Home Forums Discussions General Discussion Interesting blog

In the blog below under COMMENTS, this physician, andy bourdain, submits a comment that I find hard to even believe. It almost sounds made up just to incite people. It is certainly way out in left field.

Just wonder what others think about the article as a whole and about this guy's comments. Clicking on his name brings up his email address, but I doubt I would want to give my emaill address out to him.

I would love to coment or not but where do I look?

Sorry, I knew I would forget to paste it.

http://www.thehealthcareblog.com/the_health_care_blog/2008/05/bitter-doc-want.html

Hey very interesting blog indeed. It is amazing how some of those snotty specialists felt they should be able to reinvent FP residency programs in their own image. Funny how they where bitching about the lack of training in the most important fundamentals of Primary Care that really isn't lacking. What the F$&K do they think primaries do all day in their long clinic hours??? Damn what @$$holes. They see patients, try to tease apart their symptoms, order and interprut appropriate tests, and then provide care where needed or turf out when above and beyond. What Jack@$$es.

I wonder what andy thinks about the highly qualified specialist who removed the wrong lung (right, but it was the left lung w/ the cancer), and then tried to cover it up by lying to the patient, that was in the paper a couple of days ago.

Well that is a very interesting post. It sounds like he is someone who would be hard to debate with, (Ha!) but he raises some interesting points. I think his experience is colored by the 'GP's' he has had contact with. But he may still have some points that merit debate if not corrective action.

This is the post:

As one who has practiced in both an academic setting and as a sub specialist in a rural community, I can offer the opinion that the plight of primary care physicians in the medical social/political hierarchy begins with their training. They simply are ill-trained. One to three month rotations in many specialties do not make them specialists in anything. They dont have the medical judgement or the medical knowledge to care adequately for the sick. They survive only because of the fact that most people who go to doctors are either not sick, or have illnesses from which they will recover whether they see a doctor or not. The problem is further exacerbated with their colleagues by their own insecurities. They tend to hold on to every patient that comes through the door during office hours, but all of a sudden become totally stupid and refer everything out after hours and on weekends. The fact is that the*family physician* is a warm cuddly term that in fact was an ill-conceived concept designed to fill gaps in rural medical care. The training is attenuated and the result is a physician who is simply not prepared to make sound scientific judgments in the real world. I do not know any sub specialist who would himself put his care in the hands of a Family Physician. The medical schools have to do a lot better if this situation is going to change.


Posted by: andy bourdain | May 16, 2008 9:09:01 AM

I am a
*family physician* is a warm cuddly term that in fact was an ill-conceived concept designed to fill gaps in rural medical care.

I practice in a small town with a small hospital. I cover my patients 24-7. I see my patients at home, in the office, in the hospital, in nursing homes. All my patients get an hour of my time for their first visit and have access to me on any day when they are sick.

Most of the time, to send my patient to a specialist, they need to travel about 30 miles to another town. I consult the few specialists in my town when my patients are in house when I have a problem I can't solve. Same for outpatient. I just sent a patient with a somatization disorder who was admitted last month for chest pain to a cardiologist in another town mostly for reassurance. She had a negative echo and stress test in our hospital. He cathed her and sent her back and told her that I need to send her to a gastroenterologist for an egd for her GERD and a pulmonologist for her asthma. She has mild intermittent asthma and h pylori that is in the process of being treated.

Most specialists I deal with are not like the fellow who wrote the blog or the one I mentioned above. Thank heavens. Most specialists I deal with are helpful and appreciative of the role of family physician.

I do think the author has one point that I think family medicine should address. While not true for most family physicians, family medicine is a last choice for many medical students. It is also seen as a place to get a foot in the door for some before they get into the field of medicine they "really" want to be in. We need to do a much better job of selling our profession not only to idiotic colleagues like Dr. Bourdain, but also with future generations of doctors.

I'm sorry I got carried away-we're all busy and don't have time for long winded discussions. From my viewppoint, Dr. Bourdain is misguided.

Assuming Bourdain has a private practice (of course he probably doesn't) the best way to educate the clown is to stop sending patients to him. I bet he'd realize the PCPs are smart enough to not send him business when he insults them. Unfortunately, many patients have that same attitude and when they see a General Internist or FP as their PCP, their attitude is really "I need to see this person so I can go to the real doctor." I know some real dozies, and I keep threatening my sister that I'm gonna write a book.

Write it Wayne, write it!!! Someone has to get the truth out there.

Vickie, you have nothing to appologize for what so ever, so says the king of long winded posts. I grant you immunity.

