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silence_kit posted:Is medical malpractice actually a big issue for doctors or are they just overreacting? Most doctors wind up getting sued once or twice. Money-wise, it is not a big issue. They have malpractice insurance and it's just a cost of doing business. The issue is more how it affects doctor's actions. Doctors don't like getting sued. Nobody does. It's an unpleasant process, there's depositions, your behavior gets litigated, the plaintiff seems sympathetic. And many of them go to trial that shouldn't - for the overwhelming majority of lawsuits, if it goes to trial it's a coinflip because the only cases that go to trial (instead of settling early or getting dismissed) are the hard ones. Medical cases go 66-33 for the doctor, meaning that about 1/3rd of the cases shouldn't have gone to trial, but usually they do because the patient either has a strong belief someone hosed up even if they didn't, or our lovely safety net means that they need to win to financially survive. So the problem is that the very prospect of getting sued impacts doctor's behavior because they don't want to get sued. It's the whole unpleasantness of the process that's so repelling, and that's why medical malpractice reform is bullshit: it's not the potential for huge verdicts they're worried about, it's just getting sued in the first place. It does result in "defensive medicine": doctors act in a way so they don't get sued. On one hand, that's good - that's what we want doctors to do, follow the standards of care so they don't get sued. On the other hand, they tend to be biased based on the biases of the court system: a jury is going to look a lot harsher on "doing nothing" than ordering a test and doing something based on the test. And, of course, doctors have little faith in a jury understanding their job. So the incentives they're given, and that they respond to, may not be the best ones. There's similar incentives in other fields - like, for example, if you're in a field where you might ever get sued it's just best never to use digital communication for shooting the poo poo or talking about sensitive matters - but doctors personally wind up getting sued more often than the average person so they care about it more. I generally think lawsuits are a poor substitute for effective regulation and oversight and I think a good system would replace most medical malpractice with basically a "workman's comp" system where bad medical results are essentially insured against on a no-fault basis, plus beefed up oversight and regulation. I don't have any reason to believe doctors don't want other, lovely, doctors punished. Malpractice reform tends to just gut lawsuits as a form of regulation without replacing it with anything, and without giving people who are injured a real way to recover. They're always dumb posturing poo poo where politicians can pretend they're doing something without doing anything at all.
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Jun 28, 2017 22:10
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evilweasel posted: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. But that would be knowingly doing harm. If my tumor has a .01% chance of killing me but I have a 1% change of dying of a hospital-acquired infection post surgically, the doctor who performs that surgery is actively doing harm to me. That's unethical. That they do it anyway means that the customer is always right attitude has no place in health care.
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Jun 28, 2017 22:21
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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 Americans demand treatment because if you've missed work (unpaid) to see a doctor and are paying a thousand dollars for the privilege, you drat well want a result Getting almost anything treated in America very quickly hits the sunk cost fallacy; you've put in time and money, you want something back
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Jun 28, 2017 22:25
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Thanks for your post!
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Jun 28, 2017 22:28
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Teriyaki Koinku posted:I'm only vaguely familiar with what happened with that, but what was Lieberman's personal motivation to get rid of the public option in drafting the ACA? And why is he such an rear end in a top hat to his own party coalition? I can't tell if someone beat me to this, but Connecticut, Lieberman's home state, is the home of Aetna, Cigna, and the Hartford. The main office of Travelers is also there. There are also countless other offices of brokers and financial services people who work with those companies too. The state is incredibly dependent on and influenced by the insurance industry. And capitalist running dogs who have homes in Greenwich.
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Jun 28, 2017 22:51
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cis autodrag posted:But that would be knowingly doing harm. I disagree that's doing harm. It's not a "the customer is always right" attitude and you keep trying to characterize it to make it an easy problem instead of a hard one. Plus, your rationale just outlawed cosmetic surgery. If a tumor has a lower chance of killing you than surgery does, there are rational reasons you might prefer the surgery. For example, you're an anxious person, and you may simply be unable to happily live with the knowledge there's a tumor growing inside of you. Or you may simply prefer that if you're going to die, you'd rather die relatively quickly and/or under surgery than dying slowly of cancer. Or you may feel like you couldn't live with yourself not trying. Or whatever. It's your life, as long as you are making an informed choice with the relevant information and can make that choice, the default should be that the choice is up to you, even if the doctor considers it the wrong choice.
