8 ms·

One of the major reasons why medical care in the US is so expensive is the over-reliance on expensive and often unnecessary testing. However, 'often' isn't the

One of the major reasons why medical care in the US is so expensive is the over-reliance on expensive and often unnecessary testing. However, 'often' isn't the same as 'always'. Seeking to reduce costs means using human judgement calls to replace 'unnecessary' testing. When I was in my late 20s, I had my vision go black for a short period. A concerned doctor had a full MRI workup done on me with review by a neurology team. They confirmed from the tests, as was 99.99% likely to be the case in an otherwise healthy 20-something, that it was an ocular migraine - alarming, but harmless. Problem is, what if it was the miniscule chance of being a stroke. The original doc could've sent me home with an aspirin, but could have also caused my death or severe disability if she was wrong.

junofan 4y ago
I’m glad the government isn’t in charge of my family’s health. Maybe it’s not trendy, but honestly over the course of several lives lived we’ve had doctors catch one or two things.
- fooblaster 4y ago
  I'd encourage you to think about the consequences of over testing. Although it is somewhat counter intuitive, there are many negative consequences to patient outcomes from overtesting. A deeper overview: https://www.youtube.com/watch?v=yNzQ_sLGIuA https://www.youtube.com/watch?v=yNzQ_sLGIuA
- CogitoCogito 4y ago
  Are you saying the problems with the care of the girl in the article are due to the government being in charge?
  - macinjosh 4y ago
    The point is they _were_ in charge.
    - midasuni 4y ago
      They weren’t. As it clearly said the hospital has many clients and a variety of funding including private patients and donations.
      - origin_path 4y ago
        The hospital in question is an NHS hospital i.e. run directly by the British state as basically all hospitals are. The NHS does occasionally rent out surgical spaces to the private sector but the UK private health care sector is comparatively tiny, and the hospital itself is still run by the government. In this case however the family weren't private clients so the whole thing was state run end to end.
        stuaxo 4y ago
        That's a vast over simplification large parts of the NHS have are run by private providers.
        origin_path 4y ago
        Like what? The NHS is basically entirely state run. Yes, they buy supplies and equipment from the private sector - they don't literally smelt their own sand into silicon - but the NHS employs all the staff, they own and maintain the buildings, they buy all the drugs and equipment. Private sector involvement in British healthcare is minimal. Literally every single person in the story about this poor girl is a state employee. And that is why this tragedy happened. The outcomes here are terrible but exactly what you'd expect and what the NHS's critics have been saying for decades. Talk to people who used to live in the Soviet Union and you'll hear stories indistinguishable from this one. There are people and equipment there, in theory the ingredients for success are available, but nobody seems to care about the results. So the system steadily degrades into ever more dysfunctional states, the problems are obvious to everyone who interacts with the system and yet it cannot/will not improve. This is exactly the reason communism failed and now the NHS is failing in the exact same way, for the exact same reasons. It's not even a new set of problems, it's just that the state of collapse is now so bad that even the most ideological people (e.g. Guardian editors) are starting to open up about it. Sadly this poor woman is still a long way from being able to understand what happened to her family. Her conclusion at the end of the article is "don't blindly trust doctors, research things on the internet and speak out". Yeah, and then what? She was already doing those things and the doctors/nurses were ignoring her. Patients in the NHS are totally disempowered. It's not like a private sector system where you have options and could go to a competitor. If the doctors aren't diagnosing your child's problem properly because they're WFH then, well, you're just screwed: the child is going to die and the resulting investigation will be a whitewash in which the doctors who messed up the worst get promoted. That's what happens when you have one state run system for everyone.
- maxboone 4y ago
  Ah yes, that must be it. It is not at all due to complex constructs that waive responsibility and invalidate criticism, as explained in the article. https://www.oecd-ilibrary.org//sites/3b4fdbf2-en/index.html?itemId=/content/component/3b4fdbf2-en#figure-d1e15830 https://www.oecd-ilibrary.org//sites/3b4fdbf2-en/index.html?...
t6jvcereio 4y ago
I'd never thought about it this way, thanks for the perspective.
kurupt213 4y ago
Aren’t they subject to malpractice lawsuits if they don’t properly evaluate differential diagnoses?

junofan 4y ago

I’m glad the government isn’t in charge of my family’s health. Maybe it’s not trendy, but honestly over the course of several lives lived we’ve had doctors catch one or two things.

fooblaster 4y ago
I'd encourage you to think about the consequences of over testing. Although it is somewhat counter intuitive, there are many negative consequences to patient outcomes from overtesting. A deeper overview: https://www.youtube.com/watch?v=yNzQ_sLGIuA https://www.youtube.com/watch?v=yNzQ_sLGIuA
CogitoCogito 4y ago
Are you saying the problems with the care of the girl in the article are due to the government being in charge?
- macinjosh 4y ago
  The point is they _were_ in charge.
  - midasuni 4y ago
    They weren’t. As it clearly said the hospital has many clients and a variety of funding including private patients and donations.
    - origin_path 4y ago
      The hospital in question is an NHS hospital i.e. run directly by the British state as basically all hospitals are. The NHS does occasionally rent out surgical spaces to the private sector but the UK private health care sector is comparatively tiny, and the hospital itself is still run by the government. In this case however the family weren't private clients so the whole thing was state run end to end.
      - stuaxo 4y ago
        That's a vast over simplification large parts of the NHS have are run by private providers.
        origin_path 4y ago
        Like what? The NHS is basically entirely state run. Yes, they buy supplies and equipment from the private sector - they don't literally smelt their own sand into silicon - but the NHS employs all the staff, they own and maintain the buildings, they buy all the drugs and equipment. Private sector involvement in British healthcare is minimal. Literally every single person in the story about this poor girl is a state employee. And that is why this tragedy happened. The outcomes here are terrible but exactly what you'd expect and what the NHS's critics have been saying for decades. Talk to people who used to live in the Soviet Union and you'll hear stories indistinguishable from this one. There are people and equipment there, in theory the ingredients for success are available, but nobody seems to care about the results. So the system steadily degrades into ever more dysfunctional states, the problems are obvious to everyone who interacts with the system and yet it cannot/will not improve. This is exactly the reason communism failed and now the NHS is failing in the exact same way, for the exact same reasons. It's not even a new set of problems, it's just that the state of collapse is now so bad that even the most ideological people (e.g. Guardian editors) are starting to open up about it. Sadly this poor woman is still a long way from being able to understand what happened to her family. Her conclusion at the end of the article is "don't blindly trust doctors, research things on the internet and speak out". Yeah, and then what? She was already doing those things and the doctors/nurses were ignoring her. Patients in the NHS are totally disempowered. It's not like a private sector system where you have options and could go to a competitor. If the doctors aren't diagnosing your child's problem properly because they're WFH then, well, you're just screwed: the child is going to die and the resulting investigation will be a whitewash in which the doctors who messed up the worst get promoted. That's what happens when you have one state run system for everyone.
maxboone 4y ago
Ah yes, that must be it. It is not at all due to complex constructs that waive responsibility and invalidate criticism, as explained in the article. https://www.oecd-ilibrary.org//sites/3b4fdbf2-en/index.html?itemId=/content/component/3b4fdbf2-en#figure-d1e15830 https://www.oecd-ilibrary.org//sites/3b4fdbf2-en/index.html?...

t6jvcereio 4y ago

I'd never thought about it this way, thanks for the perspective.

kurupt213 4y ago

Aren’t they subject to malpractice lawsuits if they don’t properly evaluate differential diagnoses?