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In Australia, where public hospitals provide a free service, antibiotics are first line for uncomplicated appendicitis. Most people recover just fine. It's ama

by jazoom 8y ago

In Australia, where public hospitals provide a free service, antibiotics are first line for uncomplicated appendicitis. Most people recover just fine. It's amazing how things are different when a surgeon doesn't want to do a procedure since it means more work for them, compared to where a surgeon wants to do a procedure since that's how they get paid. Obviously, it's much better for the patients if they avoid unnecessary surgery.

sonnyblarney 8y ago
Even in socialized medicine systems, doctors who do more stuff get paid more. 'Single Payer' usually means the government runs insurance not the doctors office. So the doctor bills more in both cases. Both of those inscentives are maligned though - the doctor should do 'what's right'. What's also nutbars is that there isn't a standard playbook for this stuff. There should be specific procedural research on all of this stuff with the 'best practices' updated all the time. There should be ongoing debate and churn around the practice, but once it's published, the doctors should all be in sync. Doctors, like judges, have too much leeway. I think they feel that 'every case is special' and they are to some extent, however, I feel that they are playing against a statistical game and that their 'gut' is not right. Just like airline pilots go through massive 'checklists' ... so should doctors. I've been misdiagnosed for heart burn (doc thought it was heart palpitation) and for wound infection (was not infected, just a little red) - which is tragic because those are very common things.
- seszett 8y ago
  Actually, at least in the medicine systems I know (France and Belgium) doctors can either be independent or employed. It's about 50% each in both countries. Independents are paid more when they do more stuff, but employed doctors are usually paid a fixed salary depending on fixed work hours. Depending on the system, the practice either bills patients directly per consultation, or the social security organization, or gets a fixed income from social security or from the ministry of health that does not directly depend from how many patients they see. All three systems exist. Best practices and procedures are usually handled at the hospital or... "medical house" (maison médicale or wijkgezondheidscentrum, the place where several non-independent doctors work as a team) level. It is indeed not something that really gets standardised at a higher level, although doctors also have a number of mandatory meetings that get conducted with attendees from different practices and that help with diffusing procedures, best practices and knowledge. They don't all get in sync at the same time, but knowledges and best practices do diffuse through all doctors. Although independents usually try to attend the bare minimum because meetings directly translate to missed income for them. I don't think the current model is wrong, although I think independent doctors are ill equipped to stay up to date, and not enough incentivised to do so.
- zaphod12 8y ago
  These standards of care do exist for a lot of things. (see NCCN treatment guidelines for ones related to oncology). Oftentimes a doctor will not be reimbursed by insurance if they give treatments that are outside of approved standards. There is leeway given, though, because its just damn hard in many cases. Patients can present with 4/7 key symptoms and may report other unrelated issues. Or ailments can act differently in different people. Or maybe you have never been able to sleep well and don't even notice that, and it's a key issue related for a diagnosis. 1 really interesting point about it, though: They vary WILDLY by nation. You wouldn't think it would make a difference, but because of the varied regulatory bodies, and even culture, it does. (This was an issue that Watson for Oncology ran into after being trained by US doctors. In Japan, even on the occasion is gave a reasonable answer - it was watson after all - it often was not how the Japanese doctors would act in that circumstance).
- rsynnott 8y ago
  Depends on the system. Most hospital doctors here (Ireland) are just employees of public hospitals; beyond overtime (and they tend to be right on the legal limits provided by the working time directive for that; the system is understaffed at the moment) they don’t get paid more for doing more procedures. Similar in the UK.

by jazoom 8y ago

sonnyblarney 8y ago

Even in socialized medicine systems, doctors who do more stuff get paid more. 'Single Payer' usually means the government runs insurance not the doctors office. So the doctor bills more in both cases. Both of those inscentives are maligned though - the doctor should do 'what's right'. What's also nutbars is that there isn't a standard playbook for this stuff. There should be specific procedural research on all of this stuff with the 'best practices' updated all the time. There should be ongoing debate and churn around the practice, but once it's published, the doctors should all be in sync. Doctors, like judges, have too much leeway. I think they feel that 'every case is special' and they are to some extent, however, I feel that they are playing against a statistical game and that their 'gut' is not right. Just like airline pilots go through massive 'checklists' ... so should doctors. I've been misdiagnosed for heart burn (doc thought it was heart palpitation) and for wound infection (was not infected, just a little red) - which is tragic because those are very common things.

seszett 8y ago
Actually, at least in the medicine systems I know (France and Belgium) doctors can either be independent or employed. It's about 50% each in both countries. Independents are paid more when they do more stuff, but employed doctors are usually paid a fixed salary depending on fixed work hours. Depending on the system, the practice either bills patients directly per consultation, or the social security organization, or gets a fixed income from social security or from the ministry of health that does not directly depend from how many patients they see. All three systems exist. Best practices and procedures are usually handled at the hospital or... "medical house" (maison médicale or wijkgezondheidscentrum, the place where several non-independent doctors work as a team) level. It is indeed not something that really gets standardised at a higher level, although doctors also have a number of mandatory meetings that get conducted with attendees from different practices and that help with diffusing procedures, best practices and knowledge. They don't all get in sync at the same time, but knowledges and best practices do diffuse through all doctors. Although independents usually try to attend the bare minimum because meetings directly translate to missed income for them. I don't think the current model is wrong, although I think independent doctors are ill equipped to stay up to date, and not enough incentivised to do so.
zaphod12 8y ago
These standards of care do exist for a lot of things. (see NCCN treatment guidelines for ones related to oncology). Oftentimes a doctor will not be reimbursed by insurance if they give treatments that are outside of approved standards. There is leeway given, though, because its just damn hard in many cases. Patients can present with 4/7 key symptoms and may report other unrelated issues. Or ailments can act differently in different people. Or maybe you have never been able to sleep well and don't even notice that, and it's a key issue related for a diagnosis. 1 really interesting point about it, though: They vary WILDLY by nation. You wouldn't think it would make a difference, but because of the varied regulatory bodies, and even culture, it does. (This was an issue that Watson for Oncology ran into after being trained by US doctors. In Japan, even on the occasion is gave a reasonable answer - it was watson after all - it often was not how the Japanese doctors would act in that circumstance).
rsynnott 8y ago
Depends on the system. Most hospital doctors here (Ireland) are just employees of public hospitals; beyond overtime (and they tend to be right on the legal limits provided by the working time directive for that; the system is understaffed at the moment) they don’t get paid more for doing more procedures. Similar in the UK.