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Doctors Are Creating Too Many Patients
Hugh Pickens writes "H. Gilbert Welch writes in the LA Times that the threshold for diagnosis has fallen too low, with physicians making diagnoses in individuals who wouldn't have been considered sick in the past, raising healthcare costs for everyone. Part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. 'But part of the explanation is behavioral: We look harder for things to be wrong. We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease (a fasting blood sugar of 130 was not considered to be diabetes before 1997; now it is).' Welch says the problem is that low thresholds have a way of leading to treatments that are worse than the disease. 'We are trained to focus on the few we might be able to help, even if it's only 1 out of 100 (the benefit of lowering cholesterol in those with normal cholesterol but elevated C-reactive protein) or 1 out of 1,000 (the benefit of breast and prostate cancer screening),' writes Welch. 'But it's time for everyone to start caring about what happens to the other 999.'"
Perhaps the title of the article should read lawyers and doctors create too many patients.
So we should wait till everyone is symptomatic?
Many conditions can be treated more effectively and cheaply if they're detected early.
Some conditions dont' even become symptomatic until significant damage is done.
The question really is how to balance the best treatment with the financial constraints.
Study after study shows people with access to more health care live longer. I'll point out John McCain and Earvin "Magic" Johnson as too people that'd be dead w/o the extensive and highly personalized healthcare they receive. This sounds like another conservative shill trying to convince the poor they don't need to see doctors like their rich people do, but than again the author could be another one of those Homeopath loons/Charlestons...
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As I understand the current situation:
1) If they don't do the tests and catch a problem, the doctor and hospital will be sued.
1a) The results of a trial may put licenses at risk, depending upon the State Board's agressiveness.
2) If they due the tests either tax subsidized insurance or a Medicare type program will pay for the tests and treatment.
Conclusion: How could the situation any different.......
You were demonstrably sick.
Here's what generally happens in the US of ADD. Someone comes in to the doctor's office overtired. They have a cold because they overworked themselves and shot their immune system to hell through fatigue.
The doctor then proceeds to order up bloodwork, EKG, MRI... a thousand useless tests. Even worse is the "full body scan" crap advertised on Right Wing Wacko Radio lately. Spend thousands of dollars getting scanned, followed by thousands of dollars fixing the 3-4 "abnormalities" it finds in every human that are of no danger to your life whatsoever.
Y'know what would have worked equally well? Send them home with a doctor's note, have them get some fucking rest, and while we are at it, reinstitute actual worker protections so that they weren't burning the candle at 5 ends at their job taking home 50+ hours of work home each week on top of the 60 they already spend in the office including "working through lunch" out of fear that thanks to the the Retardicans fucking up the economy they're going to get downsized or replaced or their job sent to India.
in the UK for the NHS, and her position on this has always been that patients want you to diagnose them with something, and if you do not then they will re-present either to another doctor at your practice very quickly, or at the local accident and emergency room. And last month she was provided with the best example of this ever...
Ever since I met her, she has complained to me (in a friendly way) that people present to the A&E (she was working A&E minors at the time) with conditions that 30 years ago would have been treated at home, but because the home remedy and care experience isn't being passed down these days, current generations of parents do not know how to care for minor conditions any more and are quick to panic.
One example of this is D&V (diarrhea and vomiting - generally any tummy bug that causes you to crap loads and throw up loads) - patients, or the parents of young patients, will regularly show up to A&E with D&V and expect the doctors to do something. If they were to be admitted, it would remove a bed from use for other more serious reasons, and the only thing they would get would be intravenous saline, and thats not even guaranteed. Seriously, would you rather be crapping and throwing up at home in privacy, or in a hospital in public? Do it at home folks.
Anyhow, on with the example - in this case, she was working as a GP at a practice and a mother presented her 3 year old child with D&V, my wife kindly explained that everything was fine, the kid was not in undue distress, they don't tend to worry that the kids not eating or drinking for at least 5 days, and it was just a case of waiting it out. After a lengthy consultation, the mother and child left.
