Response to Adam Conover’s Tweet | Hospitals & Mammograms | Wednesday Checkup

Response to Adam Conover’s Tweet | Hospitals & Mammograms | Wednesday Checkup

October 6, 2019 100 By Ewald Bahringer


– Wow. Adam Conover from
Adam Ruins Everything responded to our reaction video. And you critiqued it as well, so we’re talking about it on this weeks Wednesday Checkup. Beewoop. (upbeat music) Just to catch everybody up, a couple weeks ago, I did a reaction video to the show Adam Ruins Everything. The topic of the episode was hospitals. So I was very comfortable giving genuine opinion on the matter. Since then, it got a lot of attention. Over 11 thousand comments,
two million views, the host of the show actually responded via twitter. So I wanted to take some of his critiques, some of your critiques, address them, and explain to you how
I film a reaction video. Cause I think its important
for you to understand not only how my mind works, but how this editorial process happens. If you look at a TV show, they have multiple rounds of revision. They can film extra
things, plug things in, have experts come in, give extra advice. I don’t do that. In this channel, it’s myself, my awesome videographer Dan Owens. We sit down in front of the television and we watch the episode
for the first time. I’ve never watched these episodes before because I feel like if I go in with some kind of
preconceived talking points it loses the genuine
nature of the conversation. And I feel like there’s something special when both you and I are watching this episode for the first time. When it comes to the editing process, I never fill in information. If I don’t know something, I
look it up on camera with you or I don’t include it in the final edit. I don’t know all the terms. I don’t know all the conditions. But if there is something
that I do know about I chime in and try and present it in the easiest, most fun, entertaining way so that you can understand it as well. That doesn’t always hit home, so if I discuss a subject that I feel didn’t come off well,
or wasn’t explanatory in a way that’s understandable I’ll edit that part out. I will never edit it to
make myself look smarter or to make someone look stupid. It’s simply to make the
information digestible, interesting, and so that
the pace of the piece kind of moves quickly. Now that you know the process I go through in filming one of these, lets talk about the comments and critiques
you left underneath the video. First you mentioned that you suspect that I have a level of bias, because I am employed
by a hospital system. Well, actually you’re
right. On two counts. First, all humans have some level of bias. In fact, those who are more educated have a higher level of bias, because they are able
to convince themselves by rearranging data and information to suit their own beliefs. Second, I do work for a hospital system. I am an outpatient, office based doctor so I’m not really in the hospital but it sort of holds true still. However, I have to push back a bit here. What I’m most passionate about, what I pride this channel on, is that we identify bias,
and we try and prevent it from corrupting this information. I try to present information as honestly and accurately as possible, without putting my own opinions in, unless I’m explicitly saying
that this is my opinion and not everyone else’s. Or not matching of the facts. I’m no stranger to controversy, and I’ve covered some really controversial topics on this channel like polarization, diversity, telemedicine statements made by politicians
and health care professionals and I’m not afraid to face my biases and their biases head on, so that we can have a healthy debate, have an honest conversation. And if you ever catch me being biased, or I ever catch myself being biased I’m going to be the first
to admit that on camera. The next point you’ve brought up quite commonly in the comment section is that you worry that Adam actually explained certain points
but I don’t show that, therefore I make it look like I know something that he doesn’t. I don’t edit in this type of bad faith. If there was something that I critiqued about the show, and then he went on to correct it, I would either a jump in and say, oh, he pointed that out,
so we’re on the same page or I would completely erase my critique and not include it in the final cut. To make someone look bad, just
to make myself look better that is something I absolutely abhor, and will avoid doing at all costs. And the final point that
I saw a lot of critique on and rightfully so, is that
I didn’t quite qualify why I believed hospitals
to be so expensive if it wasn’t just to make a buck. The reason why I left that bit out, is because when I explained
it on that first take I don’t do extra takes it wasn’t clean when I
looked back at the edit, didn’t explain it well, and I felt it would slow down the overall pace of the video, so I just completely deleted it and felt that if you wanted
further clarification I could do it in the comments or do as I’m doing now. But let’s chat about why
