Re: Herd instincts?

On 11/23/07 11:05 PM, in article 0phfk3d5oujmmgnann75fpa4bchst99a3k@xxxxxxx,
"Jeff Liebermann" <jeffl@xxxxxxxxxx> wrote:

bill.sloman@xxxxxxxx hath wroth:

On Nov 23, 11:45 pm, John Fields <jfie...@xxxxxxxxxxxxxxxxxxxxx>
wrote:
On Fri, 23 Nov 2007 12:28:16 -0700, Jim Thompson

<To-Email-Use-The-Envelope-I...@xxxxxxxxxxxxxxx> wrote:
So why is it the Europeons and Canadians troop to the US when they
need some kind of critical quality medical care?

---
Bill will probably claim that it's because of the illegal immigrant
Mexican doctors who can do it better and cheaper than Gringos can.

I think that it is more likely that the Europeans and Canadians come
to US because they can buy medical procedures there that look like
dangerously premature interventions to medicos outside the U.S.

I beg to differ. My friends in Canada tell me that it takes forever
to obtain even an evaluation appointment, much less surgery, in
Canada. I can supply a few horror stories if you're interested. It's
the long wait that inspires the pilgrimage.

My medically qualified younger brother tells me that U.S. doctors
spend a lot more money on tests than their foreign counterparts, and
are much more likely to intervene (at vast expense).

Yep. I just went through that myself. I had my prostate and a large
piece of my bank account surgically removed at a local hospital.
Patients that have insurance, Medicare, medical, medicruz, or other
reluctant payers, tend to over test. Similar surgeries required a
wide spectrum of pre-operative testing, most of which were to assure
the financial provider that the surgery is really necessary and that
some alternative treatment isn't possible.

I note in your post, a lot of skeptical comments about US doctors, but I
want to comment only on this paragraph I split.

Tests are required to satisfy the doctor that surgery is required, not, as
you put it, to "assure the financial provider...." Elevated PSA can result
from causes that *may* go away. For a more complete view of a prostate
condition, a more complex blood test may be requested, bringing the total
test so far to two. In my recent case, the latter test guided the doctor to
decide the elevated PSA was *very possibly* a result of recent chemotherapy,
and we should adopt a wait-and-see posture for 6 weeks, which we did. An
invasive biopsy was not justified. All of this was to benefit ME, not an
insurance company.

The next complex PSA blood-work showed a remarkable improvement and I'm now
back to getting a simple PSA test included in my annual general exam, which
is recommended for men over about 50. Had there been no improvement, or if
the PSA level had got higher, other tests would have been called for.

I hope you can see that there are good reasons for a doctor (in this case
the Urologist) to call for reasonably required tests, and then to wait and
see or to advance other tests in preparation to a potential biopsy and/or
prostate surgery. Insurance companies DO NOT get to say whether such
required tests or surgery are done.

In fact, some surgeons use expensive, minimally invasive robotics in the
surgery even though this more expensive process is not covered by insurance.
It greatly benefits the patient's speed of recovery, while reducing the
doctors earnings.

And finally, to complete this blog; in my opinion, a doctor who has
diagnostic tools available, but does not use them when they are called for,
is dangerous to your well being. But if you want fast, reduced cost
doctoring, you may find a surgeon who will remove your prostate without
discovery of to what extent it may be needed, and with little delay.
Hopefully though, not in the U.S.

It also satiates the legal
departments appetite for cover-thy-posterior test to avoid subsequent
litigation for malpractice or damage mitigation.

The usual result is that surgery and other expensive procedures are
delayed until the absolute last moment. All manner of alternative
remedies are attempted in the hope that the condition will fix itself
or the patient will die prematurely, thus avoiding patient
compensation. Only after all the cheaper alternatives have been
explored, is surgery authorized.

In my situation, I paid cash, mostly in advance. Strangely, after the
price was renegotiated multiple times, it was almost as cheap to pay
for local surgery, than to make the pilgrimage to India or Mexico.
Take out the insurance companies and government assistance, and what's
left is fairly affordable medicine. Anyway, instead of a multitude of
pre-operative tests, I had exactly 2 invasive tests (other than the
usual blood test and chest x-ray). Most of the others were apparently
un-necessary to properly perform the surgery.

Anxious patients often want their doctors to "do something" when the
Cochrane collaboration would advise a wait-and-see approach
http://www.cochrane.org/reviews/en/ab004326.html

Maybe. I have a dim view of sites that have a financial agenda
(selling some potion or procedure). Chochrane is not one of those.
They have no obvious agenda, but are lacking in the numerical detail
to substantiate their conclusions. They also tend to be rather
simplistic. Methinks it is much better to dig through the complex and
confusing medical research reports reference on Medline or various
online medical journals, than to rely on what I consider to be a
simplistic conclusion. For those that want fast answers, sites such
as Cochrane are good enough.

I agree on the wait-n-see approach. Many conditions magically fix
themselves without any intervention or treatment. I know of one
person with an obvious case of prostate cancer that juggled his diet a
little, but basically did nothing. The cancer was gone in about 6
months and hasn't come back in the last 2 years. I decided to try
several alternative treatments, each with their fan clubs and
promoters. Nothing worked. When it was obvious that I was headed for
surgery (or radiation), it took about 3 months to schedule the surgery
(which was rescheduled 3 times). Judging by the pathology report,
another month or two, and the cancer would have spread. Wait-n-see
has it's benefits, but don't drag it right to the bitter edge.



.

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