Why all the/. love for universal health care? Its not just/. It cuts across the entire US population. And its for several reasons.
First, with more and more people who are uninsured or underinsured, the experience of finding oneself with a serious illness and no way to get help without bankrupting yourself and your family is becoming more common. This experience is also entering into the middle class (and even upper middle class) ethos because its not just a poor person's problem anymore.
Second, any idiot with a modicum of intelligence can see that the US health care system is failing the US population. Even those who are insured cannot be guaranteed care when they need it. The US is undergoing an emergency care and on call crisis due to the problems created by uninsurance. If you are a specialist and agree to be on call for a hospital, or you are a hospital who has an ER, or if you are an ER physician on duty in those hospitals, you are bound by the EMTALA law which says you have to provide care for all medical emergencies regardless of ability to pay. This unfunded mandate is pushing emergency care to the breaking point. From 1993 to 2003 in the US, 425 hospital EDs closed their doors; the number of ED visits rose by 26% during the same period (Institute of Medicine, 2006). Moreover try to find that on call neurosurgeon you need to drain your epidural hematoma or the hand specialist to reattach your finger in under 4 hours. Specialists are now refusing to take call because it makes them vulnerable to provide uncompensated care. So while years ago, it was only the poor who suffered, now even the insured are suffering because ERs are overcrowded and specialists are just unavailable. (See what's going on in LA's now as its emergency system implodes if you would like an example.)
Third, (and this is the only thing that has kept me from leaving the US to practice in Canada), I genuinely think the American people are good and want a system that provides people health care just like we provide every child an education and other services like EMS, fire, and police. When bad things happen to others, I think Americans really do want to help. I saw that when I was a chief resident in the ER at Brooklyn's largest trauma center on Sept 11, 2001. We saw it in the actions of individuals and organizations to help NOLA after Katrina when our government stood by with its hand up its ass. Most of us, at heart, are not hateful neocon hawks. However, the hateful neocon hawks have pretty mighty propoganda machines and they were able to fool a lot of people a lot of the time. But eventually we do come around. Witness the phenomena of Evangelical Christians who won't vote Republican because while they don't support abortion rights, or my right to marry my partner, they think that the US's inaction in Darfur, the war in Iraq, the fact that Americans are dying as I type this from preventable diseases, the fact that poor children are abandoned in drug and gun infested warehouses that used to be schools are far worse tragedies than the fact that I have buttsecks with the man I call my husband.
And I would damn rather work in an organization with one of those folks or have one as my neighbor than you. Because she and I would both be Americans who love our country and understand that diversity of beliefs are OK, but that first and foremost we have to ensure that there is social justice, that every child has an education, that every person has health care when they need it, and that our military and our political capital is spent on real problems like resolving the tragedy in Darfur and creating freedom in China rather than creating a profit for Haliburton.
Nick
Institute of Medicine. (2006). Hospital based emergency care: At the breaking point. Washington, DC: National Academies Press.
The more intelligent solution is to outlaw discrimination based on pre-existing medical conditions (thus destroying the business model of the insurance industry as it exists now in the US, which wouldn't be a bad thing). The point of the medical industry is to cure people. The point of the medical insurance industry is to make the most money possible. They are contradictory goals for which only legislation can facilitate a more rational change. Except that its the 'for profit' part that is the problem, whether its health insurance or health care delivery. For profit providers of health care also have the same problem (like the famously substandard care that is delivered at nursing homes owned by large for profit corporations.) And similarly, non-profit insurers (cough-Kaiser-cough) in the US are way not as evil as for profit ones. I have had several patients (in the sliding scale clinic where I volunteer 2 days a week) who sought individual policies who had pre-existing conditions - while none was offered any plan by BCBS, Aetna, Health Net, et al, Kaiser covered them all - albeit after I had to send a buttload of tests on some of them and one with an exclusion for one type of care. Kaiser is also one of the few insurers who doesn't as policy drop individual members when they become ill. But then they spend most of the money they take in on care, and none goes to profit. If you have to pay out 25% of your money as profits and administration, you gotta pinch pennies somewhere. Pruning the sick and expensive folks is easy and very successful!
Its not rocket science: You can do health care for people or for profit. Not both simultaneously.
All that needs to be done is legislation that requires any insurance company to accept anyone, and that the rates for individuals may not differ more than by a factor of 3. More legislation to help drive the cost down: Set a max to the amount of money in case a person dies because of a medical mistake at $100,000 and for invalidity at $500,000. Of course, expect to lose a couple of more quarters for ambulance chasers turned into beggars. First, while I am a doctor and hate med-mal attorneys, they are not what is bankrupting the health care system. They add some, but systematic uninsurance and $0.25 on the dollar profit is what's crippling it.
But let me expand on your idea. Say we require insurers to just charge a set community rate, and not be allowed to decline care because of a pre-existing condition. Of course that would drive the cost of insurance up because a lot of young and healthy folks (who pay more in that they get) would opt out knowing that they could buy insurance in the unlikely event that they became ill. So to control for that, you mandate that *everyone* has to buy insurance (just like we mandate that everyone has to buy car insurance.) People unable to pay (like unemployed people, children, the disabled and elderly) get insurance for free. And people who can pay some but not all are subsidized (like the working poor.) We also decide that since the cost is pretty standard, and its required, that we will just take it out of people's paychecks so they don't have to send a check in every month. Its a higher percentage for people who make more, and lower for those who make less.
Of course its more expensive having 42 companies providing the same thing (42 separate infrastructures and every doctor has to pay people to know how to submit 42 kinds of forms for payment) so we decide that its cheaper if we just use one company to do the work, so they are all merged. And we mandate by legislation that this must be a not for profit corporation. We also can mandate that the insurance provide a certain minimum level of care... and since everyone has it, we are ensured that this level is decent because those who are wealthy and in power have to use the same system that those who are poor and disenfranchised do.
And then... we'd have single payer universal health insurance and 95% of American's health care quality would increase. Unions got a few things right: the weekend is good, child labor is bad, and the fact that we all do better when we all do better.
No. Because no one is subject to random economic events. Yes, people unexpectedly lose their jobs, but anyone who is well prepared won't be subject to significant risk because of that. They will have savings set aside and they understand that they will have the (federally mandated) option to continue their current coverage for up to 18 months if they chose to pay. So, you are working hard at your job, have no consumer debt, own your home, and have $50,000 in savings (much better than most Americans, but lets go for a best case scenario.) Then you get diagnosed with cancer. So you start undergoing treatment, but because of the toll on your health, you have to quit your job. Your EMTALA mandated coverage is $700 a month for you, but you elect to pay it because otherwise you will be unable to receive your treatment. It will take $12,800 of your savings, but that is your first priority.
You begin living as frugally as you can, but the bills keep mounting. Your insurance has a $2,000 deductible per year, then you have to pay 10% of costs up to a maximum out of pocket of $6,000 per year. So the first several months, you pay out $6,000, but then the first of the year hits and you again have to pay $6,000 in the first few months of the next year. So your $50,000 in savings is now down to about $25,000 just with your out of pocket costs and paying 18 months of EMTALA coverage.
