practice-information

Medical aid advisers- why do they upset me?

Thu, 19 Apr 2012 13:10:42 +0100

One would think, taking into consideration my career thus far as fairly typical of the average fifty year old South African doctor, that.....

.....after six years of intensive study, hundreds of hours of examinations, work experience in six hospitals, eight or so Christmas Days, and eight New Year’s Days and many special holidays on duty, missed birthday parties and family celebrations, several hundred happy live baby deliveries, and sadly several stillborn babies, dozens of caesarean sections, thousands of stitches put in to wounded people in busy casualties, being abused and spat on by drunk patients, seeing friends die from terrible diseases while powerless to intervene, performing post mortems, going to homes to break tragic news to relatives, treating crocodile, leopard and snake bits, malaria, bubonic plague, giving medical testimony in court at least a dozen times, counselling marriages and drug addiction, five more years of trying to balance training, career and family, more examinations, hours of study, the staggering success of curing ill patients, and the bitter loss of losing them, hundreds of resuscitations, closed and open cardiac massage, two years of international travel and work experience on three continents, 20 000 surgical procedures, a million consultations, a million prescriptions, millions paid in malpractice insurance and a clean litigation record, the searing agony of serious complications and the thrill of difficult surgery succeeding....

.....that medical advisers, technocrats and bureaucrats would give me the right to decide what is best to offer my own patients. I think I’ve earned it.

Sadly not.

My journey to belief in Jesus

Thu, 19 Apr 2012 13:10:32 +0100

Why I am a Christian.

Do you have to sacrifice your intellect for blind belief when you become a Christian? So many people searching for meaning to their lives are put off by this possibility. The answer is an emphatic “No!” For many years before I became a Christian I believed I did. Now I know the opposite is true.

So what changed? I stopped listening to what everyone else had to say ‘for’ and ‘against’ about belief in general, and Christianity in particular, and began to examine the possibilities for myself.

It was a succession of inexplicable circumstances that got me involved, to be honest against my wishes – strange events I could not ignore, a feeling the universe itself was conspiring against me and forcing me to a turning point. I came to a decision for Christ not based on evidence, but on personal experience. Having knowledge of the heart was one thing, but as a trained doctor-scientist, coming to a ‘head’ knowledge that satisfied my sceptical mind was a challenge. I needed evidence.

Over the years I acquired this ‘head’ knowledge of Christianity from many sources, finding that science and belief are not in opposition or competition, but that there is a way of looking at both and finding amazing symmetry. By the time I had all the ‘head’ knowledge I needed, I found my heart out of place with where it should be, and another journey began.

Every journey to belief is different, and every experience is unique. Some people are indeed blessed by being able to believe without proof. I was never so lucky. Throughout my search I found time and time again compelling and challenging evidence that forced me to take the Christian narrative seriously. But none of it was coercive, forcing a change in belief against my own judgment. It was all challenging, pushing me towards an inescapable conclusion, a decision I would have to make for myself.

So what was the clincher, the final penny to drop? How would I recommend others set out on this journey, avoiding the challenges and pitfalls that characterised my own stumbling progress?

Jesus provides the answer. There is no need to start with the question “Is there a God?” because Jesus claimed he was God. So if Jesus is real, then God is real. Meet Jesus, and you meet the God who created you, the universe and everything in it. Jesus stands alone in all recorded history as the embodiment of good character and wisdom. He is the ultimate example of a good man by what he did and how he acted. What he said however is either completely or unequivocally true, or makes him out to be the worst and most deluded of madmen. There is no acceptable option in between. We are forced to make an uncompromising choice to either believe him or to dismiss him completely. In Jesus, God says to us, “Examine me. Make your choice.”

For me, the most compelling evidence of the reality of Jesus’ claims lie in the actions of his followers after the crucifixion. There is no other possible explanation for the growth of the very early church and the actions of the Apostles but that Jesus did what he said he would do, i.e. prove his divinity by rising from the dead. Every other possibility others claim of fraud or invention makes little or no sense whatsoever. There would be no reason to write the Gospels, or Acts, Paul’s letters to churches and individuals, or anything else in the New Testament if it was not a true account of what happened.

If Jesus was not who he said he was, and did not rise from the dead, his disciples would have remained exactly as they were right after the crucifixion – a beaten, scared haggle of followers of a discredited rebel, executed as a criminal and, like so many others before and after them, they would have vanished from the pages of history.

And yet, they did not. Against all the odds, these men and women changed the world dramatically. Only a real event – the reappearance of Jesus and confirmation of his divinity – would have accomplished that incredible feat.

To argue otherwise is to clutch at straws, pleading rational understanding of an irrational event. It cannot be done. The last resort of challengers is to question the authenticity of the New Testament itself, using tactics which, if applied to all other ancient scriptures, would force all recorded ancient history to fade into obscurity.

