In our discussion the other day about my leg telling the weather, I want to make it clear the brusque, perfect-looking and cruel doctor who made declarations instead of admonitions to help heal my leg is like all the other young MDs I’ve met in New York City.

These young doctors are angry and tired and terrified of going bankrupt in an industry that doesn’t begin to pay their high scale-rents and mountainous student loan debt. Many want to make a killing on the backs of their patients as quickly as possible before the insurance companies cut their payments even more.

The new thing in New York City is for young doctors to accept NO INSURANCE at all and run a cash-only walk-in business. Cash has always been King in New York and the young doctors are cashing in by cashing out on the needs of most people who need an insurer to help cover astronomically rising healthcare costs.

Some doctors, in an attempt to keep their conscience clear, accept one or two boutique insurance plans with high payouts while the rest of us, especially the elderly, are pressed farther apart from a routine relationship with a physician and are fated to suffer at the whims of an Emergency Department. I lost two fine doctors when they went cash-only. One was a dermatologist who, fed up with not getting paid by insurance companies for services rendered, decided to take it out on his patients.

He railed at me one day that the skin tags he had been cutting off of me were not getting reimbursed by my insurance company because that “surgery” was seen as elective and cosmetic. I asked him how taking off a couple of skin tags could be surgery. “Surgery, from the insurance company perspective,” he explained between gritted teeth, “is any procedure where any part of the body is cut or scraped.”

I told him the three tags he “cut” off — pulled off, really — had been rubbing against my shirt collar and causing me pain and while that may have been “surgical” it was not “cosmetic.” “Well,” he said, “You can cut them off yourself now.” I asked him how to remove them. He looked at me like I was stupid and then told me he was kidding.

I asked him if he was going to remove the two skin tags I had left. He would remove them for $100 cash each. I did not have $200 and I wondered if I could cut them off myself at home with a pair of nail clippers. He gave me a horrified expression and said, “No, I wouldn’t do that. You’ll bleed.”

“Well, if you won’t do it,” I reasoned, “Then I have to do it.” I had been in New York City for a couple of years and I had learned you had to aggressively stand up for yourself at all times and, if that failed, then you had to rely on only yourself for remedy. I continued, “What if I heated up the head of a nail with a match and then touched the nail head to the tip of the tag?

That would burn it off faster without any bleeding, right?”

He shook his head. “No, no. You can’t do that, either.” “Will you do it for me today, then? I’ll never ask you to remove them again.” He stared at me with his fists on his hips. “You already used a disposable scalpel to cut away the dead skin on my scar. Can you get the scalpel out of the trash and make two quick swipes?” He stared at me with death eyes and told me to turn around. I gave him my back and I heard him open the lid of the trash can. He spun me back around to face him.

He put his face so close to mine I could see the pores in his nose as he whispered, “And I’m not using anesthetic.” I nodded to give him his vengeance. I didn’t remind him he’d never used anesthetic before. “They’ll only grow back, you know.” With two fast flips of his plastic, green-handled, scalpel, he was done. He threw the scalpel back into the trash can and said, “We’re finished here. Don’t come back.”

I dressed myself and never saw him again because he closed his medical practice the next month and opened up a cash-only Day Spa in the same space. An older doctor friend who, when I shared that story, told me: “I know that guy and he was pulling down six million a year pinching pimples and now he’s making 10 packing mud on old lady faces. Nobody makes more money for less work than a Dermatologist.”

I have since used the nail clipper method of home skin tag removal and it works just fine. I don’t bleed much. The trick to finding an MD or dentist in NYC, I have learned, is to find one over the age of 70 — they’ve made their money and if they’re still practicing they’re doing it because they love their patients and not their payments. The old guys hate the young guns and how they behave.

One solution to remedying Angry Young Doctor Syndrome might be to find a way to reduce the financial burden it takes to get a medical degree. Some teaching hospitals are trying to find ways to achieve happy young doctors. One medical school in Long Island, New York will waive the $250,000 four year tuition price if a graduating doctor agrees to work in their hospital — with appropriate pay — for a fifth year.

I think that is a great first step in helping vest young doctors directly into the ongoing care of their patients and I hope other creative solutions can be found to once again make medicine about people and not prices. If we continue down our current pocked road of medical despair, we’ll be forced to do our own elective surgery at home on the kitchen table. My nail clippers remain ready.

22 Comments

  1. So funny I cried. Doctors seem to prescribe their own horror stories. Lucky to find a good one and they either move or retire.

  2. Simmering —
    I think the key to finding a good doctor is to ask your friends for recommendations and to keep looking if you don’t find one you like.
    Don’t settle for mistreatment just because you get tired of looking.
    Many of the good doctors, I have discovered, don’t accept new patients. The doctors who routinely accept new patients are the young doctors trying to build a practice.

  3. That story scared me just a little…
    I think I’ve mainly lucked out with doctors. My dad is an eye doctor (Phd, he does research on blindness and such) and has been good about helping me find the best doctors when I need it. I got I think the very best doctor for my Mammoplasty when I was 15.

