Article - unnecessary medical care

[Bluegoat]

I thought some here might be interested in this this New Yorker article on medical care - it's one of the better ones I've read.  It is largely about the American system but speaks to many other countries practices as well.

 

Overkill - America's Epidemic of Unnecessary medical Care

[Annie G]

That was interesting. Thanks for posting!

 

[JumpyTheFrog]

I will have to read it tomorrow. For now, I will say that I am amazed at how many people go to their doctors for fatigue without even trying to get enough sleep first. I'm not talking about people with insomnia, but people who don't bother to get more than 6-7 hours and then complain about being tired all the time. We need to change whatever is wrong in our culture that makes middle-class adults (who don't need to work two jobs to make ends meet) act like little kids who refuse to go to bed and then wonder why they are tired, cranky, and overly hungry.

[milovany]

Good article, thanks.  I experienced this for the first time myself a couple of times this past late summer/early fall.  I have hardly ever gone to the doctor as an adult. Very healthy with little need, but once in awhile something has come up and if I needed care, I went in. I had recently chosen a PCP and had an annual exam.  There, she both scheduled me for a mammogram (even though I have no family history, am not 50 yet, had no discernible or possible lumps, and have nursed seven babies) and wanted to remove a dark, uneven mole by my belly button that has been there forever and hasn't changed one bit. I didn't do either of those things. 

 

A month or so later, I developed an itchy itchy rash on both my forearms.  It was spotty and spreading so I went in.  On this visit, she looked at the rash pretty thoroughly including through a magnifier.  Without any kind of test (there's no perfectly conclusive test, but there are two things one can at least try), she said she thought it might be scabies and proceeded to write the prescription for what was basically a pesticide that I was supposed to rub all over my body and leave on for 8-10 hours. I had a really hard time committing to doing that when she only thought it was scabies.  After some research online, I realized that usually you treat everyone in the home if one person has or might have scabies because it's so contagious, that there's something called a scratch test which can easily come out with a false negative result but might come out very positive, and that you can do a simple test with a sharpie on the skin to see if you see the mites' tunnels. I started doing some hot bath treatments I read about online while I decided what to do.  I went to see a PA a couple of days later, who has had scabies herself from her work with AIDS patients, and she was flabbergasted at the scrip and said, "You didn't do it, did you?!"  I was relieved.  Then when I was at the hematologist a couple of weeks later, for something else, he thought from my records that I had done the treatment and when I told him I actually hadn't, he was very relieved. (It's since gone completely away).

 

These experiences left me a little bit skittish, but I relate very much now to what the articles says.  I know that medical care isn't bad, but I do think too much is prescribed to "be on the safe side." 

Edited November 20, 2015 by milovany

[Mergath]

Good article, thanks.  I experienced this for the first time myself a couple of times this past late summer/early fall.  I have hardly ever gone to the doctor as an adult. Very healthy with little need, but once in awhile something has come up and if I needed care, I went in. I had recently chosen a PCP and had an annual exam.  There, she both scheduled me for a mammogram (even though I have no family history, am not 50 yet, had no discernible or possible lumps, and have nursed seven babies) and wanted to remove a dark, uneven mole by my belly button that has been there forever and hasn't changed one bit. I didn't do either of those things. 

 

A month or so later, I developed an itchy itchy rash on both my forearms.  It was spotty and spreading so I went in.  On this visit, she looked at the rash pretty thoroughly including through a magnifier.  Without any kind of test (there's no perfectly conclusive test, but there are two things one can at least try), she said she thought it might be scabies and proceeded to write the prescription for what was basically a pesticide that I was supposed to rub all over my body and leave on for 8-10 hours. I had a really hard time committing to doing that when she only thought it was scabies.  After some research online, I realized that usually you treat everyone in the home if one person has or might have scabies because it's so contagious, that there's something called a scratch test which can easily come out with a false negative result but might come out very positive, and that you can do a simple test with a sharpie on the skin to see if you see the mites' tunnels. I started doing some hot bath treatments I read about online while I decided what to do.  I went to see a PA a couple of days later, who has had scabies herself from her work with AIDS patients, and she was flabbergasted at the scrip and said, "You didn't do it, did you?!"  I was relieved.  Then when I was at the hematologist a couple of weeks later, for something else, he thought from my records that I had done the treatment and when I told him I actually hadn't, he was very relieved. (It's since gone completely away).

