From Men's Journal:
Every time you walk into a physician's office, you run the risk of overtreatment: Tests you don't need, medications that are ineffective (or dangerous), procedures that cause more problems than they solve. In many cases the best thing for your health is to do nothing.
Make no mistake: A good doctor is, or should be, your most trusted resource if you're sick. If you're not sick and he wants to treat you anyway, that doesn't necessarily make him a bad doctor. But it does make him a player in a system that operates according to the unspoken and often unexamined assumption that more treatment is better for the patient. It's unquestionably better for the financial health of the stakeholders in the system: the doctors, the pharmaceutical industry, the health-insurance companies, and the hospitals. If you don't know how the game is played, the odds go up that you'll wind up the loser.
What do you people think, will people change if they know this?
(Score: 2, Informative) by dublet on Wednesday September 24 2014, @04:01PM
Don't really have these sorts of problems in the NHS, as there's no financial incentive for doctors to give you any particular treatment over another. GPs get paid per patient they have, AFAIK.
"If anyone needs me, I'm in the angry dome. [dublet.org]"
(Score: -1, Flamebait) by Anonymous Coward on Wednesday September 24 2014, @04:24PM
Yes on the NHS everyone gets treated equally incompetantly while civil servants pocket most of the funding. Isn't socialism wonderful.
(Score: 3, Interesting) by Anonymous Coward on Wednesday September 24 2014, @04:47PM
I'd like some statistics on the equally incompetent treatment across the entire NHS, it sounds terrible.
I have friends and family in the UK and there must be a gagging order to stop people talking about the shameful service. Apart from relatively minor issues and personal annoyance with a specific nurse or doctor, incompetence is not something that i've seen leveled across the service as a whole.
A good friend of mine was very appreciative of an emergency surgery within an hour of being admitted to hospital, and no fear of astronomical bills and arguments with insurance companies. A elder family member is also very pleased with the cancer treatment received, with the reservation the annual checkups can be a little tedious, but it did catch the cancer a second time very early. yet again, no paperwork to fill out or bills to pay at the end of it.
So please enlighten me as to the incompetence across the NHS which the socialized system is to blame. On that, it must be good news that the NHS is now using US private-healthcare consultants to see how they can move away from this apparently dreaded socialized medicine and move the money from the civil servants into the hands of outsourcing multinationals.
(Score: 3, Informative) by isostatic on Wednesday September 24 2014, @04:56PM
I have friends and family in the UK and there must be a gagging order to stop people talking about the shameful service.
It is, bloody shameful. In some parts of the UK you have to PAY TO PARK YOUR CAR when you visit the hospital for your free CT scan.
(Score: 2, Informative) by turgid on Wednesday September 24 2014, @08:01PM
I rely heavily on the NHS for my on-going well-being. Let me just add to your comment that I've only been let down by them on very rare occasions (caused by bad apples - i.e. unprofessional staff) but I am constantly impressed by the level of care and respect I receive from the NHS. Without them, I'd have ended up dead a long time ago.
I refuse to engage in a battle of wits with an unarmed opponent [wikipedia.org].
(Score: 3, Insightful) by VLM on Wednesday September 24 2014, @09:34PM
"caused by bad apples - i.e. unprofessional staff"
The thing I've never understood about the american neocon's loud trumpeting (farting, I guess?) of anecdotes involving people like that, is they assume we're dumb enough to think that a purely profit oriented faceless soul less corporate monopoly would somehow care enough to get rid of jerks, and we're dumb enough to have forgotten the last 50000 times things didn't work out so well under those conditions.
(Score: 2) by Wootery on Wednesday September 24 2014, @08:10PM
Indeed, but we Brits do at least have the sense to treat that as scandalous.
(Well, sometimes, anyway. Whether the practice has categorically ended, I don't know.)
(Score: 2) by monster on Thursday September 25 2014, @03:12PM
That's outrageous! What will be next, force people to use their legs and (gasp) walk? Oh!, the humanity!
(Score: 3, Interesting) by Zinho on Wednesday September 24 2014, @07:27PM
I'd like some statistics on the equally incompetent treatment across the entire NHS, it sounds terrible.
Well, you'll have some trouble there; apparently the NIH doesn't keep track of that sort of thing.
There was a pilot study [nih.gov] done on negative patient outcomes in London hospitals:
almost 11% of patients experienced an adverse event, over half of which were deemed preventable judged by ordinary standards of care. More worryingly, at least a third of these events led to disability or death. This was a pilot study but there is no reason to believe that the results are unrepresentative. The frightening extrapolation of these data suggests that in England and Wales adverse events lead to an extra 3 million bed days at a minimum cost of £1bn per year.
To be fair, the U.S. has a similar problem with reporting such "adverse events", and other studies (cited in my previous link) found them in 5-10% of U.S. hospitalizations.
And, since I'm human and these numbers have little emotional impact on me, I'll share a personal anecdote. My sister, a U.S. citizen married to a Brit, gave birth in a British hospital and nearly became a statistic for a story like this. She was hemorrhaging postpartum, which was not detected for over three hours because the nurses on duty neglected to check on her status during that time. A visiting family member noticed that my sister was becoming listless, pale, and incoherent in her speech, and called a nurse. She could have bled out while the hospital focused on the newborn, and was lucky enough to have family close who detected what the hospital should have but did not.
I'm not going to pretend that my story is representative of all NIH hospitals, I know that anecdote is not the singular of data. Obviously, your relatives had good outcomes, as you stated in your anecdotes. I would encourage you, however, to not bury your head in the sand and pretend that shameful service is impossible under the NIH.
Regarding the American attitude towards Socialist medicine, I think I can give you a tutorial on our mindset. Capitalism has so pervaded our culture that we assume financial incentives are the only significant ones. It's hard for us to imagine that without the threat of increased malpractice insurance rates or other financial penalties that doctors would care about patient outcomes. The perception in the States is that British doctors don't get fired or face loss of license even in the event of gross negligence in their practice. If there is no downside personally to the doctor for malpractice, what motivation does the doctor have to practice well?
