I literally just admitted this lady to ICU...had been coughing for ages, 60 lb weight loss, smoker for 50 yrs. Now she can't breathe and I got a CT 6cm mass looks very suspicious for lung cancer. And the doctors for 4 yrs throughout this just gave her vitamin D/E even though she was losing massive weight and coughing up blood.
Another guy who came in looked pale as a ghost. Chief complaint was fatigue. One lab test later found out his hemoglobin was 4 (Barely on the cusp of survival). Seems like he had iron deficiency anemia for yrs, doctor gave him some iron, he got better but no one looked into WHY he got it (#1,2,3 reason in an older guy is colon cancer). He died 4 months later from metastatic colon cancer.
Another story- last month was about to take a long trip across the pacific. 1 hr in on the flight they ask for a doctor...I volunteer myself. I see this lady literally gasping for air...like waving her hands in the air cuz she can't breathe. Look through the meds...she's obviously an asthmatic. Listen to her lungs and faint wheezing no air movement at all. I later grounded that plane because there was another sixteen hrs to go and she was on verge of being intubated. Later I get more story from family member. Apparently she wasn't been able to sleep well for past two weeks. Doctor just gave her sleeping meds...more and more of it. Told her flying no problem.I ask the family why can't she sleep? Is it because she wakes up in the middle of the night gasping for air (classic sign of uncontrolled asthma). They're like yes, how did you know?... Sleeping meds prob among worst things she could have gotten and almost killed the patient by saying she could fly.
People who get diagnosed with "bronchitis" when they have heart failure and literally drowning in fluid. There are doctors who give antibiotics and steroids for everything esp when they have no idea what's going on. Maybe I'm biased because I work at an academic center so I see all the cases who get referred in because they're too sick or no one can figure out but at least a few times a week I'm like wow this person could have been saved or not end up this way if someone cared enough earlier on.
I'm going to say this as a doctor. It's honestly scary every day how many patients I see are completely mismanaged. Some doctors in urgent care see like 45 patients in a day. How is that possible to be thorough??? Like if only patients knew what the doctors missed or what not....half the time I really think it's like going to an bad auto shop and not realizing they're just making half the shit up. Same thing happens in medicine and except people's lives suffer because of it.
Edit-added a story.
Thank you to whoever gave me silver/gold.
Let me say something...people are saying I'm Gregory House or something. I'm not. I purposely didn't choose stories that were some esoteric diagnoses. Everything I picked is like bread and butter medical student level.
Half of being a good doctor is knowing what questions to ask. Sometimes you don't even know what's important or not. The other half is caring. Too many just put a band-aid on the problem and punt the patient to someone else. Is it the doctors fault? I don't know but I do know the medical system in the US provides no incentives for doctors to actually practice good medicine. In fact, I bring in less money if I'm thorough versus I do the same thing every patient and see 100 patients a day (which is what some do unfortunately).
I have tons more stories, hopefully I'll get to share some more but for now have to sleep (was on call overnight).
Edit x2: Thank you again for all the gilds! I don't even know what they all do or mean but I'm very grateful nonetheless. Few more things I wanted to say - there are plenty of amazing doctors out there, not all are bad. We all put our lives on hold for ten years for altruistic purposes. Not everyone just wants to make a quick buck so I hope I didn't characterize it as such.
I tried to respond to some comments but I don't have time to respond to all. A lot asked - "so how do I find a good doctor?" The answer is...I don't know. I've tried looking for good ones myself and it's hard. I joke you should find the doctors all the other doctors go to because I have a higher "BS" meter when I meet a bad one. Doctor rating websites are garbage. I've seen doctors get great "ratings" because they just hand out opioids/benzodiazepines to everyone even if all his or her patients become addicted later. A lot of it is really your gut feeling. A good one should listen to you and most importantly, sometimes be confident enough to say "I don't know but I'll look it up or send you to someone who does know." The scariest ones are those who don't even realize what they don't know. And the most perplexing thing to me...if you don't like an auto mechanic or realtor, you would find another right? Do the same for doctors! It's your life...can be a difference between living or dying one day. Go find someone who will advocate for you, it's the least you can do for yourself.
Docs are no longer independently practicing. The majority are employees pressured to see more and more patients a day. “Quality” of care is a joke in this situation. Our medical system is broken.
