johannbok

At the lower end of the market the printers are sold below-cost and the profit is in the ink. Above that, there's laser printers, which are far less prone to this.

Are we looking for someone to sell an ink-based printer that will cost more up front than its competitors, and then willingly forego the revenue that comes from market ink prices?

As a psychiatrist, I'm just going to tip my toe into this conversation:

I have not read the entire list. I read a good chunk of it. Almost everything on it is -not- stuff I see among my colleagues, and appears to be how psych stuff is presented /in popular media/ rather than in the profession. Which is fine if one targets this for the science media/science communication types, but it seems very odd to apparently have a target audience of psych professionals. So of course there's a list of 'inaccurate and misleading' terms - you can't simplify something without losing /something/ of its complexity, but it still needs to be communicated.

The other thing to point out is that some of their criticisms are just ... well, outsiders commenting on things they don't know about. It's a team of academic psychologists. Psych PhDs generally don't do frontline stuff - they do targeted 1-on-1 therapy, or group therapy, but they tend to parachute in and out, they're not doing the days-long care-and-feeding of these patients where some of the terminology they're criticizing comes from. For instance, they take issue with the use of splitting, but ... clearly don't work on the unit. Splitting isn't just about wanting to avoid the thoughts of your loved ones being flawed beings; it's about the emotional hyper-sensitivity of a BPD patient resulting in them condemning as awful anyone that is less than entirely positively oriented towards them, because they can't take any negative interaction (see paragraph 1 about "I'm oversimplifying shit to communicate to people outside my profession", so don't come at me to pick nits. I know it's simplified-into-wrongness.) The result is that when they a unit staffer enforces boundaries, they're instantly terrible; as opposed to that "other" staffer that didn't have to enforce boundaries with them, who is wonderful, can I talk to them now please instead of you, you awful monster? And so the psychodynamic 'splitting' leads very quickly into 'pitting staff against each other'. It's not a mis-use of the term, it's a specific manifestation of the term that you deal with on the unit. Which the authors would know, if they were frontline workers rather than consulting therapists.

And the section on pleonasms is just nit picking for the sake of nitpicking.

This article doesn't do anything in the way of making psychology nor psychiatry more precise. This article is a lot of nit picking, in ways that look valid externally but would have anyone familiar with these things wondering why this was worth writing.

And if you call to ask, the front desk secretary will have absolutely no clue how to route an out-of-the-ordinary request. If the doc you're calling doesn't already do the type of service you're looking for (e.g., a phone consultation), be absolutely firm about wanting to speak with the office manager.

The office manager may not be able to accommodate you, but if it can be done, they're the ones with the authority and autonomy to make it happen.

Generally, you have to ask doctors already in the know. You find the top academic medical center in your area, and you ask the relevant specialist there who the absolute top person in their field is for a second opinion.

It's not always a guaranteed correct answer - I know for a fact of some people at absolutely top ranked institutions, with top pedigrees, who clearly got there by academic skills and are absolute shit as clinicians - but for the most part, it'll get you where you need to go. Generally the only way you'll end up with one of those shiny pieces of shit is if referred to them strictly by reputation; no one that's worked with them would make that referral.

It's also an answer likely to overlook excellent clinicians - many (many!, maybe most) very good clinicians aren't academics, and this won't route you to them. But you're okay with overlooking excellent docs, as long as you end up at a top doc.

Finding excellent doctors without shiny pedigrees is not something a layman can do. It's just something that local docs eventually come to know about other docs in their social-professional network, and by no means is it an unbiased assessment.

If all you have available is people's online CVs, look strongly at people with mediocre or shitty medical schools and highly prestigious residencies and fellowships. Those are people who had networking and social signaling working actively against them, and managed to positively impress everyone they worked with. E.g., a buddy of mine got into a shit medical school, and got one of the country's most prestigious subspecialties in a prestigious institution. He had to impress every single person he worked with, had to do surpass everyone on his standardized exams, and otherwise be top-of-the-top in every way. He's a ridiculously top-notch doc.

Robert Spiera, currently director of vasculitis at the hospital for special surgery, still maintains a private practice in Manhattan. He's worth every second of the wait time, and every penny of his consultation fee. He is ridiculously good.

That's right, only there is no normal physician visit that bills $1300. The absolute highest reimbursement you're gonna get for an outpatient visit - a level 5 evaluation and management first-time patient visit plus double-coding an 'prolonged visit for high complexity care' (some handful of insurers allow triple-coding a G2212) - (a 99205 + G2212 x 2) is 244.99 + something like $30 (I don't recall the G2212 reimbursement off the top of my head, but it's in that ballpark), for a total of about $275. +/- some adjustment for geography.

That's not what patients pay - that's the total allowable reimbursement to the doc via medicare.

I use medicare numbers here because almost all private insurers negotiate as %medicare. If I'm a hot specialty people are willing to pick an insurance plan over (say, cardiology) and there's a shortage of my folks in the area, I might negotiate up to something like 110-120% of medicare. Most of the time I'll be happy to get 105% medicare, and some folks will end up getting something like 95% of medicare.

To hit $1300 there'd have to be:

-A procedure, likely an inpatient or facility service, such as a small outpatient surgery, or an infusion. - Your doc has an in-house blood work lab and your insurer doesn't cover it, and the bill is actually a lab work bill

That latter bit is a gray area - it's actually barred under the Stark Law, as clinical lab work is considered a Designated Health Service that's barred from self-referral, if it's a third-party lab that they own or co-own. If it's their own actual in-clinic lab, though, I'm unsure of how that works out (I don't run my own lab, so I just know of this second-hand).

If you have a private-information-redacted copy of a 'normal' bill for $1300, I'd be happy to eyeball it - either to let you know something is off and worth appealing, or to learn something new for my self.

Government regulations have been dragging back price of care for ages. Multi-month waiting lines to see a doctor are largely about price ceilings. If docs could price up, their waiting lists would go down commensurately.

Constrained physician supply doesn't do much when physicians can't raise prices in the face of greater demand.

People in these discussions always make things about physician costs. The majority of expenditures in the healthcare system are on drugs and equipment, followed by procedures - physician visits make up a tiny fraction of that.

This is partly true. In no small part because they tend to control the bulk (or all) of our patient supply. In part because people have gotten the idea that insurance equals care, and vice versa - so people tend not to think about high-impact moments where it pays to go cash.

For instance, I specialize in neuromodulation for highly-treatment-resistance psychiatry. I'm very good at what I do; my mentor is (IMO) better, and one of the absolute best in the country. A single consultation session with him is around $200 if he happens not to take your insurance. If you have a highly-treatment resistant condition, and are about to embark on a course of neuromodulation, it absolutely behooves you to go to him for a single session consultation to plan out your intervention before going to some local mediocre whatever to actually slap the equipment on your head and carry out the intervention.

For instance, people have incredibly debilitating autoimmune conditions. Rheumatic conditions are notable for their polymorphic presentations. It absolutely behooves you to go to an absolute top rheumatologist for one to three visits to confirm your diagnosis before going on a lifelong adventure of immune modulating drugs.

But folks hear "this guy doesn't take my insurance" and treat it as equivalent to "I can't get care there," even when they can afford it. I have a chronic condition, it's terrible, and my absolute world-famous specialist costs me about $250/yr - a small fraction of my monthly insurance premium. Less than my monthly prescription costs. Yet people will go to whatever specialist happens to be near them, while bearing all those other costs, and not investing in the linchpin.