Re: Canadian doctors coming to the US

From: dahmd (dahmd_at_cfl.rr.com)
Date: 09/06/04 

Date: Mon, 06 Sep 2004 15:12:10 GMT

"George Conklin" <nilknoc@earthlink.net> wrote in message
news:2zZ_c.7497$Vl5.311@newsread2.news.atl.earthlink.net...
>
> "dahmd" <dahmd@cfl.rr.com> wrote in message
> news:deO_c.16827$uN5.2066@tornado.tampabay.rr.com...
> >
> > "George Conklin" <nilknoc@earthlink.net> wrote in message
> > news:c1M_c.7373$Wv5.2280@newsread3.news.atl.earthlink.net...
> > >
> > > "dahmd" <dahmd@cfl.rr.com> wrote in message
> > > news:51H_c.15386$Of3.6663@tornado.tampabay.rr.com...
> > > >
> > > > "Founding Father" <ff@qwest.net> wrote in message
> > > > news:BLo_c.28$0P5.5692@news.uswest.net...
> > > > >
> > > > > "dahmd" <dahmd@cfl.rr.com> wrote in message
> > > > > news:7iPWc.47629$4s6.35165@tornado.tampabay.rr.com...
> > > > > >
> > > > > > "George Conklin" <nilknoc@earthlink.net> wrote in message
> > > > > > news:UdlWc.1231$Y%3.494@newsread2.news.atl.earthlink.net...
> > > > > > >
> > > > > > > Good. Would you support laws which allow pharmacists to
> > > substitute
> > > > > if
> > > > > > > the patient wants a generic and that little box on the
> > prescription
> > > > pad
> > > > > is
> > > > > > > not checked?
> > > > > > >
> > > > > >
> > > > > > No problem.
> > > > >
> > > > > But I bet there WILL be a problem if the patient has a bad outcome
> > with
> > > > the
> > > > > generic and sues the doctor - even if the problem isn't even
> directly
> > > > > related to the generic. If it is, he should, of course, sue the
> > > > pharmacist,
> > > > > but you know THAT won't happen - deep pockets and all that (just
ask
> > > John
> > > > > Edwards).
> > > > >
> > > > > > To my knowledge that's how it's done in Florida.
> > > > > > Alternatively, I receive faxes from insurers every day that
> request
> > > > > > substitution of a name-brand to a generic, or from one type of
> > > > medication
> > > > > to
> > > > > > a similar, less expensive medication. I review these and,
almost
> > > > always,
> > > > > > auathorize the change. Note that I receive no compensation for
> this
> > > > > > service, which does not benefit me in any way. Further, you
might
> > be
> > > > > > interested to know that patients (not physicians) are the
driving
> > > force
> > > > > > behing requests for name-brand prescriptions. Most patients
want
> > "the
> > > > > very
> > > > > > best" and are unhappy about receiving generics. Ask any
> pharmacist.
> > > > They
> > > > > > want the name-brand, because they "are paying good money for
> > > insurance."
> > > > >
> > > > > There's that damned insurance problem again. People always want
the
> > > most
> > > > > expensive when someone else is paying for it.
> > > >
> > > > Absolutely. It's human nature. Very few of us are altruistic
enough
> to
> > > > reject "the best" care for the second-tier care, even if it's almost
> as
> > > > good. If an x-ray can diagnose the problem 97% of the time but a CT
> > scan,
> > > > which is about 10 times more expensive, can make the diagnosis 98%
of
> > the
> > > > time, people are going to want the CT scan.
> > >
> > > Such scans are pushed by the medical-industrial complex. Stop
> blaming
> > > the public if they bought into the propagana machine that 'we have the
> > best
> > > medicine in the world.' That mantra demands that people ask for 'the
> > best,'
> > > not second best. As for 'people.' Are you saying everyone? Or just
> those
> > > who think we get the best medical care in the world? I know we do
NOT,
> > and
> > > do not ask for tests.
> > >
> >
> > For certain medical therapies, such as pharmaceutical agents, I would
> agree
> > with you. However, who "pushes" CT scans?! Doctors get nothing out of
> > ordering them. I can't recall ever seeing an ad for a CT scan, although
> > there are a few ads out there for "open MRI" machines. It's possible
that
> > physicians in part are to blame for overstating our ability to diagnose
> and
> > cure illnesses, but I thought those days were gone. If anything,
> physicians
> > are so paranoid about lawsuits that they understate the potential for
> cure,
> > so that patients don't get their hopes falsely elevated. After all, if
> you
> > expect the procedure to have problems, and problems occur, you
> theoretically
> > are less likely to sue. I have not heard a physician say that a
treatment
> > is "a piece of cake" in many years. Rather, when I hear informed
consent
> > conversations, they usually involve a detailed discussion (in part) of
all
> > the bad things that could happen if you choose that therapy. I stand by
> my
> > original comments: one of the reasons we have costly health care is
that
> > patients are pseudo-consumers. They want the best available, regardless
> of
> > cost, but don't have to pay for it directly. When was the last time you
> > went into a store and bought something without knowing how much it cost?
> > Medical consumers frequently demand expensive tests or medications, and
> > don't even know the cost differential between that therapy and less
> > expensive ones.
> >
> > Ashley
> >
>
> Let me follow up my earlier posts based on Clinton's heart bypass.
> Surgeons stated for the press that they do NOT give out death risks,
unless
> directly asked. NY State is very advanced in making risk-adjusted death
> rates available for every hospital. But I don't think the public knows
> enough to ask for that data, and press reports state you must know about
it
> AND ask to get it.
>
> The hospital where Clinton rests has a risk-adjusted death rate of 4%,
vs.
> 2% for NY State as a whole. This is a figure adjusted for something like
> 30+ risk factors, so all hospitals are rated as if they were operating on
an
> idential patient.
>
> Hospitals bitterly fought NY State's plans to release risk-adjusted
death
> rates, but they lost. One earlier report cited the good which has come
from
> it. One hospital had a very high death rate and was investigated by a
team
> of experts. They found out that the hospital was so efficient they rushed
> surgery soon after a heart attack. That turned out to be the risk. When
> they waited several days, their rates fell to average. That was a new
> finding. Press reports also state that at some hospitals deaths
following
> heart bypass surgery apporach one third. Do you think ANY patient would go
> to that hospital if they knew? But nothing is done about that kind of
thing
> in most states.
>
> So, let me ask you this: If you had a 4% risk of death from a certain
> surgery, would you get it? Given that you are equally as likely to be
alive
> after a heart attack in Canada after 5 years (or 9 I think), and they
don't
> do that much bypass surgery, would you go for the surgery? And heart
> catherizations go with a certain risk too. When my wife asked about the
> death rate from this at UNC Hospitals, she was given NATIONAL data. When
> she ask what the risks were for UNC Hospitals, she was told, "We don't
know
> that." Right!!!!
>
> So do you get all the data? Heck no. You either are not told, or are
> told "We don't know," or you have to know the data is there, and demand
it,
> or look it up yourself.
>
> Several musicians I follow have died following heart procedures. June
> Carter Cash and Carl Story are two. They would still be around if they
had
> just said NO.
>
> So what would you do Ashley? I'd go for another hospital myself. A
> different team.

