Dr. Doug McGuff on Fitness, Health and Liberty

Back in August I had the great opportunity to present at The 21 Convention alongside longtime friends Keith Norris, Skyler Tanner, Greg Swann and...Dr. Doug McGuff. After Doug's presentation, we headed over to Skyler's house for a meal just hours before I was to fly out.

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R-L: Skyler, Keith, Michelle, Sarah, Doug

A few days later I blogged about Doug's presentation in detail: Dr. Doug McGuff’s The 21 Convention Presentation in 2 Words: You’re Fucked. Lot's of good comments on that post expounding upon the problem.

So just today, the video of his full presentation has been released on YouTube. His previous 21 Convention presentation a few years back stands at nearly 190,000 views, so that's an indication of the quality, depth and insight Doug always brings. Of course, those who have read his co-authored book, Body by Science, already know the kind of knowledge and experience Doug brings to the table.

So here you go. Make yourself some available time and watch this, and then spread it around, especially in a time when everyone's going on and on about who's gonna pay for there health care besides themselves. Here's a true look, from the inside and in the trenches.

If I've ever met a nicer guy than Doug, I just don't remember it. Here's a guy who has practiced as an ER doc for 23 years—a place where seconds count and there's never a second chance. He cares deeply for people, yet is no willy-nilly bleeding heart. He knows what it really takes to provide real medical care competently.

Unfortunately, guys like him will never have a seat at the healthcare policy table, when in reality, guys like him are the only ones who ought to have such a seat.

Comments

  1. Unfortunately, guys like him will never have a seat at the healthcare policy table, when in reality, guys like him are the only ones who ought to have such a seat.

    Nor at other importanttables. Talk about anarchism beginning at home…

    I just wish Doug had more time and inclination to blog.

  2. Bottle throwing anarchists at that dinner table, obviously.

  3. My only complaint about the healthcare system is that I think I should have the opportunity to buy enough morphine to kill a horse. Given that I am willing and able to pay cash money for it, I don’t see why I shouldn’t be able to walk into a pharmacy and say “Hello, I would like to purchase enough morphine to kill a horse.”

    Instead we got a three year long debate about health care and a bill that has 22,000 pages in it, when all I am asking for is the opportunity to buy enough morphine to kill a horse.

  4. As a kid, I had to put up with asshole PE teachers, and their non-exercise plans performed in a group setting. Same thing in boot camp. As you can imagine, for me, “exercise” was something to disdain, rather than embrace. But McGuff changed all of that. About twenty minutes once a week of high intensity suits my personality perfectly. The fact that twenty minutes, albeit twenty grueling minutes, and I’m done for seven days makes so much sense. Who in hell wants to live in a gym? I have seen people who spend countless hours of their life pumping away, while too much time is spent looking at their image in a mirror, and frankly don’t achieve much. They kind of remind me of of squirrels on a treadmill.

    • If I could I would spend 12 hours a day in the gym but alas I can only recover from 4 hours a week of lifting.

      No place I would rather be. When I am at the gym I am perfectly content with life, the universe and everything.

  5. Wooo,

    So what’s your take on the actual video?

    • There are historical models for the efficacy of charity as welfare provider in industrial societies. It doesn’t need to be conjecture.

    • Shorter Wooo: it’s not possible without stealing. That’s the way to produce the bestest values.

    • The bill is artificially high. More people could pay with unremarkable salaries and life-savings if there were not insurance wolves demanding payment and refusing coverage left and right. I want to buy healthcare from someone who cares about me, i.e. someone who answers to me rather than to some punk in a suit (whether that punk be a government bureaucrat or a private insurance agent). Current regimes for socializing medicine seem to be pushing my desire for a real physician beyond the realm of possibility (at least legally: I look forward to the day when there is a thriving black market in healthcare in the US; maybe it is already there, and I am just late to the table).

      Do you know that McGuff took out loans to pay for med school? My father went on the GI bill, and med school back in the day didn’t cost as much as it does today (socialized education in this country costs more, kind of like socialized medicine).

