Why Did My Patient Leave Me?
cancer.nautil.us
cancer.nautil.us
- reluctance to diagnose and treat the ailment instead of the symptoms and
- simply refusing to hear what the patient says.
I had an oozing rash break out behind my knees. The dermatologist said "That'll go away easily if you put some OTC corticosteroid cream on it." Wrong! The rash flared up within hours and nearly ate the flesh off the back of my knees. I happen to know that this indicates a fungal infection so I stopped the steroids and applied an OTC antifungal regularly. Slowly it began to heal.
A week later I had a minor bout with detergent dermatitis around my jeans pockets (happens every winter if I use a strong detergent).
Next time the dermatologist sees the residue of my scarred legs behind the knees and the "jeans-pocket" rash, I tell her that her steroid recommendation was absolutely a wrong call, what happened and how I treated the problem.
Rather than take a culture from the back of my legs (and later possibly prescribing an antifungal), she then prescribes not a tube, but a 1-pound _tub_ of corticosteroid cream and tells me to put it on all rashes (behind knees and on "pocket" rashes) for six weeks!
So I figure either she's deaf, has a serious learning disorder or flatter myself that she is trying to kill me. In any case I won't see that dermatologist again.
On the upside: I have an unopened pound jar of steroid skin cream in my refrigerator.
In the case of the fungus, prednisone would have been a mistake, but I nonetheless sometimes feel I am a target for a form of alternative medicine. Why didn't _I_ get a prednisone pill instead of a tub of corticosteroid lard?
As for chiggers: in college I got a serious case of chiggers from a romantic blanket evening in the Texas desert. We two were apparently the only mammals within miles as every chigger available mobilized to fulfill its Darwinian destiny. Next morning I awoke up with a maddening itch everywhere (and I do mean _everywhere_) that lasted until the chiggers died (~3 days IIRC). Best treatment was to take as hot a shower as possible [The only thing better than sex is steaming hot water on chigger bites - it's like the Scratch of God]. Rest 30 minutes and repeat. I've heard a hair dryer works too. Thanks to your recommendation I'll keep the tub of steroid cream around just in case.
I think my dad also takes it in much lower doses for asthma.
But, it has horrible affects both long and short term.
Google "Hells itch"; it's worse than chiggers. Had it twice. First time I needed a steroid injection. Second time 20 years later I knew what it was and heavily dosed myself with Benadryl for 2 days.
I agree that, on average, doctors are smart. But my newly-minted MD fiancee would be the first to tell you that they're not the "just about the smartest" and that she can basic algebra, no more.
And, for example, they only have to pass introductory physics. My undergraduate university had a special lower-level physics course specifically made for pre-med students.
There is a notable exception for surgeons though, every one of whom I've met is a badass. Again, this is based on anecdotal experience and I'm sure there are exceptions (or maybe I've just had poor sampling, but the sample size is dozens of people). But I do know that most doctors are not taught how to think, but much more how to follow processes that are incredibly similar to basic computer scripts (if X then Y).
Most medical students and doctors have a fairly poor understanding of math and statistics, a level of understanding of chemistry that's not particularly difficult, and a level of understanding of physics that doesn't go beyond a freshman level.
Have you actually looked at MCAT study materials? Anyone who's majored in biology would know the material. What determines how well you do is the quality of your study habits.
That said, hard work is usually what wins in the end in most fields, even those that do tend to attract the brightest.
no disrespect to doctors but you really don't
have to be that smart to become one.
For the software engineer example again, if just being able to do the job proved your intelligence, then no one would ever have to go through the marathon interviews to prove that they are competent
There are too many qualified doctors in the major metro area I live in to put up with ones where I can't quickly and efficiently make an appointment, can't get an appointment in a timeframe that is useful to me, and where their staff can't seem to successfully process routine insurance claims with major insurance providers.
Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...).
As for actual "doctor specific" reasons for leaving a doctor, not explaining the reasoning behind his/her recommendations for me to get certain medical tests or procedures done will get me to look for another doctor. I don't actually need to fully understand the reasoning (I'm not, afterall, a doctor), but I need to know there is a reason beyond "hey, you said your elbow hurt and I think I can get the insurance company to pay for an MRI!".
This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer. Getting a simple biopsy done on my leg resulted in a $250 upfront new patient fee, $2300 for the biopsy, then an additional $400 for lab fees some months later. Aside from the new patient fee, I had no idea or indication about any of the other fees until a bill arrived in the mail, despite asking and persisting about it throughout the visit, and since I had to take time off of work to get an appointment, I was at a loss as to how to "make a stand" to get such information.
Compared to where I've been abroad where it's been an upfront fee for walk-in visits. Appointments were needed, but it was a day or two in advance. And when I got insurance through my workplace, it was equally simple.
It's not like you would just fly in, get cut and fly back in a week.
You would have to set up some kind of support system for yourself there, which would be very expensive.
That said, I consider myself lucky to have been in Japan when my lung collapsed. The surgery itself was $80!
Even when you make a steady livable income, it's really crappy to have to go to the doctor in the US.
If you have cancer and can afford it you come to the US for surgery and chemo consults because the best treatment is here.
That's partially because of the money made in US by drug and device makers. But it's mostly because of US government funds spent on research, and because of the US university system with its medical research that attracts minds from all over the world.
Yeah, the system is deeply busted.
Without price transparency you can't have a market system -- America already has a socialist health care system because no one can price shop.
Your Better Health Care organizations do publish prices. The outfit across the street from PAMF does not publish prices and as you could guess, they end up being at least 10 times higher. For everything.
Outcome transparency without thought about capacity leads to other issues: the best don't have enough time to serve everyone.
We need to figure out how to improve the baseline rather than improve the top-end, which is what things are currently focused on (if my insurance has no problem with me going to a more expensive, highly-regarded provider, why won't I try to get in there?). How is a "market" supposed to work for life-saving surgery?
I would be very interested in how much money is wasted on wrong treatments, unnecessary tests, fixing mistakes like disease transfer in hospitals, versus just paying the best doctors and surgeons for their time.
The benefit is that with the smaller patient load, you can almost always get an immediate appointment. The doctor will actually get to know you and your history, have time to call and followup with you and overall just provide a tremendously better experience. Additionally, if you're ever travelling you can go see an MD VIP doctor wherever you are.
It's a really good setup for people who are willing to pay extra for a better experience.
We tried it after my wife went from doctor to doctor trying to figure out her symptoms that we'd experienced over the course of 2 years. The doctor she went to put some serious research time into narrowing down and figuring out what was going on...and correctly identified the issue, finally.
We paid the $1500 a year a few times. Got a thorough physical - but Dr. and office dropped the ball on follow up.
So when we didn't renew, we were bombarded by AOL-like contact wondering why we left. (We hardly ever say negative things on questions like this)
But it got worse. We wanted a simple refill on an inhaler and the mdvip Dr refused. We had to rejoin first!!! Pay $1500 for a Rx!!!
Called the former local Dr office and they Rx one emergency refill even after not seeing the practice for years.
We will go back to the mdvip dr again because but only when and if the condition calls for. The Dr may not be good at follow up but we liked his diagnosis skills
I told them to cancel the appointment then. They asked if I wanted to reschedule "Nope. I'm going to find another office".
I did find another office, and the doctor was more professional, thorough, and I had next to no wait time.