The chemo and radiation you receive gives you profound weakness and nausea/vomiting. Unfortunately the inexpensive antiemetics phenergan, compazine, and reglan all give you a severe dystonic reaction. So the only one you can take is zofran, which your insurer refuses to pay for because its non-formulary. You only use it for the worst days after your rounds of chemo and split pills when you can, but its the only thing that will help. Even ordered online at the cheapest Pharmacy you can find they cost $10 a pill. So you end up spending an extra $300 per month for medicine in addition to the $15 per month copay each for your other half a dozen medicines. So your out of pocket drug costs are $400 per month. That plus your bare minimum living expenses (food, utilities, tax on your house, travel to and from the hospital) are about $2000/month. So by the middle of the year, your savings have dwindled to almost nothing.
So you begin borrowing by taking a loan out on your home, this gets you through the end of the year and into the beginning of the next. Unfortunately, as a result of the treatments, you suffered a mild stroke and now have to walk with a walker. So you begin the laborious process of applying for disability. You are initially denied, and hire a lawyer who works on commission, but he tells you it will probably be a year or more before you get disability (and hence medi-medi coverage as well.)
I'm getting tired of writing this, and depressed because its all too common. Over half of people in the US in 2006 who filed for bankruptcy did so because of health care bills. Over half of those were employed and insured when they became ill. Don't fool yourself into believing that you can render yourself immune from this should you lose your health and hence your usefulness to a capitalist society. We discard 'useless people' like yesterdays newspaper. And the only reason it hasn't happened to you is you are still producing.
Except that (given the current model of insurance and health care as a commodity rather than a human right) when you purchase and insurance policy they have every right as a business interested in making money to say: "Do you have any pre-existing medical condition or genetic predisposition to any significant medical illness?" If you say no when the answer is truly yes, you are violating your end of the contract. If that can be proved in the future by subpoenaing your private health care records or if you actually do something like the woman in TFA that reveals your genetic status in your health care records, they can cancel your policy, since you lied when entering the contract for health insurance.
And since this is a business contract, your medical privacy is meaningless since the insurer can also (as a condition of selling you the policy) require you to allow access to all medical records and tests. Of course they likely won't do that unless you actually become sick and they have to pay money for your care. If they do, they hire people to scour your medical record for one slip up (like you may not have revealed you had a cold in December 1987 for which you were prescribed robitussin with codeine) as a means to void your policy.
Events like the recent ruling in favor of a woman whose insurance was canceled while she was undergoing treatment for breast cancer (because she had failed to reveal a history of a heart ailment and she mis-estimated her weight) are unusual - but only in that the arbitration judge ruled in her favor. Most of the time, arbitration (which you must agree to when buying any private insurance - they all require it) goes in favor of the side with the best attorneys to back them. No surprise that the insurers love arbitration. However this case was so egregious that even the arbitration judge was shocked - for example by the fact that healthnet maintained there was no real harm to the woman from dropping her (since after a couple of months she was able to get care in a state program) or the fact that company documents revealed that employees of healthnet actually got bonuses based on the number of policies the were able to cancel for patients on whom the company was losing money (i.e. sick ones.) http://www.latimes.com/features/health/la-fi-insure23feb23,1,2680255.story
People already do this with tests other than genetic ones. I have heard many times: "Don't write this in my record but..." with regard to 'stealth' health care problems. In most states you can order labs without a doctor's prescription through direct to consumer labs, so you can find out all sorts of things that can effect your insurability. Heck, go to a pharmacy and you can check your BP for free.
The solution of course isn't congress passing a bill that makes such discrimination illegal, but rather to pass a bill that establishes universal health insurance (preferably single payer, but lets be honest, the US is far too much a classist society to adopt that... sigh.) Though what's particularly stupid about such a bill is that it would outlaw discrimination from insurers if I noted in your record that you had a blood test that said you were predisposed to diabetes or hypertension, but it would not outlaw the same discrimination that would occur if I noted in your chart that your BP was 160/100 or your fasting blood sugar was 160. If we diagnose your hypertension or diabetes with a $2000 test, you are safe, but if I diagnose it with a $3 lab test or by taking your BP several times, you are hosed.
Actually you are not even asking the right question: it isn't whether the patient is seeking drugs, but why, and whether or not those are appropriate medicines to use. If a patient with metastatic cancer comes to the ER and says 'I ran out of my dilaudid and I am hurting' he is indeed seeking drugs. And I will give him whatever he thinks needs and ask him if he wants fries with it.
In fact most people who are labeled 'drug seekers' are experiencing significant pain (often including withdrawal pain.) And there are many people who are not labeled 'drug seekers' who take far more opioid pain meds than your average ER seeker. The difference between the two is that those labeled as seekers have developed very dysfunctional methods for meeting their need for pain relief. They perceive the only way to get relief is with a certain opioid rx. So they lie and say they are allergic to 'all nsaids'. I saw yesterday a person who listed an allergy to tylenol, but could take vicodin (which contains tylenol.) So they will say the 'right things' to get what they think they need.
But its not because they are not hurting, but because of dysfunctional care seeking behavior. So they get labeled a seeker and then the behaviors get even worse... because they will do what they have to in order to get what they see is the only way to get relief from pain. So if they have to do more acting out, they will. And not knowing what is going on, allows the patient to doctor shop and double dip without anyone being able to intervene and actually help the person. The sad part is, most can be helped with a motivated primary care doctor and a commitment to be honest and transparent. But if the chance for them to roam ER to ER exists, they will usually see that as the 'easiest way'.
Lastly, you've got to be kidding about detection. Yes, I can find 75% of 'seekers' with my eyes closed, but its the 25% that don't fit the profile that are hard to detect (and hence probably never get 'counted'.) Diagnosing a heart attack is easier.
Giving people their records doesn't solve it. Its not just a question of whether the notes/docs in that system are digitally signed, but also whether every note that a provider wrote is included. Say for example, your name is Rush and you like oxycodone and hydrocodone. A lot.
So on Monday you go see Dr Smith, who writes you for 120 x 10mg doses. Then you just erase Dr Smith's note from your record, and on Tuesday go see the good Dr Mendez, who writes for 80 x 10mg doses. Then delete again and go to see the esteemed Dr Patel on Wednesday, who writes you for 90 x 10mg doses.... you get the idea. And that's just one example, there are many others... the schizophrenic who does not have schizophrenia, the patient with active TB who doesn't want to be bothered wearing a mask when he goes to the ER, the patient who has a history of violent behavior to female health care providers, etc.
So while it might be very distasteful to some, its not only important that you can only add verifiable data to your record, but also that many things should not be suppressible by the individual. Its as much a lie to say that Dr Smith diagnosed you with cancer when he didn't as it is to remove the data that you have active TB. So a third party is actually a good compromise. Neither the provider nor the patient has total control, but each can add to the record in a manner that is bound by established, transparent, and reasonable rules.
Your religion dictates that you ignore any and all science that runs contrary to your belief system. Hmmm, never knew secular humanism espoused that.
