31–40 of 178 posts
In other words, train doctors to be social justice activists rather than scientists? No thanks.
For better or for worse, everything in America is a business -- healthcare is no exception. Helpful to keep in mind when you think about potential improvements or solutions.
" everything in America is a business " If by "business" you mean a public/private hybrid in which profits are privatized while losses are socialized, then you are correct, in so far as health care goes. And that seems to be the model that is now being adopted in more and more areas of economic activity.
I will say that truly private medicine is, in my reasonably broad experience, excellent. I use a private subscription-only medical service in the US which is excellent (and procedures are generally cheaper than they would be in a public hospital, whether I’m paying with insurance or out of pocket), and my experiences with private medicine in SE Asia and Mexico have been excellent (and affordable) as well (to a greater degree than can be explained by labor cost differences).
Earlier quoted context omitted.
In addition to this, many doctors want to re-take the history from the patients and re-examine them for themselves, rather than rely on a brief handover or potentially sub-optimal notes from another doctor. Clinical signs can be subtle, as can points in a patient's history that may point to a diagnosis. I see patients often frustrated at being asked the same questions by each doctor they see, but most of the time thi…
I try to preempt the frustration by saying that we each take our own history for the purpose of making sure no details are missed, but rest assured, I’ve gotten the overview from your other docs. I then make sure to complete a sentence for them once in a while, to evidence that that is the case. A good percentage still get frustrated. Can’t be helped. Patients reshape their narrative, remember new details, just plain…
I think about this when it comes to providing a patient with "informed consent" for a particular treatment/operation. What does "informed" really mean in this case? A brief overview of the main risks and a couple of statistics? Or a thorough understanding of the pathophysiology of the disease and the trial data supporting the therapy? How long is a piece of string?
Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…
An awful lot of hospitals are organized as non profits. Same with insurance. Spending goes up because a majority of politically engaged people have good access to care that they don't directly see the cost of.
Yep, and they all have administrators that make a ton of money.
I worked for a Blue Cross Blue Shield franchise a decade ago. It is/was a "non-profit", the CEO made 2.1 million dollars per year.
Non-profit != Money well spent
Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…
> Doctors / teachers often don't seem to communicate / care. You really don't have much contact with teachers if you believe this. The education system runs in spite of its systemic horribleness precisely because there are enough teachers who do care and fight/ignore the system when necessary. If you want to actually fix the educational system, we have models for doing so in several different countries. However, they…
This seems to imply that the US doesn’t spend enough money on education, even though it is (one of?) the highest spender(s) on education in the world (just from a quick Google search). I believe the real change needed is better management of how the existing money is spent.
Going to a doctor in America, for whatever reason, the first thing that happens is that a nurse comes and takes your blood pressure. I wonder why? Never happened to me in Europe.
Also, BP, weight, and temperature are important diagnostic indicators
Earlier quoted context omitted.
An awful lot of hospitals are organized as non profits. Same with insurance. Spending goes up because a majority of politically engaged people have good access to care that they don't directly see the cost of.
> An awful lot of hospitals are organized as non profits. Same with insurance. Yep, and they all have administrators that make a ton of money. I worked for a Blue Cross Blue Shield franchise a decade ago. It is/was a "non-profit", the CEO made 2.1 million dollars per year. Non-profit != Money well spent
But hundreds of millions in executive salaries at companies that pay billions in insurance claims isn't the thing driving health care costs. It barely registers.
How would this help solve the problem the article started with, that patients don't heal because they're deprived of sleep by being woken up every 4 hours? It's a problem everyone knows about (I saw complaints about it online years ago) -- so it's not directly a communications problem. Leadership I can see: it seems needed to dig the system out of an inadequate equilibrium (https://equilibriabook.com/molochs-toolbox/) but that's pretty different from college courses in leadership.
> To restore balance between the art and the science of medicine, we should ... make room for training in communication, interpersonal dynamics and leadership. How would this help solve the problem the article started with, that patients don't heal because they're deprived of sleep by being woken up every 4 hours? It's a problem everyone knows about (I saw complaints about it online years ago) -- so it's not directly…
Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…
This sounds like first world problems. You have a doctor you trust to go off script? You trust that when your kids' teachers treat them differently they aren't just stereotyping and limiting them? Lucky you. While you work to unshackle your providers from the mediocrity of "best practices" (and I say that as someone for whom "best practices" is a bane in my own work) keep in mind there are a lot of people for whom competent cookie-cutter care is a wish, not a disappointment. In technology we can let a thousand flowers bloom and we all get to choose and enjoy the most beautiful ones, but in education and health care there's no natural elimination of the worst and amplification of the best. Everyone just lives (or dies) with whoever they randomly end up with, so worst-case performance matters just as much as best-case, and average-case matters a whole lot more.