Doctors, Revolt • Hacker News Board

Re: Doctors, Revolt

#111

Post by limeblack » Sun, Feb 25, 2018, 7:11 AM UTC

candiodari wrote: post #49

dkarl wrote: post #40

Earlier quoted context omitted.

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…

Maybe at some hospitals but not mine. I have tried scheduling for example sleep apnea tests at my hospital and I have go through a doctor. I had a second one with in a year and they required me to still see a doctor for some reason. No exceptions. You would think a test like this wouldn't require an initial visit, an actual overnight stay and a follow up reading of the results with the doctor but it does.

Re: Doctors, Revolt

#112

Post by watwut » Sun, Feb 25, 2018, 7:11 AM UTC

erentz wrote: post #63

bsder wrote: post #50

Earlier quoted context omitted.

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 t…

Not trying to be antagonistic, but aren’t you kind of proving the point? You've shown the US funding for education is good, it’s comparable with other countries that have good education systems, but the results seem to be poorer. (I guess that’s what people are saying but I haven’t verified that myself.) Thus there seems to be inefficiency in how that funding is allocated/used compared to other countries. So increasi…

If food for poor kid in Netherlands goes from different fund while in US education funding, then funding inUS should be higher to cover that up.

Also, schools in US are not funded equally and sports have special status in society. You have art teachers paying supplies out of pocket in one district and expensive stadium in another district. You have well funded schools and badly funded schools.

Re: Doctors, Revolt

#113

Post by jhanschoo » Sun, Feb 25, 2018, 7:14 AM UTC

It is a nice coincidence that a video by an educational YouTube channel Kurzgesagt discusses homeopathy and why it still remains popular—hypothesizing that one reason may be that their practicioners pay good attention and affection to their patients. https://m.youtube.com/watch?v=8HslUzw35mc

Re: Doctors, Revolt

#114

Post by beagle3 » Sun, Feb 25, 2018, 7:19 AM UTC

maxerickson wrote: post #86

adventured wrote: post #83

Earlier quoted context omitted.

And further to that point, the admin side of US healthcare costs have massively expanded - similar to what has occured in education - over the last 30 years. That 25% share, is about double what it is in Canada (although a few are equally high, the Netherlands is at 20%). The famous chart showing the US growth in admin vs physicians since 1970: https://i.imgur.com/lnIcjo2.jpg

Is there one that shows dollar amounts instead of growth? If a dollar amount chart showed the same effect it would do a better job of making the point that chart is intended to make. But I think it is pretty likely that the 1970 administrative baseline is tiny (because in 1970 there were lots of small hospitals run by 1 doctor).

It needs to be inflation adjusted, and then you have to agree about which inflation measure (there are several, and the differences over 50 years are significant)

But you could sidestep all of that by comparing to other countries, non of which ever had a significant number of “small hospitals run by 1 doctor”; their expenditure as a percentage is mostly consistent through the years and about half as high as the US, with similar trends in education.

Re: Doctors, Revolt

#115

Post by robbiep » Sun, Feb 25, 2018, 7:33 AM UTC

bob_theslob646 wrote: post #48

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...

This is an absurd and oft-repeated claim that taps into variations of the conspiracy thinking around 'doctors keeping the cure for cancer (or insert other condition here) secret' because powerful lobby groups insist that there is more money to be made in 'treating' than 'curing'. It is patently untrue.

Firstly, it assumes that neither doctors, nor the scientists and researchers working in the companies and universities that drive medical progress forward, have an ounce of self-respect for either themselves, their family members or members of the community - because if true, either family members and themselves would never get cancer or other chronic diseases that we 'treat', or if they are somehow as vulnerable as the rest of the population to these conditions, that maybe there is a secret stash of 'cure' somewhere that they allow out to the people in the know. The conspiracy goes deep...

Secondly, it throws out the window all the evidence around what we can actually cure and what health policy seeks to do. We have an entire field of medicine called preventative medicine that aims to stop conditions before they happen, by lobbying governments to ie. Ban or decrease rates of Smoking and alcoholism, to provide safe needle exchange so IV Drug Users don't get bloodborne diseases, to improve exercise rates, to provide vaccination programs - all of which stop disease from happening. The fact of modern life in a western country is that most of the burden of disease is related to lifestyle factors or age related - Osteoarthritis (Age and Obesity), Cancers (Lifestyle risks and age), Diabetes (Diet, exercise, genetics) Cardiovascular disease (Exercise, Age, Lifestyle risks, diet).