As for this bozo, if you folks return to the blog many others there have kind of mentioned many of the things we have all spoken to here. I can only hope that the PCP's in his area read his posting and do as Wayne said, stop refering to him. When his practice dries up and shrivels on the vine, then he can rant to his heart's content about how stupid all those PCP's were for not refering to his self proclaimed superior @$$. Only nobody will be listening... Screw him.

And there was this other guy who was carrying on about this PCP who dropped out of insurance and how unethical it all was because he had a practice full of upper middle class patients who could afford to pay him cash on the barrel and that he was proud and unappologetic about it. It's easy to sit in judgement of someone else when the system you defend still takes decent care of you and you are talking with your mouth full, because you can still feast on the takings. Most PCP's no longer have such luxuries or liberties to spare. Most of you have but two choices, get 'em in and spit 'em out, high volumn crumby care or slow down, and do proper care while starving your ethical beliefs as Nancy and I are doing. I want to see all these specialist idiots and AMA snoots practice with your payment levels and keep to their position on this kind of CCHIT.

I learned a long time ago at the ripe age of 18 as much as I wanted to care for many others and assist them with their problems, one can not afford to care for others until they have half secured a place of stablity for themselves first.

Well funny how none of the specialist docs see the RUC wing of the AMA that so wrongly colludes with their well protected specialist bretheren to keep the RVU's for procedures so artifically high, while the RVU's for office visits are set so arificially low as OK, nothing wrong there now is there??? Then these same SOB's try to take over your IPA's and PO's to get contracts that make it even worse with bumps for procedures higher then office visit doubling the insult to all of you.

We have such a contract with one of our major carriers, who will remain nameless, right now thru Nancy's PO here in town. The RVU's for procdures are already biased heavily towards procedures and surgical things, but none the less, the board keeps this contract at 10% higher for procdures as compared to E&M codes! Makes my blood boil when I see this CCHIT. You guys need to know more about the business side of your businesses. This is how you get screwed each and every day, right under your own noses and you don't even know it...

This is reason enough for me and I would hope each and everyone of you to write the AMA and tell them you will never return until the RUC revamps its BULLCCHIT standing on procedures verses office visits, other E&M codes. Your own collegues and proffessional organizations are telling you just how much they value you... And their answer is that they DON'T! Please get the message and start to act upon it.

I keep saying the PCP's need to form a more radical all PCP inclusive organization that finally stands up for what is right, not for what is profitable for everybody else but patients and primary care providers... Please get the hint folks, please. For your own sake, all the patients' sakes, America's sake. Someone finally has to take a stand and say what needs to be said, and do what actually needs to be done. And for better or for worse, this task falls to you...

Good Night and Good Luck,
Paul

I just mailed out some links on all of this to the IMP folks to link to this thread as well as to the orginal blog. Perhaps we shall gain some additional traction there....

@Wayne, please send the link to the lung thing

@Paul, great viewpoints as usual. Have to get the log out of one's own eye.... if I heard you right

@Vicki, great posts. I hate to get all weepy, but you are the reason I keep practicing. Adam and I practice 24/7 medicine. It's tiresome but rewarding. And, I don't know how many times I hear, "Yeah, I went to the ED last night, but I wanted to hear it from you."

I had a patient who had lower leg hypotonicity where three specialists said his MRI was normal, and he was fine. I sent the MR to Boston after conferring with another radiologist here in Bangor and three weeks later he had neurosurgery and is now jumping three feet off the ground. His mother was asking him to stop crashing my office and, for once, I was enjoying sitting back and watching a three year old just run and jump and trash my place. Primary care is incredibly important.

Thanks for reading the blog and commenting. Wanted to know what my friends thought. Of course, maybe this guy isn't even a specialist and just wanted to stir the pot. I will give him the fact that he gave his real name (we think). Of course, maybe andy bourbain is a competitor of his, lol.

Paul, your idea of banding together whether antitrust or not should be a topic at the next ACUC (after discussing with a lawyer whether it is antitrust). Wouldn't it be incredible if a large group of ACers were the ones to turn this whole medical issue around?

Whether or not as an offical union or more like an AAP, AAFP business association that can do press releases and lobbying for real effective change. The IMP folks are talking about going offical but as a non-profit and this ties ones hand they say from lobbying.

Now there is the possiblity of having two separate but sort of brother, sister organizations so they can both do their own separate but kind of coordinated operations. So like one as a professional organization ala the specialty organizations do now, but one that can combine all MD, DO like PCP's. Peds, Internal Med and Family Practice. The opressors like insurance carriers love to see folks divided up because it makes you a smaller weaker target.

