Home » Dr. Jayne » Currently Reading:

EPtalk by Dr. Jayne 3/15/18

March 15, 2018 Dr. Jayne 4 Comments


Theranos CEO Elizabeth Holmes is charged with fraud and has agreed to a settlement without admitting guilt in the matter. People were eager to believe in the promise of new technology without proof. Various family connections and their endorsements added to the investment frenzy.

I see dozens of startup proposals every year and have a high degree of suspicion for vaporware or vaportech. I’m happy to sign non-disclosure agreements with organizations that legitimately want my opinion, but they have to be willing to show me what they’re doing before I’m going to get on board. I think some folks have lost their ability to perform due diligence given the constant hype around innovation and being the Next Big Thing. I feel sad for the lower-level investors who were caught up with Theranos and its deception.

This article from The Guardian was a hot topic in the physician lounge today. Physicians took immediate exception to the comparison of US physician salaries to those from other nations, noting that in other countries, physicians do not have to incur significant debt to complete medical training as they typically do in the US. No one disagreed with concerns around the cost of prescription drugs or administrative costs.

One member of the hospital administration noted that some of the starting administrators at Big Health System make more than starting physicians, which is a sad state of affairs since starting administrators often have minimal experience beyond their MBA coursework. Similarly, there was no disagreement with the US having worse population-based outcomes.

Every time I have to argue with a patient about unneeded tests, there is typically a comment from the patient along the lines of, “We have the best technology in the world and I deserve this test,” or, “I’m paying a lot for my insurance and it’s covered so I want it.” Patients often don’t see past their individual situations and don’t want to have decisions made based on populations and statistics rather than their own personal feeling about what should happen.

Culturally, we have issues with desiring invasive care, often to our detriment (take a look at some of the childbirth data) and not understanding the need to pursue lifestyle changes rather than medicating everything. We don’t want to wait things out. We want medication now whether we need it or not.

Also culturally, we make it difficult for people to access care. Many of my patients come to urgent care after 6 p.m. because they can’t take off work or have no sick days to seek medical care. Very few primary care offices in my area have evening hours, so the more expensive urgent care begins to fill the primary care void.

Having the worst maternal mortality rates among other “developed” nations is embarrassing and should be avoidable, but we’re not tackling it very well. Infant mortality is also nothing to be proud of. I’m shocked by how many Americans keep up with the Kardashians and a host of other celebrity or social media personalities, but can’t name things they can do to keep themselves healthy. Prevention isn’t sexy, nor is doing the hard work needed to lose weight or stay in shape. Insurance plans often don’t cover preventive treatments or put hoops in place for patients to jump through when they want to pursue non-invasive or non-surgical treatments for some conditions that might improve quality of life.

I had a patient recently who switched insurance plans and her new coverage won’t allow for replacement of her custom shoe inserts, which had broken down over time. The patient had previously been active and now has constant foot pain, which has limited her activities and probably has contributed to her weight gain. She was in to see me about a cortisone injection, and even just looking at the cost of my visit plus the cost of the injection and potentially a follow-up visit, it would have been cheaper to just pay for new orthotics than to treat the foot pain. The patient had lost her job and is working as a restaurant server, which isn’t helping her pain either. She’s diligently trying to save for a new set, but that’s hard to do when you’re living paycheck to paycheck.

HIMSS may be in the rear-view mirror, but the onslaught of emails and cold calls is just beginning. I’ve finally learned to link my HIMSS registration to a dummy email account so that the contacts can be sorted out. I used a burner phone number as well. A couple of the post-HIMSS emails have been personalized greetings from a specific resource thanking me for the interaction at the booth and making note of our conversation. Others follow a formula that doesn’t help me at all: Thank you for your visit to X Vendor, we are hoping to help your organization, we will be reaching out to you directly. A link to the company website or an attached product portfolio PDF might be helpful memory jogs and might be less easily deleted than the form email.


The best outreach I have received so far was from Formstack, with the subject line “Have you worn your green Formstack socks yet?” and asking for a follow-up. It definitely caught my attention, and yes, the socks were perfect for coming back from HIMSS. I’m sending my VMWare socks to my favorite engineer, so I can’t comment on their comfort. I wasn’t lucky enough to score Google Cloud socks. Socks were certainly on the menu this year. I did finally score some #pinksocks this year and they got some looks wearing them around town.

