dagblog - Comments for "Big Med"

We had to research treatment

PeraclesPlease — Tue, 21 Aug 2012 06:35:20 +0000

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.

Testing What We Think We

artappraiser — Tue, 21 Aug 2012 06:13:56 +0000

In reply to Big Med

Testing What We Think We Know
By H. GILBERT WELCH, Op-Ed Contributor, New York Times, August 19/20, 2012

(H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is a co-author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”)

BY 1990, many doctors were recommending hormone replacement therapy to healthy middle-aged women and P.S.A. screening for prostate cancer to older men. Both interventions had become standard medical practice.

But in 2002, a randomized trial showed that preventive hormone replacement caused more problems (more heart disease and breast cancer) than it solved (fewer hip fractures and colon cancer). Then, in 2009, trials showed that P.S.A. screening led to many unnecessary surgeries and had a dubious effect on prostate cancer deaths.

How would you have felt — after over a decade of following your doctor’s advice — to learn that high-quality randomized trials of these standard practices had only just been completed? And that they showed that both did more harm than good? Justifiably furious, I’d say. Because these practices affected millions of Americans, they are locked in a tight competition for the greatest medical error on record.

The problem goes far beyond these two. The truth is that for a large part of medical practice, we don’t know what works. But we pay for it anyway. Our annual per capita health care expenditure is now over $8,000. Many countries pay half that — and enjoy similar, often better, outcomes. Isn’t it time to learn which practices, in fact, improve our health, and which ones don’t?

To find out, we need more medical research. But not just any kind of medical research. Medical research is dominated by research on the new: new tests, new treatments, new disorders and new fads. But above all, it’s about new markets.

We don’t need to find more things to spend money on; we need to figure out what’s being done now that is not working. That’s why we have to start directing more money toward evaluating standard practices — all the tests and treatments that doctors are already providing.

There are many places to start [....]

mixed feelings. Health care

artappraiser — Mon, 20 Aug 2012 22:59:59 +0000

In reply to An interesting article that

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.

Duplicate removed

EmmaZahn — Mon, 20 Aug 2012 22:11:38 +0000

In reply to Big Med

Duplicate removed

An interesting article that

EmmaZahn — Mon, 20 Aug 2012 22:10:50 +0000

In reply to Big Med

An interesting article that produced 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.

I have seen a healthcare REIT flout state requirements for CNAs per patient in an assisted living community because they thought their model of care was better. And it was not some red state corporation overriding some blue state 'socialist' government. It was an Oregon-based REIT telling the State of Georgia that their requirements were too high. Maybe they were right but it really seemed more like they just wanted to drive away residents that needed more expensive care to free space for less labor-intensive ones.

The most intriguing part of the story to me was that more and more doctors are choosing to be employees and not entrepreneurs. A very interesting development.

Thanks for the link.