People have stopped going to the doctor and most seem fine(nytimes.com)
nytimes.com
People have stopped going to the doctor and most seem fine
https://www.nytimes.com/2020/06/22/opinion/coronavirus-reopen-hospitals.html
75 comments
In my mind, the missed cancers could be a problem.
But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5% "here's the same drug, with an adjust dose".
Those appointments should only occur if there's an issue that requires new dosing or a change of medication. The rest of the time, it should be either completely automatic, or at most a simple phone call. I assume this doesn't happen, either because it's a CYA maneuver by the physician, or because the physician wants to bill for the appointment.
But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5% "here's the same drug, with an adjust dose".
Those appointments should only occur if there's an issue that requires new dosing or a change of medication. The rest of the time, it should be either completely automatic, or at most a simple phone call. I assume this doesn't happen, either because it's a CYA maneuver by the physician, or because the physician wants to bill for the appointment.
But you cannot trust patients, and as a doctor you have to do the due diligence; if the patient's health changes (e.g. weight, blood pressure, adjustment to the medication) they may need to adjust the dosage. That 5% can save lives. Prescription medication should not be fucked with.
> Those appointments should only occur if there's an issue that requires new dosing or a change of medication.
But isn’t that a little bit of Monday morning quarter backing? In other words how does a doctor know if a therapy/Rx needs to be modified for a chronic condition without a doctor visit and in many cases blood work?
In fact a 6 month therapy for a chronic condition would suggest The doctor has extreme confidence in the patient to adhere to their therapies...statistically about 1M hospitalizations occur in the US per year (Coating billions) because of lack of medication adherence (and these are only those cases resulting in hospitalization), how many more simply result in a sicker patient without a hospitalization event?
But isn’t that a little bit of Monday morning quarter backing? In other words how does a doctor know if a therapy/Rx needs to be modified for a chronic condition without a doctor visit and in many cases blood work?
In fact a 6 month therapy for a chronic condition would suggest The doctor has extreme confidence in the patient to adhere to their therapies...statistically about 1M hospitalizations occur in the US per year (Coating billions) because of lack of medication adherence (and these are only those cases resulting in hospitalization), how many more simply result in a sicker patient without a hospitalization event?
Things like asthma inhalers don't normally require bloodwork. Just a quick Q&A, which could be done less expensively over the phone, if it's even really necessary. Or, annually instead of bi-annually.
Even in the case of asthma, I think a doctor would hopefully not treat it like cookie cutter Health care. Surely there are standards and best practices, but then there is also the actual practice of medicine.
Standards might suggest 1 year is fine, but he Generally a doctor might want to see young (Kids) and old patients more often than a otherwise healthy adult, perhaps the doctor has reason to belief seasonal allergies/pollen may be effecting patients more in a given year, and (not to give doctors to much credit)again the idea the doctor has concerns with a given patient’s track record of adherence Issues and/or medication related hospitalizations.
Standards might suggest 1 year is fine, but he Generally a doctor might want to see young (Kids) and old patients more often than a otherwise healthy adult, perhaps the doctor has reason to belief seasonal allergies/pollen may be effecting patients more in a given year, and (not to give doctors to much credit)again the idea the doctor has concerns with a given patient’s track record of adherence Issues and/or medication related hospitalizations.
I'm an asthma patient in Germany. I visit my lung doctor twice a year for checkups, but the checkups are performed by a nurse. My doctor then briefly looks at the data collected by the nurse and decides whether she wants to talk to me in her office, which happens about once every two years. If that's not the case, I just get my usual roundup of refills and everything is said and done in about 30 minutes.
If all the doctor does is say "here's another dose", then something is wrong, for sure. My experience in needing occasional prescriptions for asthma inhalers (not in the US) has been that the doctor gave me a quick but thorough check up every time to ensure that my condition was not worsening. That's the reasoning behind it. Whether it's a valid reason or not, I don't make a claim either way. But I don't think this level of cynisism that says the doctors only do it for a paycheck is fair or warranted.
A less cynical analysis would be that there is a risk of changed conditions that it is good that the doctor notices.
I recently started paying for Direct Primary Care. We signed up as seeing a doctor during COVID became even more difficult than usual. It’s definitely a luxury but I pay $100 a month and my wife and I can bug our respective doctors (she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients) whenever we want. Obviously we try not to bug them all the time and be respectful, but I’m seeing weird spots at 7pm; text my doctor he says don’t worry about it. I’m kind of a hypochondriac — this saves me a trip to the ER. I say I’m pretty sure I have a sinus infection, and the symptoms are similar to one I had last year. He wrote me a prescription for antibiotics, tells me to let him know if it doesn’t clear up.
It feels how I’d expect modern medicine to feel, rather than everything being set up to gatekeep me from interacting with the doctor in any way except for fifteen minutes after paying $150 for the pleasure. The doctor has an incentive to keep us healthy because we’re not paying by the visit anymore.
I love love the direct primary care approach and wish I’d started paying for it sooner.
It feels how I’d expect modern medicine to feel, rather than everything being set up to gatekeep me from interacting with the doctor in any way except for fifteen minutes after paying $150 for the pleasure. The doctor has an incentive to keep us healthy because we’re not paying by the visit anymore.
I love love the direct primary care approach and wish I’d started paying for it sooner.
You really shouldn't take antibiotics unless they are really needed... microbes get more resistant to them
Effectively you're paying $100 a month to be treated for hypochondria?
