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View Diary: US Health Care Unmasked: A true story (122 comments)

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  •  Most of them are caring and honest. (2+ / 0-)
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    Angie in WA State, Joe Bob

    But because they're trying to give every patient the "best" care regardless of economic factors, which are Evil, they prescribe the drug and/or treatment which they have been convinced is the best first.  And the education by which they determine that treatment is highly biased and skewed by the self-interest of every medical provider there is.  Companies that manufacture equipment sponsor studies proving that their equipment will increase early detection of cancer by 5% convince national boards that the test is therefore essential.  Pharma companies sponsor studies showing that their drug is the best under very controlled and specific conditions, then market it for every condition remotely related.  Device manufacturers sponsor studies that "prove" that their devices are good for "severe" Condition A, then market the device as absolutely essential for any degree of Condition A, even so mild that the patient is completely unaware they have a "condition".  Improvements of less than 10% over lack of treatment are considered "significant" and therefore justify price tags in the hundreds of thousands.  Every patient must be prescribed the BEST!

    Doctors are victims of the information which constitutes their training.  They are TRAINED to overprescribe, and disciplined for failure to overtest.  Even if they don't think a test is really necessary, they have to worry that their supervisor (most of them have those, these days) will second-guess them.  And they are rigorously trained to avoid pragmatic and expedient treatment in favor of extensive and expensive testing to determine every last factor . . . which, when you add up the likelihood of minor errors in a battery of a hundred tests, actually increases the probability that SOMETHING will show up that looks wrong, just by sheer random chance.

    Sorry, I've worked with the beast for twenty-five years, and I've never met a doctor who didn't prescribe unnecessary tests and futile or unnecessary treatments.

    •  while I mostly agree, consider also (0+ / 0-)

      that for 'family doctors', previously known as G.P.s (general practitioners); a considerable amount of the testing they order is to "rule out" specific conditions.

      Remember, medicine is still as much an art as it is a science, when it comes to determining the diagnosis for any given patient. The physician takes the patient's described symptoms and a physical examination, and goes from there. So, testing is as much to 'rule out' as it is to "confirm" the physician's preliminary (or working) diagnosis.

      This may be seen as "over-testing" to someone who does not know any better.

      "I like paying taxes...with them, I buy Civilization" -- me

      by Angie in WA State on Mon Dec 10, 2012 at 12:18:20 PM PST

      [ Parent ]

      •  In many cases (0+ / 0-)

        no doubt.  But as a patient, I don't think I needed 50 different things checked when I was obviously presenting with high blood pressure.  I needed medication for the high pressure.  And as a sleep tech, about 50% of our patients came in with a "rule out" order, which ended up in fully 80% of them diagnosed with sleep apnea which was so mild that it would never have caused them any harm EXCEPT that putting them on CPAP involved a second $2000 test night, equipment sales and fitting, and followup every six months for life.  Again, in people with mild to moderate "disease" that there is and was no research justifying treatment for.

        Doctors overtest, overdiagnose, and overprescribe.  No businessman is going to pass up an obvious opportunity for a sale.  And no one is so virtuous, as to lack a bias towards doing what is in his own best interest.

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