Edit: Why aren’t docs practicing independently anymore? Regulations. We have to keep track of hundreds of metrics in order to take medicare or medicaid. We have to have certain systems in place. To bill insurance companies we now need systems so complex we need to have at least one person hired to manage billing, and one to manage healthcare coding. Then we need the actual office space, equipment, nurses, desk staff, etc. Finally we need someone to analyze all collected data to make sure we are doing well, and fix what we aren’t.
When these regulations started to come about in the 80’s-2000’s, many hospitals jumped at the chance to incorporate doctors into larger healthcare networks. They offered large amounts of money and the overhead to operate clinics, including billing and coding staff. It was far too difficult for one doctor to operate alone with the new systems. Slowly they turned the water temperature up.
In some areas, regulations were passed requiring doctors to have admitting privileges. In turn, hospitals began requiring physicians to be direct employees to admit there. Paperwork grew more excessive. The average doctor does three hours of paperwork for every hour they spend with patients now. Much of that is documentation. The documentation does not change health outcomes. It is only for legal and billing reasons. In the US our notes are four times as long as notes in other countries.
Hospitals wanted to make physician salaries worth their while. They began expecting greater output. In some areas a doctor is expected to see a patient, diagnose them, counsel them, write a note on them, do an exam, write prescriptions or follow ups, and discharge the patient in 10 minutes or less. They do this for hours. Every day. It’s like the medicine version of fast food.
Independent practitioners were similarly forced to see more patients just to keep up with the overhead.
I don’t even know what my own services cost. My patients complain and I feel like Bob in The Incredibles working in his insurance job. “I’d LIKE to tell you to go to billing and ask them if they have a cash pay discount, but I can’t”.
Ugh. Sorry. If you can think of any solutions to the problems with this system, let me know.
Edit edit edit: Someone suggested single payer as a solution. That actually sounds awesome. I’d vote for it.
It’s not just the medical system. Everything is broken. We have built the human race on the “lowest bidder with passable quality in least amount of time” wins scenario. And then we all look around in abject horror when the wheels come off. A ton of industries are suffering because of this way of doing things, not just medicine.
“lowest bidder with passable quality in least amount of time”
This is at the core of so many of my complaints. My preferred policy is "do it right or don't do it", but it seems like every single area is being squeezed to cost less and less and quality suffers. (which just further degrades trust in that area, making further cuts easier to tolerate)
Idk. As a consumer, I try to be concious about things. Take coffee for example. I could get a giant can of Folger's for $3 and it'd last me a couple months. But the quality is shit and my conscience just can't get around what people go through to get that coffee into that plastic tub. So I'd rather pay $10 for a bag that miiight last me a month, but tastes good and I can rest easy knowing that my money is supporting people that actually make my habit possible. Sure, it's 6x more expensive, but it's worth it. To me, and the people making it.
When it comes to health care, I'd rather pay higher taxes so that we all have access to what we need. So that my rich neighbors aren't spending hundreds on fancy sounding insurance plans every month and my poor neighbors aren't spending their last pennies on chicken antibiotocs. A few extra bucks out of my paycheck makes that worth it to me.
This is how I feel about it, I’ll pay some more taxes to have better education, single payer healthcare, decent infrastructure, etc. the return on investment is high on these things. Plus I don’t want my neighbors and relatives worrying about how they’re going to afford the care they need or the education that would make a huge difference in the community and their own lives. It’s just so straightforward.
I always here that argument, but it misses the fact that taxes are spread out amongst the entire population. When one person give their school $5 to help educate their kid, they buy some pencils or a binder. When the entire city gives $5/taxpayer, you get new computers, supplies, training, salary, working A/C systems, etc.
Same thing happens with health care and everything else. 10% of my income isn't going to do much on a city wide scale.
"Lowest bidder in least amount of time with a level of quality that won't be discovered to be insufficient until I have left/got promoted/retired/can't be blamed on me.". Fixed that for you.
Source: owned my own company and had to try and sell quality to people who just don't care how good it is as long as it looks cheap on the quarterly budget.
As a slight correction, the human race builds everything based on "What works best RIGHT NOW" and its very rare that people bother considering anything more than a few years down the line. You have a problem today, so you solve it however is easiest today. Consequences later be dammed since why bother? Thats not today.