That last question wasn't rhetorical, by the way. I delivered your statistics, please return the favor by clearly explaining for citizens of the U.S.A. in the audience what incentives/penalties are in place in the N.I.H. to reduce "adverse effects" due to malpractice.
"Space Exploration is not endless circles in low earth orbit." -Buzz Aldrin
(Score: 1, Informative) by Anonymous Coward on Wednesday September 24 2014, @08:11PM
Thanks for your reply. I am in no way saying the NHS is perfect, there are many problems and people are failed by the service every day to varying degrees.
My point in general was, I don't think this is unique or because socialized system in the UK. Humans make mistakes and fail, not all treatments are available, passing the buck happens to meet targets, the list goes on. I was using my anecdotes as a counterpoint to the blanket assertion of the original AC that the NHS fails everyone.
However for all the horror stories from the NHS, they don't seem to hold up against the horrors of the U.S. system, which everyone seems to have a story of. I've seen healthcare systems all over the world, and if i was in a top income bracket in the US, I no doubt would think very highly of the system over there. Saying that, one of my US horror stories is about a high income family being essentially bankrupted, after cancer treatments (unsuccessful) of the main breadwinner (supposedly covered by insurance through their employer).
But in answer to your question
From 2012 [theguardian.com]:
While the system may have its flaws, there are still consequences of not providing adequate care (perhaps not enough), and even if you're a doctor or nurse, you're not above the law.
The problem now as i see it, reforms that are happening are not being made to improve the quality of care, they are being made to drive down the cost and enable for-profit corporations to provide more services, but only the bits they can make money on. The government will have to pick up the tab for the rest of it, as it always has. The NHS is not long for this world it feels, and that's not a good thing. As mentioned before, they're getting U.S consultants in to help carve it up for maximum profitability.
(Score: 3, Interesting) by Zinho on Wednesday September 24 2014, @09:46PM
Excellent reply, that's exactly what I was looking for.
I'm sorry to hear that you're importing the worst part of our medical culture; having businessmen take over hospitals here has been a bigger disaster than their takeovers of the tech sector - at least when HP gets driven into the ground no one dies.
I'm holding out hope that regardless of the system in place the doctors who are healing people for the love of humanity will stick around and keep being motivated for the right reasons. The stats I quoted seemed to put the U.S. and U.K. at about the same level of outcome, and I'd like to take that as evidence that the horror stories we've heard about each others' systems fall within the (unfortunate) norm. Medicine is hard. =(
"Space Exploration is not endless circles in low earth orbit." -Buzz Aldrin
(Score: 2) by cafebabe on Thursday September 25 2014, @01:56AM
Form follows function. Private healthcare in the US has spawned a large industry of medical software. Through the NHS wanting to modernize and computerize and through software houses seeking additional sales, US medical software is now widely deployed in the NHS. This has stratified the NHS in addition facilitating financial settlement between administrative boundaries. Unfortunately, this fails and it has now become routine for parts of the NHS to sue other parts.
1702845791×2
(Score: 2) by c0lo on Wednesday September 24 2014, @11:12PM
Outsourcing multinationals? How about out-of-network doctors [nytimes.com]?
The effect [nytimes.com]:
What are you doing to yourself, guys?
https://www.youtube.com/watch?v=aoFiw2jMy-0
(Score: 1) by Whoever on Thursday September 25 2014, @02:36AM
I would agree with you that NHS treatment is generally very good. In fact, one experience I had was a diagnostic treatment in the USA (which found nothing), followed by seeing an NHS doctor who provided an actual treatment for my condition and also remarked that the diagnostic treatment I received in the USA wasn't indicated based on my symptoms. Relatives on mine have received excellent care for cancer.
On the other hand, there is this:
http://en.wikipedia.org/wiki/Stafford_Hospital_scandal [wikipedia.org]
(Score: 3, Interesting) by urza9814 on Thursday September 25 2014, @03:08PM
Yeah and I live in the US with decent health insurance (Cigna) and when I had a severe flu I was told "We can give you an appointment in six months." Yeah, that's a big help...
People talk about high costs and long waits as the reason to avoid socialized healthcare...yet I'm paying about $200/month for insurance and still paying out of pocket at clinics for all my healthcare because I can't get in to see an actual doctor.
Oh, and the best part? I work for a healthcare company.
(Score: 3, Funny) by isostatic on Wednesday September 24 2014, @04:53PM
That's why the average life expectancy is higher in the USA than the UK, it's why Stephen Hawking would never have survived under the NHS, it's why countries such as the UK, Cuba, Norway, France have higher infant mortalities than the USA.
(Score: 4, Insightful) by hoochiecoochieman on Wednesday September 24 2014, @05:42PM
That's simply a lie [wikipedia.org].
Couldn't you find a better example? Hawking is not even by far a regular patient, he's extremely, extremely exceptional. He's the subject of bleeding-edge experiences. WTF?
Another lie [wikipedia.org].
It's funny that you compare the richest country in the world to... Cuba, a very poor country with no resources and an economic embargo for decades. It's like the schoolyard bully winning at arm wrestling by a very close margin against the weakest guy in the school and then bragging about it.
More ironically, in this case (infant mortality) the weak guy kicks the bully right in the ass. Couldn't you come up with an indicator where you win? Just like... the health care cost. In that category, you win big time! The most expensive health care in the world! America! Fuck Yeah!
(Score: 3, Informative) by rcamera on Wednesday September 24 2014, @06:00PM
fyi - hawking is british and actually credits the NHS with saving his life [telegraph.co.uk]. did you know oxford isn't in the good 'ol us-of-a?
