Medical Malpractice Myth

December 18, 2005 7:24 PM

Medical Malpractice Mythexplores the idea that it's not litigious patients, ambulance chasing lawyers and runaway juries behind the rising costs of medical malpractice insurance. It's the increasing occurrence of medical malpractice that's driving those insurance rates up.
posted by jperkins (105 comments total)

From the posted url:

What the medical societies did not tell my father, or almost anyone else, was that their own research showed that the real problem was too much medical malpractice, not too much litigation. In the mid-1970s the California Hospital and Medical Associations sponsored a study on medical malpractice that they expected would support their tort reform efforts. But, to their surprise and dismay, the study showed that medical malpractice injured tens of thousands of people every year—more than automobile and workplace accidents. The study also showed that, despite the rhetoric, most of the victims did not sue.

...except for auto accidents and the occasional “mass tort” situation like asbestos, Agent Orange, or breast implants, Americans actually do not bring tort claims all that often, especially compared to the number of accidents and injuries there are. We now have two decades of solid research documenting this fact.

I'll admit to being nearly completely ignorant of the medical, legal and insurance industrys and how they work and am hoping for some commentary from mefites who are more familiar with how this all actually works to shed some light.
posted by jperkins at 7:25 PM on December 18, 2005

There are definitely many more medical mistakes than the public knows about.the first thing that is needed to lower malpractice insurance rates is for doctors to police their own. This is not currently done. In fact (personal observation, I work in the medical field) much more common is for doctors to cover other doctors mistakes.

There is lots of talk about the heavy burden that “defensive medicine” imposes on health costs, but the research shows this is not true.

Actually defensive is driving up the cost of medicine, but it does little to lower the number of mistakes because many of the doctors don't fully understand what the tests they are ordering can and do show.
posted by ScotchLynx at 7:45 PM on December 18, 2005

argh-
actually "defensive medicine"
posted by ScotchLynx at 7:47 PM on December 18, 2005

Disclaimer: I am the son of doctor and a law student

The major research on the topic is the Harvard Medical Practice Study. Basically, a medical team and a legal team reviewed (medical) cases, analyzed them for malpractice, and then determined whether the case had merit. Then they looked and saw whether the patient actually sued, and if they did, if they actually won.

The main findings were that malpractice is relatively rare, most injured patients do not bring claims, and (this is the biggie, I think) there is no correlation between the existence of malpractice and whether the patient won the suit. In fact, there is some suggestion that it is precisely those cases without merit that win and those with merit that do not.

Personally I don't buy the idea that the reason there are a lot of suits is that there is a lot of malpractice. Generally speaking medical education and certification in America is comparable to that in other countries, yet there are more malpractice suits in the US than the rest of the developed world. So if it's bad here it must be downright awful in the rest of the world. Maybe it is, but I'd like to think it isn't.

ScotchLynx: You're right about the lack of self-policing. Fear of litigation keeps doctors and hospitals from creating effective feedback loops. No one will admit to making mistakes. As regards defensive medicine, there's some evidence that it actually makes things worse. And not just in the 'all those unnecessary CT scans are going to give us cancer' sense (although there's some real concern about that).
posted by jedicus at 7:51 PM on December 18, 2005

Meta-disclaimer: that is, I'm a law student and my dad's a doctor, not that I'm the son of both.
posted by jedicus at 7:53 PM on December 18, 2005

Quick toss-out: the more doctors there are, the more BAD doctors there are; and the more medicine being practiced (especially elective -- non-critical -- medicine), the more malpractice there'll be.

Med school should be at least as hard to get into as veterinary school. From what I've seen of the graduates of both, I keep wanting to remind the "exotics" vet we use that dammit I'm really just a bald chimp and deserve the same quality care that our ferrets get!
posted by davy at 8:01 PM on December 18, 2005

The main findings were that malpractice is relatively rare, most injured patients do not bring claims


And this study can be spun a different way...

A study of medical malpractice in New York State, conducted by the Harvard Medical School, confirms that the incidence of malpractice is much larger than the incidence of claims.

Can you find the study? Seems as though it looks pretty inconclusive from what I have read.

"More than with most studies, however, the Harvard group’s results are subject to sharply different interpretations and depend heavily on definitions and assumptions with which many will differ. "
posted by j-urb at 8:08 PM on December 18, 2005

i'm sure i read somewhere that medical error was the 3rd leading cause of death in the US. shhhh...it's a secret.
posted by brandz at 8:08 PM on December 18, 2005

As the most popular Doctor, Tom Baker certainly is qualified to write about matters of medical malpratice.
posted by kindall at 8:10 PM on December 18, 2005

j-urb: I looked pretty hard to find the study itself. I couldn't even find a proper citation or a for-pay link. Disconcerting, seeing as how everyone and their dog mentions it.

And I freely admit that the perspective from which I view it is very different from the one that most lawyers view it from.

In all seriousness, I wonder what dios thinks about this guy's thesis.
posted by jedicus at 8:13 PM on December 18, 2005

Doctors commit a great deal of malpractice; patients rarely sue or get compensated at all for the malpractice they endure. Doctors are well paid; doctors in the U.S. net an average of $200K or so, after malpractice insurance and taxes, while in other developed countries it's more like $100K. Try talking to some surgeons at cocktail parties - they treat their profession like woodworking. Chop here, slice here, staple there, got two more scheduled before lunch. Remember: half of all surgeons are below average.

But one of the largest reasons rates are skyrocketing is that the economy has been crap. Insurance - all insurance - works by taking your money now and possibly paying you later. The insurance industry sits on trillions of dollars, and they get the returns from investing it while they wait to possibly pay out, and the investment returns go into the business just like the premiums do. When the stock market is up up up, like it was until 2001, you can stop raising premiums at all, because investment returns are outrageous, and this is in fact what happened. When the stock market is crummy, like it has been since 2001, then the premiums need to go up up up like the stock market used to.

So to a first approximation, the reason that insurance rates are up hugely since 2001 is that the stock market is bad. Nothing more, nothing less.

Going slightly deeper, the US medical insurance system spends about 1/3 of every dollar it receives trying to deny care to people. That's really the main medical insurance line of business - finding healthy people to insure and finding sick people to cut off insuring.

The current system is massively subsidized by the US government, because insurance premiums are not taxed. If you're getting insurance from your employer, you're also getting massive subsidy from the Federal and State governments, whether you're aware of it or not. Overall, the U.S. government pays more per capita (across the whole population) for health care than Canada or any other nation, and yet only manages to get health care to half the population. That's the real shame.

Overall, the U.S. health care system is a failed one. If the government subsidies ended, the whole thing would collapse. You get much less for your tax dollar than citizens of other countries do - in Canada, you can get run over by a truck, spend a month recuperating in intensive care, get an aide to come to your home and do rehab therapy for a year, and be out of pocket exactly $0. For this, the Canadian citizen pays less in taxes than you do - not even counting the money you pay for health insurance, I'm talking about the money that you pay in U.S. taxes that ends up going to health care. The Canadian pays less than you do and gets free health care. For everyone. U.S. citizens are getting the shaft.

[Aside on j-urb's comments above: please don't mistake hackjob commentary from a "thinktank" paid to influence public debate, like that Manhattan Institute, with real scientific commentary. If you have trouble determining, just substitute "paid lairs" for the word "thinktank" and see if that helps.]
posted by jellicle at 8:19 PM on December 18, 2005

So if I'm one of Jellicle's woodshop surgeons, practicing in Canada, making a third of my prior income, with little chance of getting sued, exactly why, again, do I give a shit if I leave behind a sponge? Oh, right, because everywhere else in the world doctors are selfless, virtuous, and motivated by altruism.
posted by docpops at 8:31 PM on December 18, 2005

So to a first approximation, the reason that insurance rates are up hugely since 2001 is that the stock market is bad. Nothing more, nothing less.

jellicle has this exactly right. Malpractice is most definitely not driving up the price of insurance, to any significant degree.

