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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)

#71

Post by DanBC »

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…

He's just regurgitating conventional medical wisdom that's routine in countries that aren't the US.

We've been talking about the risks of over-testing, over-diagnosis, and over-treatment for many years. Mostly in the context of full body MRI scans for healthy people, or early testing for prostate cancer, but also many other things.

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

#72

Post by mobilefriendly »

manjushri wrote: post #52
kreco wrote: post #45

For the physical harming, Nassim N. Taleb wrote a book called "Anti-Fragile" desribing the concept of iatrogenic illness. https://en.wiktionary.org/wiki/iatrogenic An alarming fact was less dying patients when an hospital workers were in a strike action (during 2 weeks).

Johns Hopkins study suggests medical errors are third-leading cause of death in U.S. https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-...

I was on a multi-corporate task force on medical errors in the late 1990s and the working number was about 80,000 deaths per year. I remember GM saying that statistically it worked out to something like one GM worker or retiree like every week, and that if they had that kind of mayhem on the assembly line there'd be outrage... but the inept health care system just quietly kills people.

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

#73

Post by walshemj »

LeifCarrotson wrote: post #27
vonmoltke wrote: post #16

Earlier quoted context omitted.

> I showed up for my intake appointment and the young, rushed doctor said they wouldn't enroll me as an official member "Intake appointment"? "Official member"? What kind of system is this?

Sounds like a typical American family doctor's office? All of them in my area have long waiting lists. You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical. They're typically booked solid for a few months in advance. Calling to book an appointment requires being a registered patient or member of that office. If you want to change your primary care physi…

Its the same in the UK you have to register with a GP's Practice.

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

#75

Post by westbywest »

whb07 wrote: post #42
phil21 wrote: post #33

Earlier quoted context omitted.

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…

So much this! I broke my leg a decade ago and asked my doctor how much did it cost to get X done if I wanted to pay in cash. He didn’t know and looked dumbfounded by such a simple question. In what other profession can a professional perform a task not knowing what he’s charging for the services being rendered?

Plenty of professions, actually. Especially those where skills cultivated by individuals become highly specialized, and companies thus maintain a large number of employees to ensure their business requirements (including billing and bookkeeping) are met by dedicated staff of sufficient skill level. Not all medical practice can be done like sole-proprietor design shops.

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

#76

Post by pjc50 »

tonyedgecombe wrote: post #55
LeifCarrotson wrote: post #27

Earlier quoted context omitted.

Sounds like a typical American family doctor's office? All of them in my area have long waiting lists. You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical. They're typically booked solid for a few months in advance. Calling to book an appointment requires being a registered patient or member of that office. If you want to change your primary care physi…

that would be anarchy Yet it's exactly what we can do in the UK, I remember needing to see a doctor whilst on Holiday in Scotland, I just phoned the local GP and got an appointment the next day.

That must have been a while ago or in a quiet area; if I want to see my GP I have to either redial and hope from 8am or wait at least a week.

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

#77

Post by vonmoltke »

LeifCarrotson wrote: post #27
vonmoltke wrote: post #16

Earlier quoted context omitted.

> I showed up for my intake appointment and the young, rushed doctor said they wouldn't enroll me as an official member "Intake appointment"? "Official member"? What kind of system is this?

Sounds like a typical American family doctor's office? All of them in my area have long waiting lists. You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical. They're typically booked solid for a few months in advance. Calling to book an appointment requires being a registered patient or member of that office. If you want to change your primary care physi…

> Sounds like a typical American family doctor's office?

Not any that I have ever been to, and I have been to several across two different metro areas.

> All of them in my area have long waiting lists.

I have yet to encounter a waiting list.

> You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical.

Actually, I just book an appointment. Only once have I started out with my physical being the first appointment.

Calling to book an appointment requires being a registered patient or member of that office.

> Calling to book an appointment requires being a registered patient or member of that office.

I am not a "member" of my doctor's office, not have I ever been. I just go on ZocDoc or my insurance company's website, pick a doctor, and make an appointment. Sure, some are marked as "not accepting new patients", but I just ignore those.

> If they are, they'll get your medical records transferred and set you up for an intake appointment where they check to make sure that they know your status, and then you are able to schedule future visits.

I have never had my medical records transferred, nor have I ever had an intake appointment. I just go in, discuss my issues, present any relevant history myself, and go from there. If I ever become dissatisfied, I just start going somewhere else.

> You certainly don't just call any convenient office and expect to get an appointment in the next couple days, that would be anarchy.

That's all I have ever done, so I don't see how I "certainly" don't. In fact, here is a ZocDoc PCP search using my insurance centered on Grand Central:

https://www.zocdoc.com/search?address=Grand%20Central%20Term...

There are seven doctors on that list that I could see today. No intake appointment, no physical, none of this crap you are talking about.

So I ask again, what kind of system are you dealing with?

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

#78

Post by walshemj »

emodendroket wrote: post #56
heimidal wrote: post #49

Earlier quoted context omitted.

Even as an existing patient, I’ve been quoted wait times of more than three weeks to see my PCP.

Me too, but it seems like there's a hierarchy depending on what your complaint is. When I needed to schedule a follow-up post-hospital discharge they had no problem getting me in, but when I had other complaints it was see an NP or wait months.

Yes as they say that's what the receptionist is to triage patients so that the worried well or those with a cold who want antibiotics dont get seen as quickly as those of with chronic conditions

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

#79

Post by tinokid »

Retric wrote: post #48
phil21 wrote: post #33

Earlier quoted context omitted.

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…

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.

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

#80

Post by s3nnyy »

Nassim Taleb explains this in "Skin in the Game" rather well. If you are sick a little bit, don't take drugs prescribed by your doctor. If you come to the doctor with a little coughing, the doctor knows you're likely fine and there is a high chance you won't need any meds BUT if you happen to die the next day, the family of the former patient will find something and might sue you because you - as a doctor - didn't prescribe the needed drugs. Some drugs are known to cause problems 10 years down the line, but this is not the doctors problem because he fixed your primary problem but doesn't really care about second-order/side-effects of the prescribed drugs.
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