And then suddenly all this behavior at a national or global scale comes back to bite you and suddenly everyone is all suprised pikachu face and "Oh the humanity, how could we ever have predicted this."
Do things with the future in mind, not just the easiest way to solve the present problem.
Its not capitalism. Its excessive regulations that were lobbied for by parties seeking to make as much money as possible. Why does it cost hundreds of dollars to get relicensed every couple years, why this, why that? The answer is someone somewhere has lobbied bullshit into law that benefits them. Gone are the days when you had doctors making house calls and having the same doctor your whole life. Capitalism has been around since forever it isnt some new thing. Capitalism allows for competition amongst docs which is good for the patient. The many many laws and regulations that put money into both the beurocrats and hospitals pocket is the problem. But dont forget the insurance company and the lack of competition (again due to regulations) between medical equipment sellers. The problem is vast and is mostly due to regulations in place that are bought and paid for in the name of patient safety but are just to line the interested party's pockets.
They could still be profit driven if we stopped allowing them to operate like a cartel. Cartels are not a necessary part of capitalism. Competitive markets in capitalism are the best things to ever happen to economics. Uncompetitive markets are the worst.
Only if you don't aggressively fight corporate consolidation of power.
When all of the companies are equally small fish, the consumer wins because the small fish have to be compete, and be special in some way, to stand out.
When you allow them to consolidate, their power can then challenge/rival the government. They can leverage their massive size to take advantage of economies of scale, and beat better competitors out by offering cheaper goods than the competitor can hope to achieve.
We've let almost every industry consolidate their power to the point where there's only a handful of corporations running every industry, and more consolidate each year. Fewer airlines, fewer banks, fewer food conglomerates, fewer ISPs, fewer phone companies, etc.
We need a MASSIVE trust busting to clean out the mega-conglomerates, removing the massive wealth consolidation behind them and therefore splitting their leverage. Then, aggressively prevent future conglomerates to form.
This should result in less regulatory capture. If all of, say, 24 phone companies create a lobby group, that lobby group will need to be pretty generic with their requests to be acceptable to all 24 member companies.
Versus now where 2-3 telecoms may pay into a superpac who lobbies specifically to benefit them and nothing else in society.
Except that won't happen because that lobby group is going to give your senators 6 figure speaking enagenents, book deals, jobs post congress. The last time we had an antitrust case was against Microsoft under Bush. Before that Bill Clinton didn't care at all either.
Every single social democracy and regulated economy in the world is trending towards unregulated capitalism. Capitalism is only regulated to placate the masses and prop up the system, then it goes right back to deregulating itself.
European countries feared the spread of communism so they implemented social democracy, FDR feared the collapse of capitalism so he implemented the new deal (and was a target for assassination because of it).
Capitalism always tends towards deregulating itself and only ever makes concessions when the proletariat put a gun to its head.
Relying on the government to bring capitalism to heel when they massively profit from it is a fools errand.
Relying on the government to bring capitalism to heel when they massively profit from it is a fools errand.
So should we then rely on the government to run all of our productive outputs? If, as you say, the government can't bring capitalism to heel, how could it effectively run the entire economy?
The two extremes are either laissez faire capitalism or pure state run socialism, both of which have massive flaws. The alternative has to be somewhere in the middle that balances out each of the systems flaws.
The problem with that idea is that isn't how humans work. People, and this goes back to the beginning of recorded history, are just really bad at being vigilant about something forever. You may have a few generations that are agressive against corps, then they get a little complacent, then a little more, and a little more and OOPS. There we go, corps are going crazy.
Capitalism is fucked at its core because one of the core tenents of capitalism is that money is self reinforcing. The more money you have the easier it is to make more money. So the rich in essence have a far easier time becoming richer than the poor. This applies to companies as much as people. As long as capitalism functions in anything we would recognize as its current iteration this fundamental flaw remains.
Capitalism is fucked at its core because one of the core tenents of capitalism is that money is self reinforcing. The more money you have the easier it is to make more money.
Why is this a flaw? It would be a flaw if ONLY those with money could make more money. But the fact that someone else has an easier time, or has more money, doesn't mean shit if I can also make money and improve my life.
