<p>I haven’t found that my health care has improved with a provider with higher intelligence.
Rather, what has made a difference is greater compassion and humanity.</p>
<p>One of the things that I really enjoy about these threads is the opportunity to learn how things work in other parts of the country. It’s possible to sometimes assume that the way it is here is the way it is everywhere, but that’s clearly not the case.</p>
<p>[Sick</a> Around The World | FRONTLINE | PBS](<a href=“http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/]Sick”>Sick Around The World | FRONTLINE | PBS) A great Frontline about medical care in other countries.</p>
<p>My 88-year-old stepmother was having terrible gastrointestinal problems. The gastroenterologist administered a colonoscopy and endoscopy, and didn’t remember that he had performed a bowel resection on her a few years before and then prescribed the test in which the patient swallows a small camera that transmits photographs.</p>
<p>At a routine visit with her gerontologist, a primary care doc, he took a look at the list of her meds, discontinued one of them, and the diarrhea stopped within a day.</p>
<p>So much for the wisdom of specialists.</p>
<p>“I haven’t found that my health care has improved with a provider with higher intelligence.
Rather, what has made a difference is greater compassion and humanity.”</p>
<p>Um, not for me! I want my doctors to be the best and the brightest and I don’t care if they have horrible bedside manner. I pay them to cure me not make me feel warm and fuzzy - if they happen do both, fine, but not a requirement of mine.</p>
<p>Actually, studies show that when Drs treat patients as people, rather than interupting them as if what they say is irelevant, they give better care.</p>
<p>[Getting</a> Doctors To Listen to Patients | Managed Care Magazine Online](<a href=“http://www.managedcaremag.com/archives/9612/9612.listening.html]Getting”>Sitemap - Managedcaremag.com)</p>
<p><a href=“Tips to make sure doctors don’t tune you out - The Boston Globe”>Tips to make sure doctors don’t tune you out - The Boston Globe;
<p>agree with your perspective EK, doctors need emotional intelligence as well. if doctors don’t listen, or respect their patient’s perceptions they are unlikely to understand what’s going on or to be able to “cure” them.</p>
<p>After having surgery I reported symptoms to a physician who ignored them, only to respond to them weeks later when seeing them for himself on a test he finally ordered. He didn’t believe me therefore he didn’t treat. I missed additional weeks of work because of his refusal to honor my own accurate perceptions. (I left that physician as I heard from others he had this pattern)</p>
<p>When my dad was having some rather serious surgery done I was actually pretty amazed at what his insurance would and wouldn’t cover. They would pay for someone that’s never met him to pray for him over the internet, but they would only cover a couple of sessions of physical rehab.</p>
<p>Mini, I know where those Canadians hide. They are the ones that need care that is not available in Canada. I see them with their kids with neuroblastoma and other cancers that just cannot be treated up there. </p>
<p>My friend who heads a drug lab (legal one now) would not be working there if the US did not pay what it does for his work. He sure as heck isn’t looking up there for work. No money, and his company has some of the innovative drugs in the last 10 years that are being used. He wants the big house, college choice for his kids and a nice retirement like his class peers from college, and can get it. </p>
<p>I also saw the Canadians in line to get their Whipples here in the US. They didn’t want to wait their turn in Canada and the number of those sections done there are not particularly comforting when one looks at the statistics. When you are at the wire, and yes, I’ve been there, you want the options that are capitalist system has produced.</p>
<p>“Have to look where the biggest least effective expenses are–end of life care. And nobody is willing to go there. I may not be willing to go there. But it’s easily the biggest single most wasteful spending.”</p>
<p>"It’s hard to have any meaningful discussion of this particular problem when those who are willing to go there as accused of advocating for “death panels.” </p>
<p>I’m hopeful that eventually we will all recognize the folly of our medical industrial complex and the younger generation will force long needed changes.</p>
<p>Oh, I am sure that there is care in short supply in Canada (especially in Ontario), just as there is in the U.S… I am sure that the system there could use more resources. I am sure that there are people in Canada who come to the U.S. for care, just as there are thousands of Americans who go to India for care because they can’t get it here, even if they have insurance. And, yes, sadly, both here and elsewhere, people suffer because they don’t get the care they need.</p>
<p>But you ask Canadians, and virtually none of them will trade systems with us. Once you get rid of insurance companies, and everyone is in the system, and everyone has a stake, positive changes can be made. They won’t necessarily be made, but they can be made. It’s the way democracy works.</p>
<p>As for who works where? Average pay for a family physician in Canada is $239,000/year. And there are four hospitals in Vancouver alone that perform high-volume Whipples.</p>
<p>hugcheck --</p>
<p>Thanks for sharing the Frontline story. Interesting to read how the UK, Germany, Switzerland, Taiwan, and Japan handle their health care.</p>
<p>
</p>
<p>It is true in any country that there are medical conditions that are poorly serviced in that country. Some people in the US go to countries in Asia for medical treatment for a specific condition that is well known in those countries, but poorly known in the US (this is distinct from those who go there for other conditions because medical treatment is less expensive there).</p>
<p>Canada seems to provide equal or better medical care on average than the US on significantly lower cost. Of course, individuals are not average, but there are likely more people who would do better in Canada than people who would do better in the US, medical care wise (not even including the cost issues).</p>
<p>The high cost of medical care in the US is also a drag on employing people in the US; companies pay more per employee for medical care in the US than they pay (including through taxes) for medical care in other rich countries. The high cost of medical care in the US is also a government budget buster; the US government spends about 7% of GDP on medical care (Medicare and Medicaid) for a portion of the population, while other rich country governments like that of Canada spend about 7% of GDP on medical care for their entire populations.</p>
<p>Hi Aqua: actually I live in one of the most expensive areas in America (upstate NY). I took a 12k pay cut when I moved here from Tennessee. I was astounded, especially since my pay went down 12k and my property taxes (same basic house) went up 6K!</p>
<p>I obviously need to find out where NPs are making so much. Starting NPs here and where my sister works (bay area) is less than $30/hr</p>
<p>Jamiecakes,</p>
<p>I checked on the Bureau of Labor Statistics web site. They didn’t specifically provide the wage breakdown for NPs by state, so I looked at Physicians Assistants. For NY, the mean wage is $93,600 and $45/hr. For TN, the mean wage is $90,000 and $43/hr. Here is a link to the web site if you want to compare averages for each state as well as metropolitan areas and cities:</p>
<p><a href=“http://www.bls.gov/oes/current/oes291071.htm[/url]”>http://www.bls.gov/oes/current/oes291071.htm</a></p>
<p>I didn’t realize that upstate NY is considered to be a high cost of living area. Not sure what city you live in. The cost of living for Syracuse is slightly lower than the US average. For Rochester, it is 16% lower than the US average.</p>
<p>I have a couple questions about NPs/ physicians assistants.
