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How about not letting the AMA artificially limit the supply of doctors? How about letting patients care for themselves? Acquire their own medicine? Ask for th

• physcab 17y ago
  You really think people are smart enough to care for themselves? The government is trying to protect us from ourselves, hence the "click-it or ticket" seat-belt law. Maybe the best way to fix our health-care system is to fix our educational system first.
  • randallsquared 17y ago
    You really think people are smart enough to care for themselves? Of course. I know more than one person who was forced to diagnose themselves and then insist on the tests that would prove it to the doctor. People know more about themselves than their doctors do, and have a much higher incentive to get it right.
    • physcab 17y ago
      Just because they...err we...have a higher incentive doesn't mean we have a better ability to diagnose. I'd like to think I'm a smart guy (3rd year PhD student) and I can't tell the difference between a cold, flu, allergies, or mono.
      • stcredzero 17y ago
        My girlfriend works in Public Health, and finds herself in the position of correcting doctors' misconceptions about illnesses she is monitoring. Seems like she gets to correct someone who should've known better about once or twice a month. What makes this even more ironic -- as a patient, she has a very difficult time communicating with doctors. When she was in graduate school, she did studies on disparities in health care based on race. Somehow she gets caught up in those mechanisms without seeing the patterns she once studied in grad school. (She's African American, and she constantly has problems convincing doctors that she's not exaggerating the degree of her pain, and at the same time constantly disregarding her doctor's instructions. A couple of days ago, I did a double-take and said, "OMG, a little voice in my head is yelling 'African American Health Disparities!' Do you realize you're living a stereotype?")
      • gnaritas 17y ago
        > and I can't tell the difference between a cold, flu, allergies, or mono. Then you haven't had them enough to get to know them well. Get something often enough and you don't need a doctor to tell you which it is, you learn from experience to know exactly which it is.
    • Evgeny 17y ago
      Looking at the number of people who are overweight/obese, who are smoking, who are abusing alcohol etc, I can not agree. It seems very simple to me to understand how to eat/exersice properly and how to not poison myself. All the information is readily available to anyone who needs it. Now if so many people can not even get this bit right, what chance is there that they would be able to diagnose more complex cases?
      • randallsquared 17y ago
        You assume that people actually prefer health to overeating, smoking, and alcohol. I would suggest we can tell what people prefer from what they do, given that everyone knows that overeating, smoking, and drinking too much alcohol are very bad for you. I say this, by the way, as an obese guy with a roommate who smokes, if that matters. :)
        • Evgeny 17y ago
          But would the people then actually prefer to actively prevent illnesses to just dealing with them as they happen? I have doubts ... I know I'm guilty myself - I need to make 2-3 visits to the dentist to fill some cavities, but I tend to delay this because of time issues, financial cost and pure laziness ... and I think I care about my health reasonably well compared to the majority.
      • elai 17y ago
        Obesity & drug addictions are significantly more difficult to fix behavior wise than a proper diagnosis and a non-addictive drug to cure it.
        • Evgeny 17y ago
          My point is - would obesity & drug addictions be so widespread if people cared about their health in the first place? Babies are not born being obese and drug addicted (the vast majority). And if they don't care that much already, how can we expect them to care enough to put some effort into diagnosing themselves?
    • helveticaman 17y ago
      At one point I told my doctor (a psychiatrist) I had ADD and needed ritalin. Stupid bitch said I didn't...cost me a lot of suffering before another doctor confirmed it.
      • helveticaman 17y ago
        Sorry about the vulgarity. It's just that the price I paid for that was enormous; I'd say it cost me a year and a half of suffering.
  • pj 17y ago
    Yes, I do think people are smart enough to care for themselves. It's more philosophical than whether or not people are smart enough though. I think people should be able to choose. If I make a mistake in my own health care and I die, then that is okay. I could fall off my roof while I'm trying to fix that too or repair my car's brakes wrong. Doctors make mistakes in patient care too and they are still allowed to practice medicine. I also think we should fix our educational system and one way would be to allow students to break free from the lowest common denominator factors that are also ruining our health.
    • physcab 17y ago
      I think you're totally right. And honestly I think the side-effect of having a ridiculously costly health-care system is that people just end up caring for themselves anyways. Unless of course you're my dad, who fainted at the wheel, was taken to the hospital unconscious, and then charged because he didn't call our insurance to pre-approve the ambulance...
