https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/
David Freeman claims that US health care costs are high at least partly due to American patient preferences and habits.
This lost me in the first few paragraphs. My dad attributes his longevity to not going to doctors and after his last hospitalization and the incompetence and missed communications we encountered during that time I had to agree. The added costs were NOT from my dad asking for anything but the establishment padding bills is the problem. The bureaucracy is a tangled mess
How many “referrals “ do you need in 10 min increments of “hi I’m Dr X. Just came in to see how you’re doing. “. Never to be seen again. And worse yet a recommendation that is totally off base.
Every patient entering the system needs a 24 hour patient advocate to make sure they navigate the maze and get the care they deserve. I know this will never happen but I can dream.
Just keep reading the “parents caring for parents” thread and that’s worth a million times more than this useless article.
Some of that is clearly true: Americans would be in a lot better health if they all quit smoking/drinking/using recreational drugs, started eating healthy, took their prescribed medications, and exercised regularly. Some patients sound crazy: demanding exploratory surgery for non-specific pain. Other issues, like heading to specialists might be something the US does right. There’s a growing body of evidence procedures are best done by specialists. A family physician might be able to do your colonoscopy, but a gastroenterologist is likely to have fewer complications and catch polyps or cancer a family doctor might miss. In the old days or in a rural area, a family physician might deliver a baby. Now, almost all women would insist on a OB/GYN. Would you rather have your family physician or an orthopedic surgeon fix a broken bone?
My dad does have preferences that might “drive up costs”. He prefers a doc that actually knows what they’re talking about vs a fresh “practitioner “ (nurse, PA) who doesn’t have any experience.
My DH claimed the same thing until it turned out that ignoring a recommendation to get an early colonoscopy resulted in a fulminating cancer that wasn’t discovered until Stage 3, necessitating radiation, chemo, and life altering surgery in order to save his life. Happy to be alive but his lifestyle forever changed, he kicks himself for his “arrogance”, and wishes he had taken on a more balanced approach.
Can’t imagine going to a “family physician” for a colonoscopy.
My dad follows doctor orders and is great at lifestyle changes. Probably why he’s still here. He’s 97. He exercises and takes care of himself.
But he pays close attention to his body signals too. If he needs sleep, he needs sleep. He does what’s needed to heal.
In the hospital he was woken up every couple hours for a week for vitals, blood test, meals, PT, doctor visits, rounds, nurse change of shift, social workers, chaplains, the “turn team”. Or was supposed to—we (sis and me) literally threw staff out of the room. Even when orders were written to let him rest undisturbed he was disturbed.
He lost 15 pounds in a week. 136 to 122. Ridiculous. Brainwashing has less torture involved. So much strength lost.
I was there. They wanted to send him to rehab. I took him home. That was tough. But I think they would have literally killed him from lack of food and sleep. He thought so too. Everyone was “following orders”. They all did care. I’ve no doubt. They were too busy looking at a computer screen and checking boxes to really connect with what my dad needed.
And that’s what’s really wrong.
Articles like this are way too black and white. Some patients are like this. Some patients aren’t. Sometimes hospitals are efficient. Sometimes they are not.
If/when I’m ever in the hospital again and some doctor walks in and says, "Hi I’m Dr X. Just came in to see how you’re doing,“ I"ll ask him/her his/her speciality and why s/he’s visiting me. Then, if it makes no sense, I’ll tell that doctor that I’ll be scrutinizing the itemized hospital bill and not paying his/her portion.
Big talk, I know. The insurance will pay it before I even see the bill. Patients are powerless.
@VeryHappy it’s very likely you will see a hospitalist at least once while you are in the hospital. It’s their job.
To manage the specialists who visit me?? Or, just to visit me?
Uh, no way is that possible! You have clearly never had a colonoscopy.
@VeryHappy —here’s the trick—when you’re the patient you can’t remember. You’re in pain, asleep, don’t know names etc. you’re eyes are closed.
My dad went to the ER and got a bill later. Blew a gasket at the price and was sure half those people didn’t show up. But I was there with him. I looked at all those name tags.
I knew what department they were with and what their job was. Yep. The doctors, the X-ray people, the nurses (saints), the PA. I knew what each had done.
But that doesn’t always happen.
Many doctors make infrequent visits to hospitals. Actually many primary docs don’t do hospital rounds t all in many places. Hospitalists are doctors who manage the day to day things a doctor needs to manage in a hospital.
If you have specialists, yes, they will see you in the hospital.
Gee, why did I just know, before opening up the thread, that this was going to be another one of those threads declaring how awful Americans are?
Really? Not going to the doctor is an American phenomenon only? Not taking meds as prescribed happens only the the USA?
This is about Canadian health care, but see this study.
https://www.sciencedaily.com/releases/2010/02/100223100657.htm
H is a primary care physician/geriatrics.
Amen to this article. Patients may admit that their own “lifestyle choices” (unhealthy diet, lack of exercise, smoking, drug/alcohol abuse, etc.) are the source of their illnesses, but they refuse to change their behavior. And the older the patients, the less likely they are to change old habits. They want the doctor to fix decades of self-inflicted damage with a magic pill or procedure. Spend a day in a Medicare clinic and see for yourself. The system is broken in many ways, and this is just one of its problems. How can physicians care for people who (proudly) refuse to care for themselves?
And who wants to pay for someone else’s poor choices?
@roethlisburger Thanks. I would never have a colonoscopy without a gastroenterologist.
Is the supply of doctors kept artificially low in order to maintain high salaries?
On CC, you see posts all the time talking about aspiring doctors being advised to avoid competitive majors and/or schools in order to keep their GPA high for med school applications. This makes me think we may be preventing some qualified people from becoming doctors.
@OhiBro that’s because there are thousands of applicants at most medical schools for less than 200 spots.
Medical school and medical residency training is expensive. The latter is subsidized by the government, while the former costs are borne by the medical students (sometimes subsidized by state governments). Because physicians typically carry a huge debt burden from medical school, they “need” high pay to be able to pay off their debt – and they get it because the limited number of medical residency places limits the supply of physicians.