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Give Me Your Tonsils, Give Me Your Money

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President Obama's comment during his press conference on the health care crisis has raised some eyebrows, including mine.

Doctor examing kids throat

Nina L. Shapiro, MD: Obama stated that doctors are now forced to make decisions based on fee payments, and that if someone comes in with a sore throat, or multiple sore throats, a doctor may think, "Hey, I'd make a lot more money if I just took this kid's tonsils out." Well, I haven't been in proximity to Barack Obama since we were graduating from our respective schools in 1991 on the Harvard Yard -- he from Harvard Law School, me from Harvard Medical School. He has surpassed me professionally in countless ways, but medical knowledge is not one of them.

First of all, doctors who see children for a sore throat, or even repeated sore throats, are primary care doctors, pediatricians, or family practitioners. They do not remove tonsils, and they have nothing to gain financially or otherwise to recommend such an operation. Otolaryngologists (ear, nose, and throat specialists) remove tonsils. Our patients are REFERRED to us by other doctors who have recommended CONSIDERATION for a tonsillectomy. As a specialty, we otolaryngologists strive to practice evidence-based medicine, whereby we make and carry out recommendations based on medical evidence that a given recommendation will benefit the patient. This evidence is not based on an individual's experience, how one was taught in residency, anecdotes, or an article one read in a recent medical journal. Evidence-based medicine is that which is a compilation of medical literature leading to specific guidelines for specific diseases.

Second, doing ANYTHING for personal financial gain alone is unethical. Whether it's selling a lemon of a car, giving inaccurate legal advice, or doubling an initial contracting estimate, it's wrong. While there are many unethical doctors out there, believe it or not, the majority of us ARE ethical. We enjoy seeing our patients stay or become healthy, we want to do the right thing, and we try to do so to the best of our abilities.

Third, tonsillectomy is not done "for the money," and most otolaryngologists actually deplore performing this procedure. Don't get me wrong -- I love performing tonsillectomies -- it is a wonderful operation, and it can remarkably change a child's life for the better. It is not without risk, however, and those risks are not small. There is a 1-5% risk of post-operative bleeding, and children have even died after a tonsillectomy. Anyone who performs this operation knows this, and most parents whose child has had a tonsillectomy knows that there are risks.

So, Mr. President, I appreciate that the health care system is broken, but please don't break down the doctors as well.

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17 comments so far | Post a comment now
Sara July 24, 2009, 3:20 PM

My husband and I and our children have all had our fair share of health problems but I have NEVER ONCE felt that doctors were trying to do more than needed. If anything I think they do their very best to recognize ways to help us save money in some ways. We’ve had numerous times when our pediatrician or family doctor has had wonderful suggestions that saved us money. They certainly never tried to get more money out of us by anything unnecessary. And besides, we always have the option to say no to a treatment, procedure etc. And as far as tonsillectomies…. my son gets strep over and over and over and they are VERY hesitant to do that surgery anymore. It’s just not very common anymore so that was a dumb thing for Obama to have referenced to. Heck, even back when I was a teenager I had to have strep throat for nearly three months straight before they’d finally do it and we were begging them to take my tonsils out! Obama really needs to get his info straight… it is NOT the doctors who are the problem!

rugbymom July 24, 2009, 3:22 PM

Thank you! I was wondering if anyone who blogs for Momlogic would say any opposing argument on a topic addressing Obama’s policies or things that he had said. I am in a healthcare-realted field and although I am certainly no doctor, I deal with physicians on a daily basis and concurr with your remarks. I posted 2-3 remarks or comments on momlogic opposing things that have been said supporting the president and NONE OF THEM HAVE POSTED! I have emailed momlogic with no response. I have gone back the following day and even edited my remarks to see if they would post and they have not. What is up MOMLOGIC? Are you screening? There sure are a lot of worthless blogs about what Michelle Obama is wearing, why can’t we comment on something that actually matters?

Well done Dr. Shapiro. Finally someone is addressing the facts or lack thereof and the inflamatory statments that have been made in support of an incredibly flawed healthcare agenda. Thank God they put off the vote until the fall so people (who will be voting on this) could actually read the proposal!

dean July 24, 2009, 4:43 PM

I agree 100% rugbymom!

me too July 24, 2009, 4:47 PM

Rugbymom - I also have state opinions against Obama even against poster Mommy2Be and has been “banned” for up to 2 weeks from posting any further comments. It would say “invalid response” I also sent 3 emails to Momlogic before I could post again. I see many more posts on this site that are more judgemental than mine but I guess I was on the “wrong side” of the judging. But back to health care, of the 47 million who don’t have it, 10 millions are illegal immagants, 20 to 30 millions are 20 to 30 years old who can have it thru their work if they want to but chose not to so I don’t believe that we have a health care crisis but we certainly need to regulate the insurance companies and billing practices.

me too again July 24, 2009, 6:34 PM

Also, from here out I will check w/ my state representative office and if they have not read any and all bills from front to back then I will no longer support them for their next term. We need to demand more from the people that we elective into office and if it means crossing “political party” to get our message across then I will do it. LAWMAKERS - PASS NO BILL UNTIL YOU HAVE READ IT!!!