  • Zak 17y ago
    I don't know if they are, but I do know that a lot of times, doctors aren't smart enough[0] to make medical decision for patients. Twice, I have correctly identified effective treatments for chronic conditions following years of failures by doctors. I'm a hacker, not a doctor; I have no medical training, but I know how to reverse-engineer a system enough to figure out what knobs there are to turn, and I know how to use Google. The first case was a woman suffering from prolonged, heavy menstrual bleeding. I don't mean an extra few days a month. I mean 45 days in a row with maybe a week between periods. The bleeding was enough to cause anemia, itself requiring medical treatment. The response of doctors was always the same: birth-control pills. At first they worked, but eventually they didn't. Certain pills, I don't remember which, made it significantly worse. She finally insisted on alternate treatment. The doctor insisted on another month on yet another pill, certain that her problem was polycystic ovarian diseas despite having found no cysts or other matching symptoms in an examination. It didn't work, so he decided the problem must be uterine polyps and scheduled a dilation and curettage - essentially scraping out the inside of the uterus. He could see no polyps during the procedure, but insisted that they're sometimes too small to see. It worked for a month. After that, the bleeding was back just as bad as ever. I came along to the doctor's office to help insist on a hormone test. He resisted, but eventually gave in. He resisted more when we wanted a copy of the results sent to us directly - in Florida, it's illegal for a test lab to deliver test results to anybody, including the patient without the doctor's permission. A couple weeks later, the results came in. All the levels were within the normal range, though luteinizing hormone was near the top of what seemed to be a rather wide range. A quick trip to Wikipedia made it clear this was part of the problem[1]. I went looking for a way to reduce the LH level, and quickly found that supressing the activity of another hormone called GNRH would do the trick, and that there are prescription drugs to do so. We brought the test results to an endocrinologist and first waited to see if she saw what I did. She didn't, so I told her. She agreed and wrote the prescription. With a retail price of around $60,000 an ounce, nafarelin acetate is the single most expensive substance I've interacted with, but it beats bleeding to death. In the second case, I found a treatment simply by talking to the patient on IRC. He had a seizure disorder. The actual cause wasn't and still isn't known, but he had been seeing a neurologist. At one point, the neurologist prescribed gabapentin, a drug that acts an an analog of the inhibitory neurotransmitter gamma-aminobutyric acid. This was effective for about a week, but the patient quickly built up a tolerance. After reading what gabapentin was, and how GABA itself is made in the body, I asked the patient if he noticed a decrease in seizures when he ate foods high in MSG. It turns out that he did. He has been taking glutamine in pill form for about two months now, almost completely suppressing the seizures. So, is everyone smart enough to care for themselves? Of course not. Are doctors necessarily smarter? At least some of the time, the answer appears to be no. I think most people should see a doctor for treatment of most medical conditions, but the idea of laws that prevent people from treating themselves seems like a fundamental violation of the rights of the individual. [0] The actual cause of repeatedly coming up with wrong answers may be any number of biases, incorrect uses of heuristics or otherwise bad decision-making rather than a lack of intelligence. [1] http://en.wikipedia.org/wiki/File:MenstrualCycle2.png http://en.wikipedia.org/wiki/File:MenstrualCycle2.png
• gabrielroth 17y ago
  Perhaps a more realistic proposal than self-care is clinic-based care by registered nurses and other well-trained non-MDs.
• randallsquared 17y ago
  Imagine if we forced companies and individuals to go to people with computer science degrees to get help with their computers. If the occasionally recurring calls for licensing of "software engineers" is any guide, some of the people reading this are imagining the legislation of supply and salivating at the higher salary this would mean for them. :/
  • deleted 17y ago
    [deleted]
• logjam 17y ago
  Disclaimer: I am a physician. There are greedy physicians. There are bad physicians. These physicians can drive up health costs. I do not find, however, much evidence to support the idea that physician reimbursement has anything to do with our high national health costs. Most I know are neither bad nor greedy. Generally, my colleagues are the best, most compassionate, smartest humans I know. The physicians I know have worked 60-80 hours a week for their entire professional lives, went into enormous debt to finance their professional educations and make between $140-200K annually before paying for their own expenses, health care insurance, sick time, vacations, etc. I understand what you are saying about taking your health destiny into your own hands. Most physicians, including myself, want you to do just that, and will work with you to encourage you to efficiently and cheaply monitor and care for your own conditions. Most of us feel that has to be the future. Most of us believe strongly in preventive medicine, and feel caring for chronic disease is like trying to put the toothpaste back in the tube. I'm with you, notwithstanding your hyperbole about the illegality of caring for your own health in a free nation. But I think you might agree that when your 9 month old starts wheezing one February day in the midst of a common respiratory syncytial virus outbreak, despite all the self-learning you did on the Internet, you're probably best advised to seek counsel, evaluation, and treatment from someone who has seen a few cases of RSV, seen a few more cases of how fast children can go down with something so seemingly simple, and can treat it effectively.
  • bokonist 17y ago
    The problem is not with physicians, rather its a structural problem with the American political system. I have no doubt that you and many of your colleagues are compassionate and well intentioned. But you also pay dues to an organization that has a political lobbying arm. This is of course, entirely understandable. Washington has a ton of power, power which can be used to steam roll you. Thus you support an organization that has a goal of looking out for your interests in Washington. It does so quite well. Too well, in fact. As a result of AMA lobbying, America has far fewer doctors than most other developed countries. The result is higher prices for consumers, and no evidence of better care. See: http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-of-trying-to-control-health-care-costs-in-a-country-short-of-doctors/ http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-o... Again, I don't blame the doctors, I blame the design of the political system that creates constant factional fighting over the resources of the country, with some factions getting screwed and others doing the screwing. ( Oh Madison, how wrong you were ... ) Part of the way the restrictions of new doctors work is by restricting medical schools. This of course drives up the price of medical schools, sending doctors into massive debt. Frankly, there is no reason that doctors need four years of college on top of four years of college on top of four years of high school. I'm sure the whole thing could be compressed into eight years, as other countries have done. For new doctors, loosening the barriers to entry would be a Pareto optimum improvement. Salaries would fall, but so would the costs of schooling. Overall the public would benefit without harming new doctors. But existing doctors would get screwed, as you point out. To be fair, any reducing of the barriers to entry should include compensation for current doctors.