hospitals are so expensive. I don’t disagree with Adam, that part of the reason why hospitals have such crazy prices,
is to make a profit. That definitely exists, and I think that certain hospitals, based on
how much money they spend on marketing, branding, hiring new talent, innovation, all of these factors, charge more money and they
want to make more money and it’s a for profit business. Whether you agree with a hospital being a for profit business is a whole different conversation. But that is not the only reason why hospitals charge so much. And in fact, it’s not
the main reason either. The major reasons of why
hospitals charge so much, first and foremost, is
administrative costs. When you look at a graph
of how much physicians have been costing the health care system over the last 30 years, it
hasn’t really changed much. The real uptick in spending has come from the administrative burden
placed on the system and doctors as well. In fact there’s this whole spike in doctors being unsatisfied
with what they do. It’s not because medicine’s changed. It’s because the administration
of medicine has changed. The reason for this
uptick in administrators comes from the fact that our system is so complex and not intuitive at all. When a patient is admitted into a hospital from the emergency room, there has to be three people to figure out how to best bill that patients insurance so that they approve the fee, and get the hospital can get paid. Then if I didn’t fill
out the patients chart in a way that’s applicable
to that insurance policy I have to then go and change the chart. The system is so fraught with inconsistencies, with redundancies, that the cost goes up significantly, to receive the same thing that if you were in another country, it would cost a portion of the price. There was a great interview done in 2010 from a Harvard economist, who said that as an example in Duke University hospital, that there was a 900 bed hospital. Means that they could fit 900 patients. And they had 1,300 billing employees. You don’t even need 900 doctors to take care of 900 patients. But you need 13 hundred
billing specialists to take care of 900 patients. Something’s wrong there. The second reason why
hospitals are so expensive is because doctors are afraid to get sued. And they begin practicing
what’s known as C-Y-A medicine. Cover your butt medicine. This is where doctors
order confirmation tests or extra imaging, or prescribe
unnecessary treatments just based on the fear
that they may get sued. A great example of this is antibiotics which Adam does a great job
of covering in his video. Where doctors are
worried that if a patient has a virus, but gets worse, and they didn’t prescribe antibiotics, it could be blamed on
them, and they may be sued. So they prescribe unnecessary antibiotics. I don’t like when doctors practice this type of protective
or defensive medicine. It’s not honest, it’s not ideal, and you’re not helping the
human sitting in front of you. The third reason why
hospitals are so expensive is because in the United States, we have more specialty care, than anywhere else in the world. Specialists cost more money. This is why I’m a strong believer in primary care medicine, family medicine what I do, because we not only lower the cost of healthcare, we prevent problems from happening, and we educate our patients to live the best quality of life possible, to avoid these situations in the future. I have no shortage of examples of patients coming in,
asking to see a specialist for some very common conditions. High blood pressure, high cholesterol, skin biopsies, and I remind them as a family medicine doctor, I’m fully capable of taking care of a lot of these common conditions. That’s not an exhaustive list of why hospitals are expensive, but I think those reasons are a lot more important to take action
on, and talk about, than just the profiteering
by some individual hospitals. And that was my issue with Adams segment. Again, he wasn’t saying anything wrong or innacurate, it’s just the focus of the piece was, I
felt, a little misguided. Let’s move on to Adam Conovers tweet. And I have to say at the outset, I’m so happy that he did this publicly that we’re able to have our sort of different point of views
put out into the web. Have a healthy conversation about it. So that everyone learns
what our points of view are where we’re coming from,
because that’s what it’s about. It’s not about labeling someone, or calling someone a name, that’s not ideal for
this type of discussion. I think the best way to do this is I’m just gonna read a
couple sentences of his tweets and then just respond to them one by one. In this video, real doctor mike affirms that every factual point that we make in our episode is correct so we’re off to a great start. His only criticism
seems to be of our tone. I disagree with that a little bit. While I did say a few things about the tone of some of the pieces, some of my critique comes from the focus. And we’re gonna be getting into that as we cover each point, but know that my critique