/* no comment */
(Score: 0, Flamebait) by wantkitteh on Wednesday September 24 2014, @07:10PM
"A big whoosh" - is that what you call it when you complete fail to put any actual indication of sarcasm in your writing? I suggest learning the basics of forming sentences and punctuation before you attempt such difficult things as the lowest form of wit.
(Score: 1, Flamebait) by isostatic on Wednesday September 24 2014, @08:20PM
Funny how Americans can't sport sarcasm unless it is covered in massive glowing lights. Sigh.
(Score: 2) by hoochiecoochieman on Thursday September 25 2014, @09:06AM
Dude, you really fooled me! And I'm not an American.
Ok, ok, I reckon I had a knee-jerk reaction, but this wasn't an easy one to spot. I should have seen that it was too stupid to be sincere. But there are actually people out there who are that stupid.
(Score: 2, Informative) by rcamera on Thursday September 25 2014, @06:00PM
but on the more serious side, the infant mortality rate isn't a fair comparison. in the US, we consider a live birth to be... well... anyone that's born alive. many other countries don't count a "live birth" unless the fetus meets certain weight or gestation duration requirements. we count preemies in our IMR - they don't.
/* no comment */
(Score: 2) by EvilJim on Thursday September 25 2014, @12:25AM
Funny... his voicebox doesn't seem to have a british accent
(Score: 2) by wonkey_monkey on Wednesday September 24 2014, @04:29PM
That doesn't stop drug reps taking GPs out to lunch (both literally and perhaps metaphorically) - hence the existence of http://www.nofreelunch.org/ [nofreelunch.org]
Just make sure the doctor doesn't rifle through his complimentary pen collection before putting you on DangerousSideeffect-a-thol!
systemd is Roko's Basilisk
(Score: 0) by Anonymous Coward on Thursday September 25 2014, @03:28PM
I clicked the "Click for HELP!" link at the bottom of the opening blurb.. it 404's.
Apparently, no help for you!
(Score: 2) by Alfred on Wednesday September 24 2014, @04:40PM
Their financial incentive sounds like moving through more patients faster, leading to incomplete consideration and possible missed diagnosis.
(I intentionally did not put misdiagnosis)
There probably is a cap to the number of patients a doc can see and charge for in a month.
(Score: 5, Insightful) by Buck Feta on Wednesday September 24 2014, @04:01PM
One of the biggest problems with the medical system here in the USA is that providers, consumers, and payers are all divorced from the cost of service. Often I'll ask how much a test or procedure might cost, and the physician can't give me an estimate to order of magnitude. So how am I expected to make rational choices about my health care consumption if I don't know the cost? I suspect that more cost transparency in the medical and insurance system would create more elasticity of demand and bring down costs for everyone.
- fractious political commentary goes here -
(Score: 2) by bob_super on Wednesday September 24 2014, @04:20PM
I asked my US dentist about doing this vs that tooth first, and (what was I thinking?) whether it would cost less doing it under my current insurance vs new insurance after the yearly change.
The competent lady needed a few hours to get the answers. Which were wrong. Then she gave me a discount on the lowest of the two prices to apologize (still more expensive than a flight plus the same thing done in Europe).
So the system is overly complex, requires every doctor group to pay for dedicated insurance people, raising everybody's costs even before lawyers step in, and in the end they still are not sure and can make up a price on the fly.
Most doctors in France work alone in their office (though they often use a grouped system for appointments). Single payer. Limited liability. Cheap.
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @11:03PM
Won't fly in the US: no room for someone with an MBA to add value. It's funny - in "corrupt, 3rd world" systems, every exchange includes a little bribery. A little extra money for the official or worker to actually do his job. It makes everything much more expensive than it's supposed to be, but the system seems to run fine. In the US, lawyers and MBAs have legislated themselves as middlemen in most exchanges. Their fees are a lot more expensive than bribes, and they go to people who have no legitimate part in the transaction, but the system seems to run fine.
(Score: 2, Interesting) by skater on Wednesday September 24 2014, @06:14PM
It was really refreshing when I took my cat to the vet and they actually discussed options and costs for his illness. Depressing as all hell, especially since we all knew he was dying, but it was also nice to hear the different options and select one that made the most sense for the cat. (Example: We were reasonably sure he had cancer, but there was no way to tell without an expensive biopsy. But his health was sliding regardless of the reason, and we knew we might extend his life a few months at most.)
(Score: 2) by mmcmonster on Wednesday September 24 2014, @06:36PM
Agree 100%. Another part of this is cost of medications.
We've recently seen the rise of cost of several medications which used to be generic and low-cost. Two that come to mind are colchicine and digoxin.
(Score: 2) by unitron on Wednesday September 24 2014, @04:07PM
...some of that possibly unneeded stuff is so that you can't turn around later and sue them for not having done it if there's a chance that a lawyer can convince a jury that your less than perfect outcome (which may not have been preventable under any circumstances no matter who your doctor was) would have been perfect if only your doctor had done x, y, or z.
something something Slashcott something something Beta something something
(Score: 3, Funny) by bob_super on Wednesday September 24 2014, @04:11PM
Medecine is a perfect science where getting all the information about the system results mathematically in the desired outcome.
I saw it on TV, your honor.
(Score: 5, Informative) by VLM on Wednesday September 24 2014, @05:04PM
My mother in law went thru something like this for weeks recently WRT gallstones, they won't just treat the gallstones, she had to spend about two weeks making sure she isn't pregnant (she's in her 80s) or cancer or appendix or ulcer or STDs or heart problems or neck nerve pinches or ... Finally they took out the stones and all is well (she's not yellow any more, healthy, gettin around again, energy coming back, etc.) Its getting to the point where no diagnoses will be ever made, just an immense list of things that can be ruled out via tests, and after all the tests when only one thing is left, then and only then will they go for it. She's OK now, but holy cow they did everything head to toe on the poor woman. Anecdotally she says she'll never voluntarily set foot in that hospital again, and I can't blame her. Of course with consolidation there's only two chains in the area, so hope she doesn't get pissed at the other chain. Which works exactly the same way. Whoops.
