Sunday, December 13, 2009

Health Care Reform

So many people have asked my opinion on this tricky subject.  This is what I think about it as an Emergency Medicine physician.

Who can really say if healthcare is an intrinsic right? I don't know or really care, but I do know that by law I cannot turn anyone away from the ER without receiving medical care (EMTALA). I also would have an ethical dilemma turning away someone in need of help because they cannot pay. My oath obligates me to service of all.

I deliver about $150k of uncompensated care a year. This is not the subsidised Medicare, caid, cal underpayments that don't even cover my malpractice insurance. Despite that, I make a decent living. Not a killing. I owe about $200k for my training, and my twenties and all my previous hobbies mostly evaporated (except for climbing) with my decision to endure the rigors of meodern medical training.

Tort reform is a must. I order WAY too many tests because I am scared of losing my license and missing a diagnosis on someone and getting sued.  It sucks to have that affect your clinical decision making. This drives up healthcare costs.

I think we have a duty to help our fellow human who is suffering with illness.

We need a huge redirection of focus to preventative medicine. Cigarrettes should cost $40 a pack and the cost should go towards paying for healthcare reform.  Specialists should not be so highly incentivised, the highest compensation right now goes to specialists, so of course more medical students want to go into specialties.  Duh.  We need our best and brightest delivering exceptional primary care medicine.
This all seems like common sense, something sorely missing in modern day politicoeconomics.  This is a brief synopsis of my thoughts on heathcare reform in this country.
Noah T. Kaufman, MD
Seek perfection of character. Respect others. Try Hard.


  1. So many issues to bring up, so little time. The income physicians receive is in large part controlled by the insurance industry. The cost of doing business for potential medical malpractice claims is controlled by the insurance industry. The insurance industry is uncontrolled by any federal anti trust or price fixing laws as it is exempt, just as is sports. See price of tickets, quality of product, profit of owners.
    Why has the medical profession not gotten outraged and demanded accountability of its insurance companies both as to premiums for malpractice insurance and compensation for its services instead of rallying against the judicial system that provides compensation for meritorious claims of injury due to negligence, the system that serves us for all types of claims, including those of medical malpractice.
    Your statement that you are doing things that aren't necessary to avoid losing your license. Do you know or have you even heard about any physician who has lost his license for ordering tests that were unnecessary. Or for not ordering a test that was even prospectively deemed unnecessary much less considered unnecessary retrospectively?

    Equally important, what happend to your age old ethical obligation to do no harm to your patients. Are you really ordering tests that are unnecessary including CT scans that do have potential long ,term risks for patients because of their radiation load)? And are you doing that out of concern for your own well being and the distant trheat of a possible law suit?
    Are unnecessary tests the product of fear over a distant law suit or are they the result of convenience, limited time, and the lack of adequate training to ask questions and listen in order to make a diagnosis without the resort to fancy dancy and expensive testing?
    You are the one on the line so I respect your take on this but I also question whether you have really thought this out and the ethical considerations involved if you are really doing what you say you are doing.

    I have been addressing these and related issues on my blog which I invite you to visit.

  2. Daniel, thank you for your excellent thoughts and questions. The truth is when I practice medicine, I think only about the patient's well being. It is only when I go home after a shift that I think "did I really need that test?" or worse "should I have gotten another test?"

    I think you are right, CT scans that I deliver unnecessarily will cause some leukemias down the road. that sucks. One huge problem is that hindsight is 20/20 but when faced with the immediacy of a decision, one holds no crystal ball. There is often only a right and wrong after the outcome is known, and that is the minefield which is modern medicine.

    I agree that the insurance industry is a huge problem for us, and I agree that physicians do not spend enough time battling for ourselves, mostly because we're too busy studying and reading try to stay current with modern medicine and its frequent changes in "standard of care."

    Daniel, you must concede, however that there is great profiteering going on by many in the judicial system (eg Sokolove.) Frivilous lawsuits against physicians are real and they are a real problem, hiking up our med mal insurance and eroding our income.

    Helping people is priceless and is the only reason left to go into medicine. It's a disaster watching your income drop EVERY YEAR and being mostly powerless to do anything about it.

    Thanks for your comments, daniel. Is there anyway you can help us?

    Noah Kaufman, MD


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