At THCB we regularly repost content from other blogs and we delight in giving those authors access to a different audience as well as giving our audience access to other viewpoints that I and the team here frequently don’t agree with. However, sometimes we make mistakes and this post represents one of those times. This post originally was published on the Sermo blog as an example of a community post–one that non-MDs cannot access–which stirred a lot of controversy on Sermo. This post attracted more than 200 comments on Sermo, and they highlighted it on the Sermo blog from which we syndicated it.

But unlike how we originally bylined and presented it on THCB, this post was not written by Daniel Palestrant MD, CEO of Sermo, and does not represent Sermo’s corporate opinion, and I can assure you definitely does not represent Daniel’s personal opinion.

The first 19 comments on THCB come from people who we misled by our error into thinking this was Daniel’s post. We’d like to apologize to Daniel, Sermo, drspuds and our readers.

But as this post (like it or not) does represent the view of at least one physician and maybe rather more, we’re going to keep it up on THCB-Matthew Holt

* * *

Dear Mr. and Mrs. America, by Sermo member “drspuds”

You live in one of the greatest countries on earth, one of the
richest ones, yet arguably not one of the best for medicine.
You may question why that is.  I think I may have some
answers.  Essentially, you want to have your cake and eat it too.

When you are sick or injured, you want the best healthcare money
can buy.  But you want someone else to pay for it.  You
feel should not be made to pay for things that are not your fault,
as you perceive it.

When you do not feel you have gotten the best healthcare someone
else’s money can buy, you scream, yell, threaten and generally act
like a child.  Then you demand to be respected as an adult.
You take the same approach to “free” care, such as telephone calls,
disability paperwork and public aid.

When your treatment does not go as you planned, you want to keep the legal option to sue a doctor for “everything he’s got”, but want to keep “good” doctors in your community so you don’t have to drive 6 hours to get your brain tumor operated on.

You want to be able to drink and smoke as much as you want, and then when years of beating the crap out of yourself makes its presence known, you want us to rescue you.  We told you 40 years ago not to smoke.  Now you want us to save your life from the CAD, emphysema and lung cancer you caused.

You want to drive a car at 90 mph while drunk, “because I’m having fun” but want us to put all the pieces back together when the inevitable happens.

You want a single-dose pill to take care of anything that ails you, aka the “magic pill.”  But you complain about the realistic medications you will need to take every day for the rest of your life. 20 years ago, these pills did not exist and you would have had only a few years left to live.  Now we can keep you around for many more years for you to keep complaining about the pills you have to take.

You complain about the 3 antihypertensives, the 2
cholesterol-lowering drugs, the glucophage and other pills keeping
you alive and adding years to your life, while refusing to quit
smoking, cut down the drinking, eat healthier and get some exercise
once in a while.

You spend a ton of money on highly-processed,
marginally-tasteful, completely unhealthy food, and then ask us for
a pill to help you lose weight. 90% of the treadmills you own are
collecting dust or acting as coat racks.

You want a “lifestyle” pill for every unpleasant symptom you
have. You’d rather not do the therapies that can effectively treat
your insomnia, you just want a sleeping pill.  Besides, all
those commercials on TV for Ambien, Sonata and the others tell you
you are entitled to a good night’s sleep, by pill if necessary.

You use the ER as your primary care provider, then complain
about the wait to be seen there for a URI.

You give us vague complaints, with vague histories and onsets of
symptoms and then ask us to make a specific diagnosis.

You demand tests without any knowledge of what “false-positive”
means or its potential implications for you. You don’t consider the
downside of testing.

You have asked for, and now get “informed consent” before any
treatment, but don’t want to be held responsible for your part in
the decision-making process when things don’t go well.

Birth control is an option, one you have often declined to
use.  Now the rest of us get the pleasure of helping to pay
for that little bundle of joy you didn’t want and the “father”
declines to acknowledge. Hopefully we can help you finish your GED
so you can meaningfully contribute to society rather than live off
of it.

You want to legalize marijuana, “because it’s safer than
alcohol” or so you think.  Two bad things apparently make one
good thing.

