Do your best not to end up in a hospital without an advocate (friend, relative) watching out for you. They'll fail to treat you at best, then discharge you with a shrug and a huge bill; and they'll kill you with mistakes, at worst.
I am afraid all this technology is taking away all of our wisdom. Too easy to know things, very hard to understand them.
If anyone is interested, it seems it is partly (mostly?) caused by a Purine nucleoside phosphorylase deficiency. (PNP gene)
Doctors generally see 6 patients an hour, and have 5-7 minutes of paperwork per patient. The remaining 3 minutes gives enough time to diagnose the obvious, but not much else.
But I literally showed my doctor the cutaneous lupus in my ear and she said "Oh, some people just get gunk in their ears" and would not send me to a rheumatologist.
The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism.
It's why we have this.
United States – $316,000 Germany – $183,000 United Kingdom – $138,000 France – $98,000 Italy – $70,000 Spain – $57,000 Brazil – $47,000 Mexico – $12,000
This. This is the problem - not the vague spectre of "capitalism" being waved around.
Once capital gets power it uses a government to enforce that power.
We do not have anything close to socialized medicine.
In France for example you can walk into any doctor and they will see you.
Please stop blaming every problem on your ideological pet peeve. Society is too complex for every single issue to be caused by capitalism, financialisation, the patriarchy or systemic racism.
Veterinary care would be much closer to the model of a capitalistic solution.
The interviewee says that the Reagan administration tried to drive down the cost of health care by increasing (as opposed to, say, lifting) the quota on production of doctors, with the idea in mind that more supply of doctors would drive down costs. And he goes on to say that the idea backfired by raising medical costs.
In the interviewee's mind, the problem is that doctors can "make their own work" -- with more doctors around, more medical care can be performed than was possible with fewer doctors, and so the cost of health care went up instead of down, making the policy a mistake. That is the beginning and end of his analysis.
No one asks whether the cost of particular treatments went up or down. If total national spending on health care went up, the policy is supposed to have been a failure.
This remark seems somewhat lacking in rigor. I know bagging on capitalism is a common reflex, particularly in medicine, but something more is almost certainly going on.
The default thought process for a retailer is to move units. A lawyer wants to rack up billable hours. A subscription service wants more subscriptions.
So why would a specialist look for fewer cases? There is almost certainly a perverse incentive involved, because a competitive market would usually prompt a service provider to accept business and grow with demand.
However, failing to communicate to a patient that a diagnosis is provisional might serve to undermine their faith in the healthcare system leading to periods of fatigue wherein one doesn't have the self-efficacy to continue seeking care if things haven't improved even if quality of life is severely impacted.
From my limited understanding of the US healthcare system I'd imagine you don't want an excess of cases because each case
1. Is a responsibility, and thus a liability, and 2. every patient your staff needs to accommodate is draining (risk of overwork).
If that would apply to a country with socialized medicine I imagine that Item 1. receives significantly less consideration but that Item 2. is still very much considered. If a unit isn't a first-line care-provider they can in theory be a bit more guarded about who they receive, while first-line just has to bear whatever comes through the doors.
I feel as if I'm shifting to a different point of discussion but I still struggle not to mention the fact that a specialist may not be readily at hand depending on what city you are in.
The way it's supposed to work is that the general practitioner rules out a bunch of stuff, and then starts referring to specialists who can diagnose/treat the rare things.
In practice it's not quite perfect, but it's hard for me to think of a better way to deal with it.
You missed a whole bunch in that progression. You forgot the insurance companies for one thing.
And you are wrong about the diagnosis process for Lupus. My Primary Care gave me the worst test for diagnosis ANA levels for Lupus. It came up negative. Therefore, I could not see a rheumatologist even though I had documented (MRI) spinal arthritis, kidney problems, and all the other symptoms.
When I found out it was a bad test I demanded they did the correct one it came up positive. So you see, when they do not know what is going on, the give up. They do not dig deeper. The process is a failure for people with chronic illnesses.
The better way to deal with it is to have fewer specialist, get rid of insurance companies, and just have more doctors that can spend more time with their patients and learn more in the process. Primary care doctors need to know more and investigate more.
And the only reason specialists time is extremely valuable is because they make sure there are not a lot of them.
A full round of blood tests by a few specialist would’ve saved everyone involved a lot of money.
Wasn’t even a super rare thing. Just 2 somewhat common conditions. One of which is known for being dismissed as anxiety.
There's no magic doctor who would be a flawless diagnostician if he just had more time to spend with the patient and less interference by the insurance companies. And if he did spend hours and hours on your case, and run all the tests, that would be hours he's not spending helping other people and delays in other people's labwork.
Medicine is imperfect, and diagnosis is based in large part on probabilities. Doctors do what their education and experience tells the is most likely to help. Sometimes they are wrong, because people are different, and some doctors aren't as good as others. Sorry your chronic condition was misdiagnosed. It sucks. There's no magic answer.
A hard fight later I started treatment. Dramatic and immediate health improvement. Some of my doctors still refuse to believe I have condition. Process Took 3 years. The average time for diagnosis is 7 years. Had about 30 doctors during this time frame.
Not even a rare condition.
Consider that the AMA is a monopoly enshrined by the government, and their purpose is to limit the supply of doctors, which they do by limiting the seats in medical schools.
It's not capitalism.
See Competition & Monopoly in Medical Care by Frech.
https://www.amazon.com/Competition-Monopoly-Medical-Care-Fre...
