Sunday, March 15, 2009

Reader Quiz

Can anyone guess what's going on here? I mean when you are holding a pair of aces do you turn them up for all to see? I guess you do when the only rule is, "house wins all hands". Coming to a hospital near you... Death by Committee.

12 comments:

  1. So can we safely assume that under this system one treatment will be right for every patient?!? That is insanity.

    Medicine is an art....as well as a science.

    And where will this leave medical decision making based sometimes based on nothing more than "gut instinct".....something that every doc I have worked with has in spades?

    This advocates nothing more than assembly line medicine!

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  2. Nothing new here... This is what private insurances companies have been doing all along, denying coverage, delaying costly treatments and making people wait endlessly for an OK on a recommended procedure. Maybe people on welfare are used to 1st class treatment, but we, the working middle class have been subjected to this for a long time.

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  3. amy-65c,
    that is a fantastic point and one that didn't occur to me as i wrote this, but you are right. one thing that we DO still have is choice, and even though the 'choice' to pay for a procedure electively is not much of a 'choice' in certain cases people take out mortgages to buy homes and there is such a thing as medical financing so there is choice, and choice between insurance companies.

    in canada, however, there is no choice. there is some post in our archives about a canadian gentleman with a brain tumor who came to the US to expedite care because it was going to be months waiting for his 'free' care in canada.

    the cadanian govt. as the sole payor refused to pay for his diagnosis and treatment and he sued the canadian government. can't remember the results. sorry for the crappy link but here it is...

    http://docsontheweb.blogspot.com/2007/10/blame-canada.html

    now imagine trying to argue, not with some private insurance company flunky, like lofty tells about here...

    http://docsontheweb.blogspot.com/search?q=blame+canada

    but with some gs10 'lifer' who has friends over at the IRS and friends in other places and has no incentive to help you other than the smiley face stickers her gs11 boss hands out for motivation!

    so, i'll still take whatever private enterprise mish-mash hell we have now over something more befitting of one of breznev's five-year plans. our freedoms are being stolen without a fight and we don't seem to care. i gotta work on that not caring part.

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  4. Dearest 911,
    You and I have had that argument before, so I am just going to tell myself that we have to agree to disagree, but maybe you don't want to agree at all...
    Bonne Nuit! :-)

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  5. hell i didn't even know we were arguing. guess that's one of my problems especially with the fairer sex... i just start getting interested and all of a sudden i'm in an argument!

    buenas noches

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  6. And how did Breznev get into this picture? A Queen Elizabeth's former boyfriend, uh?... or should I say eh? ;-)

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  7. Welcome to last month!

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  8. oh... hey anonymous... didn't expect to see you here in last month, got a note from some shitbag 'anonymous' on march 16th, 2009 at 12:15am and am glad to see it wasn't you!

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  9. Amy-65C
    I'm curious... do you think that the implementation of committee medicine is actually a clandestine way of reigning in the 1st class Medicaid medicine to the level of what insurance does now?

    With the ER co-pays skyrocketing, our ER has seen a shift from private pay plans to mostly medicaid/medicare and no-pay. (I actually saw a patient that had to take a payment plan on his co-pay!!) Any attempt to force Medicaid to copay is met with brigade of ACLU lawyers, and has been rapidly killed. EMTALA and the lawyers prevent us from just "screening" the patient and sending them home without defensive testing. Maybe this is a backdoor way to slow medicaid/medicare demand by making the ER and primary care visits unproductive...

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  10. Disgruntled Internist6:56 AM, March 16, 2009

    You'll notice the choices were not between one pharmacologic treatment and another--for which randomized, double-blind, placebo-controlled trials are numerous--but for drug treatment vs. non-drug treatment, such as surgery or physical therapy.

    The reason this is needed is that whereas drugs have to be demonstrated safe and effective before approval, non-pharmacologic treatments (surgery, PT, manipulation, etc) have only to be proven safe, without the same standards of efficacy required of drugs. Moreover, often the FDA simply approves a new surgical device, prosthesis, or implant on the basis of its "substantial similarity" to an already existing device, without even proof of safety.

    I say it's about time surgical therapies are subjected to scientific scrutiny.

    What are you surgical types afraid of? That the treatments we fleas prescribe will be demonstrated to be cheaper and more effective?

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  11. My 5 year old son has this game he made up that we play sometimes. The rules of the game change depending on who is winning. He always wins. It's actually one of the rules. It's funny because he's 5.

    I would prefer my doctor to be my doctor rather than some rules about what works and what doesn't, what is allowed, what isn't. If it were always clear cut, if everyone responded exactly the same to each treatment choice that would be fine I guess (although I still wouldn't like it) but I thought doctors were the ones who could tell what was best for their patient.

    Right now when my doctor says something is necessary and the insurance company disagrees, I pay for whatever it is because I know my doctor is looking out for my best interest while the insurance company is looking out for the best profitability and my health if it is convienent/not too expensive for them. It sounds a lot like that choice may be taken away from me, which scares me a lot considering my recent health issues.

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  12. Any decent doctor can just look at someone and tell if they have cancer... like those cancer sniffing dogs, but just try and tell that to the Insurance Companies...

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