Then the office can offer expedited check-in for patients that use the app, because they know the patient will arrive on time and don't have to pad the check-in time estimates. Bonus for watching traffic patterns and looking for accidents/road closures, then giving the patient a heads up to start making their way to the office earlier than anticipated; bonus for storing trending data on individual patients to adjust reminders (those more consistently tardy get earlier and more frequent reminders).
Doctor Revenue = Number of Hours Worked / Yr / Duration of Average Visit * reimbursement for average visit
That's capped, and everyone is squeezing down on it constantly. Every bit of healthcare reform in the last couple decades has been unfunded mandates (aka, increased overhead) coupled to ongoing reductions in reimbursement rates. For that matter, as is usually the case when price ceilings are implemented, demand > supply, and docs are booked to capacity in most places.
This creates a problem when it comes to hiring staff. Better staff comes directly out of your pocket, and it doesn't translate into higher revenue: it's just a cost. Er... most businesses don't throw money out of the window if they can avoid it.
The exception is billing staff (some of whom are better than others at maximizing your revenue from insurers), and if you plan on moving into a luxury all-cash niche, in which you can demand market rates for better service.
So I spent several hours doing research on orthopedic surgeons and went to visit one of the best ones at the best hospital in the city (who also happened to be in-network). He looked at my X-rays and recommended against surgery, saying that the break wasn't that bad and that it would heal fine with just the cast I was already in! He was not as personable and a bit more robotic than the other guy who was giving off the salesman vibes, but I trusted him because of my research rather than the first doc who was essentially just some random referral through happenstance.
A year has gone by now and I'm glad that I didn't get the surgery, because my ankle healed perfectly without it (the second doc was right). I would've been walking faster with the surgery, it's true, but I also would've had permanently implanted metal hardware (which can cause lifelong irritation issues), and which could have necessitated a second surgery for later removal. In hindsight I regret nothing, and of course not having the surgery was also much, much cheaper.
So if that first doctor were to ask me why I'd leave him, I'd just say that it seemed like he was placing profits above the best interests of the patient, or, more charitably, that since he's a surgeon he thinks of surgery as the solution to every problem, even when it's not necessary.
i'm not a doctor, but that makes sense to me.
i sometimes hear that medicine has entered the "post antibiotic" era. i can't help but wonder: are surgeons about to take a big financial hit because of that?
- orthopedists make money from each surgery they do. Many orthos are honest, but some areas of US have orthos who run joint replacement factories to maximize profit. In the past few months I've gotten two junk mailings from orthos advertising joint replacement. If doctors are advertising, you know their financial incentives are wrong.
PT's... are fine folks. But if you want to avoid surgery and need a proper injury evaluation, you go to PM&R.
http://www.scrantonhipandknee.com
Landing page is all about how great hip and knee replacements are.
That would have been hard to argue as sufficient reason to switch but I figured that if his primary worry in a situation where a patient has clearly expressed a need is his perception then he shouldn't have become a doctor in the first place and likely that would get in the way of him providing care.
I've talked this over with a nurse friend of mine and they totally confirmed that this is normal, doctors, especially in a hospital setting, are on top of a hierarchy that tends to self-reinforce their importance. And yes, they are important. But in the end what is most important is that they realize that the only reason they have a job is because someone else is in trouble and that some humility goes a very long way towards establishing real rapport.
The one thing that stood out for me on this subject that I read about a while ago (not sure if it was in a book or online) was that actually being in the hospital as a patient immediately made doctors a much better doctor for their patients.
Dogfooding works, even for doctors.
Another reason why people don't leave feedback: they don't want to get into an argument, they just want to switch and they already have enough on their plates and fortunately in many places they have that right.
It seems possible that was a hygiene issue. For example the doctor knew that he'd need then to wash his hands again (possibly twice, once before going to the cupboard, once after), or change his gloves, before continuing with your consultation?
From my own experience the US is a weird mix of "can do" attitude on the one hand with strict hierarchies and enforced policies on the other hand.
Also, I love it how I relate something where I was present and observing the whole thing and then you come along and tell me what really happened.
No, he definitely was not on a tight schedule, in fact he waited around for the nurse to come and hand me my cup with water from that very same tap before we continued our conversation which indicates the opposite. I'd had a tube down my throat for 6 hours or so and the irritation was such that I couldn't speak otherwise, but I was still too unsteady to get it myself or I would have happily done so. A few minutes would have made a big difference to me.
I get that it's very efficient to work this way, but I'm not sure I'll ever get used to it. My father, now long retired, used to be a family doctor back in France. He shared his office with 4 other family doctors + 1 secretary that they paid with their combined income to take care of their appointments. He used to spend 20 minutes in average with each client. One of his colleagues routinely spent 30 minutes.
I should ask him about his churn. :)
Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere.
http://krant.telegraaf.nl/krant/archief/20020319/fotos/bin.v...
It was a pretty bad accident (5 dead, 55 wounded of which 3 critical one of those criticals was my family) with lots of beds suddenly occupied by people not speaking French and a large multiple of that in foreigners roaming the corridors and yet they dealt with all that with grace and understanding.
Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly.
This leads to a number of limitations on what kind of care patients can get what machines they can buy, what medicine etc.
Not saying the US system is better but all systems have drawbacks.
NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before.
Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.
I.e. no one should be bankrupted because they get a serious illness.
With regards to France healthcare system here is an article who seems to think it wont survive though.
https://www.bloomberg.com/news/articles/2013-01-03/frances-h...
I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.
> most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg
Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures.
They typically can't pay for a new washing machine if their current one breaks down.
There is a large number of people who can't afford to buy a washing machine but it's not most people.
Wrong, income distribution isn't normal, it's bottom-heavy, and most people are well below the mean.
Exactly. In 2015, most (50.08666%) wage earners earned less that $30,000/year.
While it isn't a majority, the fact that 3-in-10 (29.72726%) earn less than $15,000/year is a travesty.
Of the income or wealth distribution - not a hope, it's Pareto all the way. You've got a really warped view of the world there.
In Belgium, you are charged based on your income, and they don't ask you how much you can pay when you get admitted.
As US ex-pats, we made enough money that we were in the top payment bracket.
Yet, for a significant surgery that kept my wife in the hospital in a private room for two weeks, we still paid less for the whole surgery plus hospital room WITHOUT insurance, than we would have paid in the US but with insurance.
That kind of social medicine does actually work, and work pretty well.
It's 100% free to go to the doctor yet a lot of people don't go for checkups it's not a common thing to do.
Furthermore the situation is even worse for men over 50.
So access to healthcare has very little to do with that.
> Its important to remember that in a state economy where
> healthcare is free or semi free it's operated as a cost
> center and thus has budgets that are politically mandated
> not determined by market demand at least not directly.
> My personal suggestion for a good balanced system is that
> most people pay most of the cost for normal healthcare costs
> like going to the doctor for a checkup, most of the cost for
> one of things like a broken leg but that society pays for
> more serious and longer term situations like cancer, heart
> surgeries where you are supposed to stay at the hospital for
> a longer time.
> It's 100% free to go to the doctor yet a lot of people don't go for checkups it's not a common thing to do.
So which is it? Does healthcare that is 100% subsidized distort demand so that people seek unnecessary care, or is demand so inelastic that people and populations who would benefit from it decline to use it?
EDIT: add third in situ quotation. Add comma in last sentence/question. Change pronoun to conjunction in last sentence; pluralize noun.
"1000 paid Russian trolls are spreading disinformation on US social media"
And recently said
>Be careful what you read on the internet because paid trolls are influencing what is discussed.
Perhaps parent poster is getting his info from disinformation sources like RT, Breitbart, Fox News, IJR, Limbaugh etc.
