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Why Did My Patient Leave Me?

cancer.nautil.us

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Re: Why Did My Patient Leave Me?

#41

Post by ajnin »

ThomPete wrote: post #24
jacquesm wrote: post #18

Earlier quoted context omitted.

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant…

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

You're right that the budget is tighter, however the healthcare budget is separate from the main state budget, and you can't have a situation where for example you'd allocate less to health to pay for schools or army or something like that. The money still comes from taxes though and there is enormous pressure currently due to the economic situation in Europe, especially from businesses, to lower those taxes. It can be sometimes hard to get people to defend this system when they have never had a big health concern before.

However when you switch to a for-profit healthcare then the interests of the operators stop being aligned with those of the population. Even if there is more money, like in the US where the budget per person is about double that of France, it is not necessarily spent in a way that benefits the patients. State-run health avoids multiple administrative costs due to multiple actors, it avoids having to pay dividends to share holders, and as a single payer it has much more power over the pharmaceutical industry to lower costs. Overall it is a more efficient use of people's money.

Re: Why Did My Patient Leave Me?

#42

Post by maxerickson »

ThomPete wrote: post #24
jacquesm wrote: post #18

Earlier quoted context omitted.

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant…

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

Much of the US has certificates of need which impose limits on who can operate certain machines or have a hospital.

And Medicare makes funding decisions based on what sort of care hospitals provide to patients. Critical access hospitals get higher reimbursement; maintaining that certification means a short average for length of inpatient stays and not growing to meet demand.

Re: Why Did My Patient Leave Me?

#43

Post by DanBC »

ThomPete wrote: post #24
jacquesm wrote: post #18

Earlier quoted context omitted.

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant…

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

> and thus has budgets that are politically mandated not determined by market demand at least not directly.

Why is market demand a good thing?

In the US the government spends more per capita than France, but gets worse health outcomes.

Re: Why Did My Patient Leave Me?

#44

Post by jacquesm »

ThomPete wrote: post #32
jacquesm wrote: post #26

Earlier quoted context omitted.

Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it. NL had a very good system which got replaced by something much less efficie…

My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they g…

Yes, those poor people with recreational broken legs really should pay for their own work. That's only about 25K or so in a bad case without further complications... /s

Re: Why Did My Patient Leave Me?

#45

Post by agumonkey »

XorNot wrote: post #39
agumonkey wrote: post #10

Earlier quoted context omitted.

Well, I've been plunged into this very issue. Even for cancer care, I found no trace of collaboration. It was bureaucratic, sometimes cold, out of sync (no news, contradictory news). No team work possible. Also if you ever try to mention alternate ideas, you get dismissed right away. And for fallacious reasons. Mostly statistical and experience driven, which looked like myopia to me. I'm actually collecting evidence…

People looking for alternatives for cancer care tend to look for things which literally do nothing (high profile example: Steve Jobs), or get fixated on experimental drugs which have a high likelihood of being ineffective or much more immediately fatal.

Fair point. I just think a bit like DeVita: delay death (in a moral manner, not at any cost); then treat with recent combinations/molecules. The regulations forbid combinational trials first and delay learning (according to him).

There are potent tumor inhibitors like CBD that aren't accepted by most of the medical field, thus patients too (high trust in the doctors). They can alleviate symptoms and slow down metastasis (some academics have seen regression even). This gives time to plan for the rest. Instead you're sent home to die thinking it's hopeless. I guess it's better than dying at hospital, or being cut into pieces by resections... but it's far from acceptable IMO.

Re: Why Did My Patient Leave Me?

#46

Post by cortic »

ThomPete wrote: post #24
jacquesm wrote: post #18

Earlier quoted context omitted.

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant…

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

I do question the morality of the US system, and the sustainability of inflated prices it creates.

Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly.

This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc.

Not saying the EU system is better, but then that depends whether you are a shareholder or a patient.

Re: Why Did My Patient Leave Me?

#47

Post by ljoshua »

DanBC wrote: post #40
ljoshua wrote: post #9

This is a growing and very important aspect of value-based care, and really factors into the discussion of quality that will be more a part of reimbursement than it ever has been. The article focused mostly on the provider him or herself, but patients also take into account the entire experience, including office staff, scheduling and billing procedures, etc. Shameless self promotion: this is the exact problem my co-…

People interested in this might also like the "Friends and Family test", which is used extensively in the English NHS. http://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/nhs-frie... https://www.england.nhs.uk/ourwork/pe/fft/

That's virtually the exact same thing as the question we're asking, which is virtually exactly the same as NPS (net promoter score). Thank you for the links, I hadn't seen those ones before.

Re: Why Did My Patient Leave Me?

#48

Post by dexterdog »

lmns wrote: post #28

So, in this sense, vaccination should be an individual choice? This is something which concerns the individual, but has consequences for society as a whole.

Not related. Vaccination is for the population as a whole more so than the individual. Experimental treatments are a risk the individual should be able to choose to take.

Re: Why Did My Patient Leave Me?

#49

Post by jacquesm »

QSIITurbo wrote: post #34
pbhjpbhj wrote: post #6

Earlier quoted context omitted.

>the doctor then ordered someone else not in the room to come and get me a glass of water // It seems possible that was a hygiene issue. For example the doctor knew that he'd need then to wash his hands again (possibly twice, once before going to the cupboard, once after), or change his gloves, before continuing with your consultation?

Another alternative that I've run into. Visiting a doctor friend of mine. She needed to deliver some papers to another room and summoned the nurse for that. I joked that why you can't do that yourself (omg) and she replied that the nurses start to complain if you do stuff that's earmarked to them. It might be that it's because they're in a union or it's a company policy. Who knows, I never asked. But the point was th…

That would still not trump patient comfort. It's ego all over again, now from a different angle.

Re: Why Did My Patient Leave Me?

#50

Post by chimeracoder »

speeder wrote: post #20

I don't bother explaining to doctors why I switched. Every time I did in the past they got personally offended and refused to address their flaws, so why bother? Also I am almost convinced good medics in certain fields (endocrinology for example) are almost nonexistent.

> Also I am almost convinced good medics in certain fields (endocrinology for example) are almost nonexistent.

Endocrinologists are legally all but required to have the presumption that their patients are criminals, and that the patient must prove otherwise.

Because of the ban on "cosmetic" use of anabolic steroids and other hormones, which was passed under Bush Sr., endocrinologists are flooded with patients who concoct really elaborate stories explaining why they need hormones.

The liability is so high for endocrinologists that they are incentivized not to be the most convenient provider around, lest they develop a reputation as the one who prescribes easily.

The people who suffer the most from all of this are the people who need hormones the most: transgender people and people with serious hormone disorders, but the system is not designed to make their lives convenient.

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