  5. Well I had big boobs 🙂 At age 15 I had I think DDD and obviously it was quite a pain. I couldn’t take off my bra without being in the most awful pain. So I decided I wanted to have them reduced. On my april vacation I had the surgery (I won’t even get into the pain of it) and was in bed the rest of it. Oh and I missed out on my marching band’s trip to Virginia and to this day I kind of wished I’d waited on the surgery because I hate that I missed it. Everyone who’s seen the scars say it looks like the best job they’ve seen and I lucked out. Many women I guess have many problems after the surgery. It was the best decision I’ve ever made. Althoug now that I’ve gained weight I’m up to a DD again but we won’t get into that 🙁

  7. Sure. Obvioulsy I’m kinda an open book. It was a tough thing to go thru at 15 and I look back just amazed I made it thru it in one piece (no pun intended). You know…I remember so well this semi-formal I wanted to go to with my boyfriend before the surgery but I couldn’t fit in any dresses. We had to have one made for me. I’m very proud though of what I went thru and I know I’m a better person because of it.

  11. I recently switched doctors when I started having my stomach pains. It wasn’t that my previous doctor was bad, but his office was just mismanaged. He had one person dealing with records, appointments, billing, etc., and she NEVER answered the phone – even if you hit 0 to get the operator in an emergency!
    My new doctor is part of a group that has a separate appointment area and billing area. It’s soooo nice, and someone ALWAYS answers the phone. This new doctor is much more thorough. When I had my physical a couple of months ago, he notice a couple of moles on my back that, while he believes they’re okay, he thinks should be removed. My previous doctor never mentioned them.
    My new doctor mentioned wanting to do the procedure around the end of October, but I didn’t make the appointment right away. A couple of weeks ago, his office called to set up the appointment. I didn’t even have to call!
    As for doctor’s accepting cash, my uncle told our family the story of the Hispanic men that work for his company who don’t have insurance. They won’t have the money deducted from their paychecks. One man went to the doctor to have a cyst removed from his hand. The doctor told him it would be $150. The man said he could pay him $100 in cash that day. The doctor made a deal.

  12. Hi Carla!
    The one thing you cannot teach doctors is to care about their patients. They either have that in them or they do not.
    I challenge my graduate MPH and MD students to — instead of remaining distant and cold from their patients like caregivers used to be in the olden days — instead love their patients. Not a romantic love but a human love and to unconditionally love them all.
    When they resist the idea of love as a method in medicine, I ask them what other choice do they have? To remain neutral? To be distant? To remain “professionally disengaged?”
    Then I ask them to reverse the roles: Would they want someone taking care of them to love them or to be neutral, distant and disengaged? They always prefer to be loved. 🙂
    Cash always wins the day. Untraceable. Unreportable. Fast. Invisible. Ghostly.
    Get rid of those moles! They sound like trouble!

  15. Here is a glimmer of hope in the despair of the region of health care. The Institute for Healthcare Improvement is a movement HQed at Dartmouth.
    http://www.ihi.org/ihi
    It is for real. Don Berwick, physician and CEO of this institute which recognizes that there are many “broken” pieces in the American health care system. A pragmatist, Berwick does not look at the broad issues of universal health insurance, but rather looks at how current systems can be improved. His idea has become an international movement to improve quality of care.

  16. Hiya Jeff!
    It’s so nice to hear from you on this issue and your hotlink is a great read. It’s wonderful to see good people working hard within the current system to find some hope for the rest of us. 🙂

  17. in nursing school we talk about how its basically up to us to make steps to reduce healthcare costs. One of the ways is wellness promotion (illness prevention) instead of just treating and illness. Interesting topic.

  19. Erin’s education has it right. One good solution to the health care crisis is long term thinking. Lifestyle choices (nutrition, exercise, rest, etc.) do play a huge role in health. The problem? Many insurers think in the short term. How can we reduce costs now?
    Some companies are very forward thinking. Clif Bar, the sports nutrition bar company actually allows their employees to exercise an hour a day on company time. They realize that work related injury and absences are related to poorer health. So they invest in the health of their employees. I wish that a health insurer would have to foresight to pay for a health club membership for enrolees, realizing that the up front cost would pay off in lower health related costs in the long run.

  20. Well said, Jeff!
    I wish more companies would tend to their employees with a whole-body approach to healthy living instead of seeing them as cattle in cubicles where one method and one path of treatment will work for everyone.
    Choices in getting healthy are more nourishing for the spirit as people feel they are valued beyond their ordinary bodies.

  21. Interesting that you remember as many word-for-word quotes so well. If you really wanted to unleash your frustrations, you could have given good ol’ OSHA a call and reported the doc for throwing a scalpel into the trash rather than a sharps box (not to mention pulling it back out again and using it on a patient). That would have been a pretty $50,000-$200,000 fine. Oh well, it made for an entertaining tale.

  22. I see you’re writing from the University of Maryland at Baltimore, Cynthia. Do you study or work in the health field? I find your OSHA comments unrealistic in the real world.
    I remember the “quotes so well” because it was an experience I will not forget.

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