And he's also spot-on in saying the US health care system is a failed one. We pay more than anyone else, yet we receive slightly inferior to massively inferior care, depending upon where you lie in the system. The average Joe with insurance gets care that is slightly less effective (by several metrics), and pays more for it, IF he is insured, compared to those in other countries of similar wealth. (He pays something like 2-4 times as much).

If you're one of those 45 million uninsured, you care is much, much less than that you would receive in one of those "socialized medicine" countries. Further, a significant chunk of these people do pay for insurance -- it just doesn't go to them. They pay taxes for military, Medicare, and Medicaid insurance. For others. They themselves are uninsured.

Nice system.

For a vanishingly small number of super-rich people, the American system may be the best in the world. For the overwhelming majority, it is not, and it's damn expensive, to boot.
posted by teece at 8:36 PM on December 18, 2005

There was a very interesting CBC TV program on related subject matter a couple of years ago, Inside the Canadian Medical Protective Association.

There was a discussion on CBC Radio's The Sunday Edition with Dr. Pat Crosskerry (audio file). The intro to that piece claims that medical mistakes are the 4th leading cause of death in Canada.

Finally, I can recall a discussion from a couple of years ago about how lack of sleep effects doctors - not surprising that doctors are effected just like the rest of us. I can't find the link, but here is a recent Scientific American news brief on the subject.
posted by Chuckles at 8:44 PM on December 18, 2005

If you're one of those 45 million uninsured

Keep repeating the same lie often enough...
posted by Kwantsar at 8:45 PM on December 18, 2005

hmm, Cato, Cato, where have I heard that thinktank in the news lately...
posted by Heywood Mogroot at 8:50 PM on December 18, 2005

jellicle: Try talking to some surgeons at cocktail parties - they treat their profession like woodworking. Chop here, slice here, staple there, got two more scheduled before lunch.

When it comes to surgery, you really want the procedure to be absolutely the most routine thing in the world to the people performing it. If it isn't very well understood, and very easy (easy for the practiced professional, that is), it isn't something that should be tried very often.

That doesn't excuse the attitude though, of course. The sleep issue is a great illustration of the problematic culture of doctors...
posted by Chuckles at 8:54 PM on December 18, 2005

Remember: half of all surgeons are below average.

Keep in mind, however, that it is quite difficult for a below-average medical school student to get accepted to a surgical residency program. Half of MIT-educated engineers are below average MIT-educated engineers, but even the below-average ones are pretty damn good.

But, yeah, sometimes a surgeon will screw up in the middle of the procedure, correct his mistake, go back to what he was working on, and sew up the patient, all while the patient is under anaesthesia. How much you want to worry about all the mistakes that surgeons make that you won't even get a chance to notice because the doctor fixed it while you were under is a matter of how much paranoia you're willing to accept.
posted by deanc at 9:04 PM on December 18, 2005

Try talking to some surgeons at cocktail parties - they treat their profession like woodworking. Chop here, slice here, staple there, got two more scheduled before lunch.

Oh please! They perform the same procedured day in and day out. Do you really think that your case is so damn special?
posted by c13 at 9:16 PM on December 18, 2005

Q: What do they call the person that graduates last in their class at med-school?

A: Doctor.
posted by tozturk at 9:19 PM on December 18, 2005

If you're linking to cato.org about some factual matter, you've already lost. Remember: replace "thinktank" with "paid liars".

The Census Bureau states pretty comprehensively that 15.7% of the U.S. population - 45 million people - had no health insurance for any part of the year 2004. Or you could believe the Cato Institute, who are paid to influence public opinion via lying. Your choice.

About 27% of the U.S. population is covered directly by the government. So you already have one-quarter of universal health care, you just need to work on the other 3/4.

People are commenting on my description of surgeons. I mean only to demystify what surgeons and all doctors do, not to denigrate them. It's a job. It has a great deal in common with automobile assembly. Patients come at you on an assembly line, you perform your technique on them, and they're gone to the next guy down the line. Depending on the factory, the assembly line may be run fast or may be run slow, you might get breaks or not, you might take pride in your work or you might not, you might be concentrating on the job or thinking about what to have for lunch when you're treating any given patient, etc. etc. People treat doctors as some sort of mythic authority figures when they really shouldn't. Not that all doctors are hacks, but rather that those doctors who are hacks can easily get away with it by parading around in a white coat with a stethoscope.

Hmmm. The NY Times has a story summing up the experience of sick people in America - you get a job, you have great health insurance, you get sick, you lose your job, you lose your health insurance because you lost your job, you go bankrupt.

Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle.
"That's some catch, that Catch-22," he observed.
"It's the best there is," Doc Daneeka agreed.
posted by jellicle at 9:24 PM on December 18, 2005

Fact: The typical family practice doctor in the United States makes $120k. This number has not changed in ten years.

Fact: Most medical malpractice policies have a maximum payout of $1M per incident. This renders "megaverdicts" and "pain and suffering" damages a non-issue for the insurer. Damage caps are a red herring.

Fact: Doctors have no control over how much they will pay for malpractice insurance. In many cases, he has a choice between 2-6 companies that offer it in his state, and depending on his scope of practice some of them will not cover him for any price. Some states have seen double digit rate increases in each of the last five years.

Does the author really mean to say that the incidence of malpractice has gone up that much in the last rive years? You might not want to get me started on this issue.
posted by ilsa at 9:25 PM on December 18, 2005

Are you a doctor yourself, jellicle?
posted by c13 at 9:31 PM on December 18, 2005

no, but he plays one on TV...
posted by Heywood Mogroot at 9:34 PM on December 18, 2005

Read this pNew Yorker iece by Atul Gawande (a doctor) in the New Yorker and you'll see, much better than I can state, how the truth is a lot more difficult to entertain than one might imagine.TAG OFF!

If only there were some way to mark text in such a way that clicking on a phrase of text would link one to a longer article that expands on the text that the user clicked on, instead of simply being forced to read the entire article on the same page it was referenced.
posted by deanc at 9:41 PM on December 18, 2005

end /em, dude
posted by es_de_bah at 9:42 PM on December 18, 2005

narebuc: It's usually people who are not doctors who make claims like "medical errors kill lots of people." This might be "true" in a very loose causation sense. Yes, some type of event that didn't go perfect or according to textbook ended up in adverse result. But, wow, there's usually a lot more to a story: ...

In the CBC discussion I linked they say that 5% of errors are due to negligence. Personally, I don't care why the errors occur, the error rate needs to be reduced, period.

And... Your "if your not a doctor you can't talk about this subject" bit is not helpful.

What's wrong with the tort system is that it focuses way too much on blame in order to get even larger and larger jury rewards and, really, in the vast majority of malpractice cases -- blame is a questionable thing.

I doubt it... However, Tom Baker's idea seems to be that tort is an effective check against malpractice. I doubt that too...

I think that civil engineering and civil aviation have a lot to teach in this area. It is my impression that both fields have done a masterful job of improving error rates over time, the medical profession doesn't seem to have followed suit.

I don't think tort had anything much to do with the improvements made in civil aviation and civil engineering safety records. I think the improvement came about because the public demanded better performance, and industry decided it would be good for business to spend a lot of money/time/effort learning how to do better.

Of course there is a big difference between the different industries. A plane crash effects tens to hundreds of people, which justifies spending huge amounts of money on investigation. Also, people tend to distrust aviation, and many just wouldn't fly if they didn't know how seriously safety is taken. A medical error normally effects one person, and people have a tendency to trust, even deify, doctors.

Of course that is just a personal theory...
posted by Chuckles at 9:44 PM on December 18, 2005

So to a first approximation, the reason that insurance rates are up hugely since 2001 is that the stock market is bad. Nothing more, nothing less.

Going slightly deeper, the US medical insurance system spends about 1/3 of every dollar it receives trying to deny care to people. That's really the main medical insurance line of business - finding healthy people to insure and finding sick people to cut off insuring.

