Originally shared by Roger Henry
I knew about the futility of antibiotics for sinus infections. The rest was news to me.
http://www.nbcnews.com/id/50879495/
I knew about the futility of antibiotics for sinus infections. The rest was news to me.
http://www.nbcnews.com/id/50879495/
Lots of money being spent on helping doctors and medical companies make money.
ReplyDeleteJohn Blossom Pooja Srinivas
ReplyDeleteMy funda is very clear. I order a test only if it might potentially make a difference down the line some way. Same goes for every element of the prescription, all from first principles. Although I am sufficiently consistent that I can expect myself to do the same thing every time I face the same situation, I do not believe in fixed protocols. American medical practice has too much of mindless protocols inspired by defensive medicine. Things would not change without tort reforms and limitation of medical malpractice compensation. Unless there is criminal negligence, the onus on insurance should be with the customer (he can take insurance according to his/her own self worth rather than bankrupt the system with unviable iinsurance premiums which drive up the cost all around with lawyers and insurance firms being the only winners overall. What I do will not be feasible in US out of fear
Able Lawrence I don't think this is a US specific issue. I've seen many doctors in India do the same regardless of whether there's medical insurance involved.
ReplyDeleteManny Brum Protocols are for the average doctor who cannot think through everything. Granted they have a role but if you can see through all, every patient is unique and a lot of things are useless
ReplyDeletePooja Srinivas There is a different reason a lot of doctors do these. In US and in most private Indian doctors, their income is based on the revenue they generate or procedures they do. Doctors get a certain percentage of the revenue (usually about 25%) from investigations and procedures. So there is a perverse incentive for ordering unnecessary tests. There are also doctors who earn a percentage from prescriptions and so costlier medicines means more revenue. I decided to join the government sector precisely because I considered it unethical. The fear of malpractice suit is only the moral justification. I am able to bargain with pharma companies for huge discounts on costly medicines for my patients. I believe it is the usual margins that normally go you know where. Sometimes discounts can be as much as 50-75% of the MRP. I like that my income is not related to any of these factors. I just work for pleasure and am happy to get paid for doing something I like.
ReplyDeleteAble Lawrence Thanks, and yet so many are more interested in being "right" than in doing the right thing...
ReplyDeleteManny Brum Sorry! In Rheumatology, science is 100 years behind other speciality. I should have clarified that I work in a speciality and my comments are about my speciality. No two patient is alike in Rheumatology. Expertise makes a significant difference in my area. I am not talking about mature specialities like Cardio and other specialities where data for patients with several thousands of subjects are available. In my speciality large trials are available only for very few diseases like rheumatoid arthritis. You can say treating RA is a science but my patients budgets ranget from 40 dollars a year to occassional pt with 25000 dollars a year (that is India!). So protocols are just meaningless here. As for lupus, there is a huge paradox between a disease experts know like the back of the hand and total inability of large trials to measure or comprehend the disease. Other diseases and then mixtures of diseases, the less said the better (except for lupus nephritis and vasculitis where initial treatment has been protocolized)
ReplyDeleteM Monica I have read your story before. Remembered your picture in the post. Our patients have entirely different set of problems. It would have been great if there was a way to arrange you to talk to our patients. I mean it should help both sides. But they are not tech savvy.
ReplyDeleteWhat I love about treating patients with Lupus is that I have to individualize treatment, the very opposite of what american healthcare system strives to do. Standardized care is very good with average doctors. I believe in setting goals for patients and working to attain those goals provided patient and me are on the same page. Kind of like Harvey Specter in Suits. Win some lose some but keep your goals in mind and try hard. America has the most money for healthcare but a lot of the wastages and problems are because doctors are forced to treat court cases rather than patients. There is no gain without risk.