U.S. to make More Drugs Easily Available, Cutting Role Doctors Play • Hacker News Board

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#301

Post by yourapostasy » Thu, Jul 19, 2018, 1:53 AM UTC

darkerside wrote: post #293

yourapostasy wrote: post #188

Earlier quoted context omitted.

> They are legally...bound to serve their patients. In the US, with the cost of attorney-mediated access to the judicial system, this is not really a protective constraint for the bottom 90-95% of the population against exploitation by unethical medical providers. I'm interested in discussions about data transparency: anonymized, aggregated data about the patient population seen, the outcomes, and the amount spent, p…

I don't agree. It is a protective constraint because of the legions of trial lawyers who are happy to bring a malpractice suit, albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. It doesn't come close to making anybody whole when things go wrong, but the threat of litigation certainly modifies the way medicine is practiced.

> ...albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor.

> It doesn't come close to making anybody whole when things go wrong...

You are advocating that the system works for a value of "works" that rises above the hurdles of incentives where the minuscule fraction that trickles down to the patient and where "the way medicine is practiced" is a lucrative enough target for the expensive litigation. If you build software systems like you advocate for course corrections in medical practice, then you'd bin every trouble ticket until it came from a "big enough" customer with a "severe enough" problem. To each their own, but I'm personally in favor of granular, incremental changes that are more manageable and responsive to the market.

Waiting for litigation to change medical practices is no different than ignoring a defect in the design, implementation, and testing phases of software, and letting users find it beat down your door before fixing it. US doctors largely won't even adopt checklists yet, despite proven efficacy. It is unacceptable to have to wait for future litigation to see it adopted in mainstream medical practice.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#302

Post by madhadron » Thu, Jul 19, 2018, 2:14 PM UTC

fjsolwmv wrote: post #225

madhadron wrote: post #220

Earlier quoted context omitted.

> There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. In the US, where we have no standards of care, this is true. In centralized systems like France, doctors receive updates to expected standards of care annually based on analysis of the latest evidence. This has interesting effects. My father did the statistical work for a set of expert consensus gu…

Italy is 5x as dense as the USA. There is no equivalent to rural USA in Italy.

I'm not talking about Montana. I'm talking about Virginia outside of Charlottesville, Richmond, and Washington, DC.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#303

Post by darkerside » Thu, Jul 19, 2018, 5:04 PM UTC

yourapostasy wrote: post #301

darkerside wrote: post #293

Earlier quoted context omitted.

I don't agree. It is a protective constraint because of the legions of trial lawyers who are happy to bring a malpractice suit, albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. It doesn't come close to making anybody whole when things go wrong, but the threat of litigation certainly modifies the way medicine is practiced.

> ...albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. > It doesn't come close to making anybody whole when things go wrong... You are advocating that the system works for a value of "works" that rises above the hurdles of incentives where the minuscule fraction that trickles down to the patient and where "the way medicine is practiced" is a…

I'm not saying it works. I said it operates as a protective constraint. The current system undeniably prevents some cases of medical malpractice. You're talking about repairing harm done, and I'm talking about preventing harm.

For the record, I agree that there are many things that could be improved in the current medical system.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#304

Post by thatcat » Thu, Jul 19, 2018, 7:51 PM UTC

seandougall wrote: post #193

kbutler wrote: post #141

Earlier quoted context omitted.

The prescription is probably good for some limited number of refills.

No, if it’s good for refills then that process isn’t even necessary until those refills run out; the pharmacy keeps track of them automatically. What GP is describing is a refill authorization request, which happens when no refills are left. It does require the doctor’s approval, but usually does not require a visit as a matter of course, unless there’s a concern the dosage may need adjusting based on, say, new lab t…

>but usually does not require a visit

Things are probably different if this is a long term doctor you've established a relationship with; but in my experience no lab tests were done, just a lot of unnecessary paperwork and pay the lady at desk.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#305

Post by yourapostasy » Fri, Jul 20, 2018, 12:14 PM UTC

darkerside wrote: post #303

yourapostasy wrote: post #301

Earlier quoted context omitted.

> ...albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. > It doesn't come close to making anybody whole when things go wrong... You are advocating that the system works for a value of "works" that rises above the hurdles of incentives where the minuscule fraction that trickles down to the patient and where "the way medicine is practiced" is a…

I'm not saying it works. I said it operates as a protective constraint. The current system undeniably prevents some cases of medical malpractice. You're talking about repairing harm done, and I'm talking about preventing harm. For the record, I agree that there are many things that could be improved in the current medical system.

Point taken, thanks.

Litigation does have a preventative effect, but I only see its effects at a more macro, large-scale level, like removal of Vioxx from the market. We are lacking more effective micro, local-scale incentive mechanisms to effect change more incrementally instead of waiting for a generation of doctors to pass through, or for the nuclear blast from litigation to blunt-force change the medical landscape. Just as basic hygiene was the game changer for public health and increasing median lifespans in the past several centuries, I anticipate a smaller, basic change like checklists will in hindsight materially, beneficially alter medical cost and delivery outcomes.

Own technical fields faces similar challenges, so this is I suspect a very human gap.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#306

Post by walshemj » Fri, Jul 20, 2018, 6:50 PM UTC

LinuxBender wrote: post #285

walshemj wrote: post #125

Earlier quoted context omitted.

Yes well I am sure that's what the guy next to me when I was in hospital last year thought until he took supplements plus his prescribed meds and had 100% kidney failure.

What were the results of the autopsy?

luckily they caught it in time though I suspect his daughter had some strong words for him.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#307

Post by walshemj » Fri, Jul 20, 2018, 6:51 PM UTC

pkkm wrote: post #275

walshemj wrote: post #125

Earlier quoted context omitted.

Yes well I am sure that's what the guy next to me when I was in hospital last year thought until he took supplements plus his prescribed meds and had 100% kidney failure.

Do you remember what supplements and meds he took?

Large doses of Zinc some reaction with his other meds and the hadn't told his GP about the zinc pills.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#308

Post by InitialLastName » Mon, Jul 23, 2018, 4:54 PM UTC

rdiddly wrote: post #64

When you already know what drug you need and just need somebody to sign a prescription, it's a very silly and awkward process to find a doctor, make the appointment, wait for the appointment, show up to the appointment, fill out the history forms and so on, meet with the doc, tell them you've got [disease] and the drug for it is [drug], let them examine you until they agree with your "diagnosis" of [disease], and let…

> it's a very silly and awkward process to find a doctor, make the appointment, wait for the appointment, show up to the appointment, fill out the history forms and so on, meet with the doc, tell them you've got [disease] and the drug for it is [drug], let them examine you until they agree with your "diagnosis" of [disease], and let them recommend and prescribe [drug].

I'm with you up until all the people who "know" they need antibiotics for things that antibiotics don't work for. There's strong public health justification for putting a doctor in the loop on occasion.