Along with potential overprescription of antibiotics, which is a bad thing for the individual and a bad thing for community health. Mayo Clinic says "Acute sinusitis usually doesn't require any treatment beyond symptomatic relief".
> she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients
Is that legal?
Is that legal?
> Is that legal?
IIRC, gynecologists aren't even allowed to treat men, even though they're most qualified to treat certain diseases/problems that males can have (just far more rarely than women). I don't remember the specifics, though.
IIRC, gynecologists aren't even allowed to treat men, even though they're most qualified to treat certain diseases/problems that males can have (just far more rarely than women). I don't remember the specifics, though.
Is this true? It seems like a decision that was in effect for less than three months only in the US back in 2013 and it was quickly reversed. Has this been reinstated since?
https://www.cbc.ca/radio/whitecoat/why-can-t-gynaecologists-...
https://www.cbc.ca/radio/whitecoat/why-can-t-gynaecologists-...
Perhaps due to religion or culture, the doctor is allowed especially in primary care?
In the UK my follow ups( every 8 to 10 weeks) for a kidney transplant are done over the phone now - its just the bloods I have to go into the hospital for.
Its a real pity Theranos has tainted the testing with small amounts of blood area for the next decade.
Its a real pity Theranos has tainted the testing with small amounts of blood area for the next decade.
I agree the longer term studies are going to be fascinating.
Anecdotally, in Australia (where I work/practice and have many colleagues completing their specialist training currently) presentations for chest pain and total heart attack presentations are down significantly. No studies yet. Will be interesting to see if we will see deferred cases present later and with greater morbidity or just what the hell is going on, but my incoming assumption would have been that heart attacks would be something that someone is going to present with anyway.
As an example of how COVID has changed our approach in hospital, telehealth clinics are now replacing many outpatient visits (your other commenter below hits on the wastefulness of this). 10 years of IT change came to healthcare in about 2 weeks. It’s been wild.
It’s also caused us to get much more efficient with referrals. My colleague is a Plastics resident and had to trim his 500 patient referral list into must see and defer piles. He trimmed it to 100 by ensuring that, for instance, skin cancer referrals had tissue diagnoses before coming into clinic to be booked for surgery (something that the GPs should have done anyway) - so everyone is being forced to polish up their referral pathways and pull their weight along the healthcare chain, rather than what I often witness which is everyone just picking up slack wherever it lands.
Will be interesting to see how far this holds as life returns to normal here
Anecdotally, in Australia (where I work/practice and have many colleagues completing their specialist training currently) presentations for chest pain and total heart attack presentations are down significantly. No studies yet. Will be interesting to see if we will see deferred cases present later and with greater morbidity or just what the hell is going on, but my incoming assumption would have been that heart attacks would be something that someone is going to present with anyway.
As an example of how COVID has changed our approach in hospital, telehealth clinics are now replacing many outpatient visits (your other commenter below hits on the wastefulness of this). 10 years of IT change came to healthcare in about 2 weeks. It’s been wild.
It’s also caused us to get much more efficient with referrals. My colleague is a Plastics resident and had to trim his 500 patient referral list into must see and defer piles. He trimmed it to 100 by ensuring that, for instance, skin cancer referrals had tissue diagnoses before coming into clinic to be booked for surgery (something that the GPs should have done anyway) - so everyone is being forced to polish up their referral pathways and pull their weight along the healthcare chain, rather than what I often witness which is everyone just picking up slack wherever it lands.
Will be interesting to see how far this holds as life returns to normal here
This whole crisis has seen constant articles that, at least on the clickbait level which actually influences our discourse, present reasoning like "we didn't notice anything bad (yet)" -> "maybe nothing's ever bad again!"
This is like a cruel joke...its like saying if you are not diagnosed with a disease you don't have it.
All anyone need to look at is the incidences of people getting a chronic condition as soon become medicare eligible. Its like magic people are healthy, then they receive Medicare and they get chronic conditions...no they had the chronic condition they just weren't diagnosed and treated until Medicare eligible.
Medicare Patient Chronic Condition Statistics:
Over one half of beneficiaries less than 65 years had two or more chronic conditions compared to: Sixty-three percent of those 65-74 years, • Seventy-eight percent of those 75-84 years and, • Eighty-three percent of beneficiaries 85 years and older.
If people were covered and had access to care then the incidences would dramatically go down, instead we all but ensure by the time they hit Medicare and the taxpayers pick up the bills they have multiple expensive chronic conditions that have gone undiagnosed and untreated for years.
All anyone need to look at is the incidences of people getting a chronic condition as soon become medicare eligible. Its like magic people are healthy, then they receive Medicare and they get chronic conditions...no they had the chronic condition they just weren't diagnosed and treated until Medicare eligible.
Medicare Patient Chronic Condition Statistics:
Over one half of beneficiaries less than 65 years had two or more chronic conditions compared to: Sixty-three percent of those 65-74 years, • Seventy-eight percent of those 75-84 years and, • Eighty-three percent of beneficiaries 85 years and older.
If people were covered and had access to care then the incidences would dramatically go down, instead we all but ensure by the time they hit Medicare and the taxpayers pick up the bills they have multiple expensive chronic conditions that have gone undiagnosed and untreated for years.
> .its like saying if you are not diagnosed with a disease you don't have it.
