As you can tell

from the lack of recent posts, I'm finding family medicine less than inspiring. 72% of the patients have what amounts to the sniffles or a pulled muscle but will not leave until prescribed entirely unnecessary painkillers and/or antibiotics. 3% are undertreated psychiatric patients. A good 21% are lonely or depressed and just come by to have someone to talk to/something to do. The remaining 4% that are actually in need of a doctor are immediately referred away to the emergency room or to a specialist.

By far the most interesting thing that happens at the clinic is that the receptionist's bra always, and I mean always, perfectly matches her shoes. And they're different colors every day. Impressive.


The one part I have enjoyed is the walk from my house to the clinic. It's about an hour walk, the clinic is located on the outskirts of the city almost in the desert, and on the way I pass through the Bedouin market, which is always a neat reminder that I am definitely not in Maryland anymore. Yesterday, I passed a boy grazing his cows in the community park, and this morning two old women rode by me, side-saddle, on mules. The patients sometimes stop by the market on the way to the clinic so we get gifts of herbs or tapestries or, occasionally, a chicken or two.

To make the culture shock as dramatic as humanly possible my first fourth-year elective is smack in the center of New York. I start one 12 hour flight and four days from now. I am beyond excited to be able to speak English with my patients, to use needles with safety caps, and to be back in the ER again.

It's going to be tough though to be back in NY and not be doing theater. I have a constant inner impulse telling me to tear off my gloves, walk out of the hospital, get some new headshots, and start going out to open calls.

Well, someone needs to save the world I guess. Are you ready for me New York?

Socialized healthcare strikes again

I entered my clinic the other day to find my supervising doctor furtively folding a New England Journal of Medicine article and sliding it into unmarked envelopes.

I should explain that this is the doctor who snuck into his own clinic and tore down all the ceiling fans overnight in order to get them to install air-conditioning. A year later, he actually tore down all the internal walls in order to convince the government to pay for renovation. So I was, let's say, concerned. I enjoy working in a clinic with walls.

He didn't explain himself but throughout the rest of the day he muttered to himself and made multiple threatening and vague-sounding phone calls in between patients.

In the afternoon, the story came out. In Israel, the outpatient clinics are funded by the government, doctors are paid a steady salary. To assure quality, doctors are reviewed every year and receive either a financial "punishment" or "reward" based on their performance.

Now how are they reviewed? The blood sugar level (HbA1C) and blood lipid levels (cholesterol, etc.) as well as a few other measurements of all their patients are averaged and the doctor is assigned a quality score based on the health of their patients.

A flawed system? Obviously. I mean, obviously. The system basically encourages doctors to refer away their sick or difficult patients. It also pushes towards treating numbers, to overmedicaton possibly.

So my attending refused to do this, he's been refusing to play the numbers game for years, and as one of the most respected and experienced doctors in the area, he receives the most difficult and elderly patients, pushing his score down even more.

So this year, not only has he been financially penalized again, but they want to bring him before a review board. Meanwhile, two new studies have shown that overly controlling diabetes actually increases mortality. So my doctor is refusing to go to his hearing until he receives a written apology from the committee for penalizing him and an admission that he's actually been the only one, according to this new study, who has been appropriately and safely treating his diabetic patients. He's also been anonymously mailing copies of the article and making threatening phone calls.

I really hope this turns out his way, though I'm pretty sure it won't. This man has 40 years of experience, built his clinic from the ground up, works 60+ hours a week, treats the kinds of cases most family physicians wouldn't touch with a 50 foot pole wrapped in liability waivers, and is loved, I mean loved, by his patients. And he may lose his practice precisely because he chooses to treat sick people instead of healthy ones and to treat patients instead of blood tests.

So it goes.

Who says drug companies don't spend their money wisely?

Patient(bursting in without an appointment): I saw a commercial for a drug! I need you to give it to me.
Doctor: Do you know the name of the drug?
Patient: It was on tv! With the people! It's supposed to work good. I need it.
Doctor: Well, do you know what the drug is for?
Patient: It's. A. Pill. The one with the commercial on tv!! It was on the tv! Last night! For people. To feel better. They said it works really really good. I need a pill that works good! Give it to me.



Later in the conversation. . .
Doctor: ::gives up:: Okay, we can talk about medication in a minute. Is there anything else I can help you with.
Patient: My shoes have anxiety.