I'm an unabashed Howard Stern fan and have been listening since he came to Los Angeles terrestrial radio back in July of 1991 on KLSX. And of course I have migrated with him to Sirius satellite radio.
When Stern isn't broadcasting live in the morning on Sirius channel 100, or when I have already caught up on replays, I will explore his other Sirius channel, 101. One of my favorite programs on 101 is the Dr. Harry Fisch show.
Driving home from a meeting yesterday I was tuned into the Dr. Harry Fisch show, laughing hysterically as usual, while the good doctor, and his co-host, Shuli Egar, make humor out of the various men's health maladies that are presented while also giving medical advise.
Then one caller who apparently had called in previously sounded concerned. He said that he went to a urologist as Dr. Fisch had recommended but the doctor seemed to have dismissed his complaints rather summarily, and sent the patient packing without much confidence or discussion about his condition. In the meantime, the caller said, his symptoms seemed to have increased in frequency and magnitude.
Dr. Fisch then commented on the state of medicine in this country - that too many physicians spend too little time with their patients: they just don't listen.
Remember the stereotype of the "good old days" when doctors made house calls, and at least on television, were mild mannered, patient listeners who always had the right answer full of wisdom and knowledge? I'm sure that stereotype wasn't accurate, but at least it is an ideal that most people hold on to.
I was a source of repetitive medical attention as a child. Seems I was always doing something to risk life and limb, and about every six months some limb succumbed to my inaccurate risk assessment.
I was on a first name basis with the local orthopedist, Dr. Ed Wiater in San Pedro, CA. I was just a kid so my memories are probably clouded with sentimental optimism. Needless to say, I was fitted with quite a bit of plaster as a kid, but Dr. Wiater always seemed to have some time to talk to me about whatever was going on in my youthful mind.
I don't know how Dr. Wiater got paid - I'm sure we had some insurance. I don't know how many patients he saw daily, what his hospital rounds were like, how much he had on his social calendar, etc. I just know that when I broke something on my body Dr. Wiater spent some time with me, asking about my life, school, sports, etc. before directing the nurse to wet the plaster strips.
The motivations behind physician payment don't foster that kind of attention to patient interaction any longer it seems, and Dr. Fisch said as much yesterday. He commented that the business of the practice of medicine makes it very difficult for physicians to spend much time beyond diagnosis and treatment with the patient.
But it is the listening part that is most particularly healing to people. Some doctors are really good at this part of the job, and others not so good. I have to believe that physicians intuitively know whether they have the bedside manners to be a listener or not, and then choose their career paths accordingly.
Still, the bottom line is that doctors need to make a living, and since these are highly motivated, disciplined people (how else does one get through the grueling training to become an MD?) they are generally going to execute their jobs in the most financially efficient manner possible - which means seeing as many patients as possible within any given time period.
And patient interaction - i.e. listening - takes a hit.
I don't fault the medical profession for this at all. This is just a recognition of the reality of the business of medicine.
In workers' compensation, I often hear how the injured worker just needs someone to listen to him or her. It's not just the complaints of the injury, but the doubt, the questions, the unfamiliarity with processes, the scary forms and publications, tales of abandonment, and other discouraging or frightening ordeals.
The physician is the first line of communication for these concerns - but it seems that the path to such medical nirvana steers away from these primary needs.
Starting January 1, 2014 California moves to the Resource Based Relative Value Scale. This has been a long time in the making and isn't without controversy for sure.
But one of the key elements of the RBRVS is that there is greater reimbursement schedules for listening. The primary treating doctor is given higher regard under this schedule and specialists are relegated a back seat.
So specialists aren't too happy about moving to the RBRVS, and California employers aren't too happy because the initial costs are estimated to actually be higher than the current medical fee schedule.
But proponents argue that overall costs will decline over time, or at least the growth will slow down, because primary care physicians will be motivated to listen and perhaps better understand what is actually going on with the patient.
I don't know who to believe just yet. It's a complicated formula, and it's a reality. California is moving to the RBRVS and only time will tell whether sufficient numbers of physicians will participate in the system to meet the needs of the injured and their employers; and whether there is any impact on clinical quality and outcomes.
I think that what Don Schinske, a lobbyist for the Western Occupational and Environmental Medical Association, told WorkCompCentral is probably the best analysis - it’s not a perfect process, but it’s “the cleanest dirty shirt that’s out there.”