How twitter helped a technology consultant escape from an evil hospital

This article in the New Yorker is excellent:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...

Atul Gawande argues that the problem with healthcare in the US is overutilization.

The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.

Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.

One's choices are never completely at the whim of someone else's rules.

As much as I think "tort reform" is a right-wing dog-whistle term, medical malpractice law has a lot to do with cases like this. Put simply, if you're insured and there's an incredibly remote chance that a test could show something, most doctors will issue it - it doesn't cost them anything, it doesn't cost you anything, and it protects them if something happens to you in the long run, at which point they can say "well, we tested for it and it was negative, so it's not our fault". From the doctor's point of view, ordering the additional test (or surgical procedure, etc.) has very little downsides and either marginal or significant upsides, depending on what ends up happening.

If you're interested in this, read up on the PSA (Prostate-Specific Antigen) test: it's the main test used to check for prostate cancer in males. You'd think that doctors would issue it to all males of a certain age annually, and up until recently most doctors did that. But there's been an interesting change of thinking in the past few years: someone noticed (and importantly, some insurance companies agreed) that the combination of an increase in the power of drugs/surgical techniques available to treat the disease and a stabilization of the relatively-high false-positive rate in the PSA test (and the dangers of what happens with a false-positive) means that unless someone has a predisposition to prostate cancer, it's often better not to test for it. The net result when the options are getting prostate cancer and taking the treatment vs. getting screened early and undergoing the invasive diagnostics needed to confirm a PSA test at that stage, it's usually a better choice just to get prostate cancer.

Note that this math goes out the window, however, if you have a family predisposition to prostate cancer. In that case, the risk of option #1 goes up (since it's predicated on the relatively low incidence rate of prostate cancer), and the dowsides of option #2 go down (since the probability of a false-positive is much lower).

I do to from time too, but I asked because personally, I rarely see people get questions answered on Facebook the way they regularly do on Twitter. But then again, the people that Twitter and get questions answered quickly are probably your blogger, big personality types too.

And then yet back on the other hand, as you say, there is no friend requirement so those big personality types could really only amplify their voice in that way over Twitter.

If my friends (who are sane and not dumb) decide it is best to jump off the bridge, I think I will jump also. I get the feeling that there is something on the bridge that will have a higher chance of killing me then the fall from the bridge. Also, it is always the idiot who stays and says "what's going on" that get killed in the horror movies.