But most "seem fine" :-)
But most "seem fine" :-)
There is an (admittedly controversial) idea within the medical community of Specialist induced demand. I have heard it quoted to me that studies have shown that when a medical specialist moves into an area that they then generate more demand for related procedures. Personally I am not in the medical profession but am wondering if anyone more knowledgeable can speak to this. Specially what percentage of procedures could be considered in this category or is this just ridiculous?
As a personal example, I received a nose surgery once that opened my nasal area so I could breathe better but it only lasted a few months and after that it seems to have reverted so it appears to be an unnecessary procedure at the end of the day. I have just decided to live with the difficulty as the recovery was awful.
Potentially relevant link: http://www.mit.edu/~erinmj/files/PID.pdf
As a personal example, I received a nose surgery once that opened my nasal area so I could breathe better but it only lasted a few months and after that it seems to have reverted so it appears to be an unnecessary procedure at the end of the day. I have just decided to live with the difficulty as the recovery was awful.
Potentially relevant link: http://www.mit.edu/~erinmj/files/PID.pdf
> In a recent survey, only one in 10 respondents said their or a family member’s health had worsened as a result of delayed care during the pandemic.
That's 30 million people. And in a fantasy world where going to the doctor in America was cheap and easy, I imagine most people would be happy to go regularly if they knew there was a 10% chance it would make them healthier.
Also, how are people answering this survey? One of the main points of going to a doctor is to detect problems or risky behavior that you don't know about. You cannot replace going to the doctor with answering the single question self-assessment "Has my health worsened?"
That's 30 million people. And in a fantasy world where going to the doctor in America was cheap and easy, I imagine most people would be happy to go regularly if they knew there was a 10% chance it would make them healthier.
Also, how are people answering this survey? One of the main points of going to a doctor is to detect problems or risky behavior that you don't know about. You cannot replace going to the doctor with answering the single question self-assessment "Has my health worsened?"
If the average family size is three, then to account for the "or a family member's health" would mean something on the order of 10 million Americans adversely affected.
That's true. But again, how could people know? My parents are not going to mention some minor health problem on the phone with me, especially if they can't go to the doctor to confirm there's something wrong.
And younger people's health is going to be generally better right now just because they're not getting colds all the time.
Yeah, like we had few colds/flus in the past year or two for our large-ish family, but now it's gone to zero for the past 4 months which is... impressive.
So does that mean when things come back on that we can expect a flurry of illnesses going around?
So does that mean when things come back on that we can expect a flurry of illnesses going around?
If I could get antibiotics for strep or sinus infections without going to them, I'd pretty much never go. Those visits are really dumb because I already know what's wrong, and just need them to say "yep, it's the thing you already knew it was, here's a prescription and a bill for doing nothing useful"
... actually on reflection already knowing what's wrong and just needing a doctor to say it so treatment can proceed is the norm for interaction with doctors generally among friends and family. Including having to gently walk the doctor to the correct diagnosis so they don't waste a bunch of time and get you in for more visits and tests than you need.
... actually on reflection already knowing what's wrong and just needing a doctor to say it so treatment can proceed is the norm for interaction with doctors generally among friends and family. Including having to gently walk the doctor to the correct diagnosis so they don't waste a bunch of time and get you in for more visits and tests than you need.
The fact that you used antibiotics as the example makes me very uneasy on this.
Antibiotics are almost certainly over-prescribed, and humanity is ultimately going to lose them as a result. It's good to make absolutely sure that you need them.
Antibiotics are almost certainly over-prescribed, and humanity is ultimately going to lose them as a result. It's good to make absolutely sure that you need them.
By the time I get them for those things I'm usually sitting at about 4 hours of sleep over the last 48-72(!) hours and unable to eat or (sometimes) even keep water down, so yeah, I need 'em. I wait that long so my body has a change to fight it off without resorting to antibiotics, which sometimes does work. Though also to avoid spending two and a half hours being sick and miserable in the car, at the doctor's office, in the car again, at the pharmacy, then in the car again, rather than at home resting, until I just cannot avoid it.
Actually, the medical system has probably on net contributed to antibiotic abuse. Yes, if antibiotics were OTC, people would use them more.
However for decades, doctors have universally instructed patients that they must finish the prescribed course. Even if the symptoms abate, patients are instructed to keep taking the dosage until done.
However this maxim was never supported by evidence[1]. Careful studies show that this approach leads to worse outcomes, because the patient's more likely to develop resistance on subsequent infections. And on average it leads to people taking two to three times more antibiotics than if they followed the intuitive approach of stopping when they feel better.
[1] https://www.nhs.uk/news/medication/questions-over-advice-to-...
However for decades, doctors have universally instructed patients that they must finish the prescribed course. Even if the symptoms abate, patients are instructed to keep taking the dosage until done.
However this maxim was never supported by evidence[1]. Careful studies show that this approach leads to worse outcomes, because the patient's more likely to develop resistance on subsequent infections. And on average it leads to people taking two to three times more antibiotics than if they followed the intuitive approach of stopping when they feel better.
[1] https://www.nhs.uk/news/medication/questions-over-advice-to-...
Genuine and slightly off-topic question out of curiousity: how often do you have strep, a sinus infection (that doesn't go away on its own), or some other condition that requires treatment with antibiotics?
I think I've needed a course of antibiotics perhaps twice in the past ten or fifteen years (can't remember exactly; not often anyway), and one of them was in an exceptional situation.
