Did Anyone Actually Believe That Medical Care Companies Were Honest or Ethical?

Doctors at a hospital chain in Los Angeles have complained about pressure to make unnecessary hospital admissions.  It takes a lot to make doctors complain.  These sorts of actions are rare enough that my gut reaction is to believe that where there is smoke, there is probably fire.

A long time ago, a preceptor, or teaching doctor, in psychopharmacology told me to read business newspapers like the Wall Street Journal if I really wanted to know what was going on in drug development.  I never seemed to have the time, but he certainly did. He had a nice family and a fairly large home.  A little more recently, my husband told me if I was ever approached by Mike Wallace, then the star reporter of “60 Minutes” on CBS, with a microphone and a camera, I should probably run like hell.

I am delighted this group of doctors complained.  The health care company has denied the allegations.  They say the data, collected by a third party, does not support the allegations. They don’t provide a link to the data, and I can’t locate it anywhere, so I guess I’ll just have to take their word for it. Cute, huh?  One thing I have learned about all allegedly scientific data, whether it is a result of pouring things in test-tubes or a lot of people counting numbers, is not to judge the results until I know who paid for them.  This hospital apparently paid someone to check if their admissions were appropriate.  Can anybody possibly trust this data, especially knowing it is unavailable and its collection was paid for — if not supervised — by the hospital in question?

I pride myself on being an ethical human, although it can get lonely, and I do not generally deal with excess money.  I can promise you I will never try to sell you any oceanfront property in Oklahoma. But I simply do not trust “health companies.”  If they are not directly insurance companies, they are in bed with them.

Now look at Obamacare.  Everybody is going to have to be insured, unless they want to pay for the right not to be.  The people who make out like bandits are going to be the health management companies.  The money you pay to insurance companies will go to people like this.  Believe me; it will not go to the doctors. Maybe Obama tries to be decent.

Maybe no president can deal with the pressures associated with such enormous amounts of money.  But it seems to me that he is trusting insurance companies and hospitals to do things appropriately.  They can’t refuse people with pre-existing conditions — whoopee.  But they get to insure everybody and they will make the money.  Americans have increased access — whoopee.  Nobody talks about quality, and again somebody is making a lot of money off people getting sick.  It is not me and it is not physicians.  They are too overworked to think and it is becoming too expensive to exist. Doctors are becoming extinct.  Medicine as we know it is going down because we have sold out too much for so long.  I give it 15 years at best.

I have avoided working inpatient for many years, mainly because, well, there is always pressure to admit people.  In outpatient clinics, I have never, not in either a private or public or even federal government clinic, been permitted to discharge a patient from the “system”.  Every single time, I have been told that funding is dependent on “capitation.”  “Caput” means “head” in Latin, so this is literally a head count.  I have terminated patients from psychotherapy when they were in university full time or working full time.  Every single time, another doctor, or even a therapist, or maybe a secretary for all I know, would insist the person still needed care and get him or her back into the system. I would get angry and usually wound up leaving the institution.

I have been told people need support because they come from dysfunctional families.  Last time I checked, so do about 98% of us.  It doesn’t mean we all need psychotherapy.

Most of the therapists I have known, although admittedly empathic folks, have very little training in psychotherapy and are technically incompetent.  I spent an entire year of my residency learning to do psychotherapy.  I know to plan every word and to watch the clock so halfway through the hour you attack the most painful and difficult material and gently put the patient back together enough so they can walk out of the door of the office ready to re-enter their lives.

I have learned how to do multiple “modalities” of therapy ranging from psychoanalytical to cognitive restructuring.  I have never, ever, dealt with a single therapist who had the level of psychotherapy training that I’ve had.  I have worked with therapists who filled their offices with candles, shut off the lights, and had pleasant conversations.  I have worked with therapists who would play pleasant music and think about elves and pixies.  I have even worked with therapists who told patients that medications were no damned good and they should get off of them.  Sometimes the patients did.  I will admit, I once had the power to refuse payment for therapy to a “therapist” who had taken the patient bungee-jumping for an hour.  He had nothing better to say than “I do that with everyone; it helps me relate to them better.”

I have often discovered medical illnesses that present as psychiatric problems, such as an undiagnosed diabetic who presents as a lethargic depressed person.  An untreatable anxiety disorder that turns out to be a thyroid problem.  Although diabetes, other sugar tolerance problems, and thyroid problems are the most frequent, there are tons more.  Like the sad gay guy who ended up being one of the first cases of HIV ever diagnosed, or the woman in kidney failure.  In every single case, I did the papers, fired a symptom free person from the clinic, and ended up with the patient turning back up in the clinic.

I can think of only one exception.  She was a lovely older woman who came to my private practice with a treatment resistant depression.  She had a really screwed up thyroid.  I remember the day I said good-bye to her.  She had tears and hugged me.  No antidepressants or psychotropic medications can do anything at all if a bum thyroid is the real cause of the problem.  I did not even charge her for her last appointment; I just explained the test results and told her all I could think of about how to tell if her thyroid doctor was doing a decent job.  I even remember looking out of the window and watching her walk to her car in the parking lot.  She was fairly well-to-do and I had just sent away one of the most affluent patients I had ever seen.

There must be someone, somewhere else, who would have done that.  I just do not know such people; and if I can think of some who have this level of ethics; well, they are not doctors. I cannot believe that there is anyone like this at the hospital in question for pushing unnecessary hospital admissions. Perhaps I’m no longer alone. Perhaps there’s more to the story.