I was responding to a post who claimed that if there isn't free checkup for all then people wouldn't go to get checked.
I simply pointed out that even in a country like Denmark which is 100% free people thats not the case.
So you would have to show causation between general checkups and cost of healthcare I don't think you will be able to find that.
On the other hand, in Denmark where basic healthcare is free, the data you allude to (but do not present) show that even then "a lot of people don't go for checkups [because] it's not a common thing to do." Additionally, you write "Furthermore the situation is even worse for men over 50."
So my confusion comes from your contradictory assertions about the effects of fully subsidized basic healthcare. Either free healthcare generates cost overruns because people seek out unnecessary treatment, or free healthcare does not generate cost overruns because people do not seek out even necessary treatment.
Your assertions about the effect of free healthcare are paradoxical, hence my confusion.
EDIT: fix typo, recast first sentence of penultimate paragraph. Remove redundant prepositional phrase from last sentence.
I am not sure where you get that I want less people to go to the doctor. I just want to be able to pay for the situations you can't afford by asking for money in situations where most people can. And yes if you don't have any money then you should get help, but for people who make enough it should cost something.
So there is nothing paradoxial going on here. You just assumed I wanted fewer people to go to the doctor which I never said anything about.
With single payer, taxes cover the cost of care for everyone. With private insurance, the costs for more expensive care is covered by the premiums of healthier individuals, which is sort of like what you suggest but does not financially punish people who get sick.
What you propose may not be workable (or humane, for that matter) because it distributes the costs of extraordinary care to people who already have more-than-routine care. Presumably these people already have paid their premiums and now would shoulder most of the cost for maladies such as broken bones.
EDIT: add missing word "workable".
The main premise of this discussion is that it's not possible to pay enough for healthcare. I.e. even if you taxed people 100% there still would be things they couldn't get because it has to be available to everyone and there are always new treatments being developed, new machines, new drugs.
Whether you find it humane or not is based on what you consider the end-game of healthcare.
Be careful with articles about single payer healthcare systems in the US. Most similar countries to the US have functional single payer plans. It's a false talking point pushed by conservative media that those systems don't work well. Conservative media pushes those falsehoods because the media is funded by the very wealthy and those who want to cut taxes to line their own pockets at the expense of most Americans.
The issue that might make single payer difficult in America is we don't trust our political system to manage good programs, because the GOP is committed to destroying government (to benefit the super rich) rather than trying to get things done.
I don't want people voting based on their appendix, their bad knee surgery, or a skin rash. Involving government in healthcare inevitably leads to possible futures wherein a country is brought to it's knees by colonoscopies. One's enemies can only laugh.
It's easy to sketch convincing strawmen. But if you could actually point to somewhere that is choosing between kidney transplants and bullets, I'd eat my hat.
Plenty of single payer systems decides how long they are going to keep someone on treatment, what kind of products they allow them to be treated with etc.
A single payer system is based on a budget which means that budgets size is based on how it's prioritized.
Healthcare isn't perfect anywhere in the world whether private or public.
And even the US healthcare system isn't really market driven.
Opening with "let's have a market" isn't opening with a cogent position, since rational actor economic theory is completely unable to deal with this (sure, there might be others, but no one making this assertion wants to talk about them).
My premise is that you can never spend enough money on healthcare. There is always a need for better treatment, more treatment, new machines etc. Even if you taxed people 100% you could still spend more money because as you say it's worth everything to save it.
But a political system is made to prioritize the resources that we have and so a singlepayer system cannot escape to have to come to terms with the boundaries of the budget it's given.
There are many areas where a patient will not be treated or where the system decides it's not worth continuing to pay for some treatment.
In a singlepayer system it gets decided what gets treated in a system which is more open to demand the market decides.
None of these are without fault it's just important to keep their limitations in mind. This is why ex. the french system as much rave reviews it's gotten also sets limits to who it will treat.
We can then have a discussion about whether it's better that everyone gets access to the same treatment or whether it's better that some people can get access to better treatment methods than others.
But to ignore that a single payer system comes with it's own problems such as limits on how many people can be treated and for what and how long, is not taking the discussion serious.
However when you switch to a for-profit healthcare then the interests of the operators stop being aligned with those of the population. Even if there is more money, like in the US where the budget per person is about double that of France, it is not necessarily spent in a way that benefits the patients. State-run health avoids multiple administrative costs due to multiple actors, it avoids having to pay dividends to share holders, and as a single payer it has much more power over the pharmaceutical industry to lower costs. Overall it is a more efficient use of people's money.
And Medicare makes funding decisions based on what sort of care hospitals provide to patients. Critical access hospitals get higher reimbursement; maintaining that certification means a short average for length of inpatient stays and not growing to meet demand.
Medicaid and Medicare are more than a third of spending and don't necessarily cover the total costs of the care provided under the programs (any unmet costs are a hidden tax). The VA is not nearly as expansive as those programs but is another couple whole percentage points of US health spending.
And you've also got Tri Care and some BIA stuff, and state expenditures that are outside of Medicaid.
My point is that a singlepayer system payed by the taxpayers and budgeted by the politicians isn't making money it can only spend less money.
A system like the american overall can make money, it's it's goal to profit.
That's the difference between whether it's a market driven market or not IMO.
The US has all sorts of constraints on the supply side and a lot of the demand side is treated under various mandates.
Without easy entry on the supply side, there can't really be a market response to changes in demand, hence not really market driven.
When care is provided to comply with government mandates and incentives rather than because it can be priced above cost, not a market driven transaction.
Thats not a useful way to look at things.
Why is market demand a good thing?
In the US the government spends more per capita than France, but gets worse health outcomes.
The US system isn't the only way a marketdriven system can be and a lot of it's problems are lobby and politics related.
Market demand is a good thing in the sense that it creates better allocation of resources.
The US doesn't have a healthcare market driven by market demand. But the fact is that the US system has more advanced treatment methods.
The problem is that it's not evenly distributed.
Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly.
This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc.
Not saying the EU system is better, but then that depends whether you are a shareholder or a patient.
The US system isn't better it's different. The inflated prices aren't due to it being more privately driven but because of lobbying which can be dealt with.
The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlepayer system.
In a system more driven by market you can actually make money.
It's finding the right balance between those two I consider the most interesting part of this discussion. Unfortunately it's impossible to have this discussion because people either see you as a singlepayer proponent or a 100% marketdriven proponent.
"you can never spend enough money on it" - i say again, 'enough' is defined differently, a 'socialist enough' is enough to please the people; where a 'capitalist enough' is the smallest number that can sustain profit. these 'enough's are radically different.
"In a system more driven by market you can actually make money." - only by denying treatment. this is the cornerstone of the market model, those who can't pay don't matter.
"It's finding the right balance between those two" - In the UK, we are bringing private companies into contracts within the NHS, its always been a disaster, costing much more money that the services needed to cost, the inefficiency inherent in private companies (from bloated wages of CEOs to dividends) drag the whole system into financial crisis. The people who pay for the profits at the top are always the poor users of the service.
If you get more and more treatments available and what people consider being part of healthcare and you are running a cost center then your system gets more and more expensive.
No enough here is meant as there will always be things you can spend to make your system better than it is. It's not a matter of opinion it's a matter of what kind of treatments are available compared to how many you can offer.
The single payer system is also denying treatment exactly because it can't pay if everyone used it. It's just another way to say some people don't matter enough.
In the UK system is also deciding which drugs it will prioritize and which it wont.