is not coming from a producers standpoint, a
TV executives standpoint, entertainment standpoint,
it’s strictly coming from a doctors concern
of what an average person may take away from one of these pieces. He seems to have two complaints. One, that we’re being too mean to hospitals that systematically overcharge their patients, two, that our mammogram segment might frighten women away from getting mammograms all together. It’s not so much that I care that he’s being mean to hospitals, it’s the fact that I feel the focus, is too heavily places on profiteering when I feel there’s other
systematic issues at play that weren’t adequately
discussed within the episode. And the second point, dead on. I agree, that’s what I was worried about that the mammogram segment actually does frighten women away
from getting mammograms. It’s unclear why Mike believes that hospitals should be above criticism. He agrees that their pricing is capricious and inflated, and that it has devastating
costs for the uninsured. He even criticizes these practices in the pharmaceutical
industry, so why not hospitals? First, I don’t believe
hospitals are above criticism. I think no one is above criticism. And I don’t think criticism
is even a bad thing. You can give constructive criticism. In fact in my residency program, which is part of my hospital, we consistently give
criticism, to improve it. So that where we work is a better place. Next line, I do believe that these crazy elevated costs are out of control and they have devastating
effects on the uninsured. (ding) totally see eye to eye on that one. Mike claims that hospitals
aren’t in it for the money, but there are thousands of for
profit hospitals in the US, and even non-profits wildly overcharge. Yes there are many causes
of high healthcare costs but this is one of them,
and it deserves scrutiny. I don’t think that I ever claimed that hospitals aren’t in it for the money. I agree that for profit hospitals exist and I think in the video
I actually mentioned that hospitals need to turn a profit. I agree that it deserves scrutiny. But I think the laser
focus that was placed on hospital profiteering,
was a little misguided because there’s so many other things that are contributing more so to the rise of healthcare costs, that weren’t discussed. My job is to use comedy to point out bad business practices that hurt people. I’m not in the business of protecting the feelings of hospital bosses. I respectfully reject this criticism. I agree, I don’t think he should worry about offending hospitals. And I don’t think this
is an issue of outrage that I think that hospitals are
being unfairly treated here, and hospital bosses feelings
should be under consideration. No, this is a business,
and it’s a big industry that effects millions of individuals. So we should be criticizing it openly. I just think that if we’re
gonna criticize any topic or debate any topic,
we need to think about all the factors at play, and if we’re gonna be
discussing any of them at such a high stake and with such focus it should be the ones that are the major drivers of this problem. And I just don’t think
hospital profiteering is one of those main drivers. It’s definitely one of them, and it deserves scrutiny, but the other issues
deserve more scrutiny. That’s all I’m saying. Mike worries that we send the message that no one should ever get a mammogram. This is odd, since our episode clearly and explicitly lays out
that the United States preventive services task force guidance. You like how I know what that stands for. That you should discuss routine mammograms with your doctor starting in your forties. Again, factually this is all good stuff. And I don’t think that
there’s a problem there. My issue lies with how the average person will interpret the way the
information is presented. The order, the tone, all of these things. When we had the segment critiquing antibiotic overuse and overprescription, that’s really good. Because patients actually come in requesting unnecessary antibiotics, and doctors give it. What happens much much less often is patients coming in, asking
for unnecessary mammograms and then doctors giving them. I don’t think that this is even a situation I’ve ever encountered or heard of a doctor encountering. Being a primary care doctor, I have a pulse, that’s funny
that I used this metaphor, but I have a pulse on what my patients think about medicine,
what their fears are, what they think works, doesn’t work. and their feelings on
mammograms are negative. They don’t want them,
they’re afraid of them. They’ve heard that they hurt, they’ll do anything to get
out of getting them done. And when patients at baseline are already scared of them,
by presenting them information the way that it was presented, I think that it could turn
them off even further. Mike also seems to take issue with our over criticism of how mammograms were over promoted in the eighties. However as he admits,
those myths contributed to a dangerous over
