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This article seems to suggest that because no spike in short-term ailments due to lower frequency of care has been observed in a 5-month span, there is no damag

This article seems to suggest that because no spike in short-term ailments due to lower frequency of care has been observed in a 5-month span, there is no damage to the quality of our society's physical health overall. That seems incredibly myopic to me. The real question is whether there there will be statistically detectable increases in severity or prevalence of chronic or emergent ailments in the long run. How many cancers are detected later, how many lower-back pain cases are allowed to degenerate further, etc etc. And further, do those (to my mind inevitable) subtler long-term consequences outweigh the societal gain from less healthcare spending? They may or may not, but this article doesn't even ask the question, let alone suggest ways to answer it. This feels like low-effort clickbait to me.

pfkurtz 6y ago
This whole crisis has seen constant articles that, at least on the clickbait level which actually influences our discourse, present reasoning like "we didn't notice anything bad (yet)" -> "maybe nothing's ever bad again!"
alistairSH 6y ago
In my mind, the missed cancers could be a problem. But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5% "here's the same drug, with an adjust dose". Those appointments should only occur if there's an issue that requires new dosing or a change of medication. The rest of the time, it should be either completely automatic, or at most a simple phone call. I assume this doesn't happen, either because it's a CYA maneuver by the physician, or because the physician wants to bill for the appointment.
- rightbyte 6y ago
  A less cynical analysis would be that there is a risk of changed conditions that it is good that the doctor notices.
- throwaway_jobs 6y ago
  > Those appointments should only occur if there's an issue that requires new dosing or a change of medication. But isn’t that a little bit of Monday morning quarter backing? In other words how does a doctor know if a therapy/Rx needs to be modified for a chronic condition without a doctor visit and in many cases blood work? In fact a 6 month therapy for a chronic condition would suggest The doctor has extreme confidence in the patient to adhere to their therapies...statistically about 1M hospitalizations occur in the US per year (Coating billions) because of lack of medication adherence (and these are only those cases resulting in hospitalization), how many more simply result in a sicker patient without a hospitalization event?
  - alistairSH 6y ago
    Things like asthma inhalers don't normally require bloodwork. Just a quick Q&A, which could be done less expensively over the phone, if it's even really necessary. Or, annually instead of bi-annually.
    - throwaway_jobs 6y ago
      Even in the case of asthma, I think a doctor would hopefully not treat it like cookie cutter Health care. Surely there are standards and best practices, but then there is also the actual practice of medicine. Standards might suggest 1 year is fine, but he Generally a doctor might want to see young (Kids) and old patients more often than a otherwise healthy adult, perhaps the doctor has reason to belief seasonal allergies/pollen may be effecting patients more in a given year, and (not to give doctors to much credit)again the idea the doctor has concerns with a given patient’s track record of adherence Issues and/or medication related hospitalizations.
- wincy 6y ago