That leads me to somewhat doubt most (generally healthy) people would manage to get infections requiring antibiotics so often that it would lead to the large (now temporarily reduced) total number of doctor's visits that the article brings up. Or if they do, then people are getting infections that require medical treatment way more often than I imagine. (That's also possible, since I live in a northern climate that doesn't really promote infections most of the time.)
I think I've needed a course of antibiotics perhaps twice in the past ten or fifteen years (can't remember exactly; not often anyway), and one of them was in an exceptional situation.
That leads me to somewhat doubt most (generally healthy) people would manage to get infections requiring antibiotics so often that it would lead to the large (now temporarily reduced) total number of doctor's visits that the article brings up. Or if they do, then people are getting infections that require medical treatment way more often than I imagine. (That's also possible, since I live in a northern climate that doesn't really promote infections most of the time.)
Ages 0-22: zero times, basically never sick, never had strep or a sinus infection even once. Maybe, maybe had very mild cases of the flu once or twice when very young but then never got it again in that age range, despite never bothering with the vaccine or taking any precautions whatsoever. I'd get my "annual sniffles" when I felt slightly off and had a slightly runny nose for about 36 hours. That's as sick as I got.
After that, once a year in a good year, twice in a bad one, and I get the flu every other year or so, even with the vaccine. If I get the flu it also gives me a sinus infection more often than not. Nose slightly stuffy 100% of the time, now. Almost all my strep and sinus infections trend toward landing me in the ER, on saline, if I don't get antibiotics—rarely do they just go away. Haven't made it quite that far yet but I've been damn close.
All I can figure is HGH is a hell of a drug. I was also super-fit (looking, plus solidly healthy-range BP) until about the end of that age range, despite eating ~2x my on-paper "maintenance" calories of pure garbage food every day. Go figure. I eat much less and much better now, am fatter, and get sick sometimes rather than never getting sick. Getting old sucks.
After that, once a year in a good year, twice in a bad one, and I get the flu every other year or so, even with the vaccine. If I get the flu it also gives me a sinus infection more often than not. Nose slightly stuffy 100% of the time, now. Almost all my strep and sinus infections trend toward landing me in the ER, on saline, if I don't get antibiotics—rarely do they just go away. Haven't made it quite that far yet but I've been damn close.
All I can figure is HGH is a hell of a drug. I was also super-fit (looking, plus solidly healthy-range BP) until about the end of that age range, despite eating ~2x my on-paper "maintenance" calories of pure garbage food every day. Go figure. I eat much less and much better now, am fatter, and get sick sometimes rather than never getting sick. Getting old sucks.
I see. I'm sorry you've seen such a drastic change.
I'm 37 now and went for years in my 20's without needing to visit a doctor more than a couple of times in total. I can see some of the changes that come with age but for me they're mostly related to slower physical recovery after exercise and some general wear on knees etc. Common colds might also make me feel somewhat worse than they would have 10 or 15 years ago, but I almost never develop any complications that would require anything else than time, and the change has been gradual enough to make it difficult to judge.
I'm 37 now and went for years in my 20's without needing to visit a doctor more than a couple of times in total. I can see some of the changes that come with age but for me they're mostly related to slower physical recovery after exercise and some general wear on knees etc. Common colds might also make me feel somewhat worse than they would have 10 or 15 years ago, but I almost never develop any complications that would require anything else than time, and the change has been gradual enough to make it difficult to judge.
Whilst I can’t speak for your particular circumstances and will assume you know exactly what is wrong with you and what you need, this assumption cannot be applied more broadly.
In many respects the family practitioner’s role as gatekeeper to further medical care is anachronistic; perhaps we will be able to solve this with better technology. Until then, it provides a important centre for coordination of care and the prevention of unnecessary care (however imperfect this is at present)
As someone who rarely goes to the doctor (unless it's very serious) and when he does, does extensive "internet research" of his symptoms beforehand to come in knowledgable, I agree that for me, GPs gatekeeping medicine is unnecessary.
BUUUUT, I have a family friend who is basically a hypochondriac. She goes to the doctor ridiculously frequently, and is always trying to convince them (and everyone else who will listen) that she has all these undiagnosed medical conditions that she needs constant treatment for. Usually she's just sent home, where she does more and more "internet research" to find even more things that must be wrong with her. And it's not substance addiction: She's not going in there seeking abusable medication. She just wants validation that she has all these terrible conditions that she's dreamt up, and someone to finally tell her she's right. So, I guess at the end of the day we do need the gatekeepers, as anachronistic as they seem.
BUUUUT, I have a family friend who is basically a hypochondriac. She goes to the doctor ridiculously frequently, and is always trying to convince them (and everyone else who will listen) that she has all these undiagnosed medical conditions that she needs constant treatment for. Usually she's just sent home, where she does more and more "internet research" to find even more things that must be wrong with her. And it's not substance addiction: She's not going in there seeking abusable medication. She just wants validation that she has all these terrible conditions that she's dreamt up, and someone to finally tell her she's right. So, I guess at the end of the day we do need the gatekeepers, as anachronistic as they seem.
Counterpoint: What if she's not faking it? There's conditions like endometriosis that are horribly underdiagnosed and often dismissed as IBS; the average diagnosis takes seven years. Recently a 40-some year old died after being dismissed for years; her abdomen was riddled with endo tissue and adhesions, likely killing her in the end.