You are mixing two things together. Yes there are plenty of issues with the US system but the single payer system have issues too and they are not the same.
'cost center' Vs 'profit center' <why would the profit center be cheaper? its the same as a 'cost center' with an added money drain and incentive to inflate prices..
'[denying treatment] because it can't pay if everyone used it' - This is just false, moneys going into a countries nationalized health system is high return (due to taxes), its also cheaper (due to group union prices). So long as its a healthy part of a healthy GDP (12%) it should have capacity for everyone in the country. compared to the US system which costs over 40% of your GDP and still does not have capacity for all your citizens.
'which drugs it will prioritize' - true, but this is done mostly on evidence of usefulness, not price.
I largely agree with your last statement, but whatever problems a socialist system has, they pale in comparison to the misery caused by Laissez-faire in our health system.
Switzerland has universal healthcare but it's based on private insurance. In other words it's not that simple.
In general I find this discussion hard to have because you are assuming so many things about what I say or mean, that simply aren't true.
I am not saying that a profit center is cheaper than a cost center I am saying that its able to make money which gives it flexibility.
The incentives that drives the US healthcare system are pretty shitty but they aren't incentives which are unique to a private system. On top of that in the public healthcare systems you see more and more new public management to hold down cost, which itself is expensive. But it's not something that's set in stone. It's not a property of the system it can be changed.
Changing the US healthcare system to patient outcomes incentives would do a lot to fix the incentives and there is an active program trying to do that.
And no it's not false that there are limits to a public healthcare system. Believe me I have lived in one and it doesn't only get realized by not doing certain treatments it also reflect in waiting time for operations, to see a specialist etc.
In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in.
In Denmark my biopsy had to be done at the hospital. In the US they made it right away at the dermatologist the same day.
With regards to drugs it's actually based on the cost, the rarity of the decease etc. I think it's in the UK where they have a list in order to prioritize.
Switzerland has very heavy regulations, everyone is covered by a national insurance system like other EU countries, but the very fact that its private companies that carries out the health care show in the stats, they pay almost twice the GDP of the UK for about the same outcomes, same with Germany, which has a similar system, its about 18% of GDP (and their GDP is higher per person).
"I am saying that its able to make money which gives it flexibility" - if this is really what you are trying to say, then you should have started with "Private, profit driven health care is fine for rich people", which i would have agreed with.
"waiting time for operations, to see a specialist" - this is a bad example, how many Americans wait all there lives for an operation, or never see a specialist because of the price. if you factored this in the average waiting times in a private unregulated system would dwarf a socialist waiting list(which by definition includes everyone).
"With regards to drugs" - in England we have 'NICE' which is a public board mandated to approve drugs and procedures on the NHS, with the fist stipulation that the drugs or procedures are shown through proper trials to work. This system is not perfect, but its a hell of a lot better than a private board incentivized to approve any BS treatment on profit basis alone.
"In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in." Try to put your personal feelings aside and look at the stats; http://www.nationmaster.com/country-info/compare/Denmark/Uni...
It's either socialist or Laise-Faire, Switzerland is heavly regulated, Public boards are based on rationality, private boards are based on greed alone.
No a taxpayer paid healthcare system does not make it a socialist system anymore than a taxpayer police force or army does. And the US system isn't laissez faire just because it's broken in many ways. Most economies are mixed economies.
So I am not sure what you are trying to prove here. The fact remains that public healthcare has it's own issues regardless of whether you personally think they are better issues to have and any honest dive into those the countries systems will show you that. You can't both have your cake and eat it. Switzerland is heavy regulated you claim (which is wrong) but they pay twice the GDP for about the same outcome. So what is it? A system governed by the state, a system that's private or something in between? With regards to Germany most of their insurance is covered by public healthcare 80% if not more. So why is that?
Furthermore the US is a huge country with hundreds of millions of citizens and millions of illegal immigrants and spread out over a huge area. Based on it's circumstances it's not doing too shabby regardless of the statistics.
It's just not as simply as you would like to paint it in those extreme corners.
There is an interesting discussion around Medicaid vs. private insurance in the US you can read about here:
https://www.forbes.com/sites/sallypipes/2014/08/14/no-really...
My point was never to say one thing was better than the other yet thats what we are really discussing here.
My point was that there are tradeoffs in both systems.
The reality is that that so many people in this country have bought into some kind of Capitalist Calvinism, where the suffering is not only pre-ordained by "market forces," but considered salutary itself, that it's sickened our culture beyond the capacity for reason. We'd really rather watch our friends, families, and neighbors die in sickness and poverty, than admit the failure of the grotesque just-world fallacy that is our economic ideology.
The reason why the US system is so expensive is because of perverse incentives given to the industry.
As long as you can afford it I would rather be treated in the US system than the French or Danish system.
So does the US, they just use one's wealth as a proxy to arrive at demonstrably worse results for everyone overall.
If you want to have a system where one's income determines their ability to survive because you have enough money and that works for you right now, go ahead. But at least drop the pretense that it's in any way just or moral.
You can be of the opinion that everyone should get access to the same treatment or you can be of the opinion that they shouldn't and that people who can afford better treatment should be able to.
All I was doing was point out that a single payer system has it's own issues as well.
Whether you are a fan of one or the other is more a political discussion.
"The reason why the US system is so expensive" - Is because an individual with a health condition is in a poor position to negotiate the price of a treatment for themselves. To the extent a private company could give fair prices, they would have to be regulated heavily.
"As long as you can afford it I would rather be treated in the US" - You believe this because much of the massive profit margins goes into advertising.
On the other hand, you will likely have been on the receiving end of millions in advertising, and since your 'opinion' is in line with that advertising... its a good bet it is the result of it.
if you are interested in some conflicting 'studies of one' have a watch; https://www.youtube.com/watch?v=thkBLpRwdSM
I know the documentary but what does that have to do with whether the US system have access to more advanced healthcare than most other places.
I don't need a documentary to tell me the many issues with the US system just like I don't need one to tell me the many issues with the Danish system.
Most (but not all) single payer systems coexist with private payer.
In England you can get all your care on the NHS, or you can mix and match with NHS or private care.
Docs are the chokepoint in the process. Overseers track very carefully how much time you spend, how productive you are, etc. and surround you with lower-wage employees to do every last thing except those responsibilities that you, by law, have sole power to do.
My buddies are in latter years of residency and no one works <90 hrs/wk (including paperwork they have to finish when they get home, 'cause otherwise they'd never see their families). And that's despite running around like their hair is on fire. I assure you, it's not voluntary.
New med schools are opening every day, but they're an irrelevancy when the chokepoint is actually getting narrower.
Additionally, docs are just the most expensive staff members. It's bad business to have someone who costs $10/hr doing work someone else can do for $5/hr. Hospital CFOs don't care if it makes patients feel like shit, and doctors feel like shit; they don't want to pay out the marginal $/hr.
Yes, this is a lot of bureaucracy, but there is a reason for it. If your surgeon thought there was a good chance that you'd have to go back in for surgery soon, he'd likely want you to be NPO (no food or water intake) to minimize the risk of aspiration and choking during anesthesia and intubation if you were to undergo surgery again. He might want you NPO if you had just had some sort of GI surgery or were due for a barium swallow study. A lot of patients are NPO in the hospital, and for consulting doctors, it's much easier to defer to your nurse or your primary doctor for even basic needs like food and water.
Ok.