diagnosis and over treatment. Since they’re still with us today, it’s important we correct them. I don’t think necessarily
mammograms were over promoted, because at the time, our best research showed that getting
mammograms was beneficial. Now we know that starting later in life is more beneficial and less harmful. So, I wouldn’t necessarily call these myths that were propagated, it was the best research
that we had at the time, but as we know now, that isn’t the truth. That’s the thing with medicine. A lot of the things I’m doing today, that are accurate based on
the evidence that I have will be proven wrong in the coming years. This is just bound to happen, as more research comes out. We need to not be afraid of that. And while I agree we do need to point out that advances in research, and changes in guidance have happened, that’s really something for
doctors to take note of. Because if we overload patients with when they should be getting this and how these rules
change year in year out it’ll cause so much confusion
for the average person that they won’t be able to
make and accurate decision. The average person wants
to avoid mammograms and has an unfavorable
view of them already. And now were just throwing
more fuel on the fire. Finally, Mike says that as a doctor, he may have presented the
information differently. I agree that when covering medical issues, deferring to doctors is essential. That’s why our script was reviewed by a physician, cancer researcher, and our expert for this
episode, Doctor Joan Elmore. We did multiple rounds of
revision on this script based on Doctor Elmore’s extensive notes and feedback which drew from her clinical experience
treating cancer patients. It was vert important to us and her that the segment accurately represented the advice she’d give in her office. Again, I agree that this
episode is factually accurate and I loved the sit down interview that was done at the end of the episode. However that initial skit, which is the most engaging
part of the episode and the first part of the episode, that’s where people pay attention to most, really painted mammograms
in an unfavorable view. I understand that factually speaking, it was painting them
in an unfavorable view when patients don’t need them, like getting them too early, but I don’t know if that was clear. And I worry how that might affect somebody who’s already having a fear
of getting a mammogram. Which is most patients. So if I was to redo this episode, or do it on my own, all
I would do to change it is take some of the information that was given in that sit down interview, and incorporate it in that beginning skit. Or, maybe make the
beginning skit even clearer that we’re talking about people
who don’t need mammograms. Cause there’s a huge
percentage of the population who do need them, but are afraid, and we don’t want to scare them away. Of course, we knew taking a comedic look at such an important medical
topic risked misunderstanding, that’s why this segment had
one of the most thorough fact checking and review
process we’ve ever done. We took it extremely seriously, and sacrificed comedy
for clarity many times. That said, we were of course limited by the six minute segment runtime, that’s why we brought Doctor Elmore in for an extended interview on our podcast, where she went deep on
the nuances of the issue. I think comedy’s a great tool to educate people about health, and I think that simplification is actually a good thing, because we want the average person to
understand the basic concept get a level of general interest, and then do a deep dive into the research. What I don’t think is ideal
is oversimplification. When we take a complex, nuanced matter like why the American health
care system costs so much, and we just limit it to talking
about one of the factors, and its not one of the
most important factors. I think that can be deceiving. I think that when we’re
talking about mammograms and we don’t focus on right away the benefits that mammograms carry, that’s a little bi deceiving. Because it’s such a nuanced matter that oversimplification
can be dangerous at times. We need to constantly
reevaluate our good intentions and see if they match
up with good outcomes. Again, I wanna give a huge huge thank you for Adam Conover, for
tweeting me this reply so that we can continue this conversation and really understand that
we’re not disagreeing on much. The facts that are in
this episode are accurate. And the fact that we’re talking about this and getting people engaged on a topic like the American health care system and mammograms is amazing. This is what I’m all about, and I encourage all my patients to educate themselves further. This type of debate is healthy, and I want to continue encouraging that by telling you to go
into the comment section write up your response, who do you agree with, do you
have your own point of view? I enjoy learning from you guys as much as you hopefully
enjoy learning from me. So drop your comments your thoughts your own point of views
down below in the comments, and as always, stay happy, and healthy. (jazzy music)