Good points and I think they are legitimate. I probably should not have posted a think tank link, however, my point was that without me actually being able to read the Harvard data the study is inconclusive and I can not make any objective decision toward it.
posted by j-urb at 9:46 PM on December 18, 2005

Q: What do they call the person that graduates last in their class at med-school?

A: Someone who's still more intelligent and hardworking than 99% of the general population that could never even dream of making it that far.
posted by drpynchon at 9:48 PM on December 18, 2005

Jellicle,

Unless you are a doctor, and apparently one with a pretty low opinion of yourself, you're talking out your ass anytime you claim to know what the life and practice of a physician is like.

Stick to making points that don't have the validity of three-dollar Gucci wallets.
posted by docpops at 9:49 PM on December 18, 2005

hmm, Cato, Cato, where have I heard that thinktank in the news lately...

If you're linking to cato.org about some factual matter, you've already lost

You can either debunk or go all Ad Hominem. Laziness is your prerogative.
posted by Kwantsar at 9:49 PM on December 18, 2005

So a human being is as simple of a mechanism as a bridge or an airplane? Is that also a part of your personal theory?
Do you also mean to say that there is no difference between making a choice between flying or taking a train and between having a broken bone set, or a tumor taken out, and not doing it?
posted by c13 at 9:54 PM on December 18, 2005

Kwantsar: from the cato report you link to

The Congressional Budget Office shot holes in that statistic last May when it reported the correct figure is between 21 million and 31 million.

I guess 21-31 million people without any type of insurance is just fine and dandy with you.
posted by Freen at 9:59 PM on December 18, 2005

Bastard.
posted by Freen at 10:02 PM on December 18, 2005

And a little Non Sequitur. Bravo.
posted by Kwantsar at 10:02 PM on December 18, 2005

Poopy Pants.
posted by Kwantsar at 10:02 PM on December 18, 2005

Is there are reason you need to be in attack mode c13?

Indeed, biological systems are more complex than human designed systems. That should probably teach us to tread more lightly in those areas...

Or do you prefer attack mode? Then tell me again why 80 hour work weeks are acceptable for resident's when 60 hours is considered the limit for truck drivers?
posted by Chuckles at 10:02 PM on December 18, 2005

Do you also mean to say that there is no difference between making a choice between flying or taking a train and between having a broken bone set, or a tumor taken out, and not doing it?

For some procedures, there is an actual choice between, say, surgery and extra drugs or the use of one procedure versus another.... or attempting a risky surgery versus not doing anything at all. Choices and opportunity costs exist in medicine as well as transportation.
posted by deanc at 10:02 PM on December 18, 2005

being in a professional field (computer science) I've noticed that most of the people in comp sci are actually idiots. I assume the same is true of doctors and lawyers and so on, and it's rather frightening.
posted by delmoi at 10:05 PM on December 18, 2005

Chuckles, I'm not saying you have to be a doctor at all. I'd just like something more than a purely legal "blame/negligence/pain and suffering, etc." way of looking at it. Anyone who wants to apply real scientific rationales and robust critical thought is welcome. Its just that anyone who says -- too much malpractice is the problem is lost from the beginning.

I'm too lazy to post the links here -- but do a search for civilian aviation and medical errors and, yes, the health care industry is taking a huge cue from that area. It's slow in coming, and you're spot on about the differences, but in terms of simple things like repeating back an order: a la: Doctor: "I need 0.5 mg of ceftriaxone" Nurse: "Ok, you asked for 0.5 mg of ceftriaxone" instead of "Ok" -- it's already happening at my hospital. The differences have also been discussed -- and, please, I hate to get back to hit but the human body is a lot harder to understand than an airplane.

Dean -- I went to the newyorker.com and it was not being released to the public. So, I got it from another source for which the link (I thought) was not publically available. At least I italicized it -- so sue me. Ok, bad joke right here. :)
posted by narebuc at 10:06 PM on December 18, 2005

Anyway, the real problem with medical costs is that the baby boomers are getting old, and old people incur a lot of medical costs.

Solution: Kill all the boomers. They're so annoyingly self-centered anyway, so no big loss.
posted by delmoi at 10:08 PM on December 18, 2005

c13 your analogy is false sir. He was refering to the technicians perspective. Not the perspective of a passanger or something that is being manipulated. Of course this is a difference betweeen choosing what vehicle you going to a passenger in and wheter or not the ohave surgery on you body. I will not deny that both relate to earthy conveyance. The rhetoric however is still deceptive.
posted by Rubbstone at 10:09 PM on December 18, 2005

Remember: half of all surgeons are below average.

Actually, it could be a lot more then that. If only half of all people can be surgeons, then the number of below-median doctors would be closer to 7/8th then 1/2...
posted by delmoi at 10:14 PM on December 18, 2005

Ergh. Malpractice is horrifying in that if something goes wrong during a medical procedure, there are many, many reasons why that may have happened- physician's error, pre-existing conditions, pure bad luck. My father's a physician, and told me once that, as a doctor, you really just have to make the best decision you can, the absolute safest bet, and then stick by it, because if something goes wrong and you weren't 100% sure about that something, it's going to dig at you forever, even if you weren't at fault. And patients need to realize this- when the doctor tell you possible side effects of a procedure, and they mention death, it might be just to cover their ass, or it might not. For almost all serious medical procedures, there is a chance that you might die, and you need to be fully aware of that.
On another note, the most obvious case of malpractice my father ever saw was...well...if you're having a procedure done, and the doctor accidentally cuts another organ, they will often quickly cauterize it. The largest exception to this rule is if the physician accidentally ruptures an un-prepped colon, because an un-prepped colon is filled with combustible gases, and when you cauterize that... My dad knew of two times that this had happened locally in the last 25 years, and both times the patients died on the table because they suddenly found themselves with large, smoking holes where their lower GI tract should have been. Remember, kids, virtually all operating room fires ignite on or in the patient!
posted by 235w103 at 10:34 PM on December 18, 2005

Deanc, there is a difference between your argument and mine. I say that, if you don't trust one mode of transportation, use a different one. You're, on the other hand, talking about surgery vs drugs. But both the surgery and the durgs require you to go see a doctor. If you'd rather go see you local yoga master when you have an acute appendicitis, then you're really talking about choices.

Rubbstone, allow me to clarify: we (as in humans) know exactly how an airplane operates, we know everything about all of it's parts -- their functions, dimensions, materials they are made out of, etc. We can predict exactly what will happen in response to a certain input. Therefore we know exactly what we should and should not be doing when operating an airplane.
But we don't know much at all about how a human body operates or how it will respond to a particular treatment. That's why the error rate is higher.

Remember, we still have a 100% mortality rate.

And finally, Chuckles, it bothers me when people criticize things they don't know a low about. And especially when they try to offer suggestions. It is not specific to the topic at hand. I would be just as irratated if docpops, for example, posted about how a steel industry is full of incomeptent hacks and if only they did things the way they do it in the cheese industry, things would be so much better.
posted by c13 at 10:35 PM on December 18, 2005

You can either debunk or go all Ad Hominem. Laziness is your prerogative.

bringing the ideologues of Cato in this is just retarded. Sorry. Cato, like Heritage, AEI, and Manhattan, are in fact paid liars when it comes to anything smacking of socialism, so bringing them & their op-eds up is just a side-track.

In two seconds of googling I see a recent Kaiser org study showing 30-40M under-65 uninsured, with pretty charts and shit.

There is also a CDC study with similar numbers. Calling the 45M number 'a lie' is adding more heat than light to the issue.
posted by Heywood Mogroot at 10:38 PM on December 18, 2005

hmm, Cato, Cato, where have I heard that thinktank in the news lately...

I have a soft spot for Cato, FWIW, They oppose the war on drugs and oppsed the Iraq war(!).
posted by delmoi at 10:38 PM on December 18, 2005

c13: That's why the error rate is higher.

I never intended to compare the raw error rates, not even the magnitude of the incremental improvements, only the direction of the change in error rate over time.
posted by Chuckles at 10:50 PM on December 18, 2005

A: Someone who's still more intelligent and hardworking than 99% of the general population that could never even dream of making it that far.

