kallend 2,027 #51 March 13, 2012 QuoteQuoteQuoteIt is a prooven fact that doctors order unneeded tests to cover their but from lawsuites and other things like that, if the insurance companies and the government backed off and just let doctors run only the needed test it would save alot of money. I agree, but that's not what you said. You said you wanted doctors to prove the tests were needed. The flip side of the coin is that many labs are owned by doctors, so the doctors have a financial interest in ordering as many tests as possible. There's nothing illegal about this (unfortunately), but it's a huge ethical problem. the government and insurance companies should give a list of possible needed tests for each part of treatment and the doctor should discuss them with you. then decide on path to follow. How does the physician know the treatment BEFORE getting the tests done? Clairvoyance?... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
marks2065 0 #52 March 13, 2012 QuoteQuoteQuoteQuoteIt is a prooven fact that doctors order unneeded tests to cover their but from lawsuites and other things like that, if the insurance companies and the government backed off and just let doctors run only the needed test it would save alot of money. I agree, but that's not what you said. You said you wanted doctors to prove the tests were needed. The flip side of the coin is that many labs are owned by doctors, so the doctors have a financial interest in ordering as many tests as possible. There's nothing illegal about this (unfortunately), but it's a huge ethical problem. the government and insurance companies should give a list of possible needed tests for each part of treatment and the doctor should discuss them with you. then decide on path to follow. How does the physician know the treatment BEFORE getting the tests done? Clairvoyance? are all liberals this incompetent? we need to start thinking for ourselves people! let me spell this out in small simple words. when you go in to the doctor with an issue, the doctor looks at you and says " you may have this", "this" being what ever, you should have some place to look to find out what are the reccommended procedures to follow for what ever "this" is. these recommended procedures should be listed by a board that is medically trained and has no connection to the doctor or hospital. then I can look this up and then discuss with my doctor on how to procede with my treatment. my treatment should not be controled by the government or insurance company. I only need to know proper treatment and tests needed for whatever "this" is. Government, insurance companies, and lawyers should have nothing to do with my choices on how to procede with my treatment. there is nothing about government control in anything I said. I want no government regulations controling the path of health care. government is there for our benifit not to control us. Quote Share this post Link to post Share on other sites
billvon 2,998 #53 March 13, 2012 And your one warning. Quote Share this post Link to post Share on other sites
marks2065 0 #54 March 13, 2012 QuoteAnd your one warning. Sorry but sometime people can not look past their book smarts to actually see what is happening in front of their own eyes. people need to stop depending on the government and start thinking and acting for themselves. The government has screwed up everything they have ever put their hands on and I can see why more every day. If it takes a warning to get a couple people to open their eyes I welcome it. Quote Share this post Link to post Share on other sites
mnealtx 0 #55 March 14, 2012 QuoteHow does the physician know the treatment BEFORE getting the tests done? Clairvoyance? That wasn't what he said. Quoteshould give a list of possible needed tests for each part of treatment "Well, Mr. Jenkins, your bloodwork came back with a cholesterol level of 500." Your EKG was good, but let's go ahead and do a stress test and echocardiogram just to make sure your heart isn't being affected by this and we'll schedule you with a nutritionist to talk about diet and exercise."Mike I love you, Shannon and Jim. POPS 9708 , SCR 14706 Quote Share this post Link to post Share on other sites
GeorgiaDon 362 #56 March 14, 2012 Quotegov should only have an advisory board for health care, and no control over anything. that is what gov is for is to protect us not control us. all choices made should be between the doctor and the patient not the ins company or the gov. Advice is what we need not control. What you are describing is exactly what the Obama administration proposed as "evidence based medicine". This was relentlessly attacked by the Republicans as government intrusion. Even one or two of the doctors who used to post here in SC opposed it as intrusion into the doctor-patient relationship. I recall being surprised that anyone could object to a mere list of treatments for each diagnosis that have been found to be effective in clinical studies, but I guess if the Obama administration said the sun is hot certain people would disagree. I do agree that such a list would be helpful in cutting down on defensive medicine and unwarranted lawsuits. The problem is these days everything is seen as fodder for political spin and advantage. Some people will do anything to gain power for themselves, and don't much care who they have to throw under the bus. Don_____________________________________ Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996) “Education is not filling a bucket, but lighting a fire.” (Yeats) Quote Share this post Link to post Share on other sites
