Hacker News Reader

>That doctors are (rightfully) unable to pay proper attention to everyone and everything just due to the sheer number of patients they must see.

Why are we excusing this? This is an allocation and resource problem.

Frankly, I never understood why I need to schedule an appointment with a doctor and also visit a pharmacy to get drugs like anti-acids, allergy medicine, short doses of painkillers, antibiotics, short doses of anti-anxiety drugs, anti-depressants, etc. My doctor spends, what I imagine, most of his time on trivial issues and I sympathize with those who have non-trivial issues. It doesn't seem fair to them that they get the same 30 minutes I get for my minor issues.

I think society needs to ask itself if we need a full-fledged doctor for many of these tasks. The politics of healthcare are really ugly. Sorry, but a lot of this level 1 stuff could be done by a non-expert. I should be able to just buy these things. Or, at worst, pharmacists should be able to prescribe this stuff. The system as-is is designed to maximize labor, thus billable hours, for doctors. Its a mess when it comes to actually providing care.

I understand there's potential for abuse here but I kinda don't care. In my society you have the freedom to stuff your face with Big Macs 3x a day, smoke, become an alcoholic, and soon smoke pot all day. Those all have major risks and are completely legal and mainstream. Yet when I want to heal myself, suddenly the regulators, rent-seekers, and moralists come out of the woodwork.

Devil's advocate: one man's cure is another's demise. The vast majority of people know how to regulate their consumption of those not-so-bad things, but regulating their consumption of healing technology without understanding the potential downsides is what the powers at be are concerned about.

But I generally agree with you, it is an allocation problem, and the best way to allocate resources is removing arbitrary barriers to trade and promoting specialization. We're overly concerned about what might kill us and hardly concerned about improving the overall quality of our lives. The latter makes the former easier to deal with, but the need to feel safe and taken care of trumps freedom, I guess.

I've had stomach trouble my whole life. It was a Big Deal for my uninsured parents to get me Zantac. It involved a script from a specialist and paying out the inflated cost at the pharmacy. This was done for my safety, afterall, the industry and doctors were worried about risk, right? I'm just a dumb patient. What could I know compared to the experts, right?

Zantac can now be gotten OTC for next to nothing. Its completely safe. There was no patient risk for this drug. Same when I had to ask a doctor for Claritin. It also is safe as an OTC drug now. Meanwhile, we have research that shows that even a slight overdose of acetaminophen can seriously damage your liver.

The whole system is about maximizing profits for healthcare. It has very little to do with outcomes or patient safety. This is why so many people aren't getting the care they need. The industry is too busy creating "make work" for profits.

I share your concerns with the US medical system. It is a bunch of busy, reasonably bright people caught up in an insane circus. It on average produces adequate care, but you shouldn't expect much more. Having an active and informed advocate can make an enormous difference.

On the other hand, I agree that more data isn't necessarily better. There are plenty of examples. E.g.:

http://www.bloomberg.com/news/2012-05-21/prostate-cancer-tes...

If you do early prostate screening, you get worse medical outcomes than when you don't screen. Or consider whole-body scans:

http://www.radiologyinfo.org/en/news/newdetarget.cfm?ID=5

They will detect a lot of stuff that doesn't matter, but proving that it doesn't matter will be expensive and possibly harmful.

You see a similar phenomenon in investing. As Fooled by Randomness explains well, for most people the best strategy is to set your investments and look at them very rarely. If you watch the investment news all day and trade actively, you may not do better, you could easily do worse, and you'll certainly be much more stressed. But still, there is an endless supply of day-traders.

Brazilian here (and surprised to see they used Brazilian research software in a top HN story!). Couple years ago, my wife had a mass on her throat that turned out to be thyroid-related but (thankfully) benign.

I had the EXACT same feeling as you, and feel we're copying the US in only the wrong aspects. "A bunch of busy, reasonably bright people caught up in an insane circus" sums it up better than I could. I'll digress here and vent about another aspect of it, but I liked your links about too much data, thanks.

Not sure how it is in the US, but what is strange for me here is that it's not only about cutting-edge tech, even old stuff (Email? Messaging of any kind? Hell, phone calls!) is not really used by our hospitals and doctors.

Here, if you do any type of imaging exams, y'll have to wait a few days for the results, get them on the lab - physically -, schedule another doctor appointment, wait an hour or so in the waiting room just so your doctor can take a look at the images and tell you, basically: "Ok, you're fine", or "Hmm, I need these other exams to be sure. Here, take this piece of paper where I describe what I need and get it done".

Seriously, we use instant messages delivered to phones all around the world simultaneously to share pictures of ourselves, of our cats, dogs and dinners, just for a giggle. And we can't do it to save lives!

You probably don't want sensitive medical information in unsafe messaging systems.

Yeah, I thought about that too, but I'm pretty sure that there are lots of cases where you don't care.

In our case, I know we would both EASILY take that trade off. Sending her imaging exams via, well, whatever really, on the same day, and get SOME answer. Instead of waiting anxiously for days and then hours at a hospital waiting room, stressed out and missing work.

Yeah, I'd take that any day for most things.

My wife is Brazilian and she actually prefers that way of getting lab results (get it yourself) to the American way: Results are sent directly to the doctor, to encourage you to schedule and pay for another doctor's visit to have the results read to you by a nurse.

In her opinion it was a violation of patient rights when we were unable to retrieve some lab results directly from the lab. In order to do that we would have to file some paperwork with the lab company and get the results mailed to us in 3-4 weeks.

Historically I have fallen into the "don't do unnecessary tests" camp, but I would be willing to consider an alternative viewpoint. Perhaps what is needed is continuous monitoring of biochemical data from volunteers longitudinally to help us understand if any of that data is actionable in a way that reduces suffering or prolongs life. I think the right sensors have not yet been invented for this purpose, but they are probably getting close.

You're not alone. I agree with you and a very wealthy friend of mine who owns his own company bought an MRI machine for his employees and had it installed in the building he owns.

paradoxically there is also a risk involved with false positive diagnosis (be it unnecessary procedures, CT scans, surgeries, anxiety etc.) Also the detection window can be small from detectable to symptomatic for (especially) aggressive tumors. An example is the very difficult discussion on general population mamma carcinoma (breast cancer) or colon cancer screenings.

However being well informed and questioning everything is the very best way to be a patient.

Wait, does he actually run a medical firm that is licensed to use the MRI machine, or did he just buy one outright? I was told that people couldn't just buy one, you had to represent some kind of medical entity to be able to purchase one.

Did they give a reason?

I can't think of really bad stuff to do with it (except very locally to my own building, and it's not like those are very mobile), and except maybe impersonate a medical entity and rip people off.