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

newyorker.com

221–230 of 256 posts

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

#221
post #200

Earlier quoted context omitted.

> 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 numbers of 193 per 100k. Hmmm... Apply a 25 year lag. https://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m4843a2f1.... >PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer r…

Lung cancer has not changed overall numbers all that much from 1990. https://seer.cancer.gov/statfacts/html/lungb.html So, no it's not responsible for the massive drop in cancer deaths by age group. I included HPV and Stomach cancer in a PS specifically because they are minor changes to overall numbers. Sunscreen also impacts the rates people get cancer, but it's a very minor effect.

"Not all that much" is not how I would describe a chart like this: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanag...

And lung cancer is not the only cancer caused by smoking.

In any case, cancer death rates and changes in risk factors do not speak directly to the claim about treatment effectiveness. If you are diagnosed with cancer, you are basically every bit as f'ed today as you were 50 years ago, except in the special case that your cancer happens to be one of those that never would have been noticed back then.

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

#222
post #15
post #4

It sounds like in the "free market healthcare" system hospitals are incentivized to get the patient to spend as much as possible. That's aside from other bad incentives of such a system such as hospitals not wanting to be transparent with their prices, insurance companies not wanting to take patients with pre-existing conditions, also wanting to cover as few conditions as possible, Big Pharma being incentivized to as…

You should look up the definition of "free market". We do not have a free market in healthcare.

Exactly. It's a non-free market and whenever reforms are enacted - see ACA - they make it a bit more like itself, which is to say a bit less free. And when that doesn't work what's the fix? - more reform. More like itself. More a bit less free.

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

#223
post #200

Earlier quoted context omitted.

Lung cancer has not changed overall numbers all that much from 1990. https://seer.cancer.gov/statfacts/html/lungb.html So, no it's not responsible for the massive drop in cancer deaths by age group. I included HPV and Stomach cancer in a PS specifically because they are minor changes to overall numbers. Sunscreen also impacts the rates people get cancer, but it's a very minor effect.

"Not all that much" is not how I would describe a chart like this: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanag... And lung cancer is not the only cancer caused by smoking. In any case, cancer death rates and changes in risk factors do not speak directly to the claim about treatment effectiveness . If you are diagnosed with cancer, you are basically every bit as f'ed today as you were 50 years ago, ex…

Notice that Male at the bottom of the cart women are only down 17%. That makes the impact on overall numbers significantly lower. It's also a chart of deaths, what you want to support the idea that treatment is useless is a chart of new cases.

Also, see that huge drop in Prostate and Colorectum cancer. Yea, that has nothing to do with smoking it's almost completely related to better treatment making a huge difference.

And again, we are not looking at equivalent populations. The older the US population the worse cancer numbers look in absolute terms.

So, even the chart you are using to support your argument actually supports mine.

PS: To account for a 25% drop in cancer deaths lung cancers could have hit zero in that cart and it would still not be enough.

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

#224
The article's author, Atul Gawande, has written four books. So far I've only read _The Checklist Manifesto: How to Get Things Right_ and have been applying it to various aspects of work and life (travel packing checklist, Engineering team runbooks, etc). I would strongly recommend it.

All his other books are on my "to read" list...

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

#225
post #37

I live in a 3rd world country (Sri Lanka). Healthcare is not as advanced as it is in the US, but it is decent for all except the most complicated cases. The vast majority of people use the free services at state hospitals. If you want slightly better care, you can go to a private hospital and still come out with most of your wealth intact. I recently had a minor surgery to remove a conjunctival granuloma from my left…

You bring up a couple of interesting points even if you don't realize it. There are a couple of things that impact your experience that are externalizations. For example, your "cheap" healthcare is largely due to massive amounts of subsidies and NGO work that goes into helping third wold countries provide such "cheap" medical services. In many ways, due to rather authoritarian types in control in government in the west, who think they have the right to steal from their own citizens through taxes in order to "help" others, it is actually even more expensive for Americans in particular to receive medial care because none of those costs of shipping off billions and trillions of Americans' dollars overseas to "help" others is ever included in the cost of things like healthcare. You may ask yourself how that correlates, but it's because, e.g., while American doctors and people are overseas training and "helping" others, they are neglecting their own society and people, and while billions upon billions are spent to subsidize and "help" others, those billions and billions of dollars are drained from America and Americans and their communities, which in turn is money that they cannot use to receive quality healthcare in some cases.

