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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.
You'd expect doctors to know how to use contraceptives to prevent this.
http://alternatives.rzero.com/
That's the sound the point of this story made when it flew past your head. Maybe you missed the part about "diagnosing people with no symptoms".
Anyway, we're all sorry for you and we'll all cry ourselves tonight hugging our loved ones thanks to your heartfelt tale, but it has nothing to do with what is being discussed here. Maybe you should submit this to your doctors : Reading Comprehension fail might be another symptom.
"Not to mention all the idiots who use words like boxen."
Anonymous Coward on Monday August 04, @06:49PM
You know, when it comes to testing... you have to do more and more to reach that payoff...
Diabetes is something you're never cured from. No matter what such and such a diet might say, it may greatly improve things, but the diabetes is still there. Fasting blood sugar over 126 is a sign that something is up. Starting lifestyle changes and/or beginning treatment early on helps slow down the progression, and avoids later complications. In this case it actually reduces the number of patients with severe complications... It's not a case of declaring people diabetic who aren't really. It's a case of getting it under control before it progresses too much. Because if you hit 130, without at least diet changes, the diabetes is most definitely going to get worse.
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...
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
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.......
if you need a haircut! -Warren Buffett
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.
If the doctor determines that the reported problem is trivial, he has to protect himself from a lawsuit. That means, the avoidance of a lawsuit takes precedence over trivial problems that would go away on their own. So, put limits on what can be sued for medical reasons, and that will result in better diagnosis for non-trivial stuff.
Leslie Satenstein Montreal Quebec Canada
"We look harder for things to be wrong..."
If seeking an answer, it is best summarized in my sig.
This is very worrisome, glad to see it being discussed. According to the USA Bureau of Labor Statistics, health care employment accounts for (by far) most of the growth in jobs in the USA http://www.bls.gov/oco/cg/cgs035.htm. What happens when a new sport surgeon opens an office in your county? What happens when a urologist opens an office in a town of 10,000 residents? The free market says that when people take employment providing a "service" which they themselves are empowered to prescribe, that prescription rates increase proportionately to the wages.
I realized this when I broke my arm in almost precisely the same place, in almost exactly the same way. The first time it was a reset, an X-ray, and a cast. The second time, a new Osteopath building had been opened in town, with two new very smart and very nice doctors. Good people. Outcome was surgery, metal plates, screws, therapy, etc. My insurance paid for both treatments, but I got to see the bills. The second broken arm was over $10,000 more expensive than the first time. And when I read about the dangers of putting people under anesthesia, I really wonder how the risk was weighed against the benefit of making payments on the new doctor's office. I'm not grossly cynical about the health industry, but whenever a field of the economy becomes too respected (think Catholic Church), people begin to assume the best, and that's a recipe for problems.
By the way, there is a new Urologist in my town of 10,000, with a lovely office. He just told my wife that both our sons need teen circumcision, under anethesia. What is really worrisome is that the USA's aging population makes for an almost infinite number of diagnostic tests, etc., for these people to fill. If the government paid for car repairs, we'd have lots of mechanics and lots of repairs.
Gently reply
He'd prefer people to get really sick before they get significant medical attention.
I realize not every doctor is actually good, and that they can make egregious errors and need to be corrected. Enact tort reform, cap damages, and actually encourage preventative medicine instead of paying lip service to it and you'll get lower costs and better yield for the non-sick 999.
I don't expect a doctor to start caring about the other 999 until that 1 possibly sick person can't sue him and take everything he owns.
In a court of law the question to be asked "Was there a test to determine the problem with my client's husband that would have saved his life if you had done it?" That single question is the reason for all of this, because if the answer is "yes", which is always is even if there were no legitimate reason to run said test, then the doctor is guilty of malpractice. He does that three times, he is no longer a doctor.
Stop blaming the people trying to help you, who have to protect themselves from the lawyers. Blame the root cause.
TFA makes a lot of assertions about unnecessary treatment and increased costs with no associated benefits, but doesn't present or link to a single piece of actual peer-reviewed data. In the specific case of changing the cutoff of blood glucose levels from 140 to 130, the appropriate question to ask is whether or not treating the many side effects of diabetes sooner saves more than it costs.
The reason is neither technological nor behavioural. It is purely financial. Pharmaceutical companies and hospitals need to make money. To make money they must offer drugs and services, the more expensive, the better. Since people really are healthy most of the time, they can avoid paying for health care at all, which naturally is unacceptable. Hence doctors try very hard to create more sick people to create more income. Whether it is by selling hypertension drugs to people with 140/90 (which was considered perfectly normal 50 years ago), cholesterol drugs to everybody, unnecessary vascular stents (which, according to studies, temporarily relieve pain but have no effect on longevity), unnecessary screenings, unnecessary surgery, unnecessary psychoactive drugs, and heck, heaps of drugs of all kinds. The average american is from birth convinced that he is sick all the time and that without health care he will die. What better incentive to buy medical services?
Doctors and other medical professionals HAVE to find something wrong, and then , to overmedicate.
Such is life. It is sad that actual diagnosis, falls by the wayside when the pressure is to find the
problems that can be medicated.
My parents, deceased, had DOZENS of contradictory medicines prescribed to them. When a
real doctor took them off the additional meds, they improved, sadly it was all to late. This is
basically unacceptable. Such is life in the big pharma theory. Old age is simply old age, not
something to combat!!!
Seems every personality trait (inability to pay attention to boring teachers; enjoying math more than people; shyness; risk-taking extroverts; etc) are being labeled with some mental condition that shrinks like to charge a lot for.
Did you tell the doctors about the shemales? That may fit into the puzzle.
Doctors give more tests because they're afraid of being sued if they don't.
http://www.usatoday.com/news/health/2010-06-20-ER-overtreated_N.htm
"The average reporter we talk to is 27 years old......They literally know nothing." - Ben Rhodes
Besides advocating a fairly narrow theory on how to live healthily, this lecture by John Mcdougall talks about the questionable (non-positive) benefits of medication for chronic problems. It was an eye-opener for me, as someone who used to blindly follow his doctor's guidance for all health-related issues. https://ssl.sonic.net/mcdsite/free/DLV04-V01.zip Warning: It's about 80 minutes long - so probably better saved for a rainy day.
Not specifically about shemales, I don't think that matters. However my patient papers does say I had countless amount of sex with both locals and local prostitutes, so I did tell that.
Yearly sinus infection. Needs a $8 bottle of keflex to get rid of it.
So i goto the doctor. ($80) And go home with 4 perscriptions. None of which are keflex. ($280)
What used to cost me 8 bucks to get rid of... Now costs $300+
Maybe you just need a new doctor? When I've told my doctor what treatments have worked in the past for me, she generally goes along with it (unless there's a medical reason not to) and gives me what I want.
TFA might have a point. But I wouldn't bother reading to find out with a bullshit summary like that. Really, prostate screening isn't worth the horrendous cost to those 999 out of 1000 people who don't have cancer. Oh yes, the one person who doesn't die of cancer is greatly outweighed by those other 999 who had to get a finger up the ass FOR NO REASON, THEY WEREN'T EVEN SICK! Won't somebody think of those poor unfortunate souls? Seriously, did Peter Griffin write the summary?
ASCII stupid question, get a stupid ANSI
This is not news for nerds. This is aging population concerned with health problems magazine selling bullshit.
Closest thing to nerdiness is the fraction 1 out of 100, which is also bullshit.
Slashdot's early adopters (and its editors) are starting to move into that aging population demographic...
DAMMIT!!! I want my mod points!!! +5
I'm an ER doctor. I can't create patients as they come to me with symptoms. I will say that people come to me with minimal symptoms such as cough and fever and then demand blood work, X-rays, and antibiotics, even though the majority of the time their symptoms are caused by a virus and will get better all on their own. Somehow, our society has become so weak that every cough, scraped knee, or hangnail requires a visit to the hospital. And somehow we think that physicians can't diagnose anything without a thousand dollars worth of painful tests. Whenever I try to explain to someone, "You have a cold. You're going to be fine," that's not a good enough explanation. I've even had a few people demanding admission to the hospital---which, if you didn't have a life-threatening disease before, you can certainly pick one up during a hospital stay. This problem is societal in nature and has been made worse with television shows such as House and ER where lay think that every problem requires specialists and lots and lots of tests. Don't blame me; I'm just a cog in the wheel.
