7 ms·

My dad almost died in the 90s because they couldn't diagnose his lupus.

bryanlarsen 5y ago
Lupus is really hard to diagnose. There's a reason that ends up being the diagnosis on pretty much every episode of House M.D. Doctors generally see 6 patients an hour, and have 5-7 minutes of paperwork per patient. The remaining 3 minutes gives enough time to diagnose the obvious, but not much else.
- FollowingTheDao 5y ago
  It is not hard to diagnose once you eventually get to a person that can diagnose it. You said it yourself. It is not about difficultly, but time spent with the patient. But I literally showed my doctor the cutaneous lupus in my ear and she said "Oh, some people just get gunk in their ears" and would not send me to a rheumatologist. The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/
  - GFischer 5y ago
    You're blaming Capitalism, it isn't great, but the problem is that in the United States healthcare system you have Capitalism without Free Market, you have "crony"/rent-seeking/regulatory-capture Capitalism. You can get a rheumatologist TODAY if you're willing to pay (quite a bit) more (at least here in Uruguay). THAT is free-market capitalism. If you don't have money, you'll have to wait 2-3 months (quite a lot less than what you're saying), and you'll have it for free (here). That's socialism. In crony capitalism, you have the worst of both worlds...
  - JamesBarney 5y ago
    There are too many patients and not enough doctors. This isn't caused by capitalism, capitalism doesn't limit the # of doctors. Becoming socialist doesn't magically allow doctors to see patients for twice as long. If we had socialism more people could afford doctors(a good thing!) but it would make this specific problem worse, because there would be more patients. This is caused by the AMA lobbying to limit the supply of doctors in order to drive up salaries. It's why we have this. United States – $316,000 Germany – $183,000 United Kingdom – $138,000 France – $98,000 Italy – $70,000 Spain – $57,000 Brazil – $47,000 Mexico – $12,000
    - throw10920 5y ago
      > This is caused by the AMA lobbying to limit the supply of doctors in order to drive up salaries. This. This is the problem - not the vague spectre of "capitalism" being waved around.
      - FollowingTheDao 5y ago
        Since when do salaries have nothing to do with capitalism?
        JamesBarney 5y ago
        The Soviet Union had wages to, and far worse problems with shortages then capitalistic countries have ever had.
        deleted 5y ago
        [deleted]
        e-dt 5y ago
        Yes, but not in general shortages of doctors. It's a totally different problem, so this isn't really a helpful way to look at it. After all, if there's a shortage of cabbages, it doesn't mean the remaining cabbages benefit and can lobby to keep it that way!
        bryanlarsen 5y ago
        Cabbage farmers can, though.
        e-dt 5y ago
        Yes, but when that sort of thing happens in commodities it's an illegal cartel, whereas when it happens with jobs it's responsible self-regulation by a professional association.
        5y ago
  - bryanlarsen 5y ago
    Lupus is a broad category of auto-immune diseases. Some are easier to diagnose than others. It sounds like yours was one of the easier ones. Easier, but not easy! Many Lupus diagnoses rely on differential diagnosis. AKA eliminate every other possible diagnosis and if they all are negative it must be lupus.
  - mmcdermott 5y ago
    > The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. This remark seems somewhat lacking in rigor. I know bagging on capitalism is a common reflex, particularly in medicine, but something more is almost certainly going on. The default thought process for a retailer is to move units. A lawyer wants to rack up billable hours. A subscription service wants more subscriptions. So why would a specialist look for fewer cases? There is almost certainly a perverse incentive involved, because a competitive market would usually prompt a service provider to accept business and grow with demand.
