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Why Did My Patient Leave Me?

cancer.nautil.us

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Re: Why Did My Patient Leave Me?

#81

Post by giardini »

In my case,

- reluctance to diagnose and treat the ailment instead of the symptoms and

- simply refusing to hear what the patient says.

I had an oozing rash break out behind my knees. The dermatologist said "That'll go away easily if you put some OTC corticosteroid cream on it." Wrong! The rash flared up within hours and nearly ate the flesh off the back of my knees. I happen to know that this indicates a fungal infection so I stopped the steroids and applied an OTC antifungal regularly. Slowly it began to heal.

A week later I had a minor bout with detergent dermatitis around my jeans pockets (happens every winter if I use a strong detergent).

Next time the dermatologist sees the residue of my scarred legs behind the knees and the "jeans-pocket" rash, I tell her that her steroid recommendation was absolutely a wrong call, what happened and how I treated the problem.

Rather than take a culture from the back of my legs (and later possibly prescribing an antifungal), she then prescribes not a tube, but a 1-pound _tub_ of corticosteroid cream and tells me to put it on all rashes (behind knees and on "pocket" rashes) for six weeks!

So I figure either she's deaf, has a serious learning disorder or flatter myself that she is trying to kill me. In any case I won't see that dermatologist again.

On the upside: I have an unopened pound jar of steroid skin cream in my refrigerator.

Re: Why Did My Patient Leave Me?

#82

Post by dom0 »

jacquesm wrote: post #55
lmns wrote: post #28

So, in this sense, vaccination should be an individual choice? This is something which concerns the individual, but has consequences for society as a whole.

> So, in this sense, vaccination should be an individual choice? Emphatically: YES. Bodily integrity is something that is very high on the list of things that a person should have a say over. Whether they do it because they are mis-informed, dumb, irrational or religious doesn't matter, they still should have the final say over whether or not they get a specific injection or not. There are many things that concern th…

I believe that there should be no obligation (in Maximum America mode that'd imply SWAT kicking in doors, restraining and injecting people), but society and state always manages to provide incentives to do things. Be it making things opt-out (possibly with a small fee), forbidding entry to institutions (e.g. only vaccinated people in schools), or just good ol' looking down on parents who don't vaccinate.

For example, in my country there are mandatory check-ups for children every couple years, which include a baseline of vaccination unless opted out. There are also mandatory check-ups conducted in schools (IIRC teeth and also vaccination - interdisciplinary, so to speak).

Re: Why Did My Patient Leave Me?

#83

Post by dom0 »

brightball wrote: post #52
josephorjoe wrote: post #33

The primary reason I have left healthcare providers has been the poor quality of their administrative staff. There are too many qualified doctors in the major metro area I live in to put up with ones where I can't quickly and efficiently make an appointment, can't get an appointment in a timeframe that is useful to me, and where their staff can't seem to successfully process routine insurance claims with major insura…

If you can justify the expense, MD VIP ( http://www.mdvip.com/ ) is worth exploring. You basically pay an annual fee and in trade, the doctor's office caps their patient load at a certain number. The fee also includes an annual executive physical and work up. The benefit is that with the smaller patient load, you can almost always get an immediate appointment. The doctor will actually get to know you and your history…

This stuff would be absolutely hilarious, if it wasn't about health care.

Re: Why Did My Patient Leave Me?

#84

Post by falcolas »

foobarian wrote: post #78
csydas wrote: post #35

Earlier quoted context omitted.

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...). This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer…

I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.

My parents actually had a doctor's office say "why do you care, insurance is covering it", and the insurance company say "we'll get it fixed, but you realize you won't get anything in return".

Yeah, the system is deeply busted.

Re: Why Did My Patient Leave Me?

#85

Post by maxerickson »

ThomPete wrote: post #77
maxerickson wrote: post #42

Earlier quoted context omitted.

Much of the US has certificates of need which impose limits on who can operate certain machines or have a hospital. And Medicare makes funding decisions based on what sort of care hospitals provide to patients. Critical access hospitals get higher reimbursement; maintaining that certification means a short average for length of inpatient stays and not growing to meet demand.

