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My own private conspiracy

August 2011

Published in the August 2011 issue of Today’s Hospitalist

I HAVE LONG BEEN A CONSPIRACY THEORIST. Don’t get me wrong: I wasn’t a birther (not that crazy), but I do want to know what the government is hiding in Roswell. That’s probably why I wasn’t the least surprised to find out that the feds are indeed watching us, or at least they had some harebrained scheme to that end.

Alarmed by the shortage of primary care doctors, the government was prepared to spend close to $350,000 to snoop on them in an effort to find out just how difficult it is for patients to access care. Federal officials provided the New York Times, which broke the story in late June, the following example of the not-so-secret-shop- per phone call they planned to make.

Mystery shopper: “Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible.”

Doctor’s office: “What type of problem are you experiencing?”

Mystery shopper: “I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath.”

Who writes this stuff? In this litigious age, I doubt there is a primary care office out there that would not have immediately replied, “You missed the prompt. True emergency: Hang up and dial 911.”

But it quickly proved academic, given the ample outrage heaped on the proposal by doctors and politicians alike. Once the plan came to light, the administration abandoned it faster than an insurance company dumps you for a preexisting condition.

What they already know
While almost $350K would be a great salary for a hospitalist, even in the rural Midwest, shouts of massive government waste seem a bit overblown. All of us are probably treating a patient with a terminal condition whose tab will far exceed the amount earmarked for the study.

Further, in a $2.2 trillion dollar industry, research aimed at measuring patient access accounts for a mere .0000015% of the total budget. A much more fair criticism of the scheme is that it simply wasn’t needed. Sen. Mark Kirk of Illinois reported, “There have been a number of reputable studies that confirmed many patients on Medicaid and Medicare cannot find a doctor to see them.” No doubt, he is correct.

There is also the issue of honesty. This initiative was deceptive in that callers would have intentionally misled the primary care staff. Needless to say, deception should be used sparingly, particularly as a tool against your own professional (and influential) citizens. While there is a time and place for white lies, given the current state of health care, the feds lying to doctors for the sake of proving what they already should know strikes me as just plain irresponsible.

Fool me twice
Anyway, back to my conspiracy theories. While the government has reportedly put the kibosh on this particular project, who knows what other covert operations are already in full swing? I suspect the government is more than a little curious to know if there are enough hospitalists out there. After all, you can’t ration the biggest ticket item of them all, hospital care, if you don’t have enough hospitalists. (Yes, I am being tongue in cheek, but let me finish.)

Armed with this suspicion, I was able just yesterday to see right through the government’s web of lies. Here’s how the potential sting went down:

A nurse called me. “Dr. DeLue, Mrs. Jones is having trouble breathing. She looks terrible, come here stat.”

I was immediately on to her. I replied, “Yes, Mrs. Jones. Short of breath. Sure, she is. What did you say your name was again?”

“Sally RN, you know me, I have worked on the third floor with you for the past four years. We were just speaking about Mrs. Jones yesterday. You were the one who said not to worry about DVT prophylaxis because you saw her ambulate just last week.”

As the saying goes, fool me once shame on you, fool me twice shame on me. “Right, right. And I guess there is no chance you work for the CMS. And of course, there is no way you aren’t a secret shopper trying to snoop on us, just to find out if we are available. Hey Sally, I wasn’t born yesterday! You tell Big Brother there are plenty of hospitalists, no shortage here, and we are ready to carry out whatever diabolical plan he has for us!”

The next thing I heard was “click.”

Quite pleased with myself, I headed off to the cafeteria, sat down and was suddenly startled by:

“Code Blue, third floor! Code Blue, third floor!”

As I bit into my tuna salad, I had to grin. “My god,” I thought, “will they stop at nothing to deceive us?!”

Erik DeLue, MD, MBA, is medical director of the hospitalist program at Virtua Memorial in Mt. Holly, N.J. Check out Dr. DeLue’s blog and others here