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axeil posted:A huge problem is American patients almost demand some form of treatment when they see the doctor. I went to my ENT (ear/nose/throat) doctor a few months ago as I was convinced I had a sinus infection. Doctor takes a look and says "nah you're good" and immediately jumped into explaining why he wouldn't be ordering any follow-up tests or prescribing medicine or anything of the sort, despite my repeated insistance that I know "no sign of infection = no drugs". They have to reflexively explain like this because people can and will doctor shop for someone who gives them pills or a CT scan or whatever else because people cannot cope with "yes you are ill, no there is no recommended treatment at this time." Honestly, we should just start giving people true placebo prescriptions because it seems to be the only way to placate them. Isn't it strange that Americans, and only Americans apparently, "demand" treatment that just so happens to enrich their providers It's far more common to have doctors prescribe unnecessary tests than to have them launch into diatribes about how they don't want money
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Jun 28, 2017 18:26
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call to action posted:I'm pretty sure that's the definition of a concern troll, right? Someone who hears "everyone should have access to healthcare" and responds with "but if they did, more tests would be administered, therefore more unneeded procedures would be performed, therefore people shouldn't have easy access to healthcare"? It's more that they're explaining why "Medicare for All" falls as flat as "If you like your doctor, you can keep your doctor." Boy, who knew that healthcare was so complicated? Edit: ^^^ Have you ever felt too upset about the world around you? Ask your doctor if our mood leveling pills are right for you. Ceiling fan fucked around with this message at 18:35 on Jun 28, 2017 |
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Jun 28, 2017 18:30
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Rhesus Pieces posted:Found it: A turtle and an rear end in a top hat walk in to a bar and kill 50,000 people a year. What a joke.
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Jun 28, 2017 19:09
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call to action posted:Isn't it strange that Americans, and only Americans apparently, "demand" treatment that just so happens to enrich their providers The New Yorker article has a story about how an oncologist recommended against surgery but the patient insisted on it anyway and post-surgical analysis indicated there was cancer, but it was unlikely to ever spread. There's lots of blame to go around.
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Jun 28, 2017 19:10
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axeil posted:For a sadder example of this, look at pain management. You have some doctors giving out pills like candy and getting folks who don't need pain meds addicted, and at the same time there are folks who legimately need pain medication to function and are denied because they're "drug seeking." And I bet you can't guess who is more likely to be judged as drug seeking! https://www.theguardian.com/science/2016/aug/10/black-patients-bias-prescriptions-pain-management-medicine-opioids
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Jun 28, 2017 19:10
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axeil posted:The New Yorker article has a story about how an oncologist recommended against surgery but the patient insisted on it anyway and post-surgical analysis indicated there was cancer, but it was unlikely to ever spread. It's not like the doctor has to approve the surgery though? Doesn't approving a surgery they truly think won't help violate their oath due to the inherent risks in any surgery?
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Jun 28, 2017 19:14
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axeil posted:A huge problem is American patients almost demand some form of treatment when they see the doctor. All patients everywhere do this. It's not an American thing. It's solvable with a bit of people skills.
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Jun 28, 2017 19:14
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Reik posted:It's not like the doctor has to approve the surgery though? Doesn't approving a surgery they truly think won't help violate their oath due to the inherent risks in any surgery? The surgeon and the oncologist may be different people. A doctor I worked for joked "a surgeon has never seen a problem surgery couldn't fix"
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Jun 28, 2017 19:16
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Reik posted:It's not like the doctor has to approve the surgery though? Doesn't approving a surgery they truly think won't help violate their oath due to the inherent risks in any surgery? They'd generally rather risk the surgery than the malpractice suit if the "unlikely to spread" cancer surprises them.
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Jun 28, 2017 19:19
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BarbarianElephant posted:All patients everywhere do this. It's not an American thing. It's solvable with a bit of people skills. China is notoriously bad for this and doctors give a grab bag of pills anytime you see them that includes at least one type of antibiotic whether needed or not.
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Jun 28, 2017 19:21
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For a heart-warming tale of a doctor adroitly avoiding unnecessary surgery for his patients, check out the classic Kurosawa film Ikiru.
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Jun 28, 2017 19:22
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oldskool posted:They'd generally rather risk the surgery than the malpractice suit if the "unlikely to spread" cancer surprises them. Gods forbid they make a difficult decision after swearing an oath to make those difficult decisions?