I've heard that one a thousand times. It doesn't matter who I reference, if they disagree with you, you paint them as an oil shill, a bush-ite, or just plain crazy. Ahh, so you mean you can't make a reference from a reputable scientific organization. Because there isn't any. So you imply that you could... you just won't because I will call the French National Academy of Science a bunch of cheese eating denier-monkeys?
Your refusal to provide any legitimate scientific support for your ideology covered by a thinly veiled attempt to distract from the real point is completely transparent. Perhaps you could look at a few Creationist arguments, they at least do them with a bit of style.
Schools are required to teach a lot of specific things. For example in CA, here are the (very detailed) state mandated standards for primary science education: http://www.cde.ca.gov/be/st/ss/scmain.asp
Schools aren't required to teach about the dangers of ozone depletion, nuclear fallout, or mercury poisoning -- what exactly is it that elevates this particular environmental catastrophe to the point of being required curriculum in primary education? We mandate you have to teach kids to read in English, but not that they are fluent in Latin. You can't teach fourth graders everything, but you can make sure you hit the high points - a threat to humanity of this magnitude is a high point. In addition, like evolution in biology you can't really teach Earth Science without covering this. It would be like trying to understand biology while ignoring evolutionary theory: you can do it, but it resembles stamp collecting more than it does science.
Most global warming cultists are entirely unaware that an opposing view even exists and that makes them easy targets whenever there is a discussion that their religion views as heresy. You take arguments about the details of the theory to indicate that there is a real opposing view to the concept itself. That is no more true for global warming than it is for evolutionary theory.
Creationists are fond of 'airing the dirty laundry' of evolutionary biologists by flying real academic debate up the flagpole. When Stephen Jay Gould said Darwin was wrong about gradualism. Punctuated equilibrium is a better model of evolution that was shortened by them to Darwin was wrong.
You are doing the same thing here. Show me a reputable scientific society or organization that does not agree that global warming is happening and humans are part of the cause. They might argue that its 50% instead of 80%, but no one is arguing its not there.
Same difference. No its no. It is different in exactly the same way that mandating teaching evolutionary theory is not the same as mandating teaching creationist nonsense. They are not 'equivalent theories'. One is unanimously supported by experts in the field in the scientific community, the other is a bunch of shite supported by a bunch of religious whackjobs who work out of single wide trailers in the middle of North Dakota that they call international scientific institutes.
Its not that mandating is bad. Its that mandating based on religion, racism, xenophobia, homophobia, or any other fucktarded cognitive dissonance extravaganza is bad.
They establish the new climate change curriculum, which of course is biased towards the fanatical environmentalist agenda, and teachers have to cover it whether they like it or not. OK, how about this then. We legislate what is supported by NOAA, the USEPA, the American Meterological Society, and the US National Academy of Science? Completely boring, pocket-protectored, the bibliography is the best part of the journal article, geektastic real scientists? No Greenpeace Rulz, hemp is a viable product, anti-GMO, anti-vaccination, crystal wearing weirdos?
and teachers have to cover it whether they like it or not. Exactly, then if you were a teacher you would have to teach that global warming is real and man made. Since that's what NOAA et al support. You would of course hate this, because you get your scientific information the popular media and your skepticism has its roots more in Rush Limbaugh than in a scientific journal. And that's precisely why you'd be pissed and precisely why we need legislation like this.
Whether you agree with the Bushies or the Greens, this seems like a bad idea to me. Do we really want politicians mandating which subjects our children are taught? Shouldn't that be left to someone... I dunno... competent? Yes, great idea. Consult with experts. We do that in many areas of the government. For example the government mandates that the VA system exist and that it meet certain minimum standards. However its not like congressmen are mandating that no patient can die at a VA hospital or UTIs have to be treated with Cipro as a first line agent. Because they consult with experts and leave that to the experts... like say, I dunno....
* The National Oceanic and Atmospheric Administration
* The US Environmental Protection Agency
* NASA's Goddard Institute of Space Studies
* The American Geophysical Union
* The American Institute of Physics
* The National Center for Atmospheric Research
* The American Meteorological Society
* The Royal Society of the UK
* The Canadian Meteorological and Oceanographic Society
* And Academies of Science in 20 countries
Or wait... lets ask a real expert: CA State Senator Jeff Denham (R-Modesto)
"From what I have seen the Earth has heated and cooled on its own for centuries. I don't know that there's anything that is a direct cause of that right now, but we can do a better job of cleaning up our planet." Thanks for clearing that up for us professor Jeff!
Um, that's called establishing a curriculum and its no different than mandating other specific educational goals. In public schools there should be a basic standard. That standard includes at a minimum what concepts must be covered in a subject.
The Creationsts probably wish that mandated curriculum didn't exist in the first place since intimidating individual teachers in small towns is easier than school boards (Kansas notwithstanding.) However as they do exist, the creationists will use them to the best of their abilities to cripple science education and push their religious agenda.
OK, I had a look. From that article:
It's very difficult to obtain accurate statistics when studying unnecessary surgery. Dr. Leape in 1989 wrote that perhaps 30% of controversial surgeries are unnecessary. Controversial surgeries include Cesarean section, tonsillectomy, appendectomy, hysterectomy, gastrectomy for obesity, breast implants, and elective breast implants. This is a good example of why Mark Twain was right. Take for example appendectomy which they cite as a 'controversial' unnecessary surgery. There is no controversy that an appendectomy is necessary for real appendicitis. Without it, you will likely die from complications. However, especially in the era before CT scans (when the article they cite was written) the certainty of the diagnosis of acute appendicitis was always in question.
Faced with 100 patients with fever, right lower quadrant pain, and vomiting, 50 of whom have appendicitis and 50 of whom don't, you do 100 appendectomies. There is no way to know who really has appendicitis till you open them up. If you operate on no one, 50 people will die. If you operate on all of them none or very few will die.
However, you can say retrospectively that you did 50 unnecessary surgeries.
The same can be said for Cesarean Section. If you have 100 babies in distress, 50 might come out fine if you don't do a section. The other 50 are placed at risk of serious complications or even death. If you know prospectively who will do great, then you will never do an 'unnecessary section'. However neither the OB or the patient knows that so both usually choose to err on the side of caution.
Of course that caution saves lives but allows fear-mongering pseudo-scientists whack-jobs to make statements like the World Natural Health Organization you cite. Its no wonder if you go to the main page they also don't believe in global climate change, are anti-gay-marriage, anti-vaccination, anti-flouride, anti-abortion, and anti-aspartame, whack jobs. They also hawk ministerial credentials, have a 'Responsibility in Free Speech' banner, a homeland security threat advisory, and a fetus near the bottom of their main page. http://www.wnho.net/
Those are definitely the people I'd go to for my health care info. I'm sure that's completely unbiased.
As a constructive suggestion though, the next time you'd like to make that point, you could do so without having to quote whack-jobs like those. The 1999 Institute of Medicine Report "To Err is Human" gives reliable figures, though the number of deaths is an order of magnitude less than the figure you quote. Its still an issue that needs to be addressed by systems change, but the sky isn't falling.
