Big Med

mixed feelings.   Health care as we know it could definitely use some standardization.  What is worrisome is how often standardization goes too far especially when profit-making enterprises are involved.

Nod, nod. It all depends on what is to be standardized. Sterilization protocols, steps to take to eliminate often missed diagnosis, stuff like that, great. But it must still allow the actual practice between doctor and patient to be an art and not a science, because that is what I believe good medicine is; that's more crucial than with other fields, that there be that flexibility. The problem has been profit incentives to the docs themselves, if now on salary, that's gone, but will the management bring in other distortions according to the profit gods?

more and more doctors are choosing to be employees and not entrepreneurs.

I personally found about this happening in Manhattan about a year ago. When I called my Gyn for my annual (who I've been going to for decades,) he said he's finally retiring and if I wanted he could get me transferred to one of his former Residents who was now on the "best doctors in New York" list. I said: but I can't pay fancy Gyn rates, I know you've always been very generous about what you charge me but it's really all my budget can afford. He said that shouldn't be a problem because he's joined one of those new big group practices where they are all in one building with a main management, and he said something like "all the younger guys seem to be going into those things" and that their charges are standardized, not fancy Manhattan.

So I go and it's really a surprise, it's like a mini-mall or perhaps more like a Trademart, with long corridors with individual glass "showrooms" along them. Each "showroom" is the office of an individual doctor, maybe 50-75 of them there. And they don't individually have any staff except a Physician's Assistant or nurse for blood pressure taking if they want one, all what would be staff duties-(appointments, secretary, billing, insurance) are done by reception at the entrance of the building, for all the doctors. The upside and the downside at the same time: they are protected by the management so they can just practice medicine, but they are also protected from patient's phone calls when patient has a problem or dispute--their call might be forwarded to an on-duty nurse or to managment; they are encouraged to be totally electronic, they are set up for prescriptions to go to your pharmacy of choice with a keystroke, and tests to be handled with a keystroke, use email not phone calls, etc; talk with another specialist might mean a few doors down the hall, but then there's the echo chamber effect.

So I am simply glad to see articles noting this happening elsewhere, people paying attention to it happening and how.

We had to research treatment for prostate cancer some 10 or so years ago, and at the time it was scary and bizarre - about half of male cadavers showed raised PSA levels, meaning either it's a huge cause of death or more likely almost meaningless symptom.

And then there were the options - the knife, including good chance of sterility and often incontinence, or the then-in-testing radiation capsules, and a more serious radiation treatment.

Knowing that all of it might be completely unnecessary. Throw those dice again?

Sadly, Bob Somerby has been railing on that $8K/capita spending per year - long before ACA. And still we didn't address that spend very well. But I'm sure there will be many more of those radiation thingies to try out.