It reminds me of my son being diagnosed with wheat (gluten) allergy. Well, surely it would be better for the doc if he had stomach cancer because we can treat that, but an allergy can't be treated so we'll never test for that until everything more profitable is tested for and ruled out. Oh drat, the MRI doesn't show stomach cancer? Well, we can treat leukemia, so lets try testing for that. Drat, the boy doesn't have that either. The doc actually looked defeated and unhappy when he finally ran a blood allergen test after months and then reported he just cant eat wheat stuff. Unfortunately for the doc, there's no money to be made off that, you see. Years later, with no wheat in his diet leading to no constant "digestive malfunctions", he's perfectly healthy now and has almost caught up with growth for his age, but what a mess when he was little.
The standard SN automobile analogy is modern medicine in 2014 is like taking your car to the mechanic, and no matter whats wrong with it, the mechanic just starts replacing the most expensive thing first, and working his way down the list until accidentally your problem is fixed. Come in with "funny scratch sounds when braking" "I don't care what you think, you're getting a new engine first, then we will replace the heater core, don't tell me how to be a mechanic".
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @08:34PM
Sounds like your physicians are practicing defensive medicine. I guess courts have been all to happy to award jackpot lawsuits in your area. You reap what you sow.
(Score: 3, Interesting) by VLM on Wednesday September 24 2014, @09:12PM
You are correct in the former, AC, donno about the latter, sounds believable.
The problem with defensive medicine is you can replace a very expensively educated doctor with a very small shell script.
Then again since 1950 or so, you could replace a very expensive pharmacist with a vending machine, and we're still stuck with them. Like, WTF? It would be like if travel agents still existed, or local bookstores. Its just weird. I remember being a smart as hell young kid (as opposed to my currently being a smart old-ish man) and thinking, yeah, that pharmacist gig sounds like it would be an awesome lifestyle, but those guys are all going to be replaced by a vending machine powered by one of those new fangled microprocessors like that brand new 8080, so forget pharmacy school. And here I am in 2015, if I had become a human vending machine I'd probably own a private island by now, but no, I'm slinging boring Scala code for internal apps and maintaining Perl data processors. Bummer.
(Score: 0) by Anonymous Coward on Thursday September 25 2014, @01:31AM
I realize you were just making a simple point, but I must argue that "very expensively educated" is not equivalent to an actual good, effective doctor. In fact possibly it's an inverse correlation where it's all prestige on the degree and no actual practical experience (heaven forbid we let our students touch actual patients, any incident could destroy our reputation!). Speaking from experience as a cheaply educated 3rd world doc who scored much much higher on the USMLE than US candidates did...
It's nice to read about all these fancy tests you can do in America but out here in the boondocks where there are only 3 CT and 1 MRI (and no PET) machines in the country, lab tests are extremely limited, etc, well, we tend to rely more on little things like patient clinical history and physical exam, basic tests and brainpower. And we seem to be doing quite ok, statistic wise... our limited health dollars go much, much further. At one point medicine becomes about all the toys and tests and the patient is forgotten. I always tell students TREAT THE PATIENT NOT THE LAB RESULTS.
(Score: 2) by strattitarius on Wednesday September 24 2014, @08:54PM
It reminds me of my son being diagnosed with wheat (gluten) allergy ... there's no money to be made off that, you see.
You nearly described my kids path to finding his peanut allergy, but instead of digestion issues it was overnight stays in ICU.
A lot of his symptoms where difficulty breathing, wheezing and all that. So after the second stint in the hospital a asthma specialist came by and diagnosed him with severe asthma. But that did not make sense (I was able to predict one of the hospital visits the night before... does that sound like asthma?). We got in an argument right there in the ICU room, with her final argument being that what she said was correct because she was an asthma specialist doctor. Regardless of all that, she was a bitch.
After an hour wait in her waiting room on the first visit, we just left... "Yeah, you'll get that $25 no show fee... bill me."
Fast forward a few months and I, the idiot father, give the kid some peanut butter and BAM... and soon as it hit his mouth he reacted like it was cayenne pepper. He seriously looked like a still image from when Neo blows up the agent at the end of the Matrix (the bumps/hives on his head). The next week he was at an allergist getting tested and sure enough... several allergies, the main one was peanuts.
More than likely a less knowledgeable, less confident, and less "well off" person would have submitted to the numerous in-office breathing treatments, medications, and probably spent thousands before realizing one day it was a peanut allergy. Not only that, the kid could have actually gotten the peanut down his throat and that's when they die from anaphylaxis.
Watch out for your own health (and you kids). Nobody gives a damn as much as you do.
Slashdot Beta Sucks. Soylent Alpha Rules. News at 11.
(Score: 2) by VLM on Wednesday September 24 2014, @09:25PM
"her final argument being that"
With all due respect sir she might have said exactly what you reported, but I'm fairly certain she was thinking the whole time "I can make a sh!t load of money off a lifetime of asthma diagnosis, but this gravy train is over when someone tells him not to eat peanuts anymore"
Did the allergist schedule followup appointments?
My son's gastroenterologist scheduled us for $450/hr follow up appointments after the diagnosis and some elaborate A/B testing (Oh look, he eats pure cooked hamburger meat for a day and like a miracle no problem, but every time we do a trial with whole wheat bread 3 hours after he explodes out both ends till he's dehydrated... golly wonder if he might be allergic to wheat? So for $450/hr, every six months for the next 80 years, its all "so hows that not eating gluten containing wheat and barley and stuff going?" "Oh its going great? In that case I'd suggest continuing to do that, that'll be $450 see ya in 6 months, sucka" We cancelled the future appointments with the nurse freaking out that child protective services is going to take him away if we don't pay the gasto-ent the proper protection money. Called their bluff and all is well and happy for the last decade, although the doc hasn't been getting his protection money. He has an iron stomach, in fact a bottomless teen boy iron stomach, my god can he eat, just don't feed him wheat / dairy / soy or his iron stomach turns into a volcano for about a day.