    - leksak 5y ago
      Specialists are hard to get a face-to-face with even with socialized medicine (personal anecdote from Sweden). I assume that one thing that transcends national borders is that unless your symptoms suggest anything life-threatening care will be administered in accordance with heuristics. The most probable diagnosis is set, and it is assumed that a patient will return if things does not improve. However, failing to communicate to a patient that a diagnosis is provisional might serve to undermine their faith in the healthcare system leading to periods of fatigue wherein one doesn't have the self-efficacy to continue seeking care if things haven't improved even if quality of life is severely impacted. From my limited understanding of the US healthcare system I'd imagine you don't want an excess of cases because each case 1. Is a responsibility, and thus a liability, and 2. every patient your staff needs to accommodate is draining (risk of overwork). If that would apply to a country with socialized medicine I imagine that Item 1. receives significantly less consideration but that Item 2. is still very much considered. If a unit isn't a first-line care-provider they can in theory be a bit more guarded about who they receive, while first-line just has to bear whatever comes through the doors. I feel as if I'm shifting to a different point of discussion but I still struggle not to mention the fact that a specialist may not be readily at hand depending on what city you are in.
    - throwawayboise 5y ago
      Specialists are called that for a reason. They are not general practitioners and their time is extremely valuable. Access to them needs to be managed so that they do not waste their time on people who do not need their specialty. The way it's supposed to work is that the general practitioner rules out a bunch of stuff, and then starts referring to specialists who can diagnose/treat the rare things. In practice it's not quite perfect, but it's hard for me to think of a better way to deal with it.
  - tyrfing 5y ago
    > Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. Typically that's anti-capitalist: there are very strong government and regulatory limits on who can perform the services, and for self-serving reasons, they maintain shortages of supply. The free-market capitalist solution would be for prices to rise to a point where supply and demand are balanced, either by supply increasing (people switching fields), or reduced demand from prices rising.
    - ClumsyPilot 5y ago
      > for prices to rise to a point where supply and demand are balanced Is there a limit to the amount of money you would pay to save your life? Is there a predatry loan you wouldn't take to pay for life-saving surgery for your child? Has this ever been demonstrated to work in healthcare in the real world, outside free-market fantasy land?
      - WalterBright 5y ago
        Yes, in the US before the government took over health care. BTW, no government is going to spend unlimited sums to save your life.
        FollowingTheDao 5y ago
        > Yes, in the US before the government took over health care. When did that happen? If you are thinking Obama care, uhm, no. > BTW, no government is going to spend unlimited sums to save your life. You are missing the point. Supply and demand curves break when it comes to life and death matters. That is why prices should not be dictated by a free market. Well, I guess that is fine if you are a sociopath.
        WalterBright 5y ago
        > When did that happen? Not all at once, but decision by decision. One big change was when the AMA was granted a monopoly over the education of doctors. Then there was when companies got around wage controls in WW2 by tying health insurance to employment. Then in the 1960s there was enormous expansion of the FDA, and then Medicare and Medicaid. Then there were laws that required emergency rooms to treat people for free. All these measures sound great, but they completely mess with the structure of how markets work. And so we have the very expensive, and often dysfunctional, system today. > That is why prices should not be dictated by a free market. The free market doesn't dictate prices. Governments dictate prices, which always leads to shortages. > I guess that is fine if you are a sociopath. If you have a case, you should be able to make it without insults.
  - zo1 5y ago
    I live in a country with private Healthcare and I could call and book an appointment with any kind of specialist anywhere from a day to 6 months. The reason it takes longer is usually because they're fully booked due to demand. And when I get an appointment, I can sit in that office for an hour asking anything I want. And my medical aid will pay for it. That is capitalism.
    - FollowingTheDao 5y ago
      > And my medical aid will pay for it. That is capitalism. No, that is socialism inside capitalism. Let me explain. I assume by "medical aid" you mean insurance, right? What is insurance? It is a bunch of people pooling their money so they can reduce risk and pay for each others health care. Capice?
      - zo1 5y ago
        Difference being I get to pick in one and in the other I have no choice. Also the medical aid or insurance makes a profit, yet more capitalism. Either way, we're talking passed each other because we have different definitions.
FollowingTheDao 5y ago
Sorry. Yeah, my mother suffered her whole life with it and never new it. She was in a wheelchair for the last 10 years of her life with all kinds of issues. It was our kidney issues that tipped me off. That is the reason I went into the genetics, because she, and several other in my family have the same issues. If anyone is interested, it seems it is partly (mostly?) caused by a Purine nucleoside phosphorylase deficiency. (PNP gene) https://pubmed.ncbi.nlm.nih.gov/28859258/ https://pubmed.ncbi.nlm.nih.gov/28859258/

Lupus is really hard to diagnose. There's a reason that ends up being the diagnosis on pretty much every episode of House M.D. Doctors generally see 6 patients an hour, and have 5-7 minutes of paperwork per patient. The remaining 3 minutes gives enough time to diagnose the obvious, but not much else.