And that is why I am a Christian.

What should doctors tell young people who want to study medicine?

Fri, 22 Oct 2010 10:44:35 +0100

Every now and then a young person approaches me for advice on studying medicine. The majority are extremely bright, capable and enthusiastic semi-adults, with strong desires to change the world and to ‘make a difference.’

I was once like that, once upon a time, long, long ago……….

I have wanted to be a doctor for as long as I can remember. At a very early stage in my life, as soon as I could walk and talk, I also wanted to be a Royal Marine. As an adult I got to be the closest equivalent to both I possibly could be. But the reality of being a fighting soldier – yes, a doctor and a fighting soldier (South Africa was a crazy place in those days)– was more in line with my expectations than those of being a doctor. Even while growing up I had a keen sense of what the military expected of me, and what it would do to me in return. For the realities of practicing medicine I was, and probably still am, completely unprepared.

Part of the problem is that in the 30 years it has taken me to ‘arrive’ as a specialist surgeon with my own practice, medicine has changed completely, and not for the better in my opinion. It is just not a ‘comfortable’ profession anymore, because of the outside influences of managed healthcare, litigation, health economics and others. Helping people, and curing some of them, is still a big plus. It is the other ‘stuff’ that goes with that that has become difficult. The level of frustration is getting so high it is almost part of the daily job description.

So, when young people approach me asking if they can job-shadow me for a while, I have to watch myself very closely in trying to give good, solid advice that will not put them off, but at the same time, not help steer them careering into a profession for which they may be both ill-suited and ill-prepared.

These are a few things I tell them, I hope with a sense of reality, tempered with awe of the incredible responsibility:

· Unless you really, really want to be a doctor, have no other alternative in mind, are willing to do as much as it takes to get into medical school, even if it means getting another degree first, don’t even think of it. The novelty of being ‘doctor’ wears off a lot sooner than you may think.

· If you are bright enough to get into medical school, you are bright enough to do any other job or profession, and to be a success at it. With something tangible to show for that success. But if ‘success’ is defined in your mind as financial wealth, choose another easier route! Or redefine ‘success’ in your own mind, leaving out the fast cars and fancy houses.

· Medical school is going to drain your resources, and put you five years behind your peers in earning potential.

· Being a doctor may leave you physically, emotionally and mentally exhausted for long periods of your life.

· The establishment takes the brightest and most enthusiastic of a country’s youth, loads them with debt, and then pushes them into a workplace which is invariably understaffed, ill-supervised, overworked and underpaid. For years at a time! Are you prepared to go through all that?

· Take a look at the doctors around you and how they practice medicine. In ten years time everything will have changed dramatically. No one can really say whether or not for the better.

It’s not all bad:

· The highs in medicine can be very high, bordering on euphoria, at a challenging job well done.

· You will never be short of a job somewhere. It may not be the job you wanted, or where you want to be, but there will always be work for you.

· You can take your qualifications and experience with you anywhere you go.

· Other jobs may have diminished appeal after being a doctor, somehow lacking in relevance.

· You have a wide range of options within medicine itself, so careers can develop in different directions at different stages. Which is a good thing.

When I have had the opportunity to say these things, my young would-be doctor may look quite thoughtful or even apprehensive. Many tell me that they never realized that there was a dark side to being a doctor. I refer them to other sources, websites and blogs like this one, and wish them all the best of luck.

How many have I seen come back to me as qualified doctors? I’m still waiting…….

But I know of one who became a water sanitation engineer.

In terms of ‘saving lives’ and ‘making a difference’ he probably has the edge on all of us!

What has alternative medicine got that traditional medicine has lost?

Wed, 16 Mar 2011 07:51:19 +0100

I remember talking to the wife I had just met of an old friend whom I had not seen in twenty years. She was an avid avoider of medical doctors, preferring to take her family to alternative health practitioners. Learning I was a doctor, and to my dismay, she began telling me about her fantastic homeopath, and how he had sorted out numerous problems that previous ‘inept’ family doctors had struggled to heal. Her approach, as I have come to expect, was both provocative and accusing.

The family had just come back from a holiday in a malaria area. I asked whether they had taken prophylaxis.

“No.”

I asked her how she would treat one of her children if he became sick with malaria.

“At the homeopath.”

“And cerebral malaria?” I explained what that was, and the high mortality rate.

“Still at the homeopath.”

“What if your child became ill with meningococcal meningitis, and there was a normal doctor nearby with the emergency antibiotics that would be critical in offering hope of cure?”

She wavered slightly, and I pounced.

“You would rather risk your child’s life than see a normal doctor?”

The discussion, as I anticipated, ended badly.