Well, if you multiply Intelegence and hardworking ness maybe, the problem with working hard is that even a complete idiot can work hard. It tells you nothing about a person's competence.

I don't want a "hard working" doctor. I want one who can take one look at me and know exactly what's wrong and how to fix it.
posted by delmoi at 10:55 PM on December 18, 2005

There is also a CDC study with similar numbers. Calling the 45M number 'a lie' is adding more heat than light to the issue.

Er, isn't heat what you want?
posted by delmoi at 10:57 PM on December 18, 2005

Bringing the nanny-statists of the Kaiser Family Foundation into this is just retarded. Sorry, Kaiser, like Rockefeller, Pew, and Johnson are in fact tax-exempt ideologues when it comes to anything smacking of personal responsibility or free markets, so bringing them & their studies up is just a side-track.
posted by Kwantsar at 10:58 PM on December 18, 2005

so bringing them & their studies up is just a side-track.

Follow the money, buddy.
posted by Heywood Mogroot at 11:01 PM on December 18, 2005

"You can either debunk or go all Ad Hominem. Laziness is your prerogative."

"And a little Non Sequitur."

Or you can italicize and capitalize all your Latin phrases, as if to say, "Gentlemen, gentlemen, please: I'd just like you all to note that I've invoked Latin. A learnéd man am I. As you were."

You have probably never won an argument. As you were.
posted by electric_counterpoint at 11:10 PM on December 18, 2005

Oh, and Kwantstar, while I've got you here:

You can either debunk, or ... ah, you know.
posted by electric_counterpoint at 11:12 PM on December 18, 2005

Er, isn't heat what you want?

No, getting into a pissing match as to exactly how many millions of Americans cannot gain affordable health insurance is rather besides the point. No sane person given a choice, under Rawl's "veil of ignorance" as to original position, would choose the present US model over any other G7 democracy's.

But this is a malpractice thread so I'll leave all the argumentum from me there.
posted by Heywood Mogroot at 11:15 PM on December 18, 2005

I never intended to compare the raw error rates, not even the magnitude of the incremental improvements, only the direction of the change in error rate over time.

Then compare the patient conditions and the outcome of medical procedures done in Civil War (or early 1900's, or 1950's) hospitals with the modern ones. I think you will be satisfied with the direction.
posted by c13 at 11:17 PM on December 18, 2005

Okay, buddy. You think these hands are clean?
posted by Kwantsar at 11:21 PM on December 18, 2005

And counterpoint, it was pretty obvious that I was throwing Mogroot's rhetoric back at him. Nice latin troll, too. GFY.
posted by Kwantsar at 11:23 PM on December 18, 2005

PS, Heywood, You're doing it again. Not even Kaiser claims that all the people in its study couldn't afford health insurance. In fact, over 1/3 of those cited were over 200% of the federal poverty line.

In 2003, I was one of those uninsured, and it was voluntary.
posted by Kwantsar at 11:26 PM on December 18, 2005

I was one of those uninsured, and it was voluntary.

Because you felt not paying the premium was worth the risk.

The Canadian system is eminently affordable in such situations, as was the Japanese 80-20 system when I lived there. People, regardless of ability to pay, get first-class, well, not the shitty treatment the uninsured get here.

Like I said, getting into a pissing match as to the exact number of millions of people not served by this lurching market failure we call a health insurance segment is besides the point, and is horribly off-topic besides:

the original point you called a lie:

If you're one of those 45 million uninsured, you care is much, much less than that you would receive in one of those "socialized medicine" countries

is still true regardless whether going naked was a lifestyle choice or not.
posted by Heywood Mogroot at 11:38 PM on December 18, 2005

...unless one is independently wealthy, then of course standards of care are the best here. Hence Heritage, AEI, Manhattan, and Cato barking their masters' tunes wrt single payer.
posted by Heywood Mogroot at 11:40 PM on December 18, 2005

Kwantsar, if your going to go all high and mighty with your Latin terms ...

How's about you justify the bullshit rhetorical grenade you threw, eh? So, a disagreement about a hard to pin down number is "a lie." And conveniently, you choose the number you don't like as the "lie."

Census Bureau vs. Cato, hmm...

I know the Census Bureau hires statisticians and such, and comes up with such numbers for a living. I know that Cato makes a living making the data fit a particular world view. Gee, should I debunk Cato? Or should I pick the lint from my belly button?

Maybe you could refrain from lecturing people about ad hominem when you pull transparent bullshit like that?

If you were actually interested in reasoned debate, you wouldn't have called the number a lie -- because it isn't, and you know it. And of course, even if the number is only 20 million, you still made an outstanding addition to the discussion by calling the other number a lie, right?

So you don't even know me, you call me a repeater of lies with zero justification, and you lecture people about ad hominem? What's the Latin term for that? Trollus Assholus?
posted by teece at 11:47 PM on December 18, 2005

Well, if you multiply Intelegence and hardworking ness maybe, the problem with working hard is that even a complete idiot can work hard. It tells you nothing about a person's competence.

I don't want a "hard working" doctor. I want one who can take one look at me and know exactly what's wrong and how to fix it.

Rare are the disease processes that can be diagnosed by taking one look at a patient, and far more complex are the decisions about how to intervene in most cases than you suspect them to be.

You assume that doctors can just get by on hard work and seem to think that medicine is like other 'professional' fields when that simply isn't the case. I know it's easy for me to say, but until you've studied for and passed the countless exams required, from the MCAT to the USMLE to the frequent recertifications, you can't really appreciate the massive fund of knowledge required to even get a medical license (let alone be a 'good' doctor). What's more, in medicine far more so than any other business, you need to retrieve that information from memory spontaneously and under difficult circumstances. Perhaps the obvious is overlooked -- place yourself in the position of being responsible for someone who may be dying in front of you, sometimes rapidly, and having to make split-second decisions which in restrospect are dependent on libraries full of literature. Next time you think that guy in the ER is just some hardworking dumbass, try putting yourself in his shoes. Also consider the risks he is taking and the difficult decisions he is making countless times on a daily basis.

That said, to get back on topic, the reality is that even the very best physician is human and has to make a ton of judgment calls which can often have grave consequences. In light of that, medical errors (however you wish to define them) are a statistical certainty over any doctor's career. I submit that the physician who is a repeat offender or who demonstrates a dubious track record is certainly a problem, but in general, such physicians are exceptions to the rule. So while malpractice serves some theoretical purpose, the real solution is developing flexible systems with appropriate failsafes in healthcare. As countless studies have shown there is absolutely no correlation between the merits and the outcomes of malpractice cases in the United States, which if you ask me, is enough to indict that whole process as it stands.
posted by drpynchon at 11:48 PM on December 18, 2005

^^
posted by Heywood Mogroot at 12:05 AM on December 19, 2005

Lots of emotion here.

I'm either going to be ignored or flamed, but has anyone done an analysis on the relative pay for physicians compared to the general population/skilled workers and the rate of malpractice (or just plain "whoopsies?").

eg - physicians in the United States tend to draw a far higher salary (gross/net) compared to physicians in the UK/Canada.

Is there an increased percentage of people who are willing to slug it through med school & internship just to make bigger bucks as a doctor (as opposed to being an impecunious scientist) whereas, in other countries physicians are paid well, but not so loftily compared to the rest of the population as is the case in the United States?

In other words, is the (perceived?) disparately high income of medical doctors causing the "wrong" type of people to pursue careers as physicians? anecdotally, from medical doctors, for sure - but these are just "bad apples," I guess
posted by PurplePorpoise at 12:12 AM on December 19, 2005

So the fact that doctors kill more people than cars, jobs, and terrorism combined is swept under the rug as a footnote to a summary study that is not widely circulated.

