Great, great reportage. Is this congery of problems just an American phenomena or is it, it something like it, encountered everywhere? Frankly, after reading this, I don't want to deal with any GP or specialist who doesn't practice minimalist/conservative medicine.
I've thought for years that the insurers and economics were the drivers forcing health delivery systems and individual providers to skew their practices. Moral ambiguity from the moment a PT enters the door....
The economics of the medical field are much different in the US, but anywhere there is sparse or conflicting evidence about the best treatments, anytime doctors feel like they have to do something for a patient who has found no relief, this dynamic will exist. There are rare cases where the US has gotten something right while the rest of the world jumped off the cliff (see: thalidomide). It's undeniable that a fee-for-service model and third party payers can distort incentives.
As for what to do on a day to day basis, it unfortunately comes down to educating yourself as best as possible, asking your healthcare providers questions, and advocating for yourself. Fair questions to ask when discussing anything major:
- "How much is this going to cost?"
- "What is the evidence behind this? / What does the research say?"
- "Is this going to fix my problem or just be a stopgap?"
- "What are the alternatives?"
- This one may be awkward, but its not wrong to ask about conflicts of interest: "Have you ever consulted on or been paid to promote this [drug/device/surgery etc]?"
Michael, wanted to add some wise advice on this topic from a recent post on surgical complications with Inside Medicine by Jeremy Faust, MD:
"If it were me, I’d ask my potential surgeon more than the just the rate of serious complications. I’d specifically ask “Have you ever seen one of these cases go badly?” From there, I’d ask how and why things went south, and what the end results were. I’d ask what caused the complications; sometimes it’s the patient’s own frailty (which can’t be helped) and other times it’s just bad luck or a mistake (which a surgeon is unlikely to admit—though I’d respect them for admitting that they are human if they did)."
Great, great reportage. Is this congery of problems just an American phenomena or is it, it something like it, encountered everywhere? Frankly, after reading this, I don't want to deal with any GP or specialist who doesn't practice minimalist/conservative medicine.
I've thought for years that the insurers and economics were the drivers forcing health delivery systems and individual providers to skew their practices. Moral ambiguity from the moment a PT enters the door....
The economics of the medical field are much different in the US, but anywhere there is sparse or conflicting evidence about the best treatments, anytime doctors feel like they have to do something for a patient who has found no relief, this dynamic will exist. There are rare cases where the US has gotten something right while the rest of the world jumped off the cliff (see: thalidomide). It's undeniable that a fee-for-service model and third party payers can distort incentives.
As for what to do on a day to day basis, it unfortunately comes down to educating yourself as best as possible, asking your healthcare providers questions, and advocating for yourself. Fair questions to ask when discussing anything major:
- "How much is this going to cost?"
- "What is the evidence behind this? / What does the research say?"
- "Is this going to fix my problem or just be a stopgap?"
- "What are the alternatives?"
- This one may be awkward, but its not wrong to ask about conflicts of interest: "Have you ever consulted on or been paid to promote this [drug/device/surgery etc]?"
Michael, wanted to add some wise advice on this topic from a recent post on surgical complications with Inside Medicine by Jeremy Faust, MD:
"If it were me, I’d ask my potential surgeon more than the just the rate of serious complications. I’d specifically ask “Have you ever seen one of these cases go badly?” From there, I’d ask how and why things went south, and what the end results were. I’d ask what caused the complications; sometimes it’s the patient’s own frailty (which can’t be helped) and other times it’s just bad luck or a mistake (which a surgeon is unlikely to admit—though I’d respect them for admitting that they are human if they did)."
Post: https://insidemedicine.substack.com/p/two-stories-which-highlight-a-medical?utm_source=%2Finbox&utm_medium=reader2