      If you look at my life, I am not in McGuff’s shoes. I am neither rich (in the American sense: I think I am rich, and most non-Western foreigners would agree with me, I believe) nor poor. My wife and I together make a little over $40,000 per annum (a recent jump: until this year, it was more like $30,000). We don’t own a house (and won’t, until we can pay for it, which is probably not ever going to happen). We know that Social Security won’t be there for us. We know that we cannot walk into the ER and walk out with our wallets intact (been there, done that, and it wasn’t free: we paid $7000 for insurance and $700 so that my son could have five minutes with a doctor and a single stitch put in his head). Maybe if we were dirt poor or “illegal” (not that I find that problematic at all, personally), it would be different? (Or maybe Mitt Romney is just clueless.) Or we could just be millionaires (not going to happen, unless we get hit with a Black Swan). But I am not banking on any of that. I am just tired of people (politicians and other punks in suits) ignoring me as they make it impossible for me to even try to live my life outside the narrow lines they want to color because they have discovered how to save the world (using the model that bankrupted the USSR, Eastern Europe, and soon Western Europe as well).

      When I get hit by a car tomorrow and the ambulance shows up, I might seriously tell them to just let me bleed out. I might refuse all treatment and die rather than run up a bill that my family has no way of paying (let alone society). Why should society make me live? I am not eternal. I was never meant to be. I have no “right” to live any specific amount of time in any condition. Pretending that I do just screws somebody else over. I don’t want to do that. I would rather die (or not: if someone feels able and willing to save my life gratis, because they can and desire it, then I will be grateful).

  6. Nice job skirting the difference between enslaving people to give you goods and services you want, and charity.

  7. I haven’t had regular health insurance since 1995, basic medical services are just a rumor to me.

    It’s not bad once you get used to the fact that you can’t get sick. I think we should do away with the whole industry and go to a do-it-yourself system, everybody Googles their symptoms, figure out what medication they need then goes down to the pharmacy and get it.

    You take all the doctors, nurses etc. out of the system and health care costs will drop by 90%, also I will finally be able to get my Bucket Of Morphine.

    Stupid people would be at a disadvantage but hey, that’s natural selection for you.

    • rob, you have no idea how in line with you I am on that.

      I make an exception though: mechanics. When something is really broken and needs cutting into or whatever, mechanics of surgery do wonders. I don’t consider that medicine, though.

      I prefer to think of it as “out-competing God.”

    • Wooo that is kind of a stupid post if it is directed at me.

      “or thinking you are too special to ever get sick”

      Did you not notice that my only complaint is my inability to acquire enough morphine to kill a horse? What the hell do you think I intend to do with that much morphine? It’s for when I get sick.

      You are coming across very chick-y in that one.

      • Shorter Wooo: just go steal it. It has to be stolen or it can’t possibly be produced.

      • That’s how I’ve lived for a quite a few years, since I pay out of pocket for anything under $10k, I try not to get sick, if I do then I have to do cost/benefit analysis on whether to seek medical care

        When I recently had a urinary tract infection I self-diagnosed, weighed the pros and cons, decided to ride it out rather than go to the doctor.

        It’s just reality to me. Would have been nice if I could have gotten some antibiotics at the pharmacy but that is forbidden.

        I’m not a fan of the medical industry and I can hold a grudge forever so even if I have regular insurance again (probably when I qualify for Medicare) I’ll avoid having anything to do with it if I can.

      • Shorter Wooo: it’s my job (we get paychecks), I know about this shit. You were stupid not to come pay us.

        It could be true. That, I acknowledge. At the same time, I suspect rob is kinda a guy like me. I don’t go to doctors if I can help it. Instead, I try to figure what Im fucking up. But people run to medical at the drop of a hat. Because they have the false sence that its free and others are paying. I can’t account for that despicable, depraved sense of mind that Wooo celebrates, as I hate theft and she loves theft so long as her profession benefits.

        Isn’t it so fuckimg amazing we exist, 4 million years and counting? Thank fuckimg Jesus for Wooo and her profession over the last few decades of that. What would we have possibly done without her, uh, them.

      • Woo I’m not going to respond to any more of your posts because you tend to insult me.