What is it about alternative medicine that its adherents find so compelling? What has conventional medicine lost? With the heavy burden of evidence-based medicine, and cries for proof of efficacy, legislation and regulation, why are so many people willing to put their faith in therapies that have no scientific basis or evidence whatsoever?

I had got as far as this point in writing this post when I discovered a book called “Bad Science” written by Dr Ben Goldacre, a NHS doctor, journalist and columnist for Britain’s Guardian newspaper. I consumed it over the next two days, finding in its pages a hilarious debunking of alternative medicine (with homeopathy his primary target), bad research, unethical practice by big corporations, the dodgy qualifications and practices of health ‘gurus’, and the downright dangerous beliefs that irresponsible doctors have encouraged in an unsuspecting and gullible public. All done with incisive insight, brilliant logic and superb analysis. And simple mathematics. I stand in awe of the man.

You can read the book for yourself for the details, and I am not going to repeat them. Or go to his web initiative at www.badscience.net. Homeopaths, among his other targets, have got to hate him, for nothing else than suggesting those sensible enough should look for more grounded careers. In short, I share his beliefs.

But the growing shift towards alternative healthcare, despite the lack of evidence of efficacy, has to suggest worrying failures with modern medical practice. What have we doctors done wrong? Or, to put it another way, what does alternative therapy, homeopathy included, do better than we do?

For a start, I would guess these therapists spend a lot more time with their patients, in environments that themselves are therapeutic – less formal, less threatening, with nicer colors and smells.

That the pace of consultation is calmer and more methodical.

That communication is better, even if the scientific quality of the content would raise Ben Goldacre’s eyebrows off his forehead.

That the explanations given are more people friendly (“Your fundamental frequency is out of tune with the world’s harmonic C”) even if no one else can make any sense of them!

That there is a ‘connection’ between therapist and patient based on shared beliefs and trust.

All these points are known to enhance healing based on the placebo effect. That IS scientifically proven - Goldacre makes that point very clearly - and works for both types of medicine. So for many users these methods do ‘work’, and have positive outcomes, even if no better than placebo. Even if the methods, explanations and treatments are mumbo jumbo.

I suspect the following points are critical in the growing popularity of alternative methods:

1. Faith of the patient in the art, method or skill of the healer

2. No expensive referral to specialists, and no ‘passing of the buck’ between doctors

3. No expensive investigations – the method is the art and is complete

4. No need for medical insurance

5. Time spent in the process and method of healing

6. Listening and communication skills

7. No prospect of hospitalization

8. Limited medication costs

If I look at these points I see that modern conventional healthcare has become a frightening place for many where high costs, painful or uncomfortable interventions and uncertainty rule. That alternative healthcare, for all its unproven and mystifying claims, is a safer and less scary refuge, where ‘healing’ is the art and process of enabling the body to heal itself.

So what have we, the conventional medical system, lost in comparison? I think it may be the knowledge of the ‘warm and fuzzy’ things about being healers – the mind-to-mind interactions, the common purpose, the reassurance, the art of medicine. We have come to believe that every presenting complaint needs to be analyzed, tested and treated, with focus on the problem rather than on the person.

You might say modern medicine is in danger of losing its soul.

An interesting fact about medical aids

Fri, 22 Oct 2010 10:45:14 +0100

Few people realise how much money medical aid administrators consume to administer the business of processing medical aid claims. One of the biggest medical aids in the country takes 15% of the total member payments for administration and profit.

This is put into perspective when one realises that this is the same total amount as every consulting doctor in the country combined.

The medical aid has staff of about 4500, and I estimate no more than ten office complexes around the country. Consulting doctors (15 000) combined have an estimated 15 000 offices, and another 30 000 staff.

For which the same percentage is deemed adequate!

If that doesn't make you think about where YOUR money is being wasted, nothing will!

Let's discuss fees!

Thu, 25 Feb 2010 18:51:22 +0100

Part of transparent and open medical care is an up-front discussion of costs and expected fees.

For consultations I work close to the old 'medical rate' because I do many rooms-based procedures, and these amount to a figure I consider fair return for my services.

For operations I base my fees on 'private rates' which may be significantly more than medical aids pay. It all depends on what medical policy you have. Some pay my fees in full, others as little as one third.

The days of the 'medical aid rate' are over. At present it is against the law for anyone to recommend or publish fees over and above what is known as the National Reference Price List, based on the old 'medical aid' rate, and used only by the Department of Health as a standard.

The old 'medical aid rate' was a negotiated settlement where doctors cut their fees by 50% in return for guaranteed numbers of patients with unlimited benefits. Those days have long since vanished, and the original terms of this contract have been forgotten.

Medical costs, especially of running a practice, have soared. Doctors have been asked to submit cost studies to the government. These have been ignored because the results showed the NRPL seriously undercuts the value of doctors' services.

I welcome frank and open discussion about fees, and will always make allowances for those in financial difficulty.