There is no easy way to solve the problem of mis- or un-diagnosis, except better training, better awareness and hopefully better diagnostic techniques
Counterexample from recent personal experience: I developed pain in my hand which made it difficult to type. Some googling revealed that my set of symptoms could be caused by 3 rather different underlying causes requiring very different treatments. Failing to treat the correct underlying cause could permanently damage my ability to use my hand, and thus my ability to earn a living.
I _needed_ to go to a physician for a preliminary assessment and then needed to get an X-ray, and have the X-ray interpreted by a professional, to know how to proceed.
Unless you somehow have built a medical lab in your basement with instruments and reagents to do bloodwork, take X-rays, etc., doctor visits are occasionally absolutely needed.
I _needed_ to go to a physician for a preliminary assessment and then needed to get an X-ray, and have the X-ray interpreted by a professional, to know how to proceed.
Unless you somehow have built a medical lab in your basement with instruments and reagents to do bloodwork, take X-rays, etc., doctor visits are occasionally absolutely needed.
And what are the odds you will encounter that situation again in the next 10 years? In the same time period, what are the odds you'll need a prescription for antibiotics for a common disease?
No one is saying you should stop seeing doctors entirely, but several things that currently require a doctor's appointment probably shouldn't.
No one is saying you should stop seeing doctors entirely, but several things that currently require a doctor's appointment probably shouldn't.
Anecdotally I have required antibiotics once the last 30 or 35 years so I doubt I would need it any time soon and if I need it I do not think I would be able to self diagnose reliably. Maybe I am an extreme outlier but I do not think taking antibiotics is common among my friends and family either, other than a friend who has chronic ear issues.
Personally I think antibiotics is one of the cases where having a gatekeeper is the most important since we must fight antibiotics resistance.
Personally I think antibiotics is one of the cases where having a gatekeeper is the most important since we must fight antibiotics resistance.
Based on past experience, I expect to encounter a situation requiring expert medical attention every 5 years, and a situation requiring only a common antibiotic prescription every 1-2 years.
The doctor can check for problems with similar symptoms. The simple act of looking up your nose and into your throat tells a lot.
Simply thinking "I hurt, like I hurt the last time I got strep" isn't a diagnosis. Its witchcraft essentially.
Simply thinking "I hurt, like I hurt the last time I got strep" isn't a diagnosis. Its witchcraft essentially.
>sinus infections
I previously had sinus infections all the time. I also took allergy pills every day. Now I don't.
I discovered 'sinus rinsing', you get a sinus rinse bottle (such as name brand NeilMed), a cup of distilled water, an appropriate amount of sea-salt, and microwave for x seconds (30-40).
This solves mold induced migraines, stuffy sinus from tree and grass allergy, and headaches from breathing pollution.
If you rolled around in grass and had itchy skin - you would shower and wash. Contrasted with breathing tree pollen all day - then taking a pharmaceutical anti-histamine.
I previously had sinus infections all the time. I also took allergy pills every day. Now I don't.
I discovered 'sinus rinsing', you get a sinus rinse bottle (such as name brand NeilMed), a cup of distilled water, an appropriate amount of sea-salt, and microwave for x seconds (30-40).
This solves mold induced migraines, stuffy sinus from tree and grass allergy, and headaches from breathing pollution.
If you rolled around in grass and had itchy skin - you would shower and wash. Contrasted with breathing tree pollen all day - then taking a pharmaceutical anti-histamine.
If people could get antibiotics on demand, the antibiotics would stop working a lot sooner...
Mind you, penicillin is cheap and widespread enough that we could probably hand that out.
Mind you, penicillin is cheap and widespread enough that we could probably hand that out.
We could, but we shouldn't because there's already too much superbacteria that are resistant to penicillin. Antibiotics should NEVER be handed out.
GP's really should go away. We need specialists and technicians to perform tests when necessary.
Medical training for everyone but surgeons should not take more than 5 total years including undergrad. Arbitrary number, but it should be significantly less time than it takes now.
Technicians who can be trained on specific technologies (x-ray, ultrasound, etc) should be able to handle most cases.
Medical treatment in the US today is a horribly inefficient hybrid of old and new.
Medical training for everyone but surgeons should not take more than 5 total years including undergrad. Arbitrary number, but it should be significantly less time than it takes now.
Technicians who can be trained on specific technologies (x-ray, ultrasound, etc) should be able to handle most cases.
Medical treatment in the US today is a horribly inefficient hybrid of old and new.
This is the role that physician's assistants (PAs) and nurse practitioners (NPs) fill at most large family practices in the US. I haven't seen an actual MD for a physical or sore throat in many years. And my communication with the practice is with a PA. Same for my wife, who has an in-house clinic at her employer (not in the medical field, just a perk).
> Most
Isn't the primary point of going to the doctor "anomaly detection" i.e. this thing is bothering me, will it go away on its own or do I need to do more? Most being fine is expected, doesn't mean losing doctors visits was not a big deal. I've heard lot of speculation that we've lost months of early cancer detections due to the lockdown for example. Future date statistical analysis will confirm the long term cost of sacrificing thousands of doctor visits.
Isn't the primary point of going to the doctor "anomaly detection" i.e. this thing is bothering me, will it go away on its own or do I need to do more? Most being fine is expected, doesn't mean losing doctors visits was not a big deal. I've heard lot of speculation that we've lost months of early cancer detections due to the lockdown for example. Future date statistical analysis will confirm the long term cost of sacrificing thousands of doctor visits.
