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

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

#111

Post by CaptainZapp » Fri, Mar 02, 2018, 3:36 PM UTC

s3nnyy wrote: post #100

CaptainZapp wrote: post #92

Earlier quoted context omitted.

Apart from the fact that it costs a lot of money. What do you want to achieve with a full body MRI scan ?

A friend of mine who wasn't even 30 years old had a serious brain tumour where they said "ouh, if we'd had done a MRI scan some years ago, it would have been much easier to fix." So that is why it might be a okay'ish idea to do a MRI scan of the brain every 5 years or so? Depending where you live they are actually cheap and can be paid out of pocket.

Fine and fair enough.

But that scan would be limited to the head and not cover the entire body.

I'm also not convinced that MRIs are a great, general purpose diagnostic tool, if it's not used to diagnose concrete issues. The experience of your friend, who I hope recovered from the tumor not withstanding.

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

#112

Post by DanBC » Fri, Mar 02, 2018, 3:38 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.

I dislike Taleb, but in this case he's right. Conventional, standard, advice in anywhere but the US is that over-testing, over-diagnosis, and over-treatment cause harm and should be avoided.

The problem is that Taleb is packaging up this standard advice and pushing out as some wisdom he has that he wants to impart to the masses.

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

#113

Post by lebski88 » Fri, Mar 02, 2018, 3:45 PM UTC

ams6110 wrote: post #84

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…

> if you have terminal cancer Maybe you meant "if you have treatable cancer" If it's truly terminal, not much a doctor can do for you other than palliative care, which generally shouldn't require a hospital.

That's not really true. Having just been through this with my mother there is a huge amount of hospital care required during terminal cancer.

For starters radiotherapy is often used to control symptoms. It may not do anything for length of life but targeting key tumours can keep you mobile for longer, reduce the risk of seizures etc. It can be a boon to quality of life.

There will also almost certainly be other things that occur along the way that require visits to hospital. That is complications that could kill you but can be treated without too much discomfort where you can get back onto your feet. Infections are incredibly common for example. Particularly if you're on steroids.

Obviously you'll rule some things out, e.g. chemo as not worth the cost during palliative care.

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

#114

Post by theseatoms » Fri, Mar 02, 2018, 3:48 PM UTC

notyourday wrote: post #102

hidenotslide wrote: post #89

Earlier quoted context omitted.

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.

My wife professionally interacts with a lot of top level surgeons -- the ones that have institutes named after or created for. They universally say it is all about risk management and risk mitigation. Trauma and neuro and cardiac surgeons of today are likely to be able to fix amazing number of issues just to have patients become gravely ill from secondary infections/non-top-notch care after the surgeries.

That's the frustrating thing though. Doctors tend not to talk in probabilities of outcomes. Fortunately I haven't had a ton of experience trying to get them to do so.

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

#115

Post by tinokid » Fri, Mar 02, 2018, 3:49 PM UTC

phil21 wrote: post #33

0xcde4c3db wrote: post #23

Earlier quoted context omitted.

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

I think HN could do with some older folks on it. Heck, I remember growing up and using insurance was rare. You paid cash for your doctor visits, and typically only used insurance for major hospital stays as that's more or less all it covered. Doctor visits just 30 year ago did not cost what they do today. You could get a clean break in your arm, go into your GP, have it fully fixed and be out the door for less than a…

"People cared" maybe plays a bigger role than you realize here. There were stronger social norms back then about the role of medical care in society. Most hospitals were community or religious owned, physicians were content with merely above average professional salaries, and you never saw any kind of advertisement that ended with "ask your doctor about X".

I think it's naive to assume the 16.5%-of-GDP octopus we've created wouldn't figure out a way to profit from the removal of all regulations.

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

#116

Post by neonhomer » Fri, Mar 02, 2018, 3:49 PM UTC

Cenk wrote: post #28

tr0ut wrote: post #11

Earlier quoted context omitted.

You have the wrong idea. A better example of what you're calling "free market" would be dentistry or something like Lasik surgery. You can shop around and figure out the prices because they are very much apparent since you pay out of pocket for the majority of the former and completely for the later. Would Medicaid/Medicare be "free market"? Why bother shopping around when someone else picks up the tab? Insurance com…

I recently read this great article about this: http://time.com/4649914/why-the-doctor-takes-only-cash/

Here's their actual price listing. https://surgerycenterok.com/pricing/

It would be great if the insurance companies would get behind these kinds of prices as this is probably the same as their negotiate rates they pay other surgery centers. Seems like it would be a lot less hassle for them to process.

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

#117

Post by hestipod » Fri, Mar 02, 2018, 3:49 PM UTC

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 several doctors that I never needed the surgery but the catastrophic damage was done, but they did improve things slightly and Ive been trying to get back to live there but cannot.

A few years later in some nightmare the "repair" surgeon messed it up far worse and changed the procedure we had agreed on, but I signed the vague forms hurridly shoved in front of me as I was being prepped and legally he as allowed to. I never would have agreed to that procedure he did had I been clearly informed. They got paid...my life got ruined...and things slid downhill from there as systems and people failed me. Now I am facing seemingly insurmountable needs and costs and more surgery which terrifies me and I would never trust having in this country if at all.

It's long story that has no TLDR. I am at my wits end and don't know if a comment here is the right place to share whole thing, or if I should make my own post now or Monday...I need as many eyes on it as possible if there is any hope.

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

#118

Post by arkades » Fri, Mar 02, 2018, 3:50 PM UTC

wdn wrote: post #81

There issue is two folds here. 1. Medical liability. Doctors must cover their basics or will get sue. 2. There is no cost relationship between doctors and patients. Doctors and patients work with 3rd party call health insurers. Worst, a lot of people (medicaid recipients) have no skin in the game. Obama could have fixed item #2 with a universal health care that require (1) doctors to list the price of their services…

>Paying 20$ per visit...

Such experiments have been made with Medicaid demo projects in the US. They've failed every time. People can't distinguish needed care from unneeded care; they end up foregoing needed care, deteriorate, and end up costing the system much more in the form of hospitalizations, disability, etc.

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

#119

Post by Retric » Fri, Mar 02, 2018, 3:50 PM UTC

tinokid wrote: post #79

Retric wrote: 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.

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 numbers of 193 per 100k.

PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer rates will similarly drop from the HPV vaccine.

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

#120

Post by fpgaminer » Fri, Mar 02, 2018, 3:52 PM UTC

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…

People are _really_ bad at self diagnosing. So who's to say that the risks of going to the doctor are greater than the risks of self diagnosing?

Off the top of my head I know three family members who now suffer some disability because they didn't go to the doctor for symptoms they thought were non-threatening.