You want opioids to be available anytime you deem your pain
severe us to deserve them, but don’t want us to restrict them
simply because a bunch of yahoos use the recreationally or for
income. The fact that we have been burned so many times by so many
people should have no bearing on you, the seemingly-legitimate pain

You want us to trust you implicitly to follow our
recommendations, yet you don’t trust us enough to finish taking an
antibiotic for 10 days when we tell you to. Many times you don’t
even trust us enough fill the prescriptions we write.

You take whatever the guy at GNC says you should take, and pay
him ridiculous amounts of money for unproven therapies, then
question us on every potential side effect for anything we
prescribe that has gone through a full FDA approval process. And
you reserve the right to sue us and the pill manufacturer (and the
pharmacist who sold it to you) should you have a side-effect from
it, even if we warned you about it.

You argue with us about co-pays, deductibles and out-of-pocket
expenses that we have no control over.  Take it to your
insurance company or employer.

You want your doctor available 24/7/365, but you want him or her
to be well-rested when you come in.

You raise hell when you are made to wait 15 minutes in the
waiting room, while your fellow citizens arrive 20 minutes late,
with 3 young kids in tow for the annual pap smear.  You then
want to take up 30 minutes of my time addressing every health
concern you have despite booking only one 15-minute time slot.

Unfortunately, Mr. and Mrs. America, you cannot have things both
ways.  You cannot have “free” healthcare that covers anything
and everything.  You cannot have an unhealthy lifestyle and
expect to be kept healthy by us.

You have been given the knowledge and resources to prevent or
treat most any disease or injury known to man, and you have
declined the opportunities repeatedly.  Instead, you have
opted for the “quick fix” so you can get back to your life of

And I’ll still be here, for a while anyway, trying to fix the
things you’ve broken.

Daniel Palestrant, MD is the Founder & CEO of Sermo, Inc.  A frequent contributor to THCB, his work also appears on the FtF blog at Sermo.com, where this piece first appeared.

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Categories: OP-ED

17 replies »

  1. Matthew will you be posting about how demanding blog readers are and how much they expect from blog host who provide this service for free, minus the cost of seeing advertising? Maybe its not just medical care but society overall that has unrealistic expecations, demands might be a better word, for services they consume. At least for today guess your human.

  2. Matthew, I hate to say it; but that’s a horrible error. Maybe it was your editor’s mistake and not yours, but geez, I already quoted from it on another blog. Now I have to go back and correct THAT so as not to further besmirch Dr. Palestrant’s reputation.
    Somebody pay more attention next time.

  3. As noted in the intro to the piece NOW, we goofed badly here. This post was NOT written by Daniel Palestrant, but was one Sermo highlighted in their blog written by a member. So while the opinion is heartfelt from a real MD, it is NOT Daniel’s opinion and he doesn’t agree with it. So to all who have commented thus far, my apologies, but if your comment mentions Daniel, I’m going to take it down and re-send it to you, and ask you to re-post an edited version if you like.

  4. ” She called me yesterday to say she should not have to pay her co-insurance share because she did not actually need to see a specialist.”
    If the brake store can do a free inspection why not doctors? LOL the sense of entitlement in the country really has reached a dealy point. We can’t even discuss patient entitlement in a professional forum without people going nuts. We already know some of them throw out the sex card to kill any discussion, wouldn’t surprise me if they don’t use the race card to avoid any productive argument as well. Everythiong listed is a real problem that needs addfresses, its denying these truths that got us where we are today. If I didn’t fear the forming lynch mob I would add 20-30 equally silly demands some of the general public have of insuranc, starting with insurance is only good if the premium is less then your claims.

  5. ” You cannot purport yourself to be a member of a noble, selfless and caring profession, while engaging in offensive and callous monologues aimed at ensuring your income level is preserved”
    Yet Margalit when politicians and journalist do this you support them? At least the good doc actually does something in return for his income level.

  6. I understand why some object to the tone of this post. But the post does make a salient point – doctors can’t control outcomes once patients leave the hospital or the office. That’s why many metrics about disease outcomes are meaningless. Patients spend 99.9% of their lives outside physicians’ offices. What they do outside – what they eat, how much they exercise, whether they take their pills – determines more about their health than what doctors do or prescribe inside.

  7. Hey jd, I just would like to know, if you see a physician for some type of care, WHEN he/she fails you in your assorted needs, as we are humans remember, do you insult and demean the doctor in the office, or just find a deflection to deride the MD later?
    Let’s face it, as MDasHEll called you on it at another post, you despise doctors. Hopefully, and thankfully, you do not soil my doorstep!

