Medicine Follow The Money

Thanks for posting CJ. Some sad stories in that article.
Imagine men who are not educated about the disease, being diagnosed, not finding a place like HW, and being like i think most patients are, blindly following the diagnosing Doctors recommendations.

HitchHiker said...
*disclaimer* I have only read the first couple of posts - which if I'm interpreting correctly are essentially talking about the bias of money on healthcare decisions. Bias exists in every segment of our economy. The practice of medicine relies on the Hippocratic oath that doctors take, along with other processes to ensure bias is minimized, but it still happens. I just read this article earlier today on bias with IMRT in PCa treatment as an example:

www.bloomberg.com/news/articles/2012-11-06/prostate-patients-suffer-as-money-overwhelms-optimal-therapy

Food for thought to be sure.

Quite the article. Which is why I have always tried- as hard as it is to do as a patient- to watch for bias in this entire business, just like any other business. And that is whether listening to advice from various doctors about various treatments, or reading studies.

I think I have given this example before, so you may want to by pass it if you have already read it. But during my 45+ years of hospital work, including about 36 years giving anesthesia for surgery and OB, I saw a lot of questionable things. A whole lot. Probably never realized what I was seeing for the 1st 15 or 20 years, just whatever the doctors said must be right and I was there to help the patients by helping them. Even when I became convinced somethings were questionable(along with my co-workers) I was rarely in a position to do anything about it. And since I rarely knew all the facts regarding the patients the doctors brought to the OR, much was just suspicion on my part, couldn't really prove anything usually.

But one event stands out. A lady arrives in the OR for a breast biopsy. The MD anesthesiologist had pre-oped her and OK'ed her for anesthesia, so I went ahead with my assigned job. But she arrives in the OR wild, apparently with dementia. I get her to sleep and get her airway established, and the surgeon comes in and starts to work. After questioning him and studying the chart in more detail, we ascertain that the problem with her wild out of control behavior is metastasis to the brain, as well as all over her body. Her expected life span was very short, and I think she died within a month or two at most. Most of the room expressed surprise as to why he was putting her through this breast biopsy under general anesthesia when she was a terminal patient already diagnosed with widespread mets. How was it going to help her to confirm that the lumps in her breasts were indeed also cancer, just like she has cancer mets everywhere else including her brain? Even if she did also have breast tumors, what was he going to do about it at this stage? He became indignant at the questioning and said "I did it because the family insisted".

Well, no one really accepted that- though we had no way of knowing- and even if they did insist on this, he is the doctor and should explain why this was putting her through something very unlikely to ever help her. But for this guy(also a well known arrogant horses behind) it was just an opportunity to slip in one more case on his OR schedule, an send the resultant bill. After all, he did not become a surgeon to seek opportunities to cancel surgery. And he is not a rare example. Thank goodness I do know some good examples also.

If there is an opportunity- as in this article- to bill $40,000 to MC (and maybe not even have to be in the room with techs doing the work? The patient says he never even saw his doc there) you can rest assured that there are going to be folks who really want to do it, who will also think it is the greatest thing since sliced bread. Follow the money, though that is really hard to do as a patient.

Post Edited (BillyBob@388) : 2/15/2016 11:09:52 AM (GMT-7)

Hitch, exactly. A lot of it comes down, however, to us being incredibly "I" focused. By our insistence that everyone have immediate access to the 'latest' of everything in medicine, we drive the cost up with no proven improvement in either life span or quality of life.

In the PC world, the perfect example, to me, is proton beam radiation. The cost of installing the machine...and learning how to use it...is much, much higher than anything else out there. The treatment cost, where it's available, is also way up there. And, as far as I know, there is no real proven benefit of it over the more traditional external beam systems. And yet, everyone hopes that it is coming 'to a hospital near me'.

Same with the newest and 'best' drugs. Sure, some of them are great, and work wonders, for small numbers of patients.

Don't get me started on the 'we'll spend anything we have to in order to extend someone's life (hospital stay) for one extra day' attitude. For many of our physicians (and many of us, lets be honest), death is a defeat, it's a mark against the character and reputation of the physicians and a sign of failure. No, it's not. It's just part of life.

I will take our system over any system gov't run anyday. Maybe I am in the minority here, but being self-employed most of my life and having had to deal with gov't entities for licensing, payroll taxes, state county and town regulations, etc., it is just madness when dealing with them, esp. when they make the mistakes; which they do quite often. And their 'gatekeepers' really are the most frustrating to deal with, esp. when there are plenty of times when I know their regulations better then the person I am speaking to and I've learned to tread lightly as they can make the mess more complicated. I've had situations where I'd been penalized with interest wrongly, spent weeks or months to convince them and they would remove the penalty but still charge me interest on the penalty because no one knew how to remove it on the computer. I would just give up and pay it because I could not deal with the frustration anymore. Insane.

I know the insurance companies can be just as frustrating but I like that the good Drs can be rewarded financially and I can use my judgement to decide which Drs. are in it for the money alone. The insurance companies are the current gatekeepers(with the gov't calling the shots) and they too are making a mess of things(some family members are Drs. and the new regulations are destroying them), but money will never be out of the equation because quality healthcare is very expensive. I think Drs. need more input not less and think they ultimately have to decide on the care for each individual patient. No system will ever be perfect and there will be bad Drs in any system, but that is why it's up to the patient to educate himself. We can't always protect everyone from their own uneducated decisions.