FollowingTheDao 5y ago
It is not hard to diagnose once you eventually get to a person that can diagnose it. You said it yourself. It is not about difficultly, but time spent with the patient. But I literally showed my doctor the cutaneous lupus in my ear and she said "Oh, some people just get gunk in their ears" and would not send me to a rheumatologist. The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/
- GFischer 5y ago
  You're blaming Capitalism, it isn't great, but the problem is that in the United States healthcare system you have Capitalism without Free Market, you have "crony"/rent-seeking/regulatory-capture Capitalism. You can get a rheumatologist TODAY if you're willing to pay (quite a bit) more (at least here in Uruguay). THAT is free-market capitalism. If you don't have money, you'll have to wait 2-3 months (quite a lot less than what you're saying), and you'll have it for free (here). That's socialism. In crony capitalism, you have the worst of both worlds...
- JamesBarney 5y ago
  There are too many patients and not enough doctors. This isn't caused by capitalism, capitalism doesn't limit the # of doctors. Becoming socialist doesn't magically allow doctors to see patients for twice as long. If we had socialism more people could afford doctors(a good thing!) but it would make this specific problem worse, because there would be more patients. This is caused by the AMA lobbying to limit the supply of doctors in order to drive up salaries. It's why we have this. United States – $316,000 Germany – $183,000 United Kingdom – $138,000 France – $98,000 Italy – $70,000 Spain – $57,000 Brazil – $47,000 Mexico – $12,000
  - throw10920 5y ago
    > This is caused by the AMA lobbying to limit the supply of doctors in order to drive up salaries. This. This is the problem - not the vague spectre of "capitalism" being waved around.
    - FollowingTheDao 5y ago
      Since when do salaries have nothing to do with capitalism?
      - JamesBarney 5y ago
        The Soviet Union had wages to, and far worse problems with shortages then capitalistic countries have ever had.
        deleted 5y ago
        [deleted]
        e-dt 5y ago
        Yes, but not in general shortages of doctors. It's a totally different problem, so this isn't really a helpful way to look at it. After all, if there's a shortage of cabbages, it doesn't mean the remaining cabbages benefit and can lobby to keep it that way!
        bryanlarsen 5y ago
        Cabbage farmers can, though.
        e-dt 5y ago
        Yes, but when that sort of thing happens in commodities it's an illegal cartel, whereas when it happens with jobs it's responsible self-regulation by a professional association.
      - 5y ago
- bryanlarsen 5y ago
  Lupus is a broad category of auto-immune diseases. Some are easier to diagnose than others. It sounds like yours was one of the easier ones. Easier, but not easy! Many Lupus diagnoses rely on differential diagnosis. AKA eliminate every other possible diagnosis and if they all are negative it must be lupus.
- mmcdermott 5y ago
  > The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. This remark seems somewhat lacking in rigor. I know bagging on capitalism is a common reflex, particularly in medicine, but something more is almost certainly going on. The default thought process for a retailer is to move units. A lawyer wants to rack up billable hours. A subscription service wants more subscriptions. So why would a specialist look for fewer cases? There is almost certainly a perverse incentive involved, because a competitive market would usually prompt a service provider to accept business and grow with demand.
  - leksak 5y ago
    Specialists are hard to get a face-to-face with even with socialized medicine (personal anecdote from Sweden). I assume that one thing that transcends national borders is that unless your symptoms suggest anything life-threatening care will be administered in accordance with heuristics. The most probable diagnosis is set, and it is assumed that a patient will return if things does not improve. However, failing to communicate to a patient that a diagnosis is provisional might serve to undermine their faith in the healthcare system leading to periods of fatigue wherein one doesn't have the self-efficacy to continue seeking care if things haven't improved even if quality of life is severely impacted. From my limited understanding of the US healthcare system I'd imagine you don't want an excess of cases because each case 1. Is a responsibility, and thus a liability, and 2. every patient your staff needs to accommodate is draining (risk of overwork). If that would apply to a country with socialized medicine I imagine that Item 1. receives significantly less consideration but that Item 2. is still very much considered. If a unit isn't a first-line care-provider they can in theory be a bit more guarded about who they receive, while first-line just has to bear whatever comes through the doors. I feel as if I'm shifting to a different point of discussion but I still struggle not to mention the fact that a specialist may not be readily at hand depending on what city you are in.
