4 ms·

In my area there has been a lot of consolidation in healthcare in the last decade or so, and care has gotten noticeably worse. My dad, living 200 miles away, h

In my area there has been a lot of consolidation in healthcare in the last decade or so, and care has gotten noticeably worse. My dad, living 200 miles away, has similar experience. He describes his provider as "Procedure oriented". If they can see you and quickly decide you need a procedure, they will do so, because they can bill for both. If anything is wrong with you that they don't immediately understand, or can't treat with a billable procedure, they don't have time for you. Profit driven health conglomerates are looking for efficiency. Inefficient patients are not profitable.

enragedcacti 4y ago
I have an unfounded suspicion that that this phenomenon is driving part of the increase in anxiety diagnoses. Based on what I've seen in a couple of different chronic illness forums, lots of people have the impression that when doctors can't easily test for something then they often just drop it into the bucket of "anxiety", even when that experience of anxiety could be driven by physiological issues and not the other way around.
- hotpotamus 4y ago
  Certainly possible, but the problem is that anxiety is extremely common and can have quite pronounced but generalized symptoms. The saying in medicine is "when you hear hoofbeats, think horses, not zebras". Meaning that you should not jump to exotic diagnoses lightly.
  - enragedcacti 4y ago
    You're right and I think its a good principle in general. I just wonder in this particular case how often it actually is zebras and if we would see doctors identifying true-positive cases of zebras (or just not dismissing it when the patient comes in and says "I think it's zebras because XYZ") more often if the medical system had different priorities.
    - hotpotamus 4y ago
      Indeed, there are zebras out there, which is a problem. https://www.sciencealert.com/a-case-of-schizophrenia-found-to-be-a-bad-case-of-cat-scratch-disease#:~:text=Bartonella%20henselae%20is%20a%20bacterium,the%20heart%20and%20nervous%20system https://www.sciencealert.com/a-case-of-schizophrenia-found-t.... I read a long form story of that case where the teen's parents spent 2 years and nearly half a million dollars on medical treatment until the father actually was able to put the correct diagnosis together himself. I don't disagree that profit-driven healthcare is incredibly problematic.
sarchertech 4y ago
Yep that's what happens when the doctor no longer owns the practice. Most doctors I know got into medicine in some part to help people, but when a doctor owns the practice, there's an additional motive to consider the long term implications of every patient interaction. When they are just an interchangeable employee, you're back to all the problems that come with motivating employees. The easy and most common solution is to tie pay to performance--where performance is measured in how much the employee brings in for the company. This gets even worse when instead of the employer being a non profit healthcare organization, the employer is owned by a private equity firm.
- VancouverMan 4y ago
  There are worse situations. Government-run, "socialized" health care (especially with unionized staff) is one example. As a monopoly, government has no financial or other incentives to provide efficient and quality service. If more money is needed/wanted, it's simply taken from taxpayers. Even worse, there are no real consequences or accountability for poor performance from any of the participants involved. We end up with bloated health care organizations that deliver slow and ineffective treatment at a massive cost to society at large. If the government-run health care system employees are unionized, it's even worse. The unions involved will effectively become political entities, doing everything in their power to block or impede any kind of meaningful reform or optimization of a broken (but beneficial to them) health care system. It gets even worse when the government-run health care system, despite imposing a massive tax burden on taxpayers, doesn't even cover common procedures or treatments (dental, vision, prescriptions, and so on). So those already paying into this "socialized" system often end up needing some sort of costly private insurance, often offered through an employer, or they have to pay out-of-pocket. What's described above is what we find with the various provincial government-run health care systems in Canada. Canadian patients who can afford to do so will usually seek treatment at a private provider in the US or elsewhere. It may be expensive, but at least those patients tend to get effective treatment in a timely manner, which is something that's extremely rare with Canada's various "socialized" health care systems.
  - enragedcacti 4y ago

enragedcacti 4y ago

I have an unfounded suspicion that that this phenomenon is driving part of the increase in anxiety diagnoses. Based on what I've seen in a couple of different chronic illness forums, lots of people have the impression that when doctors can't easily test for something then they often just drop it into the bucket of "anxiety", even when that experience of anxiety could be driven by physiological issues and not the other way around.

hotpotamus 4y ago
Certainly possible, but the problem is that anxiety is extremely common and can have quite pronounced but generalized symptoms. The saying in medicine is "when you hear hoofbeats, think horses, not zebras". Meaning that you should not jump to exotic diagnoses lightly.
- enragedcacti 4y ago
  You're right and I think its a good principle in general. I just wonder in this particular case how often it actually is zebras and if we would see doctors identifying true-positive cases of zebras (or just not dismissing it when the patient comes in and says "I think it's zebras because XYZ") more often if the medical system had different priorities.
  - hotpotamus 4y ago
    Indeed, there are zebras out there, which is a problem. https://www.sciencealert.com/a-case-of-schizophrenia-found-to-be-a-bad-case-of-cat-scratch-disease#:~:text=Bartonella%20henselae%20is%20a%20bacterium,the%20heart%20and%20nervous%20system https://www.sciencealert.com/a-case-of-schizophrenia-found-t.... I read a long form story of that case where the teen's parents spent 2 years and nearly half a million dollars on medical treatment until the father actually was able to put the correct diagnosis together himself. I don't disagree that profit-driven healthcare is incredibly problematic.

sarchertech 4y ago

Yep that's what happens when the doctor no longer owns the practice. Most doctors I know got into medicine in some part to help people, but when a doctor owns the practice, there's an additional motive to consider the long term implications of every patient interaction. When they are just an interchangeable employee, you're back to all the problems that come with motivating employees. The easy and most common solution is to tie pay to performance--where performance is measured in how much the employee brings in for the company. This gets even worse when instead of the employer being a non profit healthcare organization, the employer is owned by a private equity firm.

VancouverMan 4y ago
There are worse situations. Government-run, "socialized" health care (especially with unionized staff) is one example. As a monopoly, government has no financial or other incentives to provide efficient and quality service. If more money is needed/wanted, it's simply taken from taxpayers. Even worse, there are no real consequences or accountability for poor performance from any of the participants involved. We end up with bloated health care organizations that deliver slow and ineffective treatment at a massive cost to society at large. If the government-run health care system employees are unionized, it's even worse. The unions involved will effectively become political entities, doing everything in their power to block or impede any kind of meaningful reform or optimization of a broken (but beneficial to them) health care system. It gets even worse when the government-run health care system, despite imposing a massive tax burden on taxpayers, doesn't even cover common procedures or treatments (dental, vision, prescriptions, and so on). So those already paying into this "socialized" system often end up needing some sort of costly private insurance, often offered through an employer, or they have to pay out-of-pocket. What's described above is what we find with the various provincial government-run health care systems in Canada. Canadian patients who can afford to do so will usually seek treatment at a private provider in the US or elsewhere. It may be expensive, but at least those patients tend to get effective treatment in a timely manner, which is something that's extremely rare with Canada's various "socialized" health care systems.
- enragedcacti 4y ago