Another point you bring up is that while you are using facilities that are spartan compared to US standards but more than adequate for providing health services, in the USA the very same people who lament the cost of healthcare want well appointed and lavish facilities that are beautifully designed and have cafes and restaurants. I have this kind of argument all the time in a country where people think that a $120 million dollar library with a $10 million dollar yearly maintenance and operation cost is an even remotely reasonable cost when you could provide the very same kind of service in a facility that isn't like a luxury hotel.

It's not just that doctors don't face the same kind of fear of malpractice suits, those doctors are also not under constant pressure to perform unnecessary procedures to pay for the $1.3 billion ... yes, BILLION ... hospital and the health care sector in many countries is not the scheming and conniving and fraudulent get rich quick kind of scheme it has become in the USA. In many of the emerging countries, doctors and hospitals perform their services out of a desire to help people, in the USA there is a whole cottage industry of the medical services that has figured out how to latch onto all the various Socialist schemes Liberals devise on how to dispense with other people's money to "help", which affords them fleets of private planes and ocean side mansions.

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

#226
post #183

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…

We know at least some widely used surgeries are probably no better than a placebo. "Placebo" in surgery is when they get a surgical crew together, anesthetize the patient, make an the appropriate incision, and then dick around for the time it would take to perform a surgery, maybe passing some tools back in forth. Basically, an elaborate ritual. https://fivethirtyeight.com/features/surgery-is-one-hell-of-... >A 2014…

The patient would have probably been even better if the sham surgery wasn't performed at all. Placebo effect nowadays is understood to be very small or even nonexistent, see e.g.[1][2][3]. What is actually going on is that patients most often just tend to get better with time, and this is just as true for common cold as it is for pain or injury. Researchers just confused this with some mental effect of giving placebo.

[1] - http://www.nejm.org/doi/full/10.1056/NEJM200105243442106 [2] - https://www.ncbi.nlm.nih.gov/pubmed/15257721 [3] - https://www.ncbi.nlm.nih.gov/pubmed/20091554

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

#227

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 exa…

I don't understand this argument at all. The poster claimed that his provider automatically scheduled an x-ray before any patient was seen. My understanding while reading was that this was regardless of the reason for the appointment.

How can this be reasonable? It's impossible to know if imaging is required before seeing the patient, so it seems to me that a large number of these x-rays were unnecessary. In fact, the poster mentioned that on his last two visits he skipped the imaging and the doctor wouldn't have needed it anyway, bolstering my suspicion.

I could be totally misunderstanding, but it sounds like you are arguing that requiring imaging before each visit is reasonable. That just sounds way off base to me and like an easy way to ratchet up the cost for each and every patient.

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

#228

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

I know of a doctor in my area who has nearly killed several patients. One of these patients I know personally and they confided to me that they looked and looked for a lawyer but couldn't find one who would take their case.

I am sure being on a fixed income influences the types of lawyers one has access to and the distance that is affordable to travel. Nonetheless, I found the whole situation appalling. If patients are unable to sue physicians who are incompetent, these incompetent physicians will simply hurt more and more people.

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

#229
post #37

I live in a 3rd world country (Sri Lanka). Healthcare is not as advanced as it is in the US, but it is decent for all except the most complicated cases. The vast majority of people use the free services at state hospitals. If you want slightly better care, you can go to a private hospital and still come out with most of your wealth intact. I recently had a minor surgery to remove a conjunctival granuloma from my left…

You bring up a couple of interesting points even if you don't realize it. There are a couple of things that impact your experience that are externalizations. For example, your "cheap" healthcare is largely due to massive amounts of subsidies and NGO work that goes into helping third wold countries provide such "cheap" medical services. In many ways, due to rather authoritarian types in control in government in the we…

Do we see these same trends of ridiculous costs across other philanthropic and "liberal" (you seem to apply more meaning to the word than I) countries? Because as a Canadian I can say that I fear no bankruptcy via health issue, and trust that I will be taken care of if I am in medical need.

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

#230

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…

An X-ray is really a cheap procedere compared to other imaging techniques. In germany a doctor gets around 20$-30$ for an X-ray.

http://www.e-bis.de/goae/Goae00000137.html#O1

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