 

These experiences left me a little bit skittish, but I relate very much now to what the articles says.  I know that medical care isn't bad, but I do think too much is prescribed to "be on the safe side." 

 

What is it with doctors thinking every rash is scabies? That happened to dh. He had an itchy foot rash with peeling skin that wasn't going away with foot cream, so he went in to see the doctor. She told him it was scabies, wrote a prescription for all of us to slather that poison crap all over our bodies even though dh had it for months and dd and I had no symptoms at all. Scabies is highly contagious, from what I've read. There's no way he could have had it on the bottoms of his feet for months without dd or I getting it too. I mean, we all go barefoot at home. And she didn't test it to make sure or anything. Just looked at his feet and said, "Yup, scabies."  :cursing:

 

He went to another doctor who actually figured out what it was, and yeah, it wasn't scabies. I'm really glad we never filled those prescriptions.

[Ms.Ivy]

This is why we have problems with antibiotic resistance now.  It's frustrating because medication over-use is portrayed generally as a patient problem, but it's also the doctors over-prescribing.  I had an ER nurse go ballistic on me for not giving my toddler ibuprofen for a normal fever.  She thought I was going to make my kid have brain damage from seizures.  I explained to her that I was following the pediatrician's advice to NOT give pain meds for normal viral fevers, and that he said pain meds do NOT prevent febrile seizures, but she had a major case of fever phobia and ridiculed me and berated me for quite some time.  (My doc confirmed the next day that I was totally in the right).  And then there was the time an OB wanted me to take THREE GD screens during my 5th pregnancy because my 3rd baby was big, even though I had been screened for it for all of my previous pregnancies, never had high blood sugar, never had a previous GD diagnosis, and had no current symptoms.  But by golly, I had a big baby so we must keep testing!  And my mother in law, who goes to the doc for every cough and sniffle, gets prescribed antibiotics EVERY time!  That is so frustrating to me!  

[SarahB82]

I really enjoyed this and agreed. Thanks for sharing.

[creekland]

All I know is I'm looking forward to when middle son graduates from med school.  I trust him and know he'll be a great adviser for when to do what and who to see.

 

Until then I'm finding that medical stuff really gets me frustrated - not knowing when to do what or what to be concerned about and what to ignore.

[J-rap]

I think doctors have gotten paranoid about missing something and then being held responsible.  Or patients demand further tests for peace of mind.  I'm often surprised at the number of people who bring their children in to the doctor for the flu.  I mean, if it gets really bad and it sounds like it's turned into pneumonia or something -- fine.  But just the regular old flu?  Sure, it makes you feel really sick and it lasts for a few days, but then it goes away.  You usually don't need a doctor for that.

 

I always appreciate doctors who have common sense, and it helps when you have a history with the same doctor too.

 

Then again, I think of when my husband had one of his really, really bad migraines (which he got once/year) and the doctor offered to do a CAT scan, which my husband declined because he really did get them that bad about once a year.  It turns out he was stroking and didn't know it, and if he had only had that darn CAT scan...

 

So, I guess that's the type of thing doctors are afraid could happen.  Still, I agree -- lots of unnecessary testing going on.

[SparklyUnicorn]

Yeah this is why I don't go often.  I don't want to be treated for nothing.

 

Couple of years ago my husband decided to get a physical.  So the doc ordered the lab stuff.  DH went in for the other parts.  They scheduled a follow up to discuss the lab work.  The lab work all came back showing no issues at all.  So kinda dumb to do a follow up for that.  But then after they told him to schedule a follow up to the follow up.  So a follow up after a follow up for normal lab work?!  My husband said no thanks and found a different doctor.  That's so ridiculous. 

 

I went to the OB when 38 and she schedule a mammo.  For what I do not know.  I didn't go.  Good grief. 