(he's also allergic to soy and casein, its a rather elaborate procedure with antibody blood tests followed by all manner of crazy (yet rather obvious) A/B testing, which you probably got to experience although with nuts, although I donno if they'd be crazy enough to A/B test him with peanut butter if its ICU time)
(Score: 2) by strattitarius on Wednesday September 24 2014, @09:46PM
"Protection money" - yeah they didn't threaten CPS but it was more a "think of the child - he could die from an attack" type of stuff. The whole thing changed me from a typical person that trusts doctors as "experts" to someone who realized that I was probably smarter than the doctors and had much more information than they did. I am not going to try my own surgery, but I will be active in diagnosis from now on.
Slashdot Beta Sucks. Soylent Alpha Rules. News at 11.
(Score: 2) by VLM on Wednesday September 24 2014, @10:00PM
"renew his prescriptions for his epi pen"
ah that makes sense especially if its dosage depends on body weight. That at least makes sense, even if they probably bill $450/hr like our specialist.
(Score: 2) by sjames on Wednesday September 24 2014, @11:39PM
That used to be the go-to excuse and even made some sense. Until several states capped liability severely and suddenly healthcare got MORE expensive.
I'm not so sure I buy it. And it doesn't explain prescribing new and expensive medications over older cheaper and better understood medications that are just as good for the vast majority of people.
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @04:22PM
The doctor is there to give you professional advice. If you disagree with that advice, you can say so and ask for alternative. The doctor also has a right not to offer you further advice if (s)he believes you are not rational.
When you find a doctor, ask them whether they view their opinions as written in stone or are they flexible. If their idea of medicine is "my way or the highway", then you may want a different doctor.
You have to know what you are doing if you want to go against your doctor's advice - by this I mean things like stopping medication You also need to listen to your body and know if something is potentially a side-effect creeping up on you. A good sign of side effects is some symptom that has never happened before. The more acute, the more easier to spot. Things like "pain that doesn't go away", that did not happen before you started some medication, could mean it's a side-effect. Stopping said medication (if medication is not critical!) could solve this dilemma. A doctor can't see your pain, for example. And yes, it could take months for side-effect to occur (speaking from experience!)
Anyway, you have to be rational here. If your idea is "I'll take these antiobitics for a while, and when I feel better, I'll just stop them", then that is not rational. Or "these antibiotics for my TB make me feel bad, I'll stop them - I've been taking them for over a month anyway" - also not rational. Another would sign of irrationality is "chemo? I'll try so holistic vitamins instead".
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @05:12PM
Agreed. I recommend using a PDR (Physicians Desk Reference) or maybe the internet to see what the drug is all about. What side effect has it caused in others? Some patients get a long string of drugs that treat a side effect that came from the previous drug. This is why you shouldn't get scripts from different doctors without telling each doctor.
Agreed, however there is this next tag-along statement trying to gain validity from the previous ones.
I don't entirely agree here. Chemo is the nuclear option and it mostly works if you survive. It is bad medicine. I really get annoyed by the stupidity of the "we don't understand cancer but if you advocate anything but chemo your a witch doctor" attitude prevalent in the medical community. I don't think you beat cancer with vitamins but I am sure there is a better way, too bad if you don't tow the chemo line you are run out of town. Between chemo and vitamins is a better answer but...
This is the medical community's blanket stance with chemo. Ask if there is anything else and they can get police to force it including repossessing your family or children.
Some use the follow the money logic to show that chemo is a cash cow for big pharma. If a cure for cancer was found big pharma then would be pissed, though not bankrupt, and WebMD would, well, I don't know, say I have cancer.
(Score: 1) by linuxrocks123 on Wednesday September 24 2014, @07:28PM
I don't think you're right about us not understanding cancer. We've got a handle on what it is pretty well. It's your own body's cells that got a mutation in their DNA that disabled the "die when not needed" gene. Therefore, the cells continue dividing exponentially making a large tumor that sucks up energy from the rest of the body, and flakes of that tumor then go through the bloodstream and land somewhere else. This is called metastasis and if it happens makes the problem much, much worse.
Given that, we've got a number of logical treatments that are used in practice. We don't JUST have chemo. There is:
1. Surgery: cut the tumor or tumors out. Disadvantages: might not get it all, might die from surgery since it involves, you know, cutting your body open with a really sharp knife and all.
2. Chemotherapy: put poison in your body that kills cells when they divide. Works because cancer cells are distinguished by dividing very frequently. Disadvantages: healthy cells are also killed. That's why it's poison.
3. Radiation: Expose the tumor to radiation which kills the cancer cells because radiation kills things. Disadvantages: the radiation kills healthy cells, too
4. Immunotherapy: train the immune system to attack the cancer. Disadvantages: The immune system is DEADLY. Fucking with the immune system can result in REALLY bad things happening if you don't know exactly what you're doing. One woman in an experimental treatment died MINUTES after being injected with the treatment because her immune system decided her lungs were really bad things and just had to go.
Immunotherapy is the newest option and still mostly in clinical trials. So, yeah. The "establishment" isn't suggesting chemo only, although it is a very versatile therapy and so is recommended for a wide range of cancers (compared to immunotherapy which is only available for a select few cancers right now). There's other stuff out there. This is a really hard problem, but a lot of bright people are working on it.
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @04:36PM
Sometimes doctors certainly seem too fast to offer band-aid treatments.
Another problem is just plain ignorance.
Had an infection here in the tropics which admitedly looks like leishmaniasis.