Keep in mind that while you are being so diligent over here, there are literally billions of people in China, India and the like who simply take antibiotics for every illness, bacterial or viral. There is a pool of 2 billion people abusing antibiotics, creating resistant strains. The precautions you take within our tiny population have essentially no impact on the bigger picture. And statistically speaking, me voting in an election will have no effect whatsoever on the leadership of my local, state, and federal government. But I still vote. And statistically speaking, if I don't make decisions about my carbon footprint, it will have almost zero effect on the ultimate result of global climate change. But I still drive my 2003 civic hybrid which my partner and I share (my partner also has a motorcycle), limit my meat intake, recycle, live in a small well insulated house (with solar panels.) If everyone acted in the way you suggest we'd be in deeper shit than we already are.
And occasionally, you get it wrong and fail to prescribe an antibiotic to someone who needs it. So take your diligent practice and shove it. You're not a scientist, you're a procedure-following monkey. Um, scientists are procedure following monkeys. Disregarding things like biohazard precautions, the scientific method itself is a procedure. Its when you start having the hubris to say that you are above the scientific method that you cease to be a good scientist. Its when you have the hubris to say that regardless of the conclusions of evidence based medicine and research into best practices, you know what's best that you cease to be a good doctor. When I make decisions, you are right that I occasionally get it wrong. However, I think I am a much less dangerous practicing to the best of my abilities according to evidence based medicine than if I practiced as you suggest. Not prescribing antibiotics for viral infections decreases the risk of resistance when everyone does it, but also decreases the risk to individual patients of adverse effects (anaphylaxis, stevens johnson syndrome, antibiotic associated enterocolitis, etc.)
So yes, I am a procedure following monkey. I also follow the ideal of 'think globally, act locally' in both my practice and my personal life. And you bet your ass I am very proud of that.
Several posters already beat me to rebut most of your post, but I do have a few additions.
You, someone who thinks that 30 minutes is WAY to long to discuss a persons treatment. Actually I would be pleased as punch if I could have a full hour for every single patient. However last night in the ER, in the ten hours I was there 30 people insisted on coming to the ER making an hour per patient impossible without a rent in the time-space continuum. So in order to spend extra time with the people who were truly sick, I had to spend a little less time with the people who were less sick. Unfortunately its people like you who insist that they deserve 30 minutes to wheedle and annoy your doctor into acquiescing to your insistence on antibiotics or other unnecessary treatments who make it so that I don't have enough time to spend on the patients who really need it.
Of course the argument could be made that there should be more doctors (on staff in a hospital ER, and in the universe, if you believe that everyone not just yourself deserves an hour or more of time for each visit to the doctor.) Which will make things a great deal more expensive. If you only want that for yourself, you also always have that option. In many places in the US, you can find what are referred to as a 'concierge doctors.' These are physicians who provide exactly what you want: excellent access to physicians (always can get same day appointments, available by phone 24/7), extra time at each visit (an hour or more at each visit, even if its for a sore throat), doctors who will spend extra time to research problems and solutions, and even (gasp) house calls.
However, to use your restaurant analogy: you aren't getting Le Bec Fin for the cost of a McDonalds Super Value Meal. Concierge practices are expensive, often do not take private insurance. So if you want that, you'll have to pay extra.
Your hostile arrogance simply reinforces the distrust of doctors. I know that I don't want someone with your level of hostile arrogance cooking my food, and I definitely don't want someone with your level of hostile arrogance deciding important factors in my health. Again, I will use your restaurant analogy, since I worked in the food service industry pretty extensively to get through school. Its a shitty analogy the way you use it, but its a good one for making one point to you. Most people don't assume that waitstaff spits in your food. Most waits don't spit in your food. A minority of patrons (generally asshats like yourself) do think their food is spit-enhanced frequently. A miniscule number of times, some psycho wait does probably spit in your food. So the asshat patron minority does several things: 1) they perpetuate the myth that food is often spit-enhanced, 2) they taint every interaction with waitstaff with a defensive and distrustful feeling that poisons the relationship, 3) in doing so, they actually make it more likely that the few psycho waits really will spit in your food, 4) asshats usually don't tip, so they reinforce the 'patron=prick' assumption psycho waits have, thus increasing the spit risk for even normal patrons.
But fortunately most people really are decent. Most patients, most doctors, most waits, and most patrons. So the majority of interactions don't go the way yours often do. Most people go to a restaurant assuming that the wait will treat them OK. Most people go to doctors assuming that the doctor really will try to help them to the best of his ability. So perhaps you should ask yourself why you so often have bad interactions with physicians (and waits and cops and salespeople, etc.) Perhaps you should consider for just a moment that the common thread that runs through all of your dysfunctional relationships is YOU.
Really? Evolution has been progrmaming people to kill their mates through disease? Whoa, I've missed a lot in sex ed! Gee, why just sex ed?
That box of chocolates you were considering getting your honey for V-Day? You want to give him/her diabetes and coronary artery disease?
Driving over the posted speed limit, using your cell phone while driving, or driving with less than eight good hours sleep last night with your partner in the car? You want to kill him/her in a fiery motor vehicle accident?
Taking your honey on vacation this year to some exotic locale? Well the extra radiation exposure from the plane flight might cause him/her ultimately to die from cancer. Not to mention the risk of malaria, dengue, etc.
Perhaps you can't pull the pole out of your puritanical ass long enough to realize that the reason you have singled out sex as the object of your ire has nothing to do with the risk to which you place your partner and everything to do with the tremendous amount of cognitive dissonance rattling around in your uptight little brain.
However, consider: those millions of years of evolution made us complex thinking animals who defy the black and white reasoning that you seem to believe rules our decision-making. People's choices reflect the sum of multiple factors with varying levels of influence. A mother who gives her child an ice-cream because he's skinned his knee is not a bad person who has no love for her son. Certainly that sort of use of sugary treats as a comfort may ultimately cause him health problems later on. Mom may even know that.... but her baby is crying and she knows what will make him feel better then. So she may make a decision that is not the perfectly best course of action for her child.
But you weren't talking about an ice cream and a skinned knee, you were talking about faggots having buttsecks. That's different!
Its no cure (get it & you're still going to die The question is whether you will die with it instead of from it. There is no cure for diabetes, but if treated properly you can control the disease and live to a ripe old age and die from something else. Similarly, there is no cure for HIV. However we are getting to the point that HIV is becoming like diabetes: depending on your age at diagnosis, treat it appropriately, and you will live to a ripe old age and die from something else.
Once you take a disease and extend the average time from diagnosis to death past a certain point that is greater than the average life expectancy, it ceases to be a death sentence and becomes a chronic illness. If you contract HIV at age 40, and on average people live 35 years after diagnosis, and your life expectancy is 73 years, HIV becomes like diabetes. Its just a matter of extending that time from diagnosis to death long enough.
It wasn't as fun as having sex, but I had made the decision to not take post-exposure prophylaxis after a needlestick in an HIV positive patient when I learned his viral load was undetectable. Having taken PEP before (crixivan gave me a kidney stone and I pretty much puked non-stop) I know the adverse effects. However, PEP decreases the chance of transmission significantly in the case of blood or sexual exposure to HIV.... but you have to take it for a month.