Now there is a local of the teamsters union here in our area that is trying to organize doctors but until we use our combinded resources and knowledge to finally find a way to get around the anti-trust laws we will always be nothing but a bug to be squashed. I still think with some combined financial resources to fight and figure out the best way to legally solve this one problem, then we can finally make some real headway.

I wonder if there might be some ethical lawyers (ya I know we all think that label is an oxymoron but there are a few, like this lady at the ACLU I just made friends with) who might give of their time for free or reduced rates because they can see the connection between what is good for primary care docs is really good for everyone and the country as a whole. We need to break the strangle hold these SOB's have on the proffession of medicine. And we need to finally have someone talk about helping us in ways other than Malpractice reform. For most PCP's, as much as it is any issue, it really is not our main issue. Our rates are almost semi-reasonable. It's everything else that is really killing us. This is a specialist's issue and again the AMA and the Medical Societies represent those guys not you folks....

Anyway, I've got a few games this evening and need to get ready for them. I'll try and check back here late tonight or tomorrow in the am... Have a great night folks...

"Solidarity forever, our union keeps us strong...."

Paul

Paul,

So what if we do break the anti-trust laws (like the FQHCs), what can they do to us? Make us stop seeing Medicaid. If all PCPs in Maine stopped seeing Medicaid patients (just a theory here), the system would fall apart in less than a week. Then, there would be some chairs around a table.

Unfortunately, the lung thing was in the newspaper last week. I'm not sure if it was the Star Ledger, NY Times, or WSJ since I alternate between the 3. I think it was SL though.

Whoop! Here it is!

http://www.wnbc.com/news/16709032/detail.html?rss=ny&psp=news

But he doesn't get punished too badly. I wonder how long it took him to make $81K. Not long, I bet.

The State Board of Medical Examiners found Dr. Perera guilty of gross negligence, assessed him a mere $81,000.00 in fines, and revoked his medical license temporarily. That’s right… temporarily. Under the ruling, Perera can appeal for an early restoration of his medical license after six months.

Three cheers to Vicki. I'm right there with you. I do the same, as does my friend Bert. Great post!

That Bourdain dude needs some Christian prayer for him.

Sung or read to the tune of You're So Vain by Carly Simon:

Hey andy,

You're so vain, I bet you think this song is about you.
You're so bourdain! I bet you think this song is about you, don't you, don't you.

I had an interesting idea... What if those of us who are not actual doctors, family, friends and staff, "Friends of Primary Care Providers" had even a third organization. Like who here right now knows more about this stupid business but your biller or your practice manager. I'm not feeling a 100% confident, but I think that we are not bound by the same laws. We certainly are not the one's who are bound by the anti-trust laws that is for sure.

I'm just not sure because like so many other things in the stupid business, the doc still pays the price for the "Violations" of their staff. So am I for example truely free to speak my mind and out these SOB's or would they still prosecute my doc because I am in her employ and so like billing and coding, no matter who picked the final code or submitted the actual bill, in the end the doc pays the price none the less? Also might I be subject to some forms of civil or legal penalties for disclosing the terms and conditions of these private and "proprietary" contract terms and conditions...

All of this reminds me of the fight Ben & Jerry's had many years ago with Pillsbury. There was something where they were trying to silence B&J and the basics got out in the news up in Vermont. And so there was this grassroots like support the guys like thing that sprung up around town, with folks wearing t-shirts and making bumper stickers with the phrase; "What's the DoughBoy Scared Of???"

It just about the same thing. These guys know that if we outed them for all the restrictive stuff and CCHIT that is in their contracts, most people would get it and be pissed as all hell, and so they also load our contracts up with all these terms and penalties that don't allow folks to out them and talk about them... Ya just can't make this kind of stuff up.

We need a medial business wistle blower forum to protect the whisler blowers which gives some basic cover to the person who outs these bastards so the story can finally be told.

Hey did you guys hear about the 10 repreve from the Medicare cuts to get us over the 4th of July holiday? So congress has 3 days to solve the problem when they get back or else.... Lovely.

Hey I did it, I really did it and signed on as Hockeyref too!!!

I just couldn't stand those idiots over at that blog anymore so I finally slammed them one but good. Oh I feel so liberated and I hope they are all freaking out just about now...

Go check it out when you can and tell me what you think. Those bozos had it coming to them... Although it felt a bit cathartic and good, I'm still not sure how I feel completely about it all....

Anyway it is very late and I need to get some sleep here. Have a great night one and all....

Paul

Damn it, Paul. You are going to get banned again, lol. Remember that blog has a EULA and they can take your whole computer, lol. OK, sorry everyone, I brought up the EULA. I will do ten pushups now.

Get down and give me ten son!!!

Hey I'm a hockey coach, I'm allowed to give those orders....