My Doctor Says: Get a Boob Job

My wife, my children, and I are all patients at the Palo Alto Medical Foundation (PAMF). I am grateful for the world-class care that we all receive there, and I continue to refer many friends and colleagues there.

We recently received a mailer from PAMF, addressed to my wife and personalized with her name showing what they think her summer to do list should include. (I've blacked out her name in the photo of the mailer below.) The list ends with: "Do something REALLY special for myself!"

Cute, I thought, and wondered what would be inside. Perhaps some tips on exercise or eating smart, or a reminder to get caught up on important screening tests. My jaw dropped when I opened the pamphlet and saw: "To look and feel your best, you don't have to look far", and listed the following services:

- Breast Reshaping
- Tummy Tuck
- Face, Eye, and Neck Lift
- Liposuction
- Rhinoplasty (Nose Reshaping)
- Laser Skin Rejuvination

I think it is entirely appropriate that PAMF offers these services. However, I am deeply concerned that they are advertising them as the way -- for a woman in particular -- to do something really special for herself and feel her best. Body image issues aside, what does this say about our physicians? PAMF represents my wife's primary care doctor (and mine), and I suspect many patients see this type of promotion as coming from their doctor. Did she approve this, we wondered? If so, what should we think when she recommends a mammogram or a colonoscopy? It begs the question of whether the primary goal is my health or profit for the health care provider.

I've commented previously on Atul Gawande's eye-opening piece in the New Yorker about McAllen, Texas, a town where health care costs are among the highest in the country, while the quality of care is no better than average. Gawande explains:

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

Perhaps we are asking too much of physicians. They should have only my well-being in mind, while at the same time their decisions about my care often impact whether they can afford to send their kids to college. In case you're worried about your own bills, don't worry -- as you see in the screenshot below, for these procedures you can get a FREE private consultation and financing options are available.

Ideally, it won't be long before we get much better at measuring the quality of care, and physicians will get payed for delivering quality. In the meantime, demand the facts and make informed decisions.

Follow Roni Zeiger on Twitter: www.twitter.com/rzeiger

Comments

[Factonfact]

You should live in my city of 150,000 pop. where only the general practitioners who handle mostly the poor will accept Medicare patients. My next door neighbor's doctor of some 30 years promptly dumped him when he became eligible for Medicare. Yes, dumped him; i.e., refused to see him anymore. Plain enough? He's wondering now where he can get his annual flu shot, among other things. We don't hear this sort of thing discussed in the current health care reform debate.

I don't understand this sort of thinking. Whatever happened to the Hippocratic Oath?

Learn, though, that in the current debate, you should not autmatically lionize doctors and hospitals. As evidenced here, doctors can be at the root of the problem -- not just the greedy, manipulative health care insurers. As for the hosptals, I could go on . . .

[QOTW]

Bingo, that's just another ludicrous example of how 30+% of your premiums get wasted that don't go toward your medical care - to pay for share holder equities, CEO salaries and admin, admin that includes unsolicited advertising for unecessary non medical procedures. In some cases it's nearer 50% and some people think reform is unnecessary? It would be funny if it wasn't so damn frightening.

[kissmygrits]

Gross.

[PeterMuir]

Having worked at a large multi-specialty clinic (on the IT side) I have some insight into their motives. As insurance companies continue to squeeze the providers and limit compensation for services, the only place the clinic can look is to elective services, like plastic surgery, for which patients pay for out of pocket. It's not that they WANT to sell boob jobs and tummy tucks, it's that these subsidize the mamograms and colonoscopies.

[noweknow]

The answer: their profit.

[Just Margaret]

With this kind of junk mail coming into the home, is it any wonder that so many of today's women and girls have eating disorders and body image issues? Ugh...

[Openyoureyes1]

where does the ad say, "you need a boob job?" it looks to me as though it says, "if you're considering cosmetic surgery, here is a place with surgeons who are board certified in plastic surgery that work in a reputable institution who are available to give you information, and if you desire, provide service." also, cosmetic surgery isn't the same as standard health care that one seeks for routine or other medical problems over which they have no control . rather it is an elective and conscious choice that people freely make that has nothing to do with insurance based medicine, so to compare the two in the setting of health care reform seems inappropriate.

[SangZe]

I have yet to meet a doctor who wasn't in it for the money. Example: At the urging of a primary provider, I had a test. I paid the doctor $85.00 for this advice and had the test, for which I also paid (via insurance). Then, the specialist who administered the test asked me to come in to go over the result. At his office, I didn't even have the chance to sit down. I was charged $85.00 to hear him say "The test was negative." This is the state of medical practice in the U.S. Money, money, money.

[Roni Zeiger - Huffpost Blogger]

Fortunately, I know many doctors who are not in it for the money, including those my family sees at PAMF. I think one of the biggest challenges ahead of us making it easier for those doctors to practice the way they believe is best.

[quillsinister]

"It begs the question of whether the primary goal is my health or profit for the health care provider."

How is this a question? Hasn't the answer been painfully obvious for a long time now?

[Fudgefase]

Offering preventative services in order to catch any problems early should be encouraged, but a boob job hardly falls into this category.

