Rolfe
Adult human female
Health care - administrative incompetence
- Thread starter bigred
- Start date
Tatyana
Illuminator
- Joined
- Oct 23, 2009
- Messages
- 3,701
We are working on changing doctors' sick notes.
Instead of being signed off for extended periods of time, doctors are meant to write what sort of duties and for what amount of time a patient is able to do.
Having had one LONG period of sick leave when I ruptured my achilles, I would have preferred to come in part-time for computer work rather than not working at all.
It also takes ages to get back into work, as it is a gradual re-entry (for example, the first week, you would work three hours for four days and gradually increase the hours over a month+).
Being at work at least gives you something else to focus on, and the social interaction is also beneficial.
Gandalfs Beard
Graduate Poster
- Joined
- Feb 14, 2009
- Messages
- 1,548
The REAL deadbeats are the Billionaires that profit from the value added to resources by Labour who actually produces the wealth. These Billionaire deadbeats also get tax-breaks and subsidies which the "regular folk" will never have access to.
It's also a well recognized economic fact that production creates surpluses, which in turn creates pools of "surplus" labour (the unemployed). Alan Greenspan let the cat out of the bag when he stated years ago that unemployment was necessary to keep wages down which in turn keeps inflation down (the Right Wing's answer to surplus labour pools).
In other words, it doesn't matter if there are some poor "deadbeats" in an industrialized economy, because there are plenty of resources to spread around (which is the "Lefty" answer to surplus labour pools).
So rather than a return to the Dickensian notions of the deserving and undeserving poor, you are both economically and morally correct to point out that everyone deserves access to health care in a civilized society.
The problem in the US is that people have been propagandized for generations about the "Evils" of Socialism, and now are prepared to go to bat against their own interests on behalf of the interests of the Rich. It seems like a lot of people don't even realize that they are advocating against their own interests.
GB
Ivor the Engineer
Penultimate Amazing
- Joined
- Feb 18, 2006
- Messages
- 10,645
THERE CANNOT AND WILL NEVER BE A FREE MARKET IN HEALTHCARE.
People can't shop around for the best value healthcare when they're incapacitated by disease. People can't shop around for the best value healthcare when they don't have the knowledge to judge what healthcare is appropriate.
That's not my opinion, it's REALITY.
bookitty
Philosopher
- Joined
- Jul 26, 2009
- Messages
- 5,732
I'm sorry, I phrased that poorly. I was distracted by the too-practical-to-be-implemented idea of cutting out the current insurance networks, the full-time malpractice lawyers, the divisions dedicated to finding loopholes in who gets coverage. All the messy peripherals that have turned basic care into a luxury for people above the upper-class level.
The idea that we go back to an archaic barter system for modern medicine was too ridiculous to actually consider.
bookitty
Philosopher
- Joined
- Jul 26, 2009
- Messages
- 5,732
This.
It's surreal at times. The vilified poor have no power. They can't lobby, they can't influence, they have no sphere, they are passive. Yet they get blamed for the ills of our country. Meanwhile those who actually have power and influence abuse the public trust and get rewarded, even lauded.
Rolfe
Adult human female
Bookitty's story about her MiL, and Ducky's experience, make me wonder about the state of CME in the USA. Maybe this needs another thread, but let's see where it goes.
Bookitty's MiL's doctor didn't tell her about her positive cervical smear tests. That is negligence. It is practice so poor it's pretty much off the scale.
Ducky's original doctors didn't refer him for any spinal imaging despite repeated presentations of a young man in a sedentary job with severe and worsening back pain. I could make a case for that being negligence too. It's certainly extremely poor practice. Then the first hospital he went to x-rayed the wrong part of his spine and missed the lesion, leading to entirely inappropriate treatment recommendations.
OK, there are idiots everywhere. You can find similar stories in the NHS. However, what struck me about these tales was the lack of repercussions.
When this stuff happens in Britain, the patients are likely to sue. But even if they don't, a complaint will almost certainly be made to the hospital or health authority, who will have to investigate what happened. If an individual doctor has been negligent (failure to inform a patient about a positive smear test would qualify), then he will be reported to the GMC. None of that seems to have happened in the cases we're hearing about.
