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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#41

Post by candiodari »

OliverJones wrote: post #21

Let's be careful about nostalgia for the "good old days" of medical practice. Keep in mind that standardizing medical care process has done more to get physicians to WASH THEIR HANDS than all kinds of exhortations about relationships, partnerships, and healing. And washing hands has, since Semmelweis's discoveries 150 years ago, been known as the easiest way to promote healing that medical people don't do. Why do the…

This. Every healthcare system in the world needs to choose.

We simply cannot have healthcare for everything, including rare, expensive and/or hopeless diseases (or all 3 at the same time). As long as that's what we demand, healthcare will go wrong.

And let's please just stop pretending that this is somehow an America-only problem, caused by whatever (democrats: by not being public conservatives: by public largesse. And yes, despite how it sounds I do think both arguments have merit). True, America has it bad, but healthcare is failing, financially or otherwise everywhere in the developed world [1]. And healthcare in the non-developed world ... well, this was in the newspaper 2 days ago [2].

Healthcare is failing in the developed world for economic reasons. Those are not about to change, so it will get worse unless we figure this thing out with major changes (which ARE going to include limiting treatment).

[1] https://www.politico.eu/article/europe-health-care-systems-o... or more specific https://www.theguardian.com/society/2016/aug/16/nhs-cancels-... https://www.bloomberg.com/news/articles/2013-01-03/frances-h... and let's just not mention Spain or Greece's health care system.

[2] http://deredactie.be/cm/vrtnieuws.francais/Soci%25C3%25A9t%2...

Re: Doctors, Revolt

#42

Post by GiorgioG »

maxerickson wrote: post #37
GiorgioG wrote: post #34

Earlier quoted context omitted.

> 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

Gee I wonder why I used the exact phrase organized as non profits . 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.

Administrative overhead in 2014 accounted for 25% of US hospital spending.

http://www.commonwealthfund.org/publications/in-the-literatu...

Overall the administrative overhead is 8% for healthcare in the US, more than double global average (3%)

http://money.cnn.com/2017/01/11/news/economy/healthcare-admi...

Re: Doctors, Revolt

#43

Post by aaavl2821 »

OliverJones wrote: post #21

Let's be careful about nostalgia for the "good old days" of medical practice. Keep in mind that standardizing medical care process has done more to get physicians to WASH THEIR HANDS than all kinds of exhortations about relationships, partnerships, and healing. And washing hands has, since Semmelweis's discoveries 150 years ago, been known as the easiest way to promote healing that medical people don't do. Why do the…

That may be true, but one aspect of the "good old days" (at least in the common cultural imagining of the "good old days") is that you could get more attention from doctors outside of a hospital setting, even at home, and that doctors had more time overall to spend with each patient

All the procedures you describe seem like very important improvements in quality of hospital care, but there is (or should be) more to the healthcare conversation than what happens in the hospital

Re: Doctors, Revolt

#44

Post by araes »

mikecsh wrote: post #28
araes wrote: post #22

Earlier quoted context omitted.

This was the desired behavior. Its not that they reviewed existing info to check for changes, its that they knew nothing. Like the last 30 minutes of questions and chart didn't exist. On the side of the patient, this does not inspire confidence. It projects a sense of confusion and disorganization.

> its that they knew nothing That does sound rather concerning if that's the case! As a medical student about to sit my final exams, I have shadowed hundreds of doctors of different grades and specialties in many different hospitals and family practices, and I don't recall ever seeing a doctor not review the notes before seeing a patient. Often here in the UK at least there is a large amount of time pressure and it w…

You bring up good points and your last is particularly relevant in this case, as the patient arrived with what were termed simple problems, was expelled due to lack of finances, died suddenly a week later apparently due to MRSA contracted at the care facility, and the family is now considering malpractice. Your name on the line is a very real risk.

Unfortunately, I expect this may create a lawyer averse culture where process is as repeatable as possible, because in the event of a suit, systematic process is a solid defense.

Re: Doctors, Revolt

#45

Post by [deleted] »

kbenson wrote: post #10
araes wrote: post #6

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…

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

[deleted]

Re: Doctors, Revolt

#46

Post by aaavl2821 »

Healthcare in the US has left the era of the small business and is entering the era of the nameless corporation. What wal-mart did to all of the mom-and-pop shops is happening to healthcare. Except that instead of lowering prices, it is raising them

Physicians have gone from small business owners to rank and file employees of large corporations. The burnout that is increasingly common among physicians is not unlike that of american office workers in the 1990s.

I'd love for the next stage of the evolution of healthcare to see physicians as customer focused, tech savvy entrepreneurs

Re: Doctors, Revolt

#47

Post by [deleted] »

bsder wrote: post #30
araes wrote: post #6

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…

[deleted]

Re: Doctors, Revolt

#48

Post by bob_theslob646 »

Article does not address the problem why the doctors' behave this way: insurance companies.

Unfortunately, treating makes more money than curing and the United States is scared to death of what shall they do with all that free time if they actually do cure, while other countries do not work themselves to death because they do not have an artificially controlled supply of Doctors...

Re: Doctors, Revolt

#49

Post by candiodari »

dkarl wrote: post #40
araes wrote: post #6

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…

They treat the customers like replaceable widgets 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)…

The problem is MBA administrators looking at their little accounting tables and deciding that not letting patients actually see a doctor is their purpose in life, just so they can pay everyone at a hospital as little as possible. This of course leads to global cost blowups and worse care.

Of course, by now there is no turning back, and the government has decided that actually training doctors must be prevented at all costs.

VERY short term vision, constantly sacrificing the future for a quick buck, leads over the span of decades, to spiraling costs and worse outcomes. Who knew ? Well, everybody knew.

Re: Doctors, Revolt

#50

Post by bsder »

whatthesmack wrote: post #35
bsder wrote: post #30

Earlier quoted context omitted.

> 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…

> HOWEVER, that is going to cost money. Quite a lot of money. And, really, nobody is actually interested in doing that in the US. 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.

You are regurgitating a "misused funds" talking point that Republicans always fall back on when facts don't support their position.

The US isn't that out of line with spending:

US is $15,171 per student while Switzerland is $14,922 per student. US is 7.3% of GDP while Denmark is 8% of GDP.

Source: https://www.cbsnews.com/news/us-education-spending-tops-glob...

There is not some magic bank of "misused" money waiting to be tapped.

The US also has a lot of students who fall into the education assistance category (free breakfasts, lunches) who would fall into a "social safety net" in countries like Sweden and Norway. A lot of the poorest students eat up the largest chunks of funding.

Finally, the Gates Foundation, whom I don't necessarily like, has shown time and again two fundamental things about education attainment:

1) any SUSTAINED focused resource improves educational outcomes

2) resource allocation is strongly sub-linear--it takes FAR more than 10% more resource to cause 10% improvement in outcome from our current system

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