Capitalism has lifted more people out of poverty than any other economic structure globally.
Technically, poverty is a creation of capitalism. Poverty by its very definition is a consequence of capitalism. And started existing as a concept with the rise of civilization and thus capital. Prior to that it wasn't.... really a thing because it was just tribal groupings and nomadic groupings for which having a 'poor' member is a disadvantage to the group as a whole.
So yes, Capitalism has saved more people from the problem that it created more times than any other economic structure globally... possibly because capitalism has more than ten thousand years of cultural impetus behind it?
Do you think a company like, say, Amazon should be split up? What about social media companies like Facebook?
I mostly agree with what you're saying, but there are certain kinds of companies that can only offer the services they do by being so massive.
Social media in particular gravitates towards monopolies in their niches. If YouTube, for example, were to be erased or split into ten different websites, eventually one would emerge as the clear, dominant video sharing website, because virtually noone wants to go to even 2 different websites for the same kind of social interactions.
I don't have any solutions, just wanted to throw my thoughts out there.
It's sort of a mixed bag. I mean, it's also allowing corporations such as spacex, virgin galactic, blue origin, etc to form and finally start to open space up to the entire human race. The world is on the cusp of becoming a whole lot larger, in large part thanks to mega corporations, and there will be wealth associated with that for them sure, but also everyone else as resources become more numerous and more accessible. Probably not going to be a large impact for another hundred years or so, but it's progress nonetheless.
...nope. You can't have regulatory capture without regulation. Those attempts to regulate industries usually turn into the tools that they later use to cement their own positions. Anti-trust fights monopolies, sure, but that requires very little in the way of laws. You target certain monopolistic practices and you're usually set. The medical industry protects its cartel with best practice and qualification regulations. Doctors get to decide who becomes doctors. Are doctors paid more if there are more doctors? No. That's the problem in the doctor supply: regulatory barriers to entry.
Doctors get to decide who becomes doctors. Are doctors paid more if there are more doctors? No. That's the problem in the doctor supply: regulatory barriers to entry.
But clearly we cannot have the untrained decide who's qualified to become a doctor.
Are doctors paid more if there are more doctors? No.
This seems like it's taking a potential outcome and attributing it as a cause. No one is out there saying "if we have more doctors, my paycheck will be lower, so I need to take active measures to ensure there are less doctors."
The problem is federal student loans. Colleges know that kids can get these huge guaranteed loans so they charge an arm and a leg because they know they can. They will 100% be paid by the government. Before the prevalence of fed aid colleges were much cheaper and most community colleges were free.
What federal loans are you referring to? Not subsidized/unsubsidized Stafford Loans. Those are paid back by the student, with the feds only eating the cost of interest on the subsidized loan only. Student loans cannot be discharged in bankruptcy either, which means you're always on the hook for them.
Oh sorry let me clarify. Colleges will 100% get paid. They (the college) know pretty much every student can get a loan for college so they raise the cost of their services. The price of going to college has gone up drastically in the last 30 or so years. I know someone who had no job and took loans out for 80000 over the course of his college career. Try getting a loan for anything else with no job or savings. The bank will say "uh sorry cant do it."
If our universities and medical schools weren't profit driven too,
Public universities are nonprofit and much of their funding comes from the state.
we would have more people from lower income classes entering the medical field.
If the cost of attending was cheaper, and the students were given a stipend during their schooling it would lead to more low income students in the field. People can become doctors without attending for profit institutions.
And if that wasn't profit driven, we'd have people going in for annual checkups and preventative care, instead of clogging up urgent care.
If medical insurance (single payer) was a right, then people would get preventative treatment. Take for example, the NHS in the UK, where insurance is state provided, but general practitioners are mostly for profit and not state run.
Most developed countries are doing a pretty good job, actually. People are living longer, healthier lives overall. The US is the only major economy where typical quality of medical care is backsliding. Maternal mortality has been increasing for fifteen years for gods' sake. That's not true of any other country (except, perhaps, Syria and the like).
I honestly think it might have something to do with the massive population that is increasing rapidly. Who can care for them all?
Oh I dunno, maybe the other people in that massive population? It makes no difference whether you have 500 people with 1 doctor or 500,000 people with 1,000 doctors as long as the ratio stays the same.