In my case the infinitesimal increase in a miniscule risk that I would contract HIV from a patient with an undetectable viral load because I didn't take PEP was not worth the certain risk that I would feel craptastic for 4 weeks and possibly have another kidney stone.
And I didn't seroconvert. That was four years ago, when we were only mostly sure.
For every one antibiotic rx I write for an illness that probably doesn't need it (generally because I am a wimp) I have to convince another ten people who are certain that they need antibiotics... that they don't.
Generally the reason most physicians prescribe inappropriately is because asshats like Mr "I have not had a doctor do, or say anything to me that I did not already know since I was about 10" know better that they absolutely do need antibiotics (when they obviously don't). It takes thirty seconds to write the prescription and sometimes thirty minutes to escape the asshat.
I actually had a complaint letter written to the CEO of the hospital where I worked a few years back from a parent who brought their child into the ER with what was obviously a viral syndrome. Their letter literally said I brought my child to the ER to get a prescription for antibiotics, not to be told that he didn't need antibiotics. And I get several complaints yearly from irate people who didn't like my answer that they didn't need antibiotics. I've never gotten a complaint when I prescribed them.
So you can't have it both ways. If you want a doctor who has real clinical acumen, you can't also have him be a prescription vending machine.
"because it's *not* the trivial step that you claim it is". Please be so kind and show me where I said it was trivial. What I said (and in fact what I repeated again) is that while they do finance some parts of drug development, they finance a smaller part than does the federal government. (And in fact the research they do perform is also subsidized by tax breaks.)
Here's a bonus question to redeem yourself: Why do you think pharmas give free pizza to physicians? Duh. Because it works. (Quite well actually.) That's why I have since residency not taken a single pen, pepperoni, or post-it note from drug reps. I also don't allow them to detail me. The only thing that I will take from them at all is drug samples, largely because the patient population I see is very often uninsured. I actually am a bit neurotic about it. If there is a Pharma sponsored talk that I really want to see (not all of them are bad), I will either take a bag lunch or tell the restaurant that I want to order and pay for for myself off the usual menu. I also don't allow my prescribing practices to be available to drug reps. (And they wouldn't like it anyway, I am a big fan of older drugs that have been taken by a gazillion people - even in my insured patients. Older often = safer.)
(Hint: how do 100% objective, licensed, certified, don't-you-fucking-ever-question doctors make health care decisions for patients?) In my case, read the NEMJ weekly, occasional reviews in other good journals, cochrane, up-to-date, AAFP's free online journal Family Practitioner, eMedicine. Though I also encourage people to ask questions and am beyond neurotic about the informed consent process. And there is no such thing as objective, but then even if it were possible, it would be undesirable in most physicians. If you care about your patients as a person, they are more likely to get 'the care I would want my mom to get.'
But let me give you a little piece of free advice. If you go in to see a physician (or any person-person interaction) without that chip on your shoulder the size of Wisconsin, you might get a better response. There are great people and consummate dicks in every profession - medicine, computer science, police, teaching, etc. However, if you make the assumption that every person in a given field fits your preconceived notions (as you apparently do about medicine) that's going to be apparent to anyone with half an ear or eye open. With a cop, you'll often get a ticket. With a doctor, you will often get defensive medicine without the human component that is critical (IMO) to practicing decent medicine.
I don't know what bad experience you had with health care, and I honestly am sorry you had one or more. I believe that everyone deserves high quality, compassionate, and culturally competent health care. I insist in my own practice that I have ten minute longer appointments (30 instead of the standard 20) because I want to make sure that people have the time to get their questions answered. And most of my sick patients have my personal cell phone and email address. I think that the fact that a third of non-elderly adults in the US are uninsured for part or all of every year is a moral disaster of moonumental proportions.
Incidentally, why don't you spend some of your time providing the more expensive pharmaceutical work for free instead of the less expensive work that you currently do for free? I mean, since you're so indignant about their returns and all... For the same reason I don't volunteer as a teacher, for habitat for humanity, community developer, etc. While I could probably do those successfully, I wouldn't be happy and I probably wouldn't be as good at those as I am at being a primary care doctor. I have a certain skill set and the best thing I can do with my volunteer time is use that skill set to the best possible advantage. Its like if you are an attorney and want to do 12 hours a week volunteer work - why work handing out soup at a soup kitchen when you could give a lot more valuable resource if you did pro bono legal work? To each according to his need, from each according to his ability. (Yes, I am a socialist-pinko-fag.)
Slashdot Mirror
First, with more and more people who are uninsured or underinsured, the experience of finding oneself with a serious illness and no way to get help without bankrupting yourself and your family is becoming more common. This experience is also entering into the middle class (and even upper middle class) ethos because its not just a poor person's problem anymore.
Second, any idiot with a modicum of intelligence can see that the US health care system is failing the US population. Even those who are insured cannot be guaranteed care when they need it. The US is undergoing an emergency care and on call crisis due to the problems created by uninsurance. If you are a specialist and agree to be on call for a hospital, or you are a hospital who has an ER, or if you are an ER physician on duty in those hospitals, you are bound by the EMTALA law which says you have to provide care for all medical emergencies regardless of ability to pay. This unfunded mandate is pushing emergency care to the breaking point. From 1993 to 2003 in the US, 425 hospital EDs closed their doors; the number of ED visits rose by 26% during the same period (Institute of Medicine, 2006). Moreover try to find that on call neurosurgeon you need to drain your epidural hematoma or the hand specialist to reattach your finger in under 4 hours. Specialists are now refusing to take call because it makes them vulnerable to provide uncompensated care. So while years ago, it was only the poor who suffered, now even the insured are suffering because ERs are overcrowded and specialists are just unavailable. (See what's going on in LA's now as its emergency system implodes if you would like an example.)
Third, (and this is the only thing that has kept me from leaving the US to practice in Canada), I genuinely think the American people are good and want a system that provides people health care just like we provide every child an education and other services like EMS, fire, and police. When bad things happen to others, I think Americans really do want to help. I saw that when I was a chief resident in the ER at Brooklyn's largest trauma center on Sept 11, 2001. We saw it in the actions of individuals and organizations to help NOLA after Katrina when our government stood by with its hand up its ass. Most of us, at heart, are not hateful neocon hawks. However, the hateful neocon hawks have pretty mighty propoganda machines and they were able to fool a lot of people a lot of the time. But eventually we do come around. Witness the phenomena of Evangelical Christians who won't vote Republican because while they don't support abortion rights, or my right to marry my partner, they think that the US's inaction in Darfur, the war in Iraq, the fact that Americans are dying as I type this from preventable diseases, the fact that poor children are abandoned in drug and gun infested warehouses that used to be schools are far worse tragedies than the fact that I have buttsecks with the man I call my husband.
And I would damn rather work in an organization with one of those folks or have one as my neighbor than you. Because she and I would both be Americans who love our country and understand that diversity of beliefs are OK, but that first and foremost we have to ensure that there is social justice, that every child has an education, that every person has health care when they need it, and that our military and our political capital is spent on real problems like resolving the tragedy in Darfur and creating freedom in China rather than creating a profit for Haliburton.