        I thoroughly researched the issue, concluded the infection had not spread to the kidneys, and therefore I was in no danger. If there was any sign the infection had spread to the kidneys I would have sought medical care.

        I have eight years of higher education and five decades of life under my belt, I don’t need you to tell me what I easily researched on the net.

      • Shorter rob: I’ll take my chances. Though I have no doubt your “concern” is feigned, mine is real. Thanks anyway. ….Don’t forget to pick up that paycheck, BTW.

      • “…you seem not to realize how myopic and impractical your advice is for many other people who don’t have the option of just not seeing a doctor.”

        What a laf.

        This is part of of the delusion, manipulation, etc., etc., many medical practitioners want you to believe—especially those who derive paychecks from the status quo.

        I was the fist of four boys. My parents paid for the hospital delivery of my three younger brothers and all the care that needed to be done (yes, I know that 50 years later, humans are infinitely more in need of more care now, Wooo, daily…don’t forget to pick up that paycheck now). I just assume they did the same for me in 1961.

        I can recall listening to my dad talk to my mom about the bills every month and how “we’re almost caught up.” Can’t tell you how many times I heard that.

        They never imagined that other people could relieve them of that awful burden, of paying their own way through life.

        But Wooo fancies to imagine herself a sort of Nurse Robin Hood. I’m sure she’ll have lots of sycophants over that.

      • There was a network of clinics in the last town I lived in where doctors volunteered to see patients fee-for-service. You had to wait in line, but prices were reasonable, and you could get stuff checked. No insurance required. It was great. What keeps that model from catching on? Maybe it is greed in some cases. I think there should be legal ways of living without insurance (which is really just for rich people: the insurance poor folk get is a cheap knock-off that makes kind Democrats feel good without actually doing anything, except bankrupting the government).

      • Back in ’96 or thereabouts, before I was making any money, no health insurance, I eded up with a plantar wart on my foot. When the pain got to be unbearable, I simply called around until I found a podiatrist who would slice it and freeze it for $80. Took about 10 minutes. I was perfectly satisfied.

  8. Wooo,

    What do you actually know about Mr. Doug McGuff, individual? Anything first hand? How about second hand or third hand.

    Have you ever met a physician where you said to yourself, this is one amazing and awesome guy or gal? And if you haven’t what in the fuck are you doing being where you are?

    It’s really, really, really, really, really, really, really, really, really, really, really, really, really, really telling to me, and undercuts virtually every ounce of capital I’ve built up for you over the past months that you engage in wide sweeping generalities and don’t even address one single thing—not a single fucking word or sentence—this ER doc of 23 years said in a 1 hr and 12 minute presentation.

    So, was I wrong to think you were better than that?

    • gabriella kadar says:

      Richard, you DID ask her for her opinion.

      Today a guy in Alberta drove his van into a schoolbuilding. http://news.nationalpost.com/2012/10/25/car-crashes-into-high-school-classroom-in-st-paul-alberta/

      What should happen to the children in this situation if things would be in accordance with your stated position?

      • “What should happen to the children in this situation if things would be in accordance with your stated position?”

        One might hope that just as people manage to produce the values to feed, clothe, shelter and drive kids to soccer practice in their shiny cars, that they would trade values for health services as well.

        To those who see the good of medical services as something that must be stolen, fine, then let them go in and steal them themselves.

      • gabriella kadar says:

        “One might hope that just as people manage to produce the values to feed, clothe, shelter and drive kids to soccer practice in their shiny cars, that they would trade values for health services as well.

        To those who see the good of medical services as something that must be stolen, fine, then let them go in and steal them themselves.”

        Would it be possible to explain this is plain language? The kids (one of whom has died) were critically injured through no fault or activity of their own. So now there’s a huge amount of money and treatment involved in saving their lives, helping them recover etc. Are the parents, individually, somehow supposed to come up with the money for this? Or are the kids just to be left to die? Certainly the junked up dopehead who drove his van into the school building doesn’t possess the money to pay. Is ‘tough shit, this is evolution’ the appropriate response? Or what?