marks2065 0 #57 March 14, 2012 QuoteQuotegov should only have an advisory board for health care, and no control over anything. that is what gov is for is to protect us not control us. all choices made should be between the doctor and the patient not the ins company or the gov. Advice is what we need not control. What you are describing is exactly what the Obama administration proposed as "evidence based medicine". This was relentlessly attacked by the Republicans as government intrusion. Even one or two of the doctors who used to post here in SC opposed it as intrusion into the doctor-patient relationship. I recall being surprised that anyone could object to a mere list of treatments for each diagnosis that have been found to be effective in clinical studies, but I guess if the Obama administration said the sun is hot certain people would disagree. I do agree that such a list would be helpful in cutting down on defensive medicine and unwarranted lawsuits. The problem is these days everything is seen as fodder for political spin and advantage. Some people will do anything to gain power for themselves, and don't much care who they have to throw under the bus. Don this health care bill is over 2000 pages of regulation, taxes, and control over the health care system. the costs to put this together is stagering. All we need is a board of about 10 -20 people to make a diagnostic flow chart for different medical issues that the people could use to guide the doctor in our treatment. this board could be made out of elected persons in congress or opointed by someone like the surgeon general with aprooval of congress. They would have no control on anything, only there to advise and recommend. Quote Share this post Link to post Share on other sites
normiss 801 #58 March 14, 2012 This plan would also reduce the need for a trained doctor...or even nurse. "Just see the receptionist...she has the checklist." Personally, I respect my doctor's years of training and experience. I don't want a government list. I've seen what governments do. Especially with lists. Quote Share this post Link to post Share on other sites
GeorgiaDon 362 #59 March 14, 2012 QuoteQuote>opening the drug market to generic would greatly decrease drug pricing. The market IS open to generics. You can get advil under a dozen different brand names. only because the pattent has run out, many drugs are still controled by the company that made them. every drug is cheaper that hits the generic market.What you are talking about is doing away with the patent system. The problem there is that it is hugely expensive to discover new drugs, and then to prove safety and efficacy to a point where the FDA will license the drug for human use. Usually the research to uncover the cause of a disease is funded by NIH and is carried out at universities, or sometimes at the NIH itself. Once the cause is discovered and published, drug companies compete to develop and market treatments. This means synthesizing and screening hundreds of thousands to millions of chemical compounds, and then developing appropriate cell culture and then animal model assays. If you're lucky a few compounds will work and not be too toxic or have nasty side effects, and those will be tested in small scale and then larger scale human clinical trials. At the end of the day, the cost to the drug companies to get a new drug on the pharmacy shelves exceeds $500 million dollars. A period of exclusive marketing of the drug (i.e. the patent system) is necessary for those drug companies to make back their investment in the research and development costs, and begin to turn a profit. If there was no period of patent protection, the day the drug hit the pharmacy shelves it would be reverse engineered by the generic drug manufacturers, who would then sell the drug for much less because they wouldn't have to recover any R&D expenses (except perhaps a few thousand to analyze the drug and work out a process to synthesize it). The effect of your suggestion to remove patent protection would be to absolutely guarantee that no new drugs would ever be developed, because no-one is going to throw away $500 million dollars they have no hope of recouping. Additionally, you couldn't very well abolish the patent system for drugs without getting rid of it for everything else, which means you'd kill virtually all innovation, risk taking, and invention of new products, processes, etc. Technologically, we would stop right where we are now and never progress again. I think the medicine you suggest is worse than the disease it's supposed to cure. Don_____________________________________ Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996) “Education is not filling a bucket, but lighting a fire.” (Yeats) Quote Share this post Link to post Share on other sites
