Alarming Topics!

Discussion in 'Politics, Religion, Social Issues' started by Huntn, Oct 18, 2012.

  1. Huntn, Oct 18, 2012
    Last edited: Oct 18, 2012

    Huntn Suspended

    Huntn

    Joined:
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    The Misty Mountains
    #1
    Newsweek: Are Hospitals Less Safe Than We Think

    Incredibly alarming report in Newswek, Sept 2012.

    She ended up dieing...

    Apparently the solution is to stop covering up and publicize statistics, including fatality statistice to the public. I have no idea if this is happening in my neighborhood (Houston, Texas).

     
  2. jeremy h macrumors 6502

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    UK
    #2
    Interesting post. Bear in mind that putting in place good centralised reporting of issues, problems, poor outcomes will make your system look worse than those systems that don't do this. (It will then be used by politicians from other countries as a political football when discussing socialising medicine etc.)
     
  3. AhmedFaisal, Oct 18, 2012
    Last edited by a moderator: Nov 10, 2013
  4. edk99 macrumors 6502a

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    FL
    #4
    Exactly and adding Obamacare to the mix is only going to compound the issue exponentially.
     
  5. leekohler macrumors G5

    leekohler

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    #5
    Yes, we need universal health care- only way this will ever be fixed. The rest of the civilized world has shown us this.
     
  6. AhmedFaisal, Oct 18, 2012
    Last edited by a moderator: Nov 10, 2013
  7. Huntn thread starter Suspended

    Huntn

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    #7
    For this specific issue, I don't think it matters how the health system is funded. The point in this article is that until hospitals are held accountable, one option is publishing statistics, they won't act like they are accountable.
     
  8. jeremy h macrumors 6502

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    #8
    I suspect we agree but I didn't make my point well. How well you're doing is often dependent on how your measured. In our centrally funded system everything is measured to the point that it drives the medical profession here mad. (And that's a good thing - as Shaw said "all professions are conspiracies against the laity") It's measured aggressively and consistently across the entire healthcare system. It's essential, in my view, to drive up standards. For example today there's headlines that doctors are going to have their competence assessed regularly. (There's going to be a lot of howling over that one!)

    However in exposing bad results, it does create lots of bad headlines (in the last few weeks there's been headlines about poor outcomes if you're admitted at weekends) and possibly goes someway to explain why individual experience of the NHS is often very good but the general perception who haven't used it is often not so good. It also gives plenty of ammunition for vested interests in say the US, to attack our system. (That plays very, very badly here, and goes someway to explain why the somewhat mad NHS tribute in the Olympic opener was so well received here and met with incomprehension elsewhere.)

    It would find it very interesting if say, the American system were subject to the same accountability. On this general point a bit from from the Economist about cancer stats:

    We do have lots of problems here but I've often wondered about accountability elsewhere. (So I thought your post and article was interesting.) Some sort of consistency of measurement across not just individual systems but across international systems would be very interesting and good for all of us.
     
  9. Ledgem macrumors 65816

    Ledgem

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    #10
    That's one problem. I've seen it in one hospital, but across many others, profit isn't what drives unnecessary tests. It's defensive medicine.

    A physician works through a diagnosis and usually has an idea of what it is that they're looking for, and the tests confirm or redirect the diagnosis. But what if the patient has another issue - something that either isn't causing the problem, or that is masked by it? Patients can sue the physician for negligence and get a hefty sum. They're not necessarily wrong to file such a suit, but consider it from the physician's perspective. What if there's a somewhat rare condition that might affect one in a few thousand people? It would seem silly to test everyone for that condition. But you'll encounter thousands of patients, meaning that your chances of encountering that condition at some point is pretty good. Instead of getting bitten with a lawsuit over it, you test everyone for it. That way you can defend yourself in a lawsuit if it ever comes up in the future (since the test results would back your statement that you had no way of knowing), or - if you do catch it on a test - you can start treatment. There are some benefits to this, but the major downside is that it drives costs up with what are truly unnecessary tests for many.
     
  10. AhmedFaisal, Oct 19, 2012
    Last edited by a moderator: Nov 10, 2013
  11. Ledgem macrumors 65816

    Ledgem

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    #12
    Most physicians want more face time with patients, rather than less. Why is face time so limited? Part of it is the push to see more patients to maintain revenue, as you said. Another factor - a huge factor, particularly in the medical settings I've been in - has been charting. We're documenting everything in our medical notes. Why? In many cases it isn't because it improves patient care, it's because the medical note is a legal document. Consider this scenario, where I tell a patient to take a certain medication and explain the consequences of being noncompliant, but the patient decides not to. The patient suffers from noncompliance and sues me, claiming that I didn't explain it to them or tell them to take it. There's a good chance that I will lose the suit if I haven't recorded anything about the conversation that I had with the patient in my medical note.