Because where I live, I suffered from a crippling disease for 5 years that almost ended up fatally, and going week after week after week to the medic, treated like a liar or an attention whore, coming back home every day without results.
Until, finally, after years of calamity, they found what it was. About f*cking time if you ask me, it ended up being a serious intestinal disease combined with a esophagus and a circulatory thing and lots of inconvenient little things.
Please take note of the time. 5 years of my life lost without being able to go out of home and unable to work, socialize or well, just about anything that wasn't being yellowish in color.
Because of medics, who could have detected this much earlier, I lost the best years of my life, the ones between young adulthood and proper adulthood. I am like a hermit who just came out of a cave. All because medics didn't want to do a bit of work and do science stuff.
Here, where free healthcare exists, medics are only concerned about getting their taxpayer-founded salary every month, and don't give a crap if the patient dies or not.
After seeing medic after medic and having to hear "it must be psychosomatic" for years, I have very little respect for the medical guys.
A medic like the ones described in the article would have saved me 5 years of my life. That's not something trivial.
We have a WINNER!
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
Counterpoint:
Wife went to the doctor. Doctor proscribed an antibiotic ($20 to doctor and $5 to the pharmacy). Wife got worse and went to a clinic on a weekend. $80 for doctor and two medications that included an antiviral for a rash on her nose. It worked but the process took three weeks of misery for my favorite person in the world.
We have medical coverage through my employer. Why did your trip to the doctor cost so much? My wife and I go through the same thing every spring and we do sort of wonder when the doctor is going to figure this out.
bob@Osprey:~>
Part of the problem is this whole "sick culture" where people are convinced nowadays that they are all seriously ill but can simply medicate any problem away.
Listen to some of these commercials on television. A good chunk of them have side effects including triggering the things they're supposed to be helping you with. Like antidepressants that can make you MORE suicidal.
My whole response to this is "Are you fucking kidding me?"
Chas - The one, the only.
THANK GOD!!!
Someone with mod points mod this fucking AC up!
If someone is passing you on the right, you are an asshole for driving in the wrong lane.
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.
I find it rather interesting that this claim is being made when I've found it to be quite the opposite to my experiences overseas, especially in Asia.
In the US, someone gets the cold or even the flu and they just deal it. There's a massive selection of over-the-counter drugs to help deal with so many basic illnesses.
In Taiwan, as an example, feel a bit off and people start insisting you visit the doctor. And why wouldn't they when, thanks to their social healthcare system, it only costs a few dollars for a visit? So people go in constantly for things like simply colds and then get prescribed a ton of medication that aggressively deals with all the symptoms. Of course, the flip side is that their equivalent to our pharmacies are lacking in any real medication.
So doctors end up being overburdened and are underpaid when practicing for the state. Visit those clinics and the routine consists of describing your symptoms, the doctor makes a few assumptions about what you've got and prescribes something for it. I've had visits where they don't even bother measuring heart rate. The expectation is that if you've got something serious it will be apparent when your condition doesn't improve or even worsens. Many doctors open private practices where they can charge whatever they want. It's more expensive but for people willing to spend the money they can get the care they want right from the start.
And it isn't something unique to Taiwan, I've observed similar things in Japan and some parts of Europe. Who the hell isn't going to take advantage of something if it's cheap? In my experience the US is the opposite. Unless you're well-off or have a low co-pay you're going to put a visit off until you really need it.
On the other hand, I have found American doctors to be excessively cautious. But then, I've always attributed that to a fear of lawsuits. They don't want to risk overlooking something that a patient will then come back and blame them for. As always, this is a complicated issue which isn't being properly addressed.
That's not common. For one thing there's no way in hell that insurance would cover all that testing, and for another, there's only so many tests a doctor can talk a patient into for a minor malady.
Likewise, people have been convinced that expensive drugs are the cure all for everything. This leads to, for example, in the US the creation of medicare part D whose purpose is support the drug companies ability to charge higher than market values for drugs. The drug companies has the help of people like this who laugh at the medicine that has kept the human race healthy for thousands of years, and doesn't seem to understand that difference between marginal statistical efficacy and safety. We may choose to take a drug because it is necessary for our own health or the health of the community, but that in no way means the drug is safe, or the community should not ask for drugs with fewer potential side effects. At the root of this is the idea the inductive reasoning will conclusion that then become necessary conditions of life, rather than things that are probably good for you. This fallacy is promoted because it is useful, and most regular people don't know it is a fallacy.
If we have too many patients, the doctor is only partly to blame. We have an epidemic of cleanliness, kids using hand sanitizer and not getting sick to build up resistance to common bugs. We have people who never eat a real meal of fresh food, rather everything on thier paper plate is processed or synthetic. No one has a Aloe plant around. People are prescribed expensive drugs when, if the laws were tilted to the pharmcos, they could grow what the needed in a pot.
Which is not to say the many people are not genuinely out of kilter. I think the diabetes example might be silly because as we know more, we reset thresholds. Complaining about a new threshold is saying that inductive logic is infallible. In fact, all thresholds are guesses and needs to be reset with new data. In general saying people who were sick in that past are sick now is equally silly. Just because ALS was not written about until the late 19th century and was not widely known in the US until well into the 20th century means we should call these people sick and try to help them? To me this thing is not that doctors have too many patients, but that people do not seem to have a choice to become a patient or not. If you do not subject yourself to the leeches of modern medicine, you somehow are not a respectable person.
"She's a scientist and a lesbian. She's not going to let it slide." Orphan Black
Im in my 20's so i guess it started with my generation, but it seems like anyone I went to school with who wasnt interested in the subject matter or had too much pent up energy was put on Ritlin or one of its many alternatives. Instead of letting those kids expend their energy by running around it was just easier to cram a pill down their throat 3 times a day.
It might not be common knowledge that blood test 'normal ranges' (i.e. the range in which the quantity measured is said to be normal) were determined by taking thousands of healthy volunteers and performing the test - but creating the range based on the middle 95% of normal values. Therefore, even before we started testing people, we deemed 1 in 20 healthy people to be 'abnormal'.
Counting on my fingers, we do a minimum of 22 blood tests on patients admitted to our hospital. Statistically, even if you are well (though that is unlikely given you presented to the hospital, and were assessed and deemed unwell enough to be admitted) at least 1 of these blood results should be abnormal. And I haven't even started on your ECG, radiograph, blood pressure, pulse, oxygen saturations, respiratory rate, temperature etc etc etc. And if just one CT scan were performed, that looks at so many metrics, that several are bound to be abnormal to some degree (so called 'benign incidentalomas').
Part of being a good physician is knowing what abnormal results are significant, and what are red herrings. Ignoring a result is a difficult thing to do in medicine (the article has some good reasons why) and takes a good knowledge of the context, as well as plenty of experience, to be confidently able to say 'that is a red-herring'.
I disagree with the writer suggesting that thresholds should simply be raised. This is a stupid and dangerous way of dealing with this problem! The problem isn't how _far_ above threshold the value is, but whether it is or it isn't. Raising the threshold does not eliminate false-positive results, but will undoubtedly result in false-negative results. Tests in medicine are assessed to measure their 'positive predictive value' (see wikipedia), which, simply put, is about choosing a threshold that will find a balance between limiting false-positives, and limiting false-negatives. Instead of blanket raising of thresholds, doctors should be basing their decisions on the _evidence base_ - i.e. research done looking at how patients with these values fare with and without treatment. Only then will we know whether what we are doing is helpful or not.
The writer is writing in a public journal, and I think it is dangerous of him to suggest that some people don't really need treatment for diabetes - a condition that is hard enough to demonstrate to patients the dangerous long-term consequences. I wonder how many people reading this article have decided 'I don't really have diabetes - this person says so! And I thought I felt well, too!' and chucked their meds out the window. And yet, there is very strong research and evidence that shows that people diagnosed with diabetes (whatever their blood sugar) do much better if their blood pressure and glucose levels are kept below certain levels. And by 'doing much better' I mean, have less heart attacks, less strokes, go blind less, have less kidney failure, have less neuropathy and die less. All these things are real-world problems which damage peoples health. We are not just treating a number! (but we only know this from the evidence).