First, I have to ask about general CME in the USA, and how stringently it's enforced. In Britain, GPs have to undertake a specified amount of relevant CME every year, and undergo re-validation assessments every few years where their individual performance is scrutinised and tested. I have heard my GP friends moaning about it. (This has caused losses to the profession. Another friend of mine, the wife of the village doctor, is/was a doctor herself. However, she gave up work to raise three small children. She found she simply couldn't keep up with the requirements to maintain her registration, and voluntarily de-registered.) Any GP who was in the habit of not telling patients about positive smear tests would surely be smoked out and re-educated in this system.
Then I have to ask about medical audit. Within the NHS there is a great deal of scrutiny of medical and surgical outcomes, and if the performance of a particular consultant is falling below expected levels for no good reason, questions are asked. Sometimes hospitals say they have to stop doing particular classes of surgery until they find out why they have had a cluster of deaths.
I know there are some excellent medical facilities in the USA. However, I have to ask, what are the average facilities like? We know all about the Mayo Clinic and places like that, but what about Boondocks General Hospital? Are they auditing their outcomes and comparing them to the best in the country, and taking steps to rectify poor performance? Is the average town GP required to undergo the sort of regular CME and re-validation that NHS doctors have to put up with?
Another thing that struck me about Bookitty's story was the casual acceptance by the insurance company of the doctor's story that he had told the MiL about the smear test results. That woudln't wash here even in veterinary practice. If you have a positive result for a test like that, you have to tell the patient (or the patient's owner), and you have to record that in the medical notes. You have to record that you recommended the patient to go with the appropriate follow-up investigations, and if the patient declines to follow your advice you absoutely have to make a record of this. You would be well-advised to get the patient to sign a disclaimer as well.
Because if you do not do this, then the patient will be believed, when she says you didn't tell her. Even if you did tell her. There is absolutely no question about this. All Bookitty's MiL would have had to do was to make a complaint to the Health Authority, and her medical notes would have been scrutinised, and if there was no entry showing she had been given the results and rejected the appropriate advice, the doctor would have been talking to the GMC.
(Note that part of the Harold Shipman saga was his attempt to falsify patient notes retrospectively to make it look as if he'd advised them about problems they didn't have, or suspected morphine abuse. It was the study of the computer logs showing these entries were retrospective that did for him completely. He had also falsified earlier hand-written notes by squeezing extra sentences into half-filled lines - these things are hard to fake, and do get spotted.)
I'm genuinely curious here. Does the piecemeal, decentralised, every-man-for-himself nature of US medical practice mean that it's a pure toss-up whether you get someone who is on the ball and has maintained his competence, or someone who just wants you out the door so he can get to the golf course, and know there will probably be no repercussions if he screws up?
Rolfe.
Bookitty's MiL's doctor didn't tell her about her positive cervical smear tests. That is negligence. It is practice so poor it's pretty much off the scale.
Ducky's original doctors didn't refer him for any spinal imaging despite repeated presentations of a young man in a sedentary job with severe and worsening back pain. I could make a case for that being negligence too. It's certainly extremely poor practice. Then the first hospital he went to x-rayed the wrong part of his spine and missed the lesion, leading to entirely inappropriate treatment recommendations.
OK, there are idiots everywhere. You can find similar stories in the NHS. However, what struck me about these tales was the lack of repercussions.
When this stuff happens in Britain, the patients are likely to sue. But even if they don't, a complaint will almost certainly be made to the hospital or health authority, who will have to investigate what happened. If an individual doctor has been negligent (failure to inform a patient about a positive smear test would qualify), then he will be reported to the GMC. None of that seems to have happened in the cases we're hearing about.
First, I have to ask about general CME in the USA, and how stringently it's enforced. In Britain, GPs have to undertake a specified amount of relevant CME every year, and undergo re-validation assessments every few years where their individual performance is scrutinised and tested. I have heard my GP friends moaning about it. (This has caused losses to the profession. Another friend of mine, the wife of the village doctor, is/was a doctor herself. However, she gave up work to raise three small children. She found she simply couldn't keep up with the requirements to maintain her registration, and voluntarily de-registered.) Any GP who was in the habit of not telling patients about positive smear tests would surely be smoked out and re-educated in this system.