  - throwawayboise 5y ago
    Specialists are called that for a reason. They are not general practitioners and their time is extremely valuable. Access to them needs to be managed so that they do not waste their time on people who do not need their specialty. The way it's supposed to work is that the general practitioner rules out a bunch of stuff, and then starts referring to specialists who can diagnose/treat the rare things. In practice it's not quite perfect, but it's hard for me to think of a better way to deal with it.
- tyrfing 5y ago
  > Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. Typically that's anti-capitalist: there are very strong government and regulatory limits on who can perform the services, and for self-serving reasons, they maintain shortages of supply. The free-market capitalist solution would be for prices to rise to a point where supply and demand are balanced, either by supply increasing (people switching fields), or reduced demand from prices rising.
  - ClumsyPilot 5y ago
    > for prices to rise to a point where supply and demand are balanced Is there a limit to the amount of money you would pay to save your life? Is there a predatry loan you wouldn't take to pay for life-saving surgery for your child? Has this ever been demonstrated to work in healthcare in the real world, outside free-market fantasy land?
    - WalterBright 5y ago
      Yes, in the US before the government took over health care. BTW, no government is going to spend unlimited sums to save your life.
      - FollowingTheDao 5y ago
        > Yes, in the US before the government took over health care. When did that happen? If you are thinking Obama care, uhm, no. > BTW, no government is going to spend unlimited sums to save your life. You are missing the point. Supply and demand curves break when it comes to life and death matters. That is why prices should not be dictated by a free market. Well, I guess that is fine if you are a sociopath.
        WalterBright 5y ago
        > When did that happen? Not all at once, but decision by decision. One big change was when the AMA was granted a monopoly over the education of doctors. Then there was when companies got around wage controls in WW2 by tying health insurance to employment. Then in the 1960s there was enormous expansion of the FDA, and then Medicare and Medicaid. Then there were laws that required emergency rooms to treat people for free. All these measures sound great, but they completely mess with the structure of how markets work. And so we have the very expensive, and often dysfunctional, system today. > That is why prices should not be dictated by a free market. The free market doesn't dictate prices. Governments dictate prices, which always leads to shortages. > I guess that is fine if you are a sociopath. If you have a case, you should be able to make it without insults.
- zo1 5y ago
  I live in a country with private Healthcare and I could call and book an appointment with any kind of specialist anywhere from a day to 6 months. The reason it takes longer is usually because they're fully booked due to demand. And when I get an appointment, I can sit in that office for an hour asking anything I want. And my medical aid will pay for it. That is capitalism.
  - FollowingTheDao 5y ago
    > And my medical aid will pay for it. That is capitalism. No, that is socialism inside capitalism. Let me explain. I assume by "medical aid" you mean insurance, right? What is insurance? It is a bunch of people pooling their money so they can reduce risk and pay for each others health care. Capice?
    - zo1 5y ago
      Difference being I get to pick in one and in the other I have no choice. Also the medical aid or insurance makes a profit, yet more capitalism. Either way, we're talking passed each other because we have different definitions.

FollowingTheDao 5y ago

Sorry. Yeah, my mother suffered her whole life with it and never new it. She was in a wheelchair for the last 10 years of her life with all kinds of issues. It was our kidney issues that tipped me off. That is the reason I went into the genetics, because she, and several other in my family have the same issues. If anyone is interested, it seems it is partly (mostly?) caused by a Purine nucleoside phosphorylase deficiency. (PNP gene) https://pubmed.ncbi.nlm.nih.gov/28859258/ https://pubmed.ncbi.nlm.nih.gov/28859258/