DOCTORS’ LOUNGE
challenge?
after all, you are Aries and I am Aquarius.”
What might happen is that sooner or later,
the doctor who has ended up bottom of the
heap in the competition for Medicare pay
will take a hard look at her census and an
even harder look inside her heart. Which
patients have repeatedly and disastrously
failed to follow advice? Then, in the shareddecision-making module of course, the doctor will begin to warn them. “Sad to say,
you are not making the cut. You are, as they
say on “American Idol,” ‘in jeopardy.’ I am
putting you on notice: shape up or ship out."
Already there is a noticeable reluctance
among anesthesia/pain management doctors to accept any patient who has previously seen another of their ilk, no matter
why the patient wishes another opinion.
What will happen to our portly miscreants
who just can’t ever get it together? They will
wander in the Valley of the Undoctored, a
very unpleasant place to be. They will haunt
the ERs, and the whole financial point of
value-based payment systems will be undermined, since Medicare’s overall costs
will go up even more.
Does the doctor always add, you are now
costing me money? What would the malpractice attorney suggest we add? “We are
no longer compatible/your waistline is no
longer a good fit for my cost ratios/I want
you to be as healthy as you can be and you
and I have not managed to get you there yet/
All of us have taken care of people who
just systematically seemed to destroy their
health, and whom we have failed to reach
in any way that mattered enough for them
to change. When they at last went away we
were gratefully relieved not to have to feel
responsible for them anymore. There are
people to whom I have said, “Do this by
the end of the year, or I will ask you to get
a new doctor.” Couching a refusal to care
for people only in terms of their efforts to
be healthy is one thing. Telling them the
whole truth, that they are now a financial
burden as well as a professional one, is, as
we say, a whole ‘nother thing. The next few
years will be telling.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Barret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
JUST CALL ME AN OPTIMIST
Tom James, MD
A
t the 2016 Commencement Ceremony at Vassar College, Board
of Trustees Chairman, William
A. Plapinger, spoke to the 600 graduating
seniors on a number of topics. Hoping to
make an impact on the young lives before
him, this well respected New York attorney
plowed a number of the clichés of graduation speeches.
However at one point, Mr. Plapinger began
discussing optimism and pessimism. While
he was intending to speak to the graduating
seniors on a broiling day in upstate New
York, I felt that on this point he was addressing the house of medicine. Mr. Plapinger
put the context of use of the words, “optimism” and “pessimism” in a strange new
light. I began to think of my professional
colleagues and the negative terms they use
in alluding to the work of our profession.
Do my colleagues see something I don’t or
does my role allow me to look to the future
from a different perspective?
After the ceremony was over I went back
to find the words that Mr. Plapinger used
that seemed to strike a chord with me about
our profession:
“There have been articles recently—in The
Motley Fool by Morgan Housel, on why does
pessimism sound so smart, and in The New
York Times by Gregg Easterbrook, on when
did optimism become uncool—both of
which I draw from here. The conventional wisdom is that optimism has stopped
being respectable. Pessimism is now the
mainstream.
"Housel has suggested multiple reasons for
this, including—
•
Optimism appears oblivious to risks,
so by default pessimism looks more
intelligent.
•
Pessimism requires action, while optimism often doesn’t require doing
anything.
•
Pessimism sounds like someone trying
to help you, while optimism sounds like
a sales pitch.”
-William Plapinger, Chair, Board of Trustee, via http://commencement.vassar.edu/
ceremony/archive/2016/160529-plapinger.
(continued on page 28)
JULY 2016
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