We all like to think that the fundamentals of healthcare are so much different than in previous centuries. The medical industry is just more efficient in leveraging its successes to engineer the mass-scale perception that the medical industry is nearly all-knowing and benevolent. We have forgotten what once was common knowledge:

"I often say a great doctor kills more people than a great general."
--G.W. Leibniz
posted by archae at 12:13 AM on December 19, 2005

We all like to think that the fundamentals of healthcare are so much different than in previous centuries. The medical industry is just more efficient in leveraging its successes to engineer the mass-scale perception that the medical industry is nearly all-knowing and benevolent.


"I often say a great doctor kills more people than a great general."
--G.W. Leibniz


Tell that to a child whose mother's cancer is in complete remission or someone who is ten years into a heart transplant, or for that matter, anyone who has survived an appendicitis, etc.

Of course, Leibniz was an incredibly brilliant fellow, but he didn't have such people around at the time. You do, but then, you seem to lack his observation skills.
posted by drpynchon at 12:37 AM on December 19, 2005

Oh, right, because everywhere else in the world doctors are selfless, virtuous, and motivated by altruism.

Hey docpops. I understand you can make extra money and gifts by setting up your own webcam.
posted by PeterMcDermott at 12:44 AM on December 19, 2005

My dad knew of two times that this had happened locally in the last 25 years, and both times the patients died on the table because they suddenly found themselves with large, smoking holes where their lower GI tract should have been.

My wife trained as a nurse and there were a couple of incidents that made her leave the profession. One of them was just such an incident. Unfortunately though, when the patient's stomach burst into flames, the doctor reached for one of those kidney bowls full of water to douse the flames.

Unfortunately, it wasn't water, it was alcohol.

The other incident was when she worked on men's surgical. The ward was the province of two doctors -- a senior registrar and a consultant. After the op, the senior registrar would stay behind to supervise sewing the patient up, whereas the consultant would just piss off and leave the job to his students. The registrar's patients would all heal nicely, whereas the consultant's patients would have to have progressively more of their limbs removed as gangrene or infections continued to spread. (This was in the 70's, before doctors published league tables, etc.)

All of the nursing staff and the junior doctors were concerned about the state of affairs, but in those days, consultants were equivalent to God, and consultant surgeons more so, so nobody ever raised the issue.

All that said though, she later trained as a lawyer, but refuses to take on medical negligence cases as she believes that far too much of what passes for negligence is nothing of the sort -- simply the outcome of an inexact science that doesn't always have the desired outcome, and so she wasn't prepared to subject people's lives and professional reputations to that kind of scrutiny when the bulk of them will inevitably be doing their absolute best.
posted by PeterMcDermott at 1:16 AM on December 19, 2005

Ahhh the CATO instititue have some good spinners

Originally, "40-something-million-uninsured" meant the persistently uninsured, i.e., those who lacked health insurance for the entire year. The Congressional Budget Office shot holes in that statistic last May when it reported the correct figure is between 21 million and 31 million.

Ahh the goddamn CBO ! Let's concentrate on the fact that the CBO..ihihihi ..made a 10 million error. They must be nuts, these republican librulz ! Ok ok it's ONLY 30 million..relax ! That's just 1 out of 10 in U.S. population, it's not like there's still
an huge problem. Nothing to see, move on.

he CBO's figures may still be too high because they count millions of Americans who are Medicaid-eligible, and therefore have coverage whenever they need it

Equating being elegible with having the service ! Last time I checked being elegible doesn't necessarily imply one actually obtains the service, so adding them to those who are NOT covered isn't a bad idea...I'd like to see statistic on how many potentially elegible you-win-your-health actually win.

The only possible way to explain this is that they take refuge in the CBO's finding that the original, faulty government statistic does happen to be roughly equivalent to the number of Americans who lack insurance at any specific point in time, rather than for the entire year.

And that's not important no no no...let's spin it like its the CBO taking all the advantage..there's nooo problem in having 40
million people at risk of not receiving medical care at any moment in time in the world richest country...oh sorry, in the country
in the world that harbors the few richest.

Whether it is administered by government or the private sector, compulsory health coverage means government-run health care.
Oh welfare for private sectors ? How surprising..for some reasons they are not able to compete ? Oh poor ones, it must be anything except incompetence, greed and risk offloading.

It's clear that Cover the Uninsured Week will drag on until all health care costs are socialized and individual responsibility is nil

Well if true they have learned from private companies quick to socialize all the costs and privatize all the profits. But hey let's spin it another way...if I get good healthcare, splitting the costs among many is a nice idea and probably a good thing..of course if you ask me to pay a part of your car and your dvd player I'm going to say FUCK NO but I'm a tradionalist with strict priorities like health, house, food and education. Go figure why.

A better goal would be to restore to America's largely socialized health care system the market processes where producers compete to provide consumers with value, and consumers keep costs down by patronizing efficient producers and avoiding inefficient producers.

Hot air, hot air , hot air. If the producers were already so much more competitive why don't they just offer ? People will flock..or maybe not enough people could afford that because the price would be too high for many so the market isn't really that interesting ?
Probably it's only an attempt at grabbing an already existing market, inserting a lot better marketing and spin so that the sensation of a better service is offered. Obscure everything behind private sectors secrets et voilà, profit.
posted by elpapacito at 1:53 AM on December 19, 2005

So the fact that doctors kill more people than cars, jobs, and terrorism combined is swept under the rug as a footnote to a summary study that is not widely circulated.

"I often say a great doctor kills more people than a great general."
--G.W. Leibniz

Do you care to back up your numbers with some statistics? Or provide a link to this study?

As far as Leibniz goes, they haven't even invented an internal combustion engine back then.

Dumbass...
posted by c13 at 3:13 AM on December 19, 2005

Nice, elpapacito. I was going to make similar comments.

One thing I'll add is the problem I see with Cato's general approach to welfare, which is the same problem with most strong conservatives' views on the subject. (Disclaimer: I'm a moderate conservative with some libertarian and some liberal leanings).

Namely, they often invoke the free-market philosophy, suggesting that if the "invisible hand" were allowed to act unfettered, it would take care of everything. Competition would lead to efficiency and voila! A kinder, gentler society.

The problem with this view is that the invisible hand is also a discompassionate one. It doesn't care, really, if someone is stuck without access to health care. The invisible hand of free market economy only really cares if there is some profit-generating utility to insuring them. If there is not, then that person (or millions of persons) will fall through the cracks.

The idea that Cato would propose personal health savings accounts, as a solution to poor people not being able to afford insurance, is pretty laughable. If folks could afford to be saving sufficient money to create a meaningful nest egg for such an account, to weather significant illness, they could probably afford insurance to begin with.

If someone has significant health problems, they simply WILL NOT BE PROFITABLE to insure unless their insurance premiums are enormous. And if you're poor, that's impossible to support. So, you can get royally bitch-slapped by the invisible hand that Cato likes to kiss so often.

Don't get me wrong - I'm generally in favor of free market dynamics. But I think it's just common sense to realize that they have to be tempered to make sure that those regions of the economy (or society) that you want to preserve and protect are not neglected (or worse, exploited) by a dispassionate market dynamic. Hence, to "promote the general welfare" as stipulated in the preamble of our Constitution requires mandated some social programs which effect desired outcomes, so the are not simply left up to experiments in "the dismal science".
posted by darkstar at 3:55 AM on December 19, 2005

Purple – I’m not sure if anyone has performed such a rate of pay to errors – but again, let’s get away from that terminology. We’re all lost if we really talk about “malpractice” in the terms of negligence or “s/he really shoulda did that and since not, patient dead.” It’s rarely so clear. And, in the cases where it clear we either have criminal laws that are much better at righting that sort of wrong OR the no fault system would even be well equipped to get such doctors out of business – why? – because it would be a mixed panel of scientific/medical/laypeople who’d be deciding if the offense was worthy of losing one’s license.