Nick
Institute of Medicine. (2006). Hospital based emergency care: At the breaking point. Washington, DC: National Academies Press.
Its not rocket science: You can do health care for people or for profit. Not both simultaneously.
But let me expand on your idea. Say we require insurers to just charge a set community rate, and not be allowed to decline care because of a pre-existing condition. Of course that would drive the cost of insurance up because a lot of young and healthy folks (who pay more in that they get) would opt out knowing that they could buy insurance in the unlikely event that they became ill. So to control for that, you mandate that *everyone* has to buy insurance (just like we mandate that everyone has to buy car insurance.) People unable to pay (like unemployed people, children, the disabled and elderly) get insurance for free. And people who can pay some but not all are subsidized (like the working poor.) We also decide that since the cost is pretty standard, and its required, that we will just take it out of people's paychecks so they don't have to send a check in every month. Its a higher percentage for people who make more, and lower for those who make less.
Of course its more expensive having 42 companies providing the same thing (42 separate infrastructures and every doctor has to pay people to know how to submit 42 kinds of forms for payment) so we decide that its cheaper if we just use one company to do the work, so they are all merged. And we mandate by legislation that this must be a not for profit corporation. We also can mandate that the insurance provide a certain minimum level of care... and since everyone has it, we are ensured that this level is decent because those who are wealthy and in power have to use the same system that those who are poor and disenfranchised do.
And then... we'd have single payer universal health insurance and 95% of American's health care quality would increase. Unions got a few things right: the weekend is good, child labor is bad, and the fact that we all do better when we all do better.
You begin living as frugally as you can, but the bills keep mounting. Your insurance has a $2,000 deductible per year, then you have to pay 10% of costs up to a maximum out of pocket of $6,000 per year. So the first several months, you pay out $6,000, but then the first of the year hits and you again have to pay $6,000 in the first few months of the next year. So your $50,000 in savings is now down to about $25,000 just with your out of pocket costs and paying 18 months of EMTALA coverage.
The chemo and radiation you receive gives you profound weakness and nausea/vomiting. Unfortunately the inexpensive antiemetics phenergan, compazine, and reglan all give you a severe dystonic reaction. So the only one you can take is zofran, which your insurer refuses to pay for because its non-formulary. You only use it for the worst days after your rounds of chemo and split pills when you can, but its the only thing that will help. Even ordered online at the cheapest Pharmacy you can find they cost $10 a pill. So you end up spending an extra $300 per month for medicine in addition to the $15 per month copay each for your other half a dozen medicines. So your out of pocket drug costs are $400 per month. That plus your bare minimum living expenses (food, utilities, tax on your house, travel to and from the hospital) are about $2000/month. So by the middle of the year, your savings have dwindled to almost nothing.
So you begin borrowing by taking a loan out on your home, this gets you through the end of the year and into the beginning of the next. Unfortunately, as a result of the treatments, you suffered a mild stroke and now have to walk with a walker. So you begin the laborious process of applying for disability. You are initially denied, and hire a lawyer who works on commission, but he tells you it will probably be a year or more before you get disability (and hence medi-medi coverage as well.)
I'm getting tired of writing this, and depressed because its all too common. Over half of people in the US in 2006 who filed for bankruptcy did so because of health care bills. Over half of those were employed and insured when they became ill. Don't fool yourself into believing that you can render yourself immune from this should you lose your health and hence your usefulness to a capitalist society. We discard 'useless people' like yesterdays newspaper. And the only reason it hasn't happened to you is you are still producing.
Except that (given the current model of insurance and health care as a commodity rather than a human right) when you purchase and insurance policy they have every right as a business interested in making money to say: "Do you have any pre-existing medical condition or genetic predisposition to any significant medical illness?" If you say no when the answer is truly yes, you are violating your end of the contract. If that can be proved in the future by subpoenaing your private health care records or if you actually do something like the woman in TFA that reveals your genetic status in your health care records, they can cancel your policy, since you lied when entering the contract for health insurance.
And since this is a business contract, your medical privacy is meaningless since the insurer can also (as a condition of selling you the policy) require you to allow access to all medical records and tests. Of course they likely won't do that unless you actually become sick and they have to pay money for your care. If they do, they hire people to scour your medical record for one slip up (like you may not have revealed you had a cold in December 1987 for which you were prescribed robitussin with codeine) as a means to void your policy.
Events like the recent ruling in favor of a woman whose insurance was canceled while she was undergoing treatment for breast cancer (because she had failed to reveal a history of a heart ailment and she mis-estimated her weight) are unusual - but only in that the arbitration judge ruled in her favor. Most of the time, arbitration (which you must agree to when buying any private insurance - they all require it) goes in favor of the side with the best attorneys to back them. No surprise that the insurers love arbitration. However this case was so egregious that even the arbitration judge was shocked - for example by the fact that healthnet maintained there was no real harm to the woman from dropping her (since after a couple of months she was able to get care in a state program) or the fact that company documents revealed that employees of healthnet actually got bonuses based on the number of policies the were able to cancel for patients on whom the company was losing money (i.e. sick ones.) http://www.latimes.com/features/health/la-fi-insure23feb23,1,2680255.story
People already do this with tests other than genetic ones. I have heard many times: "Don't write this in my record but..." with regard to 'stealth' health care problems. In most states you can order labs without a doctor's prescription through direct to consumer labs, so you can find out all sorts of things that can effect your insurability. Heck, go to a pharmacy and you can check your BP for free.
The solution of course isn't congress passing a bill that makes such discrimination illegal, but rather to pass a bill that establishes universal health insurance (preferably single payer, but lets be honest, the US is far too much a classist society to adopt that... sigh.) Though what's particularly stupid about such a bill is that it would outlaw discrimination from insurers if I noted in your record that you had a blood test that said you were predisposed to diabetes or hypertension, but it would not outlaw the same discrimination that would occur if I noted in your chart that your BP was 160/100 or your fasting blood sugar was 160. If we diagnose your hypertension or diabetes with a $2000 test, you are safe, but if I diagnose it with a $3 lab test or by taking your BP several times, you are hosed.
Brilliant.
Actually you are not even asking the right question: it isn't whether the patient is seeking drugs, but why, and whether or not those are appropriate medicines to use. If a patient with metastatic cancer comes to the ER and says 'I ran out of my dilaudid and I am hurting' he is indeed seeking drugs. And I will give him whatever he thinks needs and ask him if he wants fries with it.
In fact most people who are labeled 'drug seekers' are experiencing significant pain (often including withdrawal pain.) And there are many people who are not labeled 'drug seekers' who take far more opioid pain meds than your average ER seeker. The difference between the two is that those labeled as seekers have developed very dysfunctional methods for meeting their need for pain relief. They perceive the only way to get relief is with a certain opioid rx. So they lie and say they are allergic to 'all nsaids'. I saw yesterday a person who listed an allergy to tylenol, but could take vicodin (which contains tylenol.) So they will say the 'right things' to get what they think they need.