 

I understand.  You go there so you are expecting something, but I really don't want unnecessary tests and procedures.  For one thing I get very stressed out going there in the first place. 

 

So basically now I only go if I have a major problem. 

[Murphy101]

I'm torn. Otoh, it's so damn hard to just get care at all. I don't know anyone who goes to the dr unless they really really think they absolutely need to. They have to take off work, usually without pay or with looking bad to their boss. They have to at least pay a copay and then of course there's the % of whatever the dr prescribed. God forbid if there's also other Appts or follow up that requires more time off work. Even a sahm, has to find childcare and it often isn't free or easy to schedule either. And then I get ticked bc I have to really come in prepared to fight for information and care. Most of the time the dr wants to do a ton of stuff that is completely not helpful in any tangible way, but won't discuss the pros and cons of my various options. If I push for anything it's always "your insurance will pay for it or your insurance won't pay for the if we don't do it this way or Drs insurance regulations say I have to do this" when I say I don't have insurance, it's like a whole new world of discussion or zero discussion bc they are overwhelmed with what all to discuss.

 

So basicly, just another example of why American healthcare is crap I guess.

 

I want my Drs to explain the pros and cons of ALL my options and why they think I should choose one over all the others. I want them to do it without fear mongering or patronizing. I want them to respect my decision based on what they have told me.

[SparklyUnicorn]

 

I want my Drs to explain the pros and cons of ALL my options and why they think I should choose one over all the others. I want them to do it without fear mongering or patronizing. I want them to respect my decision based on what they have told me.

 

I want this too, but I never come across a doc who does.  They just assume I'm going to do whatever they suggest.  Not necessarily.  I have GERD.  I take something OTC for it and that works fine.  But they told me if it doesn't go away they want to run tests.  For what?  The treatment would not be different if they discover I have GERD.  I don't want someone sticking scopes down my throat for nothing. 

[Bluegoat]

I think fear of litigation or missing something is one reason for this.  Maybe another is a tendency to see technology and medicine as solutions to problems.

 

Years ago - more than 20 now - i read a really interesting book called medicine and Culture.  It looked at the cultural attitudes of medicine in a few different countries - Germany, France, the UK, and the US.  One of the characteristics they identified with the US system is that it tended to be very aggressive - with kind of a heroic narrative attached to fighting disease.  I think that approach may go beyond medicine and be just a wider cultural phenomena that affects all kinds of things we do.

[Bluegoat]

One of the things I found really interesting in the article is that the doctors in the town that was spending so much money seemed to be really unaware that they were practicing bad medicine.

 

I agree that doctors that are so patronizing and paternal are really really annoying.  My sister and I often have trouble with doctors - we both grew up with a GP step-dad who was really big on the idea that people were in charge of their own health care and their goals for it.  And the doctor I had as a child was very much like that. 

 

Boy, was I surprised when I got older and discovered many doctors really resent patients who want to decide what is important to them, or not.

[creekland]

Boy, was I surprised when I got older and discovered many doctors really resent patients who want to decide what is important to them, or not.

 

My ideal world still has this as a team effort.  I'm in charge of the team since it's my body, but since I'm not the most knowledgeable medical person on the team, I want someone to fill in that gap and doing so by sharing their thoughts/opinions and reasons for them.  Reasoned discussion is the way I work the best.  Blind trust is the worst.

 

This is a big reason why I'm impatiently waiting for middle son to finish his schooling.  He was brought up with my ideal for teams and "getting things done."  Discussions have always been part of his life.  I'm pretty sure that even if med school tries to corrupt him, I can get him to switch back for me.

 

Since he's been shadowing multiple doctors lately he's already keyed in on those he likes/admires and others who "do their job."  His stories lead me to believe he's on the right track!

[SparklyUnicorn]

One of the things I found really interesting in the article is that the doctors in the town that was spending so much money seemed to be really unaware that they were practicing bad medicine.

 

I agree that doctors that are so patronizing and paternal are really really annoying.  My sister and I often have trouble with doctors - we both grew up with a GP step-dad who was really big on the idea that people were in charge of their own health care and their goals for it.  And the doctor I had as a child was very much like that. 