Typically that's anti-capitalist: there are very strong government and regulatory limits on who can perform the services, and for self-serving reasons, they maintain shortages of supply. The free-market capitalist solution would be for prices to rise to a point where supply and demand are balanced, either by supply increasing (people switching fields), or reduced demand from prices rising.
Is there a limit to the amount of money you would pay to save your life? Is there a predatry loan you wouldn't take to pay for life-saving surgery for your child?
Has this ever been demonstrated to work in healthcare in the real world, outside free-market fantasy land?
BTW, no government is going to spend unlimited sums to save your life.
When did that happen? If you are thinking Obama care, uhm, no.
> BTW, no government is going to spend unlimited sums to save your life.
You are missing the point. Supply and demand curves break when it comes to life and death matters. That is why prices should not be dictated by a free market. Well, I guess that is fine if you are a sociopath.
Not all at once, but decision by decision. One big change was when the AMA was granted a monopoly over the education of doctors. Then there was when companies got around wage controls in WW2 by tying health insurance to employment. Then in the 1960s there was enormous expansion of the FDA, and then Medicare and Medicaid. Then there were laws that required emergency rooms to treat people for free.
All these measures sound great, but they completely mess with the structure of how markets work. And so we have the very expensive, and often dysfunctional, system today.
> That is why prices should not be dictated by a free market.
The free market doesn't dictate prices. Governments dictate prices, which always leads to shortages.
> I guess that is fine if you are a sociopath.
If you have a case, you should be able to make it without insults.
https://youtube.com/watch?v=3qpLVTbVHnU&t=34s
The people who tend to be the most ardent defenders of private medical care are usually the same people who have had the fewest reasons to actually depend on it. They're also the same people that declare the United States the greatest country in the world despite having never lived anywhere else but the lower 48.
There are, of course, problems with a system like this. "I would pay literally everything to not die, but can't find treatment" is just not one (assuming certain values of everything), because people will take your money. Problems are things like rich people getting better treatment (happens just about no matter what, but we'd rather pretend otherwise), and evaluating treatment performance as a customer/patient (a reason for most supply restrictions.)
No, that is socialism inside capitalism. Let me explain. I assume by "medical aid" you mean insurance, right? What is insurance? It is a bunch of people pooling their money so they can reduce risk and pay for each others health care.
Capice?
Either way, we're talking passed each other because we have different definitions.
You can get a rheumatologist TODAY if you're willing to pay (quite a bit) more (at least here in Uruguay). THAT is free-market capitalism.
If you don't have money, you'll have to wait 2-3 months (quite a lot less than what you're saying), and you'll have it for free (here). That's socialism.
In crony capitalism, you have the worst of both worlds...
[0] srsly if I'm understanding some recent hospital records correctly, they still mostly work by verbally dictating at subordinates who transcribe for them. And they spend most of that dictation simply reciting the patient's known condition. Compare with programming where the working set is openly displayed on the screen (modulo scrolling), and then our contribution is only that of making changes.
And then be billed 400-800$. Such an incredible system!
I also gave up going to physicians with a chronic illness. They're in and out in five minutes, and just ramble off the top two treatments from uptodate. If it's a surgeon, they'll try to sell you on surgery or a diagnostic procedure to "re-validate" the diagnosis (conveniently to generate a trivial 10K for the hospital in a few hours). If you want anything beyond that or to have a discussion, good luck.
I only go to doctors for injuries or other clear, specific problems.
Another anecdote, my sister worked at the front desk in some department ( she was an admin and not a nurse) and a patient coded but came back by themselves. Only afterwards did the nurses realize they were marked "do not resucicate" by mistake!
i do not trust hospitals at all.
They're looking to stabilize you and get you able to survive outside the hospital, not to solve a mystery.
Great place to go if you need it, though. Got internal bleeding? Get that taken care of. The risk of a debilitating or fatal hospital error isn't that high, so absolutely go when the risk of not going is high.
TV, though, has trained us to expect to get everything figured out and root causes solved too. Unfortunately, that's just not realistic even if many of the complaints in this thread were solved. There are a lot of nasty rare diseases and conditions, and strange manifestations of conditions, that will still be missed if they have 60 minutes with you instead of 8.
You should also realize that doctor quality varies as much as any other skill. SHOP AROUND. I've had better luck with second, third opinions than I have trying to pester an original doctor into changing their mind. There are doctors out there who appreciate it if you bring up a written self-history of the condition, the strange aspects or other things that may or may not be related, what has or hasn't worked so far, etc.
Most notably, he suggested we separate diagnosticians and prognosticators from practicians. The former do their best to guess what you have, send you to the right kind of practician, and estimate your possible outcomes (with probability distribution and Bayesian goodness and all). Then whatever practician you chose do their best to treat you.
Separating prognosis from practice allows us to have a system where prognosticators are rewarded for their accuracy and calibration, and practicians are rewarded for their outcomes relative to prognosis. Being good doesn't mean having better outcomes, being good means having better outcomes than predicted.
I'm not sure how well this system would work in practice, and there may be a huge problem with eliminating the short feedback loops we can have between diagnosis and practice when they're the same person. What should be a nice separation of concern may turn into a communication nightmare.
Nevertheless, it is possible that specialised diagnosticians may be better than any expert system.
Spent $500 for a pointless MRI.
I have some specific domain knowledge on my injury (very sport specific) but obviously have not spent 10+ years in school studying hand surgery.
But I did read and send AND tell/ask in my appoint real specifically relevant med publications saying the only way to see what I wanted was an ultra sound under stress.
My PT also said this. But not a 'real md.'
So I had to pay and sit through an uncomfortable MRI for nothing. And never got the ultrasound. Should have just said no thanks.