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Jun 28, 2017 23:13
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Brony Car posted:And capitalist running dogs who have homes in Greenwich. most of those people lost their wall street jobs in the crash and the people who replaced them don't live in CT anymore because you don't save on taxes
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Jun 28, 2017 23:15
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Hieronymous Alloy posted:Americans demand treatment because if you've missed work (unpaid) to see a doctor and are paying a thousand dollars for the privilege, you drat well want a result This is absolutely true. My last set of Continuing Education courses on infectious diseases had back to back chapters on Antimicrobial Stewardship and Influenza respectively. The first chapter was mostly about how to discourage patients from presenting too often/early with cold-like symptoms so they aren't being prescribed antibiotics for diseases that are probably viral in nature. The second chapter was about encouraging patients to get seen within the first 72 hours of flu-like symptoms, since Tamiflu probably isn't worth it at that point. Combine those two impulses with the $100+ bare minimum urgent care bill a patient will receive just for showing up and you've pretty well summarized our healthcare system.
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Jun 28, 2017 23:43
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evilweasel posted:And many of them go to trial that shouldn't - for the overwhelming majority of lawsuits, if it goes to trial it's a coinflip because the only cases that go to trial (instead of settling early or getting dismissed) are the hard ones. Medical cases go 66-33 for the doctor, meaning that about 1/3rd of the cases shouldn't have gone to trial, but usually they do because the patient either has a strong belief someone hosed up even if they didn't, or our lovely safety net means that they need to win to financially survive. I don't disagree with your assessment, but l'll quibble with this part - the numbers I'm familiar with are significantly worse for plaintiffs, and adjusters know that. The defense side will frequently push things to trial on facts that in another context you'd expect to result in settlement/mediation/what have you. It's a weird area.
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Jun 29, 2017 00:33
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Ze Pollack posted:Depends on what you mean by actually. You have to report all lawsuits for malpractice to your malpractice insurance provider, state medical board, professional board, and employer. It follows you. You are also the captain of the ship and responsible for everything that everyone under you does, even if orders that you wrote are carried out wrong while you are on vacation. That said, tort reform is such a minuscule cost savings that it's only useful as a tool for the states to attract more doctors at the expense of other states because you have a better practice enviroment. Examples: Texas and Louisiana versus California and Pennsylvania. The collective cost of malpractice insurance nationwide is on the order of $10-20 billion per year.
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Jun 29, 2017 00:36
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cis autodrag posted:But that would be knowingly doing harm. You're applying statistics to people with a sample size of 1 and also giving examples where the answers are clear cut. Obviously, no surgeon would do that procedure using just your example. I can also make up a scenario where a surgeon would do a procedure most of the time: lets say someone with that tumor of 0.01% chance of death subsequently develops debilitating anxiety and agoraphobia because of that fear. They lose their job and stop eating. All other options have failed and the person begs the surgeon to remove it because they will be less anxious. I imagine most surgeons would do that procedure. Edit. God dammit I gave the same scenario as evilweasel without realizing it. My point still stands.
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Jun 29, 2017 00:46
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Hieronymous Alloy posted:Americans demand treatment because if you've missed work (unpaid) to see a doctor and are paying a thousand dollars for the privilege, you drat well want a result Fair point, taking the day off and paying a copay worth next day's pay kinda makes you want poo poo resolved
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Jun 29, 2017 02:17
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Lote posted:You have to report all lawsuits for malpractice to your malpractice insurance provider, state medical board, professional board, and employer. It follows you. You are also the captain of the ship and responsible for everything that everyone under you does, even if orders that you wrote are carried out wrong while you are on vacation. That anesthesiologist I worked for has to report a lawsuit settled for "nuisance value" because he was named in suit along with the surgeon. He never met he patient, a nurse anesthetist worked it. And it was for a surgical complication unrelated to anesthesia. The system is so weird.
