Saturday, October 31, 2015

Part II: Why Washington?

I looked out the airplane window and saw we were approaching Reagan National Airport from the south. The crisp morning sun pierced the fluffy clouds and found its way through the slit of the partially-opened airplane window shade to momentarily blind me. A small apex of the Washington Monument could be seen in the distance. To its right, the US Capitol dome shrouded in scaffolding.

Washington DC.

Having my luggage, I Uber-ed my way to my hotel. Boutique hotel next to the Capitol. Nice place. Quaint pastel-painted row houses nearby. French bistro, too. A 30-somthing hipster lady was checking out as a host brought her a few knickknacks to munch on for breakfast. The smartly dressed man  behind the front desk had an Australian or South African accent. Or was he from Belize? I couldn't tell. Relaxed. Confident. Good eye contact. He checked me in.

 This is the life of a policy wonk, I caught myself thinking.

My room was larger than I needed, the bathroom tiny, but functional. I pulled back the curtain and saw the many marble buildings surrounding the hotel and blocked the viewed of the streets further away that I remembered weren't quite so inviting.  Lots of construction in view.  Booming. I wondered if any of the other people who frequented this establishment ever saw the very different life that exists in rural areas outside the Beltway.

Probably not.

No matter. It was Washington. Time to explore. Crisp air. School kids bursting with excitement and rushing to the street corner, starry-eyed. Ever-patient chaperons shouting they could only see the Capitol if they made two parallel lines. "Quiet, please! Line up. Come on, now." Others in dark suits walking the streets. High heels with lanyards and  name badges. People walking in tandem, sharing secrets, telling jokes. Black Towncars, Escalades with tinted glass, Mercedes.  Large white buildings that dwarfed their visitors, like Poseidon looking down on a flotilla of tiny ships at sea.  Supreme Court. Library of Congress. Madison, Jefferson, Dirksen, Hart, Cannon, Longsworth, Rayburn. White. Marble. Big. Powerful. At least so it seemed. Certainly not for the faint of heart. Security everywhere. Metal detectors. Strange white mechanical roadblocks that clanked up and down to let the Important People drive their beat-up Subaru over it to head home.

A foreign land for a practicing doctor. Almost surreal.

I had arranged to meet two colleagues before the introductory dinner gathering. Each a name on The List. We never met before but shared some emails once. Nice to put faces with the names. They were more seasoned in this environment than me. But real doctors. Not pretend. Independents. Just came from work. Drove all day or flew from far away. Eager to meet others. Passionate. Each with their story - a reason to be here. Certain they could speak to a piece of the puzzle. Frustrated with things but determined to do something. I settled in. We exchanged numbers. You on Twitter? Defiantly: "Why should I use a smartphone when a tiny flip phone will do?"

* sigh * Reality.

Soon we headed to the introductory dinner. Staffers handing out sticky paper name tags that never seem to stick. (Except to things they shouldn't.) Pleasant smiles. A glass of wine. Pasta on the menu. Mingle. Where are you from? I see. The Congressman will be here a bit later. Then the Congressman arrived. Thanks for coming. Relax. Enjoy your stay. Tomorrow we'll show you our plan. Want to get your ideas, feedback. What brings you to Washington?

They all seemed to know. Me? Better to lay low for now. Who are all these people, really?

Would what I had to say make any difference? There was another plan. Another agenda.  Mine? Very small, unimportant. One doctor with a few others in a big very big pond, treading water, learning to swim. Would this be worth it? Others seemed to think so.

I still wasn't sure.


Anonymous said...

the suspense is killing me........

Last Mohican said...

My Trip to DC and Why NO MOC is Especially Important to Me.

My case. Probable melanoma.

I live on a farm well outside the beltway in Delaware. Used to drive in to a local town not so far away where I could see a physician and most specialists I needed.

Now I can usually only see an NP.

The specialists have all moved on. Don't know where they work now, but mostly from what I heard they had to move to a city to get hitched to a hospital or HMO.

Could not make it on their own was the word I heard.
No longer could they make it in specialty groups or private practice.

What happened? What did I do to have my condition confirmed and treated?

A good Delaware doc, still with paper charts, who's threatening to retire because of MOC and other money/time issues referred me for confirmation and treatment of melanoma to a professional office in Washington DC.

After driving two hours and paying my bridge toll and then taking hospital professional building parking ticket, I walked for five minutes through a few tunnels and a airport like walkway I checked in and I presented my charts to the MA.

Waited half an hour, then the MA told me the provider would see me now. Of course, After all the vitals were taken / the check list of complaints and medications were given.

I finally got to see the dermatologist. Or so I thought.

Turns our the subspecialty doc was only a PA!

He looked up at me from the keyboard only three times.

The long drive to DC and back home took me all day.
That was the hottest day when we should have cut the hay.