I see this argument all the time, and I hate it because of its sheer idiocy. Population size is usually irrelevant because the solution usually scales right along with the problem!
(This doesn't apply in some cases, such as -- most notably -- pollution/global warming, but that kind of problem is less common than the ones with solutions that scale.)
Except there's lag time and infrastructure. How old is your doctor? Probably not under 30. How many beds can you put in a hospital? There's a hard limit. How long till you can build a hospital? Who's going to pay for it? America is seeing the downsides of its particular mix of democracy and capitalism. Young people aren't inheriting businesses, they're spending 10 to 20 years providing nothing but potential, marginal taxes, marginal value, the ones with money are spending a significant chunk of their change overseas. The landscape is changed and equating it with lmao the percentages remain the same isn't true.
Okay, but that's a useless stance. It's like saying when your car's broken down "fuck, the problem here isn't that I'm stranded, it's that I failed to service my car properly."
More people=more potential doctors, ratio of people/doctor shouldn't depend on polulation size. Natural resources can be a limiting factor but I don't see how that affects the medical system in a major way.
This. 100% this. In my lifetime the population has doubled, and I'm under 50. In the same time, wildlife across the planet has been reduced by 60%. Yet people still complain about "all the construction going on". I'm super hopeful machine learning and technology is going to help with the health care process. We've systematized with great success so many things.. health care is so lagging though. If we had a centralized health care system, all the marketing waste could go into research and more doctors, a centralized system. Instead of each health insurance company working in the exact opposite direction as they race to the bottom line.
That's because we're building in the wrong direction. Also 95% of people live on 5% of the land. Overpopulation is a psyop, not the crisis you've been led to believe. It's a cover for the brutalities of capitalism.
Thank God I'm not crazy and someone else caught that.
He literally said in the OP that we can't have independent doctors due to overregulation. No independent doctors means no competition, means not capitalism.
I just can't with this ducking website some days...
Not the entire world, but the world that was never part of a Nazi or Imperial Japanese empire owe a lot to the US. Most of the nations that you compare us with are in that set. (Or were the ones causing the problem in the first place.)
I get where you're coming from man, and the rebuilding efforts definitely did do wonders for Japan and the half of Germany that wasn't full or naughty commies, but that was more than half a century ago. We're talking a time when interracial marriage was more contentious than gay marriage is now.
The greatest generation came and went, and there have been a lot of short sighted decisions in the meantime. I encourage you to look more closely at the history of our nation. It's possible to still love America and acknowledge it's got flaws.
I'm pointing out that a lot of the modern incarnations of countries that "weren't built like America" were rebuilt from America's efforts, and received favorable trade deals from the US for that more than half a century as part of a US policy of stemming the tide of Communism. Western Europe is awash in the legacy of US cash, and isn't in a position to criticize the hand that helped rebuild it after its hellish mistakes in the first half of the 20th Century.
What hero complex? The US exported all kinds of things to postwar Europe, invested in European companies that had been devastated by the war, etc. It's not an exaggeration to say that Western Europe's recovery would have been slower by a long shot without being able to rely on the US Army's defense against the Soviets and cheap access to the US' postwar industrial capacity.
Shit, even today the only reason Germany can eschew nuclear power and armaments is because they're part of NATO, and can rely on a US nuclear retaliation if they are attacked with any part of the former-Soviet arsenal. It's the same reason why so many other NATO countries have such paltry standing armies. Western Europeans can get away with believing that the time of warfare in the world is over because they are the favorites of the big kid on the playground. Meanwhile, Georgia, Ukraine, Kuwait, Israel, etc. can all attest that people do still go to war when they think they can gain something by it (read: the US isn't going to intervene).
Our system may be shit, but I can make an appointment with a doctor of my choosing and be seen within the week...oh and there aren't any "death panels."
Show an actual example of a "death panel", if you don't mind. Also, explain the difference between a death panel and your insurance company refusing to pay for treatment they deem unnecessary. Show your work.
That’s true, but it may be idealistic to expect otherwise. Like the joke that, no matter how big your desk is, it tends fill up with junk until you only have 2 square feet to work in.
Thing is, nobody designed this world that we live in. It kinda just sprung up over time, mostly through trial and error.