[KB2000]

There are big problems with the entire cosmetic surgery business. Anyone with a medical license can legally perform outpatient cosmetic surgery, without having any specific training whatsoever. A proctologist can decide to start doing tummy tucks, and can switch specialties and start advertising for patients the next day. Many doctors get tired of making a living as a General Practitioner, or Internist etc, and take a weekend course in cosmetic surgery, and make the switch, immediately performing procedures with no previous experience. Doctors can even buy "before and after" photos that they can show patients, in order to make sales. Some of the companies that sell surgical equipment for specific procedures will also sell the marketing materials needed to sell those procedures to patients

There is zero oversight and zero regulation when it comes to cosmetic surgery... there are more laws regulating hairdresse­rs/cosmeto­logists, than there are for cosmetic surgery. Used car sales are more regulated than cosmetic surgery. Because cosmetic surgery is a cash or credit-only business with no red tape and no insurance companies to complicate things, it attracts bottom-of-­the-barrel doctors who are primarily interested in making lots of money, who were also sometimes unable to succeed in their previous medical specialties. Anybody who is contemplating cosmetic surgery, you can find all kinds of exposé type websites that reveal the problems, risks and issues with various cosmetic surgery, that the glossy sales brochures fail to mention.

[foxnewsfan]

I have never received any junk mail from a doctor but if I did I would have no trouble throwing it in the trash with the AARP, dish tv, etc.etc. solicitations. It appears that some people are so in awe of doctors that that even a doctors "end of life" consultation provided by the "government option" in healthcare reform might unduly and erroronously influence the aged.

[FRobert]

If you don't want a consultation with your doctor, don't consult. There, that was easy.

[EgyptianMysterySchool]

Great opinion pieces/ articles on the pharmaceutical industry's drive for profits - no different than the medical industry...

Pharmaceutical Drug Companies Killing Middle America Legally while Robbing You Blind
http://www.betterbodyjournal.com/health/pharmaceutical-drug-companies-killing-middle-america-legally-while-robbing-you-blind
...Drug companies lie to you. Plain and simple. Those drugs you thought were non-habit forming? They are. Those drugs you thought could cure your Restless Leg Syndrome (which has got to be a made up disease), well, it causes compulsive gambling. Those drugs that cured arthritis? Well, turns out they cause heart attacks and the drug companies knew it...

Pharmaceutical Drug Companies Marketing and Policy Making
http://www.betterbodyjournal.com/health/pharmaceutical-drug-companies-marketing-and-policy-making
...."Pfizer spent $16.90 billion on marketing in 2004, and only $7.68 billion on research and development. GlaxoSmithKline spent $12.93 on marketing, and $5.20 billion on research and development. Merck spent $7.35 billion on marketing and $4 billion on research and development. (4)"...

[MerrieWay]

It's a deck of cards...exposure to this autrocity will implode on the nation as a whole.
Projecting into the future, howt will our excessive legal drugging societyof be viewed?
Do we have to wait that long to put the Pharma's on notice?
My heart is sickened by the PHARMA'S LIES - and the lives of youth that have been fractured by over medicating.

[EgyptianMysterySchool]

"Projecting into the future, how will our excessive legal drugging of society be viewed?"

That's a good question. We look back into history at the backwardness and barbarism of various cultures or small aspects of past cultures - what will we look like to those in the future? I don't think it will be favorable or worthy of praise when we have so much on record about the ill effects of our drug fueled, chemicalized society.

Where will we line up next to throwing malformed babies off of cliffs? Or slavery? Or witch hunts or crusades? To me it can be likened to a form of cannibalism - some members of our society are more than happy to poison and harm others for the sake of profit.

[Lugnutz]

Reminds me of an opthamologist I used to go to. I have a relatively uncommon type of glaucoma that hits at a young age & is particularly vicious. He had an excellent reputation for specializing in difficult & unusual forms of eye disease. He halted the progression of my glaucoma & 15 years later the surgery he did is still holding up. I could not ask for better care.

About 8 years ago he started doing laser vision correction because they are cash only & he didn't have to deal with ins co's. As he devoted more time to laser correction the quality of care for his long time eye disease patients steadily deteriorated. I walked.

Today he has 3 clinics . He still does some specialty work, fixing the botch jobs that the laser chain clinics do. He will not take any insurance, cash, credit or easy financing only.

I still occassionally run into him as he lives in the area. Back in the day, which he admitted he missed, he barely broke even. 2 staff just to do the ins paperwork handling & having to budget 2 hours a day for argueing with the ins co's to get them to cover even part of the cost of what was needed to save someone's eyesight.

15 years ago he drove a Nissan, today he drives a Maserati.

Follow the dollar, ins co's are driving the best Doctors out of the market. The overhead is way to heavy. There has

[MNKen]

Thank you for the reality check. Doctors are people, too. How many of us have changed jobs because the money is better? Yes, people like you have lost an excellent provider and others may not get care as good as your doc provided. But he followed the American ideal and went for the money. Good argument for changes in health care. Thank you

[Bluedanube]

March on Washington for healthcare reform on Sept. 13th. Pass it along. The people united cannot be defeated.

[alexhoward]

Good idea, but spam is spam nonetheless.