The other side to this argument is social. Here in the U.K. we are proud of having a largely non-private system. With all the cost and time pressures on the NHS, it means that we don't investigate or treat unless we feel it would benefit the patient. If an NHS doctor in the U.K. says you have a health problem, it's something you should probably listen up to, because he is not paid to do that. Of course some would argue that the flip-side is that patients may not get investigated or treated enough, which may be balanced somewhat by the law courts. I'm not saying it's good that doctors say 'well because this person has come in with a,b and c, and even though I don't think it is 'x', we can't justify in a law court not doing investigation 'y', but it does provide a counter balance.
Doctors should try to good, be very careful not to do harm, and base their decisions on rational arguments backed up by evidence.
(the article's suggestion of simply raising the thresholds is idiotic)
healthy pregnant women can have 130 and be fine
There's no incentive for doctors to be judicious in testing since they send the bills to the insurance company. There's no incentives for the patients to undergo less testing, since they never see the bills.
Do patients know what the charges are for various tests before they get them? No. They can't participate in any meaningful way in the whole process.
Only when doctors start putting costs in front of patients and when patients have to make decisions about how they spend their health care dollars will this entire situation begin to be reined in.
Doctors secretive billing practices and the whole Insurance company tied to your job model are to blame for this mess.
Why are you letting these clowns ruin our country?
He makes a lot of good points in his article. Obviously the length of the article limits how much detail he can go into and how much of data he can reference, but there is definitely a lot of tests and procedures which are likely causing more harm than good. He makes note of one good example (prostate cancer screening) that we know causes more harm than good in certain populations. In older men, detection of prostate cancer is far more common but the chances of symptoms from the prostate cancer is low. We actually know that in these men we cause more harm than good due to morbidity from biopsies and from unnecessary surgeries/procedures.
It is unfortunate that he mentions the lower cut-off for diabetes - even if he thinks that 130 is too low, we actually know that even people with fasting sugars of 100 are at increased risk for diabetes and, thus, for death. If the intervention is more intensive couseling of lifestyle changes, then there's not a lot of downside to increasing the diagnosis of diabetes and prediabetes.
But his central point still stands - if the US is going to tame its healthcare costs then it needs to look at overdiagnosis and its causes. In some cases, expert committees and professional societies (with their own biases) are to blame. In other cases, malpractice lawyers, the pharmaceutical industry, greedy doctors, and patients who cannot live with uncertainty are to blame. Luckily, there are entire journals devoted to this aspect of healthcare policy and it has not been ignored by mainstream medicine and those who wish to improve it.
Twice in the past two weeks I went to see a doctor at my primary care office. I first went in with severe back pain. Instead of taking an x-ray, and then putting me on pain killers and on an anti-inflammatory, my doctor wants to rule out Meningitis. I don't have symptoms for the disease that would include a significant high fever, but I did have neck pain and a headache. So for the lumbar puncture, they had to send me to the ER for everything. I was not treated at the primary care office. This was on 4/27 this month. They ended up not doing a lumbar puncture at all in the hospital and instead, a simple blood test. They put me on Oxycodone and since it didn't really relieve my pain, they decided to admit me to the Hospital (where they added a muscle relaxer, neurotin, and valium). I then spent the next 3 days as an inpatient waiting a full day to take an MRI, receive the results, and wait another day to meet with an inpatient physical therapist to get evaluated. It turns out just to be muscle pain, as I originally thought and I was about to be released. This all could have been done as an outpatient. But instead, I got a high fever and got pneumonia which I caught from staying as an inpatient in the hospital. I am released 2 days later, and receive an antibiotic. Two days after that, I get pharyngitis. I go back to the primary care office, Instead of taking a throat culture, puting me on a liquid painkiller and antibiotics, he sends me back to the ER. They do exactly that in the ER and they keep me overnight. Doctors in primary care offices seem to be sending more and more patients to the ER for things they can take care of in their offices, because they want to rule out something more dangerous. Is this absolutely necessary for medical care?
You do realize that antivirals are basically useless and your wife's immune system is what cleared the virus?
Both the doctors gave you pills knowing they would do nothing but also knowing they had to do something to get you to leave.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Chiropractors have been doing this for years. Hang on - I think one of my legs is longer than the other!
It s simple they are in defensive medicine mode. Making a mistake can cost them mush larger insurance payments because people and lawyers are sue happy.
Jack of all trades,master of none
Seems you hate 'republicans'. Well thats nice. But I see the *SAME* shit from democrats. It is a behavioral thing not a political thing.
Worked with many republicans and democrats who do the exact same shit you are talking about.
Also you may have noticed something who passed a 'major health care bill' last year? Oh yeah it wasnt the republicans. But that wasnt because it was the correct thing to do it. It was the contrarin politics that are going on now. Oh you are group X I hate group X and everything they do is stupid and wrong. Oh and let me make up some shit that is going wrong and blame group X even though Y did it. Both sides do this BTW and you are doing it right now. It doesnt help dont do it.
My father used to work in insurance selling plans to the public to cover extra costs (they usually were not much a few hundred or a thousand dollars covered max and people rarely ever got to the max). Then came mandated health care insurance plans. My dad came home that day and said "I am going to make a lot of money, but you are in 15 years going to pay a lot more in health care". He was right. There is now too much money in the system. It is why when you go in you pay 80 dollars for a cotton swab. The market will pay it. And you as a patient pay it as you dont pay it, your insurance company does. You pay 10%-30% out of pocket or some flat fee.
You think healthcare costs a lot now? Wait until everyone has it for 'free'. You think this recession is bad? Wait until your company cuts 10% of the jobs to pay for the other 90% of the people to pay for it. That day is coming mark my words and remember me.
My point? Doctors are people and they like their bad ass toys they can buy. I know personally some doctors who make upwards of 1500 an hour and do that every day for 3-10 a day 3-5 days a week. Not only can they do this they WILL do this. It is simple economics. You probably are thinking 'oh lets regulate that too'. How would you like to work in an industry where you are told here is what you get paid by the government? So you will see less workers as there will be an artificial price cap. This will create a price gap that must be made up by raising the prices and an under serviced public.
Then on top of all that people are sue happy. "You could have run this test but didnt and I am sicker than I could have been". So they run the full suite of tests. What to do they care? They have an incentive to run every test (not getting sued). They are not going to run the tests themselves, they have people for that. They can just bill the insurance company (which by law now will pay it). You are there an extra couple of hours and they saw you already for 20 mins.
Ask your company what they pay per month for you in health insurance. Bet it is a lot higher than you think. Ask a contractor what they pay for insurance. You will hear numbers like 'oh about 600 a month'. As these plans also cover their families.
Also many of those 'workers' protections you want back were stripped away under democratic congresses. You know the ones who write the bills... They were usually riders in other bills that must pass (like the budget). Before you go blaming republicans for all of this countries woes look in the mirror. Democrats are JUST as much to blame. I hold my representatives responsible no matter their party affiliation. Even when they vote yes or no for things. They are still responsible. It is why we elected them. If more people did this we could end this sillyness of parties. Urge the president to veto anything that is down party lines. It means they didnt read it and the 'party leaders' are calling the shots not our representatives.
Had that twice now. Annual physical blood test shows something half a sigma off from normal so they need to test. Both times it was harmless conditions well within the human norm, and things you can have and still live to 100.
Or heaven forbid an extra bit of blood is drawn for the PSA test. Sure, PSA can be elevated due to other causes, but NO one has a prostatectomy or radiation without DREs, and biopsies to confirm cancer. And if the DRE finds something it is probably at a worse stage (e.g. metastasis) vs first detection due to an elevated PSA.
No one has "radical life altering procedures" without a positive diagnosis. DREs and PSA are safe and easy. Even the biopsies, while uncomfortable, are safe.
The medical establishment should OFFER the PSA and DRE beginning at 35 (40 at the latest). The American Cancer Society and government agencies advocating no PSAs until 50 is practically criminal.
Let each person decide for themselves, it is their life - let the Doctors bring it up.
Essentially they seem to be saying that if the odds are less than 1 in 1000 of finding something, don't do the test. Most things occur at less than 1 in 1000, but it makes a difference to that 1. Insane.
The LA Times has really gone downhill lately.
Lately?!?!