I had to go back to DC for testing, and follow-ups, but the good news it was only BCC.

Anonymous said...

Cheap Advice:

Listen carefully until you know where the speaker is coming from....

then talk.

Free Advice said...

Good advice from "Cheap Advice!"

ABIM Connection said...

Digging for the Truth about ABIM and Its Role in the Passage of the ACA. Where Does One Start. All Roads Lead to...

Dr. Wes, (an inward conversation)

Don't you have someone closer with real access and power in Springfield?
If not, why not?

What about the mayor of Chicago? Doesn't he have a direct line to the president in DC? The father of the ACA, or so it is said.

Does not Barrack need to get his plan to really work. Not just bury the truth.

(Brain teasing thought just entered my brain.)

The ACA costs way too much to administer and their greed and selfish interests just gets in the way. This is true of the ABIM and ABMS too. ACA's a fa├žade, shoddy but costly band aid of the real healthcare reform we need and deserve. The ABMS is a sham.

It's a money making shell 'playing doctor with itself', while lying about providing quality assurance to the public.

It's the last year in office for the president. What's Barrack or Michelle got to lose by hearing real physicians and putting practical fixes, if not total recall of the ACA "as is" on their agenda.

If ACA does not create the "universal comprehensive coverage" we would have thought, the president would be justified in making radical amendments to it - or start all over again. I suspect he was lied to also about what it "would be" and what it "actually is" today.

You see the broad dilemma. The ACA is not the ACA. The president is perhaps not really the leader of our nation.

It's true, others pull the presidential strings. A whole lot of special interests. No wonder our government is fragmented, unresponsive to the people or just plain psychotic.

Not even the president of the United States of America has access to the inside track of the beltway, even though he lives in that little punctuated dot in the White House @WH.GOV.

You would think that the president has direct access and all the answers? Practically speaking, he may be just as far away as all the rest of us.

There is more than a hint of truth in what I present, isn't there?

The president is not his own man, just as much as Rich Baron is not his own man at the ABIM. Nora is not her own person at the ABMS. Someone else swivels them around in their chairs.

Big Med said...

Personally, I think the president must initiate some probes and investigations concerning why the Patient Protection and Affordable Care Act does not deliver as promised to the public.

Hard questions are needed to get to the bottom of things. Real tough questions must be asked. With honest direct answers. Not more officials pleading the fifth amendment.

Barrack needs to hold his medical advisors and cabinet accountable to the people.

A Southside Chicago ditto for the Nora/Cassel Cartel known as the "BIG MED 24 too!"

Does anyone else hold a similar view?

Disgusted Democrat said...

Total Disappointment in the DNC. I want to know what went wrong along the way.

Why was the DNC platform on UCHC presented one way for years and then surgically altered to be not the kind of comprehensive universal care the Senator, Congressman, and President get, but something else. Entirely different.

No one would not have listened to the bullshit otherwise. Not even a lifelong Dem like me. Were they just lying to me? Now the Republicans are spineless liars too!

And what seniors and veterans get is totally something else. When the government actually pays for life and not death then we will have something universal and comprehensive. If that is what the voter decides. And that is the problem. The voter never saw the plan, let alone understands anything about medical coverage. Neither did the president understand what he was signing on to when he needed an endorsement from Ted Kennedy.

Ted and his vision know...

Every lawyer has heard of the universally adapted consumer protection "buy a lemon law." It is time to take a hard look at the sales representatives masquerading as loyal democratic politicians, scientist and doctors. The advisors to the president are not loyal to him, nor are they even Democrats in any sense of the true definition. Who are the medical politicians steering our health care.

Their name is legion; an they are part of a dynasty of professional liars associated with "egregious conflicts of interest" working within the matrix of the medical industrial complex.

What's the president thinking really. We could never know. What is his present or future personal agenda. Even that I don't trust, based on the past. The truth is I really don't know, but maybe he is looking for some sound advice about how to make his healthcare legacy functional and actually work.

One big problem according to a retired Chicago preacher who was a medical aid to Lyndon Johnson and was liked by the first "Lady Bird:" our current president is very well protected to the point of being insulated and being given only partial views of the problems and how to solve them.

The pastor actually said it this way, but I made a slight alteration to the statements palatability. "The president is constantly surrounded by" [people who are bad news.]

What's at the heart of the problem? Is ABIM's scandal just a small microcosmic reflection of the macrocosm. (National problem.) A CEO surrounded by "people who are just bad news."

In the ABIM scandal we perhaps have a microcosm that sheds light on the national dilemma. The diagnosis and cure are the same.

Physicians need to be informed and active, and grow a spine a wise reported suggested.

It is the same dilemma and prescription for the citizen in standing up for ourselves and getting what was promised and nothing less than what we the people deserve from our city government, state capitol, or Washington DC.

