By Robert Kraychik
Phil McGraw, best known as Dr. Phil, credited Medicare and Medicaid with compromising the quality of health care in a Tuesday interview with Joe Rogan. Insufficient compensation for physicians via Medicare and Medicaid, said Dr. Phil, transformed medicine into a “high-volume business” in which quality is sacrificed in pursuit of quantity.
Dr. Phil characterized the status quo of American health care as overmedicating patients (starts at 25:29):
JOE ROGAN: When you see all these folks that are on medication today, how many of these people do you think legitimately should be on medication? Is it something you can asses?
DR. PHIL: I can’t answer that … but in my personal experience, most of the people that I see on medications, in my opinion, don’t need most of the medications they’re on. Now, that’s just anecdotal. It’s my opinion. If you ask me to hand you a research survey or study to support that — I can’t hand it to you, or I can’t point you to one.
I can just tell you, after 45 years in this experience, I see people that are on medication. They’ve usually seen someone for six or eight minutes, and said, “I’m really feeling kind of down.” Here’s some Prozac. Here’s this. Here’s that. They give it to them. They don’t even really ask why. They just give it to them because medicine has become a high-volume business, and that’s not necessarily the doctors’ fault. I mean, the way that it’s now funded — Medicare and Medicaid — you’ve got to turn them and burn them or you can’t stay in business. So it’s a high volume business, so they throw pills at them because they don’t have an hour to sit down or don’t take an hour to sit down and say, “Let’s find out what’s going on.”
Most of the people I see on medications — not all, but most of the people I see are on too many medications in too high a dose or either don’t need it at all, and I am really bothered by polypharmacy. Thar’s where I really get frustrated.
JOE ROGAN: Yeah, what you’re saying is a very common sense approach, but it’s not the norm, today. It seems like more people are treating this — air quotes — depression issue as if it’s a medical disorder like diabetes, or something where you need medication.
ADHD and ADD are overly diagnosed, assessed Dr. Phil.
“Wastebasket diagnoses like ADD and ADHD,” began Dr. Phil. “What used to be a spoiled brat is now ADD or ADHD, so they start prescribing these neo-cortical stimulants like Ritalin, and you give a kid that does not need a neo-cortical stimulant a stimulant, you’re really going to throw him off the charts, now, because you’ve got a normally active brain that you’re now making hyperactive,s o you’re creating a problem that didn’t exist before the medication because you didn’t do the proper diagnosis.”
“You cannot chemically babysit your children,” added Dr. Phil.
Opioids are too quickly prescribed to patients, said Dr. Phil, describing opioid addiction and abuse as amounting to a national “epidemic”:
Medications are too readily administered. That’s certainly what we’ve seen in the opioid epidemic, right now. Opioids are so readily prescribed right now that there are enough opioid prescriptions for every man, woman, and child in America to have their own bottle, and if you renew that prescription one time — one time — if you are taking those opioids at the seven-day mark, your chance of being addicted one year is one-in-12, and if renew it [and] you’re still taking them at 30 days, your likelihood of being addicted is one-in-three. These things are getting written with way too high a pill-count, and so we’re seeing a whole different kind of addiction, now, coming out of the suburbs, and they take them for awhile and they’re very expensive, and after they take them for awhile, heroin is cheaper, so they dump the opioids and start taking the heroin. So you’re seeing soccer mom heroin addicts that you weren’t seeing 10 years ago because they get started on prescription opioids and then they can’t afford them — or finally the doctor cuts them off and they’re addicted — so they start taking heroin because it’s cheaper.
Mental health professionals are insufficiently available in rural regions, stated Dr. Phil.
“Fifty-eight percent of our rural markets today have no psychiatrists available, and something like roughly 50 [percent] have no mental health professionals available, at all; none,” remarked Dr. Phil. “So there’s just nobody available in the outlying areas. I think the more people you can get into the profession, so long as there’s a degree of competency, the better.”