The reason you worry about the outlying cases, is that the risk/reward doesn't add up. For a malpractice suit, I can easily see $100k just in defense costs. That's a lot of patients at $75-150 a pop. If you miss 1:1000, you're just break-even.
Is it worth your livelihood to take a 1:10,000 chance 1000-5000 times a year? That's why you get all these tests, and treatments for borderline cases. If you tried and failed it's better than missing it entirely, in the eyes of the lawyers. Plus, the standard for malpractice is often based on what your peers do - which has been ratcheted up.
That and, of course, there's good money in investing in a testing service lab if you can refer enough business there.
Is it just my observation, or are there way too many stupid people in the world?
As a lawyer, part of me wishes they'd completely outlaw medical malpractice lawsuits. It would be amusing to see what happens when med mal costs (which are currently maybe about 1% of total medical costs, with defensive medicine making maybe another 5%) are taken out of the equation, and medical costs stay about the same or go higher (and medical malpractice increases), how people will react without lawyers to blame. Every legitimate, peer-reviewed study of the subject shows that high medical costs in the US are mostly the fault of the insurance companies, and how (to address this article specifically) doctors themselves are frequently to blame for unnecessary tests because they get paid more for ordering them.
The lawyers are only doing their job. It is the people who SUE that are the real issue.
Like the family of the two men who dressed up on body armour and went on a shooting spree. The family then had the nerve to sue the police because they claimed not enough was done to save one of their lives.
WTF? In a civilized world that family would have received a thorough beating and be made to pay for the sticks used.
Lawyers are the symptom, root out the disease, the people who sue for everything.
when really she was concerned for her kid. Maybe overly so ;) but she obviously wasn't getting satisfaction. My mother used to HAVE to give me something if I had even a simple cold. It's a thing; she was overprotective or whatever. But when her doctor wouldn't give her something for me or my sister, she'd go to the pharmacist, who'd whip her up something that knocked us out good for days (LOL, like paregoric), and she'd feel like she'd been a responsible parent. Where's the harm in that?
That's part of a PCP/ER doctor's JOB, imo: calming patients down. The patients aren't there trying to waste your time or take up beds; they really don't feel well; and it's not a joy sitting in the waiting room when you're sick. The patients are concerned about something that only a medical doctor can help them with. If a doctor brushes them off, they'll def. continue to seek care.
And while it's not been brought up yet, the mass media news is at least SOMEWHAT responsible for the public freaking out about otherwise-benign symptoms like D&V. Bird flu, swine flu, &c "epidemics" were so overly published that people would get a SNIFFLE and run to the hospital (because they were TOLD to do so). Last year they closed schools here if a kid got a good case of diarrhea. So of COURSE parents are going to worry when their kid gets a really good stomach virus going on. They need to be calmed down; they're not 'bad patients'.
"with physicians making diagnoses in individuals who wouldn't have been considered sick in the past,"
Ie, people who suffered but nobody could be bothered to help in the past (and still can't because its too expensive to be humane)
If Google really cared they would fix Android Chrome to reflow text, instead of discriminating
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.
Yeah, I don't think fucking anything that moves helped much with avoiding exotic diseases. Hope you're going to be more careful in future!
which is totally what she said
Shouldn't that be "Doctors are creating too much patience"?
...Where was the Nurse's / Nurse practitioners?
They are usually the first line in dealing with patients.
They should be trained up enough to weed out the time wasters (those with the 24h bug, small burn, a simple strain/sprain or something that is best left alone to fix itself, like a cracked rib)
The nurse usually has the ability to diagnose minor ailments and if unsure or they think it's something more major they can then get the Doctor in.
either way if any prescriptions are required then a Doc is always called in to consult and make the final diagnosis.
The patient is happy since they have been seen by 2 medical professionals, The doc is happy since he has more time with those that are really ill.
Though the nurse's taking my blood pressure last time thought i was headed for a heart attack due to the high pressure, p.s. the nurse was HOT!!! ^_~
Explaining the reason for my high pressure was a great way to get a date...
Laters Sol "Have you found the secrets of the universe? Asked Zebade "I'm sure I left them here somewhere"
The problem is (aside from Slashdots fucked commenting system) is that this patient DID NOT BELIEVE ANYONE SHE SPOKE TO despite them all giving her exactly the same advice and information. And in doing so, she wasted her GPs time, an A&E doctors time, an A&E consultants time, a paediatric doctors time and god knows how many peoples time at the other A&E department. And all of those people have waiting lists, admitted patients and other things that could have been handled if she had not rejected the advice given to her at an earlier stage.
At no point was she given "the brush off", her original GP appointment was half an hour (as opposed to 8 minutes target time), she asked questions and received answers.
So what should be done? Give the kid something useless that would just reinforce the behaviour pattern? Yeah, thats a good idea.
At what point does she become a time waster?
It happens every single day. When the doctors have incentive to find a malady that probably doesn't exist, they look extra hard. Hell, even when they don't find anything, they still make a lot of money.
Either you are sadly misinformed or tragically stupid.
I vote both.
What happens when you legislate that you cannot tap your own natural resources because of environmental concerns?
Do you think US based oil companies would charge you less out of patriotism?
Well the Venezuelan government does sell its oil cheaper at home, so clearly it can be done.
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.
Thank you! More people need to get over the whole "democrat/republican" thing because it distracts them from looking at issues that truly matter. As far as I'm concerned, there is too much money in this country and the politicians would rather obey the commands of those with money than of those from the general public. Our whole system is inherently flawed and littered with excess waste; we should just uproot the damn thing and start over!
Failure to diagnose a disease is malpractice, so doctors are generally compelled to practice CYA medicine and diagnose anything and everything possible. This has the benefit of reducing malpractice suits against doctors, and the added benefit of giving insurance companies an excuse to raise rates on people who aren't really sick. The insurance companies win big on this approach.
Someone comes in to the doctor's office overtired...
Yep, that was the only symptom my brother-in-law had, they gave him a general check up and found a large tumour on his prostrate. Luckily they cut it all out but it was a couple of months not knowing whether it had spread or not. His older brother didn't bother going to the doctor and is now terminal with prostrate cancer that has spread thru his body.
What you describe sounds like a money making scam as opposed to preventive medicine. They don't advertise "full body scans" here in Oz, but the UHC system does advertise to get people to go for prostrate checks and other types of simple* screenings, they also send doctors to give free check ups at the workplace because early diagnosis is both cheaper for the health system and less painfull for the patient.
*simple - because a finger up the bum isn't what I would call a "high tech" test.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
And you think oil companies in the USA would also do that?
Hugo Chavez does a lot of things, and I think I rather pay $4/gallon than deal with him.
If you can identify a population of patients who are very likely to progress to a diagnosis without intervention and if there are useful treatments for these patients that can prevent suffering and large medical costs down the road, then it clearly will be worthwhile to diagnose and treat the condition early, even before there are visible symptoms.
The example of criteria for diabetes diagnosis is a good one. Type 2 diabetes is a progressive condition that often starts to develop long before a patient has obvious symptoms or uncontrolled blood sugar. Patients diagnosed wih "pre-diabetes" can often avoid becoming full-blown type 2 diabetics.
The trick is to use diagnostic tests intelligently and balance the risks and benefits. Advocating "don't introduce new tests" without explictly evaluating the costs and benefits of the new tests would be a horrible mistake. On the other hand, letting the vendors push the introduction of new tests without thorough evaluation would be equally bad.
Doctors, lawyers, teachers, nurses, police officers...every job you can think is first and foremost in it to make a living.
I don't know where people get this idea that the 'helping' sector is more moral. The used car salesman is only considered immoral because they have to earn every single penny they get. So some resort to sleazy tactics.
The ones in the helping sector, don't need to resort to sleaze you face, they just resort to more grandiose sleaze. Forcing the government to pay so they can charge whatever they want. Creating pointless laws and programs to bring them business.
What do you think happens under universal healthcare? It's guaranteed business for the healthcare sector.
Ditto for the drug war being guaranteed business for lawyers and police officers, and prison guards.
And war is guaranteed business for military and military companies.
No matter which way you slice it... and politicians always try and slice it a million different ways, you will never be able to generate a more honest system than a free market where people voluntarily do what they want.
Everything else, the self-interest takes over. Hilariously, the self-interest is often disguised as the 'greater good'.
Hey, maybe we'll relearn the lessons of the enlightenment. One day... one day.
