Why Did My Patient Leave Me? • Hacker News Board

Re: Why Did My Patient Leave Me?

#161

Post by arkades » Sat, Apr 15, 2017, 4:14 PM UTC

losteverything wrote: post #68

brightball wrote: post #52

Earlier quoted context omitted.

If you can justify the expense, MD VIP ( http://www.mdvip.com/ ) is worth exploring. You basically pay an annual fee and in trade, the doctor's office caps their patient load at a certain number. The fee also includes an annual executive physical and work up. The benefit is that with the smaller patient load, you can almost always get an immediate appointment. The doctor will actually get to know you and your history…

Our mdvip experience was different. We paid the $1500 a year a few times. Got a thorough physical - but Dr. and office dropped the ball on follow up. So when we didn't renew, we were bombarded by AOL-like contact wondering why we left. (We hardly ever say negative things on questions like this) But it got worse. We wanted a simple refill on an inhaler and the mdvip Dr refused. We had to rejoin first!!! Pay $1500 for…

Depending on the time gap between your leaving and calling for an inhaler refill, that may have violated state ethics regulations and constitute malpractice. Docs have a standing obligation to former patients, generally regarded as something like 3-6 mos., to address emergency issues (e.g., writing a script for a life-saving inhaler).

Re: Why Did My Patient Leave Me?

#162

Post by ThomPete » Sat, Apr 15, 2017, 4:14 PM UTC

mistersquid wrote: post #110

ThomPete wrote: post #69

Earlier quoted context omitted.

No thats actually not true which Denmark has lots of data to show. It's 100% free to go to the doctor yet a lot of people don't go for checkups it's not a common thing to do. Furthermore the situation is even worse for men over 50. So access to healthcare has very little to do with that.

Earlier you write: > 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. and later write: > 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 f…

Not sure exactly what you are confused about.

I was responding to a post who claimed that if there isn't free checkup for all then people wouldn't go to get checked.

I simply pointed out that even in a country like Denmark which is 100% free people thats not the case.

So you would have to show causation between general checkups and cost of healthcare I don't think you will be able to find that.

Re: Why Did My Patient Leave Me?

#163

Post by arkades » Sat, Apr 15, 2017, 4:15 PM UTC

mhneu wrote: post #152

CydeWeys wrote: post #114

I abandoned an orthopedist last year because I felt that he was using hard-sell tactics on me to get me to agree to surgery for my broken ankle. Basically, he had a surgery slot open in a few days and it seemed like he wanted to book it, with increasing discounts (including exploding offers!) on the surgery as I kept demurring. He was a referral from the urgent care clinic that I went to immediately following the acc…

Things I have learned about orthopedists: - they have only one tool and it is surgery. If you don't need surgery, you need to see a physical therapist. PTs know far more about soft tissue injuries and rehab than orthopedists. - orthopedists make money from each surgery they do. Many orthos are honest, but some areas of US have orthos who run joint replacement factories to maximize profit. In the past few months I've…

Physiatrists. Physical Medicine & Rehab doctors. They're the non-surgical equivalent of orthopedists.

PT's... are fine folks. But if you want to avoid surgery and need a proper injury evaluation, you go to PM&R.

Re: Why Did My Patient Leave Me?

#164

Post by ThomPete » Sat, Apr 15, 2017, 4:15 PM UTC

mhneu wrote: post #135

Ok, now this is just being obtuse. Parent post said single payer encourages checkups. You said "but there are still people that don't get checkups in Denmark". Those two points are completely orthogonal. Single payer encourages checkups, yes. Still some people won't get them, yes. Drop the sophistry.

I said that in a system like that Danish which has single payer, that's not the case. I.e. the claim that single payer encourages that isn't true if you look at Denmark.

Make of that what you want.

Re: Why Did My Patient Leave Me?

#165

Post by CydeWeys » Sat, Apr 15, 2017, 4:19 PM UTC

HillaryBriss wrote: post #141

CydeWeys wrote: post #114

I abandoned an orthopedist last year because I felt that he was using hard-sell tactics on me to get me to agree to surgery for my broken ankle. Basically, he had a surgery slot open in a few days and it seemed like he wanted to book it, with increasing discounts (including exploding offers!) on the surgery as I kept demurring. He was a referral from the urgent care clinic that I went to immediately following the acc…

maybe it goes without saying, but you also avoided the infection risks which come with surgery.

Yeah, and the risk of spontaneous anesthesia death (it's rare, but some people simply don't ever wake up). There's always plenty of reasons not to get surgery, and the only reason to get it is if the outcome for the injury is better, which it wasn't in this case! The default should be to not get surgery unless it has a clearly better expected outcome, whereas the orthopedist seemed to default to surgery for any injury.

Re: Why Did My Patient Leave Me?

#166

Post by arkades » Sat, Apr 15, 2017, 4:20 PM UTC

peferron wrote: post #16

jacquesm wrote: post #4

I've done this, without feedback. The reason was that doctors seem to come in several varieties when it comes to bringing their ego to work and my doctor had a serious case of that. I was dehydrated after an operation and when he asked if he could do something for me I asked for some water, the doctor then ordered someone else not in the room to come and get me a glass of water. He couldn't be bothered to walk to the…

Regarding your first point, that's especially striking in the USA. There seems to be at least 4-5 assistants (nurses, secretaries...) for each doctor. Assistants check you in; you're left waiting in a room; after a seemingly random period of time, the doctor suddenly barges in, diagnoses you faster than the Flash, and leaves just as suddenly; assistants check you out. I get that it's very efficient to work this way,…

That's not a hierarchy thing.

