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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)

#231

Post by gascan »

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…

Presumably it's a throughput & latency optimization. Doc only has to see you once if they already have the x-ray, instead of ordering an x-ray and then seeing you again. We speculatively do things in computers all the time in the name of speed & efficiency.

If it cost nothing and the radiation carried no risk, nobody would have any problem with it. As it is, the cost is modest and the risk is low, so presumably healthcare waved their hands and said "close enough".

(That said I still decline pre-appointment x-rays when I do not believe they are appropriate)

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

#232

Post by riahi »

astura wrote: post #197
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…

Same thing with me when I was referred to orthopedic surgeon for a lump in the soft tissue. Before even seeing me they called me in for a pre-appointment x-ray. It was never explained to be why a lump in the soft tissue would need an x-ray. I kinda went with it because it was such a surprise but I really wish I questioned it, seems like such a waste. Especially since the doctor ordered an MRI after seeing me.

Because the Radiograph is a relatively cheap screening test to rule out an underlying bony abnormality as a possible explanation for the soft tissue lump.

Further, radiographs and MRI provide complementary information. Taken together, they provide much more definitive characterization than either alone.

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

#233

Post by FireBeyond »

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.

With those caveats in place, absolutely.

In the US, studies have been shown that physicians who own shares in CT (not so much any more, as it becomes almost 'commodity') and MRI (which is a lot, manufacturers approach physicians to form imaging cooperatives) are ordering imaging up at more than 2 standard deviations from expectations.

As noted, MRIs in themselves aren't harmful. But with prices in the four digits in the US... you can easily pay off your $1.5M MRI machine in 18 months and be printing money with your over-imaging.

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

#234

Post by mrybczyn »

SketchySeaBeast wrote: post #229
39d3493I93 wrote: post #225

Earlier quoted context omitted.

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.

If you pass triage, and wait your turn... And outside of hospital emergency visits, if you can find a family physician. Free has a large time cost associated with it.

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

#235

Post by kurthr »

theseatoms wrote: post #180
monocasa wrote: post #166

Earlier quoted context omitted.

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…

Emergency care (and EOL) represent the majority of all costs for many people. Other than regular check-ups I haven't been to the doctor more than 30 times in the last 30 years. One visit to the emergency room in an ambulance is at least $10k and that is equal to 30 years of $300 visits. A real emergency can easily be several $100k once you figure in recovery. So I can't shop at all for 50-90% of all my spending!

After a heart-attack/car-wreck the ambulance should take me to the closest hospital not the one that happens to be 30 miles farther away and in-network. If I'm EOL care, then I likely have pre-existing conditions and travel limitation that will limit my ability to change plans, much less hospitals.

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

#236

Post by SketchySeaBeast »

mrybczyn wrote: post #234
SketchySeaBeast wrote: post #229

Earlier quoted context omitted.

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.

If you pass triage, and wait your turn... And outside of hospital emergency visits, if you can find a family physician. Free has a large time cost associated with it.

That's true, it's not flawless, but you certainly aren't getting too much unnecessary medical care!

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

#237

Post by FireBeyond »

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?

You want added irony? Insurance has been known to deny ambulance bills because the ride "was not pre approved".

Including Heli EMS from car accident scenes...

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

#238

Post by Broken_Hippo »

mrybczyn wrote: post #234
SketchySeaBeast wrote: post #229

Earlier quoted context omitted.

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.

If you pass triage, and wait your turn... And outside of hospital emergency visits, if you can find a family physician. Free has a large time cost associated with it.

No system is perfect, nor is any system free. At least taxpayer funded costs are ones that can be budgeted by the citizens and it'll be affordable. Not like what you get making 25-30k a year in the US.

I'm in Norway (immigrant). I've had no issues finding a family doctor. Other immigrants have had no issues at the hospital emergency room (I've not personally needed it). They even send me reminders to get cervical cancer screenings once every 3 years. Sometimes the appointments aren't as fast as some people would like, but I ran into similar issues in the states with some doctors and most definitely with specialists. And most times, it has been tolerable. When I've really needed in, my family doctor worked me in to see her.

The cost isn't that large. Especially not compared to what I got in the states: Folks spending 2,000+ on maintenance medications for different diseases. Going without care for things. And so on. These aren't exaggerations - these were myself, friends, family, and pharmacy customers.

Perfect here? Nope. But I'll take it.

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

#239

Post by mortenjorck »

arkades wrote: post #134

I worked in health insurance, and had a graduate degree in health policy, before I second-careered into medicine. I helped implement some of the programs that Guwande promotes in this article; I was and am a true believer in some of these programs, and have built my medical career around implementing them properly. I say all that to provide an important caveat: Guwande's a Harvard-associated surgeon largely insulated…

> iatrogenesis compensation fund built at the national level

An FDIC for malpractice suits is an interesting idea. Is there anything comparable to this in universal healthcare systems like the NHS?

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

#240

Post by paulsutter »

emiliobumachar wrote: post #184
paulsutter wrote: post #140

Earlier quoted context omitted.

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

That doctor needs to be somehow shielded from lawsuits, or they'll be incentivised to give undue weight to the risk of leaving something real untreated.

Good point. Of course, the overdiagnosis is then caused by the legal environment (not the scan). As an individual of course you can always sign a release for your doctor. If he seems uneasy about nontreatment, just write a letter to release him from liability for nontreatment so he knows he can relax and actually consider your wellbeing rather than liability.
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