 

Boy, was I surprised when I got older and discovered many doctors really resent patients who want to decide what is important to them, or not.

 

Yes, and we have fairly easy access to information.  I've had doctors who were upset that I had a take charge attitude, but then I've had some that didn't mind it at all.  Heck, I even had a therapist ask me how I'd diagnose myself. LOL

 

I figured out what the spot on my son's eye was.  The regular doc did not know.  The eye doc did know, and I was correct. 

[Catherine]

I think doctors have gotten paranoid about missing something and then being held responsible.  Or patients demand further tests for peace of mind.  I'm often surprised at the number of people who bring their children in to the doctor for the flu.  I mean, if it gets really bad and it sounds like it's turned into pneumonia or something -- fine.  But just the regular old flu?  Sure, it makes you feel really sick and it lasts for a few days, but then it goes away.  You usually don't need a doctor for that.

 

I always appreciate doctors who have common sense, and it helps when you have a history with the same doctor too.

 

Then again, I think of when my husband had one of his really, really bad migraines (which he got once/year) and the doctor offered to do a CAT scan, which my husband declined because he really did get them that bad about once a year.  It turns out he was stroking and didn't know it, and if he had only had that darn CAT scan...

 

So, I guess that's the type of thing doctors are afraid could happen.  Still, I agree -- lots of unnecessary testing going on.

 

J-rap, you have hit the nail directly on the head here.  NO ONE can be certain of the outcome of any given situation.  We can't see the future yet.  

 

One point of the article is that a lot of testing and medical intervention that is done is not necessary, or is even potentially harmful.  The drivers of this phenomenon are multiple: CYA\litigation, profit, poor knowledge of scientific information, and patient fears\demands.  No one factor is responsible.  For every sensible person who declines offered antibiotics for a cold, the is another who throws a tantrum and leaves the practice over NOT getting antibiotics for a cold.  

 

Sparkly Unicorn, you have not gotten good care.  Chronic reflux is a major risk factor for cancer.  Your doctors should have explained that to you...they are not suggesting a test without good reason.  Clearly, you did not get that very important piece of information!  

[kiana]

Couple of years ago my husband decided to get a physical.  So the doc ordered the lab stuff.  DH went in for the other parts.  They scheduled a follow up to discuss the lab work.  The lab work all came back showing no issues at all.  So kinda dumb to do a follow up for that.  But then after they told him to schedule a follow up to the follow up.  So a follow up after a follow up for normal lab work?!  My husband said no thanks and found a different doctor.  That's so ridiculous. 

 

Ugh, my clinic just called me and (at my request) e-mailed me a scanned copy of all the lab work. I love this place and their hands-off approach. 

[SparklyUnicorn]

Sparkly Unicorn, you have not gotten good care.  Chronic reflux is a major risk factor for cancer.  Your doctors should have explained that to you...they are not suggesting a test without good reason.  Clearly, you did not get that very important piece of information!  

 

Right.  But so what will they do about it?

[creekland]

 I've had doctors who were upset that I had a take charge attitude, but then I've had some that didn't mind it at all.   

 

I suspect it's pretty much like every other profession (teaching, etc) where different people have different styles of doing their job.

 

FWIW, I've yet to meet a doctor I didn't like - when sitting next to them in an airplane.  They've been interesting people with diverse personal histories and quite a bit of thinking knowledge on various topics (not necessarily medical).  I have no idea how many of these I would like if I met them in a professional setting.  We never discuss that aspect or anything remotely similar to it at all.  The closest we get are suggestions from them for middle son as he approaches the field.

 

Businessmen, OTOH (IME), tend to be more self centered or self-righteous - eager to tell me what's right or wrong about any given subject.  It's not always that way, but there's a definite correlation.

 

Grandparents tend to talk about their grandkids.

 

Those may be the only people who fly as I can't think of any other category I've sat next to in the past few years.  Oh wait... college students can be fun - but I don't get to hear them often.  We tend to fly off season for their travel.

