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Doctors tackle health reform questions

Doctor holds out stethoscope

TEXT OF INTERVIEW

Kai Ryssdal: The new health care law is almost a month old now. Just barely 30 days. Which means most Americans still don't really know how it works. And they are asking the next best thing they can think of to an expert -- their doctors -- for help. So instead of the usual talks about cholesterol and blood pressure, some physicians are having to educate themselves on the minutiae of reform. We've called Dr. Winston Capel. He's a neurosurgeon in Jackson, Miss. to talk about this. Dr. Capel, welcome to the program.

Dr. Winston Capel: Good to be with you.

Ryssdal: What do you hear from your patients when they come in for a check up, and they start asking about health care reform?

CAPEL: Well, there's been an evolution from the time of the debate and passage til today. So initially during the very short debate and the passage, emotion was high, they were outraged, and then significant anxiety over the impact on them personally and how delivery would be affected. Then secondarily they were concerned about how it would impact us as physicians.

Ryssdal: Do you have the answers for them?

CAPEL: I do my best. I tell them it's certainly a dynamic process that's going to be challenged, it's going to be debated, and how it's going to impact us now is very difficult to tell them.

Ryssdal: So somebody comes in for a half hour, 40 minute consult, how much time do you think it takes away from your delivery of care?

CAPEL: It's averaging between five and ten minutes now.

Ryssdal: Which adds ups.

CAPEL: It does. And it's not something that we are completely fluent in, but I try to get them some insight as best as I can.

Ryssdal: How long do you think it's going to be before your patient can then come in and maybe not have these questions, or maybe just a couple that you could knock out right away and then get on to the examination?

CAPEL: We're seeing a little bit of decreased frequency just because they understand the answers just aren't here. But they're still anxious, they're still certainly very concerned.

Ryssdal: So we did some calling around trying to find doctors to talk about, and you know, there were some who said, yes, I've had patients complain, and there were some who said, no, my patients don't really mind. What do you guys at the watercooler, or in the doctor's lounge, or wherever you meet your colleagues, what is your conversation between yourselves?

CAPEL: Well, I could tell you this, one thing that frustrates me and my colleagues, when people talk about health care reform, they key in on three issues: the cost, the quality and the access. The one thing that is completely lost in the debate is physician morale. Physician morale is at an all-time low. And by data, we know through published data that two out of three physicians would leave medicine tomorrow if they could.

Ryssdal: What about you?

CAPEL: I would leave tomorrow if I had an alternative career. I love the science, and I love taking care of patients, but things that kill our morale are, number one, the medical malpractice threat, which looms over us every hour of every day, number two this intrusion into the patient-physician relationship, which we treasure, and the more layers of bureaucracy that separates us from our patients, the less gratifying it becomes.

Ryssdal: Dr. Winston Capel. He's a neurosurgeon in Jackson, Miss. Dr. Capel, thank you so much for your time.

CAPEL: Thank you.

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When people say that doctor's make too much money it just shows their ignorance.
You go to school for 30 years, graduate in the very top of your class, work 100-120 hours per week for 4 to 9 years in residency and graduate with 200,000 dollars in debt.
Doctors don't make too much money... rappers make too much money.

We have medical tort reform in Texas. Our insurance costs continued to rise. So tort reform turns out not to be the solution. What tort reform did do is make the patient responsible for the hospital's mistake.

A friend of mine learned of it the hard way. She went in for colon surgery. Was in for 4 days. The surgery gave her a blood clot. While being treated for the clot, she got a hospital staph infection. She was in for 30 days for that. The hospital says clots and staph are just part of care and should be covered by insurance. The insurance says the hospital should pay the costs of it's mistakes. The patient now owes the hospital $150,000. A lawyer will not take the case without a huge up front fee.

Dear Dr. Gen-Surgeon-from-Tennessee
I'm sure you and Dr. Capel work very hard, Doctor. But why exactly do you think that you work any harder than the family doctors and internists in your community. I frankly doubt that very much. Do you have any concept what it is like to juggle 23-30 patients per day and their 5-10 medical problems, 10-15 medications, the allergies, and all the interactions between those factors? Do you really think that we never face life or death decisions? Has it ever occurred to you that with a stroke of the pen a cognitively oriented physician might, while attempting to improve the condition of a patient, instead inadvertently cause his or her death? How is it that we would not lose sleep over such issues? What the hell do you think we do all day!?!

I'm sure you're called in to the hospital after-hours several times per week. Well, so are pulmonologists, nephrologists, oncologists and numerous other cognitive specialists. Just for the record, some surgical specialists in my area also think they work harder than us “cognos”. However, I know better because my windows look out on the parking lot (of three buildings full of doctors) which is empty when I arrive at seven, and empty again when I leave at seven. The main difference is, the non-surgeons are carrying a lot more work home (lab tests and reports from other doctors). And the same is true of weekends. And we do all this for the pleasure of 50 cents on the surgeon's dollar.