Four hours later, my wife switched to do a locum shift at the local A&E department - and who was her second patient...? The mother and child. The child hadn't presented any more serious symptoms and had not declined in condition, the mother just wanted someone to do something. So my wife, who had suffered the embarresment of calling the patient in and realising why they were here (the parents faces went bright red when they realised who the doctor was that was calling them apparently), had the job of telling them exactly the same thing again.
To put their minds at ease, she called her senior in who explained the same thing. And then just to top it off, had a paediatrics doctor come down to again reassure them that the only things they could do was to allow the D&V to run its course. After a six hour period in A&E, the parents and child left with no treatment, no medication and essentially nothing gained.
And then my wife finds out, a day later, that the parents had driven the twenty miles to the next major hospitals A&E department and done the same thing there - to be told the same thing and sent home in exactly the same manner.
No names and no identifiable information because I don't know any - my wife is very good at venting but retaining the pertinent private details so even I can't identify the patients.
Long story short, the patients are more of an issue these days than the medical carers - patients thing the doctor is there to treat them and damn them if they don't.
Plus, of course, its easier to overtreat for a minor condition than it is to defend the non-treatment in court for the one case in a million that goes from "minor, non-worrying condition" to "death or loss of limb". One of the things my wife is frightened about is the one in a million case where a reoccuring headache is actually the brain tumour that everyone suspects - but she cannot refer all thirty patients a week who come in with that complaint to the specialist simply because the money isn't there.
The second broken arm was $10,000 more than the first, but the first "treatment" resulted in your arm breaking in exactly the same way a second time. Don't get me wrong, there are a ton of factors involved in the location and severity of a bone break, and it may well have been inevitable that your arm would break the same way when you injured yourself in a similar manner; *but* it's also arguable that the less elaborate and complete first treatment resulted in the bone healing weaker and more likely to rebreak.
Regardless of whether the first break contributed to the second, it's also not inconsiderable that getting such a similar injury in nearly the same place caused the doctors to have to take much more care in the second treatment. Having two healed breaks, practically on top of each other, is almost certain to weaken the bone; the addition of some titanium plated for support of such a weakened bone might have been prudent caution.
You also mention therapy, which is certainly a not inconsiderable expense but can significantly increase the pace of recovery. It may not make you any stronger or healthier in the end, but the "end" might be 8 weeks instead of 12.
I'm not a doctor of course, and I don't know the details of your case, but in my mind your having had two such similar breaks is an excellent argument for the second being more expensive. Now the urologist thing does seem a bit suspect, but again, it's hard to say. Is your son experiencing some sort of symptoms that such an operation might alleviate?
I don't need a million points of light, just two points of multi-mode fiber and a 10 Gig-E router.
What happens when you legislate that the "guberment" will back loans of people who clearly will not pay them back (aka subprime loans)?
The housing market collapses.
That was not the driving factor, most sub-prime loans were not government backed. They were far to large to qualify for that.
What happens when you legislate that you cannot tap your own natural resources because of environmental concerns?
Someone else taps those resources and charges you outrageous prices. $4+ per gallon gas and rising.
Do you think US based oil companies would charge you less out of patriotism? Oil and gas prices are set by international markets for these products.
What happens when you fail to secure the borders?
You get an overwhelming flood of non-taxpaying welfare recipients who destroy your healthcare system, overload your criminal justice system, and undermine your educational system.
Most illegals are young men, between the ages of 18-35. They work here then go back home. They are not a burden but a resource of cheap labor. Also the USA-Mexico Border cannot be secured. It is too large and no fence is going to keep out anyone with a fence.
Either you are sadly misinformed or tragically stupid.
How would you like to work in an industry where you are told here is what you get paid by the government?
Doesn't seem to be a problem in England, Germany, Belgium, France, Norway, etc. etc. etc.
Capitalism is great an all, but some things (like the health of citizens) are more important than profit.