It’s been a while since I posted something on this blog. It’s been a busy time. I have been incredibly fortunate to have so many of my existing patients refer their friends and family. Honestly, nothing I’ve ever experienced is as gratifying as the recognition that these referrals represent. I’ve had a lot of jobs in medicine, but nothing has come close to being as satisfying as running my own practice has been. There have been so many interactions with patients that have made me proud, happy, sad, disappointed, enriched, hopeful, and a bunch more emotions. I know that this blog would be more interesting if I wrote about some of those experiences, but in some way, I feel like writing about those experiences would be wrong. The satisfaction that I get from these interactions seems like a private thing. And I can’t imagine anyone with whom I’ve had an interaction from which I derived some joy or satisfaction, reading about it on this blog, no matter how well-disguised his identity were. I know I am teetering on the edge of self-martyrdom; that’s really not my intention. I just feel like in our society, with our economy, with the increasing influence of technology making human interactions exceptional and fleeting, that maybe we forget how nice it is to engage with another person. Talk to a stranger, help someone with directions, maybe even help an old lady across the street – these things can have so much positive effect on our mood. Feeling that we are part of a community, that we’re needed, that we can contribute – these are as necessary as air and water for our souls. When one feels needed and included, the incredibly perverse question of, “Why am I here,” becomes irrelevant.
As you can see by the title of the blog, I was going to comment about insurance reimbursement. Not to disappoint:
Vaccinations are incredibly important public health tools. I encourage my patients to get vaccinated for anything that is appropriate. I uniformly lose money on vaccinations. Insurance companies pay me less that my cost for every vaccine I administer. However, when I take ten cents worth of liquid nitrogen to burn off a wart, they’re more than happy to pay me $50.00, more if the wart happens to be on a penis. I don’t think that it’s a coincidence that vaccines are mostly used for children. Kids don’t have lobbyists. The one vaccine that I actually do make a small profit on is the influenza vaccine. Again, can’t be a coincidence that the influenza vaccine is predominantly given to adults.
Someone asked me a few days ago what I thought was the reason that the United States spends so much more on healthcare than any other industrialized country, but has worse outcomes. I think he expected me to say that it was because doctors order more tests in America because of the fear of litigation. I’ve read several well-researched papers about this topic, and while we certainly do spend more money by practicing “defensive medicine” in the U.S., this spending probably represents less than five percent of the total healthcare budget. My response was, “We spend the majority of our healthcare dollars on people in their last six months of life.” A hospital can make a profit by keeping you on a ventilator for your last three weeks of life, but insurance companies often won’t cover in-patient hospice care, and they are certainly not making easy for primary care providers to deliver preventive measures like vaccines, sexual health counseling, and diet and exercise guidance.