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Jun 28, 2017 19:26
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I am uncomfortable with the idea that when the issue is not absolutely clear-cut, the doctor should substitute his view for the patient's view after giving them the requisite information, the doctor's recommendation, and the reasoning behind it. It's one thing to refuse to do quack surgery. It's another to refuse to do something where the risks weigh against the treatment but the patient may have reasons they prefer the treatment.
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Jun 28, 2017 19:37
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evilweasel posted:I am uncomfortable with the idea that when the issue is not absolutely clear-cut, the doctor should substitute his view for the patient's view after giving them the requisite information, the doctor's recommendation, and the reasoning behind it. It's one thing to refuse to do quack surgery. It's another to refuse to do something where the risks weigh against the treatment but the patient may have reasons they prefer the treatment. Similarly, from a malpractice standpoint, it's highly unlikely a doctor will be sued for malpractice for doing something instead of nothing. There's a difference between "no medical benefit" and "unlikely to have a medical benefit" as well. It's just general human bias that doing "something", even if that something is counterproductive is better than doing nothing.
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Jun 28, 2017 19:44
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call to action posted:Isn't it strange that Americans, and only Americans apparently, "demand" treatment that just so happens to enrich their providers Part of this is because of the way medicine and treatment is advertised in America. I'm pretty sure it's the only country like this.
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Jun 28, 2017 19:44
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Lightning Lord posted:Part of this is because of the way medicine and treatment is advertised in America. I'm pretty sure it's the only country like this. it's not there are american-specific issues but the bias towards something instead of nothing is not one of them
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Jun 28, 2017 19:46
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I have been seeing a lot of arguments about the US being a medical tourism destination, particularly for those poor souls from countries with socialized medicine. Surveys indicate the medical tourism population to be about 65-85k people worldwide per year. These are people traveling explicitly for healthcare, not expats getting care, or emergency services for tourists. The US is a major destination, being the top target for people seeking the most advanced tech. I assume this means they are likely wealthy. The US also has major outflows of med tourists, to Asia and Latin America. Americans account for 99% the group that travels for lower cost treatments. Of all medical tourists, 7% are from Canada, and 12% are European. This talking point "We have the best healthcare system because everyone comes here for healthcare!" needs to be destroyed.
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Jun 28, 2017 19:50
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Grand Theft Autobot posted:This talking point "We have the best healthcare system because everyone comes here for healthcare!" needs to be destroyed. We have the best healthcare money can buy. As long as you've got the money.
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Jun 28, 2017 19:53
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Grand Theft Autobot posted:I have been seeing a lot of arguments about the US being a medical tourism destination, particularly for those poor souls from countries with socialized medicine. what that says is that we have the best "best care money can buy", but the worst heath care system, and people talking about the issue tend to deliberately conflate the two
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Jun 28, 2017 19:55
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evilweasel posted:it's not So you don't think being blasted with medical ads makes a difference in people demanding particular treatments?
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Jun 28, 2017 19:57
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Grand Theft Autobot posted:I have been seeing a lot of arguments about the US being a medical tourism destination, particularly for those poor souls from countries with socialized medicine. I'd wonder about these people. 1) How many of them are travelling for cosmetic surgery? 2) How many of them come from the Third World? Third World countries don't have much of a healthcare system, even for cash, because few can afford it. So those that can, must travel (think African dictators) 3) How many of them are going against doctors' advice in their home countries and seeking treatments that are not considered wise in their home country? (eg. quack or futile treatments) 4) How many of them are seeking treatment that is not considered moral in their home country (gender reassignment or surrogacy) (please note I am not judging this so don't flame me) 5) How many of them are seeking faster treatment (eg Canadians) In short, how many of them merely seek *better* treatment? Because this is something that causes travel all over the world. A person might travel to Switzerland or Spain if they have the one clinic that specializes in these things.
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Jun 28, 2017 20:01
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There's a reason the US and New Zealand are the only developed countries that allow direct to consumer pharmaceutical ads.
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Jun 28, 2017 20:02
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Reik posted:There's a reason the US and New Zealand are the only developed countries that allow direct to consumer pharmaceutical ads. I just looked at the numbers and I can confidently tell you this reason is not sheep per capita
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Jun 28, 2017 20:04
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Ormi posted:I just looked at the numbers and I can confidently tell you this reason is not sheep per capita did you include sheeple?