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Jun 29, 2017 02:30
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Has anyone posted this? https://www.researchgate.net/blog/post/fewer-cardiac-arrests-after-affordable-care-act-expanded-coverage quote:RG: What did you find? The ACA helped reduce heart attacks by 17% for a certain demographic. The leading cause of death in the US for christ sake. And I just heard that DC reduced the number of drug related HIV cases to seven with needle exchanges and preventative care.
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Jun 29, 2017 02:32
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Lote posted:You're applying statistics to people with a sample size of 1 and also giving examples where the answers are clear cut. Obviously, no surgeon would do that procedure using just your example. I can also make up a scenario where a surgeon would do a procedure most of the time: lets say someone with that tumor of 0.01% chance of death subsequently develops debilitating anxiety and agoraphobia because of that fear. They lose their job and stop eating. All other options have failed and the person begs the surgeon to remove it because they will be less anxious. I imagine most surgeons would do that procedure. No, I don't think preforming surgery that is viewed as not medically necessary to treat clearly somatic complaints would be ethical in any way. Perhaps an SSRI with a benzodiazepine as needed or Cognitive Behavioral Therapy would be a bit more appropriate method of managing a patient's anxiety than random surgery? brb gonna go ask a dermatologist to remove every mole and freckle on my body on the assumption that they could turn cancerous at any moment
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Jun 29, 2017 02:37
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Dmitri-9 posted:Has anyone posted this? Which in turn reduces costs on the overall health care system but whatever.
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Jun 29, 2017 03:25
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Subvisual Haze posted:Perhaps an SSRI with a benzodiazepine as needed or Cognitive Behavioral Therapy would be a bit more appropriate method of managing a patient's anxiety than random surgery? What do you think I meant by saying all options have failed?
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Jun 29, 2017 04:37
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Lote posted:What do you think I meant by saying all options have failed? That you know absolutely nothing at all about healthcare, disease states, treatments or medical ethics?
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Jun 29, 2017 07:51
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I don't really understand why you've got such a strong reaction. People get purely cosmetic surgical procedures done all the time which aren't medically necessary that carry similar risks.
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Jun 29, 2017 09:47
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evilweasel posted:Rand Paul's demands: https://www.paul.senate.gov/imo/media/doc/HealthCareReformLetter.pdf #1 is now going to be the plan, by the way, even though it flagrantly violates the Byrd Rule. It's been a conservative ask for quite a while, since it allows insurers to sidestep state regulations through these small business associations. Combine this with slowly killing the exchanges and removing the ACA regulations on group health coverage and the ACA is basically repealed (without outright repealing it) along with bonus insurance market deregulation. It's evil and awful for consumers, but it's too subtle to scare away moderates, who can now be brought back with changing the subsidies to account for variations in regional pricing and whatever bribes McConnell digs out of the slush fund. I don't think block grants for Medicaid will go anywhere, but a lot of money can be thrown at a transitional fund to keep people on Medicaid for as long as possible so moderates can say they saved Medicaid in their state (until after 2025 when it bleeds money so fast it dies, but that's a long ways out.)
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Jun 29, 2017 15:00
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Mooseontheloose posted:Which in turn reduces costs on the overall health care system but whatever. It reduces costs on the economy. In aggregate. It slightly increases costs on the healthcare system. Because follow up care for heart problems is more expensive than doing an autopsy on the person who died before the truck showed up.
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Jun 29, 2017 16:39
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The first few years of a single payer/UHC/NHS will likely be pretty expensive as people who have undergone no preventative care their whole lives get checkups, but in the long run I imagine costs would begin yo normalize to that of other countries as the magic of preventative care works its wonders. That's not to deny the existence of issues that have been mentioned ITT, of course.
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Jun 29, 2017 16:53
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evilweasel posted:I disagree that's doing harm. It's not a "the customer is always right" attitude and you keep trying to characterize it to make it an easy problem instead of a hard one. Plus, your rationale just outlawed cosmetic surgery. And this is why professionals are completely redoing the recommendations for testing and screens. People are loving stupid (hell even most people here are badly informed on the topic).