I think it's more common than you think. Doctors have it quite easy with most people when it comes to "You have X, take Y pill!" while enjoying nice kickbacks from Pfizer, Merck, etc. Factor in the private healthcare costs and you've got an ongoing national disaster.
Grammar nazis are to this community what excrements are to gold.
I'm surprised not more people have blamed patients for causing more patients. That's the problem with the US system and capitalism. Marketing has created generations of patients. We are overly medicated, hypochondriacs, thanks to the great pharma-commercials! The basic premise of nationalized health care makes less patients--not due to less people getting treatment who need it--due to less people getting treatment who don't need it.
Screenings are one thing. Regularly scheduled screenings and checkups are an important part of medicine, if for no other reason than they establish a usable baseline that can be referenced against for future medical tests.
What goes on in the US of ADD, however? Just plain lawyer- and politician-induced stupidity.
Well, sorry to burst your bubble but there's a world outside of the USA.
Diabetes is something you're never cured from. No matter what such and such a diet might say, it may greatly improve things, but the diabetes is still there.
There is no pill to cure diabetes. But a good "acupuncturist" can balance the body's energy systems well enough to make it a complete non-issue (when combined with personal self-healing initiatives, like changes in diet and activity levels). And stopping the lipid-peroxidation chain reaction (which is caused by the great 20th-century switch in dietary fats from animal-sources to seed-oil) helps too.
Ooooh, acupuncture. I'm sure that will restore my beta cells which are all dead.
(sorry to all the other slashdotters for the sarcasm, but as a type 1 diabetic I'm sick of hearing I can be cured by wishful thinking and cow's piss)
My father works in a hospital, he says that most of the doctors are too 'scared' to deny some people medicinal care, as a lot of people would just sue if they were denied medical care.
Not to sound like a dirty-commie-hippie, but Western medicine's "fix when its broken" approach is just not a sustainable practice. Its like doing no maintenance to your computer (i.e. defragging, deleting useless files, clearing your cache, etc...) until after it stops running--and then calling an expert to help you. Doctors need to solve lifestyle problems to prevent diseases and conditions before they happen. Naturally, a lot of things can't be prevented (random viruses and broken bones come to mind), but having a stronger immune system can still help the process after the fact.
Ginga no Rekshiya Mata Each page.
Either you are sadly misinformed or tragically stupid.
The most likely option is missing. He is deliberately lying to further his ME! ME! ME! AND FUCK THE REST - agenda.
Ubi solitudinem faciunt, pacem appellant.
Getting a second opinion isn't unreasonable. Colleagues called in by a doctor might not seem like a second opinion, since they might automatically support her. The parents were probably panicking, but a doctor saying that there is no problem until 5 days without water or food would not indicate a great deal of concern to most people.
Enjoying your moralistic self-righteousness much?
Ubi solitudinem faciunt, pacem appellant.
It sounds to me like that is pretty reasonable compared to some of the other things we are getting hit with. For example many EPA and FDA regulations are aimed at reducing risks to levels of 1 in 100,000 or less.
Pharmaceutical companies are the ones who take horse piss, perform alchemedic voodoo dances, mark it up 10000x and sell it at your neighborhood pharmacy.
as a type 1 diabetic I'm sick of hearing I can be cured by wishful thinking and cow's piss
Good way to ignore the rest of that comment. Type-1 Diabetes is an auto-immune condition. Auto-immune reactions are always related to an overactive fight-or-flight system (Triple Warmer meridian). What was happening in your life when your immune system took out your pancreas?
My favorite biochemist talks about how to induce diabetes in mice by using a drug that takes out the beta cells. And how mice given a certain type of protective food are prevented from becoming diabetic when given the drug. This is the food that was displaced in the great dietary switch that led to the present Lipid Peroxidation epidemic.
Even if you can't fully recover your body's insulin-producing capacity, there are always things that can be done to improve your condition.
But never mind anything here. There's no hope for you. You probably ought to go eat a Hagen-Daaz ice cream bar, and inject some insulin.
Learn the rules so you know how to break them properly.
www.teslabox.com
At 400 bucks an hour for a hot shot lawyer, that works out to ....200 hours
me thinks the lawyers are gouging the docs, the AMA had any balls, they'd have 100 dollar an hour lawyers on retainer
you say that most ("usually") people suing are douchebags. You got any evidence, or is that just your unsupported opinion ?
oh gosh, I thought you were saying something reasonable for a while until you brought class warfare into the situation. Really? You're a vindictive brat who thinks it's ok for doctors to pay a lot because they have a lot of money? You seriously think that doctors are out to 'keep you down' or 'hurt the middle class?' Actually that's pretty good, I'm really laughing here, that's the funniest thing I've heard all day. Thankyou.
"First they came for the slanderers and i said nothing."
A lot of people I know will go to the doctor the moment they "don't feel right", and the doctor will test them until he finds something. Funnily enough, many of those same people could crap a quart of blood or run a fever of 104 and be casual about it. If we'd take some time to learn a bit more about our bodies and their normal operating parameters, maybe we wouldn't have to bother doctors so much in the first place.
I'm trying to teach myself to set people on fire with my mind... Is it hot in here?
The "back to sleep" campaign for infants aims to prevent a terrible tragedy of two in a thousand infants dying suddenly in their sleep for reasons as not yet full understood (and this practice supposedly cuts that rate of sudden infant death syndrome - SIDS -- in about half).
http://www.nichd.nih.gov/sids/
Basically, the entire process involves making infants uncomfortable -- put them on their backs instead of their stomachs, don't cover them, keep the room cold, don't co-sleep with them, and other things. But it is accepted that this distorts the backs of children's heads to be flatter, and also delays crawling development by a month or two in many children. If this was side-effects from a drug prescribed, we might question it more.
To be clear, I think it is worth to think about preventing SIDS, but one needs to ask about the costs in flattened heads and delayed developmental milestones to the other 998 out of 1000 babies. As someone else told us, the road to genius starts on the belly. We followed this back to sleep advice for our child and I regret it, especially as our child had trouble sleeping a lot in the first place, and following this well-meant advice probably just made that all worse.
Other bad advice from the medical establishment has been to avoid the sun, which has led to widespread vitamin D deficiency probably leading to increased autism rates and other health issues.
http://www.psychologytoday.com/blog/evolutionary-psychiatry/201104/autism-and-vitamin-d/
Again, we made the mistake of following well-meant advice by medical practicioners to avoid the sun and had serious health consequences from that.
Ironically, the lack of sunlight seems also to have increased melanoma rates, since vitamin D helps in the immune system destroying cancer. Ways to avoid that:
http://www.vitamindcouncil.org/treatment.shtml
The four food groups was another scam that has lead to a lot of bad health. Better advice:
http://www.drfuhrman.com/library/foodpyramid.aspx
http://www.seriouseats.com/2007/11/the-subsidized-food-pyramid.html
http://drfuhrman.com/library/article16.aspx
But these sorts of bad advice by the medical establishment have been great boons to mattress manufactures, the processed foods and animal products industries, and the medical industry.
Iodine may be another similar issue:
http://www.lmreview.com/articles/view/iodine-the-next-vitamin-d-part-I/
Remember, doctors used to recommend smoking and push infant formula, too. Example:
http://www.old-time.com/commercials/1940's/More%20Doctors%20Smoke%20Camels.html
And they helped cretae institutions that persecuted those who suggested otherwise:
http://en.wikipedia.org/wiki/Flexner_Report
http://www.soilandhealth.org/02/0201hyglibcat/shelton.bio.bidwell.htm
Vaccinations are another problematical area where it is not always clear the risk is worth the rewards for specific vaccines, or that with all the conflicts of interest involved one can know who to really believe on all that. The story on the influenza vaccine's value keeps changing, for example. As I quote here:
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
Other ways to deal with bullies:
http://www.bullies2buddies.com/How-to-Stop-Being-Teased-and-Bullied-Without-Really-Trying
Here is why the current approach pushed in schools just makes more:
http://www.psychologytoday.com/blog/psychological-solution-bullying/201011/rational-alternative-the-national-school-anti-bullying-p
Maybe what made the USA strong decades ago was a progressive tax rate that went past 90%? :-)
http://en.wikipedia.org/wiki/Progressive_tax
http://www.capitalismhitsthefan.com/
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
So which is it? Fight or flight, or the change in diet? You say it's one thing, then immediately say it's another.
