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Comment by rscho | Hacker News Reader

Yep, completely different system. Same attitude, though.

I really don't understand what you mean by 'culture' and 'attitude'; please explain.

For example: am Canadian, had to get stitches for a nerve-damaged lacerated finger. Doctor tried to prescribe me Oxy — which was absolutely ridiculous for such a small injury, so I refused it. I'm pretty certain that I'd be an opioid addict had I accepted that prescription, knowing myself.

Canadian healthcare is great, and dissimilar to American, in that it's treated as a public good.

Canadian healthcare is not great, and similar to American, in that a lot of prescription decisions are made from a similar cultural perspective as in the US, ie drugs are handed out like candy.

By culture and attitude, I do not mean the objective criteria defining the healthcare system. I mean how things go when you have a patient encounter. American patients are perceived as far more legally agressive and vindicative. True or not, this results in an overly defensive response from american MDs. Unfortunately, medicine has that in common with war that a dead patient is less problematic than an injured patient. Hence, the opiate crisis.

This is purely cultural. European patients and MDs are much less aggressive.

The USA is definitely very litigious, but I am not sure that Canada is similar. Cultural explanations are interesting, but they can be molded to explain almost anything. I could for instance say that US doctors are motivated to prevent overdoses, as their patients are a source of recurring revenue, whereas Canadian and European doctors and systems see their patients as cost centres.

Yes, of course my assertions are subjective and based upon personal experience. However, here is a very objective thing: you're a US doc and your patient is in pain. Very simple, you prescribe oxycodone and it solves the immediate problem. Then, your patient dies of overdose. But most of the time, you won't even be aware of the cause of death and simply archive the file. And, most important of all: _the patient did not overdose on your prescription, but on self-medication/street drugs_.

So in fact the difference is how MDs solve the immediate pain problem. In the US, they would try to suppress the pain (and legal threats with it). In Europe, they would try to make it bearable while keeping the patient functional, because they are not afraid of their patient.

Everyone benefits from a less tense relationship.

I understand that you think it's an incentive problem, and I agree that opiod issues are probably driven by incentive issues, but I am not sure we have the data to support your explanation. I also don't think most doctors keep track of patient fatalities at all, let alone the causes of death.

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