[Bluegoat]

Yes, and we have fairly easy access to information.  I've had doctors who were upset that I had a take charge attitude, but then I've had some that didn't mind it at all.  Heck, I even had a therapist ask me how I'd diagnose myself. LOL

 

I figured out what the spot on my son's eye was.  The regular doc did not know.  The eye doc did know, and I was correct. 

 

I've rarely had trouble with an argument over me doing research - the exception was maternity care which seems to be crazy.  In the end, what usually causes the problem has more to do with values.  So, for example, the doctor and I might know the same risk information, and the same information about a test, but I might not think it is as important or be willing to deal with the side effects, or maybe I know I wouldn't do anything differently anyway.

Edited November 20, 2015 by Bluegoat

[Bluegoat]

I find it interesting to look at some of the differences in the US and what is considered basic.  The whole idea of yearly check-ups is not normal here in Canada - once kids enter school they generally see their GP on an as-needed basis, and the same goes for adult men.  Women are a little different because they get paps, but even then it is only every third year, and if they haven't ever been sexually active they don't get them.

[SparklyUnicorn]

I've rarely had trouble with an argument over me doing research - the exception was maternity care which seems to be crazy.  In the end, what usually causes the problem has more to do with values.  So, for example, the doctor and I might know the same risk information, and the same information about a test, but I might not think it is as important or be willing to deal with the side effects, or maybe I know I wouldn't do anything differently anyway.

 

Sometimes I wish I could go back and have a redo with the maternity stuff (well no not really).  But I don't know.  The whole thing felt extremely medical to me.  Like I was dying of something serious.  I didn't like that at all.

[kiana]

I've rarely had trouble with an argument over me doing research - the exception was maternity care which seems to be crazy.  In the end, what usually causes the problem has more to do with values.  So, for example, the doctor and I might know the same risk information, and the same information about a test, but I might not think it is as important or be willing to deal with the side effects, or maybe I know I wouldn't do anything differently anyway.

 

Right. Like when the doctor wanted my mother to take a certain medication which gave her horrible side effects (constant pain and severe depression) because it would reduce her risk of a second heart attack by (literally) 5%, she said "I'll take that 5% extra chance in exchange for my life being worth living over the next year." His idea was that she should take some pain medicine and antidepressants to deal with the side effects. 

[SparklyUnicorn]

I find it interesting to look at some of the differences in the US and what is considered basic.  The whole idea of yearly check-ups is not normal here in Canada - once kids enter school they generally see their GP on an as-needed basis, and the same goes for adult men.  Women are a little different because they get paps, but even then it is only every third year, and if they haven't ever been sexually active they don't get them.

 

Yeah it's interesting.  My husband, from Germany, never had stuff like routine dental cleanings.  They did periodic check ups, but that was it.  And he had no issues with his teeth.  He does go regularly now and takes the kids, but that is mostly because it is the one thing they pay in full with the insurance. 

[catz]

I have totally seen this.  My grandmother was a perfect case study.  They ordered so many ridiculous tests for her.  She worked a night shift for 40 years and always had an off sleep schedule.  They ordered a sleep study when she was in her 80's.  And that was the tip of the iceberg. 

 

My dad dropped dead after living for 18 years with a heart condition this year at age 71.  He was living life to the fullest to the end (hiking, golfing, etc).  I do wonder if he could have lived longer with a defib and/or pacemaker.  That said, I feel like I am seeing more OVER treatment than under.  Especially in healthy people as preventative.

Edited November 20, 2015 by WoolySocks

[bagel270]

Around here you have to bring your kids to the doctor every time they get the flu, because the ps needs a note. Which is why we avoid the doctor as much as possible. 

[Ravin]

We were going down one of these rabbit holes with DD last year, with her migraines and chronic pain issues and stomach aches. More tests, more meds, more specialists.

 

What actually helped was getting out of the high-stress, not-enough-sleep environment of the brick-and-mortar school she was attending that year. Go fig.

