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Physicians’ Donations To Political Parties: You Get What You Give

Why don’t docs get more of what they want in DC?  There’s a quite instructive graph in a blog post from NRO last week (talking about Union campaign donations), but I found this one to be very instructive, and have added labels so the point cannot be missed:

In politics, generally what you give is what you get. I’ve taken to giving more to the PACs that represent me.

As an aside, it’s political malpractice to give only to one party (Teachers). Eventually that one party will be on the outs, and then where are you?

*This blog post was originally published at GruntDoc*

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3 Responses to “Physicians’ Donations To Political Parties: You Get What You Give”

  1. Ben says:

    I won’t even bother focusing on the absurdity of lumping Labor into one pile while subdividing industry, other than to point out that a more accurate comparison from the same source has been done here: (labor is responsible for a total of 5% of political donations in 2010).

    My germane gripe is that you’ve posted – and drawn conclusions from – a graph that has no bearing on what you think it is saying. If you go to OpenSecrets (where this graph gets its data) you’ll find that with the exception of lawyers (for whom healthcare is only one of many lobbying interests), healthcare professionals have since FY1990 been BY FAR the largest donors within the industries you highlighted (giving at nearly twice the level of the next health-industry sector, and – it should be pointed out – at more than twice the level of public-sector unions). You can get a year-by-year breakdown by sector here:

    As the source I’m citing here are the same one that the graph you posted claims to use, it raises the question of how the data for your graph was compiled. The National Review article where you pulled this from appears to have grabbed this graph from Anthony Davies who – in order to make labor unions look bad – used an unorthodox method of data collection: it looked ONLY at the top 100 SINGLE DONORS, rather than at industry aggregates. In other words, the Service Employees International Union as a single large entity gave a large amount of money ($8 million), whereas – because the checks were coming from several sources (AMA, ADA, AAFP, American College of Cardiology, etc etc) for the healthcare provider dollars, most of these organizations were simply excluded from the top 100 donors as they weren’t individually large to make the cut. This is an interesting breakdown of the data in its own right, but the only thing it really measures is how monopolistic the industry is: in industries with a small number of large donors – such as telecoms and investment – there is a good chance that a specific company will make the ‘top 100′, whereas in industries with large numbers of smaller companies (like healthcare providers), only a small fraction of those companies will have large enough contributions to make it into the calculation. It’s worth noting that the total donations of all the groups incorporated into this graph make up a tiny fraction of the $1.8B/yr that is donated.

    Both you and the National Review looked at the graph and saw what you wanted to see: “Labor unions are powerful”; “Physicians are getting the shaft”… but this isn’t what your graph says. As always, there are “Lies, damned lies, and statistics”

  2. GruntDoc says:

    I didn’t see what I wanted to see, quite the opposite.

    I was unaware of the methodology behind the graph, and I thought it was interesting, so I blogged it. (And I pointed out one special interest group that’s not very politically smart).

    Sorry it gave you so much heartburn.

  3. Ben says:

    haha… Yeah, perhaps it gave me more heartburn than strictly necessary. I’ve just become a little frustrated with the entire political discourse of late, where each side has its own set of facts, which are often based on major misconceptions… and these misconceptions seem to often be purposely crafted by interested parties in order to skew the dialogue. That makes it extra galling when these “facts” are rebroadcast uncritically by smart people who the public looks to for unbiased information. I’m not sure any of this is actually a new phenomenon, but it seems more overt these days. Anyway, thanks for the response.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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