That being said, I’d probably state the rate of errors is not all that pay dependent. I say that purely because the level of training is so long and comprehensive versus most other professions. Remember, you are not really allowed to make a complete decision by yourself until a minimum of seven years training. What other profession demands that? It’s not because doctors are better people or more altruistic. They might or might not be. It’s just that the system is actually set up so that you learn a lot over a long time and then you are actually responsible for knowing a lot about a certain field – especially if you specialize. Moreover, once out in practice, collaboration and consultation are encouraged to get the right diagnosis and result.

About the market arguments: Listen, it's all well and good to have the cheapest, fastest toaster -- something the market is great at encouraging. But, for health care, the market encourages both cheap and fast when such are the very things that are destructive to good health care.

The vaccine shortage from last year is a great example. Why was their a shortage? Well, according to Bush, litigation forced American vaccine makers out of business, so we had to rely on British supplies. There were errors in their producing it, so we had a shortage. YES, THE MARKET WAS WORKING! -- no inexpensive vaccines the market couldn't bear was produced. BUT, in health care, true market forces can't comprehend that perhaps it's ok to lose money on vaccines if that save you tons of $$$$ later by reduced hospital visits for pneumonia, meningitis, or even ER visits that didn't have to happen. Cato morons are never going to think like that because of their invisible hand worship. That sentence is really funny btw.

Archae – if you believe your posts about the futility of medicine in 2005, you are in idiot. I’m surprised you could find your keyboard to type that garbage.
posted by narebuc at 7:13 AM on December 19, 2005

I'm really surprised that no one has yet to touch on the real root of the higher premiums.

In the early 1990's insurance companies had vast reserves of capital (much like corporate pension programs) so they did what every big business does with such capital, they invested it. The stock markets soared, many got rich. Then, as we all know, the bubble burst. All that capital was gone.

As the companies that the capital was tied up in went bust, the lawsuits began. Expensive paper chase after wild goose chase to recover investment capital, all of which cost an arm and a leg to insurers (and pensions) but few saw and worthwhile returns.

The corporate boards meet and demand to know what happened to those fantastic figures of 1998? Why are we suddenly in the red? What are you, Mr. CFO, going to do about it?

The answer was simple for any MBA brainiac, raise premiums. Voila, so the rest of us have to pay for some moron's overzealous investment.
posted by Pollomacho at 7:33 AM on December 19, 2005

Those who would compare doctors to engineers can go read The Human Factor: Revolutionizing the Way People Live With Technology by Kim Vincente.

It has nothing to do with the complexity of systems and everything to do with the way errors and mistakes are handled. In many parts of the medical world, secrecy is still the order of the day. When a plane screws up (be it a mechanical failure or a human mistake) the whole thing is ripped apart and changes are made to help prevent the problem from happening again.
posted by GuyZero at 8:06 AM on December 19, 2005

The most widescale problems in medicine are failures in diagnosis and failures in medication.

I foresee a technological leap in medical diagnosis in the future, in which, before the patient see the doctor, they routinely, at least annually, receive a "complex screening". Individually, it would be prohibitively expensive, so a system would have to be designed to process a huge number of people a day.

To start off with, their entire medical history is put into an electronic database, and vetted with both the patient and the doctor. This incorporates as much as possible, to include dental records, dietary supplements, alternative therapies, etc. Any current acute or chronic problems, no matter how minor, would be included. This is done at leisure prior to the screening.

Then the actual screening would begin. When they arrived at the screening facility, they would bring with them a stool sample. They would get a full-body CT and Xray, which would be computer analyzed looking for eccentricities, highlighted for a CT and Xray expert to examine. (Annual full-body CTs have already proven their value where used, saving enormous amounts of health care money by catching conditions early.)

At some point they would provide a DNA, PAP or semen, urine and saliva specimen, and enough blood for a complete work-up. By then, hopefully, their blood could be drawn by a machine instead of a person.

Other test would be done on site, including weight, hearing, ophthalmological, respiratory, and even a brief degree of motion, reflexes, and neurological profile.

Once this base line had been established for them, subsequent follow-up examinations would be considerably simplified. A full complex set would probably be only needed once a decade.

For the majority of people, this complex screening would clearly create an entire program of preventative health maintenance specific to them. Almost everybody would receive a report advising them about pre-existing conditions, from genetics, health risk "windows" they were in, diet they should maintain, behaviors they should avoid, and medical treatments they should consider.

Ironically, much of this is already done, but done in a haphazard, often redundant, often neglected manner, and the data from these tests are not consolidated or put in a form most useful to the physician. So yes, initially, the cost is quite large, but the long-term costs drop drastically.

*********
The next step is a far more advanced version of a system currently in use. Doctors can plug in symptoms into a computer, and a diagnosis is reached as to probable condition and treatment. This confirms a doctor's suspicions, or it suggests a condition overlooked by the doctor.

If used in tandem with the complex screening, this system would be far more accurate. Beyond a certain point, it would be *objectively* certain of a course of treatment; which might effectively immunize a doctor against malpractice.

***********
Lastly, doctors are *not* pharmacists. This should be known and remembered by all patients. Doctors are reliant solely on trial and error of drugs, based on patient feedback, and what the doctor might learn in a haphazard way.

Even critical, life saving drugs are not standardized in their use in emergency rooms in the US. Drugs that have been long dismissed as safe and effective for conditions are still regularly used. This is most notorious for heart conditions.

Since the only rating system that really matters *is* from doctors and patients themselves, drug prescriptions should be rated for certain conditions and listed from most effective on the previously mentioned diagnosis system. It would be hard to justify malpractice if for a given condition, over 30,000 doctors had given their patients a drug which worked, but for one person they didn't.

A complex screening could also strongly help determine which was the right drug, and how much, for a person. It would take into account their age, weight, other conditions, other medications, etc., far better than could their doctor or their pharmacist.

************
The bottom line to this health care philosophy is high front-end costs and consolidated data. Its benefits really show with fewer health care dollars needed in the future, better treatments for patients, and avoidance of much error.

A truism is that "70% of our health care dollars are spent on people in the last four years of their lives". But much of this expense is just because conditions were ignored or undiagnosed for years, patients ignorantly engaged in high risk behaviors, and diagnosis and prescription were flawed.
posted by kablam at 8:07 AM on December 19, 2005

A truism is that "70% of our health care dollars are spent on people in the last four years of their lives". But much of this expense is just because conditions were ignored or undiagnosed for years, patients ignorantly engaged in high risk behaviors, and diagnosis and prescription were flawed.

Um, couldn't this be also because people get sick or injured and die, thus their healthcare would be taking place during the last moments of their lives so that when you average out the rest of us it comes to your 70% w/in 4 years figure? I've luckily never had much serious medical care in my life, but if I get hit by a bus, I'm probably going to, especially if it is a critical or fatal accident, right?
posted by Pollomacho at 8:16 AM on December 19, 2005

This is not an argument for maintaining the US healthcare status quo, but are you really sure that catching diseases earlier on would cost less then treating them at the catastrophic end-stage? In the sense that "catching them earlier on" would require more universal primary medical coverage? Just a thought....
posted by ParisParamus at 10:00 AM on December 19, 2005

I'm really surprised that no one has yet to touch on the real root of the higher premiums.

"So to a first approximation, the reason that insurance rates are up hugely since 2001 is that the stock market is bad"
posted by Heywood Mogroot at 10:03 AM on December 19, 2005

I stand corrected, I missed that in the noise, sorry jellicle.
posted by Pollomacho at 10:08 AM on December 19, 2005

but are you really sure that catching diseases earlier on would cost less then treating them at the catastrophic end-stage?

umm, for nearly everything I can think of, yeah, when looking at the overall societal costs, including productivity.

because they count millions of Americans who are Medicaid-eligible

like being on Medicaid (or Medicare for that matter) gives you access to a system of the quality of Canada's. My mom's on medicare, and has had a bitch of a time getting a red spot on her hand looked at by a dermatologist.
posted by Heywood Mogroot at 10:09 AM on December 19, 2005

The most widescale problems in medicine are failures in diagnosis and failures in medication.

Hmm. Diagnosis and Treatment. That narrows it down.

