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.