A few more points on the subject I commented on on Friday. First, costs should be compared with the non-healthcare increases in costs (colloquially referred to as the “rate of inflation”). Only healthcare and education consistently proceed ahead of other costs. They have many things in common including heavy government subsidy and artisanal production system.
James Kwak point something else out. After showing a graph of nominal national healthcare expenditures he remarks:
That’s health care spending as a share of the economy, so we don’t have to worry about correcting for inflation (as we do with Kleinke’s graph). Do you think the trend is up or down?
I found several point made by Kwak uninspiring, but the notion that health costs are not a problem (made by the other guy) are preposterous.
As an aside, two more prominent and warming advocate scientists have quit the game. It appears the data manipulation and suppression has gone too far for them. In addition, some recent CERN data on the suns cosmic rays and the effects on cloud nucleation (which would reflect heat out) would explain the sometimes inverse relationship between solar activity and atmospheric temps. there is more work to be done on the robustness of nucleation, but at the very least it lays waste to notion that “the science is settled.”
Moving along, since I’ve got time on my hands today. I noted in the comments section on Foreign Policy blogging my recent “episode” and hospitalization. What struck me is how quickly costs were mounting, although I’m not competent to know whether or not certain diagnostics were warranted. Specifically, although my father was a doctor and I know how to give a doctor a quick, relevant and descriptive history the medical team pretty much made up their mind what was going to happen in the first 10 minutes including a CAT scan. Now perhaps a CAT was warranted to rule out that I had had or was having a stroke. but I wasn’t and I wonder if this isn’t a prime example of how costs unnecessarily mount.
Don’t knock negative diagnostics. By which I mean, don’t knock tests that rule things out. If my mother’s goddamned doctors had actually tried to confirm their diagnosis of a pinched nerve a few years back she wouldn’t be dead now. But they went the cheap “It’s probably just a pinched nerve” route, refused to run the tests that would have confirmed their diagnosis, and didn’t deviate from that course of action until it was too late.
Ice pick
It’s hard to comment without specifics but Janis was lamenting a lost two years scenario with a relative a couple weeks ago.
As I understand it physiscians these days are taught to adopt a protocol that sequentially knocks out the worst case scenarios and then work back to more likely causes There’s probably only one guy here with sufficient training and expertise to really opine on that – Steve. I don’t believe this was always the case.
My point is slightly different. They were not listening to the patient. They were running student body left, and that was that.
@Drew- Depending on your presentation, people tend to work off of protocols. These can vary some from institution to institution. The availability of diagnostics (shouldnt be such an issue with our fast CT scanners today) can also shift decision making. Protocols are supposed to keep you from missing the big, awful things while leading you to the correct diagnosis and treatment. (It’s a bit controversial since lots of docs feel like it is cookbook medicine, but the literature suggests that outcomes are usually better if people follow their protocols. IMO, there are plenty of patients who do not neatly fit into a defined group, so you still need to think about how to adjust and when to depart from guidelines.)
Steve
My point is slightly different. They were not listening to the patient. They were running student body left, and that was that.
Drew, they never listen to the patient. In over four years of seeing doctors for a variety of patients and a variety of causes, we got the doctors to listen to the patient all of two times. That’s it.
Student body left? You’re lucky the next shift didn’t come on and decide to do student body right, undoing everything the first group had done. This was fairly common too. At this point it looks like enough people are dead in my family that the docs aren’t going to have much work with us for a few years, knock wood.
Ultimately I would have been happy if the doctors had done three things.
First, follow through in the manner they told us they would follow through. Frequently the doctor would tell us one course of action would be followed, and it never happened despite repeated prodding and follow-up on our part. If you say you’re going to present to the tumor board on Wednesday, do it. Don’t tell me three weeks running you’ll do it at the very next meeting and then NEVER do it. Grrr.
Second, when doctors rotate into a case, find out WHY the patient is receiving the course of treatment they’re getting. When my wife almost died a couple of years ago one set of doctors would institute a course of treatment, then a second set would get involved and institute treatments that completely negated the first course of treatment. I only figured this stuff out later when going through notes, and when I had a chance to research treatments. (That was absolutely impossible at the time.) These weren’t cases of switching to another course of treatment when the first failed, these were cases of the doctors just seemingly being unaware what the hell the other guys were doing. When you’ve got eighteen doctors coming into your room, each with a different specialty and a different idea, it gets confusing. (The number ’18’ isn’t pulled out of thin air. Nor does it count all the consulting doctors or the doctors-in-training or any of the docs that never even saw the patient but from whom we later received bills….)
Third, and this is a big one, actually CONFIRM diagnoses. Saying “Well, I think this is something minor so even though you have a history of major problems I’m just going to go with my first guess” and then just hoping for the best doesn’t cut it. A CT scan in the spring of 2010 would have saved an awful lot of misery in my mother’s case, and would have prevented what ultimately proved to be lots of completely futile treatments.
” When you’ve got eighteen doctors coming into your room, each with a different specialty and a different idea, it gets confusing.”
FFS medicine makes it more unlikely that docs will spend time doing unpaid for stuff, like sitting down and talking with other docs. Too many times you need someone to be in charge, and it just does not happen. When we have taken over some smaller hospitals at the request of our network, one of the first things I do is go in and establish lines of communication for our group. I try to get everything to go through one specialty group. This often riles the PCPs, but I think it makes for better care.
Steve
My brother’s problems started when the primary care physician’s wife took up with the local NYT bestselling author. It was downhill from there.
Protocols had excluded lymphoma fairly early on in the case for some reason. Labs in Jackson and at Duke had come back inconclusive.
So he was put in the care of an infectious disease doctor who treated him first for histoplasmosis, then sarcoidosis (though there was nothing wrong with his lungs).
Clues like, ahem, two short stays in local hospitals where blood was infused and persistent nosebleeds confused people more rather than put them on the right track. I do believe that if the PCP hadn’t been struggling emotionally, he might have taken a different tack. He was (is?) is well-thought of overall.
When bro was finally admitted to a Jackson hospital after damn near falling apart, the infectious disease doctor took issue with is previous diagnoses and sent everything she could get her hands on to Mayo Clinic. There they diagnosed Hodgkins of the bone marrow.
He was something close to dead when he was admitted immediately after the diagnosis, and at one point I called on my brothers and sisters across the country to come say goodbye before they transferred him to hospice care.
Hematologist Martin Newcombe insisted that he could be treated. And he was. The whole business was a long wrenching slog that required three months in hospitals in Jackson, much of that on his back, which led to a bad bedsore, which many months later led to osteomyelitis with another 6-week stay in hospitals and further physical rehabilitation.
Not to forget the week stay for near-fatal hypercalcemia which took me two weeks to get somebody to take seriously.
So what was a $100,000 illness, if that much, morphed into something probably near a million. I have no idea. He is currently under the care of the VA hospital in Jackson. He is a Vietnam vet.
From what I understand, treatment of Hodgkins is a real medical triumph of our times.