“Only” 1 in 10 respondents said their health had worsened due to delayed treatment? That seems really high to me! There’s a very obvious ulterior motive we could ascribe to papers publishing anti-healthcare pieces.
e: and note this is only people whose health WORSENED. People like me who have a condition which has stayed the same, but have not been able to receive further tests and treatment, are not accounted for in that figure.
e: and note this is only people whose health WORSENED. People like me who have a condition which has stayed the same, but have not been able to receive further tests and treatment, are not accounted for in that figure.
The quote is "only one in 10 respondents said their health or a family member’s health had worsened as a result of delayed care". You may still think this is high, but it's not "1 in 10" when accounting for family size.
The postponed dentist visits will have their fallout (!) eventually. Delayed annual visits to check for skin cancer, colon cancer etc will statistically hurt us. Mammograms put off, should have a definite downside in terms of early detection.
Heck, even delaying car maintenance will cost folks hard cash later. The bill will definitely come due, for the slowdown.
Heck, even delaying car maintenance will cost folks hard cash later. The bill will definitely come due, for the slowdown.
Sometimes being too cautious can cause harm too. It's not so clear cut as you might think. For instance, pushing mammograms earlier in life causes over diagnosis (around 20% in one study), leading to invasive surgeries that were not actually required, and they're not without risk. It can be pretty intense having a cancer scare, too.
So if we spend more money on these and we do them more often yet they don't actually improve mortality, is it worth it? There's a trade up there which your doctor should be making.
So if we spend more money on these and we do them more often yet they don't actually improve mortality, is it worth it? There's a trade up there which your doctor should be making.
Hm. 'Getting scared' vs 'missing a cancer and dying'. There's a disparity in the cost of those two false results. I know which side I'm on.
22% unnecessary surgeries following mammograms[1] is not just 'getting scared' these are invasive surgeries with real risks. Are you strawmanning my point or just being hyperbolic? Again, I ask, hoping for a less flippant answer; if we spend money, time, effort on increasing mammograms that doesn't actually improve overall mortality and has it's own risks, should we still do it?
I'm not saying this because I think we should never investigate or search for cancer, I'm just stating that it's not as clear as 'mammogram always good'. We must weigh the risks with the benefits and we cannot just ignore the harm because we're scared of the possibility of death.
[1] https://www.bmj.com/content/348/bmj.g366
I'm not saying this because I think we should never investigate or search for cancer, I'm just stating that it's not as clear as 'mammogram always good'. We must weigh the risks with the benefits and we cannot just ignore the harm because we're scared of the possibility of death.
[1] https://www.bmj.com/content/348/bmj.g366
That seems exaggerated - the 'unnecessary surgeries' are biopsies, right? Hardly a life-threatening procedure. That sounds hyperbolic too?
This 20-year-old study shows that mammograms are matched by excellent screening programs in Canada. Is that the choice being made today? The screening programs in Canada were discontinued. Is the real choice now between mammograms and nothing? I didn't understand that development at all.
In the last 10 years, there's been a decrease in mortality by 25% or better. That's the good news today. And its all attributed to early detection. Clearly the most important factor in survival.
I think 20-year-old data is not the greatest basis for an informed choice on this subject. E.g. MRIs became common after that study was over. The world has changed, a lot, since then.
This 20-year-old study shows that mammograms are matched by excellent screening programs in Canada. Is that the choice being made today? The screening programs in Canada were discontinued. Is the real choice now between mammograms and nothing? I didn't understand that development at all.
In the last 10 years, there's been a decrease in mortality by 25% or better. That's the good news today. And its all attributed to early detection. Clearly the most important factor in survival.
I think 20-year-old data is not the greatest basis for an informed choice on this subject. E.g. MRIs became common after that study was over. The world has changed, a lot, since then.
It was published in Feburary 2014.
I'm not intentionally trying to sound hyperbolic. Are you? They are literally classified as invasive procedures. It is by definition unnecessary. There are going to be false-positives in these screenings and these false-positives can be harmful. Early detection + cancer = good. Early detection + no cancer = bad. So we must balance these two. I agree detecting cancer early is a good thing, but that's not what I was saying.
What's the deal, do you think there's no false positives, do you think over detection has no harms?
If you want something more recent, here's one published February 2020:
"...A further contributor is overdiagnosis, or the diagnosis of cancer in people who would never have experienced symptoms or harm had the cancer remained undetected and untreated. Overdiagnosis of certain screen‐detected cancers is common including 20–50% of prostate cancer and 11–19% of breast cancer diagnoses.
Cancer can also be overdiagnosed outside screening programs. Overdiagnosis of thyroid cancer is attributable to incidental detection during investigations of unrelated problems; overdiagnosis of renal cancer and melanoma is less well investigated.
Overdiagnosis is important because of the associated iatrogenic harms and costs. Harms include the psychosocial impact of unnecessary cancer diagnoses, such as the increased suicide risk for men after being diagnosed with prostate cancer. Cancer treatments such as surgery, radiotherapy, endocrine therapy, and chemotherapy can cause physical harm, but the risks are considered acceptable if diagnosis is appropriate. When someone is unnecessarily diagnosed with cancer, however, they can only be harmed by treatment, not helped."
...
