Because my experience = the world

Two nights ago, the Better Half and I had dinner with the triage nurse in my office. Despite my best intentions to avoid talking about work too much, thus boring her loving family, talk about work we did. (Confidential to George and Alexis -- um... sorry about that.)

This is usually the Season of Horrible Insanity for pediatricians, also known as cold and flu season. I typically expect to be booked with about 25 patients a day, most of whom have coughs and colds and various other ailments of a viral and snotty variety. And I tend to hate cold and flu season, because there is nothing so demoralizing as having to explain to a cavalcade of frustrated and sleep-deprived mothers that there is nothing that one can do for little Peyton's cold, and good luck with the vaporizer and "tincture of time." (I have never actually said the phrase "tincture of time" to a frustrated and sleep-deprived mother, for fear of being summarily throttled to death. Cutesy-poo medical phrases are, to my understanding, not comforting.)

This year? Not so much. The last few months have been sloooooooow. The triage nurse is fielding more and more calls from parents who simply want management advice over the phone, and are reluctant to come in and cough up the co-pay. She's getting the sense that a lot of people have switched to high-deductible plans in an effort to save money. (I will get around to decrying high-deductible plans one of these days.)

Now, from a cost-benefit perspective, this is probably a good thing. If people are deferring unnecessary medical visits for problems that will go away with no intervention anyhow, this costs everyone less money. Obviously, one hopes that they aren't deferring care for serious illnesses, but there hasn't been a huge upswing in admissions for untreated, smoldering pneumonia and such. Most of these visits are probably ones that the patients didn't "need" in the first place.

On the other hand, this is not great for business. (For those of you clutching your pearls at the revelation that medical offices are businesses, and medical providers did not enter the field because of an undying desire to cure illness with no thought to compensation, I hope that you can rebuild your shattered belief in the goodness of humanity over time.) We kind of look to the late fall and winter as "bread and butter" time, so the bottom line starts to look a little shaky when the schedule has lots of openings.

I can't find numbers about how people access health care during economic downturns, and it's far too early to get any kind of big picture about our current crisis. But there's a lot of commentary out there that makes it look like my experience is likely to be typical, and a change is probably not going to come quickly.


  1. I look forward to seeing what Obama plans to do regarding our health care crisis. I think we need some form of national health, with an emphasis on "some", since I know government agencies aren't known for their efficiency. We shall see . . .
    I'm alarmed at the number of parents who aren't vaccinating their kids for fear of autism. Speaking of which, I forwarded a message from my cousin to you about her son, who has Asperger's.


  2. Just wait. Flu season will come and all you pediatricians will be whining like a bunch of little girls!

  3. Here comes the end of civilization, it is for each individual to determine if this is bleak or not.

    The top story of the year is that global crude oil production peaked in 2008.

    Global crude oil production had been rising briskly until 2004, then plateaued for four years. Because oil producers were extracting at maximum effort to profit from high oil prices, this plateau is a clear indication of Peak Oil.

    Then in August and September of 2008 while oil prices were still very high, global crude oil production fell nearly one million barrels per day, clear evidence of Peak Oil (See Rembrandt Koppelaar, Editor of "Oil Watch Monthly," December 2008, page 1) http://www.peakoil.nl/wp-content/uploads/2008/12/2008_december_oilwatch_monthly.pdf.

    Peak Oil is now.

    Credit for accurate Peak Oil predictions (within a few years) goes to the following (projected year for peak given in parentheses):

    * Association for the Study of Peak Oil (2007)

    * Rembrandt Koppelaar, Editor of “Oil Watch Monthly” (2008)

    * Tony Eriksen, Oil stock analyst; Samuel Foucher, oil analyst; and Stuart Staniford, Physicist [Wikipedia Oil Megaprojects] (2008)

    * Matthew Simmons, Energy investment banker, (2007)

    * T. Boone Pickens, Oil and gas investor (2007)

    * U.S. Army Corps of Engineers (2005)

    * Kenneth S. Deffeyes, Princeton professor and retired shell geologist (2005)

    * Sam Sam Bakhtiari, Retired Iranian National Oil Company geologist (2005)

    * Chris Skrebowski, Editor of “Petroleum Review” (2010)

    * Sadad Al Husseini, former head of production and exploration, Saudi Aramco (2008)

    * Energy Watch Group in Germany (2006)

    * Fredrik Robelius, Oil analyst and author of "Giant Oil Fields" (2008 to 2018)

    Oil production will now begin to decline terminally.

    Within a year or two, it is likely that oil prices will skyrocket as supply falls below demand. OPEC cuts could exacerbate the gap between supply and demand and drive prices even higher.

    Independent studies indicate that global crude oil production will now decline from 74 million barrels per day to 60 million barrels per day by 2015. During the same time, demand will increase. Oil supplies will be even tighter for the U.S. As oil producing nations consume more and more oil domestically they will export less and less. Because demand is high in China, India, the Middle East, and other oil producing nations, once global oil production begins to decline, demand will always be higher than supply. And since the U.S. represents one fourth of global oil demand, whatever oil we conserve will be consumed elsewhere. Thus, conservation in the U.S. will not slow oil depletion rates significantly.

    Alternatives will not even begin to fill the gap. There is no plan nor capital for a so-called electric economy. And most alternatives yield electric power, but we need liquid fuels for tractors/combines, 18 wheel trucks, trains, ships, and mining equipment. The independent scientists of the Energy Watch Group conclude in a 2007 report titled: “Peak Oil Could Trigger Meltdown of Society:”

    "By 2020, and even more by 2030, global oil supply will be dramatically lower. This will create a supply gap which can hardly be closed by growing contributions from other fossil, nuclear or alternative energy sources in this time frame."

    With increasing costs for gasoline and diesel, along with declining taxes and declining gasoline tax revenues, states and local governments will eventually have to cut staff and curtail highway maintenance. Eventually, gasoline stations will close, and state and local highway workers won’t be able to get to work. We are facing the collapse of the highways that depend on diesel and gasoline powered trucks for bridge maintenance, culvert cleaning to avoid road washouts, snow plowing, and roadbed and surface repair. When the highways fail, so will the power grid, as highways carry the parts, large transformers, steel for pylons, and high tension cables from great distances. With the highways out, there will be no food coming from far away, and without the power grid virtually nothing modern works, including home heating, pumping of gasoline and diesel, airports, communications, and automated building systems.

    Documented here.

  4. Dr. Wirth, perhaps you have strolled over from my father's blog? Thanks for stopping by! But your comment seems a wee bit off topic.

    (No arguments from me about peak oil, mind you.)