Unnecessary medical care is harming patients physically and financially (2015) • Hacker News Board

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

#171

Post by zzz95 » Fri, Mar 02, 2018, 4:42 PM UTC

hestipod wrote: post #131

colordrops wrote: post #129

Earlier quoted context omitted.

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

The nutshell is don't ever have foot surgery unless it's to repair a catastrophic injury/trauma and there is no choice if you want to save the foot. The risk/failure rates are so high and not honestly explained. I was left with ruined joints, damaged tendons, nerve damage, and RSD that spread up my legs and affects my whole body to a degree. I was misinformed and flat out lied to and have never met someone to this da…

If I may add, it goes for any procedure and medication. Unless, it is an emergency, or a clear case of immediate attention, avoiding is better. Unfortunately, most surgery (including dental) is crude and rudimentary, good for saving lives, but leaves the patient with chronic problems.

Unfortunately, the burden is on the patient to make informed decisions at the time of suffering.

As an anecdote, my friend was given a handful of painkillers just before a procedure. I repeatedly told that he were not used to painkillers and perhaps decrease the amount. They did not even consider the smaller size of the patient. Within 20 mins he suffered seizures with just painkillers. Of course, later they apologized. Just got lucky that no permanent damage was done.

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

#172

Post by rbanffy » Fri, Mar 02, 2018, 4:42 PM UTC

oftenwrong wrote: post #158

This article came to mind this morning when I made my second visit to the orthopaedics department at a local hospital. The department schedules all patients for pre-appointment x-rays. That is, before the patient is even seen, before the doctor can determine if an x-ray would even be useful. On my first visit, I missed my x-ray appointment. The doctor I saw that day later said that was no problem. According to him, a…

You were scheduled for an expensive, unnecessary dose of radiation that would be billed to your insurer and that's how the provider makes a ton of money out of you.

The only priority of any sane health system should be to make people's health better.

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

#173

Post by paulsutter » Fri, Mar 02, 2018, 4:45 PM UTC

astura wrote: post #164

paulsutter wrote: post #140

Earlier quoted context omitted.

Solution -> never show a scan to a doctor who will over-react to an incidentaloma

It's not "overreacting." If you do a scan in someone asymptomatic and see a tumor it's oftentimes completely impossible to know if it's a "turtle" or a "bird." They can look exactly the same and we don't have a crystal ball.

Just wait and see how it develops. My doctor agrees, you could check with yours.

By your argument, if there's no need to scan, there's no need to treat it right away either. Of course, if you are the sort of person who is prone to panic, you probably don't want to get a scan

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

#174

Post by emiliobumachar » Fri, Mar 02, 2018, 4:46 PM UTC

mhb wrote: post #110

astura wrote: post #97

Earlier quoted context omitted.

They cause harm due to overdiagnosis and over treatment. https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

Shouldn't a distinction be made between asserting this for a population vs. for an individual? Yes, for a population it results in overdiagnosis and over treatment. As a personal decision, though, I understand this and will choose how to proceed with that in mind.

It's bad for the individual too. Many checks have non-trivial rates of false positives, many treatments have non-trivial rates of severe complication.

Checking occasionally for something specific that's reasonably suspected due to symptoms is good. If you're always checking for everything, you have a high risk of finding something you don't actually have. It turns out that that risk overrides the beneficial chance of finding something real before it has any symptoms.

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

#175

Post by TallGuyShort » Fri, Mar 02, 2018, 4:46 PM UTC

hestipod wrote: post #150

TallGuyShort wrote: post #144

Earlier quoted context omitted.

For what it's worth, I have 2 friends who had knee replacement surgery a couple of years ago to address chronic knee pain, and despite being wealthy and committed enough that they were able to participate in all the recommend physical therapy for recovery, they are both still in more pain than they were before, and 1 of them has actually been getting worse in recent months, and was just told by doctors that based on…

I dont have references right now but I have continually heard that long term studies have proven that knee (which I have also had that made things worse) and back surgeries (those two common ones have been extensively studied) show no overall improvement in pain years on compared to those who skipped surgery. In fact it is often worse and precipitates new issues. Surgery is a huge cash cow in the US. The ones that ar…

It's almost like there's a closely related cash cow incentivized to keep people in worsening chronic pain such that they need pain killers or something.

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

#176

Post by rbanffy » Fri, Mar 02, 2018, 4:46 PM UTC

hidenotslide wrote: post #89

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.

> can't seem to go more than a day without picking a fight on twitter

Thanks for that. I was blocked for correcting him (I can't remember about what, it was years ago).

Also, this "only go if necessary" is bad advice unless you are a doctor and can tell, from your symptoms, whether it is or not necessary to go. Make an appointment or show up at the ER and let the doctor decide whether you need help or not.

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

#177

Post by ryanianian » Fri, Mar 02, 2018, 4:47 PM UTC

soVeryTired wrote: post #98

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…

Great advice but how do you know ahead of time whether the medical care is necessary?

"Blind" second opinions. Go to another doctor - perhaps even at a different pay-grade - and see if she recommends the same treatment without you indicating to her anything about what the other doctor(s) said.

This is slightly easier for surgeries and anything non-acute where you have at least a month or two to make a decision.

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

#178

Post by grzm » Fri, Mar 02, 2018, 4:49 PM UTC

tinokid wrote: post #167

grzm wrote: post #149

Earlier quoted context omitted.

I'm not sure I follow. Screening detects cancer that is already there, hopefully in early stages when it might be treated more easily. In both cases, cancer is already present.

Treating infectious disease than can cause cancer (H. pylori, HPV) has nothing to do with cancer treatment. Treating, for example, thyroid or prostate cancers that would not have killed the person improves cancer survival statistics but nothing else.

Thanks for clarifying what you intended when you meant screening, which is differentiated from screening for cancer itself, which is how I read your upthread comment "[s]ome nipped a potentially fatal cancer in the bud".

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

#179

Post by ryanianian » Fri, Mar 02, 2018, 4:50 PM UTC

s3nnyy wrote: post #85

DanBC wrote: post #71

Earlier quoted context omitted.

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.

The rate of false-positives is almost always non-zero. So having an MRI scan may show a problem that doesn't actually exist.

I think I remember seeing something about not doing mammogram and/or prostate screenings too often, lest they find a false-positive and do a whole bunch of followup tests and procedures that in turn keep widening the risk for complications.

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

#180

Post by theseatoms » Fri, Mar 02, 2018, 4:50 PM UTC

monocasa wrote: post #166

theseatoms wrote: post #125

Earlier quoted context omitted.

> 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 s…

How do I shop for prices when I'm bleeding out in the back of an ambulance?

What % of medical expenditures does this scenario encompass?

You're describing a corner case that can be, at least partially, planned for ahead of time (by consumers, insurers, a combination of the two, etc).

And sometimes your hand is forced in all sorts of markets. But if enough shoppers are even somewhat price-discerning, the "value per price" that you pay for a given good or service should be significantly lower than it is in the current state of affairs.