  8. Can you imagine a Hilton representative publicly accusing their guests of being slobs and not cleaning up after themselves? Or a Toyota spokesman complaining about their customers feeling entitled to both safety and low-price and that they cannot have it both ways? Or the BP CEO whining about Americans wanting to consume a lot of oil, but not willing to accept the environmental consequences?
    That doesn’t happen because every competitive industry understands that they exist to serve their clients.
    It is amazing that the medical profession still has a few members that feel entitled to insult their customers. It’s very simple: if you are not willing to perform a service for the payment you receive, then don’t do it. Maybe change jobs and join a competitive industry. Then you’ll see the things you have to do to keep customers happy.

  9. Dr. P:
    Sounds like you work in this practice. We had a woman referred to us by her PCP to rule out a serious medical issue. Our specialist examined and determined that no serious problem existed. We filed her claim and billed her for the co-insurance requirement placed on her by her commercial insurance carrier. She called me yesterday to say she should not have to pay her co-insurance share because she did not actually need to see a specialist. Just a typical day in healthcare! Thanks for posting your comments.

  10. I loved this! And you know what, the lame-o’s above who bitch and moan how inappropriate and insensitive this post is are exactly the ones you wrote about, they are beyond denial to understand it!
    Hey critics, read this link and then see your future if this piece of fecal waste called health care reform legislation stays in place:
    Thanks for taking the time to write your post, Dr P. And realize that most of the critics have never walked in our shoes. Life’s a bitch when you don’t have to do the work, just sit in the couch and be holier than thou.
    No good deed goes unpunished, that is the motto that should be above all caring and invested doctors’ doorways!

  11. Nice post, just remember that its human nature to moan and cry about everything and we are a self desctructive being.
    In the end, if it wasnt or those complaining self destrcutive people, RN’s like me would be out of a job beacuse the hospitals wouldnt be overcrowded. I just wish that the pay would increase with the hours being dished out.
    As an RN, I often see patients that do nothing but rave about the cost of healthcare. Little do they know that I’m not what you would call wealthy and I often have to work double shift whether I want to or not due to the lack of available nurses.
    But you know what, even if everyone took care of themselves as to be healthy, they would still have something to cry about when they go to the ER.

  12. Well sure everyone, except for doctors, would like a doc who lives in the back room and doesn’t eat much; but I think most Americans know that is totally unrealistic. Don’t take arguments immediately to there extremes. We are fairly rational adults here, treat us with some intellectual respect.

  13. Who exactly is “we” and “us”? Is this the Royal usage of “we”?
    And by the way, you cannot have it both ways either. You cannot purport yourself to be a member of a noble, selfless and caring profession, while engaging in offensive and callous monologues aimed at ensuring your income level is preserved while Mr.& Mrs. America are quickly sliding into abject poverty.
    Misguided articles like this one are doing more damage to the “profession” than all the recent public attacks put together.
    So you really need not stick around to fix anything. Mr. & Mrs. America are fortunate enough to have hundreds of thousands of doctors who still remember Dr. Osler and what he stood for.

  14. Wow, it does look terrible when summarized this way. Although obviously over-simplified, and few individuals have all of the described expectations, it is largely true as a generality. Honestly, I personaly experience almost every example you give in one way or another each and every week of my medical practice. Of course, I can’t claim to be perfect myself–I resemble a few of your remarks. Although sensational, the article is biased from one point of view, and offers little in the way of constructive solutions. You are frustrated. I am frustrated. Everyone is frustrated. Where do we start?

  15. “You want someone else to pay for it.” I am so sick of hearing that. People who say it don’t want to pay for their own. In fact, why don’t we just have each pay for his own health care – no insurance companies at all. I am willing to do that, if that can be the plan. People actually paying for health care would bring true reform in a hurry, and I am all for that. Meanwhile, I am not paying for anyone’s health care – not mine, and not yours. I will not contribute to the system as it is. More than that, this household will not under any circumstance purchase health insurance. Unproven and unscientific methods are what enable us to do this. Today’s medical “science” is actually marketing science, so who are you to tell me who to do business with?

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