"Overdiagnosis of breast cancers is largely attributable to the national screening program, that of prostate cancers and melanoma to opportunistic but extensive screening in Australia. Renal cancer overdiagnosis appears to be largely linked with cancers detected as incidental findings during abdominal imaging for an unrelated reason (incidentalomas). Overdiagnosis of thyroid cancer is related to both incidentalomas and to excessive investigation of thyroid function test abnormalities"
https://www.mja.com.au/system/files/issues/212_04/mja250455....
I'm not intentionally trying to sound hyperbolic. Are you? They are literally classified as invasive procedures. It is by definition unnecessary. There are going to be false-positives in these screenings and these false-positives can be harmful. Early detection + cancer = good. Early detection + no cancer = bad. So we must balance these two. I agree detecting cancer early is a good thing, but that's not what I was saying.
What's the deal, do you think there's no false positives, do you think over detection has no harms?
If you want something more recent, here's one published February 2020:
"...A further contributor is overdiagnosis, or the diagnosis of cancer in people who would never have experienced symptoms or harm had the cancer remained undetected and untreated. Overdiagnosis of certain screen‐detected cancers is common including 20–50% of prostate cancer and 11–19% of breast cancer diagnoses.
Cancer can also be overdiagnosed outside screening programs. Overdiagnosis of thyroid cancer is attributable to incidental detection during investigations of unrelated problems; overdiagnosis of renal cancer and melanoma is less well investigated.
Overdiagnosis is important because of the associated iatrogenic harms and costs. Harms include the psychosocial impact of unnecessary cancer diagnoses, such as the increased suicide risk for men after being diagnosed with prostate cancer. Cancer treatments such as surgery, radiotherapy, endocrine therapy, and chemotherapy can cause physical harm, but the risks are considered acceptable if diagnosis is appropriate. When someone is unnecessarily diagnosed with cancer, however, they can only be harmed by treatment, not helped."
...
"Overdiagnosis of breast cancers is largely attributable to the national screening program, that of prostate cancers and melanoma to opportunistic but extensive screening in Australia. Renal cancer overdiagnosis appears to be largely linked with cancers detected as incidental findings during abdominal imaging for an unrelated reason (incidentalomas). Overdiagnosis of thyroid cancer is related to both incidentalomas and to excessive investigation of thyroid function test abnormalities"
https://www.mja.com.au/system/files/issues/212_04/mja250455....
I am scared of having any sort of dental issues. The few times in the past I've had any issues, they felt... urgent.
The more I think about the healthcare problem in the United States, the more it appears to be a Gordian knot.
The author doesn't explicitly call for any policy proposal, rather he wishes some medically informed patient into existence. This effectively turns the doctor-patient relationship on its head, but, unfortunately, it seems reasonable to do so, given the opioid epidemic. I don't want to have to know as much as my doctor, I just want them to tell me how to fix it, and I am willing to bet most people largely feel the same.
On the other hand, I can hardly imagine that decreased consumption of healthcare isn't going to cause corporations to recoup lost profits elsewhere, so I'm not sure if the long-run is particularly different from the author's suggestion.
In short: indecision.
The author doesn't explicitly call for any policy proposal, rather he wishes some medically informed patient into existence. This effectively turns the doctor-patient relationship on its head, but, unfortunately, it seems reasonable to do so, given the opioid epidemic. I don't want to have to know as much as my doctor, I just want them to tell me how to fix it, and I am willing to bet most people largely feel the same.
On the other hand, I can hardly imagine that decreased consumption of healthcare isn't going to cause corporations to recoup lost profits elsewhere, so I'm not sure if the long-run is particularly different from the author's suggestion.
In short: indecision.
I can't speak for others, but I'm between jobs due to the pandemic and can't afford health care without employer-provided insurance. Most people are fine most of the time, which is why it doesn't seem like a problem. But I bet that it will eventually be a problem; chronic issues need to be taken care of, and everybody can benefit from a visit to the dentist now and then.
Not leaving home much probably minimizes exposure to all the usual threats.
Reminds me of my grandaunt who rarely left the house after the death of her husband. But she was very active, and had family members around to help out. She was quite healthy till the end and outlived her siblings/peer group by a big margin.
Reminds me of my grandaunt who rarely left the house after the death of her husband. But she was very active, and had family members around to help out. She was quite healthy till the end and outlived her siblings/peer group by a big margin.
Last time I went to a doctor, I was concerned about intestinal blockage; they gave me a prescription for a drug that slows intestinal motility. And told me I couldn't afford any tests to confirm my notions of what my actual health issues might be.
I've never been one of those who delegates the responsibility for my health to a doctor; but at least they used to be valuable consultants. Today I cannot imagine a circumstance that would make me want to be a customer of a health care provider. I can only hope to find a alternate source for any treatments they keep exclusive to themselves if i ever need one.
I've never been one of those who delegates the responsibility for my health to a doctor; but at least they used to be valuable consultants. Today I cannot imagine a circumstance that would make me want to be a customer of a health care provider. I can only hope to find a alternate source for any treatments they keep exclusive to themselves if i ever need one.
I have realized doctors don't do much good, except for very extreme treatments for life-threatening conditions (surgery, powerful medications etc). I'm not saying they never help, just that 99% they do either useless or actively damaging treatments that don't take side-effects into account. They are biased towards unecesserary action. Overuse of antibiotics is just one way this manifests itself, but it is true for most treatments.
