Originally Posted to the Sermo Community
By: A Physical Medicine & Rehab Specialist on Sermo

Dear Mr. and Mrs. America,

You live in one of the greatest countries on earth, one of the richest ones, yet arguably not one of the best for medicine.  You may question why that is.  I think I may have some answers.  Essentially, you want to have your cake and eat it too.

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When you are sick or injured, you want the best healthcare money can buy.  But you want someone else to pay for it.  You feel should not be made to pay for things that are not your fault, as you perceive it.

When you do not feel you have gotten the best healthcare someone else's money can buy, you scream, yell, threaten and generally act like a child.  Then you demand to be respected as an adult. You take the same approach to "free" care, such as telephone calls, disability paperwork and public aid.

When your treatment does not go as you planned, you want to keep the legal option to sue a doctor for "everything he's got", but want to keep "good" doctors in your community so you don't have to drive 6 hours to get your brain tumor operated on.

You want to be able to drink and smoke as much as you want, and then when years of beating the crap out of yourself makes its presence known, you want us to rescue you.  We told you 40 years ago not to smoke.  Now you want us to save your life from the CAD, emphysema and lung cancer you caused.

You want to drive a car at 90 mph while drunk, "because I'm having fun" but want us to put all the pieces back together when the inevitable happens.

You want a single-dose pill to take care of anything that ails you, aka the "magic pill."  But you complain about the realistic medications you will need to take every day for the rest of your life. 20 years ago, these pills did not exist and you would have had only a few years left to live.  Now we can keep you around for many more years for you to keep complaining about the pills you have to take.

You complain about the 3 antihypertensives, the 2 cholesterol-lowering drugs, the glucophage and other pills keeping you alive and adding years to your life, while refusing to quit smoking, cut down the drinking, eat healthier and get some exercise once in a while.

You spend a ton of money on highly-processed, marginally-tasteful, completely unhealthy food, and then ask us for a pill to help you lose weight. 90% of the treadmills you own are collecting dust or acting as coat racks.

You want a "lifestyle" pill for every unpleasant symptom you have. You'd rather not do the therapies that can effectively treat your insomnia, you just want a sleeping pill.  Besides, all those commercials on TV for Ambien, Sonata and the others tell you you are entitled to a good night's sleep, by pill if necessary.

You use the ER as your primary care provider, then complain about the wait to be seen there for a URI.

You give us vague complaints, with vague histories and onsets of symptoms and then ask us to make a specific diagnosis.

You demand tests without any knowledge of what "false-positive" means or its potential implications for you. You don't consider the downside of testing. 

You have asked for, and now get "informed consent" before any treatment, but don't want to be held responsible for your part in the decision-making process when things don't go well.

Birth control is an option, one you have often declined to use.  Now the rest of us get the pleasure of helping to pay for that little bundle of joy you didn't want and the "father" declines to acknowledge. Hopefully we can help you finish your GED so you can meaningfully contribute to society rather than live off of it.

You want to legalize marijuana, "because it's safer than alcohol" or so you think.  Two bad things apparently make one good thing.

You want opioids to be available anytime you deem your pain severe us to deserve them, but don't want us to restrict them simply because a bunch of yahoos use the recreationally or for income. The fact that we have been burned so many times by so many people should have no bearing on you, the seemingly-legitimate pain patient.

You want us to trust you implicitly to follow our recommendations, yet you don't trust us enough to finish taking an antibiotic for 10 days when we tell you to. Many times you don't even trust us enough fill the prescriptions we write.

You take whatever the guy at GNC says you should take, and pay him ridiculous amounts of money for unproven therapies, then question us on every potential side effect for anything we prescribe that has gone through a full FDA approval process. And you reserve the right to sue us and the pill manufacturer (and the pharmacist who sold it to you) should you have a side-effect from it, even if we warned you about it.

You argue with us about co-pays, deductibles and out-of-pocket expenses that we have no control over.  Take it to your insurance company or employer.

You want your doctor available 24/7/365, but you want him or her to be well-rested when you come in.

You raise hell when you are made to wait 15 minutes in the waiting room, while your fellow citizens arrive 20 minutes late, with 3 young kids in tow for the annual pap smear.  You then want to take up 30 minutes of my time addressing every health concern you have despite booking only one 15-minute time slot.

Unfortunately, Mr. and Mrs. America, you cannot have things both ways.  You cannot have "free" healthcare that covers anything and everything.  You cannot have an unhealthy lifestyle and expect to be kept healthy by us.