        It’s easy enough to say “you smoke, so you got lung cancer, so tough shit”, but these kids did not do anything.

      • “Would it be possible to explain this is plain language?”

        Absolutely. And, you’re welcome.

      • The kids lived. Living carries risk. The real question is, what are you going to do for those kids? You can help them, or you can ignore them (the way you are ignoring kids in Ethiopia right now) and go back to Wal-Mart (or Whole Foods, or your living room stuffed with cool toys, or whatever). Most of us would recognize that helping the kids is a noble cause. Most of us would also be mad if people constantly assaulted us and took our stuff “for the children” — especially if the stolen property then went to feed insurance wolves (administrators, bureaucrats, punks in suits deciding who gets to live and who has to die).

        Taking our stuff by force removes our chance to be really generous. It stifles an essential part of our humanity, perverting it to serve bureaucracy (which may or may not help humanity: personally, I am not willing to make it a surrogate for me; I want the “freedom/greed” to decide whom I help, and how).

      • @Gabriella Kadar

        “Richard, you DID ask her for her opinion.

        Today a guy in Alberta drove his van into a schoolbuilding. http://news.nationalpost.com/2012/10/25/car-crashes-into-high-school-classroom-in-st-paul-alberta/

        What should happen to the children in this situation if things would be in accordance with your stated position?”

        ##########

        This is a complete logical fallacy bullshit trap.

        Those kids were there by contradiction first, by violence. This is the meaning of “compulsory schooling”. Not to mention, it appears to be a public school, which is further funded by contradictory violence.

        Asking Richard how his position applies is borderline irrelevant. You are asking Richard “if this is wrong, that is wrong, and this is wrong, and then some catastrophic emergency happens, THEN what are we going to do with your idealistic positions?”

        This is a total setup. Forcing kids to go to school under the threat of violence is fucked 10 ways to Sunday. Funding said school with violence is equally fucked sideways.

        Then, when some jack ass drives a mini-van into the side of said school, you ask Richard what happens in rational, non-violent, la-la land?

        You’ve got to be kidding me.

      • The problem is one of agency. The kids are forced into school (where many of them learn nothing except how to be bullied). They are then forced to have insurance (which won’t do anything except make medical costs skyrocket and/or be rationed by bureaucratic fiat). They are then shunted off toward jobs in companies “too big to fail” (which will fail naturally anyway, since society is mortal just like individuals are). The solutions are always to give the individual less say in the really important matters. “Choose what shirt you wear, what insurance provider you ‘want’ (none of the above?), what miserable excuse for a career you want (one that doesn’t bankrupt the world?), but leave the life-and-death decisions to trained bureaucrats. You aren’t qualified!”

  9. Awesome video. What a class act Dr. McGuff is. Also sobering and sad at the same time.

  10. One of the first acts of the Obama administration was to remove the right of medicare to negotiate drug prices with pharmaceutical companies, the fact that did not remove this right from the VA suggest they knew that the companies would increase their prices.
    Discussions about an American national health service often take a rather hypothetical even ideological turn, they shouldn’t. Think about the national health sevice that would actually be concoted by recent US governments.
    I’m not an American so any opinions I have about social medicine are not particularly relevant but I do think that these discussions should be based on the likely social medicine set up. Social medicine has both good and bad points (I’ve lived in countries with both) but the idea of a system set up by an Obama administration is really worrying.

    • Source? Since it was under Bush mk2’s term (in 2006) that when Congress passed bills that prohibited Medicare from negotiating with the drug companies. There was an initial provision in Obamacare to allow for negotiation. But it was removed in a back room deal to get support for the bill.

      Not that the VA program is perfect by any stretch either, as it is quite limited in the number of drugs it does cover, and it appears that it targets drugs that appear to work, are “safe”, and have a good cost to benefit ratio.

      Why is such a system worrying? Are you thinking that it will primarily have the bad points of socialized medicine, or something else?

  11. Hello Dave,
    Cripes I can’t remember a source I suspect it’s the same one as for your second sentence.
    I would be concerned having any socialised medical system set up in the current “revoving door” culture between large corporations and government departments.

