http://news.blogs.nytimes.com/?p=25#respond

Okay, the stupidity of some of these commentators (if I can even credit them with that title) astounds me. My personal favorite is the moron "Ann," comment #43 who put a stop payment on a check after she had what admittedly sounds like a less than emergency situation root canal done. You fucking idiot put a stop payment on a check? of COURSE you're going to get dragged into court, and furthermore, you DESERVE to be dragged into court for such idiocy. One wonders why people like you are allowed to breed. At the very least you should not open your mouth about your act of extreme stupidity. Jesus.

And to respond with my own opinion on the subject. As you may all know, I spent the last 8 weeks of my summer suffering through clinical rotations (an eye opening experience in many respects, I'll concede) through a variety of areas of medicine and various types of practices (academic, private, clinic, etc.) and I feel sufficiently well educated on this topic to put in 4 cents instead of two.

Firstly: physicians are not mechanics. Surgeons are probably closer to mechanics but really, would you trust a mechanic to ressect your disseased kidney? I didn't think so. So shut the fuck up about physicians being mechanics; most of the ignorant fools who wrote their comments have no idea a) how long it takes to become a doctor b) the standard of knowledge that a freshly certified doctor is made to achieve and c) the behind-the-scenes process that accompanies a diagnosis. Every job has a level of craftsmanship and medicine is really no different; in fact, medicine requires a helluva lot MORE craftsmanship than the average asshole posting on the Times blog can appreciate.

Secondly: I acknowledge that a lot of doctors are influenced highly by financial incentives. The reimbursement system in medicine is procedurally based. Doctor does something, doctor gets check weeks later from insurance company/medicare/medicaid. So if the doctor just sees you but does not poke you, he or she cannot charge you for having poked you. That is illegal. However, according to this article, and yes, I know that it IS in fact true, a lot of doctors insist on poking you so they can charge you or your insurance company for poking you. That is unethical, but not illegal. The problem isn't isolated to Elyria, Ohio and it certainly isn't the best thing for anybody involved.

Thirdly: A significant part of why these doctors feel pressure to make "more" money is because of the overhead that an individual doctor in private practice has to undertake in order to be in business and deal with insurance companies. Insurance companies do NOT always pay (in fact, they often do not pay and try to get away with not paying as often as possible) and that means a doctor must hire, in addition to medical assistants, staff whose job it is primarily to phone jockey each insurance company and badger them for procedural reimbursement. And then there's the office rent. And then there's the malpractice insurance. Eesh. No wonder many doctors in Manhattan refuse to accept any kind of insurance; it's just a pain to deal with and it pushes costs up for everyone. Now this course of action is obviously not possible for all doctors, but it's a solution nonetheless.

So, with these three seemingly conflicting problems, what is to be done? Where do you find a decent doctor who a) isn't trying to rip you off/put your health in jeopardy for silly book-padding procedures, and b) who doesn't treat you like a piece of meat trying to shove you out the door as quickly as possible so that they can fit more billable "consultation" hours in?

A: The faculty practice doctors at academic institutions.

I witnessed firsthand that the doctors in the faculty practice at medical schools and their affiliated hospitals not only had time to spend with their patients, but they also did not attempt to foist useless procedures that cost insurance vast sums of money. Because they were a part of the faculty practice, (it was explicitly explained to me by several such doctors), they were given a salary, benefits which included malpractice insurance, office space and staff, and the opportunity to pursue research and keep abreast of new developments (in fact, they were required to do the latter). The bonus: only the better (dare I say even best) residents (pre-board certified MDs) get to become faculty at an academic institution (med school), so you've already gotten the self-selected better doctors out there.

Let's not forget that for every stellar doctor at the top of their class, there were 10 or 11 assholes who barely scraped by. Keep that in mind when shopping for a doctor, and don't hold doctors (or any other professionals) to ridiculous overblown standards. There are shitty mechanics and shitty lawyers all the same who are out to make a fast buck. Don't be offended by the fact that the law of averages holds true for doctors as well. Above all, don't be like asshole #43 who is so stupid, she doesn't even know what was wrong with what she did.