GeorgiaDon 362 #60 March 14, 2012 QuoteThis plan would also reduce the need for a trained doctor...or even nurse. "Just see the receptionist...she has the checklist." Personally, I respect my doctor's years of training and experience. I don't want a government list. I've seen what governments do. Especially with lists.Nonsense, with all due respect. Most of the doctor's skill comes in making an accurate diagnosis, and this takes years of training and experience. Once a tentative diagnosis is made, appropriate treatment is begun. Then the patient must be monitored to make sure the treatment is working, and if not alternative diagnoses and treatments are made. None of that can be accomplished by a list, or by a receptionist with a list. Where such a list would be helpful would be in defending the doctor against a lawsuit that claimed negligence for failing to order a test/make a diagnosis that would apply to only a tiny number of cases. Few diseases (none maybe) have a symptom so distinctive that only a single diagnosis is even possible. The doctor always has to observe the symptoms, which is not always easy as often she has to rely on the patient to describe those symptoms, and patients may not mention things because they're "embarrassing", or they don't like to complain, or maybe to do like to complain and exaggerate irrelevant issues. Once a patient becomes ill, they become aware of all sorts of aches and pains, so the doctor will often have to sift through a laundry list of "symptoms" to try to see a pattern that might indicate a possible diagnosis. Under these conditions, you'll end up with the following scenario: Tentative diagnosis A: 55% chance of being correct Tentative diagnosis B: 32% Tentative diagnosis C: 12% Tentative diagnosis D: 0.9% Tentative diagnosis E: 0.1% Let's suppose the diagnostic test for diagnosis D costs $5,000, and the test for diagnosis E is $15,000. What should our doctor do? It seems to me it would be prudent to order tests for A, B, and C, as those would cover 99% of the possible diagnoses. Usually the more commonly ordered tests are less expensive as well, just because of supply/demand. However, if our patient is that one in a thousand for whom diagnosis E applies, the doctor is potentially liable to being sued if she fails to order that test, or even perhaps if she waits for the results of ABC before ordering DE, if a lawyer could argue the delay exacerbated the disease. So the doctor orders ABCDE just to cover her ass. This is where a list can be helpful. If a government appointed panel of experts issues an advisory that says that in the case of a diagnosis of X then tests A,B,C are appropriate, and D,E should be ordered only after A,B,C have been ruled out, then perhaps the courts could exclude lawsuits based on an argument that D and E should have been done first. At least, the doctor would have a very strong defense that they were not negligent in not ordering D and E first. And once again, I don't see anything there that a receptionist would be able to handle, even if he did have a "list". Don_____________________________________ Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996) “Education is not filling a bucket, but lighting a fire.” (Yeats) Quote Share this post Link to post Share on other sites
marks2065 0 #61 March 14, 2012 QuoteThis plan would also reduce the need for a trained doctor...or even nurse. "Just see the receptionist...she has the checklist." Personally, I respect my doctor's years of training and experience. I don't want a government list. I've seen what governments do. Especially with lists. this is not to remove the doctor but to educate you. this would not be a regulation for doctors to follow but to give YOU some guide lines to follow and understand your care. With this you would be able toi go to the doctor and ask him why did you run this test or why not run that test. This would not be something like the EPA or the Board of education that hand down regulations and stipulations that must be followed or have government mnoney linked to it. Quote Share this post Link to post Share on other sites
GeorgiaDon 362 #62 March 14, 2012 Quotethis health care bill is over 2000 pages of regulation, taxes, and control over the health care system. the costs to put this together is stagering. All we need is a board of about 10 -20 people to make a diagnostic flow chart for different medical issues that the people could use to guide the doctor in our treatment. this board could be made out of elected persons in congress or opointed by someone like the surgeon general with aprooval of congress. They would have no control on anything, only there to advise and recommend. Your comments do nothing to address the vociferous opposition to evidence based medicine from the Republican Party. In fact, they oppose anything that would actually do anything significant to reign in health care