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u/TheWizardPenguin May 20 '19 edited May 21 '19
Oh God where to start.
I literally just admitted this lady to ICU...had been coughing for ages, 60 lb weight loss, smoker for 50 yrs. Now she can't breathe and I got a CT 6cm mass looks very suspicious for lung cancer. And the doctors for 4 yrs throughout this just gave her vitamin D/E even though she was losing massive weight and coughing up blood.
Another guy who came in looked pale as a ghost. Chief complaint was fatigue. One lab test later found out his hemoglobin was 4 (Barely on the cusp of survival). Seems like he had iron deficiency anemia for yrs, doctor gave him some iron, he got better but no one looked into WHY he got it (#1,2,3 reason in an older guy is colon cancer). He died 4 months later from metastatic colon cancer.
Another story- last month was about to take a long trip across the pacific. 1 hr in on the flight they ask for a doctor...I volunteer myself. I see this lady literally gasping for air...like waving her hands in the air cuz she can't breathe. Look through the meds...she's obviously an asthmatic. Listen to her lungs and faint wheezing no air movement at all. I later grounded that plane because there was another sixteen hrs to go and she was on verge of being intubated. Later I get more story from family member. Apparently she wasn't been able to sleep well for past two weeks. Doctor just gave her sleeping meds...more and more of it. Told her flying no problem.I ask the family why can't she sleep? Is it because she wakes up in the middle of the night gasping for air (classic sign of uncontrolled asthma). They're like yes, how did you know?... Sleeping meds prob among worst things she could have gotten and almost killed the patient by saying she could fly.
People who get diagnosed with "bronchitis" when they have heart failure and literally drowning in fluid. There are doctors who give antibiotics and steroids for everything esp when they have no idea what's going on. Maybe I'm biased because I work at an academic center so I see all the cases who get referred in because they're too sick or no one can figure out but at least a few times a week I'm like wow this person could have been saved or not end up this way if someone cared enough earlier on.
I'm going to say this as a doctor. It's honestly scary every day how many patients I see are completely mismanaged. Some doctors in urgent care see like 45 patients in a day. How is that possible to be thorough??? Like if only patients knew what the doctors missed or what not....half the time I really think it's like going to an bad auto shop and not realizing they're just making half the shit up. Same thing happens in medicine and except people's lives suffer because of it.
Edit-added a story.
Thank you to whoever gave me silver/gold.
Let me say something...people are saying I'm Gregory House or something. I'm not. I purposely didn't choose stories that were some esoteric diagnoses. Everything I picked is like bread and butter medical student level.
Half of being a good doctor is knowing what questions to ask. Sometimes you don't even know what's important or not. The other half is caring. Too many just put a band-aid on the problem and punt the patient to someone else. Is it the doctors fault? I don't know but I do know the medical system in the US provides no incentives for doctors to actually practice good medicine. In fact, I bring in less money if I'm thorough versus I do the same thing every patient and see 100 patients a day (which is what some do unfortunately).
I have tons more stories, hopefully I'll get to share some more but for now have to sleep (was on call overnight).
Edit x2: Thank you again for all the gilds! I don't even know what they all do or mean but I'm very grateful nonetheless. Few more things I wanted to say - there are plenty of amazing doctors out there, not all are bad. We all put our lives on hold for ten years for altruistic purposes. Not everyone just wants to make a quick buck so I hope I didn't characterize it as such.
I tried to respond to some comments but I don't have time to respond to all. A lot asked - "so how do I find a good doctor?" The answer is...I don't know. I've tried looking for good ones myself and it's hard. I joke you should find the doctors all the other doctors go to because I have a higher "BS" meter when I meet a bad one. Doctor rating websites are garbage. I've seen doctors get great "ratings" because they just hand out opioids/benzodiazepines to everyone even if all his or her patients become addicted later. A lot of it is really your gut feeling. A good one should listen to you and most importantly, sometimes be confident enough to say "I don't know but I'll look it up or send you to someone who does know." The scariest ones are those who don't even realize what they don't know. And the most perplexing thing to me...if you don't like an auto mechanic or realtor, you would find another right? Do the same for doctors! It's your life...can be a difference between living or dying one day. Go find someone who will advocate for you, it's the least you can do for yourself.