Doctor rant...can I please please????

[Loren49]

Food for thought:

Do you want your heart surgery awarded to the lowest bidder?

Loren

 

[IslandTractor]

Food for thought:

Do you want your heart surgery awarded to the lowest bidder?

Loren

You can make fun but there are excellent cardiac surgery clinics in India that get comparable results to what our very good centers get for about a tenth the cost. Volume and specialization along with a focus on quality can give great results.

I'd rather depend on a Toyota Corolla than an Alfa Romeo.

 

[dave1949]

Food for thought:

Do you want your heart surgery awarded to the lowest bidder?

Loren

You can make fun but there are excellent cardiac surgery clinics in India that get comparable results to what our very good centers get for about a tenth the cost. Volume and specialization along with a focus on quality can give great results.

I'd rather depend on a Toyota Corolla than an Alfa Romeo.

Are there statistics that correlate costs to outcomes? I'd want to know something about the success rate of a procedure at a given facility first, then consider the cost.

 

[IslandTractor]

Are there statistics that correlate costs to outcomes? I'd want to know something about the success rate of a procedure at a given facility first, then consider the cost.

General comparisons are possible but true apples v apples comparisons are difficult. It depends a lot on what the patient population is. Often the high volume fancy cardiac surgical centers don't do very many procedures on very high risk patients (those already in the hospital who deteriorate etc) and therefore as they operate more on "elective" patients, their success rates appear artificially higher than those of some city hospital academic centers (which were the places where the high priced guys trained). Inter country comparisons are also difficult for similar reasons. You never really know whether for example any hospital is reporting an accurate post op infection rate. That said, most hospitals that do hundreds of procedures per year are going to have better outcomes. Practice makes perfect. That said, the only easily accessible public data is put out by US News and World Report. It is far from perfect and it really doesn't distinguish between #1-10 in a meaningful way but you can be pretty sure that a program listed in the top 10-20 is better than one listed in the 40-50 range.

 

[Travelover]

...............I'd rather depend on a Toyota Corolla than an Alfa Romeo.

Great analogy. :thumbsup: You really don't always get what you pay for, but it is a great way to scare someone into accepting whatever rate you want to charge them.

 

[tcreeley]

After 2 months of waiting, I got an appt to get my blood pressure checked out at with my new primary care doctor. I was 7 min. late and the office staff had to confer with the office manager if I should be allowed to see the doctor, even though the parking lot and waiting room were empty.

Doc is ok, orders some blood work and a tetanus shot. I get the tetanus shot and as the tech is moving to leave I ask about drawing the blood. She goes back and checks the paperwork, says she must have overlooked it, draws blood.
I get a prescription and make a double appointment for more lab work at a local hospital of my choice.
A few days later I get a call to pre-register. I wait a week and then call. The number turns out to be the hospital that I had wanted to avoid and they have no record of a double appointment, just an appointment 4 hours after the first of my earlier scheduled double appointments.
I was fed up. I cancelled it- it was for some procedure that did not sound like the one originally described to me by the doctor. And it was at the wrong location, at the wrong time.

My next appt with this primary care doctor is in mid April. While he is ok- the system around him borders on ineptitude. 5 secretaries work in the office, for a doctor and a physician's assistant. Somehow they could not schedule the appointment correctly, or notify me of any changes.

When initial lab work came back- they sent me a copy and a new prescription (signed by the pa) to replace the original prescription. Using the internet I figured out why.

I wouldn't call this being under a doctor's care, but a "system's care".

I'm looking for other ways to regulate high blood pressure without the use of a doctor.

 

[IslandTractor]

I'm looking for other ways to regulate high blood pressure without the use of a doctor.

Diet and exercise so long as your BP is not really out of whack.

 

[Loren49]

You can make fun but there are excellent cardiac surgery clinics in India that get comparable results to what our very good centers get for about a tenth the cost. Volume and specialization along with a focus on quality can give great results.

I'd rather depend on a Toyota Corolla than an Alfa Romeo.

I did not intend to look down on much more affordable options in other counties. There is evidence of great price and results with the "medical tourism" option. Article with some examples:
As More Americans Have Surgeries Overseas, US Companies Consider 'Medical Tourism' a Health Care Option - ABC News

The point I intended to make was that in the moment of a pressing medical issue it is less likely that a patient can do much useful/rational shopping for a better price. And also that going completely on price may have its problems.

With time and enough flexibility of coverage by your insurance provider you could do some shopping but how much exploring will any of us do for a wide variety of specialists when we are not yet aware of a problem? How far from home will one travel to receive this better priced care considering possible numerous visits.

The discrepancy in the cost of various procedures, even within relatively close facilities is outrageous.
Some examples:
One hospital charges $8,000
Cost Of Medical Procedures Varies Widely Across U.S. : NPR
New law requires insurers, providers to give consumers cost estimates for their medical care - Health & wellness - The Boston Globe
Hospital costs can vary more than $200,000 for same procedure, government report reveals - CBS News

Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences

When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690.

Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.

My question did free market allow this behavior and did it self regulate.