And nobody can claim to know what causes an autoimmune disease. Unless you of course think yourself better informed than every specialist of type 1 diabetes. Stress brings out the disease, it's true. Emotional trauma, even infections can bring out the symptoms. However that's just the final straw, the extra stress that the almost depleted pancreas can't handle. Type 1 diabetes can take years to destroy the cells to a point where the symptoms suddenly appear. The stress isn't what causes it, it's just the tipping point when the pancreas gives up its fight.
Of course, nobody can claim either that stress doesn't cause it, but all the cases of stress or trauma associated with the discovery of type 1 weren't the actual cause.
As for using a drug to induce type 1 diabetes, just because the same cells are destroyed doesn't mean that you can compare the two. Changing their diet so they resist the drug is no proof that the diet would avoid the autoimmune reaction flaring up.
I'm confident a cure will be found within the next decade or two. The hospital where I do my checkups is making very good progress on a targeted immunosuppressant.
However, improving my condition? I'm sorry, I didn't realise that I was in a bad condition. Aside from having to manually keep my blood sugar stable, I'm perfectly healthy. Properly treated diabetes has no symptoms, aside from the odd hypoglycaemia.I have no complications, and in all likelyhood never will.
Either I need the jabs, or I don't. Reduced insuline needs is actually a worse situation, because when you're producing insuline, the number of units required is no longer directly proportional to the amount of carbs ingested. It makes functional insuline therapy hell, or completely useless.
But right now, there is no cure. Neither for type 1 or type 2.
I haven't paid into the medical system for over ten years, and am looking forward to defending myself against criminal charges for my "negligence". During the same period, my neighbor has received three elective surgeries, courtesy of the health care system, and is under no such danger of prosecution. It's not just the doctors who are playing it safe.
The Web is like Usenet, but
the elephants are untrained.
I think every American owes it to her/himself to read a copy of How Doctors Think by Jerome Groopman.
The book is pretty much about the title. Teaching the average person how a doctor thinks so they can leverage that information for better treatment.
Even the best doctors don't have all of the time they would like to keep on medical research. Salespeople from big pharmaceuticals are very aggressive about marketing new drugs directly to doctors and providing them with "updated educations" to go with the drugs. This is discussed in the book and how big pharmaceuticals to pathologize normal occurences in life.
A good example is that past a certain age it is normal for a man's testosterone to slightly decrease every year. Now, there is marketing for testosterone replacement pharmaceuticals......which may actually create problems where there were none.
Programmers might find this book interesting too. The author interviews many doctors about their methods for solving medical mysteries. Doctors spend a lot of time thinking about their thinking, where they went wrong and how they could have done better. I found it interesting that for each doctor who had a "smug story" of walking into a situation to correctly diagnose it quickly, the same doctor had several other stories where s/he ate humble pie by having the evidence right in front of them. Anyone who has ever had to figure out or maintain a poorly designed and poorly documented large application where non-tech people are waiting on results will be able to relate to the book.
Oh no, it's horrific, really. However, I do enjoy being able to walk.
What does being sensible have to do with morality anyway?
which is totally what she said
The reasoning here is deeply flawed- catching things earlier in a preventative phase is healthier, more effective, and cheaper. Even a fasting blood glucose of 130 mg/dL (actually it's 126) as a threshold for diabetes is way way too high. Lowering it more I think would actually reduce health care costs, because at levels lower than this diabetes can be reversed by simple dietary measures like reducing carbohydrates (especially fructose). Fasting glucose gradually progresses over a lifespan as people become diabetic and the earlier you work to correct this the more effective and easier it is. Studies show serious health problems including progressively increasing risk of heart disease in men with levels above 85 mg/dL, as compared to those with levels of 81 mg/dL or lower (http://www.ncbi.nlm.nih.gov/pubmed/16207847).
Well, you have zero prove nor any evidence that his sex life has anything to do with his illness. But, you immediately latched onto his fucking around. Naturally, it MUST be sex, because you are a puritan hypocrite. Go fuck Jesus, or whatever you guys do to get off.
Ubi solitudinem faciunt, pacem appellant.
This is so fucking obvious. This is the USA. Doctors are business men and thus a good one is hard to find. Is this news?
http://www.acetonestudio.com
I generally dislike going to see a physician. It typically goes like this, I have an appointment at some god awful early hour (to me at least) with a physician in another county. I have to take the day off work, drive through horrendous traffic, usually getting lost. It does not seem to matter if I arrive early, on time, or late but it seems that I always have to wait an hour before I can see the physician. In the mean time I'm given this form so the clinic/hospital and "update their records" in which I'm asked all kinds of detailed questions while I'm tired, sick, and/or hungry.
I made a realization one recent time I saw a physician. I think they give you that form to fill out just so you have something to occupy your time while you wait. I was fortunate that time in not having to wait long and I didn't have time to complete the form, I think all it had was my name and address, but they took the form and made no insistence that I complete the form before I left.
Anyway, I broke my feet years ago in the Army and they have now become arthritic. Since then I have been on numerous pain medications, just about all of them disastrous. I'd be given one NSAID after another, none of them working and all of them causing stomach pain. Then they tried steroids, that worked but they won't give them to me again because of side effects from long term use. Then they tried all kinds of "nerve meds" (I don't know the proper term) that are typically used to treat depression or mood disorders, and a few other crazy stuff along the way. That stuff made it difficult to sleep and I was tired all the time.
During this time I had some dental work done and the dentist prescribed paracetamol with codeine for the pain. Wow, that was the first time in years I had a good night's sleep. I didn't have the upset stomach from the NSAIDs, my feet didn't hurt, and there was nothing messing with my head.
After that every time I went to my physician I'd ask for more of that paracetamol with codeine but I'd get something "better" instead. Like an idiot I thought the physicians knew something I didn't and went along with it.
A few months ago I decided I needed to see a physician (this was not my usual physician) since I had considerable pain, hadn't slept in days, and generally could not function. They took blood tests and talked about thyroid diseases, stress, restless leg syndrome, along with "it happens and it will go away on its own". He gave me some of that paracetamol with codeine for the pain and I was able to sleep again.
The last time I go to the physician I complain about the stomach pain returning and they find I have high blood pressure. Turns out that long term use of paracetamol will cause stomach bleeding and high blood pressure. Now they have me on codeine and blood pressure medications. I can sleep and my stomach doesn't hurt. Along with the blood pressure medications they gave me a portable blood pressure measuring machine. My blood pressure is now considered normal only two days after changing my medications.
Was it the blood pressure meds that lowered my blood pressure so quickly or was it that I'm no longer taking paracetamol?
I tell this long story to get to a point that needs to be addressed when it comes to our health care. Why was I not given codeine years ago? Why did I have to suffer from all those horrendous drugs before given something so cheap and effective as codeine? I believe it is because while physicians fear malpractice they also fear being labeled as drug dealers by the government. For some reason the government deems opiate prescriptions as "bad" and will punish physicians that prescribe it too readily.
This "war on some drugs" has had a serious effect on my own personal health and standard of living. One consolation I have is that I did not have to pay for those expensive meds personally since it was provided by federal funds because the pain is considered as a result of my military service. Everyone else in this country should be upset t
I am armed because I am free. I am free because I am armed.
"nuggz" made a good point that today we can detect many diseases before someone has symptoms. Should we return to 19th century medicine, with a friendly country doctor listening to one's heartbeat, breathing, and a knock on one's knees?
The problem is not too many tests! I personally want to have every test that is available to detect things like cancer and heart disease before they manifest!!
The reason that medical costs have risen faster than inflation is not because of too much testing. Rather it is because: (1) payment should be based on the patient's health - not on procedures performed - and, (2) the incentives for the organizations that invest cures and treatments is mis-aligned with our health.
The root problem - and this has been completely omitted from the health care debate - is that drug companies make their R&D decisions based on expected ROI, and cures have a very low ROI, whereas expensive long-term treatments have a very high ROI. Thus, the drug companies will never be the ones to discover a cure for cancer or heart disease: rather, they will discover long term expensive treatments.
Health should not be about profit. It should be about health. It is a non-monetary value. That is why we should eliminate the patenting of drugs, and shift fundamental research for cures to non-profit entities.