Be informed, get connected, and grow a spine.

The intriguing part of the story concerning the microcosmic and macrocosmic view is that the same "advisor" common to both the ABIM and the White House made a lot of money from DC and Philly and California. Can we see this as professional, don't even bring up ethics, when lot of folks health and lives were and still are on the line.

Yes, sound advice from the wise reporter even more relevant to he voter/citizen. Be informed, get connected, and grow a spine.

Lisa said...

Very well written, Wes. I am glad you went. I totally agree with Cheap Advise and Free Advise. But am still glad you went. You know why? Because you are the ONE person I am SURE was representing the interests of patients--not only doctors.

So will they listen? Meh. Scope out the turf; Washington DC is filled with COI and those who represent us make special deals for themselves (and have far superior health coverage). To the Disgusted Democrat: please have someone slap you. If you got past middle-school without swirlies and think that could snap you out of this, please find the nearest gentleman to do the honors. Communism doesn't work. Trump is probably a closet Democrat, had the party not shifted wildly...I'm just saying.

This alone should tell you all you need to know about ACA:

At some point, hopefully, we will have an opportunity to clean up corruption and not have these special agendas. For now, we are all stuck with profiteering and an intentional sabotage of the healthcare system, for elderly sweating out no COLA increase and rising healthcare costs, they'll be cut from the team. It's sick, but you know one of those people whose used to cutting the budget by firing people got promoted into gov't/healthcare and is looking to reduce the liability of veterans (#22aDay) and seniors. Then we can focus resources on people who have come here uninvited.

Why would we do that? If you can make a compelling defense of why, then please see the swirly gentleman in the nearest men's room. (Never saw one, but everyone heard the flushes and screams we know what went down, and those boys never misbehaved again.)

Anyway, Wes, you shamed my tiny little flip phone so I'm shaken by this. Keep fighting the good fight.

Fact hunter said...

Lisa, (or anyone)
What is the ABIM, really? Do you have knowledge of the people who have led the organization? Any inside knowledge that could help me understand them from your point of view. Can you distill your thought, please. You mentioned communism (I think you meant socialistic forms of government or healthcare, right?) has the ABIM been secretly playing us pushing an agenda of socialized medicine. Did the ABIM manipulate our government, via the ABIM politicians who seem to have extra curricular activities lobby all over the damn place for the ACA.

Do you see that they violated our laws in any way. They seem like a branch of the government and pretend to not be. Who are these people?

Of course we see conflicts of interest at the ABIM. It is apparent with Cassel, Wachter, Baron, Holmboe (now ACGME), Langdon and others that there are severe conflicts of interest, but do you see any illegality or fraud in their financial misstatements, statements that they do not obfuscate and other dubious actions as an organization.

I would like to hear more from an intelligent person who sees well beyond surface of things.

Thanks i a.

Anonymous said...

Dr Wes,

Enjoying your artful buildup. The Charles Dickens' method of publishing in parts. Great hook.

If your visit is a step toward reigning in the Beltway docs' infatuation with Begala's "Stroke of the pen. Rule of law. Kinda cool" way of controlling our lives, then this could be quite a story.

Unless something is done, the ABIM/ABMS cartel will continue to metastasize. The latest example of this is Minn Senator Amy Klobuchar's bill S. 2118 Ensuring Enhanced Access to Primary Care Act, aka Ensuring Enhanced Access to Physicians' Wallets. Gee, wonder how that came down? Let's imagine. Corner table at the 116 Club on Capitol Hill. Lunch between the Senator and you know who at the NQF (curious thing: looks like the Senator helped swing some nice funding to the NQF. And who better to define quality than the venerable NQF? After all, it's their middle name). By the end of the lunch, ABIM/ABMS have a sponsored bill that makes them the de facto arbiter of which physicians get paid to treat Medicaid patients. Stroke of the pen. Rule of law (Sherman Act? What's that?) Kinda cool. Not.

x said...

dr wes, is some one tracking the people visiting your account. i got a suspicious download on my computer yesterday when i logged on to your site.

its name was :
the webpage it came from was :

good luck with your visit your visit to DC. hope you can be a part to some meaningful change this country can see. please convey my message too at DC that..

"a strong PCP with privileges to admit patients in any hospital of choice and the ability to start any new hospital without bureaucratic delay" is the answer to this countries health care woes and not ACA/aBIM/nqf/big university hospitals and all other administrative nonsense..

good luck

by executive action said...

dear x-

I got something similar a few times about a month ago and earlier...not sure of the source, but it appeared as though I had the "blog owners view"...maybe like viewing that what you mean?

also my use of Google search has become dysfunctional a good part of the time recently...unresponsive...

anyone else have these issues observations...

is Google experiencing downtime or server issues...