Then I have to ask about medical audit. Within the NHS there is a great deal of scrutiny of medical and surgical outcomes, and if the performance of a particular consultant is falling below expected levels for no good reason, questions are asked. Sometimes hospitals say they have to stop doing particular classes of surgery until they find out why they have had a cluster of deaths.
I know there are some excellent medical facilities in the USA. However, I have to ask, what are the average facilities like? We know all about the Mayo Clinic and places like that, but what about Boondocks General Hospital? Are they auditing their outcomes and comparing them to the best in the country, and taking steps to rectify poor performance? Is the average town GP required to undergo the sort of regular CME and re-validation that NHS doctors have to put up with?
Another thing that struck me about Bookitty's story was the casual acceptance by the insurance company of the doctor's story that he had told the MiL about the smear test results. That woudln't wash here even in veterinary practice. If you have a positive result for a test like that, you have to tell the patient (or the patient's owner), and you have to record that in the medical notes. You have to record that you recommended the patient to go with the appropriate follow-up investigations, and if the patient declines to follow your advice you absoutely have to make a record of this. You would be well-advised to get the patient to sign a disclaimer as well.
Because if you do not do this, then the patient will be believed, when she says you didn't tell her. Even if you did tell her. There is absolutely no question about this. All Bookitty's MiL would have had to do was to make a complaint to the Health Authority, and her medical notes would have been scrutinised, and if there was no entry showing she had been given the results and rejected the appropriate advice, the doctor would have been talking to the GMC.
(Note that part of the Harold Shipman saga was his attempt to falsify patient notes retrospectively to make it look as if he'd advised them about problems they didn't have, or suspected morphine abuse. It was the study of the computer logs showing these entries were retrospective that did for him completely. He had also falsified earlier hand-written notes by squeezing extra sentences into half-filled lines - these things are hard to fake, and do get spotted.)
I'm genuinely curious here. Does the piecemeal, decentralised, every-man-for-himself nature of US medical practice mean that it's a pure toss-up whether you get someone who is on the ball and has maintained his competence, or someone who just wants you out the door so he can get to the golf course, and know there will probably be no repercussions if he screws up?
Rolfe.
Last edited:
Rolfe
Adult human female
And even if there was, it would be no solution. There is a free market in cars. If I need a new Rolls Royce Silver Spirit or a top-of-the-range Porsche, and I'm below the average wage, no amount of shopping around is ever going to find me an affordable one.
Cars, it doesn't matter. A used Ford Ka will get me around just the same. Healthcare, it does matter. Ducky couldn't have made do with a course of antibiotics or Lasik surgery, he really needed the surgical equivalent of the top-of-the-range Porsche.
When consumers can't pay for items that are extremely expensive to produce, they have to go without. These items become luxury niche market goods, or they may even cease production entirely if the number of people who can afford them is too small. They don't magically come down in price to the cost of a Happy Meal.
Rolfe.
And this is what the US conservatives are missing: The NHS is a large organisation (at one stage I understand that only the Chinese Army and the Indian Railways were larger single employers).
There are mistakes and errors, and when they are discovered, people kick up merry hell, and heads roll. The horror stories are used to rectify bad practice. In the US, this often doesn't even make the news and the tricks that have been used to deny treatment are shocking to me: (US congress report - PDF here)
Last edited:
Rolfe
Adult human female
Indeed. And that brings me to another point I have raised before. Funding healthcare through taxation eliminates the freeloaders. Right-wingers bridle at this, and object, but I have to explain what I mean.
Many right-wingers are viscerally opposed to any compulsory taxation, and prefer instead to believe that everything can be funded by voluntary contributions including charity. They totally don't mind donating money to the hospital or for the care of a particular patient, what they object to is money "taken at the point of a gun" (or as we would say, taxes).