  I recently started paying for Direct Primary Care. We signed up as seeing a doctor during COVID became even more difficult than usual. It’s definitely a luxury but I pay $100 a month and my wife and I can bug our respective doctors (she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients) whenever we want. Obviously we try not to bug them all the time and be respectful, but I’m seeing weird spots at 7pm; text my doctor he says don’t worry about it. I’m kind of a hypochondriac — this saves me a trip to the ER. I say I’m pretty sure I have a sinus infection, and the symptoms are similar to one I had last year. He wrote me a prescription for antibiotics, tells me to let him know if it doesn’t clear up. It feels how I’d expect modern medicine to feel, rather than everything being set up to gatekeep me from interacting with the doctor in any way except for fifteen minutes after paying $150 for the pleasure. The doctor has an incentive to keep us healthy because we’re not paying by the visit anymore. I love love the direct primary care approach and wish I’d started paying for it sooner.
  - pjc50 6y ago
    Effectively you're paying $100 a month to be treated for hypochondria?
    - dannyw 6y ago
      Along with potential overprescription of antibiotics, which is a bad thing for the individual and a bad thing for community health. Mayo Clinic says "Acute sinusitis usually doesn't require any treatment beyond symptomatic relief".
  - smnrchrds 6y ago
    > she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients Is that legal?
    - hckr_news 6y ago
      Perhaps due to religion or culture, the doctor is allowed especially in primary care?
- C1sc0cat 6y ago
  In the UK my follow ups( every 8 to 10 weeks) for a kidney transplant are done over the phone now - its just the bloods I have to go into the hospital for. Its a real pity Theranos has tainted the testing with small amounts of blood area for the next decade.
- esperent 6y ago
  If all the doctor does is say "here's another dose", then something is wrong, for sure. My experience in needing occasional prescriptions for asthma inhalers (not in the US) has been that the doctor gave me a quick but thorough check up every time to ensure that my condition was not worsening. That's the reasoning behind it. Whether it's a valid reason or not, I don't make a claim either way. But I don't think this level of cynisism that says the doctors only do it for a paycheck is fair or warranted.
- Cthulhu_ 6y ago
  But you cannot trust patients, and as a doctor you have to do the due diligence; if the patient's health changes (e.g. weight, blood pressure, adjustment to the medication) they may need to adjust the dosage. That 5% can save lives. Prescription medication should not be fucked with.
- majewsky 6y ago
  I'm an asthma patient in Germany. I visit my lung doctor twice a year for checkups, but the checkups are performed by a nurse. My doctor then briefly looks at the data collected by the nurse and decides whether she wants to talk to me in her office, which happens about once every two years. If that's not the case, I just get my usual roundup of refills and everything is said and done in about 30 minutes.
robbiep 6y ago
I agree the longer term studies are going to be fascinating. Anecdotally, in Australia (where I work/practice and have many colleagues completing their specialist training currently) presentations for chest pain and total heart attack presentations are down significantly. No studies yet. Will be interesting to see if we will see deferred cases present later and with greater morbidity or just what the hell is going on, but my incoming assumption would have been that heart attacks would be something that someone is going to present with anyway. As an example of how COVID has changed our approach in hospital, telehealth clinics are now replacing many outpatient visits (your other commenter below hits on the wastefulness of this). 10 years of IT change came to healthcare in about 2 weeks. It’s been wild. It’s also caused us to get much more efficient with referrals. My colleague is a Plastics resident and had to trim his 500 patient referral list into must see and defer piles. He trimmed it to 100 by ensuring that, for instance, skin cancer referrals had tissue diagnoses before coming into clinic to be booked for surgery (something that the GPs should have done anyway) - so everyone is being forced to polish up their referral pathways and pull their weight along the healthcare chain, rather than what I often witness which is everyone just picking up slack wherever it lands. Will be interesting to see how far this holds as life returns to normal here