Exposed by federal database.

Loren

 

[Bird]

After 2 months of waiting, I got an appt to get my blood pressure checked out at with my new primary care doctor. I was 7 min. late and the office staff had to confer with the office manager if I should be allowed to see the doctor, even though the parking lot and waiting room were empty.

Doc is ok, orders some blood work and a tetanus shot. I get the tetanus shot and as the tech is moving to leave I ask about drawing the blood. She goes back and checks the paperwork, says she must have overlooked it, draws blood.
I get a prescription and make a double appointment for more lab work at a local hospital of my choice.
A few days later I get a call to pre-register. I wait a week and then call. The number turns out to be the hospital that I had wanted to avoid and they have no record of a double appointment, just an appointment 4 hours after the first of my earlier scheduled double appointments.
I was fed up. I cancelled it- it was for some procedure that did not sound like the one originally described to me by the doctor. And it was at the wrong location, at the wrong time.

My next appt with this primary care doctor is in mid April. While he is ok- the system around him borders on ineptitude. 5 secretaries work in the office, for a doctor and a physician's assistant. Somehow they could not schedule the appointment correctly, or notify me of any changes.

When initial lab work came back- they sent me a copy and a new prescription (signed by the pa) to replace the original prescription. Using the internet I figured out why.

I wouldn't call this being under a doctor's care, but a "system's care".

I'm looking for other ways to regulate high blood pressure without the use of a doctor.

I must be missing something. You were late for your appointment, then you get a call to pre-register and you waited a week to call????

 

[Travelover]

After 2 months of waiting, I got an appt to get my blood pressure checked out at with my new primary care doctor. I was 7 min. late and the office staff had to confer with the office manager if I should be allowed to see the doctor, even though the parking lot and waiting room were empty............

This is too funny. How many of us have arrived on time and waited a half hour or even an hour to be put in a little room and then wait another 15 minutes or more?

I'd shave a few points off your last blood pressure reading - mine would have spiked. :laughing:

 

[ultrarunner]

My Grandmother could do things that would make others cringe.

She was quite old and very proper... often with a hat and gloves whenever going out.

Sometimes I would accompany her to her Doctors visits as a child.

Still remember her just barging right in and her firm, no nonsense voice and never loud or agitated.

For instance... if the reception desk told her to take a seat in the waiting room... she would look at her watch and say she didn't want to keep Doctor waiting and march right in and find an empty exam room... when the staff wouldn't know how to handle it... she would say let Doctor know she arrived promptly for her appointment and expects the same...

She was quite a character...

 

[tom4018]

I do get it, Dr's are hardened like Cops because they see and endless line of people every day with problems. They want the facts and not the drivel("Let me do my job and go"). And, they deal with a bunch of folks that are slowly killing themselves by their lifestyle, then come in for help, not to mention the hypochondriac's, the not too bright, bad breath, etc etc. So after a while compassion takes a back seat and it's human nature to clump all your patients into one big category.

But(you knew there would be a "but" right?). We as patients are not all the same, and here is a recent experience that left me perturbed and a little pizzed off. I have been ignoring(when it let's me) my left elbow now going on 10+ years. It clicks, locks & pops, stops working when doing repetitive tasks(ummmm.. like building a house for two years by myself), numbness & tingling, range of motion loss @ 30%, then hurts like heck for a couple of days after using it before a rinse & repeat. Lately I am just losing my superhero power and about 50% is gone on that arm, so I decided to bite the bullet and go in and see if they can do something about all of the above.

I have a $5K deductible so I went right to an orthopedic surgeon which I knew would order a MRI...she did and it is a whole page of "loose material in the joint, Mr. Arthur Itis, several torn tendons, bone spurs, Carpal tunnel likely, a kitchen sink and a bag of rusty nuts & bolts." Off to another surgeon that specializes in elbows, who then tells me, I'm special and will need two surgeons...him for the arthroscopic, and another to repair tendons and possibly move things off the damaged nerves. Dr # 3 looks at everything, then sends me off for a Nerve Test to determine how bad and what nerves are shorting out so he can avoid or attempt repairs.

And, my friends we have now burrowed down into the issue, or let's say Dr #4...the Nerve Tester. First a tech comes in and hooks up some electrodes then proceeds to shock my finger & hand into doing a jumping bean dance while listening to some sounds similar to a needle dragged across a album(remember those?). Turns out, he is not measuring how big of a twitch my fingers/arm/wrist have, but it's more of a resistance test...kinda like an ohm meter. Then he leaves and #4 comes in to stick some very fine needles into my nerves while hooked up to the same machine. She was pretty good and only made it really unpleasant one time. Then she asks me about my neck...any problems there...yep, it's a long-er story, but back in the late 80's while attempting an arrest I lost the battle but won the war. Ended up with 26 stitches on the coconut, which messed my neck up for life...lot's of grinding and popping these days but I deal with it just fine. Bad guy ended up in the ER with two bullets in him...he lived.