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Jun 29, 2017 17:02
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Lote posted:You're applying statistics to people with a sample size of 1 and also giving examples where the answers are clear cut. Obviously, no surgeon would do that procedure using just your example. I can also make up a scenario where a surgeon would do a procedure most of the time: lets say someone with that tumor of 0.01% chance of death subsequently develops debilitating anxiety and agoraphobia because of that fear. They lose their job and stop eating. All other options have failed and the person begs the surgeon to remove it because they will be less anxious. I imagine most surgeons would do that procedure. This is also wrong.
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Jun 29, 2017 17:04
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TROIKA CURES GREEK posted:This is also wrong. I'm not going to argue this dumb hypothetical anymore. The original point is that medical decision making is much more complicated than risk of death with a surgery versus risk of death from the surgery. There are scenarios where risks versus benefits of medical treatment are unclear, ambiguous, and outcomes aren't well studied.
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Jun 29, 2017 18:20
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silence_kit posted:Is medical malpractice actually a big issue for doctors or are they just overreacting? This article is from 2009 but it might help you understand the situation http://www.tampabay.com/news/canada-keeps-malpractice-cost-in-check/1021977 Kind of funny that American doctors (if this is still the same as it was) are in a way victims of for-profit insurance as well
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Jun 29, 2017 18:50
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Lightning Lord posted:This article is from 2009 but it might help you understand the situation Turns out capping malpractice payments does reduce the doctors premiums but that doesn't get passed on to the patients: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1635882 quote:In sum, we find no evidence that Texas’s tort reforms bent the cost curve downward. https://www.citizen.org/sites/default/files/a-failed-experiment-report.pdf quote:Two groups have benefited greatly from the restrictions: medical liability insurance
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Jun 29, 2017 18:59
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Reik posted:Turns out capping malpractice payments does reduce the doctors premiums but that doesn't get passed on to the patients: To expand on those articles, tort reform is never going to decrease consumer costs in any meaningful way. The US spends 3.2 Trillion per year on healthcare and malpractice costs compose 0.6% of that figure from that article. It is an issue that can make or break a doctor's decision to work in a state. It's an issue that needs to be addressed, but it's a drop in the bucket when we are talking about the Medicaid cuts. It's also an issue that is in the domain of the states and won't play into what Congress does.
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Jun 29, 2017 19:37
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An additional layer in this is the aggressive promotion of off-labeling, with associated pressure on doctors to make scientific and prescription evaluations they aren't qualified to make. While the drug company finds ways to target both the end user and the clinician with advertising regarding the product. An additional, additional layer is the development of parallel pseudoprofessions that are used to "address" clinician shortages and high care costs. axeil posted:Honestly, we should just start giving people true placebo prescriptions because it seems to be the only way to placate them. no
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Jun 29, 2017 19:43
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I'm starting to think McConnell was genuinely not expecting this much resistance https://twitter.com/mj_lee/status/880494529815601152
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Jun 29, 2017 19:45
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It should only get worse for McConnell as time goes on and this bill starts to rot in the sun and bloat up like a roadkill possum Or he could just be biding his time and handing out some pork to push it through I dunno
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Jun 29, 2017 19:48
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Monkey Fracas posted:It should only get worse for McConnell as time goes on and this bill starts to rot in the sun and bloat up like a roadkill possum He's probably hoping opposition will die down, so call your representatives over the weekend.
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Jun 29, 2017 19:50
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Reik posted:Turns out capping malpractice payments does reduce the doctors premiums but that doesn't get passed on to the patients: That's why malpractice caps aren't going to make a difference in defensive medicine. Doctors don't want to go through it at all, not come out with their insurance company having to pay out less. And with malpractice awards being limited, insurers will be less likely to settle and will push more for going to trial since they have less to lose (while hoping that the plaintiffs will just give up because the cost of moving forward gets too high), dragging physicians along further into malpractice hell. You want to fix malpractice? You tier it. You start off by admitting that there are lots of people out there who do deserve compensation but who aren't attractive clients to malpractice lawyers. The moment an error or poor outcome occurs you acknowledge it even if the victim doesn't even know something happened (which is the case for a lot of drug errors and the like). You offer people compensation up front for any additional hospital bills plus a reasonable payout for non-economic harms, in exchange for agreeing not to sue. You make this step as simple as possible so that people don't have to hire a lawyer in the first place for clear cases of harm. If someone decides to refuse and wishes to sue, then they may undergo factfinding through depositions and the like and present their case to a panel of experts along with whom they would like to name in the lawsuit, and the panel can move forward in entirety against parties now officially named, dismiss the case entirely , or remove people who did not contribute to the perceived poor outcome -- the last two groups need not report anything in the future regarding their involvement and can move on with their lives. From that point on, negotiations would continue as is current practice including trial if no settlement can be reached, with the exception that expert witnesses must maintain active credentialing and patient care in the field upon which they wish to testify. This approach maximizes the number of people receiving compensation for error, minimizes the impact frivolous lawsuits have on physicians, but allows patients with extraordinary claims to make their case against the parties that caused harm. You'll find that doctors will feel more comfortable adhering to evidence-based practice instead of DOING loving EVERYTHING CAN'T MISS ANYTHING EVER, and it will decrease healthcare costs.