> The workflow of doctors in the hospital is complicated, and different doctors and nurses have different privileges for different patients, which can make things appear to be ego related. In your scenario, you're a post-operative patient. Your primary doctor is likely the surgeon that performed surgery on you. I'm thinking the doctor that saw you and wouldn't get a cup of water was a consulting-team doctor that was asked by your primary doctor (the surgeon) to see you.
All that's correct.
Even so, I was in some pretty serious discomfort, the guy asked me if he could do something for me, if I could have I would have gotten up myself and instead we spent a couple of extremely uncomfortable minutes waiting for the nurse (busy elsewhere) to perform a 10 second action. That discomfort could have easily been avoided.
If there was a more complex situation at play then there was plenty of time to explain that but no such explanation was given, when I asked later about why the doctor didn't get me the water himself (to the nurse that got it for me) her answer was because they're too good for that.
So FWIW I think the story is simply as it is at the simplest level without any need to bring in larger scenarios or extra complexity.
After 6 hours of surgery without any water and a tube down my throat a bit of water was not too much to ask for to receive right away, my throat was burning and my tongue was parched.
To me that's basic humanity, it's nothing to do with bureaucracy or complex reasoning, after all if I could have gotten up I would have gotten some water myself.
You mentioned you had a tube down your throat—that's probably an NG or OG tube, which is often used for feeding solids and liquids. If you had one of those tubes, then there's very likely a reason you couldn't take solids/liquids by mouth. Again, I don't know all the details, but I'd imagine what happened is that your consulting doctor saw you had an NG or OG tube and wasn't sure why. He probably deferred the decision on whether you could have water to your nurse who would know for sure what you were and weren't allowed to have. The nurse probably isn't aware of what the different doctors know and don't know about their patients and interpreted the request to get water as an ego thing. If my interpretation is correct, the doctor is still wrong in not giving you or the nurse an explanation of what's going on, but the issue is more communication related than it is ego related. I don't believe what happened to you is ideal or how medicine should work, but it's how medicine often ends up working with so many different people having tangential and partial responsibilities for patients.
Based on my experiences working in the hospital so far, communication issues are massive and frequent causes of problems and conflicts between health care providers and patients as well as between different health care providers. Again, the workflow in the hospital is complicated, and I don't believe any one person really knows what any other person should be doing. Each provider knows the extent and limitations of their own role, but others' roles are a mystery. All of this leads to miscommunication, misunderstandings, and massive/frequent problems like your experience.
No, it was there during the operation, not for feeding.
> Again, I don't know all the details, but I'd imagine what happened is that your consulting doctor saw you had an NG or OG tube and wasn't sure why.
No, this was definitely not the case.
> All of this leads to miscommunication, misunderstandings, and massive/frequent problems like your experience.
This may sound funny to you, but ego or miscommunication doesn't matter to me, the end result is what matters. If you can't communicate or have an inflated ego I'd rather not have you as my doctor because either one of those is an ingredient in a recipe for an accident.
I'm an engineer. I can't carry a part from one lab to another. Must have a hourly paid union member do that. If I'm caught and they file a greivance, the company has to pay them 1 hour of my salary, then I get chewed out by management. Most of the hourly staff don't care, but there are a few that are hell bent on doing as little work as possible and looking any excuse file to a greivance.
Not a chance where I live.
They don't do that anymore, as most people ignored these rules.
I can't imagine how bad software development would be if we acted like the medical system.
...which made me laugh. Until I realized you weren't sarcastic (I think).
As a healthy 30 year old, I've never met my doctor. But my 85 year old neighbour who is in and out of hospital all the time has a doctor who knows her children's names and everything.
Doctors today are literally too busy to care. They never 'Hold the Paper' to the issue. It isn't enough for a patient to manage to have the proper insurance and reach out to a primary care physician; it's now incumbent on you to continually identify the specialist areas which may be germane to your issue and make the appointments and interpret the resulting data. You, are the integral component to saving your own life, as no doctor or other medical professional is there now to provide continuity, or put any of what's happening to you into context.
I honestly think there is an opportunity for yet another layer to be inserted into American medicine - that of the patient's advocate, who is smart enough the carry the day, and who simply gives a shit.
I think she was so good because she was allowed to be directly engaged with her patients and that resulted in some sort of feedback loop where she was always striving to stay on top of the state-of-the-art.
These days, those sorts of practices are hard to find. There's the doc-in-a-box places that dominate, and they seem surprised if you want to see the same doc rather than whoever can just see you.
There's also someone else in the room these days - the government and (practically the same thing) insurance company. The doctor / patient relationship is now more like the doctor stooge snooping on the patient relationship.
Just look at how many doctors no longer will prescribe medicine for pain due to the war on drugs. They're scared of losing their license. The collateral damage is the poor people who need strong pain management but find it increasingly hard to get it.
Doctors haven't stopped prescribing opioids because of the war on drugs. They've changed prescribing because opioid meds are not effective to treat long term pain, and certainly not effective in the way they were being prescribed.
People with long term pain given opioids will quickly develop tolerance to those meds, and need to increase the dose. They quickly reach dangerous levels of opioid use, often with multiple meds, and they're still not getting relief from their pain. So now they're still in pain, and they have an opioid addiction.
People with long term pain need rapid access to specialist pain clinics, with a full range of treatment including physiotherapy and prescribing, and -if needed- carefully prescribed opioids.
Watch the documentary "Dr. Feelgood" (http://www.imdb.com/title/tt5192362/) for a couple of very extreme, living and breathing refutations of that claim. It's not nearly cut and dried one way or the other.
But on a related note: I'm not sure about the value of using patient satisfaction surveys to evaluate physician performance generally. Patients will love doctors who tell them what they want to hear, over-prescribe antibiotics, over-prescribe powerful pain killers, go along with non-vaccination, prescribe homeopathic remedies or similar nonsense.... I think most people are not in a good position to evaluate the quality of care they're getting outside of things like bedside manner, so I wouldn't pay much attention to reviews for doctors.
The former deliver no bad news ever, and treat to make you feel good and relaxed, the latter deliver nothing but bad news, but they probably save your life.
So what happens is that people mistake their subjective feelings for the objective quality of care, and discount the value of being alive immensely.
I remember losing my hairs and getting patches of super smooth bald spots. Super embarrassing for a kid in a bad neighbourhood and bad school.
Went to the doctor she looked at my charts and said I was super low on iron so low that I might even die if it continues to lower. I was given iron pills.
Two months after I went to the doctor again and said my hair patches are not fixed. She looks at my chart again and said... hey you don't have low iron you have perfect iron and I never told you to take any pills.
Then upon investigation it was noted that the staff gave her wrong chart; of a pregnant woman who had a similar "feminized" version of my name.
Edit: Addendum: finally I was sent to a skin specialist who injected me with steroids for months until my patches were fixed. They said I had alopecia.
I was furious what if the said person had cancer and they started chemo on me?
Same doctor once injected my mom with the wrong fluid. To this day we don't know. We filed a complaint but she then resorted to personal attacks in her report and the "college of medicine" or whatever it's called didn't do anything. Till this day my mom has a red/purple bump on her arms.
Finlly, most other docs don't even check me out they listen to symptoms and say it's nothing, it will go away, etc while looking miserable (no doctor should watch House MD lol). Other times they solve the symptoms by tossing prescriptions at me. Said symptoms always keep coming back and I keep getting more of the same prescriptions.
Thanks for the free health"care" Canada.
This has happened many times to me. It's quite scary once you realize it. Thankfully no one ever told me I was pregnant.