Knowing that it comes from an insect bite, I knew it was NOT leishmaniasis because I cut myself in that spot.
It was a staph infection which I healed on my own using carbolic soap.
They wanted to send me in for lab tests and all kinds of blood letting.
(Score: 2) by Alfred on Wednesday September 24 2014, @04:46PM
George Washington died from blood letting via leeches.
I don't know how blood letting ever became a thing. Major stupid idea. Maybe "oh I'm so light-headed now, that must mean I'm cured."
(Score: 2) by nitehawk214 on Wednesday September 24 2014, @04:58PM
"blood letting"
The GP was saying that they wanted him to have blood tests, and that he equates this to "blood letting."
Yeah, in this anecdote he did not have an issue that warranted blood tests. But equating modern diagnostic processes to ancient superstitious practices is either dishonest or stupid.
"Don't you ever miss the days when you used to be nostalgic?" -Loiosh
(Score: 2) by Alfred on Wednesday September 24 2014, @05:34PM
(Score: 2) by nitehawk214 on Wednesday September 24 2014, @07:06PM
Well I would agree that overdoing blood tests is useless. But comparing them to ancient superstitions is a bad analogy. An unneeded blood test wont hurt you except in your wallet. Fake medicine could kill you.
"Don't you ever miss the days when you used to be nostalgic?" -Loiosh
(Score: 2) by monster on Thursday September 25 2014, @03:33PM
Suppose that when he cut himself, some other pathogen also entered the body. Say something in his dirty hands, or something in a not clean enough bathroom. Now suppose that a doctor sees him treating the wound with carbolic soap and doesn't do any extra tests. Would the AC be so happy when, three weeks later, discovers that he contracted ebola, for example? That it's too late to treat him because some doctor decided that no more tests were needed?
The problem with 'patient pays' systems is that at the end the patient has to be his own doctor, balancing procedures done (cost) against curing himself, precisely when he's the least informed and capable of making the correct and balanced decision.
(Score: 2) by tynin on Wednesday September 24 2014, @05:02PM
Only now with the benefit of hindsight does it seem like a bad idea. The consensus of the time suggested that our bodies were governed by the 4 humors, blood, phlegm, yellow bile, and black bile. Keeping them in balance was a sign of a healthy person. It would have legitimately made people with high blood pressure feel better. But for everyone else it was likely a bad idea.
(Score: 3, Interesting) by Thexalon on Wednesday September 24 2014, @04:49PM
At least in the US, no ad will ever run saying "Ask your doctor about eating better, getting good exercise in regularly, and sleeping enough." Instead, it's all about asking your doctor about this pill or that procedure that will magically fix everything.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @11:14PM
Actually, Kaiser ran a whole series of ads just like that. Free preventative care counseling, get out and move kind of thing. Michelle Obama's "Let's Move" campaign. They're not as well funded as the Lipitor ads, and they don't close with 10 seconds of legalese, so maybe you don't notice them, but they're definitely out there.
(Score: 2) by DrMag on Wednesday September 24 2014, @04:55PM
This is hardly an issue unique to doctors. Though there may be some who knowingly recommend unneeded procedures, it may be more a fault of the system and culture we have. Single-point anecdotal data:
I needed a dentist while I was in school. A long way from home, not terribly familiar with the area, I did what seemed most reasonable: look online and see what other people thought of their dentists in my area. I selected one that had particularly favorable ratings, and scheduled an appointment. The hygienist did the cleaning, took x-rays, and then sent me away to schedule another appointment to meet with the dentist. So I did, and on my return appointment, without ever looking at my actual teeth, the dentist proceeded to recommend a long list of procedures that would have cost me $16,000 out of pocket. I thanked her for her time, requested a copy of the x-rays, and got an estimate of about $300 worth of work from my dentist at home.
It's possible some of the items on that list would have been helpful, but they weren't needed. Judging by some of the photos of famous people she had treated, I suspect the reason she got such a high rating was that people went to her and came out with a smile that looked like some idolized celebrity's. Not that there was anything necessarily wrong with their teeth before. It seems the ridiculous recommendation came from someone catering to the vanity and ignorance of other people while maintaining the pressure to make as much money as possible.
Like all things in our world, the only way out is for the desires and attitudes of all of us to change. Will people change knowing they might be recommended procedures they don't actually need? We can hope, but it's going to require education and a fundamental shift in what we value.
(Score: 3, Interesting) by bzipitidoo on Thursday September 25 2014, @03:46AM
You might find an old Reader's Digest article from 1997 interesting. In it, William Ecenbarger, the author, visited a bunch of dentists in different states to see how close their diagnoses of his teeth matched up. An unhealthy percentage of dentists tried to sell him wildly excessive treatment, pitching oral surgery, root canals, or crowns everywhere when all he needed was a cap on 1 or 2 teeth. More recently, Time ran an article on this issue called "Bitter Pill", in which they mention the "chargemaster", the mystery black box that determines what to charge for medical care.
It's clear to me that the entire medical profession in the US suffers from some serious conflicts of interest. So pervasive is it that even honest doctors have a difficult time resisting the pressures or seeing past all the propaganda-- the heavily biased studies about the effectiveness of the latest brand name drugs, the dishonest hiding of costs, peer pressure, and more. If you think it's hard to estimate how much time a software project will take, you at least have a foundation of honest data to start with. Try to get the costs of a medical procedure, and if you get anything back at all, you won't get the same answer twice. When inquiring about costs, I've been told not to worry about it, because insurance will cover it. Or assured that the costs, whatever they are exactly, will be reasonable. Or told that they themselves don't know the costs because they don't yet know what's needed. There could be extra work, you see. It's crazy.