But its not because they are not hurting, but because of dysfunctional care seeking behavior. So they get labeled a seeker and then the behaviors get even worse... because they will do what they have to in order to get what they see is the only way to get relief from pain. So if they have to do more acting out, they will. And not knowing what is going on, allows the patient to doctor shop and double dip without anyone being able to intervene and actually help the person. The sad part is, most can be helped with a motivated primary care doctor and a commitment to be honest and transparent. But if the chance for them to roam ER to ER exists, they will usually see that as the 'easiest way'.
Lastly, you've got to be kidding about detection. Yes, I can find 75% of 'seekers' with my eyes closed, but its the 25% that don't fit the profile that are hard to detect (and hence probably never get 'counted'.) Diagnosing a heart attack is easier.
Nick
Giving people their records doesn't solve it. Its not just a question of whether the notes/docs in that system are digitally signed, but also whether every note that a provider wrote is included. Say for example, your name is Rush and you like oxycodone and hydrocodone. A lot.
So on Monday you go see Dr Smith, who writes you for 120 x 10mg doses. Then you just erase Dr Smith's note from your record, and on Tuesday go see the good Dr Mendez, who writes for 80 x 10mg doses. Then delete again and go to see the esteemed Dr Patel on Wednesday, who writes you for 90 x 10mg doses.... you get the idea. And that's just one example, there are many others... the schizophrenic who does not have schizophrenia, the patient with active TB who doesn't want to be bothered wearing a mask when he goes to the ER, the patient who has a history of violent behavior to female health care providers, etc.
So while it might be very distasteful to some, its not only important that you can only add verifiable data to your record, but also that many things should not be suppressible by the individual. Its as much a lie to say that Dr Smith diagnosed you with cancer when he didn't as it is to remove the data that you have active TB. So a third party is actually a good compromise. Neither the provider nor the patient has total control, but each can add to the record in a manner that is bound by established, transparent, and reasonable rules.
Your refusal to provide any legitimate scientific support for your ideology covered by a thinly veiled attempt to distract from the real point is completely transparent. Perhaps you could look at a few Creationist arguments, they at least do them with a bit of style.
Schools aren't required to teach about the dangers of ozone depletion, nuclear fallout, or mercury poisoning -- what exactly is it that elevates this particular environmental catastrophe to the point of being required curriculum in primary education? We mandate you have to teach kids to read in English, but not that they are fluent in Latin. You can't teach fourth graders everything, but you can make sure you hit the high points - a threat to humanity of this magnitude is a high point. In addition, like evolution in biology you can't really teach Earth Science without covering this. It would be like trying to understand biology while ignoring evolutionary theory: you can do it, but it resembles stamp collecting more than it does science.
Creationists are fond of 'airing the dirty laundry' of evolutionary biologists by flying real academic debate up the flagpole. When Stephen Jay Gould said Darwin was wrong about gradualism. Punctuated equilibrium is a better model of evolution that was shortened by them to Darwin was wrong.
You are doing the same thing here. Show me a reputable scientific society or organization that does not agree that global warming is happening and humans are part of the cause. They might argue that its 50% instead of 80%, but no one is arguing its not there.
Its not that mandating is bad. Its that mandating based on religion, racism, xenophobia, homophobia, or any other fucktarded cognitive dissonance extravaganza is bad.
They establish the new climate change curriculum, which of course is biased towards the fanatical environmentalist agenda, and teachers have to cover it whether they like it or not. OK, how about this then. We legislate what is supported by NOAA, the USEPA, the American Meterological Society, and the US National Academy of Science? Completely boring, pocket-protectored, the bibliography is the best part of the journal article, geektastic real scientists? No Greenpeace Rulz, hemp is a viable product, anti-GMO, anti-vaccination, crystal wearing weirdos?
and teachers have to cover it whether they like it or not. Exactly, then if you were a teacher you would have to teach that global warming is real and man made. Since that's what NOAA et al support. You would of course hate this, because you get your scientific information the popular media and your skepticism has its roots more in Rush Limbaugh than in a scientific journal. And that's precisely why you'd be pissed and precisely why we need legislation like this.
Way to prove the point.
* The National Oceanic and Atmospheric Administration
* The US Environmental Protection Agency
* NASA's Goddard Institute of Space Studies
* The American Geophysical Union
* The American Institute of Physics
* The National Center for Atmospheric Research
* The American Meteorological Society
* The Royal Society of the UK
* The Canadian Meteorological and Oceanographic Society
* And Academies of Science in 20 countries
Or wait... lets ask a real expert: CA State Senator Jeff Denham (R-Modesto) "From what I have seen the Earth has heated and cooled on its own for centuries. I don't know that there's anything that is a direct cause of that right now, but we can do a better job of cleaning up our planet." Thanks for clearing that up for us professor Jeff!
Though I will give you the answer.... the opposing view of non-scientist whacktards.
Um, that's called establishing a curriculum and its no different than mandating other specific educational goals. In public schools there should be a basic standard. That standard includes at a minimum what concepts must be covered in a subject.
The Creationsts probably wish that mandated curriculum didn't exist in the first place since intimidating individual teachers in small towns is easier than school boards (Kansas notwithstanding.) However as they do exist, the creationists will use them to the best of their abilities to cripple science education and push their religious agenda.
Not only are you right, but succinct. I can never say that in so few words. Can I copy that and use it later?
Faced with 100 patients with fever, right lower quadrant pain, and vomiting, 50 of whom have appendicitis and 50 of whom don't, you do 100 appendectomies. There is no way to know who really has appendicitis till you open them up. If you operate on no one, 50 people will die. If you operate on all of them none or very few will die.
However, you can say retrospectively that you did 50 unnecessary surgeries.
The same can be said for Cesarean Section. If you have 100 babies in distress, 50 might come out fine if you don't do a section. The other 50 are placed at risk of serious complications or even death. If you know prospectively who will do great, then you will never do an 'unnecessary section'. However neither the OB or the patient knows that so both usually choose to err on the side of caution.
Of course that caution saves lives but allows fear-mongering pseudo-scientists whack-jobs to make statements like the World Natural Health Organization you cite. Its no wonder if you go to the main page they also don't believe in global climate change, are anti-gay-marriage, anti-vaccination, anti-flouride, anti-abortion, and anti-aspartame, whack jobs. They also hawk ministerial credentials, have a 'Responsibility in Free Speech' banner, a homeland security threat advisory, and a fetus near the bottom of their main page. http://www.wnho.net/
Those are definitely the people I'd go to for my health care info. I'm sure that's completely unbiased.
As a constructive suggestion though, the next time you'd like to make that point, you could do so without having to quote whack-jobs like those. The 1999 Institute of Medicine Report "To Err is Human" gives reliable figures, though the number of deaths is an order of magnitude less than the figure you quote. Its still an issue that needs to be addressed by systems change, but the sky isn't falling.
So yes, I am a procedure following monkey. I also follow the ideal of 'think globally, act locally' in both my practice and my personal life. And you bet your ass I am very proud of that.