costs. For example, when the topic of discussing with patients in advance their options and desires for end-of-life treatment, that became politicized as "death panels". Never mind that such discussions used to be reimbursable under Medicare, after Palin et al got done with politicizing the discussion, payment for time spend discussing with patients what treatment they want in the event of a terminal illness is now excluded. If doctors/hospitals can't get paid, how much time do you think they will spend with patients discussing these matters? So the end result is that, except for the tiny fraction of patients who have prepared a living will, hospitals are compelled to use heroic measures, costing hundreds of thousands of dollars in many cases, to keep "alive" a terminally ill patient who is not able to tell them to stop. Sure, if people were "responsible" they would take care of that, but let's be realistic. Most people don't like to think of their eventual death, and certainly don't take the time to decide what they really want, put it in writing in a legally binding document, and file that with their doctor/hospital/family. A few minutes (and $40 reimbursement) spent consulting with a patient could save tens to hundreds of thousands of dollars in hopeless treatment, and better reflect the dignity and wishes of the patient. But Palin (and earlier Santorum with the Terri Schiavo fiasco) would prefer to play it for political points. Don_____________________________________ Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996) “Education is not filling a bucket, but lighting a fire.” (Yeats) Quote Share this post Link to post Share on other sites
normiss 801 #63 March 14, 2012 My doctors have typically given me such information. Quote Share this post Link to post Share on other sites
marks2065 0 #64 March 14, 2012 Quote My doctors have typically given me such information. is your doctor looking at your best interests? or is he trying not to get sued and make money to buy a new house on the beach? I don't trust anyone right now and I think, if given some good information, I could better direct my treatment while keping the doctor on my side instead of the side of his pocket book. Quote Share this post Link to post Share on other sites
billvon 2,998 #65 March 14, 2012 >only because the pattent has run out, many drugs are still controled by the company >that made them. Correct. Article I, section 8: "Congress shall have power . . . to promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries." This is an important part of the Constitution; it means that a drug company will be willing to spend hundreds of millions on a drug that will (for example) treat AIDS or cure typhoid, because they know they will be able to make it back. That benefits you directly by supplying you with lifesaving drugs. Drug development and testing is expensive. Under patent laws, drug companies recoup their investment by people who pay for the drug. If you want to ban patents for drugs, who pays for their development? The government? Quote Share this post Link to post Share on other sites
Southern_Man 0 #66 March 14, 2012 Quote Quote My doctors have typically given me such information. is your doctor looking at your best interests? or is he trying not to get sued and make money to buy a new house on the beach? I don't trust anyone right now and I think, if given some good information, I could better direct my treatment while keping the doctor on my side instead of the side of his pocket book. You can make yourself an educated consumer of health care now. It will take some work but there is a world of information available on the internet."What if there were no hypothetical questions?" Quote Share this post Link to post Share on other sites
marks2065 0 #67 March 14, 2012 Quote Quote Quote My doctors have typically given me such information. is your doctor looking at your best interests? or is he trying not to get sued and make money to buy a new house on the beach? I don't trust anyone right now and I think, if given some good information, I could better direct my treatment while keping the doctor on my side instead of the side of his pocket book. You can make yourself an educated consumer of health care now. It will take some work but there is a world of information available on the internet. I have used the internet and other areas including my brother who is a doctor. but the information is scattered and unreliable at times. we need a way to put the information together in a way that is user friendly to all, not just a few that happen to be able to navigate the mess. Quote Share this post Link to post Share on other sites
Southern_Man 0 #68 March 14, 2012 Quote I have used the internet and other areas including my brother who is a doctor. but the information is scattered and unreliable at times. we need a way to put the information together in a way that is user friendly to all, not just a few that happen to be able to navigate the mess. Who is we? Medicine is kind of complicated. It is going to be hard for most folks to navigate on their own. Even those who use all the resources available usuallly end up knowing only some of the possibilities and have to rely on their educated, experienced doctor for the rest."What if there were no hypothetical questions?" Quote Share this post Link to post Share on other sites