You have been given the knowledge and resources to prevent or treat most any disease or injury known to man, and you have declined the opportunities repeatedly.  Instead, you have opted for the "quick fix" so you can get back to your life of self-destruction.

And I'll still be here, for a while anyway, trying to fix the things you've broken.

View comments from the Sermo physician community

Lately I have been watching with complete horror the events playing out in my home state of Massachusetts.  A bill currently under review by the state legislature will make participation in the state and federal Medicare/Medicaid programs a condition of medical licensure, effectively making physicians employees of the state.

MA Bill 2170

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This is particularly alarming because Massachusetts is essentially a leading indicator of what will happen in the rest of the country.  Several years ago the state passed a series of laws mandating health coverage.  Like the recently passed national health reform bill, the Massachusetts law did not address any of the well known causes of runaway costs, including tort reform, drug costs, or insurance regulation.  Although the state now has one of the highest percentages of its population insured, it is grappling with exploding healthcare costs.  In response, it is imposing capitation schedules, reductions in payment rates and now mandatory participation in the health programs by physicians.  What most people don't understand is that the private insurers are also free to lower their physician payments, based on the Medicare/Medicaid benchmarks.  This is all the more concerning given the fact that the Federal reimbursement rate is now scheduled to be reduced 21% on April 15.  We will no doubt see the same sequence of events play out across the country as the current versions of healthcare reform are implemented.

The net effect of these laws is that it will make it close to impossible for physicians to stay in private practice.  Patient access to physicians will suffer as more and more physicians retire and/or move to different states.  For our academic colleagues who think this turn of events can only "help" them because they won't have to compete with physicians in private  practice, just wait.  28 states are now imposing "comparability" laws that allow nurse practitioners and other allied healthcare professionals to work without the supervision of a physicians with equal pay.  Few academic departments can avoid hiring "physician extenders" if they want to stay competitive.  As this gains momentum, physician payments will be pushed downwards.  As the "going rate" goes lower, academic salaries will also get pushed downwards. 

I knew this reform effort would be bad for the practice of medicine and even worse for patient care. I just had no idea things would deteriorate this fast.

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

View comments from the Sermo physician community

Growing up as the child of a physician, it was always a sign of the utmost respect when one physician would ask another to treat a member of their family. For each condition or need, there was that one physician that all the other physicians trusted with their loved ones. Of late, I have noticed a steady increase in "Saved-with-Sermo" cases, where the Sermo community provided the decisive input on a clinical situation, leading to an improved outcome. The number of times that I have seen physicians turn to physicians on Sermo for help for themselves or their family members is nothing short of staggering. This week's Sermo Pick, is a great example.

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Sermo is almost four years old now, there have been more than 3 million comments and just under 50,000 posts. I recently did an interview with a reporter to discuss the "Sermo phenomena". The reporter's first question was "What has been the most rewarding part of Sermo?" My initial response, "not failing," was perhaps too honest. After thinking for another moment, it hit me that the real treasure of the Sermo experience has been seeing an impact on the actual care of patients in this country.

Later this year, Sermo will introduce an entirely new platform that promises to be a quantum leap forward in terms of user experience. As we gear up for that milestone, I want to ask the community to share your experiences [with links, if possible] where Sermo has impacted patient care and how this community believes the Sermo Team can best deliver on our commitment of supporting physicians and improving patient care.

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

View comments from the Sermo physician community

Today, athenahealth and Sermo released our Physician Sentiment Index℠ (PSI). With over 1,000 physicians polled, the national survey is thought to be the largest of its kind.  While many of the findings will come as no surprise to physicians in practice, the messages are nevertheless alarming.  Key findings include:

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• 64% cited the current healthcare climate as somewhat or very detrimental to their delivery of quality care
• Only 22% are optimistic about the ability of the American physician to practice independently or in small groups
• 59% are of the mind that the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve 
• The majority (54%) strongly disagree/disagree that more active government involvement in healthcare regulation can improve outcomes; less than a quarter feel otherwise
• A shift from fee-for-service to pay-for-performance gives hope to almost half (49%) who think it will have a very/somewhat positive impact quality of care but;
  • 53 percent believe pay-for-performance will have a negative/very negative impact on the effort required to get paid

View full PSI survey results (PDF)

Working with athenahealth, Sermo plans to publicize these findings to help the general public understand what is really happing in our healthcare system today and establish a sentiment indicator that can generate longitudinal trend data in this area.  In the next phase of the athenahealth-Sermo relationship, we'll be building off these findings to explore ways that physicians can run their practices more efficiently and level the playing field with insurers.

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

View comments from the Sermo physician community