  12. “No one mentioned anything about physicians strong arm monopolizing medical care in this country using the government/laws, while at the same time promoting libertarian propaganda regarding payment/compensation. Definition of hypocrite.”

    Great example of a non sequitur, as put up in my latest.

    Beyond that, just a simple strawman.

    Wooo is definitely smart, but she lacks experience.

    Wooo, you cannot fault Doug for not covering topics in his presentation you would have liked him to cover but he didn’t.

    Guess what. He’s such a sweetheart, I’ll bet that if you emailed him a list of honest questions that you’d get a publishable response witching a day.

    But you won’t do that. Theft is your agenda.

    • Oh, wait….

      Did you really watch wolf the video as you said?

      I think it’s in the first 10 minutes when Doug points a finger at himself and all other physicians.

      You trying to scam, here, Wooo? Not a good idea. I care about you. Don’t do it,

  13. “Tell you what I won’t make McGruff treat anyone who can’t pay, if he agrees to let me open Woo’s medical shop and bakery on the corner.”

    IF, big if, you wished to deal honestly in such matters, you’d state it like this:

    “Tell you what I won’t make McGruff treat anyone who can’t pay, if he agrees to let me open Woo’s medical shop on the corner.”

    …Because it’s actually a material issue and in fact, you have demonstrated in comments here that you have at least specialized, perhaps even generalized medical knowledge.

    Here’s what I’ll bet. I’ll bet you a nice bottle of wine, chosen with great care and mailed to you in bubble wrap, that you are unwilling to contact Doug personally and ask if he would be willing, in a free society, to compete with you head to head, of if he’d want all the authorities you adore to stop you.

    See, I already know what he’ll say. Hell, I’d be willing to send you a nice bottle of wine anyway if you even had the REALNESS, REALLY REAL, FOR ONCE, NO BORING 10 paragraph you-MUST-STEAL-screeds and just went and emailed and asked him.

    You won’t.

  14. Woo,

    For the record, I VOLUNTARILY write off medical care for the working poor every day that I work (in addition to the care I am forced to provide). How much charity care have you provided or paid for? Please feel free to get out your checkbook. Also, I strongly oppose medical licensing and would strongly support competition from lay providers and/or alternative practitioners.

    I would also submit that the bad old days are gone due to ongoing human advancements that occur most quickly in unregulated markets (read Matt Ridley’s book The Rational Optimist).

    You can make comments suggesting you could do it better, because you know you will never really have to put anything at stake. At the very least, volunteer at your local ER. Change some sheets and empty some bedpans and watch what is actually unfolding before your eyes. Spend a few months doing this and then reflect on what I advocate….free trade in medicine.

    • My dad was a general practitioner, and found it impossible to get any work that way. The current system, which socialization seems hell-bent on solidifying and perpetuating as long as possible, is one that makes primary practice practically impossible. The insurance costs (mal-practice for the doctors, standard-care for the patients) make it impossible. Insurance is the devil, the wolf at the door, the dog in the manger starving the whole barn. Damn insurance! (It is great for rich people, whom it was designed to serve, and for punks in suits–lawyers, agents, bureaucrats. But it serves poor people very badly.)

      • The problem, as may have been pointed out in comments in the post I linked to where I wrote about Doug’s presentation is that we aren’t even talking about insurance in the true sense of the word. Insurance ought to be merely a means of spreading your costs over the long hall rather than huge spikes, not to get something for nothing. Of course, there are the outliers on each end of the distribution, those who pay for years and years and never need it, and those who pay thousands over years and end up benefitting to the tune of millions. But mostly, insurance should be just a way to spread cost (with a portion going to administration and profit).

        But what we have now is a maintenance program. How much would your auto insurance cost if it included all routine maintenance, tire and brake changes, oil changes, window washer refills, etc, buy a qualified provider at a big facility?

        Catastrophic insurance where one pays EVERYTHING including medications, up to a point 2-5k, generally, then insurance kicks in 100%. That’s insurance. The problem is, even that doesn’t work because the whole industry is now geared to a maintenance program and the overhead and administration economies of scale have everything broken beyond repair.