Annual full-body CTs have already proven their value where used, saving enormous amounts of health care money by catching conditions early.

Wrong. Annual full-body CTs expose patients to the same amount of radiation they would get from hundreds of chest Xrays. They cause cancer in a predictable proportion of patients. Although early diagnosis will save some lives, much more often 'incidentalomas' are found which have to be 'worked up', costing money, illness and sometimes lives (iatrogenic causes).

...a brief degree of motion, reflexes, and neurological profile.

Actually, very few things we doctors do for 'screening' has ever been shown to be effective in saving lives. While the concept of the more tests the better is attractive, it is fatally flawed.

...this complex screening would clearly create an entire program of preventative health maintenance specific to them. ... diet they should maintain, behaviors they should avoid, and medical treatments they should consider.

Avoid junk food, don't smoke, wear your seatbelt, get smoke detectors, get a flu shot, vaccinate yourself and your children, don't drink and drive, child-proof the home, wear a condom, etc. etc. There, I've just saved you thousands of dollars in medical tests.

Doctors can plug in symptoms into a computer, and a diagnosis is reached as to probable condition and treatment. This confirms a doctor's suspicions, or it suggests a condition overlooked by the doctor.

If used in tandem with the complex screening, this system would be far more accurate. Beyond a certain point, it would be *objectively* certain of a course of treatment; which might effectively immunize a doctor against malpractice.

Hmm. Robodoctor. Sorry, I'm not a believer. Maybe once AI has advanced to the point where computers have a consciousness I'll buy it. Again, as a practicing physician I know there's an art to medicine... things you pick up intuitively and from experience from the patient... simple things like 'does this patient look sick'. I refer to a computer for things I can't be bothered memorizing, but a patient with a computer for a doctor is a fool. 'Objectively' applying algorythms in an attempt to escape responsibility for bad outcomes is not my definition of a 'good doctor'.

Since the only rating system that really matters *is* from doctors and patients themselves,

Oh good, we can stop all those expensive randomized double-blind clinical trials and just do a Gallop Poll to see which drugs work.

This writer actually illustrates the problem with malpractice trials... they hinge too much on people's biases rather than science.

I used to work part-time for an 'exectuive health' company giving lavish physicals. There's an argument to be made that *this* is actually a form of malpractice.

The 'full body scan' fad is dying out, partly because they are a waste of money in terms of, on average, making any average patient live longer.

-Kevin
posted by kevinsp8 at 11:39 AM on December 19, 2005

Annual full-body CTs have already proven their value where used, saving enormous amounts of health care money by catching conditions early.

This is so fucking stupid, so blitheringly wrong, so laughably, idiotically ignorant, that I'd have to be high on acid to not to shit myself blind trying to explain this cretinous assertion.
posted by docpops at 11:57 AM on December 19, 2005

AAAAAAAAAAAAAH. Please let's not make statements like "most of end of life care is due to undiagnosed or missed ailments".

I hate to break it to you kablam, but you're going to die. Yup, it's true. And, it probably won't be peaceful. Dying in the age of modern medicine probably rarely is. Whereas 50 years ago, an 89 year old's heart would hit its planned obsolescence and a heart attack would kill him or her, today it's caught at the hospital and the "heart failure" is managed for an already sick person. $$$$ of drugs are thrown at that heart. Tons of tests are used to learn where the infarct was. Then, the appropriate regimen to at least ensure a teeny bit longer life than would have happened 50 years ago is a gigantic process of trial and error and careful refinement as there are thousands of ways you can control abnormal hearts (B-blockers, calcium channel blockers, nitrates, etc., etc.). I'm not saying we need to stop giving such care. In medicine, that's never the goal. BUT, please try not to stand there and say it's "missed diagnoses" that are managed in a costly way at the end of life. I'm sorry, but it's true that, with each heart beat, your heart is taking a beating. But, you know, the pounding it takes during an appropriate cardio workout (not too hard, not too light) actually might help that damage not be so bad. That, among lots of other reasons, is why exercise is good for you. Sort of complicated, huh? Well, that's the human body for you.

No matter what, a great percentage of people are going to want every treatment in the book in order to live longer when old age's underlying ailments: failing kidneys, poor colons, a not so powerful immune system, etc. are inevitably going to ask for the $$$$$$ that is thrown at end life care.

It's funny but "old age" is not an official cause of death. It's heart failure, or pneumonia, or cancer, etc. But, underlying that stuff is really old age. They said Reagan died of pneumonia, but might you not think Alzheimer's and the accompanying mental anguish and disappearance of much of life's realized pleasures (and, it's proven link to immune system strength) had a bit to do with him not being able to battle a lung infection like he did when younger? Did treatment of that really go misdiagnosed?

Great post btw kevinsp8.
posted by narebuc at 11:57 AM on December 19, 2005

The 'full body scan' fad is dying out, partly because they are a waste of money in terms of, on average, making any average patient live longer.

anecdotal I know, but I wonder if Steve Jobs' pancreatic cancer was caught (last year) by one of these scans...
posted by Heywood Mogroot at 11:58 AM on December 19, 2005

Thanks, Kevin, for saving me the time of going through kablam's post in similar fashion. It's logical, of course, to assume that technological advances will have long term positive impacts on medicine, but to try and nail them down specifically without any idea of the science that is at work is pretty silly, and not even helpful to the point of the argument. Kind of reminds me of War of the Worlds... the martians arrived in large canisters fired ballistically out of cannons. Why? Because rockets hadn't been invented at the time it was written. If we could predict techology before it was invented, we wouldn't have to wait for it to be invented. And if we don't need fundamentally new technology for a goal, then we should be showing signs of progress in that area already. At least some proof of concept. Kablam's strange attempt at prophecy seems to miss the mark on both of these scenarios.
posted by Farengast at 12:01 PM on December 19, 2005

HM, I googled the pancreatic cancer that Jobs had and, it can actually show up via symptoms due to which pancreatic hormone (insulin, glucagon, etc.) is the cancerous cell. Such levels (or their effects in things like blood sugar) are usually wildly elevated on regular blood testing that most people his age should be getting or can be called for by complaints of things like hyper or hypo glycemic states or low/high acid levels.

But, who knows, he might have got a scan.

You can read more about his cancer at:

http://www.emedicine.com/radio/topic363.htm
posted by narebuc at 12:07 PM on December 19, 2005

hmm, as kevinsp8 says, mebbe all that scanning, if Jobs indeed was undergoing it annually, actually /caused/ the cancer. That would indeed suck.
posted by Heywood Mogroot at 12:20 PM on December 19, 2005

Jedicus sez: The main findings were that malpractice is relatively rare, most injured patients do not bring claims, and (this is the biggie, I think) there is no correlation between the existence of malpractice and whether the patient won the suit. In fact, there is some suggestion that it is precisely those cases without merit that win and those with merit that do not.

Is the result of the cases that actually reach court all that important? I would imagine that by the time it's in court and won or lost, the majority of strong cases have been settled. So what you have then is a bunch of outliers, at least from the standpoint of examining how worthy a case is. The fact that the bad cases won isn't even all that noteworthy; presumably the good cases would have been settled if the beancounters had looked at them and thought there was a good chance of the litigant prevailing.
posted by phearlez at 3:55 PM on December 19, 2005

A: Someone who's still more intelligent and hardworking than 99% of the general population that could never even dream of making it that far.
posted by drpynchon at 9:48 PM PST on December 18

So let me get this straight: someone graduating at the very bottom of their class in med school is more intelligent and hard working than 99% of the lawyers, chemists, physicists, writers, and ditch diggers? Do you have any evidence of that?
posted by Optimus Chyme at 4:37 PM on December 19, 2005

Annual full-body CTs have already proven their value where used, saving enormous amounts of health care money by catching conditions early.