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Jun 29, 2017 20:01
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Clickhole getting in on the action http://www.clickhole.com/article/beautiful-when-7-year-old-boy-could-no-longer-affo-6296
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Jun 29, 2017 20:01
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Hieronymous Alloy posted:He's probably hoping opposition will die down, so call your representatives over the weekend. Call over the weekend nothing; they're going home for the week. Show up at their house.
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Jun 29, 2017 20:13
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Ted Cruz has a hot new idea: subsidizing unhealthy people directly, in effect redistributing the cost of high premiums from everyone who buys health insurance to the federal government.quote:Cruz acknowledged that his plan would depend on taxpayer subsidization of people with high medical costs. But, he argued, it was better for the federal government to pick up the tab than requiring health plans to charge sick people and healthy people the same premiums, increasing costs for the latter. What a weird loving world we live in.
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Jun 29, 2017 20:28
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Ormi posted:
He's not wrong. But his proposed solution, in which you'd only buy a real Obamacare policy if you were sick and actually planned to use your coverage, is the same basic solution as high risk pools, and is unworkable for the same reason: you'd need to dump a ton of money into them, and he's not going to be willing to do it. So all you're left with is the stripping of the Obamacare regulations. It's just an attempt at an alternative fig leaf for moderates that actually makes the bill even worse. Fortunately it's being pushed by the worst salesman in the world.
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Jun 29, 2017 20:36
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Sir Kodiak posted:He's not wrong. But his proposed solution, in which you'd only buy a real Obamacare policy if you were sick and actually planned to use your coverage, is the same basic solution as high risk pools, and is unworkable for the same reason: you'd need to dump a ton of money into them, and he's not going to be willing to do it. So all you're left with is the stripping of the Obamacare regulations. The claim, is, in fact, that they will dump a ton of money into them. Whether that's believable is another story entirely, and it certainly makes healthcare for high-risk individuals much easier to gently caress with. But, really, rub your eyes and read over the proposal again, I know I had to, because it's literally unbelievable that this is coming from the mouth of Ted loving Cruz.
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Jun 29, 2017 20:41
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Ormi posted:The claim, is, in fact, that they will dump a ton of money into them. Whether that's believable is another story entirely, and it certainly makes healthcare for high-risk individuals much easier to gently caress with. But, really, rub your eyes and read over the proposal again, I know I had to, because it's literally unbelievable that this is coming from the mouth of Ted loving Cruz. Yeah, I don't disagree. It's only comprehensible at all as a strategy because I consider Cruz entirely untrustworthy when it comes to adequate funding for the program.
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Jun 29, 2017 20:42
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TROIKA CURES GREEK posted:And this is why professionals are completely redoing the recommendations for testing and screens. People are loving stupid (hell even most people here are badly informed on the topic). This is an issue. Science changes quickly, but public perception does not. It can take years to educate the general public on health related issues, and it can take even longer to convince them that what you said before was wrong. This is a situation where less information could be better, the government and medical community shouldn't be recommending specific tests and treatments to the general public unless they are absolutely sure it is settled science that is extremely unlikely to change. In the vast majority of cases, it is better to tell patients to trust medical professionals to recommend specific tests, since they are able to better evaluate new and changing evidence.
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Jun 30, 2017 01:28
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