Sunday, June 22, 2014

Standards of Decency in the Blogosphere

A few weeks back, I posted a piece entitled, Are Emergency Rooms Admitting Too Many Patients?   The essay was cross posted on KevinMD’s site a week or so after it appeared on my blog.  I received buckshot style criticism from various corners of cyberspace on my post.  What provoked particular ire, was my implication that Emergency Department physicians faced financial conflicts of interest with regard to admitting patients into the hospital.  

I’m open to criticism and debate in the blogosphere and in my own life.  My father was an attorney and my brother is a sitting judge.  I’ve raised my kids to question, argue and to seek out the other sides of issues despite that they may already feel that they grasp them sufficiently.  Now, that they are adults, I am often the target of these skills that I worked so hard to cultivate in them. 

Numerous physicians were offended by my reimbursement implication.  In reading their responses, it was clear to me that I was not sufficiently informed on how ED physicians are reimbursed.  In my comment on Kevin’s blog, I indicated that I was prepared to stand down from these particular statements that had caused a cyberconflagration.   I didn’t double down; I stood down.

My blog has been alive for 5 years and has over 300 posts.  With one exception, I have authored every essay and they all appear under my own name.   The blog is commentary, not immutable truth.  I expect and welcome vigorous debate, either because a reader has a different point of view or simply believes that I am wrong on the facts.  As a member of the human species, I commit error with some regularity.  Presumably, readers face this same reality.

I was disappointed that some who opposed me spewed forth venomous personal attacks against me both as a physician and as a person.  Demeaning comments and character attacks, in my view, only demean the source of the vitriol, not the target.  Many comments were ad hominem thrusts that contributed little to the civil dialogue that should have ensued from my post.  Indeed, one commenter complained that Kevin deleted his comment, and I have every reason to suspect that this decision was warranted.   I let all comments on my own site stand without revision.

As readers of my blog and others in my life know, I will not engage in this coarse caliber of discourse. 

It's easier to make noise than...

The notion, as was suggested in a vituperative riposte, that I am focusing attention on the incivility of some dissenters because I am bereft of a substantive response is false.  In contrast, I suspect that the converse is true.  Shrill and strident views are often hurled when the case is weak.   Let the argument rise or fall on its own merit.  Turning up the volume only turns off the debate.  

If you disagree with me, bring it on.  If my facts are wrong, point it out and I will readily admit it. If you charge me with having human imperfections and frailty, then no trial will be needed as I will confess to this outright.    If I have miscalculated or misfired in an essay or elsewhere, I would hope that a reader would consider the totality of my work before disparaging me in an unseemly manner.  

If I err, as I did in my post, then I will say so.  If I disagree with you, then I will explain why.  If you have the better argument, then I will change my mind.

I believe that conversations, discussions and debates in the blogosphere and beyond should occur with respect, tolerance and fair-mindedness.    If you have a different view on this style of expression, then make your case.

Words matter.   They are the tools we use to present our ideas to others.   Shouldn’t we choose them with care?  


  1. A lot of the comments made at Kevin MD were totally on target. You should consider the content of what was said instead of the way it may have been said.

    CT scans and MRI's are relatively inexpensive. Better to do one where the patient didn't need it than not to do one and find out later that there was a missed diagnosis and the patient died. Look at the history of capitation and see what your type of suggestion led to. (The payment system is putting too much pressure on not doing potentially life saving testing. More testing brings prices down in a free market and eliminates some of the human capital and hospital costs that involve even more human capital.)

    The ER doc is not at fault. The system is. You are asking trained professionals that must follow specific rules and are limited in their actions that they cannot use those same rules to protect themselves or their patients. Our government's micromanagement of healthcare is the culprit.

    So far a retrospectroscope has not yet been invented, so one should give the ER doc a bit more leeway than you did.

    Two questions regarding a mechanism of payment.

    1) Should you only be paid for a colonoscopy if that colonoscopy turns up something actionable?

    2) Should you have to eat the the pathology costs of a benign polyp?

  2. Thanks for the comment. Regarding your inquiries:

    (1) I do not think a colonoscopy or any medical procedure should be gratis if no lesion is found. Should a home inspector work for free if no defects are found? If a lawyer reviews a contract, and find it to be sound, should there be no bill?

    (2) By what rationale should the gastro MD swallow the bill of a separate medical professional?

  3. Average salary of GI doc a year: $488,000
    Cost of colonoscopy in 2003 in US: $2000
    Cost of colonoscopy in US in 2010: $4000
    Average scope time: 7 minutes
    Percent increase in scopes once a GI doc opens a surgicenter: 37%
    Time to look at your own specialty. Why prescribe a $4 GERD med when a $180 one will do? We all know GI docs are perfect, right? And seriously, the only thing I ever hear from GI docs is, "Call the hospitalist, I'll be in in the morning", so why do you even care about admissions? GI docs don't admit anyway.

  4. The numbers that the above anonymous and angry commenter offers regarding salary, etc., must be taken from the Land of Make Believe. If such a reality does exist, every GI I know here in Northeast Ohio would pack tonight and quit their jobs tomorrow.