Is the difference in the path?
A friend is a NP, & started out as an RN, but wanted to go further into her field and so she has a Ph.d.
One of my Ds friends was an EMT, then a Paramedic, then a P.A.</p>
<p>N.Ps can open their own practice ( as a psychiatric NP for example), but are PAs allowed to write prescriptions?</p>
<p>Id agree that a disproportionate amount of money is spent on the last year of someones life & not to labor the point, but I wonder if patients and their families had better communication with medical staff, if all those tests and procedures and hospital stays would be necessary.</p>
<p>We do spend money on the beginning of life though, although the pre-term birth rate has been dropping. finally.
[Map:</a> Premature birth rates](<a href=“http://www.cnn.com/interactive/2012/11/health/map-preterm-births/index.html]Map:”>Map: Premature birth rates)
[CDC</a> - Preterm Birth-Prematurity - Maternal Infant Health - Reproductive Health](<a href=“http://www.cdc.gov/reproductivehealth/maternalinfanthealth/PretermBirth.htm]CDC”>Preterm Birth | Maternal and Infant Health | Reproductive Health | CDC)</p>
<p>The thing about preventing pre term birth not only saves us money in neonatal care, but reduces the incidence of physical and mental disabilities that will need to be treated & accommodated in the schools and in the workplace.</p>
<p>“I didn’t realize that upstate NY is considered to be a high cost of living area. Not sure what city you live in. The cost of living for Syracuse is slightly lower than the US average. For Rochester, it is 16% lower than the US average.”</p>
<p>What one pays in property tax is very high here considering the cost of housing in the area. For example, I pay over 8K on a house worth approx $260K. Some other states have a similar property tax for a similar priced home (for example Texas) but the difference is my home in Texas (a wee 3 bedroom 1 1/2 bath ranch approx 1700 sq. feet) would cost much less in Texas (except probably Austin.) For $260K in most parts of Texas I could be living in a much bigger home for that price. In other parts of the country I could be living in a house which is a McMansion, costs less than my house and pay a lot less in property taxes. </p>
<p>Highest Property Tax as Percent of Home Value
- Orleans County, N.Y. (3.05 percent)</p>
<ol>
<li><p>Niagara County, N.Y. (2.87)</p></li>
<li><p>Monroe County, N.Y. (2.81)</p></li>
<li><p>Allegany County, N.Y. (2.77)</p></li>
<li><p>Montgomery County, N.Y. (2.72)</p></li>
</ol>
<p>[Counties</a> in the U.S. with the Highest (and Lowest) Property Taxes - CBS News](<a href=“http://www.cbsnews.com/8301-505123_162-41142712/counties-in-the-us-with-the-highest-and-lowest-property-taxes/]Counties”>http://www.cbsnews.com/8301-505123_162-41142712/counties-in-the-us-with-the-highest-and-lowest-property-taxes/)</p>
<p>All of these counties are in Western NY or Central NY.</p>
<p>Isnt there a property tax deduction?</p>
<p>“Id agree that a disproportionate amount of money is spent on the last year of someones life & not to labor the point, but I wonder if patients and their families had better communication with medical staff, if all those tests and procedures and hospital stays would be necessary.”</p>
<p>Medicare figured that out. The hospice care program saves you and me hundreds of millions of dollars each year. For the most part, patients rarely see doctors; they don’t go to hospitals except for conditions incidental to their terminal one (like a broken arm), they are kept comfortable, either in their homes, assisted living facilities, or nursing homes. Social workers and chaplains work directly with patients and families, and nurses (like my wife) work to maximize quality of life in the time left.</p>
<p>Without Medicare, this would never have happened. Money that would be going to insurers, hospitals, and docs is now going to nurses, social workers, and chaplains. But, as a society, through our government, we’ve decided that quality of life issues are more important in end-of-life care rather than all heroic measures, and have provided that option. No one is forced to take that route, but it is there, and growing. This is what can happen (doesn’t have to happen, but can happen) when health care is rooted in democracy rather than in corporate capitalism, and it is happening right here in the United States.</p>
<p>Hospice care for the elderly is great, but keep in mind that it is an option, not a requirement. My father ultimately died of kidney failure in hospice at 89. He was offered, but chose not to do dialysis treatments in the hospital. He had been in the hospital for weeks before that decision was made. My mother in law died of cancer in hospice at 85. She was offered, but chose not to do chemo in the hospital. She was in the hospital for weeks before that decision was made.</p>