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Medical Landscape Slippage & You

Updated: Jul 2, 2019


Not too long ago, and possibly still to some extent, it was considered unethical for physicians to sell medications from their


offices. The belief is/was that such transactions would spur treatment in the service of sales, but that may have been happening all along. Next time you go to your dermatologist or dentist or ophthalmologist, take a look around for brochures and advertisements for products with the practitioner's name on them.

You may find that dermatologists have all manner of lotions, cremes and products for your skin and hair that are all "their" personal formulations. Sorry, but I don't buy that one. I believe it's just as it is with store-branded foods; one maker prepares everything and labels the products for different sellers. No difference.

How many physicians/surgeons have been found to have performed unnecessary procedures or surgeries just to increase their bottom line? I recall a joke one physician used to tell frequently about a surgeon with whom he usually had breakfast. Toward the end of the meal, the surgeon would stand up and announce, "Sorry, but I have to do an unnecessary surgery now." They'd all laugh. Was it true? Who knows. Therapists, too, haven't been above such questionable practices, so let's not leave them out.

If selling products was blurring the lines between medicine and


retail, how will the latest trend of pharmacies buying insurance companies or insurance companies buying hospitals affect medical practice? Then, too, how will the downsizing from large hospitals to "mini-hospitals" or more outpatient clinics affect all of us?

Hospital stays have been dramatically reduced due to DRG (diagnostic related grouping). Once, women remained in the hospital for 3-5 days after a birth. Now, it may be one day IF they don't have a temperature. Temperature (aka diaphoresis), you see, is key here and if a physician can indicate you're running a temperature, voila, you can stay a day or two longer.

Knee replacement surgeries can be performed in the morning and some patients leave the same day. Gallbladders are removed in same-day surgeries at outpatient centers as are many other procedures which previously required a few days in the hospital.

Reimbursements are key to ALL medical care. I recently saw a member of a team at a psychiatric hospital bemoan the fact that their administrator wanted them to CODE DOWNWARD. This,


the administrator said, would result in more reimbursement. Usually, the tendency is to CODE UP and that's why you see those multiple charges on your bill. Coding, again, is key here. Forget about the fact that it might be on the fringes of medical fraud.

Individual practitioners, like local candy stores, will be erased from our landscape to be replaced by full-service, but small, facilities. But who will staff them and will the local, corporate-owned "emergency" shop be your new medical provider?

Where will medicine be in five or ten years and will it be to our benefit or the stockholders in these corporations? What will the qualifications and the experience level of the treating providers be? How much choice will we have when choosing someone to be our primary care provider? Will we have ANY choice? Will we be assigned to a PA (physician's assistant) without our knowledge, believing we're being treated by an MD?

How many psychologists or nurse practitioners will be providing psychiatric meds? Who will be insuring that they have adequate supervision and experience when even psychiatrists aren't very


good at prescribing psychiatric medications? The brain is still holding fast to its mysteries and no one has a computer program in their office to parse out the potential interactions and problems with the multiple meds that people take. Pharmaceutical "detail persons" (aka salespersons) do a great deal of "education" for providers and still bring lunch or breakfast for the entire staff at the facility. There have been cutbacks, but they're still out their selling their companies medications and medical-illnesses-of-the-week.

Are pharmacists to be our medication gatekeepers? Could be because they are more qualified than MDs in this area. So, will pharmacists be doing the prescribing in the future, too? The trend is moving in that direction.

The healthcare landscape is changing rapidly with the purchase of physician practices by large hospitals that are growing like Topsy. But their day will come and we need to consider how we want to proceed and what questions we need to ask when either buying insurance or considering medical by someone.

Caveat emptor, as always.

#medicine #medicalpractice #medicalethics #consumerchoice #medicalconsumerism #ethics

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DR. PATRICIA A. FARRELL