Oh, look, kablam is one hundred percent wrong about something again. Are you pretending to be a medical historian today?
posted by Optimus Chyme at 4:39 PM on December 19, 2005

Well, Optimus, 99% is probably too high of a number. I'd say its about 90%. Why? Because about 1 out of 10 applicants gets accepted into a med school. Given that the drop out rates are pretty low, its fairly valid to say that whoever gets accepted, graduates. And those 10 initial people that did apply, come from different background (undergrad majors), including chemists, physicists and writers. I don't count the ditch diggers at all, and you have to go to grad school to be a lawyer.
posted by c13 at 4:50 PM on December 19, 2005

Optimus, when the docs pull out their God complex, you just pat them on the head and say "that's cute dear."

/sarcasm

But really, the doc was speaking hyperbolically at a slight to his profession, I bet.
posted by teece at 5:10 PM on December 19, 2005

kevinsp8: My error was in one sentence, about the "annual" use of CT scans. My intention, however, was to establish a comprehensive diagnostic baseline for the use of the physician later. The impression that the entire process would be annual is false. I suggested perhaps at decade intervals, but I was unaware of the radiation hazards now associated with CT.

Would it, or would it not be advantageous to you, as a physician, to have a health base line, an ordered set of data, from which you can compare to a patients current condition?

Second, while you may be loathe to use a computer to *verify* your diagnosis, not *make* your diagnosis, do you assume that other physicians are similarly inclined to trust in their own, innate superiority in diagnosis? Perhaps you might reconsider, if by verifying your diagnosis, it provided you a modicum of legal protection from malpractice.

Third, while you seem to have great confidence in double blind testing, you are still not a pharmacist. Pharma advertisements are hardly a good source of what is best for a patient, even if their drugs have been judged "safe and effective" in some circumstances.


And a special note to Optimus Chyme: I got a sentence, or perhaps an entire posted message wrong. You are a lawyer. You got your entire soul wrong.
posted by kablam at 6:26 PM on December 19, 2005

kevinsp8:
While the concept of the more tests the better is attractive, it is fatally flawed.

Indeed "more" is not "better" neither does it constantly imply "better" ...yet the same could be said for "less" or "none"

For instance let's take a very simple do-at-home test as concentration of glucose in blood ; eventually repeating it
several times a day is not going to -cure- the -cause- of diabetes and is not adding much significant information to
what is already known ; yet a glycosylated emoglobin test seems to give some measure of average daily blood glucose which is interesting information alone or combine with spikes. That should be a recommended test, I think, as early diagnosis could reduce the number of chances of patient incurring into too high or too low sugar level.

So ,I guess, a doctor that suspect diabetes is likely to order the latter test ...but what about other pathologies that
don't show telltale signs like being overweight ? Of course there must be some cost benefit analysis, cost meaning NOT monetary cost which must remain a problem but, imho, must become the least problem...but if the cost benefit analisis is going to be made by private companies they, quite obviously, will try to discourage the most expensive ones or the ones who give the least returns or are more likely to be dangerous to the company.

So maybe a standardized, forced-into-low-cost test could become a good idea, if anything to force reduction of cost by standardization and mass production.
posted by elpapacito at 7:08 PM on December 19, 2005

You are a lawyer. You got your entire soul wrong.
posted by kablam at 6:26 PM PST on December 19

My profession as referenced in my user page is a knock at former poster esquire, who claimed to be a lawyer but who was in reality a third grader with special needs. My enemies list is a knock at dios, and my "home page" isn't even mine. I am a scheming and duplicitous fellow. :)
posted by Optimus Chyme at 7:45 PM on December 19, 2005

Because about 1 out of 10 applicants gets accepted into a med school. Given that the drop out rates are pretty low, its fairly valid to say that whoever gets accepted, graduates. And those 10 initial people that did apply, come from different background (undergrad majors), including chemists, physicists and writers.

There are plenty of brilliant chemists, physicists, lawyers and writers who have no wish to become doctors. I don't think a Drake equation-style back-of-the-napkin estimate counts as evidence, either.
posted by Optimus Chyme at 7:49 PM on December 19, 2005

Optimus Chyme....if you are scheming and duplicitous -- you'd be a great lawyer. :)

And, I'd say about 25%-30% of physicians are foreign trained. Smart people, but they test much lower than American trained physicians on average and might have gotten into medical school because, simply, they could pay in their own country. Also, you have osteopathic physicians here -- who, while also not stupid, do score lower on average than American medical students.

I just point it out to state that not all doctors went through a completely tough weed out process.

Next, most of medical discovery is PhD related -- where would be without, say, antibiotics or knowledge of physiology?! Doctors are humanists, at some level, and people who apply scientific discoveries usually created by people a lot more naturally smart than they, or at least more innovative.

Medical malpractice and corporate lawyers do suck though.
posted by narebuc at 8:35 PM on December 19, 2005

So let me get this straight: someone graduating at the very bottom of their class in med school is more intelligent and hard working than 99% of the lawyers, chemists, physicists, writers, and ditch diggers? Do you have any evidence of that?

Umm, no. Close (well, not really) reading would reveal that I said they are smarter than 99% of the general population. And for the most part, physicists, chemists and lawyers tend to be in the other 1% too. Though there was some hyperbole in the numbers.
posted by drpynchon at 9:52 PM on December 19, 2005

The most widescale problems in medicine are failures in diagnosis and failures in medication.

Completely inaccurate.

They would get a full-body CT and Xray

No point in both.

Annual full-body CTs have already proven their value where used, saving enormous amounts of health care money by catching conditions early.

Completely, malignantly, idiotically inaccurate. Regardless of whether it's annual or not, and even ignoring all the radiation therein.

Doctors can plug in symptoms into a computer, and a diagnosis is reached as to probable condition and treatment.

Entirely impractical and unreliable.

Doctors are reliant solely on trial and error of drugs, based on patient feedback, and what the doctor might learn in a haphazard way.

Are you on crack?

Even critical, life saving drugs are not standardized in their use in emergency rooms

Actually, yes they are. It's called ACLS.

But much of this expense is just because conditions were ignored or undiagnosed for years,

As with virtually every other point in your comment, you clearly have no idea what you're spouting off about.
posted by drpynchon at 10:06 PM on December 19, 2005

Umm, no. Close (well, not really) reading would reveal that I said they are smarter than 99% of the general population.
posted by drpynchon at 9:52 PM PST on December 19

Ninety-nine percent of doctors shouldn't argue definitions with those who majored in English. Just let me know what professions you want to take out of the general (i.e., concerned with, applicable to, or affecting the whole or every member of a class or category; not limited in size or scope) population so that your numbers work.
posted by Optimus Chyme at 10:38 PM on December 19, 2005

Ninety-nine percent of doctors shouldn't argue definitions with those who majored in English. Just let me know what professions you want to take out of the general (i.e., concerned with, applicable to, or affecting the whole or every member of a class or category; not limited in size or scope) population so that your numbers work.

What about the 1% of doctors who also happen to have degrees in English such as myself? You presumptuous dolt. Perhaps they didn't teach you how percentages work while you were learning all those fancy words. I don't need to take any professions out of the general, that being 100%. Most people in some few professions wind up in a certain 1st percentile, whereas most people in certain other professions end up in the lower 99th percentile. But I tire of explaining the obvious to someone so obtuse. Feel free to e-mail me. Perhaps I can teach you a few things I learned about fancy numbers while I was getting my other degree in biophysical chemistry.
posted by drpynchon at 11:06 PM on December 19, 2005

I'd have to be high on acid to not to shit myself blind...


I admit it: I chuckled at that.
posted by darkstar at 2:59 AM on December 20, 2005

What about the 1% of doctors who also happen to have degrees in English such as myself?

You have to admit it would have been a pretty sweet burn if you didn't have that degree, though.

My larger point was that if you continue to remove certain professions from the "general" population, it ceases to be general.

Most people in some few professions wind up in a certain 1st percentile, whereas most people in certain other professions end up in the lower 99th percentile.

Then perhaps I know an unusual number of non-doctor one percenters.
posted by Optimus Chyme at 7:26 AM on December 20, 2005