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Jun 28, 2017 20:06
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Lightning Lord posted:So you don't think being blasted with medical ads makes a difference in people demanding particular treatments? particular treatments, yes that when they have a problem they want treatment even if not treating it is the optimal approach, no
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Jun 28, 2017 20:07
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Reik posted:There's a reason the US and New Zealand are the only developed countries that allow direct to consumer pharmaceutical ads. Because by spending 20 seconds reading a list of possible side effects the patient is now capable of making an informed decision on if this therapy is right for them. That's seriously the rationale. Don't I feel like a fool for ploughing all that time and accruing all that debt from attending pharmacy school!
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Jun 28, 2017 20:23
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So this was from the Trump thread, and I had a quick question:evilweasel posted:Rand Paul's demands: https://www.paul.senate.gov/imo/media/doc/HealthCareReformLetter.pdf What prevents the bold item (1a) from happening to begin with? Why can't say, the Chamber of Commerce, set up their own plan and allow member businesses to join up, forming a solid risk pool of tons of small and medium sized businesses? That sort of thing seems like it would be a huge boon to smaller businesses and their employees. What am I missing here?
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Jun 28, 2017 20:31
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Solkanar512 posted:So this was from the Trump thread, and I had a quick question: People used to do association business, but it turns out groups that form for the sole purpose of obtaining health insurance are full of anti-selection and are terrible to insure. The only people that opted in to that chamber of commerce association are the people that couldn't pass medical underwriting.
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Jun 28, 2017 20:37
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Solkanar512 posted:What prevents the bold item (1a) from happening to begin with? Why can't say, the Chamber of Commerce, set up their own plan and allow member businesses to join up, forming a solid risk pool of tons of small and medium sized businesses? That sort of thing seems like it would be a huge boon to smaller businesses and their employees. What am I missing here? Agreed - isn't this already the existing state? How else do groups like SFWA, RWA, etc have their own insurance groups?
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Jun 28, 2017 20:37
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Solkanar512 posted:What prevents the bold item (1a) from happening to begin with? Why can't say, the Chamber of Commerce, set up their own plan and allow member businesses to join up, forming a solid risk pool of tons of small and medium sized businesses? That sort of thing seems like it would be a huge boon to smaller businesses and their employees. What am I missing here? I assume the wording of the statute. Also, I think what you're asking is different than what he's asking. He wants random individual people to be signing up for groups to sign up for group insurance.
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Jun 28, 2017 20:40
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https://twitter.com/npr/status/880140594772942850 That "haven't heard enough to form an opinion" tab really stands out among republicans, wonder why that is Reik posted:There's a reason the US and New Zealand are the only developed countries that allow direct to consumer pharmaceutical ads. And we get ads for poo poo that has no business being marketed to laymen at all. I can almost understand ads for stuff like boner pills or toenail fungus ointments, but I've seen repeated tv ads for stage 4 lung cancer drugs and web ads for drugs that treat pseudobulbar affect, as if that's a common disorder that the average person should ask their PCP about during their next checkup.
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Jun 28, 2017 21:05
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evilweasel posted:I am uncomfortable with the idea that when the issue is not absolutely clear-cut, the doctor should substitute his view for the patient's view after giving them the requisite information, the doctor's recommendation, and the reasoning behind it. It's one thing to refuse to do quack surgery. It's another to refuse to do something where the risks weigh against the treatment but the patient may have reasons they prefer the treatment. It's more complex than this, though, medically speaking. There are cancers (and all sorts of other poo poo) that you could operate on but not operating has a better outcome. This is because any time you do a surgery or admit someone to a hospital, you are putting someone at risk of infections, sepsis, etc. Literally any surgery has a statistically significant likelihood of killing you and the choice of whether to do surgery is to balance the negative risks of surgery against the positive outcomes from treating the disease. Doing a mastectomy on a breast tumor that has a 99.9% chance of being harmless is factually less safe than just leaving it there. By doing that surgery the surgeon is actually increasing the patient's risk of death. Doctors give in to patient pressure to do surgeries anyway for all sorts of reasons but I think you're going astray in arguing that it's totally benign if they decide to operate vs not operate.