Bing works fine but it delivers a completely different search result...

Who's on first listening to the chatter? Nobody's even on base yet. said...

It would be refreshing if others were actually listening in on the discussion here.
They might learn something and be grateful for the edification.

Dr. Wes the blog is providing useful information about how we think, what people think about the medical crisis we face today.

We have money. We have secrecy. And the public would like to have some answers.

We appreciate this blog and the unique expression of observations regarding medical science.

I am not going to flip out over the fact that my computer is being tracked by every site I visit. That information is being sold to third parties constantly.

I don't like it one bit, but until we change privacy laws these third parties including Google, Amazon, etc are going to continue to have a handsome revenue stream from even a blog site.

An example of this site and tracking: I look up something on Amazon. I go to Wes' site and there are options offered on his "free blog" of what I just explored on Amazon.

No "one" is tracking this site or targeting it. The whole internet and every place your visit is tracking you and selling your information. Where you eat, what you buy, what you are interested in online...

Until we change the privacy laws the free internet will continue to violate our privacy!

I will continue to blog here or read. We have laws that protect speech and expression of our thoughts. No one is listening in. No one even cares much about this blog or the subject matter, because the media is controlled by a few companies.

If you show how one of the MSM media companies would prosper from covering the ABIM scandal, Chris Cassel, "Maggie" Nora, or NQF then they would be all over the story.

And Wes would be encouraged by Google to put up some real advertising or a paid link to some profitable business and make several cents a hit plus the monthly advertising check from companies x,y, and z for embedding on his bio or somewhere a hot link.

Lisa said...

x: I had spyware software triggered when on twitter where the blog link is. This has not happened to me before. Not ready to call it 'conspiracy' but suggest you 'wear protection' on the net.

to Fact Hunter/i.a.: Wes has worked closely with one of the best accountants while researching ABIM problems. You sound like a government researcher asking me to research for you what has already been researched. That's not my thing. but good luck.

Anonymous said...

My google search is frequently unresponsive lately, but maybe only at the VA. Also VA wont let me post on this site, but allows posts on Sermo.

Fact Hunter said...

Lisa, thanks for your kind helpful comments and insights. I have already read what is here. I mostly was interested in a perceptive distilled comment on who and what the ABIM really is. They are an enigma.

Is it just because of the bogus science, fake professionalism, onerous busy work and undeserved money that they produce such hatred and animosity? Or is it something else?

It is apparent the ABIM does not have many friends or fans.
Their facebook page looks like a boarded up building plastered with stupid announcements and empty messages.

These announcements and messages are covered over with physicians' angry graffiti!

Dr. Wes has pleasant intelligent contributors like yourself and is actually instructive and engaging.

It would appear that the ABIM is a dead shell just trying to hold on with only a thread of something decent in the far distant past.

If anyone has time to distill their thoughts about the ABIM I'd like to read them to learn more. I have never really encountered such an organization with so many government and corporate friends but few among physicians. And the public has 0% knowledge and interest in this non-profit society that is supposed to serve the public.

Isn't that the oddest scenario of a company you ever heard. Do they even really exist. If you send them an annual check do you get a contract, a brochure, a current policy handbook, complete list of board, etc with phone and email directory?

Good luck to you too, but I'd like to learn more.

Anonymous said...

I heard of others having random issues with Google recently also.

If you type in the search space and hit enter, nothing happens.
Type in the address bar, "Dr Wes" it goes to Dr Wes.

I put Wes in my favorites and Google page works. But still Google will not actively search for anything after I hit enter.

Google is busy figuring how to put up blimps to surround the globe with its data and advertising, but does not have the router/server capacity to handle it yet.

Just writing this so the word "conspiracy" does not come to mind.

Funny Story said...

Any word on Dickey's Dacha? Has it sold yet? I drove by the building, but it does not look like 2.3 million dollar kinda place to me. I did not go in.
Did they really pay that much for it?

I had a cheap condo in downtown Pittsburgh. Nice location near a Catholic University, but it cost only 60K.

Sold it ten years later for the same price to a foreign investor. The condo dues were killing me every month, several hundred bucks.

Just before closing, some idiots from upstairs (some non profit religious group owned it) got something caught in the bathroom pipes. Completely clogged to hell.

Plumbers, maintenance, and super came knocking on my door to fix it! What is my ceiling an easement! Nothing in the owner's papers, so they had their way.

They cut out big parts of MY bathroom ceiling to fix THEIR obstruction. Needed big holes in the ceiling to get at the pipes in question. Had to hold back the closing until the ceiling got repaired and painted as well.

Long story cut short.

The pipes were filled with a few thousand condoms that got stuck with a bunch of gunk in the pipe. Years of non-profit work down the drain!

And they wanted me to pay communally!

No way!

Konflict of Interest? said...

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