Now there are a lot of problems with this, including the fact that just about everyone, even the generous, underestimates the amount of giving they ought to donate in order to pay their share in that way, and that big donors have a habit of supporting the sexy causes (so Guide Dogs for the Blind has more money than God, but geriatric mental health gets nothing), and putting strings on their donations (no ante-natal care for unmarried girls, and so on).
But the big problem is the free-loading rich. The way to get rich in such a society is to develop a hide like a rhinocerous. Send all the charity collectors away empty-handed, bin all the begging letters. Keep all your assets for yourself. Let the soft-hearted respond to the desperate pleas, so that the old widow is doing without a hot meal to help get the child next door her heart operation.
I don't want to live in a society like that. Tax the buggers and make them pay a fair contribution to the general welfare.
Rolfe.
Tatyana
Illuminator
- Joined
- Oct 23, 2009
- Messages
- 3,701
I would have thought that Ducky's M-protein would have been present in any blood work he had, or it should have been flagged for further investigation due to at least one or two abnormal results.
Tests are added on all the time to follow up abnormal results.
I wonder what would happen to labs in the US if they added on more tests and/or screens for things like multiple myeloma?
I would have to check on it, but I wouldn't be surprised if 25-50% of the multiple myeloma and or MGUS patients are found because of an abnormal lab result.
kellyb
Penultimate Amazing
- Joined
- Jan 18, 2006
- Messages
- 12,632
Yeah, I'm looking around for the costs of health care with pets (where something closer to a free market exists) and treating liver disorders in a pet can cost $60K.
http://www.kontain.com/pet-insurance/entries/103814/
It seems like even the most efficient free market would still leave high-tech treatment like Ducky got at at least $300K or so.
Strange that they couldn't explain "If cost is likely to be above $X investigate records"!
Another strange thing is this is not criticised by the ones who criticise the NHS because it is "rationed"... You'd almost think their conclusions weren't based on evidence.
Rolfe
Adult human female
I've certainly picked up a helluva a lot of dogs with that condition, just by ordering an electrophoresis if I didn't like the look of the total protein/albumin results. However, it's not a dead cert that you'll spot it.
It's not the poor practice per se that I'm querying, because there are idiots everywhere and NHS doctors are known to have done some brain-dead things too. It's the lack of repercussions I'm baffled by. (We know about the NHS doctors doing it because it's all over the newspapers at the time and then again when the GMC has its hearing into the incident.)
It's also the apparent absence of a compulsory system of CME and re-validation to try to spot and correct sub-standard practitioners before they kill someone. If medical practice in the USA is as great as they keep telling us, where are these simple, standard safeguards?
Rolfe.
Last edited:
And any outcry over such practices is so feeble compared to what would happen in the UK.
It also raises some other issues as far as comparative statistics go, one thing no one in the UK NHSs would argue is that everything is counted, tabulated and cross referenced, so when you look at statistics about the UK health system you are really looking at the facts, not estimates and so on. How are healthcare statistics about the USA collated given it has such a fragmented market?
kellyb
Penultimate Amazing
- Joined
- Jan 18, 2006
- Messages
- 12,632
Speaking of that...does the NHS do its own lab work and imaging?
I'm another sob story about health care debt, in my case, from having the audacity to start having gran mal seizures post partum after the birth of my first kid. I kept waking up in the ER.
Now, most of the bills I got were not even from the hospitals...it was from a variety of lab companies and radiology companies, etc, that I guess have "satellite operations" in hospitals?
Rolfe
Adult human female
Well, I was talking about medical errors and negligence, not rescission, but good point. I have read that document, and words fail me. It shows quite clearly that even though one or two of the examples Moore used were possibly ill-chosen, the whole thrust of Sicko was bang on the nail.
Rolfe.
Delscottio
Muse
- Joined
- Oct 20, 2007
- Messages
- 810
I know this soujds heartless but I don't really blame the insurance companies that much. Most are private businesses that by law have to protect shareholder intersts i.e make lots of money- in the insurance game there are only two real ways of doing that - charge higher premiums and become uncompetative or not pay out. Because of the frequency of denials it doesn't make the news so no damage to reputaton happens.
Quite why anyone would want to trust their life under such circumstances puzzles me like.