[kiana]

This one can be treated if it's caught early, and is not one of the "turtles" mentioned in the article. Esophageal cancer kills fast and horribly. One of my husband's coworkers died of it a few years ago. His oncologist told him that he should have been checked regularly because of his chronic reflux and it likely would have saved his life.

 

What she said. I recently lost a friend to this as well, and the passage from diagnosis to dead was not that long. He was in a high-risk category but didn't like doctors and so was never checked. 

[Bluegoat]

Right. Like when the doctor wanted my mother to take a certain medication which gave her horrible side effects (constant pain and severe depression) because it would reduce her risk of a second heart attack by (literally) 5%, she said "I'll take that 5% extra chance in exchange for my life being worth living over the next year." His idea was that she should take some pain medicine and antidepressants to deal with the side effects. 

 

Yeah, the thing with the heart attack meds, and cholesterol and such, is crazy.  It's like they don't even stop to think "how effective are these drugs, really."  How is that not something you take into consideration?  It's like they are just following a flow chart "X problem, administer X solution."

 

If that's all we need from doctors we probably could make medical school a one year program..

[SparklyUnicorn]

This one can be treated if it's caught early, and is not one of the "turtles" mentioned in the article. Esophageal cancer kills fast and horribly. One of my husband's coworkers died of it a few years ago. His oncologist told him that he should have been checked regularly because of his chronic reflux and it likely would have saved his life.

 

What is the treatment?

[Carol in Cal.]

Actually, it's the routine feeding of low levels of antibiotics to farm animals that is creating the resistant germs.  It's ridiculous.

[J-rap]

Around here you have to bring your kids to the doctor every time they get the flu, because the ps needs a note. Which is why we avoid the doctor as much as possible. 

 

Wow, that seems like a crazy system to me!  Not only is that a lot of unnecessary work and expense, but it exposes other patients at the clinic.

 

[G5052]

MRI's have really been overused. We have a big box of them in our basement.

 

And they lie. Both DH and I have had surgeries that ended up being way different than they expected from the MRI. One of DH's was totally unnecessary once they got in there.

 

Thankfully that seems to be changing though. Of late the orthopedists we've seen do a thorough in-office evaluation and x-ray, and deal with the details in the operating room.

[SparklyUnicorn]

MRI's have really been overused. We have a big box of them in our basement.

 

And they lie. Both DH and I have had surgeries that ended up being way different than they expected from the MRI. One of DH's was totally unnecessary once they got in there.

 

Thankfully that seems to be changing though. Of late the orthopedists we've seen do a thorough in-office evaluation and x-ray, and deal with the details in the operating room.

 

Not to mention they cost a million dollars.

[SparklyUnicorn]

Here's a link on early treatment. If it's not caught before it progresses it's treated with one or more of chemo, radiation, and surgery.

 

Sounds horrid.

 

I take medication and it is well controlled.  The cancer is very rare.  The surgery is also highly controversial.

[Bluegoat]

I went into the doctor about a year ago for a horrible rash on each side of my ribcage. I thought I might have had shingles. I walked out of that appointment with orders for a mammogram (I'm 43yo, no family history, no reason to suspect anything) and bloodwork (for anemia, vitamin levels, etc). I did the ordered tests, which of course came back fine. Meanwhile, the rash persisted.

 

But the thing about that initial appointment that really made wonder about this doctor is that she seemingly refused to believe that I didn't ACTUALLY come to see her for an antidepressant. I honestly have NO idea why she kept asking me if I was okay. She kept saying I seemed so sad, was there anything I wanted to talk about, am I sure I don't want a mild antidepressant. WTH, lady! I'm here for a freakin' rash!

 

There is something very disturbing about the anti-depressant thing.  The literature does NOT suggest that it is a good idea to be putting people on them casually.  Some of it even suggests that they don't actually work all that well.

[TravelingChris]

Thanks for the article.  It is why I went with a concierge doctor who uses a lot of low tech but effective ways of ruling things out.  He is not onw to rush out and prescribe but talks to us and figures out whether an illness is likely to be bacterial in nature or viral.  WHen I had a UTI, he only had me on three days of antibiotics rather than the many more my old doctor used to prescribe.