It also ignores the tremendous advances that are still occuring. When I was in my final year of Medical school, 5 years ago, Metastatic Melanoma was a condition with an average survival of 6 months. It is now (thanks to some incredible, and incredibly expensive drugs - don't get into a debate about cost here, I live and practice in Australia and the cost for a patient is capped at $46.60 per year as it is on the PBS) more of a chronic disease with average survival in the 4-5 year range. Incredible, and this progress occured in 5 years. Similarly, Hepatitis C, a condition that in it's chronic form invariably results in liver cirrhosis and failure, can now be cured - this was unthinkable 5 years ago, and is now a fact, with a 12 week course of medicine.

Please inform yourself and don't just trumpet that which you hear on the internet. Your ignorance is not as valid as my knowledge and to assume that in your version of this myth that insurance companies (but in the more common version of this myth, Doctors, Pharmaceutical Companies etc) are primarially interested in keeping the population teetering on the edge to milk them dry is disingenuous.

Re: Doctors, Revolt

#116

Post by jeffwilcox » Sun, Feb 25, 2018, 7:35 AM UTC

nitwit005 wrote: post #85

aaavl2821 wrote: post #43

Earlier quoted context omitted.

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 t…

You can still get a doctor to show up at your house. It just costs a lot, so people don't.

Sigh, so true. My first job out of college here in Seattle was by a major company that provided 100% coverage for all healthcare, $0 copay; at the time, that included doctors straight to your home, anytime. It was only after we were pushed to HSA plans that I started learning about billing, and that apparently it's basically unheard of to have physicians come to the home. Still feel whiplashed by the change...

Re: Doctors, Revolt

#117

Post by casefields » Sun, Feb 25, 2018, 9:50 AM UTC

Thriptic wrote: post #36

sampo wrote: post #7

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.

Two reasons. First, it's a clinical quality measure that needs to be collected by law. The government mandates that you collect certain data about X% of patients you are in contact with and transmit that data to relevant parties or else you will be penalized financially by Medicare. Also, BP, weight, and temperature are important diagnostic indicators

Someone didn't read the article.

"Checking things like temperature, blood pressure and respiratory rate every four hours on hospitalized patients has been the standard of care since the 1890s, yet scant data indicates that it helps."

Re: Doctors, Revolt

#118

Post by mikecsh » Sun, Feb 25, 2018, 10:00 AM UTC

paulcole wrote: post #91

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…

>Why do the overnight shift of nurses take vital signs every four hours? So they catch rapid unexpected changes in patient conditions more quickly. The first sentence of the second paragraph of the article you seemed to have avoided reading says: “Checking things like temperature, blood pressure and respiratory rate every four hours on hospitalized patients has been the standard of care since the 1890s, yet scant dat…

> yet scant data indicates that it helps

But this is not the case. In the UK, these observations are entered into a proforma by the nursing staff which allows them to calculate a "National Early Warning Score". Based on the patients score, the nurse has to escalate to an appropriate team and the doctor on the appropriate team has to take the referral.

Not only does this help identify deteriorating patients, but it helps to fight human factors like "I don't want to call such and such a doctor because they are always rude on the phone so I'll just leave it and hope it gets better"

In terms of actual data, we have a national body (NICE) that provides guidelines and recommendations based on appraising the available data and research. For NEWS scores, see:

For an overview: https://www.nice.org.uk/guidance/cg50/chapter/1-Guidance#phy...

For the full report and evidence used to compile the guideline: https://www.nice.org.uk/guidance/cg50/evidence/full-guidelin...

Re: Doctors, Revolt

#119

Post by nnq » Sun, Feb 25, 2018, 10:03 AM UTC

toomuchtodo wrote: post #79

jackcosgrove wrote: post #77

Earlier quoted context omitted.

The underlying problems in these industries are because they are labor intensive. Partly this is due to the difficulty of automating those jobs, and partly it is due to political arrangements that protect incumbents. Technological innovations that reduce costs will be the most lasting ways to reform these sectors.

Other first world countries don’t require technological innovations to deliver affordable, quality healthcare. They just break the profit motive.

Yeah, but when tech innovation becomes the only way out of a shitty situation, you incentivize tech innovation! I guess some smart folk figured out that in order to maintain superpower status at all costs you need to maintain the lead at hard-to-replicate tech-innovation, and paying the cost of this with your people's quality of life, and sometimes with their lives, is worth it. For some people at the top it's a big difference between being at the top of "just some random first world country", and being at the top of "practically the world".

Regular people can change the countries they are living in if they don't like the tradeoffs their government is doing, you know... Or vote to change them, but don't be surprised when improving lives comes at the cost of losing "top dog" status.

(Note: I'm not an American, but I see the tradefoffs the U.S. made, and I understand they make sense to some.)

Re: Doctors, Revolt

#120

Post by mikecsh » Sun, Feb 25, 2018, 10:12 AM UTC

BurningFrog wrote: post #56

mikecsh wrote: post #13

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…

Each doctor also has an incentive to re-examine the patient so they can bill for that examination.

And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money). What you describe is a pitfall of private medicine.