> We filed a complaint but she then resorted to personal attacks in her report
Care to go into more detail? I'm really interested in knowing how these details.
> Said symptoms always keep coming back and I keep getting more of the same prescriptions.
This is just called making sure your business is recurrent.
I was furious and told them to write my name, age, and gender on top of the leaflet in bold red letters and watched them do it. All subsequent visits started off with me making sure that it was the right chart. Some good doctors ask you name, age before opening the chart. Not this one..
> Care to go into more detail? I'm really interested in knowing how these details.
My mother is a registered nurse. Heck, she was part of the government that trained a school of just nurses. Needless to say, she comes from a time and with experience that would lead her to run around the nurses of today. The digression was to just point out that.. my mom knows her shit.
After injecting her, she said "OH NO" really loud and then quickly left the room after tossing the bulb in the hazard bin.
As she was gone, my mom tried to look for what it was hoping there wasn't anything else in there other than the bulb in question.
She came back and saw my mom looking and accused her of attempting to harm herself and tampering. She never physically touched anything in the room, just was leaning from her seat so she can see the contents of the bin.. What the fuck man!
> This is just called making sure your business is recurrent.
Yeah, this is why I wished Homeopathy and all those kind of things were actually realistically helpful. I think the problem is that Doctors are no different than road workers that periodically patch the cracks on the highway. Doctors need to prevent shit instead of patching shit.
Edit: Spelling error and remove colloquial tinfoil paragraph xD
Ideally yes. But we as individuals already have the capacity to do this:
- Eat well
- Exercise
- Don't smoke
- Don't drink
- Wear sunscreen
etc.
I think baking in lifestyle design or something that educates kids at an early age might help. Back home in India, I remember there used to be a kid show where they explained how mosquitoes and flies spread diseases and how this happens too often when you eat at the street vendors. I stopped doing that (of course, mileage varies)
Classic. When in doubt discredit them by making them look crazy. Coupled with being an authority figure and credibility that comes with it this is an effective technique.
> Doctors need to prevent shit instead of patching shit.
Medicine is very good at treating acute and traumatic things. Long term conditions, not really.
Every time I did in the past they got personally offended and refused to address their flaws, so why bother?
Also I am almost convinced good medics in certain fields (endocrinology for example) are almost nonexistent.
Endocrinologists are legally all but required to have the presumption that their patients are criminals, and that the patient must prove otherwise.
Because of the ban on "cosmetic" use of anabolic steroids and other hormones, which was passed under Bush Sr., endocrinologists are flooded with patients who concoct really elaborate stories explaining why they need hormones.
The liability is so high for endocrinologists that they are incentivized not to be the most convenient provider around, lest they develop a reputation as the one who prescribes easily.
The people who suffer the most from all of this are the people who need hormones the most: transgender people and people with serious hormone disorders, but the system is not designed to make their lives convenient.
I found only one willing to help, and only in an half-assed manner. I still go most for formality and legality reasons, but I am mostly treating myself as I want now.
Too many doctors seem to be of the opinion they know best and the patient should just do as they say - even if they are correct technically it is not their life that is on the line. The patient is always right.
There are potent tumor inhibitors like CBD that aren't accepted by most of the medical field, thus patients too (high trust in the doctors). They can alleviate symptoms and slow down metastasis (some academics have seen regression even). This gives time to plan for the rest. Instead you're sent home to die thinking it's hopeless. I guess it's better than dying at hospital, or being cut into pieces by resections... but it's far from acceptable IMO.
No he is not.
As a general rule delaying treatment is almost always the best option. I am glad you avoided an unneeded root canal.
The reason this is considered optimum is that a doctor hitting 0% NAR (which you might naively assume is best) is most likely being overly conservative and missing some genuine cases of appendicitis, which as we all know can be life threatening if left untreated.
1. Kittens die
2. You have a unique position to help people.
1. If you have ever cared for 4-7 week kittens then you know sometimes they just die. Don't be surprised when they do. They simply do. One moment they seem healthy and the next-they are gone.
Your patients will not come back. They just won't. Don't be surprised when they don't come back. It happens. You will not know why. It's part of life like kittens dying.
2. You help people. You give them their life back. You are One of the few people who can make someone better. You improve. You prolong happiness. You give hope. It's often invisible to you. Yet it is real. It's real when your patients can travel, cook, walk, earn a living, hug grandchildren, breathe another breath.
I can't do that. Most people can't do that. But you do. Every day.
So who gives a ### that you don't know why the kitten left your practice. It never changed all the good you did and all the good you can and will do.
So... Forget the kitten.
On average, less than 5% of all patients seen will leave feedback. When prompted, we've seen this jump to 10-15% of patients seen, although we do have a few who have much higher conversion ratios.
(This is likely due to the doctor introducing the feedback concept at the end of the consult.)
What has been most interesting to see, contrary to the story, is that most doctors and healthcare professionals are still on the fence about implementing these sorts of feedback loops.
We find often times that buy-in does not occur until the professionals can see "comparisons" as to how others are doing.
There are also a ton of hurdles to implementation of these types of feedback loops, due to HIPAA and other requirements that often makes things near impossible.
This makes the whole thought of introducing this into a practice daunting for some and that's why usage of feedback loops like these are not already widespread.
Hopefully, as legacy practitioners give way to a new generation of medical and Heath professionals, patient feedback will be more widely solicited and used.
Shameless self promotion: this is the exact problem my co-founder and I are working to address: https://www.perspexilabs.com/ (site currently looks broadly-focused, but we're targeting medical).
We're finding patients are actually very happy to give feedback, especially when given a neutral medium to discuss their experiences and when doing so very quickly after an interaction. The super-tight feedback loop not only makes everyone more satisfied, but it also has the chance to improve quality of care too.
The permission check becomes vital: it's part of the patient authorization at, for example, a first visit, and is best when also followed by a verbal authorization upon checkout. It's one of the big hurdles we're trying to overcome obviously, but we believe there are proper ways to do it and make it work within the boundaries of regulation and privacy. No good problem worth solving is without difficulties, right? :)
http://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/nhs-frie...
It is funny: prescribe pain relief, then act like I'm an addict? Give me a break. Who is selling the opiod epidemic story ad nauseum?
I'm seriously wondering how many doctors will ask themselves this question, or even notice that their patient is gone.
Emphatically: YES. Bodily integrity is something that is very high on the list of things that a person should have a say over. Whether they do it because they are mis-informed, dumb, irrational or religious doesn't matter, they still should have the final say over whether or not they get a specific injection or not.
There are many things that concern the individual that have consequences for society as a whole, in fact, it is very hard to point at a single thing that concerns an individual that has absolutely no consequence for society. And many of those things are regulated to benefit society. But your body is yours and yours alone and that's a good thing even if there are negative consequences for society.
Fortunately the anti-vaxxers are a small minority instead of a large majority so the risk is somewhat controllable and fortunately the only people at risk are those that have not been vaccinated yet (a risk that for many diseases is extremely small) so the consequences for society as a whole are manageable.
If that should change dramatically then this should be revisited but for now I'm pretty happy to support this even though I would never apply it to myself or my children (who, ironically, don't get to chose because the argument isn't really framed right, it's not an individual choice but in almost all cases a choice for a parent about their child...). This also ties in with religious freedom, and as an atheist you might find it surprising that I'm a big proponent of that, I don't believe in any of this but I will definitely defend the right of others to believe in whatever they want, including in things that may make them make sub-optimal choices when it comes to their own health or the health of their kids.