[creekland]

 refused to believe that I didn't ACTUALLY come to see her for an antidepressant. I honestly have NO idea why she kept asking me if I was okay. She kept saying I seemed so sad, was there anything I wanted to talk about, am I sure I don't want a mild antidepressant. WTH, lady! I'm here for a freakin' rash!

 

That's ok.  I'm pretty used to all of my issues being stress.  It's become an inside joke to both my family and very inner circle of friends (who know about the medical issues) considering I'm the least stressed of any of us IRL.

 

"Why do you suppose this is swelling/painful/numb?"  "Duh! It's that stress from the cold/hot/sun/wind/dinner/cat crossing my path/TV show/vacation thoughts/lack of vacation thoughts/______."

 

Considering a fair amount of time things feel relatively good we all figure that must be stressful too.   :coolgleamA:

 

Haven't had a rash (yet), but I assume those can come from stress. ;)

[JumpyTheFrog]

There is something very disturbing about the anti-depressant thing. The literature does NOT suggest that it is a good idea to be putting people on them casually. Some of it even suggests that they don't actually work all that well.

Last year I read two books by two different psychiatrists about the overdiagnosis and drugging of people, especially kids. One or both of them mentioned that studies of antidepressants show that they are about 70% effective, but the catch is that the placebos are about 60% effective. In other words, they have some of the highest placebo effect of any treatment for any condition.

[JumpyTheFrog]

When people discuss having single-payer medical care in the US, in the back of my mind I always have this nagging thought that it would turn out to be much more expensive here than elsewhere because people are so conditioned to get aggressive treatment first and only change lifestyle if pills or surgery don't work. People here don't get nearly as much vacation time as in much of Europe, so that right there makes our country's poor health harder to fix.

[JumpyTheFrog]

I just remembered an article I read about an HMO or health insurance plan in California or Nevada (I think). When analysts looked through all the claims for some time period, they found that something like 5-10% of doctors were accounting for half their expenses (and it wasn't because they were all neurosurgeons or anything like that). They decided that these doctors were either committing fraud and/or overtreating their patients, so they dropped them all from the plan. Claims dropped significantly and apparently without too many problems.

[Catherine]

Right.  But so what will they do about it?

Surveillance.  Intervention (surgical) if pre-cancerous or cancerous cells develop.  But the evidence is not yet crystal clear about the best approach to surveillance, the subgroups that benefit least and most from surveillance, and the best interventions.  It appears that surveillance is beneficial in terms of saving lives, but it's not perfect.  Some people who have had careful surveillance still get advanced cancers and die from them.  And obviously many people get no surveillance and are fine.  The details are still not clear.   

[Lolly]

I find it interesting to look at some of the differences in the US and what is considered basic.  The whole idea of yearly check-ups is not normal here in Canada - once kids enter school they generally see their GP on an as-needed basis, and the same goes for adult men.  Women are a little different because they get paps, but even then it is only every third year, and if they haven't ever been sexually active they don't get them.

 

Yep. And, if you don't make your yearly appts here, the doctors will often refuse to see you for ill visits.

Around here you have to bring your kids to the doctor every time they get the flu, because the ps needs a note. Which is why we avoid the doctor as much as possible. 

 

And, this is what has created a lot of the problem. People think that if they sneeze, they need to see a doctor. It might "be something serious". Dd22 had to go the dr because she missed class and needed a note. Why did she miss class? She was throwing up...She didn't need a doctor to tell her she had a stomach bug. But, she had to have the note to be allowed to make up work. I've been doing records for a hospital recently. They require a doctor's note for missing work. You would think a nurse would be able to tell if they are sick...But, you can't trust people I guess. Someone might skip out a day to take a hike or something...