Docs are the chokepoint in the process. Overseers track very carefully how much time you spend, how productive you are, etc. and surround you with lower-wage employees to do every last thing except those responsibilities that you, by law, have sole power to do.

My buddies are in latter years of residency and no one works that's despite running around like their hair is on fire. I assure you, it's not voluntary.

Re: Why Did My Patient Leave Me?

#167

Post by ThomPete » Sat, Apr 15, 2017, 4:21 PM UTC

cortic wrote: post #120

ThomPete wrote: post #92

Earlier quoted context omitted.

It's not that simple. Single payer systems also decide who to treat and for what sicknesses, what machines to buy etc. The reason why the US system is so expensive is because of perverse incentives given to the industry. As long as you can afford it I would rather be treated in the US system than the French or Danish system.

" [] systems also decide who to treat and for what" - in privately owned companies, this decision is made to maximize profits, in publicly owned companies this decision is made to please constituents. "The reason why the US system is so expensive" - Is because an individual with a health condition is in a poor position to negotiate the price of a treatment for themselves. To the extent a private company could give fa…

NO I say this because I have lived both i Denmark and currently live in the US and have had two melanomas and are expecting more because I have more than a thousand of them. So I have a pretty good idea of the capabilities of the US vs. ex the Danish system.

Re: Why Did My Patient Leave Me?

#168

Post by CydeWeys » Sat, Apr 15, 2017, 4:22 PM UTC

jacquesm wrote: post #142

CydeWeys wrote: post #100

Earlier quoted context omitted.

> The counter point (to that convenient strawman :) ) is that the chances of someone getting ill are not as easy to determine and that that someone might have gotten ill anyway. Cause and effect are a lot more distant in that case and much harder to relate to each other. This is wishy-washy logic. There are real evidence/data-based scientific studies that show the specific measurable increase in infections of various…

I'm fully aware that some people will suffer because of this. That doesn't mean that we should force our views and our beliefs on those that do not share those, even if we have the science on our side. There are some pretty basic elements at play here and if you want to over-rule the right to basic bodily integrity you're going to have to do better than to quote statistics. By that rule we should force everybody to e…

Do the people and babies who cannot be vaccinated not have a right to their own bodily integrity as well? If that's really what you care about, then it seems better to require most people to get mild vaccines than to force some people to get deadly illnesses.

Re: Why Did My Patient Leave Me?

#169

Post by jacquesm » Sat, Apr 15, 2017, 4:26 PM UTC

lkbm wrote: post #154

jacquesm wrote: post #55

Earlier quoted context omitted.

> So, in this sense, vaccination should be an individual choice? Emphatically: YES. Bodily integrity is something that is very high on the list of things that a person should have a say over. Whether they do it because they are mis-informed, dumb, irrational or religious doesn't matter, they still should have the final say over whether or not they get a specific injection or not. There are many things that concern th…

> and fortunately the only people at risk are those that have not been vaccinated yet No, vaccines are not 100% effective. For example, the H3N3 vaccine was 90% effective[1]. So the only people at risk are those not yet vaccinated...and an additional 10% of the people who did get the vaccine. Also, as noted in another reply, many, many people can't get vaccinated and rely on those of us who can to not be spreading th…

> and an additional 10% of the people who did get the vaccine.

That's hardly the fault of the people who didn't get vaccinated.

> Also, as noted in another reply, many, many people can't get vaccinated and rely on those of us who can to not be spreading the disease around.

True

> You can't vaccinate a newborn, for example.

Also true, I'm painfully aware of that one.

> There's a lot of value in bodily autonomy, and it's definitely questionable to mandate vaccines, but that has to be weighed against the costs, and that requires understanding and honestly acknowledging the costs.

Yes again. This also includes honestly looking at the other side of the argument: if you want science rather than regular imprecise human reasoning to take over at all levels of society you will end up with a society where freedom of religion and all kinds of other goodies that we have come to agree are good for all of us are going to be thrown out.

I would rather see steps in that direction come about by consent than by force. We're all so tremendously fanatical about protecting life, at the same time those abortion clinic bombers claim they are doing the exact same thing.

Extremist positions (such as the anti-vaxxers) are not going to yield because of a push by force-majeure. The only way you're going to get such a position to be changed is by endless education and information so that finally, hopefully soon but better later than never people will decide that this is for the best of their kids.

And if they don't then all you'll end up doing is alienating that part of society even further from reason and that's the last thing you want.

Science is a good thing, let's not make it seem as though it is perfect and let's not repeat the exact same mistakes that religions perform over and over again, such as deciding how others should live their lives. The miracles of modern medicine are large enough that they can speak for themselves and over a long enough time-span the anti-vaxxers movement will be just another blip.

But if you start to push back you are only making it bigger, better to respect their right to make the wrong decisions than to force them creating even more resentment and ill-will.

Re: Why Did My Patient Leave Me?

#170

Post by ThomPete » Sat, Apr 15, 2017, 4:27 PM UTC

cortic wrote: post #113

ThomPete wrote: post #71

Earlier quoted context omitted.

I am unconvinced any of the systems are sustainable. The US system isn't better it's different. The inflated prices aren't due to it being more privately driven but because of lobbying which can be dealt with.

EU systems get much better outcomes for a fraction of the cost, and you think that's 'unsustainable'? 'lobbying' can be dealt with a either side of the pond, the only thing you are arguing for is making profit from the poor and sick.

Better outcomes doesn't shield you from in-sustainability if your cost still is bigger than the money you can afford to put into it.

The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlepayer system.

In a system more driven by market you can actually make money.

It's finding the right balance between those two I consider the most interesting part of this discussion. Unfortunately it's impossible to have this discussion because people either see you as a singlepayer proponent or a 100% marketdriven proponent.