When I at last do see some price info, it can't be trusted at all. What happens is they bill your insurance, if you have it. Your insurance "adjusts" their crazy high fantasy land prices by knocking off about 2/3 of the amount they charge. You are them responsible for 10% or 20% (or whatever amount your insurance leaves for you to pay) of the 33% of the list price. But, if your insurance rejects the bill, then the doctors come after you. They send you the fantasy bill, which includes crap like $100 for "medical supplies", bandages and cotton balls and such like you could get at any pharmacy for 1/10th what they charge. You thought you were on the hook for a $50 copay, but insurance denied them so the doctors are now asking you for $1500! They don't tell you what really happened, they try to present that demand for $1500 like it's any other bill, like for cell phone service or something. If you pay up like a good honest citizen, you were just played for a total chump. It's sick.
Medics have been doing this for decades. I don't know how far back this price gouging goes, but it's at least to the mid 1960s. One thing we've done about it is forgo treatment, even to the point that people have died because they couldn't afford treatment. Our life expectancy is now lower in the US than most other developed countries.
(Score: 3, Insightful) by nyder on Wednesday September 24 2014, @05:47PM
If you go to a Clinic, like a one for poor people, you'll find that the doctors don't try to sell you on stuff you don't need, just trying to deal with what you need and whatever your problems are.
Sure, if you go to a stuffy rich person doctor's office, they take their time, they try to find stuff wrong with you so they can sell you prescriptions (that they get a cut from), or other shit you don't need.
For once, the poor people got it better.
(Score: 2) by mmcmonster on Wednesday September 24 2014, @06:33PM
The poor people get it better.
Unless you want to see the average lifespan and stratify by age. Or general wellness.
People who can afford testing and medications tend to live better and longer than people who cannot. I'm not saying that correlation implies causation, but it certainly seems like it.
(Score: 2) by sjames on Thursday September 25 2014, @12:11AM
That's because the poor people can't actually afford the clinic either, so they go as little as possible.
It's sad that in order to not be prescribed unnecessary treatments you have to be too poor to even afford the necessary ones.
(Score: 4, Insightful) by MrGuy on Wednesday September 24 2014, @06:18PM
Blame the doctors. It's all their fault!
Not the sheeple who see big pharma ads on TV and are constantly being urged to "ask their doctor" for a specific treatment, whether or not the doctor thinks it's appropriate.
Not the people who demand to know AT ONCE when they walk into the doctor's office whether little Billy just has a cold, or a LIFE THREATENING ILLNESS!
Not the people who expect that visiting a doctor is something you should ONLY do when you are (or think you are) sick, and never come in for regular (and cheap) checkups.
Not the people who do nothing to take care of themselves, take no preventative steps to prevent illness and suddenly discover they have major coronary issues.
Not the people who go to the emergency room when they have a cold because their doctor couldn't see them until tomorrow, even though it's way more expensive.
Not the people who expect a doctor's visit to be like replacing the muffler on their car (just give me the pill/shot to make it better!) who never go in for the 50,000 mile servicing.
Not the people who go directly to a specialist rather than a primary care doctor because they clicked on a "12 signs you may have cancer!" and matched 8 of them, so OMG I have cancer QUICK RUN THE TESTS RIGHT NOW!
Not the people who will call ANY doctor who dares use the phrase "I don't know" or "Let's keep an eye on that for a week or two" a horrible quack who should have his license revoked and tells all their friends not to go to him because "he doesn't know anything."
Not the people who sue for malpractice every time a shyster with a law degree convinces them they might have a case, because in theory if the doctor had run more tests they'd have caught the tumor a week earlier (even if running that test for everyone with the same symptoms would be prohibitively expensive).
I'm not saying there AREN'T doctors who are trying to maximize their own profits. But blaming them for all the ills of the medical system is more than a bit much. And in a lot of cases, the criticisms don't make sense. Your primary care doctor (who's the doctor most of us see most often, right?) has a long-term relationship with you, and others in the community. That doctor makes their money on repeat business. Trying to maximize your own profit by ordering dozens of costly, painful, time consuming tests for no reason is a good way to get your patients to switch doctors. Why kill the goose?
I am not a doctor, but I do feel bad for the amount of blame the doctors (and, apparently, ONLY the doctors) get around the increasing cost of health care. I do know a few doctors, and the ones I know aren't out to score as much cash as possible. They're people who want to help others and keep them healthy. Sure, they make money, but they see medicine as a higher calling, not just a good racket. There are plenty of players in the health care cost stakes (pharma companies, malpractice lawyers, private HMO's) for whom I wouldn't say the same.
(Score: 5, Insightful) by mmcmonster on Wednesday September 24 2014, @06:21PM
Please. People fear science and medicine too much as it is.
Good physicians will order tests on people who aren't sick, and may even prescribe medications even though the person doesn't perceive that he has any medical problems.
That doesn't mean the physician shouldn't be trusted, wants to line his own pockets, or is in the pocket of "Big Medicine".
In fact, I would suggest that "Big Medicine" is behind articles like this. Don't get tested if you're feeling well. Don't get vaccinated. Don't take medications to prevent the first disease event. You'll just be paying for more medications and health care in the long run.
Population Medicine/Preventative Medicine uses statistics to determine what tests are needed on a healthy group to screen for diseases, to find them early so that they can be treated before they become more a burden on society. Sometimes they're wrong, and the guidelines change. And sometimes they advocate starting treatments earlier because the cost of primary prevention (to prevent the first "event") has gone down for whatever reason. We have to trust the Population Medicine guys because they're the ones that run studies on tens of thousands of patients and can make correlations and cost assessments of a condition over a generation.
If we advocate for people to not trust their physicians, aren't we promoting an anti-science agenda?
But don't listen to me. I'm just a physician. If one of my patients refuses to take a medication or perform a test, I listen to their reasoning and try to change their perspective to understand where I'm coming from. If I can't, I just document in the chart so that I don't have to try again in the future. (I don't want to pester them too much over it -- if I do, I'll just lose the patient.)
(Score: 2) by Common Joe on Thursday September 25 2014, @05:41AM
And to a large degree, rightfully so.