If you start to take away those rights you will end up with a very unhealthy society, far more unhealthy (and unhealthy on a different plane) than the society that has to deal with some actual health issues in a small part of their population.
One of my relatives was vaccinated for pertussis, and yet still came down with it one day. Their parent had a hard time convincing the doctors to even test for it because, in their minds, it was no longer an option.
Even later, it came out that the particular vaccine that my relative had been given had a markedly lower effective duration than had been initially advertised.
So even if other entities make all the "safe" choices (presuming they're not immunocompromised or otherwise unable to be vaccinated), disruptions in herd immunity can have problematic consequences.
Loss of herd immunity effects those who have gotten the vaccine as well (especially with vaccines that have more significant failure rates). Choosing to not vaccinate your child and expecting everybody else's children at the public school you send them to to just deal is about more than personal bodily integrity.
As an analogue: if you want to categorize the non-vaccinated person as a 'drunk driver' who is not allowed to partake in traffic then you prioritize (rightly, imo) their choice to be drunk over the risk they pose to the lives and health of others because the chances of causing a serious accident are large enough - and we have the evidence to back that up - that we collectively have decided against people having that particular freedom.
So if that's your argument (which I don't know for sure) you definitely have a point.
The counter point (to that convenient strawman :) ) is that the chances of someone getting ill are not as easy to determine and that that someone might have gotten ill anyway. Cause and effect are a lot more distant in that case and much harder to relate to each other.
This is wishy-washy logic. There are real evidence/data-based scientific studies that show the specific measurable increase in infections of various diseases based on how many members of the population refuse the available vaccines. There have been flare-ups in California with dozens of people becoming infected (and some dying) when herd immunity is lost. This is not hypothetical; it is simply fact. Similarly, it's hard to say whether any individual pack-a-day smoker will die from lung cancer, but we know that, in aggregate, smoking significantly increases your risks of dying from lung cancer, so to make wishy-washy statements attempting to justify smoking as maybe not unhealthy would similarly fall on deaf ears.
And lastly -- this isn't all theoretical. I want you to watch a video of an infant, too young for vaccination, that has contracted whooping cough thanks to failure of herd immunity (i.e. anti-vaxxers). Even with all the benefits of modern medicine there is a good chance that infants like this one that contract whooping cough will die. This is what enabling anti-vaxxers does: https://www.youtube.com/watch?v=S3oZrMGDMMw
There are some pretty basic elements at play here and if you want to over-rule the right to basic bodily integrity you're going to have to do better than to quote statistics.
By that rule we should force everybody to eat healthy, to have an alcohol lock in every car and so on.
Finally your emotional appeal is nothing but the 'think of the children' argument.
Yes, it is a tragedy, no that does not mean that anti-vaxxers should not have the right to do as they please with their own bodies.
Principles only matter when there is a price to pay and in this case that price could very well be my own child. Even so, I still stand by my support of those that decide otherwise because not to do that means giving the state way too much power over our bodies.
Of course they do, but their bodily integrity does not extend to forcing others to give up theirs.
I realize this is a difficult subject because it seems so obvious to people schooled in biology and statistics but the 'greater good' here is that we have a society where you get to make that choice. That there is a price to pay for that is something that right now a majority of the non-scientifically trained people feels is a trade-off worth making.
Freedoms always carry a price, and in some cases that means that people die. Those can be old people, young people or people somewhere in the middle but it is unavoidable.
From a purely rational perspective this may not make sense to you but people are not purely rational beings, they tend to feel they should have a right to say 'no' to someone that wants to stick a needle in their arm for 'the greater good'.
The only way I see to solve this is to encourage education and to hope for informed consent, not force.
Anti-vaxxers for the most part are people that have been duped either by religion or by fear mongering that vaccinations are bad, this makes it an education issue, not an our-way-or-the-highway issue.
For example, in my country there are mandatory check-ups for children every couple years, which include a baseline of vaccination unless opted out. There are also mandatory check-ups conducted in schools (IIRC teeth and also vaccination - interdisciplinary, so to speak).
Remember that this set includes people that cannot receive the vaccine because of e.g autoimmune disorders, serious allergic reactions, etc. These people need the herd immunity to keep the general risk of infection low. As long as the number of anti-vaxxers is very small, they similarly benefit from the herd immunity as "free riders".
Once the number of free riders crosses a threshold[1], non-linear effects can rapidly amplify the spread of the disease among the population. Preventing any disease from gaining a "critical mass" in the population is an important part of how they work.
> Fortunately the anti-vaxxers are a small minority
Unfortunately that isn't really true in some areas.[2]
> so the consequences for society as a whole are manageable.
That management has already started to fail in CA (and other areas), where the rapid decrease in vaccination rates cause measles and whooping cough outbreaks[3].
[1] https://en.wikipedia.org/wiki/Herd_immunity#Mechanism
[2] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a1.htm?s_cid...
[3] https://www.advisory.com/daily-briefing/2014/09/30/in-wealth...
I believe that that line is drawn pretty accurately at the moment, there is a strong push towards vaccination, there is education and there are all kinds of programs to make sure it happens. And yet we can not force this onto people that don't want it. I'm sure that there are plenty of people that would rather see this resolved 'for the greater good', I'm just not one of those people and I feel quite strongly about this even if it is a right I myself would never make use of because I disagree with the basic premises of those that want it that way.
But I recognize their rights and will defend them.
No, vaccines are not 100% effective. For example, the H3N3 vaccine was 90% effective[1]. So the only people at risk are those not yet vaccinated...and an additional 10% of the people who did get the vaccine.
Also, as noted in another reply, many, many people can't get vaccinated and rely on those of us who can to not be spreading the disease around. You can't vaccinate a newborn, for example.
There's a lot of value in bodily autonomy, and it's definitely questionable to mandate vaccines, but that has to be weighed against the costs, and that requires understanding and honestly acknowledging the costs.
That's hardly the fault of the people who didn't get vaccinated.
> Also, as noted in another reply, many, many people can't get vaccinated and rely on those of us who can to not be spreading the disease around.
True
> You can't vaccinate a newborn, for example.
Also true, I'm painfully aware of that one.
> There's a lot of value in bodily autonomy, and it's definitely questionable to mandate vaccines, but that has to be weighed against the costs, and that requires understanding and honestly acknowledging the costs.
Yes again. This also includes honestly looking at the other side of the argument: if you want science rather than regular imprecise human reasoning to take over at all levels of society you will end up with a society where freedom of religion and all kinds of other goodies that we have come to agree are good for all of us are going to be thrown out.
I would rather see steps in that direction come about by consent than by force. We're all so tremendously fanatical about protecting life, at the same time those abortion clinic bombers claim they are doing the exact same thing.
Extremist positions (such as the anti-vaxxers) are not going to yield because of a push by force-majeure. The only way you're going to get such a position to be changed is by endless education and information so that finally, hopefully soon but better later than never people will decide that this is for the best of their kids.
And if they don't then all you'll end up doing is alienating that part of society even further from reason and that's the last thing you want.
Science is a good thing, let's not make it seem as though it is perfect and let's not repeat the exact same mistakes that religions perform over and over again, such as deciding how others should live their lives. The miracles of modern medicine are large enough that they can speak for themselves and over a long enough time-span the anti-vaxxers movement will be just another blip.
But if you start to push back you are only making it bigger, better to respect their right to make the wrong decisions than to force them creating even more resentment and ill-will.