And profit-making caregivers should not be paid based on services rendered: they should be paid based on one's long-term health. In that regime, they will want to give tests, and they will invest in the equipment needed.
"Make" more people sick, more $$$ for the hospitals, doctors, drug companies etc. On the other side of the coin, diagnostics helps detect things earlier, so they can be treated before it is too late. Plus, lets say doctor X missing something, and six months later someone finds out they have N stage cancer...too many slip & fall lawyers out there that would sue, just to make a buck.
Yes, the first thing I thought of when he mentioned disease was the big deal he made about fucking shemales in one of his comments recently. There is no evidence that it's his sexual behaviours that led him to this particular disease, but it is an indicator of a general blaise attitude to his health. I'm not religious, nor do I have any moral issues with him fucking anything he wants. I do however think it's incredibly stupid.
which is totally what she said
This graphic comparing costs and life expectancy (and doctor visits) is interesting: http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.html and appears to be well researched.
My girlfriend also a doctor (soon to be).
So how many /.er's have MD girlfriends or wives?
Back to topic. Ban malpractice suits already. In Chinese culture, we believe anything happened is in our own destiny and though no fault of anyone else.
New Economic Perspectives
The problem is, that's not actually what's happening with the healthcare "reform" in the US commonly known as Obamacare.
What's actually happening is that the US is mandating that all people above a certain income threshold buy health insurance from the existing robber baron capitalist system.
This is generally my experience too.
A few years ago I was referred to a "specialist". In the waiting room were pamphlets for some drug to treat a "rare" condition. I read one while I was waiting. Guess what? I was diagnosed with the "rare condition" and left with a prescription for the drug advertised in the pamphlet. I didn't take the drug, I went for a second opinion. The second doctor made a diagnosis that made much more sense. Are chest pains an hour after lunch, after passing heart tests, likely to be a rare form of panic disorder (treated by expensive drugs) or acid reflux? I first went to the doctor because I was worried it was heart related but once that was ruled out the acid reflux seemed more likely and was confirmed by other tests. The panic disorder drugs had terrible side effects which is why I asked a second doctor.
No, it's fine to recommend lifestyle changes where sugar is above normal, because they are homeopathic have no known side effect. However offering allopathic treatments where people are to lazy for lifestyle changes before the point where there is clear and proven benefit in doing so is irresponsible.
How about we sterilize the racists?
By which I mean you should be either castrated by brick or killed outright. Have a nice day.
Haha you can read my prior posts you so funny
Very interesting indeed.
Nowadays, we have effectively been turned into a bunch of idiots who need medical science professionals to address everything that can possibly go wrong with us, and that we are unable to tolerate even the slightest amount of discomfort or inconvenience.
Before someone says that I am an evil Right-Wing nutjob, it needs to be explained that people have progressively had less and less common sense about what is going on with their health: Sniffles and a fever are now treated with a doctor's visit and prescription medications (assuming the "patient" is a previously healthy individual over 5 years old or not elderly), when common sense remedies, like bed rest, fluids and taking it easy, should be tried first. If the condition gets worse (i.e. vomiting, bloody diarrhea, tremors, etc.), THEN a doctor's visit is warranted.
Society does not understand that it is unreasonable to see a doctor every time they feel any kind of discomfort, and that they should use common sense in treating the ailment with common sense approaches. Those that want highly personalized heath care should be the ones that pay for it. For those of us without the $$$$$ needed to pay for a personal doctor, we should be treating ailments with a common sense approach BEFORE going to the doc.
Not every illness is serious, but some are. Many can be treated without a doctor's visit.
Preventive Healthcare means PREVENTING illness to a reasonable degree. If you have a strong family history of liver cancer, then it would be a good idea to have tests performed to make sure none is developing. If you don't, then such tests are unnecessary regardless of how much emotional pining and whining that you can come up with.
ON THE OTHER HAND,
Doctors need to be able to quell unreasonable concerns from their patients, while being able to tell an 'inconvenience' from a 'condition'. Nowadays, Defensive Medicine falls into three categories:
1) They just want to keep from getting sued,
2) They want to keep the customer happy so that they won't have complaints filed against them when they tell them there is nothing wrong and that their issue is not serious or warranting of a full battery of tests and scans,
3) They do not know enough to accurately decide if a problem does, or does not, exist.
Lawsuit caps *do* need to be put in place to keep doctors from losing everything they have when an accident happens. Doctors are human just like everybody else, and they *WILL* make mistakes (anybody who think they don't, or that it won't happen to them is just kidding themselves), and people don't seem to get that, and expect flawless service whenever they ask for it.
Knowing Google's lust for data collection, the Soviet Union is still alive and well inside the psyche of Sergey Brin....
Also means testing for things to try and pick them up before they are serious. There are things that if detected in the early stages are trivial and if detected in late stages are fatal. There are also plenty of things that are much easier to treat and have less effects if caught early and treated thoroughly.
That is why they test for so much. As an example in my life at my last physical the doctor told me that I do not have enough vitamin D in my blood. I'd never heard of this for adults before and apparently it is fairly new to test for. Reason is that research indicates that low vitamin D can cause some chronic problems, even in adults. So now I take supplements, and I need a blood test twice a year to make sure I don't get too much.
So you could say this is unnecessary. After all I was fine before. No acute problems, no symptoms at all. On the other hand, this is pretty cheap prevention. I need one more blood test a year, which is not expensive ($200 at most if I didn't have insurance) and cheap supplements.
Early detection and treatment is something that goes a long way to less health problems, and that can include detection when people are completely non-symptomatic. I'm not saying there aren't problems or downsides too, but it is why access to healthcare is useful.
It is fucktards like you who make health care expensive.
Better the old, the weak and the chronically infected (looking at AIDS folks here) go ahead and die sooner, rather than later.
Draining hard working folks money to extend your useless and worthless lives is a waste of money.
If your goal was to keep your car for as long as you could, and have it run as good as it could, you'd take it to the mechanic often. You'd take it in at least once a year, more as it got older, just for a basic checkup and tune up. This wouldn't be because anything was wrong with it, just to try and catch things early. You'd also take it in any time there was something even slightly off. Like if it had a noise it didn't before, or its handling was different or any of that. You'd get a lot of service done on it.
This is in fact what happens on classic cars and things like that which are expected to last. They are extensively looked after. We don't do it on normal cars partly out of laziness and partly out of economics. We deal with our car when it needs dealing with because something is wrong enough to cause problems. Sometimes not even then. Hell my car has a non-functional AC and I've not bothered to get it fixed because I don't care to spend the money.
Well with cars, that's legit. After all when a car dies, you just get a new one. Maybe you even get a new one before it dies, it still works but is more problematic than you want to deal with.
Not so legit to do with life. Best as we can tell, the one you got is the only one you are going to get to have, so you'd better make the most of it. That means as much maintenance as possible. So what you can do not only to extend your life, but to make sure the quality of said life is high.
Well not regular e-mails. By law they can't because of HIPAA and all that they can't use e-mail because it isn't encrypted. However they contract with a HIPAA approved messaging service you can sign up for. More or less you pay $15/year for a login to a HTTPS site that does messaging which satisfies the requirements. Via that I can e-mail my doctor and get a response. Now that doesn't mean everything gets solved through e-mail, but I can get simple questions answered.
Likewise my insurance offers a 24 hour nurse line. I can call any time and speak to a registered nurse and have questions answered. The questions they can answer are less than a doctor, of course, nurses are the "level 1 tech support" of medicine but they can be helpful for many things.
To me it seems like their support works a lot like the computer support I do professionally does: You can contact via e-mail or phone for simple questions, however if something more serious is wrong, I'm going to make you bring your computer down (and they make me bring myself i) so I can have a look at it personally and render a more informed diagnosis.
If your doctors don't do that, then perhaps it is time to shop for new doctors.
This is my experience, too. Where are these doctors, giving more medical care than I need? I live in an affluent area in California. Yet no doctor has ever mentioned that I seem to have a dislocated shoulder. Yes, I have had a dislocated shoulder since childhood (near as I can figure) which was only diagnosed last year, by a neruomuscular massage physical therapist / body genius.