Without going into details, I was faced with a similar informed consent
decision several years ago. I was told that a certain invasive procedure
carried "about a 3% risk" of permanent shortness of breath. The medical
problem I had at that time was signficant (although now resolved) and I
contemplated the option. After all, 3% is not that high. However, I
decided that 3% was too high for me, and decided against the procedure, even
though it meant taking a medication with signficant side-effects. I give
similar informed consent to patients when discussing expectant management
versus medical therapy versus surgical therapy. There are several reasons
why patients decide for or against certain procedures, or, for that matter,
for or against a certain physician or hospital. Folks with scientific
backgrounds like yourself likely would go with the stats, whereas many
people go with their emotional connection, or "gut feeling" about the doctor
(or hospital). You might change hospitals if you found out a facility had a
4% risk-adjusted death rate versus another facility that had a 2% risk.
Others might decide to keep the original hospital, despite it's higher risk
status, because the physician "sure is a nice guy" or the hospital is
"closer to home" or "it has a good reputation" or "I was born there" or
"this hospital is sponsored by my religion" or for a variety of reasons.
Thanks,

Ashley

Relevant Pages

  • Re: Anti-Gun Democrats DEFEATED, Again - NINE (9) Pro-Gun Bills Advancing in Tennessee!
    ... States with Higher Gun Ownership and Weak Gun Laws Lead Nation in ... Gun Death: ... The HealthGrades Patient Safety in American Hospitals study is the ...
    (alt.politics)
  • Re: Canadian doctors coming to the US
    ... Let me follow up my earlier posts based on Clinton's heart bypass. ... Surgeons stated for the press that they do NOT give out death risks, ... The hospital where Clinton rests has a risk-adjusted death rate of 4%, ... Hospitals bitterly fought NY State's plans to release risk-adjusted death ...
    (sci.med)
  • Re: Canadian doctors coming to the US
    ... Let me follow up my earlier posts based on Clinton's heart bypass. ... Surgeons stated for the press that they do NOT give out death risks, ... The hospital where Clinton rests has a risk-adjusted death rate of 4%, ... Hospitals bitterly fought NY State's plans to release risk-adjusted death ...
    (sci.med.cardiology)
  • Re: Canadian doctors coming to the US
    ... Let me follow up my earlier posts based on Clinton's heart bypass. ... Surgeons stated for the press that they do NOT give out death risks, ... The hospital where Clinton rests has a risk-adjusted death rate of 4%, ... Hospitals bitterly fought NY State's plans to release risk-adjusted death ...
    (sci.med.nutrition)
  • Re: Canadian doctors coming to the US
    ... NY State is very advanced in making risk-adjusted death ... > The hospital where Clinton rests has a risk-adjusted death rate of 4%, ... so all hospitals are rated as if they were operating on ... That turned out to be the risk. ...
    (sci.med.nutrition)