 

In addition, our society has just become a little nuts. People don't seem to know when they should and should not consult a doctor. You run a fever at night--get to the ER. Kid has a pain in the stomach--ER now. Even though they have had that pain off and on for days. My neighbor literally takes her kids in every time they sniffle or sneeze. And, she is usually given a prescription and patted on the back for her diligence. She does not understand me at all. I taped my kids back together when they could have gotten stitches. Myself too. The scars are a little more defined than stitches would have left, but who cares about that little scar under the chin, on the knee, or (in my case) on my fingers. Our whole countries attitude towards medicine is going to need to change. If you have an eighty year old who could live another year if they receive chemo, in most cases you shouldn't treat their cancer. It is a hard and cold decision to make. But, our country cannot afford to spend thousands and thousands of dollars to provide treatment that will extend a life for a year. Yet, it is one that is done on a very regular basis. My fil died after surgery to remove a brain tumor. If it had been me, I probably would have just left it. At his age, just treating with medications to allow him to be lucid longer would have been a better option. Instead, they opted to do surgery despite his multiple problems which made surgery risky. After a couple of months in the hospital on life support, his kids finally decided it was time. When it is family, it is hard to see beyond the desire to keep your loved ones with you. They took heroic measures with mil too. It amazed me that they truly believed they were going to bring her home. I just shook my head and hoped not. I knew if she did come home, it would not be the same person we took to the hospital. And, I would be the one taking care of her. They would all come visit once, maybe twice a year.

[Valley Girl]

I think doctors have gotten paranoid about missing something and then being held responsible.  Or patients demand further tests for peace of mind.  I'm often surprised at the number of people who bring their children in to the doctor for the flu.  I mean, if it gets really bad and it sounds like it's turned into pneumonia or something -- fine.  But just the regular old flu?  Sure, it makes you feel really sick and it lasts for a few days, but then it goes away.  You usually don't need a doctor for that.

 

 

I agree with your first two statements, but I don't think the rest is really fair.

 

Not every parent feels confident in his or her ability to tell a serious from a not-serious illness. Some may have experienced the situation of having something become serious because they thought it was "just" something simple and didn't seek treatment sooner. Some may want reassurance that it IS "just" the flu and that their home care strategies are on the mark. Some may be concerned because their child feels so miserable and can't be comforted even if it's not pneumonia. There are lots of reasons some parents might seek a professional opinion when others don't.

[Guest]

Every time I read one of these threads, I want to kiss my pediatrician square on the mouth!

[Word Nerd]

High C section rates are another prime example. I'm thankful for the care I had during labor and delivery, but once they start the medical interventions, other interventions often become necessary.

Edited November 20, 2015 by Word Nerd

[creekland]

I taped my kids back together when they could have gotten stitches. 

 

You did this?  My mom would just point to the bathroom and let me take care of my problems.   :lol:  She taught me how to use antibiotic cream (and washing) and various types of bandaids pretty young.

 

Considering my folks divorced when I was 11, it was definitely at least a couple of years before that age.

 

The only "bad" time was when I fell from one of our ponies and was dragged across the paved road and dirt driveway.  That took a bit to clean up.  Nonetheless, it all healed.

 

The only time I recall having to go to the clinic was when I stepped on a nail - and that was just to update the tetanus shot.

[creekland]

ps  I still wish I could fix everything and take care of everything myself... it would make life so much simpler - no stress involved!

[Garga]

I'm always filled with unending indecision whenever something medical happens around here. Is this something worth going to the doctor for? Or not? What if I go and I've wasted all that time and money? What if I don't go and it's pneumonia?

 

I've made bad calls both ways. Took an infant to the ER with a really high fever. They gave him ibuprophen and he was fine. I should have just done that at home.

 

Didn't take a son with a persistent cough to the doctor. When I finally did, it was pneumonia.

 

I think to myself, "I'll call the office and see what they say," but they always say to come in. So, I'm left alone trying to make these calls. Sometimes I make the right choice, and sometimes like in the examples above, I make the wrong choice.

 

Did I tell you about the time the doctor gave me antibiotics for a mosquito bite that I had? True story.

 

It wears me out. I just want a clear answer. I don't want a bunch of treatment for things that aren't necessary. I want an honest opinion of whether I should come in to the office or wait it out for a few days or what signs to look for if something changes. I guess they don't have time or are scared of a lawsuit.

Edited November 20, 2015 by Garga