This is not the market fault it's the political system and reimbursement rules which creates perverse incentives. Some hospitals have begun to get reimbursed based on how well the patients gets treated called value based treatment.

I was implying that the US doesn't really have a market.

Re: Why Did My Patient Leave Me?

#86

Post by ThomPete »

jacquesm wrote: post #72
ThomPete wrote: post #70

Earlier quoted context omitted.

Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice. I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.

You wrote: > most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures. They typically can't pay for a new washing machine if their current one breaks down.

Most people in the west aren't poor just like most people aren't wealthy. Most people are in the middle.

There is a large number of people who can't afford to buy a washing machine but it's not most people.

Re: Why Did My Patient Leave Me?

#87

Post by bjelkeman-again »

foobarian wrote: post #78
csydas wrote: post #35

Earlier quoted context omitted.

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...). This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer…

I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.

$5000 bills showing up incorrectly isn't what I would call inefficiency. Attempted fraud maybe.

Re: Why Did My Patient Leave Me?

#88

Post by alphonsegaston »

cortic wrote: post #46
ThomPete wrote: post #24

Earlier quoted context omitted.

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

I do question the morality of the US system, and the sustainability of inflated prices it creates. Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly. This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc. Not saying th…

There's no question about it morality - it's immoral. Creating a system where whether you live or die is premised on your income is immoral. Even more so when single-payer systems demonstrably achieve better health outcomes at lower prices.

The reality is that that so many people in this country have bought into some kind of Capitalist Calvinism, where the suffering is not only pre-ordained by "market forces," but considered salutary itself, that it's sickened our culture beyond the capacity for reason. We'd really rather watch our friends, families, and neighbors die in sickness and poverty, than admit the failure of the grotesque just-world fallacy that is our economic ideology.

Re: Why Did My Patient Leave Me?

#89

Post by pdkl95 »

jacquesm wrote: post #55
lmns wrote: post #28

So, in this sense, vaccination should be an individual choice? This is something which concerns the individual, but has consequences for society as a whole.

> So, in this sense, vaccination should be an individual choice? Emphatically: YES. Bodily integrity is something that is very high on the list of things that a person should have a say over. Whether they do it because they are mis-informed, dumb, irrational or religious doesn't matter, they still should have the final say over whether or not they get a specific injection or not. There are many things that concern th…

> the only people at risk are those that have not been vaccinated

Remember that this set includes people that cannot receive the vaccine because of e.g autoimmune disorders, serious allergic reactions, etc. These people need the herd immunity to keep the general risk of infection low. As long as the number of anti-vaxxers is very small, they similarly benefit from the herd immunity as "free riders".

Once the number of free riders crosses a threshold[1], non-linear effects can rapidly amplify the spread of the disease among the population. Preventing any disease from gaining a "critical mass" in the population is an important part of how they work.

> Fortunately the anti-vaxxers are a small minority

Unfortunately that isn't really true in some areas.[2]

> so the consequences for society as a whole are manageable.

That management has already started to fail in CA (and other areas), where the rapid decrease in vaccination rates cause measles and whooping cough outbreaks[3].

[1] https://en.wikipedia.org/wiki/Herd_immunity#Mechanism

[2] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a1.htm?s_cid...

[3] https://www.advisory.com/daily-briefing/2014/09/30/in-wealth...

Re: Why Did My Patient Leave Me?

#90

Post by ThomPete »

mhneu wrote: post #80
ThomPete wrote: post #32

Earlier quoted context omitted.

My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they g…

That article is from 2013 and predicts crisis in as little as 3 years. It's 2017. Be careful with articles about single payer healthcare systems in the US. Most similar countries to the US have functional single payer plans. It's a false talking point pushed by conservative media that those systems don't work well. Conservative media pushes those falsehoods because the media is funded by the very wealthy and those wh…

And the french started cutting benefits already in 2014 to make sure that didn't happen.
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