Anywhoo, #4 then asks if I have any numbness or tingling on the bottoms of my feet or my toes. Well, by golly we are getting somewhere now, she is right on the money...slight numbness on the ball and pad of the big toe..both feet. She then get's up, says "You have Carpal Tunnel" (which I already knew and expected) and some nerve damage(angin no shocker there), then say's, "Oh, that numbness on your feet, it could be DIABETES, so you need to have your family Doctor run some tests"....then starts to walk OUT! WHOA whoa whoa.......hold on there Doc, whuddaya mean "diabetes", no family history, no weight issues, and I get plenty of exercise? She says, "well, your damaged nerves could be because of that, so have it checked"....poof, out the door she goes.

Need I point out that I am IN A HOSPITAL at that very moment, over an hour away from home. I am pretty sure there is someone there that could take the 3.5min to draw blood and send it off to the Lab that is on the next floor to rule in or rule out diabetes that very same day. Nope, I'm left to ponder my fate until I make an appointment closer to home to get a blood test done, and 6 days later it's confirmed...NO DIABETES. Anyway, I just wanted to rant a little and point out the overspecialization in the medical field fails to recognize common sense and the ensuing 6 day depression of a patient that might have to ponder giving up BEER....f...fffo....forever:laughing:. Thank you Doctor #4 for Mr Toads wild nondiabetic ride. I appreciate you ruling out all possibly related medical conditions to a particular ailment.....but it could have been done quicker and easier on the patient's part. :drink:

I have similar trouble with my elbow less the tendons. Doc that did mine in Nashville is an older doc and said my elbow was the worst he had ever seen. X-rays techs say they never saw one that looked like it. 2 years ago he went in there and cleaned up all the loose stuff he could find, did some nerve work and carpal tunnel work. He made no promises other than trying to improve it. Overall probably 50% better, but on my first visit he stated within 10 years I would probably need a elbow replacement but doing the surgery he did would buy me some time, replacement was not the best option. I got shuffled around to 3 docs before this one would try to help me.

 

[cqaigy2]

This is too funny. How many of us have arrived on time and waited a half hour or even an hour to be put in a little room and then wait another 15 minutes or more?

I'd shave a few points off your last blood pressure reading - mine would have spiked. :laughing:

That's because they're still looking at the guy that was 7 minute late. ..Im only kidding!!!

I feel the same way.

I get a call from the MRI people they say that an earlier appointment opened up and would i like to change my wife's appointment to the earlier time. Why sure i do, sign me up! In i go, early and the waiting room is absolutely pack with people that really look in bad shape. We sit down, an other person shows up, i give them my seat, cause, man, i thought they were going to fall down. It becomes apparent that the people that are there have been there for a long time. Three hours after 'new earlier' appointed time which would have been the original appointment time, my wife is called in. All in all wasted 5 hours on a saturday loitering around a bunch of sick people! On another note though, those sick people renewed my normally positive outlook of people because during this whole time they were helping each other cope and joking around with each other and the staff.

Turns out, somebody really messed up the scheduling and the staff had patients had to cope to make sure everybody that came in got some important testing done.

 

[Grateful11]

I've read this entire thread and I find very interesting. I too think part of the problem with healthcare is people go to the Dr. for anything and everything. Before HMO's with low co-pays people would think twice about going to the Dr., now folks drop $10 on the counter for a runny nose, a stumped toe, a cold, etc. I had major back surgery almost 5 years ago at one of the largest hospital networks in NC, one of my bills was for $100,000 in Misc. Services even though I knew my insurance was going pay it all but a $50 Co-pay I demanded to see an itemized list of exactly what that covered. I was so out of it the 5 days I was in the hospital I barely remember any of it. My wife said the trash that was under my bed on day 1 was still there on day 5. I had no deductible with my so called "Cadillac" insurance through work which at the time cost $200/month for me and my entire family. Basically I could get anything done for the cost of a co-pay. I don't have the answer to the healthcare problems in this country.

I did find the following article very interesting and well worth reading but it is a long one and part 3 of 6 parts:

In Need of a New Hip, but Priced Out of the U.S.
http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html

I have not read the rest of these in their entirety.
Part 1:
The $2.7 Trillion Medical Bill
Colonoscopies Explain Why U.S. Leads the World in Health Expenditures:
http://www.nytimes.com/2013/06/02/h...s-leads-the-world-in-health-expenditures.html

Part 5:
As Hospital Prices Soar, a Stitch Tops $500
http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html

 

[MotorSeven]

Well sports fans....my "double" surgery is scheduled .....23 April. So I have a month to cut split & stack my firewood for winter. It is good to have a deadline since I usually put it off until July then wonder what the heck I was thinking...... while sweating profusely.

 

[farmgirl19]

Good luck with getting all of your work done, so that you can sit back and heal when the surgery is done!

Keep us posted, as you can. Will be sending thoughts that you have a great surgical team, and that all goes smoothly!

 

[dave1949]

Good luck Rick. Don't be like my brother and rush the recovery.

 

[Bison]

When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690.

Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment.

A vet does the same thing for probably what....$150,...no appointment necessary .lol