    That and other factors results in many physicians feeling that they've become glorified secretaries of sorts, just writing reports and pushing papers around all with the purpose of having a rock-solid defense against a malpractice lawsuit that might come their way. It's not a personal decision, either: in many cases it's institutional policy, and of course HIPAA sets the absolute minimum bar...

    That's defensive medicine in its own way, and it's similar with the tests. There are plenty of times were a physician really doesn't need the test results and they can correctly predict what the results will be even before the test is performed. Why order them, then? Because prediction and reasoning are risky defenses in court, but test results with firm numbers are much harder to argue against. It's also worth considering that many providers are sued on the grounds of "negligence," but has anyone ever been sued for ordering frivolous tests? They have - but that usually concerns things like insurance fraud, rather than malpractice suits filed by patients. I'm sure that it's happened, but how common is it compared to the malpractice suits claiming negligence or incompetence? I'm guessing it's pretty minimal. Thus it remains "safer" to over-order than to under-order, which is the entire basis of defensive medicine.
     
  12. jnpy!$4g3cwk macrumors 65816

    jnpy!$4g3cwk

    Joined:
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    #13
    Byon

    Unfortunately I've spent quite a bit of time visiting others in hospitals over the last decade. I see two big changes from when I was young:

    First, Bring Your Own Nurse. There probably are more highly-trained RNs now than in the old days, but, not nearly as many LVNs/LPNs/etc -- the people who make sure that the patient is doing OK, is comfortable, who make sure the IV hasn't run dry, and so on. You need family and friends now to watch out for you.

    Second, hospitals were much cleaner in the postwar era. Hospital floors were so clean you could eat off of them. Everything was kept very clean and scrubbed. Somewhere along the way, people must have gotten the idea that if a patient got a postoperative infection, antibiotics were the answer, so they didn't need to worry about cleanliness any more. It would be interesting to see how hospital post-op infections compare.
     
  13. NickZac macrumors 68000

    NickZac

    Joined:
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    #14
    There are accountability problems in countries with centralized systems ran through the government as well. Accreditation in medicine is difficult and many doctors suck when it comes to continuing education. Unless you know medicine yourself or you know your doctor is up to date, you may be receiving treatment protocols that were considered modern a few decades ago but have since been replaced by newer 'gold standards'.

    While healthcare in the US has all sorts of issues, not just accountability ones, one way to mitigate this single issue is to be your own advocate and don't go to a hospital alone. Specify in a living will/AD and with relatives where you want to be taken in an emergency (we all know of those 'dirty' hospitals you want to avoid), and specify that your PCP can act as the coordinator of treatment, if possible. Ask questions and don't be afraid to shape your own treatment plan as a doctor doesn't always work in your best interest. For example, some take useless tests for the purposes of liability reduction...you can refuse these.

    Another issue in the US that comes from privatization is a tendency for pharmaceutical companies to give 'items' to doctors. These items include samples, pens, pads, tissue boxes, prescription pads, posters, clipboards, magazines, subscriptions, and even vacations. This creates a tendency for doctors to advise the use of brand name drugs that have no medical effectiveness over generic alternatives, and may not be even safe. Doctors who prescribe the brand name meds more get more perks...so you see the issue. If you are given a brand name drug that costs an arm and a leg, don't be scared to ask what makes this brand name drug worth using that may cost as much as 1,000 times+ that of a generic. If you happen to see the doctor is writing with a pen that has the same name on it as the drug the prescribe you, be skeptical.

    Above all, don't accept a doctor's prescribed treatment to be following gold standards. The internet is a wonderful thing which you can validate what they prescribe and even review them.
     
  14. Mord macrumors G4

    Mord

    Joined:
    Aug 24, 2003
    Location:
    UK
    #15
    This all doesn't remotely surprise me and has been my experience and expectation of doctors for some time.

    You've really got to read up on whatever they say or whatever you've got to make sure they don't screw you up.

    I've always found it nuts when friends mention that doctors "put them on" or "took them off" certain meds like they had zero say in the matter.

    Most recently a friend had her doctor try and take her off SSRIs that she takes not for depression but because they've consistently stopped her from hearing judgemental mean voices for most of her life, she knows going off them makes them come back. Thankfully she had the sense to say no, she wasn't going to stop.
     

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