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

newyorker.com

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

#121
post #45

For the physical harming, Nassim N. Taleb wrote a book called "Anti-Fragile" desribing the concept of iatrogenic illness. https://en.wiktionary.org/wiki/iatrogenic An alarming fact was less dying patients when an hospital workers were in a strike action (during 2 weeks).

Johns Hopkins study suggests medical errors are third-leading cause of death in U.S. https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-...

I thought this excerpt from the article you posted was interesting

"The researchers caution that most medical errors aren't due to inherently bad doctors, and that reporting these errors shouldn't be addressed by punishment or legal action. Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability."

I've seen this statistic before and had not looked into in much but it sounds like determining if docs cause more harm than good is perhaps a little more nuanced than the statistic first seems.

On a related note, below I've linked to an NPR article about how women that gave birth under the care of a doctor in the 1800s were 5 times more likely to die than those seen by a midwife because doctors were not washing there hands or medical interments.

https://www.npr.org/sections/health-shots/2015/01/12/3756639...

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

#123
post #79
post #48

Earlier quoted context omitted.

Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. However, this improvement takes a lot of effort and really does mean higher prices. So, all you are proposing is rationing care aka if people can't get care then cost is not a problem. I would suggest a public option that excluded any patented medication or extensive intervention could be really cheap if you also removed…

>Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. No. These rates are affected by more screening procedures. Some nipped a potentially fatal cancer in the bud, others just found and removed something that wouldn't have killed the person. To first order there is no change in the effectiveness of cancer treatment as compared to 50 years ago.

This isn't a misstatement it's a lie and you can't back it up.

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

#124

Earlier quoted context omitted.

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…

> Sounds like a typical American family doctor's office? Not any that I have ever been to, and I have been to several across two different metro areas. > All of them in my area have long waiting lists. I have yet to encounter a waiting list. > 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. Actually, I just book an appointment. Only once have I st…

It's all anecdotal, so I guess we can all take each other's stories with a grain of salt, but long waits and impenetrable bureaucracy has been my experience, as well. My wife is currently trying to get treatment and she's had to wait months to see various doctors and specialists. We live in a metro area in the US.

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

#125
post #70

Earlier quoted context omitted.

It actually would. No need for sarcasm on that comment.

Really, you think there's a market for healthcare? Try walking into a hospital and asking how much something costs. I can tell you that you won't/can't get an answer in over 60%, specifically because the software they use does not show prices only billing codes! So the person providing care can not find out how much it costs... how are you supposed to choose? Try calling billing once you have the correct code. I can…

> Try walking into a hospital and asking how much something costs. I can tell you that you won't/can't get an answer in over 60%, specifically because the software they use does not show prices only billing codes! So the person providing care can not find out how much it costs... how are you supposed to choose?

Exactly. This is exactly the problem. The current situation bears no resemblance to a market. Price can't seek value.

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

#126

Earlier quoted context omitted.

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…

> Sounds like a typical American family doctor's office? Not any that I have ever been to, and I have been to several across two different metro areas. > All of them in my area have long waiting lists. I have yet to encounter a waiting list. > 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. Actually, I just book an appointment. Only once have I st…

Maybe that's how things are in your part of the country. I live in Florida, and what LeifCarrotson described is exactly how it works here. I guess its nice to hear that the US medical system is working better in Manhattan.

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

#127
post #5

Sounds like another one of those "this is what happens when money (as opposed to patient wellbeing) becomes a driving factor in health care." I remember I tried to find a PCP once and I showed up for my intake appointment and the young, rushed doctor said they wouldn't enroll me as an official member unless I had two intake visits. They were gaming the insurance system.

There is definitely a game of cat and mouse with the insurance system, but bear in mind medicare is the exact same thing, only with more paperwork and less pay.

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

#128

Earlier quoted context omitted.

I'm not sure it would. Given the information asymmetries involved, how does it avoid the "market for lemons" problem?

Add a regulation that says every hospital must publish anonimized aggregated patient outcomes. Remove as many other regulations as it would take for them to be willing to compromise and accept this one.

Good reason to shy away care for bad patients if it affects your stats.

Surgeons do this today to maintain a high success rate.

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

#129

I was preparing to make a long post asking for ideas/help (been saying that for weeks but it's ready and I was waiting to Monday since weekends are slower) This sort of thing ruined my life, cost me everything, and has finally brought me to the precipice. I was convinced 15 years ago to have surgery to "prevent later disability" and it ironically left me disabled and in severe pain. I later found out abroad from seve…

Perhaps you could share the procedures so others would know to be skeptical if they are in the same situation?

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

#130

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 is in favor of subtractive medicine - many harms are caused by adding such things as smoking, sugar, preservatives, etc, and instead of adding medicine or surgery, remove the elements that the body isn't evolved to tolerate and see if it heals itself.

Yes yes yes I agree! All those poor people living in poor and crime-ridden neighbourhoods should just shop at Whole Foods! Yes indeed!

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