Nick And The Not So Happy Hospitalist

Posted by – August 5, 2009

I’ve inadvertently stirred up some shit controversy at one of the major medical blogs, Happy Hospitalist (a hospitalist is a relatively new term for a doctor specializing in the care of hospitalized patients).

Don’t get me wrong, this story is not black and white; there’s plenty of value in much of what “Happy” writes, I’ve gained a lot from his posts explaining the medical payment system and have learned about how government is skewing the incentives toward procedures and the many other failures of government health policy. So, I’ve found it informative,

THATS 15 UNCOMPENSATED MINUTES!

"THAT'S 15 UNCOMPENSATED MINUTES!"

and the frequent discussions useful, and stimulating me to think more and write more. But “Happy”‘s writings often seem the opposite of happy; he routinely complains about doctor’s pay, about being overtaxed by the government (when taxes on the rich are the lowest since the 1920s), about how he has to spend 15 minutes of uncompensated time with this patient and that patient. And how any uncompensated time is SLAVERY. After a paid evaluation is over, if the patient waylays him for 15 minutes asking questions, that’s SLAVERY! He rants about how people, heaven forbid, “feel entitled” to his time! I pretty much ignored that, until he juxtaposed all this with the ostentatious display of wealth in his hospital’s parking lot, revealing that doctors at his hospital ain’t struggling in the least. Then I blew up at him, and earned myself a new post from him focusing on what I’d said.

I may have been too strident in my initial response; I’m sorry for that. And you know what they say about fighting on the internet…. But my point was, you can’t expect me to buy into the “poor uncompensated doctor” shtick, nor can you expect the American people to support loan forgiveness or payment reform, right after showing “Drive Your Lexus To Work Day.” For most laymen, a lot full of Lexuses = doctors at that hospital are doing JUST FINE with the current system, and don’t need us increasing the fee schedule or other government help. Pleading poverty after that is going to go over like a lead balloon. If docs are really united in trying to convince the public to support their agenda, ostentatious six-Lexus-in-a-row displays should probably be avoided.

Not that some doctors shouldn’t complain; primary care physicians are grossly underpaid by our notoriously bad reimbursement system, to the extent it’s reached crisis levels. But primary care docs are mostly objecting to how they only have 10 minutes with patients, how the system harms patient care, how it hurts doctors and their patients; I don’t see many family doctors bitching about being “uncompensated” as they’re sauntering to their BMW and filing their nails. But “Happy”‘s no family practice doctor, and plenty of his posts give off that vibe.

Reading “Happy” complain is more akin to seeing the insurance companies claim poverty. I was accused of jealousy and hating the rich, but that was not my point. My point was that when (relative to most people) you’re swimming in a vault of gold, don’t whine about how unfortunate and enslaved you are! It’s too much, and sticks in my craw. And though there’s a lot I respect about the man (including how he’s built such a popular blog through sheer persistence to post 2-3 times a day) I couldn’t help but speak up on this one.

Nick