needs doing…

Posted on Thursday 28 June 2012

ACA, FDA, PDUFA V, CDER, NME, NBE? It’s a lot of alphabet soup to me and a bit too big for my limited tolerance for understanding policies and agencies. Everywhere I went this morning, there were TVs with excited pundits and politicians either smiling or frowning. I retreated to the back porch for the afternoon with my dogs and finished an old James Lee Burke Dave Robicheaux novel I had missed along the way – Heaven’s Prisoners. The un-oiled ceiling fan drowned out the mumbling from the TV inside where my wife indulged her news-junkie habit and I mostly pretended the dark world of Robicheaux’s New Iberia Parrish Louisiana and Bayou Tesh were real, the center of the known universe.

I think the truth  is that I feel drained by all the psychiatric goings on in the last month or so – the DSM-5 Task Force and APA plowing ahead at a time when there’s something else to do that would make a lot more sense, or the efforts of the APA, APF, NIMH to try to keep the Pharmaceutical Industry doing what they’ve done for the last twenty plus years. I just didn’t have the libido left over to get worked up about today’s Supreme Court ruling and listen to all the pundits talking about all the political ramifications of this decision.

This last week, I’ve had a couple of friends who needed help finding a specialist for some fairly difficult medical problems. It’s what old doctors are often asked to do. Since all my peers are now also getting old, it involves calling around finding out about medicine now. Almost reflexly, I found myself asking about my friend’s insurance, looking up the approved providers, checking the list against the names I’d come up with. It’s a complicated system I never participated in myself, but learned about since retiring. And when I run across someone at the charity clinic that needs more than we can provide, uninsured people, I have to get involved with trying to find some way to get the person treated. It’s a nightmare. We usually get the job done, but the effort required is exhausting. Finding a doctor or dentist who will help isn’t the hardest part. It’s the tests, the hospitalization, the surgeries. Let’s face it, American medical care is a mess right now.

I recently had a medical issue of my own. I had an MRI, a CAT Scan with contrast, an EMG, and a gallon of blood tests – most of which replaced what we used to infer from a physical examination. Another friend went to the ER recently and had an EKG, a chest X-Ray, and routine labs before seeing the doctor [she had Shingles, as it turned out]. That’s standard fare these days. One part of the medical system obsessed with keeping costs down. The other part piling on the charges. It all seems pretty crazy to me, like nobody’s in charge. Everybody’s working the system, because it’s too dysfunctional to just work.

My point is that it’s not just psychiatry that’s become a mess in my medical lifetime, it’s the whole of medicine. I was able to skirt the whole problem by staying in training, working in public systems, the military, and academic medicine. By the time I got to practice, it was an office practice in an area that was mostly self pay. It wasn’t my goal to avoid the nightmare of third party reimbursement and pre-approvals, but I’m sure not sorry to have missed it. About all I can say about what happened today is that I wish those who are trying to find some way to deliver health care rationally the very best. It sure needs doing…
    June 29, 2012 | 7:53 AM

    I concur: it’s a mess. Someone sent me this today “In the 1960s, people took acid to make the world weird. Now the world is weird and people take Prozac to make it normal.”

    June 29, 2012 | 5:20 PM

    I was kinda hoping the Supreme Court would invalidate the individual mandate, to force the discussion towards single payer.

    I hope regulation squeezes every drop of profit out of the health insurance companies. Paying CEOs jillions while denying coverage to sick people should be a crime.

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