on how much less money to give hospitals and doctors in Medicaid and Medicare. I thought that $7.00 for an office visit for Medicaid was a bit low but Congress voted on it. No wonder no one wants to accept that program. How about some meaningful insurance regulation?
Despite all this- if you have doctor that cares for you- you are gold- and that is why American Medicine is the jewel of the last century. Dedicated doctors, nurses, and others are contributing to making us healthy every day.

That's enough for now.

Over the course of this Diary I would like to hear from you about the reasons why you are "Mad About Medicine"-- the good and the bad.

It's only life and death. It isn't business.

-- Dr. K

Related Topics: Medicare, More than 1 in 10 in US Lack Health Insurance, Joint Replacement