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Unnecessary medical care is harming patients physically and financially (2015)

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Re: Unnecessary medical care is harming patients physically and financially (2015)

#81

Post by wdn »

There issue is two folds here.

1. Medical liability. Doctors must cover their basics or will get sue.

2. There is no cost relationship between doctors and patients. Doctors and patients work with 3rd party call health insurers. Worst, a lot of people (medicaid recipients) have no skin in the game.

Obama could have fixed item #2 with a universal health care that require (1) doctors to list the price of their services and (2) cover major catastrophic health expenses, such heart issue, cancer, long term care, etc. Prevention care should physical, cold should be out of pocket for the first 5 or 10 visits of the year, then it is covered.

I know some may called foul because poor cannot pay. Paying $20 per visit, at 10 visit, it is $200 out of pocket. They have have skin in the game. This will cut down a lot of abuse.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#82

Post by CaptainZapp »

dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

I have a couple of dislodged discs, which cause the right arm to go numb sometimes.

My GP referred me to one of the top surgeons for spin surgery, especially at the top of the spine, where cutting it up is the most risky.

After prescribing an MRI and given that the numbness is occasional and that the pain is minimal his suggestion for cutting me up was a clear NO!

This gives me a lot of respect and instills trust in an expert who provides me with advise, which runs counter towards his business model.

I hope that the situation clears itself with occasional physical therapy and exercise. But if it gets worse it's fantastic to have one of the foremost experts in the field, who can perform the surgery at your disposal (and adequate insurance to pay for him).

To make a long story short: It seems that my doc very much agrees with Nassim Taleb.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#83

Post by westbywest »

maxerickson wrote: post #67
tonyedgecombe wrote: post #55

Earlier quoted context omitted.

that would be anarchy Yet it's exactly what we can do in the UK, I remember needing to see a doctor whilst on Holiday in Scotland, I just phoned the local GP and got an appointment the next day.

A huge percentage of the US population lives within a 10 minute drive of an urgent care facility. Same day appointment, billed similarly to a GP office visit.

Billing is not always similar. Many urgent care facilities are outright predatory in pricing, to the extent they begin to look like the payday lenders of medical care. It would be a poverty to consider these kinds of operations part of the solution. https://www.nbcnews.com/health/health-care/you-thought-it-wa...

Re: Unnecessary medical care is harming patients physically and financially (2015)

#84

Post by ams6110 »

dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

> if you have terminal cancer

Maybe you meant "if you have treatable cancer"

If it's truly terminal, not much a doctor can do for you other than palliative care, which generally shouldn't require a hospital.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#85

Post by s3nnyy »

DanBC wrote: post #71
dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

He's just regurgitating conventional medical wisdom that's routine in countries that aren't the US. We've been talking about the risks of over-testing, over-diagnosis, and over-treatment for many years. Mostly in the context of full body MRI scans for healthy people, or early testing for prostate cancer, but also many other things.

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#86

Post by DonnyV »

Rationing medical care because the underlining system is broken makes no sense. People in the US already don't use enough medical services.

"For example, Americans average 4 doctor visits a year compared to 7 in France and Canada, countries with better health outcomes than ours." http://www.pnhp.org/news/2014/january/americans-underuse-hea...

Re: Unnecessary medical care is harming patients physically and financially (2015)

#87

Post by DanBC »

LeifCarrotson wrote: post #27
vonmoltke wrote: post #16

Earlier quoted context omitted.

> I showed up for my intake appointment and the young, rushed doctor said they wouldn't enroll me as an official member "Intake appointment"? "Official member"? What kind of system is this?

Sounds like a typical American family doctor's office? All of them in my area have long waiting lists. You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical. They're typically booked solid for a few months in advance. Calling to book an appointment requires being a registered patient or member of that office. If you want to change your primary care physi…

> you call to schedule your annual physical.

Annual physicals cause harm. You should avoid them unless you meet a reasonably narrow range of criteria.

> They're typically booked solid for a few months in advance.

Even in our underfunded NHS I can get a same-day GP appointment (if it's an emergency) or within 48 hours (if it isn't an emergency). And that's within a range of provision: pharmacy for general advice; 111 telephone service for advice and triage; GP for general stuff; MIU for minor injuries; A&E and 999 for life threatening injury.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#88

Post by davidscolgan »

ams6110 wrote: post #84
dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

> if you have terminal cancer Maybe you meant "if you have treatable cancer" If it's truly terminal, not much a doctor can do for you other than palliative care, which generally shouldn't require a hospital.

Good catch. I've made an edit.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#89

Post by hidenotslide »

dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

Nassim Taleb is great at providing backward looking advice. My back got better, therefore I was right to ignore the expert advice. He has predicted about ten of the last two financial crises. I wouldn't take medical advice from a financial pundit who can't seem to go more than a day without picking a fight on twitter.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#90

Post by CaptainZapp »

DanBC wrote: post #71
dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

He's just regurgitating conventional medical wisdom that's routine in countries that aren't the US. We've been talking about the risks of over-testing, over-diagnosis, and over-treatment for many years. Mostly in the context of full body MRI scans for healthy people, or early testing for prostate cancer, but also many other things.

  Mostly in the context of full body MRI scans for healthy people
Full body MRI scan? That seems completely weird.

I had a number of MRIs and believe it can be a god send. When I see the results it always feels like borderline magic and depending on the diagnosis it can be very, very useful.

It's very much my impression that MRIs are prescribed for very local issues. A bum knee, a broken toe which doesn't heal and where the doc needs a 3d view (to rule out splinters, which are not visible on x-rays) or for parts of the spine.

A full body scan doesn't only sound extremely invasive (how long do you have to lie absolutely still while the scan progesses?) it also sounds totally useless.

Edit: spello

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