pfkurtz 6y ago

This whole crisis has seen constant articles that, at least on the clickbait level which actually influences our discourse, present reasoning like "we didn't notice anything bad (yet)" -> "maybe nothing's ever bad again!"

alistairSH 6y ago

In my mind, the missed cancers could be a problem. But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5% "here's the same drug, with an adjust dose". Those appointments should only occur if there's an issue that requires new dosing or a change of medication. The rest of the time, it should be either completely automatic, or at most a simple phone call. I assume this doesn't happen, either because it's a CYA maneuver by the physician, or because the physician wants to bill for the appointment.

rightbyte 6y ago
A less cynical analysis would be that there is a risk of changed conditions that it is good that the doctor notices.
throwaway_jobs 6y ago
> Those appointments should only occur if there's an issue that requires new dosing or a change of medication. But isn’t that a little bit of Monday morning quarter backing? In other words how does a doctor know if a therapy/Rx needs to be modified for a chronic condition without a doctor visit and in many cases blood work? In fact a 6 month therapy for a chronic condition would suggest The doctor has extreme confidence in the patient to adhere to their therapies...statistically about 1M hospitalizations occur in the US per year (Coating billions) because of lack of medication adherence (and these are only those cases resulting in hospitalization), how many more simply result in a sicker patient without a hospitalization event?
- alistairSH 6y ago
  Things like asthma inhalers don't normally require bloodwork. Just a quick Q&A, which could be done less expensively over the phone, if it's even really necessary. Or, annually instead of bi-annually.
  - throwaway_jobs 6y ago
    Even in the case of asthma, I think a doctor would hopefully not treat it like cookie cutter Health care. Surely there are standards and best practices, but then there is also the actual practice of medicine. Standards might suggest 1 year is fine, but he Generally a doctor might want to see young (Kids) and old patients more often than a otherwise healthy adult, perhaps the doctor has reason to belief seasonal allergies/pollen may be effecting patients more in a given year, and (not to give doctors to much credit)again the idea the doctor has concerns with a given patient’s track record of adherence Issues and/or medication related hospitalizations.
wincy 6y ago
I recently started paying for Direct Primary Care. We signed up as seeing a doctor during COVID became even more difficult than usual. It’s definitely a luxury but I pay $100 a month and my wife and I can bug our respective doctors (she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients) whenever we want. Obviously we try not to bug them all the time and be respectful, but I’m seeing weird spots at 7pm; text my doctor he says don’t worry about it. I’m kind of a hypochondriac — this saves me a trip to the ER. I say I’m pretty sure I have a sinus infection, and the symptoms are similar to one I had last year. He wrote me a prescription for antibiotics, tells me to let him know if it doesn’t clear up. It feels how I’d expect modern medicine to feel, rather than everything being set up to gatekeep me from interacting with the doctor in any way except for fifteen minutes after paying $150 for the pleasure. The doctor has an incentive to keep us healthy because we’re not paying by the visit anymore. I love love the direct primary care approach and wish I’d started paying for it sooner.
- pjc50 6y ago
  Effectively you're paying $100 a month to be treated for hypochondria?
  - dannyw 6y ago
    Along with potential overprescription of antibiotics, which is a bad thing for the individual and a bad thing for community health. Mayo Clinic says "Acute sinusitis usually doesn't require any treatment beyond symptomatic relief".
- smnrchrds 6y ago
  > she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients Is that legal?
  - hckr_news 6y ago
    Perhaps due to religion or culture, the doctor is allowed especially in primary care?
C1sc0cat 6y ago
In the UK my follow ups( every 8 to 10 weeks) for a kidney transplant are done over the phone now - its just the bloods I have to go into the hospital for. Its a real pity Theranos has tainted the testing with small amounts of blood area for the next decade.
esperent 6y ago
If all the doctor does is say "here's another dose", then something is wrong, for sure. My experience in needing occasional prescriptions for asthma inhalers (not in the US) has been that the doctor gave me a quick but thorough check up every time to ensure that my condition was not worsening. That's the reasoning behind it. Whether it's a valid reason or not, I don't make a claim either way. But I don't think this level of cynisism that says the doctors only do it for a paycheck is fair or warranted.
Cthulhu_ 6y ago
But you cannot trust patients, and as a doctor you have to do the due diligence; if the patient's health changes (e.g. weight, blood pressure, adjustment to the medication) they may need to adjust the dosage. That 5% can save lives. Prescription medication should not be fucked with.
majewsky 6y ago
I'm an asthma patient in Germany. I visit my lung doctor twice a year for checkups, but the checkups are performed by a nurse. My doctor then briefly looks at the data collected by the nurse and decides whether she wants to talk to me in her office, which happens about once every two years. If that's not the case, I just get my usual roundup of refills and everything is said and done in about 30 minutes.

robbiep 6y ago

I agree the longer term studies are going to be fascinating. Anecdotally, in Australia (where I work/practice and have many colleagues completing their specialist training currently) presentations for chest pain and total heart attack presentations are down significantly. No studies yet. Will be interesting to see if we will see deferred cases present later and with greater morbidity or just what the hell is going on, but my incoming assumption would have been that heart attacks would be something that someone is going to present with anyway. As an example of how COVID has changed our approach in hospital, telehealth clinics are now replacing many outpatient visits (your other commenter below hits on the wastefulness of this). 10 years of IT change came to healthcare in about 2 weeks. It’s been wild. It’s also caused us to get much more efficient with referrals. My colleague is a Plastics resident and had to trim his 500 patient referral list into must see and defer piles. He trimmed it to 100 by ensuring that, for instance, skin cancer referrals had tissue diagnoses before coming into clinic to be booked for surgery (something that the GPs should have done anyway) - so everyone is being forced to polish up their referral pathways and pull their weight along the healthcare chain, rather than what I often witness which is everyone just picking up slack wherever it lands. Will be interesting to see how far this holds as life returns to normal here