Pamala July 24, 2009, 6:38 PM

Well I’ve personally experienced the if you do this I’ll get more money from doctors. Not pediatricians but rather mental health professionals. One wanted my soon to be ex to lie about his mental state so that they could bill insurance differently and make more money. Needless to say we won’t be going back to that doctor.

cyndi in pa July 24, 2009, 7:33 PM

I too have been banned for some time now from commenting, after comments that were negative toward the current administration. If this goes through, it will be the first for a month. It says “invalid response”. I too have emailed momlogic at least three times asking why my comments won’t go through. I have never posted anything vulgar or indecent, only things stating my opinion about an issue. This is really disappointing from this site.

Secret Mommy July 25, 2009, 2:52 PM

The thought of socialized medicine frightens the heck out of me. While I also appreciate that certain parts of our healthcare system might be broken, putting our government in the position of running healthcare is NOT the proper fix. The previous poster who listed stats about the uninsured is right. And I would venture to guess, as I was once in this position, that many of those 20 to 30 year old uninsured may not be offered healthcare through their employers (as I was not) but could purchase it inexpensively (as I did - for less than $150 per month) through sites like or others. Those making grandiose claims that they cannot afford health insurance probably have cable television and cellular telephones. Priorities, people.

dean July 25, 2009, 6:53 PM

Wait, so if it says “Invalid response” it means we are banned? If so, then what is the point of us commenting? I have gotten this several times, I suppose if we do not agree with them we cannot speak. I see no logic in this “momlogic”.

Sara July 25, 2009, 9:54 PM

While my posts on here DID go through, I have had many other posts NOT get posted. Why Momlogic??? Nothing was vulgar, innapropriate etc. Heck, one recent article about the mom with questions regarding her child… I had put a good 30 minutes into thinking about how to respond and ideas she could use to help her situation. Only for it to not get posted. Certainly nothing was written inappropriate in anyway at all! Nice waste of my time!

Get more logical Momlogic.

Anonymous July 27, 2009, 9:02 AM

Dean, I’m not sure if it means we are banned but for 2 weeks every post I tried to summit came back as “invalid request”. I can tell you for sure that I commented on a post written by Mommy2Be and when I click post, the site came back with “this post is being held to be reviewed by Mommy2Be” and it was after that that I couldn’t post any response for 2 weeks.

rugbymom July 27, 2009, 2:01 PM

I thought it was just me! Maybe if enough people contact they they’ll try to be legit in airing responses that are not ‘their’ viewpoint. I have just about had it with momlogic and I will be deleted my account and posting something on my personal blog as to why.

Grace July 29, 2009, 2:13 AM

I agree married to otolaryngologist. It’s not for the money (you get paid like 200 to 380 for the tonsillectomy and 90 days global which means for 90 days as many follow ups the patient doesn’t get charge because it’s covered under the 200 dollars the surgeon gets. Almost all the ENTs I know screamed when they heard such an idiotic comment from our president. He shouldn’t open his mouth on that if he doesn’t even know how basic insurance billing is. The ones who get the money are the hospitals and the surgicenters for the tonsilectomy not the ENTs and that covers the operative site, the nurses and administrators to have the surgery. ENTs who do tonsillectomys don’t do it for the money, they do it because it’s part of the practice. They get paid 100x more if they chose to do plastic surgery instead but many don’t. So Obama is saying let the kid continue to have earaches and 6-9 infections a year and miss countless weeks of school so that the system ‘saves’ money. It just made me cringe when he said that. I don’t think so. Most ENTs are ethical and the top in their classes.

airway July 30, 2009, 12:13 AM

thank you, grace.

kate August 21, 2009, 5:14 PM

i am surprised to see so many people who have never had a exp w/ a doctor, who wanted to run un-neccasary test?…i guess its just me and almost everyone i know….when my now teen sister was only five days old, and chocked in her milk and couldnt breath, my mom rushed her in to the e.r….12 days later and about a dozen test…including a spinal tap…we walked out and went to a local pediatrician, who said …”it chock sometimes, put her on her side” after the hospital billed us 40 grand…so i agree w/ the president…there are some doctors who do stuff for billing reasons

realist December 2, 2009, 12:28 PM

I am sure you and many others are ethical. However, my brother recently went in with shortness of breath. He’s quite the hypochondriac and believed he inhaled a feather into his lungs (he even repeated many times to each doctor he saw). His first doctor referred him to a heart speacialist after saying something along the lines of she felt some heartbeat irreugularities (not doubting her rationale here). He went to the Heart Specialist where he explained how he thought he inhaled a feather so he went to see his doctor after having shortness of breath and she referred him here. They followed to give him an ultrasound on his heart. They get many doctors around all looking concerned (not sure if on purpose or if there was something to be concerned with). Afterward, the specialist tells him everything “looks A-Ok.” Then she asks him why did he need to come to a heart specialist! (yes, AFTER the ultrasound!) He said “I don’t know why they sent me here. I thought I inhaled a feather and I had shortness of breath.” She said “No, if you inhaled a feather, you’d be dead.” He said “That’s all I wanted to know.” Now, he has a $4,000 bill. Please, someone has to admit that the medical system is not designed for efficient and affordable care. Let’s not bash me now, I’m a rational person, I understand those machines cost plenty and so do salries so costs must be high just to cover those costs. But that is outrageous (and unnecessary for the test to begin with) for a 19-year old kid to have to pay. Effective, yes; Efficient and affordable, no.

Clara March 23, 2011, 11:42 AM

Amazing post, honest!

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