        The obvious consequence of everyone seeking to live at the expense of everyone else.

      • This seems right. The only thing I really resent is being forced (i.e. being obligated to buy services and options that I don’t need, and having the services and options available to me predetermined by some punk in a suit).

    • I agree. I think the message would go over better if more people realized that opening the market would allow them to step outside current constraints (which mandate that doctors serve punks in suits before patients), that healthcare doesn’t actually have to be done “the way God intended” (via insurance and closed establishments seeking to apply a single standard for all care around the country). Most people would like being able to go to a doctor who actually knew them. They would like shopping around (richer people would get “more” probably, but as anyone familiar with iatrogenics knows, this is not always better). They would like making their own life choices (and living or dying their own way, as much as possible). They would like not feeling helpless and useless every time they need to deal with a doctor. (I don’t go to doctors either. Not even my dad, who still works in occupational medicine, since he cannot do general practice owing to prohibitive overhead costs.)

      People like the results the market gives: unfortunately, they tend to construe those results as anecdotes in which those who do well are saved by punks in suits (rather than the market). The punks in suits always want to close the market, so that they are in charge of it, either because they want to profit or because they think they can manage other people’s lives better than the people would. I am not denying that this might be true in some cases, but it still violates individual “freedom” (integrity) in a way that I find abhorrent: my neighbor’s marriage might benefit from an intervention, but that is no reason for some punk in a suit to intervene in mine. My neighbor’s diabetes might benefit from an intervention, but again that is no reason to force me to undergo therapy. The failure of individuals does not give society (punks in suits) a right to use me like some kind of human resource (with no volition). I don’t mind helping, but I want to help my way, not yours (especially if you are a punk in a suit with pretensions to controlling the market). The market keeps us honest. It gives us options. It prevents monopolies (since they inevitably bust, and there is no almighty punk in a suit to make us bail them out). There are definitely problems in the world, problems facilitated by the market, but contrary to popular belief these problems do not magically disappear when the “right” people (punks in suits from my party) are in charge. Nobody plays God well. People need to stop believing that someone somewhere does. Stop trusting others’ judgment and use your own (it won’t be perfect, but theirs wasn’t either). Stop demanding truth from others, and see it for yourself (you will be fooled, but we are all fools: at least now you know).

    • Shorter Wooo:

      While I spend my life and 16 hr shifts in the industry MDs created, don’t trust them and they’re all liars; even the few who profess to support a completely open market–they participate in a closed market and only because they want it that way, never because they wanted to be a doctor. While I have a guaranteed, fixed paycheck and they do not, subject minimally to the 50-70% of care they are forced to give without compensation due EMTALA under threat of jail time, and whatever they give away anyway, it’s all crap. RN’s and Nurse Practitioners can do a lot and in spite of the fact that the doctor who would agree and would welcome the competition, it’s just shit.

  15. Woo0,

    I did not know you were an RN when I posted my comment. You really seem to dislike physicians as a class and have included me. I support your notion that NP’s and PA’s could provide a lot of medical care done by MD’s and agree with you on the strong arm tactics of the AMA (an organization that I strongly oppose and that represents a minority of MD’s and DO’s despite their massive influence). I incorporate NP’s in my own practice and would have more if the government regulation over my corporate structure were not so onerous. Again, I oppose licensing and other constraints to market medicine. Oddly, everything you are advocating could be done easily in a free market of medicine that I advocate. Also, I fully understand that such a free market would likely result in lower pay than I currently receive in this unethical cost-shifting nightmare we currently have. Indeed, the entire specialty of emergency medicine may not exist were it not for the collectivized system that has evolved. Sounds like you are determined to hate me, even though in many ways I may be more on your side than you know. Oh…and thank you for your work in the belly of the beast, I know it is backbreaking and we should all be thankful you continue to do it.

    • “know it is backbreaking and we should all be thankful you continue to do it.”

      One very sound reason I love and treat Wooo differently. I know for sure she puts her ass and hours where her mouth is and only a fool would not make critical distinctions.

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