I'd love to go to the doctor, but I don't have a pressing emergency; no-one is willing to schedule an appointment.
I'd love to do to the dentist; the very few I've found willing to do routine teeth cleaning have a reservation system that requires winning the scheduling lottery.
I guess that superficially, I'm fine. For now, at least. At least I have an HSA; most of my health insurance money is sitting in an account instead of being lost forever.
I'd love to do to the dentist; the very few I've found willing to do routine teeth cleaning have a reservation system that requires winning the scheduling lottery.
I guess that superficially, I'm fine. For now, at least. At least I have an HSA; most of my health insurance money is sitting in an account instead of being lost forever.
Iatrogenesis. Nassim Taleb explains a great deal about it in Antifragile: https://en.wikipedia.org/wiki/Iatrogenesis
Most people were also stuck at home, living a much lower impact lifestyle.
I wondered about that - the cost to the environment (is that what you mean by 'impact'?).
I guess this is off topic. But not travelling - check. Ordering all the stuff online from different vendors, consuming more (because, more idle leisure), doing more home projects cost something.
Heck, construction is booming. That's an impact too. I wonder what it'll all add up to.
I guess this is off topic. But not travelling - check. Ordering all the stuff online from different vendors, consuming more (because, more idle leisure), doing more home projects cost something.
Heck, construction is booming. That's an impact too. I wonder what it'll all add up to.
Necessary or not is subjective. For example, at the collective level, lung cancer screening costs outweigh the benefit. At the individual level, early detection gives the best chance for survival.
This isn't that surprising. Healthcare economists have known for a very long time that medical spending, on the margin, has precious little impact on actual health outcomes.[1]
Basically there's a "core" set of medicine that constitutes basic care and is essential to health. But even during deep budget cuts or quarantine, very few people are avoiding vaccines, not setting broken legs, and letting appendices explode.
In contrast an enormous amount of healthcare is very expensive and of dubious effectiveness at best. For example it's not uncommon for courses of certain chemotherapy to cost $400,000 and have no statistical effectiveness.[2] Overall nearly half of medical procedures are unsupported by evidence[3]. Even procedures we take for granted, like routine mammograms[4], have no actual impact at reducing mortality at the population level.
This is what economists call "on the margin". These are the treatments that get cut first during rationing.
[1] https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-med... [2] https://freakonomics.com/2013/10/22/the-unsustainable-econom... [3] https://www.vox.com/the-big-idea/2017/12/28/16823266/medical... [4] https://theconversation.com/routine-mammograms-do-not-save-l...
Basically there's a "core" set of medicine that constitutes basic care and is essential to health. But even during deep budget cuts or quarantine, very few people are avoiding vaccines, not setting broken legs, and letting appendices explode.
In contrast an enormous amount of healthcare is very expensive and of dubious effectiveness at best. For example it's not uncommon for courses of certain chemotherapy to cost $400,000 and have no statistical effectiveness.[2] Overall nearly half of medical procedures are unsupported by evidence[3]. Even procedures we take for granted, like routine mammograms[4], have no actual impact at reducing mortality at the population level.
This is what economists call "on the margin". These are the treatments that get cut first during rationing.
[1] https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-med... [2] https://freakonomics.com/2013/10/22/the-unsustainable-econom... [3] https://www.vox.com/the-big-idea/2017/12/28/16823266/medical... [4] https://theconversation.com/routine-mammograms-do-not-save-l...
"seem fine" covers a lot of situation for example your having an ultra sound and they say "oh that looks a bit small" you go from fine to not fine very quickly
My impression is that at a Public Health level most forms of medicine don't make much of an impression.
Antibiotics would probably be an exception. Vaccinations if you choose to call them medicine.
At the population level though most of the things that affect health and life expectancy are life style choices of one type or the other that Doctors have not show an ability to control.
My Dr. might be able to tell me that my smoking is bad. That I need to lose 10 lbs. That getting black out drunk every weekend isn't doing me any good. All of that and more. But Dr's aren't any good about doing anything about those things.
You could add clean water and clean air in that pile.
Compared to that cancer detection and extending the lives of people with cancer is a drop in the bucket. Of course if you fall into that category then it's a huge difference but overall I don't think it makes a huge difference.
Antibiotics would probably be an exception. Vaccinations if you choose to call them medicine.
At the population level though most of the things that affect health and life expectancy are life style choices of one type or the other that Doctors have not show an ability to control.
My Dr. might be able to tell me that my smoking is bad. That I need to lose 10 lbs. That getting black out drunk every weekend isn't doing me any good. All of that and more. But Dr's aren't any good about doing anything about those things.
You could add clean water and clean air in that pile.
Compared to that cancer detection and extending the lives of people with cancer is a drop in the bucket. Of course if you fall into that category then it's a huge difference but overall I don't think it makes a huge difference.
A good time to advocate for telehealth, remote visits.
NYT also has the counterpoint:
"Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits"
https://www.nytimes.com/2020/04/23/health/coronavirus-measle...
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The real question is whether there there will be statistically detectable increases in severity or prevalence of chronic or emergent ailments in the long run. How many cancers are detected later, how many lower-back pain cases are allowed to degenerate further, etc etc. And further, do those (to my mind inevitable) subtler long-term consequences outweigh the societal gain from less healthcare spending? They may or may not, but this article doesn't even ask the question, let alone suggest ways to answer it. This feels like low-effort clickbait to me.