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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)

#211

Post by thomastjeffery »

edwhitesell wrote: post #19

After recently getting a cancer diagnosis and going through surgery and chemotherapy, the best advice I can give is: ask lots of questions and you are your own best advocate. As with any profession, there are some great doctors who are truly looking out for your best interests and will pursue any direction you want. There are others who simply want to "follow the standard practice", even if what they know as "standar…

> Find a PCP who is part of a hospital system with specialists using the same computer system.

I really can't comprehend how these people don't feel a critical need for compatible open formats, and think they are fine using incompatible proprietary ones. How is sharing information seen as a negative in this scenario?

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

#212

Post by jxub »

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…

After having a glance at the submission title, I directly CTRL-Fed, and wasn't disappointed to see the mention of stressor avoidance from the Lebanese philosopher and twitter sophist.

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

#214

Post by troycarlson »

rbanffy wrote: post #172
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.

Bundled payments are slowly gaining traction and help align incentives a little better.

https://en.wikipedia.org/wiki/Bundled_payment

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

#215

Post by Retric »

astura wrote: post #207
Retric wrote: post #119

Earlier quoted context omitted.

That's demonstrably false. Early screening is useful, but that's also a medical procedure. Really what we care about is cancer deaths at a specific age AKA what % of 15 year old people die of cancer and that really has dropped. Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population…

Its complicated... https://sciencebasedmedicine.org/the-early-detection-of-canc... >Unless one can follow a cohort over time, there is no way of accurately estimating the probability that a subclinically detected abnormality will naturally progress to an adverse outcome. The probability of such an outcome is mathematically constrained, however, by the prevalence of the detected abnormality. The upper limit of this pr…

That's a problem if you want to compare the effectiveness of specific treatments. AKA, is doing A, or B, better than C. Or even more basically are screenings useful?

If you want to look overall you can look at the number of people dying at each age of each type of cancer independent of both diagnosis and treatment. AKA how many 43 year old women died of breast cancer. That also has some problems for people that died of cancer before it was detected as cancer, or people who died of suicide or related complications but not necessarily cancer on it's own. Even more critical is reduction in the rate people get cancer in the first place.

Still we are not talking about a small gap, when you start seeing a 30+% drop for a wide range of cancers it's easy to see that yes treatments are extremely useful. Even if you only get an extra say 2 years that's still 2 years to die of a car crash and not cancer.

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

#216

Post by thebladerunner »

hestipod wrote: post #117

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…

Please do share your story! We need to understand your situation first. I'd suggest a separate post but also link it here.

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

#217

Post by TallGuyShort »

conanbatt wrote: post #202
TallGuyShort wrote: post #142

Earlier quoted context omitted.

>> vague forms hurridly shoved in front of me as I was being prepped and legally he as allowed to One of the many problems when the legal system has just become "formalities" that only get used by the powerful against everybody else. Last time we had a baby the hospital was so prepared they were able to bill us for the entire pregnancy when we arrived for our first prenatal check-up. But somehow they couldn't show my…

> they billed her regardless of correctness of timeliness until she was dilated to an 8. This has to be contestable in court

In my opinion it was, and I tried to get that far at which point they invested in doing it correctly just in time, such that they legally charged us correctly before state law required them to and thus our claims could no longer be tried in court. I might be tempted to fight them on it, but then I might give up when I get sent a letter from a lawyer referencing the contract with my wife's signature. Few people I think would then hire their own lawyer to fight the legality of a contract you did sign. It's all about getting people to just pay to make it go away without them trying very hard. And if someone wants to take it to court, okay we'll do it correctly. Same as plea deals: most people don't exercise their right to a jury because they choose between their constitutional right + exaggerated threats and just accepting a plea deal.

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

#218

Post by hestipod »

thebladerunner wrote: post #216
hestipod wrote: post #117

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…

Please do share your story! We need to understand your situation first. I'd suggest a separate post but also link it here.

I thought linking to other self posts was against the rules...is it allowed? I was also advised by several people to post early in the week and morning for best traffic. Friday evening seems the worst time to start new and this post will be dead by tomorrow. I've been agonizing over how and when to post for a while now as it's my hail mary and it is just such an all encompassing misery. Facing actually laying my soul bare and fearing the judgement is making me terribly anxious. I am also panicking over edits and fearing missing the mark or just annoying people with the hopelessness Im feeling even though I've tried to temper it.

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

#219

Post by joshgel »

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…

But you are underestimating the degree of variability between providers. Some providers may have felt the XRay was necessary and others may have not.

In general, I find that patients have a sense that there is always a 'right' answer for what tests to order in order to diagnose their conditions. Some expect expensive tests to confirm a diagnosis that can be easily made at the bedside (like an MRI for sciatica for example). Others aren't interested in going through the difficulty of obtaining a somewhat difficult test like an MRI for a condition that is harder to diagnose at the bedside and would require further imaging to make a diagnosis.

The truth is that diagnoses are rarely 100% certain. How certain you need to be to make the diagnosis depends a lot on the risks of being wrong or missing a diagnosis and the risks of the potential treatment. For example, we want to be as close to 100% that someone has cancer before we give them chemotherapy. But, are willing to be less sure about diagnosing a cold. Sure, it could be the flu, but the risks and outcomes aren't that different.

The problem is that these probabilities aren't clear and doctors are humans and humans are bad at estimating with unclear probabilities. So there will be some doctors who estimate that the pain you were having that caused you to seek that doctor's opinion WAS enough to justify ruling out a fracture, because the risk of missing a fracture was worth the expense and very minor risk of radiation. Whereas the second doctor, may have seen things differently. AND this doctor has the added insight of the time that has past since your first appointment, ie you didn't get worse during that time (or maybe you did). That additional information of time, may have played into his estimation of the risks and benefit analysis for deciding on testing.

This is a good article to really understand the much wider than expected variability in professionals, including physicians. https://hbr.org/2016/10/noise

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

#220

Post by bobo_legos »

maroonblazer wrote: post #105

Growing up with a mom who was a non-working registered nurse, every time I or my siblings came down with symptoms like fever, nausea, vomiting, etc she almost never took us to the doctor. Instead it was rest and liquids, maybe an aspirin. I would always plead with her that we needed to seek professional medical advice. Now as an adult I realize that she knew too well the limitations of that advice when it comes to mo…

Same exact story except my mom is and still is a working R.N. There was no running to the doctor or emergency room if I got sick or banged up an knee or elbow. To this day as a grown adult I still work this way. It's a completely foreign concept to me to automatically run to the doctor like so many people around me seem to do.

You're other point about knowing the limitations of doctors is completely valid. Every night at the dinner table I heard one horror story after another about the crazy shit doctors would do at her hospital. Maybe its why today I don't run to the doctor for every little thing. I got the understanding that just because someone went to medical school and got an M.D. doesn't mean they're a miracle worker. There's just as many screw ups in that industry as any other.

On the upside though if something does happen where I(or someone in my family) need a doctor I can go to her(and my R.N. sister) to tell me who the good ones are and who to avoid like the plague.

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