> Science is a good thing, let's not make it seem as though it is perfect
Uh....I want our decisions to be based on evidence. Science is not a moral theory, and I'm not pretending it is, but it our most reliable source of empirical data. Science never says "you should do X", so you don't have to worry about that. It only says "Best data available says that doing X will result in in Y with probability P".
> But if you start to push back you are only making it bigger, better to respect their right to make the wrong decisions than to force them creating even more resentment and ill-will.
I'm all for a pragmatic, effective approach to getting people to vaccinate, and I want one that balances people's rights. I also agreed that turning the issue into a culture war is counter-productive.
At the same time, I want to get people to vaccinate, and while I won't hold them down and jab a needle in their arm to do it, I am in favor of doing what we can to effectively get them to vaccinate.
Anecdote: I have a friend who got sick during the Ebola scare, and had recently been in [an Ebola-free country in] Africa, so the police came by and forced her to go to the hospital where they determined she didn't have Ebola and sent her a bill. Which she had to pay.
I'd argue that forcing her to go to the hospital was reasonable (or would have been if it hadn't been predicated on the idea that "Africa" is one homogenous place full of Ebola), but that charging her for it was not. I think we as a society have the right to demand people with serious contagious diseases be quarantined and receive treatment, and that we as a society should pay for that.
I assume that at least if she had Ebola, you'd agree with overriding her bodily autonomy for a forced quarantine. That's further on the freedom end of the "bodily autonomy vs. societal well-being" scale than I'm on, but still one that recognizes the trade-offs and makes a thoughtful, pragmatic balance rather than holding one goal, bodily-autonomy, as completely outweighing the other.
I don't actually know if you'd agree with the forced quarantine, but I'm making the assumption that, like most everybody, you agree that the trade-off is sometimes worthwhile.
With vaccines you absolutely reasonably take the stance that requiring them is the wrong balance, but you seem to be arguing as if even evaluating the cost-benefit is wrong--at least judging by your initial post. "But your body is yours and yours alone and that's a good thing even if there are negative consequences for society."
It's hard to draw a line about where the balance lies, and it feels more principled to say "value X always outweighs value Y", but very, very few people are willing to take the hard stance. Instead they take the hard stance where they've drawn the line, and pretend that's the non-arbitrary line, dismissing the reductio as "well, yes, in that example it's obvious".
Are you willing to actually go with "bodily autonomy trumps societal consequences in every situation"? Or are you striking a balance? Because if you're striking a balance, the debate has to be about where the balance lies, not just "bodily autonomy uber alles". And that requires--in addition to moral beliefs--using empirical data ("science") about what the costs and benefits are.
But we don't live in societies ruled by scientists, as much as we would like. And it's not as if scientists are perfect either, they have their own shortcomings, both individually and as a group.
> Science is not a moral theory, and I'm not pretending it is, but it our most reliable source of empirical data.
Yes, so consider it a failure of communication that not everybody sees it that way. And it's up to the scientists to figure out better ways of communication. It's a sales job.
> Science never says "you should do X", so you don't have to worry about that. It only says "Best data available says that doing X will result in in Y with probability P".
Yes, but by the first press release that will already have been changed into 'you should do X or terrible thing Y will happen'.
And that's not even getting into those scientists who let themselves be harnessed into doing active wrong.
So scientists are not above doubt and would do well to remember that the vote of an anti-vaxxer counts for just as much as the vote of an MIT graduate and that the latter are likely in the minority. So you have to at least try to figure out a way to bridge the gap if you want the problem to be solved.
> I'm all for a pragmatic, effective approach to getting people to vaccinate, and I want one that balances people's rights. I also agreed that turning the issue into a culture war is counter-productive.
> At the same time, I want to get people to vaccinate, and while I won't hold them down and jab a needle in their arm to do it, I am in favor of doing what we can to effectively get them to vaccinate.
So, what would you do other than what we do today?
> Anecdote: I have a friend who got sick during the Ebola scare, and had recently been in [an Ebola-free country in] Africa, so the police came by and forced her to go to the hospital where they determined she didn't have Ebola and sent her a bill. Which she had to pay.
> I'd argue that forcing her to go to the hospital was reasonable (or would have been if it hadn't been predicated on the idea that "Africa" is one homogenous place full of Ebola), but that charging her for it was not.
Agreed on all counts.
> I think we as a society have the right to demand people with serious contagious diseases be quarantined and receive treatment, and that we as a society should pay for that.
Yes.
But vaccination against diseases that are endemic and that have far lower incidence rates, mortality and so on are a different thing than ebola, which has a quality all its own. Also, visiting a country with an elevated risk was a decision made of free will whereas being born is not.
> I assume that at least if she had Ebola, you'd agree with overriding her bodily autonomy for a forced quarantine.
I do.
> That's further on the freedom end of the "bodily autonomy vs. societal well-being" scale than I'm on, but still one that recognizes the trade-offs and makes a thoughtful, pragmatic balance rather than holding one goal, bodily-autonomy, as completely outweighing the other.
Yes. And it is also roughly where society is at these days.
> I don't actually know if you'd agree with the forced quarantine, but I'm making the assumption that, like most everybody, you agree that the trade-off is sometimes worthwhile.
I do.
> With vaccines you absolutely reasonably take the stance that requiring them is the wrong balance, but you seem to be arguing as if even evaluating the cost-benefit is wrong--at least judging by your initial post. "But your body is yours and yours alone and that's a good thing even if there are negative consequences for society."
In principle yes, I think that is a very high bar to cross and there should be an extremely carefully laid out argument if you want to cross that line. And we do have mechanisms for that if it is so required up to and including placing children in foster care if their parents do not take proper care of them.
But such a maneuver should always carry the signature of a judge.
> It's hard to draw a line about where the balance lies, and it feels more principled to say "value X always outweighs value Y", but very, very few people are willing to take the hard stance. Instead they take the hard stance where they've drawn the line, and pretend that's the non-arbitrary line, dismissing the reductio as "well, yes, in that example it's obvious".
It's never simple. But I'm comfortable with hard lines being drawn and judges being allowed to cross those lines at their discretion. That's enough of a safeguard for me.
> Are you willing to actually go with "bodily autonomy trumps societal consequences in every situation"?
Yes, unless a judge overrules that.
> Or are you striking a balance?
I think that's balanced enough because it allows evaluation on a case-by-case basis whilst erring on the side of caution and giving maximum power to the individual as long as they are capable of taking the responsibility for that power. Just like we are able to commit people to mental institutions against their will and without their consent but only after a very thorough look at the case.
> Because if you're striking a balance, the debate has to be about where the balance lies, not just "bodily autonomy uber alles".
No, but it's a good default.
> And that requires--in addition to moral beliefs--using empirical data ("science") about what the costs and benefits are.
Obviously, and the empirical data so far does not warrant a de-facto 'vaccinate or be relieved of your parental duties' regime. It may come to that but for now we don't have it and there are all kinds of options that should be maxed out first before we'd let it get that far.
It's funny, I wonder how the debate would go if the choice were a life ending injection because of the cost to society instead of a life-saving injection at the beginning to statistically expand your life-span.
I'm pretty sure a lot of the people arguing for vaccination would switch sides to 'bodily integrity' in an eye-blink.
Parent post said single payer encourages checkups.
You said "but there are still people that don't get checkups in Denmark".
Those two points are completely orthogonal. Single payer encourages checkups, yes. Still some people won't get them, yes.
Drop the sophistry.
Make of that what you want.
We detached this subthread from https://news.ycombinator.com/item?id=14120716 and marked it off-topic.