The shoulder is now relocated (what an amazing feeling of relief and right-ness) but I will need physical therapy for a year or more, to offset the problems caused by other muscles "shouldering" the problem of how to keep my body upright. In retrospect, my physical complaints of being un-coordinated, stumbling into walls frequently, my posture, and my inability to dance or move smoothly, were clearly begging for medical attention.
IMO what we need are more people with knowledge, seeing fewer patients, so they can treat the whole patient, not just a currently-manifesting problem. A life-long Scientist, I now believe that holistic medicine is equally powerful. Science let me down. A dyslexic and unassuming body-worker, making a low-to-comfortable income, was far more effective than a series of well paid doctors over decades of my life.
So which is it? Fight or flight, or the change in diet? You say it's one thing, then immediately say it's another.
Both are important. The twentieth century saw both the dietary oil switch, and the rise of an environment with which our bodies are evolutionarily unequipped to deal with (thereby triggering the fight-or-flight response).
I'm confident a cure will be found within the next decade or two. The hospital where I do my checkups is making very good progress on a targeted immunosuppressant.
You can wait on that. I've seen my dad work with his patients diabetic patients, and the end stage isn't pretty (I assume you still have all your toes). Me, I much prefer to help train my body to have a more productive immune response.
I had an auto-immune condition too, but it wasn't easy to classify & treat like yours, so my doctors brushed me off. Best thing that ever happened to me, as I had to find my own answers.
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Low hanging fruit: Harvested. Difficult questions: Fruit harvested only when money is evident.
Please point to where anyone does that kind of work up.
Fucking people like you who have no clue about the medical industry.
and yes, real worker protections need to be in place.
The Kruger Dunning explains most post on
false. where then fuck do you get this pieces of shit info?
Here is a clue, Dr.s aren't making near the money you seem to think they do.
" Hell, even when they don't find anything, they still make a lot of money."
So?
The Kruger Dunning explains most post on
" while enjoying nice kickbacks from Pfizer, Merck, etc"
that is extremely rare. stop lying. god d,nm you people are ignorant as fuck; which would be ok if you weren't so fixated on spreading you idealogical belief of the medical industry.
I have seen to many people die because of people with your attitude.
The Kruger Dunning explains most post on
what goes on here in the USA is the same thing as Tapecutter posts.
The Kruger Dunning explains most post on
Put simply, I think that, in general, D.O.'s tend to have more tools in the toolbox when it comes to diagnosis.
Some D.O.s have a more tools in their toolbox when it comes to treatment, too. All Osteopathic medical students are required to take courses in "Osteopathic Manipulation", which is very appropriate in many cases.
http://osteohome.com/ is a nice site run by a D.O. who actually uses his hands-on training... Most don't, some use it occasionally, and a few specialize in it. Cayce sometimes advocated osteopathic treatments, and Dr. Reilly has a very nice book: http://books.google.com/books?id=nZHTAJDgozoC
Learn the rules so you know how to break them properly.
www.teslabox.com
I'm not saying they are finding things that don't exist, I'm saying they have EVERY INCENTIVE to do so, because regardless if the malady exists or not, they get their compensation from the insurance company. This is ruining our economy while doctors play golf and drive fancy German cars.
I suggest that a 10 minute office visit costing $150 would infer that doctors make a lot of money. I make $40 an hour and live very comfortably. Quadruple my hourly rate and I'm straight up rich. What in the world are you smoking that would make you think doctors aren't making near the money I seem to think?
Now if you'd like to have a civil conversation, I'm all ears, otherwise piss off.
I know you're super-confident in your beliefs about how incurable diabetes is, but I maintain that there are options. And lookie at what I just read on the wikipedia:
The real problem with western medicine is that it leaves no room for "hope". You've accepted medical dogma that you'll be injecting insulin for life, baring some magic pill or other outside therapy. Beliefs create our personal realities.
Anyhow, good luck with those injections.
Learn the rules so you know how to break them properly.
www.teslabox.com
I'm curious, which part of "I'm confident a cure will be found within the next decade or two. " in my previous post did you understand as me saying it's uncurable.
There is currently no cure. No alternative to insuline pump ou injections. One of the most promising papers as of late was about introducing a gene into either kidney or liver cells (I forget which), which then start producing insuline. As they're not the same as the beta cells in the pancreas, they don't get attacked by the immune system.
However, if you actually keep up on the publications on a specific subject, you'll see a LOT of papers that show a cure. We're constantly being told that the cure is just about ready, just a couple more years to finish developing and testing it. I've seen dozens of either cures or revolutionary treatments published in scientific papers. And so far not a single one has mounted to anything.
So, until there is actually a publicly available cure, then there is no cure. Ongoing medical research doesn't count, as it's constantly promising but never delivering.
And all the "blue dog" democrats who insisted on that instread of single payer are out of office, replaced by republicans. I can't remember the last peice of actually liberal legilsation passed in the United States at the federal level. Maybe Clinton's budget where he cut military spending in 1998? Kind of a weak example.
That was not the driving factor, most sub-prime loans were not government backed. They were far to large to qualify for that.
Well, they weren't, until the bottom fell out. Just sayin'.
Karma: Poor (Mostly affected by lame karma-joke sigs)
Comment removed based on user account deletion
i know i'm posting this late, long after attention has turned its focus to newer stories.
but i know a doctor and i asked for his opinion on this article...
and boy did he have one!
---
What a fuckin Joke,
To think all the voting public is out there, being influenced by this....this guys a fuckin Idiot, but ignorant people believe this guy... life Ain't fair -
Its b/c of attorneys....
The article speaks of the 1 out of 100 we can save...as though that's minor.
The authors a fucking idiot.
If his wifed was 1 in a hundred, now he'd be concerned, or if that was his kid.
I do a hundred patients every 5 weeks, u saying I want death, or a compication?....ONLY ONCE EVERY 5 or 6 weeks?
U think I wanna give away my MD licence for some attorneys Re-Creation of the truth in front of ignorant dumb american jury.?
Fuck you I say to the author, I wish he'd come into my OR, he'd be my next poor outcome, oops, shit happens ...
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i'm just copying and pasting it - his words - probably typed it out on his cell ph
there was more - but i'm sure his opinion wouldn't play well to the slashdot crowd!lol
The simpler explanation as told from my last dental visits:
I was seeing your average mid-life dentist, you know the kind, the one that generally has his assistant do everything except the 'heavy lifting'. He found two cavities, and while prepping me for the drill, aimed himself at the wrong tooth, not once but twice. After his second miserable failure in a matter of seconds I told him to stop what he was doing, as I was about to leave to get another opinion.
A week passes, and I finally get an appointment with another doctor, and guess what... No cavities!
No, there are more sick patients now, because the economy sucks and it pisses off your doctor something fierce that he had to delay his 2nd Ferrari purchase. Plain and simple. My original dentist knew I had good coverage, and this 15 minutes of drilling someones face meant adding to his bottom line. Do no harm my ass.
There is currently no cure. No alternative to insuline pump ou injections
The gallbladder apparently has a roll as a backup insulin-producing organ. Had you heard about that? The alternate to insulin injections is to eat foods that don't require insulin, and allow the gallbladder to take care of the body's reduced insulin needs.
So, until the medical establishment decrees that diabetes has been cured, then there is no cure.
There, fixed that for you. A cure could be staring you in the face, but diabetes is much more profitable for teh medical establishment to treat than to cure. Good luck waiting for them to fix it for you.
Did you see AC's response to your post?
Wow. Typical shit a doctor would say: "Diabetes is something you're never cured from."
1. Not YET, dammit!
2. AS FAR AS YOU KNOW, for god's sake!
The proper statement is:
"Diabetes is something you can not yet be cured from, As far as I know."
There could be a cure right now, that you just haven't heard of, or chose to ignore.
A cure could be available by tomorrow, if someone suddenly comes up with one. Which is likely to happen in the future.
Everything else is extreme arrogance.
- http://slashdot.org/comments.pl?sid=2134108&cid=36057670 (emphasis added)
Thanks for the thread. :)
Learn the rules so you know how to break them properly.
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got your attention? Sorry, I'll be good, but hear me out. I've seen more than one case where a doctor wouldn't order necessary tests because if they come up blank the insurance companies refuse to pay. There's an entire industry (medical billing) that exists to deny care. Just think about this: you're doctor is making decisions about your health care base on how much trouble he'll have to get paid...
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