billvon 2,998 #69 March 14, 2012 >>only ordering tests that are medically needed and making the doctors proove that >>the test is needed. >All we need is a board of about 10 -20 people to make a diagnostic flow chart for >different medical issues that the people could use to guide the doctor in our treatment. So a "death panel" who would decide to kill your grandma to save money? (sarcasm there) Yes, that board would be a good idea - but it is exactly what the GOP labeled the "death panel" a few years back. If one of the effects of Romney's entrance into the race is that people are more willing to talk about increased government oversight of healthcare without screaming "DEATH PANEL! SOCIALISM! EVIL!" then that's a good thing overall, IMO. Quote Share this post Link to post Share on other sites
SkyDekker 1,465 #70 March 14, 2012 QuoteWell, Mr. Jenkins, your bloodwork came back with a cholesterol level of 500." Your EKG was good, but let's go ahead and do a stress test and echocardiogram just to make sure your heart isn't being affected by this and we'll schedule you with a nutritionist to talk about diet and exercise." How did he get the blood test and EKG? Wouldn't he have needed proof of requirement? Quote Share this post Link to post Share on other sites
marks2065 0 #71 March 14, 2012 Quote>>only ordering tests that are medically needed and making the doctors proove that >>the test is needed. >All we need is a board of about 10 -20 people to make a diagnostic flow chart for >different medical issues that the people could use to guide the doctor in our treatment. So a "death panel" who would decide to kill your grandma to save money? (sarcasm there) Yes, that board would be a good idea - but it is exactly what the GOP labeled the "death panel" a few years back. If one of the effects of Romney's entrance into the race is that people are more willing to talk about increased government oversight of healthcare without screaming "DEATH PANEL! SOCIALISM! EVIL!" then that's a good thing overall, IMO. That is because it was a death panel, planning for end of life. This would only be panel to determine best course of treatment, there is a difference. Quote Share this post Link to post Share on other sites
marks2065 0 #72 March 14, 2012 QuoteQuote I have used the internet and other areas including my brother who is a doctor. but the information is scattered and unreliable at times. we need a way to put the information together in a way that is user friendly to all, not just a few that happen to be able to navigate the mess. Who is we? Medicine is kind of complicated. It is going to be hard for most folks to navigate on their own. Even those who use all the resources available usuallly end up knowing only some of the possibilities and have to rely on their educated, experienced doctor for the rest. Skydiving has a SIMS manual, why can't we have a SIMS manual for health care? Quote Share this post Link to post Share on other sites
Southern_Man 0 #73 March 14, 2012 QuoteQuoteQuote I have used the internet and other areas including my brother who is a doctor. but the information is scattered and unreliable at times. we need a way to put the information together in a way that is user friendly to all, not just a few that happen to be able to navigate the mess. Who is we? Medicine is kind of complicated. It is going to be hard for most folks to navigate on their own. Even those who use all the resources available usuallly end up knowing only some of the possibilities and have to rely on their educated, experienced doctor for the rest. Skydiving has a SIMS manual, why can't we have a SIMS manual for health care? You can. It would be thousands of pages long to account for just a fraction of the contingencies."What if there were no hypothetical questions?" Quote Share this post Link to post Share on other sites
SkyDekker 1,465 #74 March 14, 2012 QuoteSkydiving has a SIMS manual, why can't we have a SIMS manual for health care? The same treatment for all people (except of course the few who are allowed a difefrent treatment). Hmmm, where did I see this concept before...... Quote Share this post Link to post Share on other sites
popsjumper 2 #75 March 14, 2012 Quote You can. It would be thousands of pages long to account for just a fraction of the contingencies. Not really. Simple flowchart...I think this is what they use right now as a matter of fact. Pulse absent? Send him to the morgue Pulse present? Charge him an arm, a leg and his first born to do as many tests and procedures as possible to maximize earnings.* *Makes you think: a. This bozo has no idea what he is doing. b. This bozo has a Ferrari payment due.My reality and yours are quite different. I think we're all Bozos on this bus. Falcon5232, SCS8170, SCSA353, POPS9398, DS239 Quote Share this post Link to post Share on other sites