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Jun 28, 2017 21:08
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Reik posted:People used to do association business, but it turns out groups that form for the sole purpose of obtaining health insurance are full of anti-selection and are terrible to insure. The only people that opted in to that chamber of commerce association are the people that couldn't pass medical underwriting. Is there an actual case study about this? I just remember back when I was with my lovely food safety lab, we only had a few hundred employees and the company provided (lovely) healthcare plans. As long as the group at large could come to an agreement, you could throw in the BBQ joint next door, the coffee stand in their parking lot, the mechanics across the way and even the strip clubs down the street. As long as you aren't overloading the pool with some weird niche with high accident rates, you should never get any worse than the deal the lab alone had, but together the larger pool should have better stability and more leverage to improve prices and diversity of benefits. I get you would have to be choosy at first when the pool is smaller but over time even moderate to large companies could find themselves saving money by joining rather than sticking with their own plans and smaller pools, right? Look, if I'm all wrong and this is dumb feel free to say so, but this really feels like something businesses can do right now without waiting for Congress to actually do something. evilweasel posted:I assume the wording of the statute. Also, I think what you're asking is different than what he's asking. He wants random individual people to be signing up for groups to sign up for group insurance. Ok, thanks for that clarification. Seems a little more odd this way, but if you can get enough people together I don't see a problem here either.
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Jun 28, 2017 21:20
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oldskool posted:They'd generally rather risk the surgery than the malpractice suit if the "unlikely to spread" cancer surprises them. Is medical malpractice actually a big issue for doctors or are they just overreacting? silence_kit fucked around with this message at 21:26 on Jun 28, 2017 |
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Jun 28, 2017 21:23
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Reik posted:There's a reason the US and New Zealand are the only developed countries that allow direct to consumer pharmaceutical ads. And there is literally nothing that can be done to fix this Fun
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Jun 28, 2017 21:26
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Solkanar512 posted:Is there an actual case study about this? Not a case study, but it's generally accepted actuarial knowledge. It's covered in my Group Insurance text book: http://www.actuary.org/files/publications/AssociationHealthPlans_021317.pdf https://www.amazon.com/Group-Insurance-Daniel-D-Skwire/dp/1625426828
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Jun 28, 2017 21:31
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Solkanar512 posted:Is there an actual case study about this? Instead of joining an association pool, moderate to large companies would generally choose to self insure to save on administrative costs and get the benefits of ERISA. Unless, of course, they had very high claims costs. Then they might realize that they could get a better deal from joining an association, and mix in all of their bad risk with the rest of the association's good risk. This jacks up the rates. Similarly, if a company has a lot of good risk, then they don't actually see a benefit to being a part of the association. They would make their own deal with an insurance company, leaving only the bad risk.
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Jun 28, 2017 21:33
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cis autodrag posted:It's more complex than this, though, medically speaking. There are cancers (and all sorts of other poo poo) that you could operate on but not operating has a better outcome. I don't view it as a benign choice. I am taking as a given that the surgery is a bad choice and saying that I am uncomfortable with the idea that as long as it's a bad choice that the patient's wishes shouldn't be honored. If you explain to the patient the negative risks and they have been provided with the full information, I think the patient should be able to make that decision rather than doctors refusing to participate when they disagree with the decision. There is a limit, of course: where there's no reasonable basis to do the surgery at all, it's a quack surgery, whatever. But I disagree with the person I originally responded to who was, in essence, arguing it's wrong for a doctor to agree to do that surgery. I believe the doctor's responsibility if he believes the surgery is a bad idea is to provide the information, provide the recommendation, and provide the basis for that recommendation, but then go through with it if that's the patient's decision.
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Jun 28, 2017 21:36
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"I don't care if you'll lose your license doctor, I need this gorilla vagina transplant STAT!"
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Jun 28, 2017 21:43
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silence_kit posted:Is medical malpractice actually a big issue for doctors or are they just overreacting? Depends on what you mean by actually. Is it an issue doctors care about? Absolutely. You want a doctor's opinion on how to lower medical costs, they'll always find their way towards talking about tort reform, because that's the one piece of the puzzle that actually impacts them financially. Malpractice insurance ain't cheap, and there are more than a few no-win scenarios where they can technically be sued for their decision no matter what they decide, and worst case scenario lose their license to practice medicine. Is it actually something that seriously impacts them, ahahaha no. The same logic that means insurance companies are usually safe screwing someone who's about to die means doctors are usually safe committing malpractice, and where tort reform has been accomplished it hasn't done poo poo to costs. But human risk analytics being what they are, the fear that any second Zeus might hit you with a thunderbolt for a gently caress-up scares people a lot more than knowing Zeus is going to hit you with a thunderbolt if you gently caress up.
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Jun 28, 2017 21:50
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