I’m still recovering post-HIMSS, most likely because I landed, unpacked, repacked, and immediately went cold-weather camping, which probably wasn’t in my best interest. From there, it was on to client work and clinical shifts. The 12-hour days are becoming more and more difficult. Maybe the longer daylight hours in the evening will lift my spirits. I don’t mind it being dark in the morning since I can sleep without the birds trying to drag me out of bed.

I’m putting together the list of meetings I want to attend the rest of this year and also planning for 2019, when I get to take my board recertification exam. What’s on your list of can’t-miss meetings? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Featured Sponsors


Currently there are "4 comments" on this Article:

  1. This post was all over the place, but I can’t help but notice some huge inconsistencies in your stance here.

    In one sentence it seems like you want to make the argument (you more pin the argument on your colleagues rather than you actually making the argument) that it makes sense that docs get paid what they do because they have to go to extra school… yet pharmaceutical and administrative areas shouldn’t be paid what they are. Yet, last time I checked if you are going to be a pharmacist/scientist that is creating and preparing these drugs you too need extra schooling, not to mention that almost all hospital administrators also need to have extra schooling as well. But I guess only medical school costs money and puts people into debt.

    Then you jump into patient blaming when talking about tests and healthy lifestyles, as if this whole issue didn’t start from doctors pushing these tests on patients and not preaching preventative cares for years because before recently providers were able to line their pockets with sick patients and big pharma kickbacks. Now that reimbursement models are moving to be more outcome driven and not care driven, providers are backpedaling and it seems from your arguments looking to blame anyone but yourselves.

    I agree that the costs are too much, but maybe the first step of the problem should be shouldering some blame on you and your fellow providers, rather than trying to deflect it to everyone else.

    • I agree with the salary comment: everyone with an advanced degree is in debt, and while physicians may be in *more* debt due to the cost of private medical school versus a state-university MPH program, I don’t see too many of them driving to work in a busted up 15-year-old Honda, either.

      Speaking of irresponsible lifestyle choices…I listened to a really interesting talk a few months ago regarding social determinants in care (the latest buzzword/phrase). The upshot of that presentation was that countries with better outcomes for less money *also* have strong social programs that help with other factors that directly impact people’s health, namely: food insecurity, housing insecurity or simply unsafe living conditions that are actively making people sick, unemployment assistance, etc. It’s particularly churlish to lay blame on people who are under tremendous stress in their lives due to any of the above, or more, for wanting to turn off their brain for a couple hours a day to watch trash TV or eat mashed potatoes instead of broccoli because they want something nice to taste. We’re human, and we crave comfort when things are tough. Its how we’re built. I agree that its unfair and irresponsible to lay this at the feet of physicians, they certainly aren’t in control of all the economic and social factors that inform the health of this country, but its equally unfair to point the finger at patients themselves as if all the external circumstances that impact them (housing, job, food access, sexism, racism, homophobia, you name it) are 100% in their control, as well.

  2. @HypocritOath – you nailed it. I work in an IT dept of a large IDN. The physician salaries and perks are obscene. We talk about all “waste” in health dollars but I would like to see all these hospital costs out in open and distinguish between the costs borne by the hospital for conducting the tests and costs due to physician salaries/payments.

    Looking at what goes on in our system, physician compensation is the biggest elephant in the room.

  3. From Dr. Jayne:

    I’m shocked by how many Americans keep up with the Kardashians and a host of other celebrity or social media personalities, but can’t name things they can do to keep themselves healthy.

    Doesn’t that say it all? It does seem to me that we are trending towards understanding and appreciating healthier lifestyles. That’s a good and necessary first step to transitioning towards healthier lifestyles.
    Eat real food.
    Move your body.

Text Ads

Recent Comments

  1. Carle Health + HealthCatalyst: We keep hearing from experts that the way to improve healthcare operations is to make sure…

  2. Speaking of content ideas, with the 20th anniversary of HIStalk coming up, I think it would be fun to revisit/skewer…

  3. Probably not a great way to make friends with your sponsors :) but have you considered doing a year in…

  4. UCSF integrating oral and overall health records is a huge step that should not be understated! Given all the focus…


Founding Sponsors


Platinum Sponsors





















































Gold Sponsors











Sponsor Quick Links