Of course the argument could be made that there should be more doctors (on staff in a hospital ER, and in the universe, if you believe that everyone not just yourself deserves an hour or more of time for each visit to the doctor.) Which will make things a great deal more expensive. If you only want that for yourself, you also always have that option. In many places in the US, you can find what are referred to as a 'concierge doctors.' These are physicians who provide exactly what you want: excellent access to physicians (always can get same day appointments, available by phone 24/7), extra time at each visit (an hour or more at each visit, even if its for a sore throat), doctors who will spend extra time to research problems and solutions, and even (gasp) house calls.
However, to use your restaurant analogy: you aren't getting Le Bec Fin for the cost of a McDonalds Super Value Meal. Concierge practices are expensive, often do not take private insurance. So if you want that, you'll have to pay extra. Your hostile arrogance simply reinforces the distrust of doctors. I know that I don't want someone with your level of hostile arrogance cooking my food, and I definitely don't want someone with your level of hostile arrogance deciding important factors in my health. Again, I will use your restaurant analogy, since I worked in the food service industry pretty extensively to get through school. Its a shitty analogy the way you use it, but its a good one for making one point to you. Most people don't assume that waitstaff spits in your food. Most waits don't spit in your food. A minority of patrons (generally asshats like yourself) do think their food is spit-enhanced frequently. A miniscule number of times, some psycho wait does probably spit in your food. So the asshat patron minority does several things: 1) they perpetuate the myth that food is often spit-enhanced, 2) they taint every interaction with waitstaff with a defensive and distrustful feeling that poisons the relationship, 3) in doing so, they actually make it more likely that the few psycho waits really will spit in your food, 4) asshats usually don't tip, so they reinforce the 'patron=prick' assumption psycho waits have, thus increasing the spit risk for even normal patrons.
But fortunately most people really are decent. Most patients, most doctors, most waits, and most patrons. So the majority of interactions don't go the way yours often do. Most people go to a restaurant assuming that the wait will treat them OK. Most people go to doctors assuming that the doctor really will try to help them to the best of his ability. So perhaps you should ask yourself why you so often have bad interactions with physicians (and waits and cops and salespeople, etc.) Perhaps you should consider for just a moment that the common thread that runs through all of your dysfunctional relationships is YOU.
Damn you! You figured out the trick! Now we will have to kill you.
That box of chocolates you were considering getting your honey for V-Day? You want to give him/her diabetes and coronary artery disease?
Driving over the posted speed limit, using your cell phone while driving, or driving with less than eight good hours sleep last night with your partner in the car? You want to kill him/her in a fiery motor vehicle accident?
Taking your honey on vacation this year to some exotic locale? Well the extra radiation exposure from the plane flight might cause him/her ultimately to die from cancer. Not to mention the risk of malaria, dengue, etc.
Perhaps you can't pull the pole out of your puritanical ass long enough to realize that the reason you have singled out sex as the object of your ire has nothing to do with the risk to which you place your partner and everything to do with the tremendous amount of cognitive dissonance rattling around in your uptight little brain.
However, consider: those millions of years of evolution made us complex thinking animals who defy the black and white reasoning that you seem to believe rules our decision-making. People's choices reflect the sum of multiple factors with varying levels of influence. A mother who gives her child an ice-cream because he's skinned his knee is not a bad person who has no love for her son. Certainly that sort of use of sugary treats as a comfort may ultimately cause him health problems later on. Mom may even know that.... but her baby is crying and she knows what will make him feel better then. So she may make a decision that is not the perfectly best course of action for her child.
But you weren't talking about an ice cream and a skinned knee, you were talking about faggots having buttsecks. That's different!
Once you take a disease and extend the average time from diagnosis to death past a certain point that is greater than the average life expectancy, it ceases to be a death sentence and becomes a chronic illness. If you contract HIV at age 40, and on average people live 35 years after diagnosis, and your life expectancy is 73 years, HIV becomes like diabetes. Its just a matter of extending that time from diagnosis to death long enough.
It wasn't as fun as having sex, but I had made the decision to not take post-exposure prophylaxis after a needlestick in an HIV positive patient when I learned his viral load was undetectable. Having taken PEP before (crixivan gave me a kidney stone and I pretty much puked non-stop) I know the adverse effects. However, PEP decreases the chance of transmission significantly in the case of blood or sexual exposure to HIV.... but you have to take it for a month.
In my case the infinitesimal increase in a miniscule risk that I would contract HIV from a patient with an undetectable viral load because I didn't take PEP was not worth the certain risk that I would feel craptastic for 4 weeks and possibly have another kidney stone.
And I didn't seroconvert. That was four years ago, when we were only mostly sure.
For every one antibiotic rx I write for an illness that probably doesn't need it (generally because I am a wimp) I have to convince another ten people who are certain that they need antibiotics... that they don't.
Generally the reason most physicians prescribe inappropriately is because asshats like Mr "I have not had a doctor do, or say anything to me that I did not already know since I was about 10" know better that they absolutely do need antibiotics (when they obviously don't). It takes thirty seconds to write the prescription and sometimes thirty minutes to escape the asshat.
I actually had a complaint letter written to the CEO of the hospital where I worked a few years back from a parent who brought their child into the ER with what was obviously a viral syndrome. Their letter literally said I brought my child to the ER to get a prescription for antibiotics, not to be told that he didn't need antibiotics. And I get several complaints yearly from irate people who didn't like my answer that they didn't need antibiotics. I've never gotten a complaint when I prescribed them.
So you can't have it both ways. If you want a doctor who has real clinical acumen, you can't also have him be a prescription vending machine.
But let me give you a little piece of free advice. If you go in to see a physician (or any person-person interaction) without that chip on your shoulder the size of Wisconsin, you might get a better response. There are great people and consummate dicks in every profession - medicine, computer science, police, teaching, etc. However, if you make the assumption that every person in a given field fits your preconceived notions (as you apparently do about medicine) that's going to be apparent to anyone with half an ear or eye open. With a cop, you'll often get a ticket. With a doctor, you will often get defensive medicine without the human component that is critical (IMO) to practicing decent medicine.
I don't know what bad experience you had with health care, and I honestly am sorry you had one or more. I believe that everyone deserves high quality, compassionate, and culturally competent health care. I insist in my own practice that I have ten minute longer appointments (30 instead of the standard 20) because I want to make sure that people have the time to get their questions answered. And most of my sick patients have my personal cell phone and email address. I think that the fact that a third of non-elderly adults in the US are uninsured for part or all of every year is a moral disaster of moonumental proportions.
Incidentally, why don't you spend some of your time providing the more expensive pharmaceutical work for free instead of the less expensive work that you currently do for free? I mean, since you're so indignant about their returns and all... For the same reason I don't volunteer as a teacher, for habitat for humanity, community developer, etc. While I could probably do those successfully, I wouldn't be happy and I probably wouldn't be as good at those as I am at being a primary care doctor. I have a certain skill set and the best thing I can do with my volunteer time is use that skill set to the best possible advantage. Its like if you are an attorney and want to do 12 hours a week volunteer work - why work handing out soup at a soup kitchen when you could give a lot more valuable resource if you did pro bono legal work? To each according to his need, from each according to his ability. (Yes, I am a socialist-pinko-fag.)