I used to be very much pro-doctor. Today? I'm very skeptical to take anything at face value and I encourage anyone to challenge their doctor on everything. I was married somewhere between 10 and 15 years ago. Since then my body and my wife's body has changed -- normal aging stuff, I suppose, but we've developed a few chronic conditions. In that time, we have both been lied to, cheated by, and given wrong advice more often than not by doctors. At this point, I think there are more bad doctors than good ones out there. The best thing I ever did was stumble across a book for my first chronic condition. It was written by a person who took 20 years to diagnose herself. She gave better advice than the two professional doctors I saw who were supposedly professionals in their field. Her book kept me off medication. Was she against meds? No. She dedicated a whole chapter to them describing when it was best for you and how to work with your doctor to choose the best medications for you. (Other chapters covered things like medical descriptions, short term fixes, choosing good doctors, exercising for the condition, proper diet, etc.) Both doctors gave me advice that would have made my condition worse. One, after a way-too-short 30 minute exam, wanted me on medication which I haven't needed at all. All of those experiences left a very sour taste in my mouth.
As for my other conditions? I have yet to find a doctor that will treat all of my conditions together. I have chronic symptoms that interact with one another, flare up together, and go away together. I can only get treatment for one at at time. The last time I went to a doctor for one part of it, it took me three months of follow ups. There is no way I'm going through that again for every other symptom I have unless I'm dying. At that point, I'll be in a hospital and maybe someone will listen to everything that is going. But I doubt that too. You should hear my friend's horror stories of doctors and hospitals dealing with his paralysis.
I am definitely not anti-medicine, but your professional colleagues are pushing people away from doctors and medicine. We, the non-doctors, and rightly becoming very wary of people in your profession. If you're a good doctor as you claim, we need a lot more like you. If you want more of my story (since I may seem like a nut job to you without the details), you can email me privately and I'll answer any questions you have.
(Score: 2) by Common Joe on Thursday September 25 2014, @06:26AM
Damn it. I wanted to say something else about this, but I'm encountering the lameness / spam filter and it won't let me post my other comment. Anyone have any ideas about this?
(Score: 3, Insightful) by PizzaRollPlinkett on Wednesday September 24 2014, @07:54PM
What's really behind unnecessary tests is how the insurance company will disallow costs. If a doctor orders a blood test, he'll charge $150 and the insurance company will allow only $30. So the perverse incentive is to do more tests because each one is cheaper, and to jack up prices of tests the way a clothing store doubles the price of a t-shirt and marks it 40% off. Price creep gets built into the system. I call it the "Dover effect" because of how the sleepy math book publisher had to radically jack up their cover prices several years ago. They used to sell cheap math books, but the book industry shifted to huge discounts, so they practically doubled their cover prices overnight a while back. Yesterday's $15 book was suddenly a $30 book, just to be able to absorb 30% retailer discounts (remember that publishers get even less because they sell books to retailers at a discount from cover price).
(E-mail me if you want a pizza roll!)
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @09:48PM
No. What happens is that there is no known amount for any particular test. There isn't anything like a common price list, or even anything as fuzzy as an MSRP. What does an MRI cost? Who knows! The insurance companies individually come up with a number that they are willing to pay. Company A may allow $300, Company B $700, and Company C $400. What the providers do is charge them all $700 so that they're sure to get the maximum amount they can from all the companies. The problem is that they aren't allowed to charge different amounts to different groups, and this is why the uninsured person gets screwed because they get charged the full $700. This is one of the biggest reasons that support the arguments for people who advocate a single-payer system.
(Score: 1) by Username on Wednesday September 24 2014, @08:56PM
In my experience general practitioners are like used car salesmen or first line tech support. It's always iffy dealing with them. The doctors you can usually trust are the surgeons and other specialists. Never hurts to get their opinion.
(Score: 2) by c0lo on Wednesday September 24 2014, @11:26PM
https://www.youtube.com/watch?v=aoFiw2jMy-0
(Score: 3, Insightful) by digitalaudiorock on Wednesday September 24 2014, @09:20PM
It seems to me that most people just don't question a doctor prescribing medications at all.
The last time I had a routine colonoscopy as part of a physical, there were many others in the same part of the hospital getting them as well. A nurse was questioning each of us as to what medications we were on.
I was one of the oldest people there, and was the *only* one that wasn't on one or several full-time prescriptions. One young guy there...decades younger than I...was on five full time prescriptions, and couldn't even recall what two of them were for. Mind bogging.
This is how people end up on as many as ten things, interacting in ways that are obviously impossible to predict...something that no sane doctor should ever let happen to anyone...madness.
(Score: 2) by mmcmonster on Wednesday September 24 2014, @09:58PM
Unfortunately, there are some conditions that require multiple medications to suppress. One easy one seen in younger people now is coronary heart disease. If a person has a heart attack it's quite common to be on 5 medications for it. Each one prevents a different complication of the disease process. Do they work? Let's just say that you're 10 times less likely to be dead a year after a heart attack if you take all the medications than if you didn't take any of them.
(And I mean suppress in the first sentence above. We don't have proper cures for a lot of medical conditions other than some infectious diseases. We have medications that help suppress them. You stop the medications, bad things happen.)
(Score: 0) by Anonymous Coward on Wednesday September 24 2014, @11:18PM
I was once offered a drug for gout. I knew that the
drug was new, and not part of the standard of care. I refused it. The drug?
Celebrex. It was being heavily advertised at the time. This was
before it was found to have side effects more severe than initially disclosed.
I went through a period of taking generic Allopurinol and changing my diet.
That's consistent with the standard of care. Know the standard of care
for your condition. If the physician deviates from it with some new drug,
ask why. In some cases, you should INSIST on the prior standard of care.
Why be a guinea pig? 3-digit ID, but I prefer not to disclose health info.