Doctor, you may wish to spend a day following one of your non-surgical colleagues around. My guess is that by noon, you'd be toast. Or if you prefer try this: turn on a TV and a radio, do a crossword puzzle, a sudoku and play chess simultaneously for eight hours in a row. Then go back to your office, and make a full and accurate report on everything you've just done, seen and heard. That's what cognitive medicine feels like to me. I realize this is way off the subject, but I've heard this blarney from surgeons just once too often.

I too, was extremely disappointed by the one-sidedness of Dr Capel's comments. As a Neuro-surgeon, he sees only well insured patients. As a family doctor, I see patients year in and year out, when they have their insurance, when they lose it due to losing a job, when they apply for insurance and are refused due to a pre-existing condition, when they get really sick and neither they nor I know what to do with their problem under the current situation (which is nothing short of a thieves' banquet). Dr. Capel's receptionist would not even make an appointment for my uninsured patients unless they were to plunk down a large amount of cash. How he can blather on about the “anger” and “anxieties” of his fortunate, insured patients while tens of millions of Americans and legal aliens are on the world's longest waiting list for medical care (uninsured in the USA) is beyond me. How he can look at himself in the eye is an even bigger mystery.

And I have news and advice for his fortunate, insured patients: they are only one pink slip away from being uninsured, and in most cases uninsurable, themselves. They would therefore be foolish to waste too much anger or anxiety on that “evil socialist dictator” who “crammed this plan down our throats”. They might want to save a little bit for those paragons of virtue in the health insurance industry.

Bruce A Robertson MD

Anxious fascination best describes how a relatively new American like me followed the health-care debate in this country for the past 20 years. Arguments for the anti reform movement vary from too much, too soon to not at all needed. But they all share a common thread of irrational anger. Anger that transcend the familiar passion abundant in right wing politics. So intense was the anger that not a moment of reflection is spent to even ponder the pro reform proposal. All what was left was an endless supply fear and hate that poisoned any chance of conducting a constrictive debate. Now that the reform has passed, the mood among anti reform groups is that some mysteries wrong that has been done to the country. It's like mourning the death of a person that is dear to you without being able to remember his name, what he looks like or whether he ever existed. Doctor Capel's could not explain his apparent disillusionment with the passage of the health-care reform other than he shared his patients alleged anxiety of the unknown and the uncertain future but offered no reasons or explanations to their existence. The Doctor's unhappiness seem to be his worries over medical malpractice. You think focusing on patient access and quality of health-care will lead to healthier patient population and therefor happier doctors with high morale, but in the case of Dr Capel, it's a morale buster. It's so bad that he and others have contemplated quiting the profession and trying something else. Well Doctor, may I suggest a Motivational speaker to GOP crowds? It's highly paid, has flexible hours and you can remain extremely short details.

I am not quite as offended as other listeners, but I do love Dr. Capel's comment regarding physician morale. Really? Physician morale is at an all-time low? You mean in the worst economy since the Great Depression? I wonder what the morale numbers are in other professions? Would it be a surprise that they would be the same? And, if what Dr. Capel stated is true, I suspect that it is the costs of medical school that have kept many physicians from jumping out of their occupations, which means we have a bunch of doctors that don't want to be doctors, and that is a sad statement of the state of our healthcare system in of itself.

And I can't stand posts on how much certain people should earn. You may need brain or spinal surgery to save your life or relieve back pain so you can work...and you only want to pay a few $$. The guy deserves to drive a BMW (if he chooses). One bad move and your paralyzed, can't speak or your dead. I'm sure no one in your neighborhood besides a doctor owns a BMW. Sometimes life is "rocket science" or "brain surgery", and those people should be adequately compensated.

As a general surgeon, my experience (education, work schedule and patient interaction) will be much different then a primary care doctor. While the interview was shaort and plain, it does echo many doctors sentiments. Maybe the sentiments of procedure oriented physicans (surgical specialists)? These are the doctors that deal with more malpractice exposure, more night and weekend work schedules, more paperwork and staying awake at night thinking of their patient's surgical outcomes. Even in the profession, its easy for a family doctor to be "dismayed" at another doctor earning >$250,000. They don't know anymore of the surgeon's work schedule, paperwork/documentation, or lifestyle. They don't know what's its like to have a patient die after a procedure you do (fortunately, this is relatively rare) or have a significant complication. This is why committees and debates should be broad based across and within disciplines; experiences and needs will be different.

I was dumbstruck listening to this infuriatingly one-sided interview, which seemed to have no purpose other than to once again air toxic Republican talking points that have already been repeated endlessly on Fox News. I found it unbelievable and irresponsible that Ryssdal made no effort to challenge Dr. Capel's specious arguments.

I couldn't wait to get home and comment on this story last night! As a family physician, I was really upset by Dr. Capel's comments. Many of your listeners have already made my points in a much more articulate way so I will simply conclude with this request: PLEASE INTERVIEW SOMEONE IN PRIMARY CARE!!!!

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