Posted on 07/25/2009 10:45:06 AM PDT by Brilliant
I’m not disagreeing with any of your suggestions. I used your previous post as a jumping off point to make the case that practicing good medicine is something that requires more than a degree, and more than training.
Maybe I misinterpreted your original post 23, but I took you to mean that being a doctor involved mainly “suture[ing], splint[ing] a leg, pull[ing] a tooth, read[ing] PDR to figure a dose on an antibiotic, and so on.” I know you didn’t explicitly say that’s what being a doctor is all about, but that’s what I thought you were implying.
Thing is, we already have lots of MDs, PAs, and RNs to do those things; I certainly don’t object to more numbers, but, in my opinion, the raw number of MDs, PAs, and RNs is not the limiting step in the provision of good medical care. The limiting factor is GOOD (pretty much means “intelligent,” in this context, but “incorruptible” is a key attribute as well) MDs, PAs, and RNs. Getting more good / intelligent / incorruptible people into medicine requires more, in my opinion, than simply admitting more people to professional schools.
We can easily open the gates of medical schools to get more people into medicine. However, an emphasis on raw numbers can lead to higher costs / problems, for the simple reason that bad medicine can often be far more expensive / dangerous than good medicine.
“Wait!” I hear you (possibly) object. “I thought good medicine was expensive. How can bad medicine be even more expensive? Shouldn’t it be cheaper, if it’s bad?” Ummm ... doesn’t really work out that way. Here’s an example:
I had a fairly young patient from Africa, who had been living in the USA for years, and who had a history of having swollen legs and more, and had occasional high fevers. He’d been treated for years in the USA with intermittent hospitalization for IV antibiotics (mainly cephalosporins), and nothing else. Overall cost of his treatment, including multiple hospitalizations, by the time I saw him was probably in the hundreds of thousands of dollars. The legs had never recovered, and the patient continued to have intermittent fevers which were being diagnosed and treated as recurrent simple infections. For the most part, whatever had been spent on his care had been spent in vain.
Turns out, this patient apparently had lymphatic filariasis; in fact, he could have been presented as a textbook case of the disease. All that wasted cost and wasted time could have been avoided if he’d been treated earlier with albendazole / ivermectin / DEC rather than just with cephalosporins. In such a case, the raw (and large) number of MDs, RNs, and PAs who saw him did him no good; what he needed was ONE person (ahem) to put the whole picture together (Africa, swollen legs, young age, intermittent fevers).
That’s one example of how bad medical care can cost more than either good medical care or no medical care at all. Again, my point is that simply training people to “suture, splint a leg, pull a tooth, read PDR to figure a dose on an antibiotic, and so on,” is just not enough. You have to get the RIGHT people into medicine if you want to have any hope of avoiding costly and dangerous medical misadventures, even for what seem like simple problems.
That said, it turns out that you and I agree on your list of solutions. Making medicine more pleasant to practice, as you describe, could help attract and keep the people required to keep it running. Further, I’d make medical training easier, not harder; the long years of toil in training are really mainly a benefit to the pockets of the training program administrators (my training program allegedly used the residents to perform procedures for which the training program “routinely misbilled” ~ 22.5 million dollars). Making medicine more like the postal service ... probably not so useful at attracting the right people to medicine. Ayn Rand put it this way: “Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents itand still less safe, if he is the sort who doesnt.”
So, a summary:
good doctors are indispensable to the provision of good medical care
a greater number of doctors does not necessarily mean better medical care
attracting / keeping good doctors to medicine is probably cost effective, and best done by making the practice of medicine more pleasant.
Congratulations to you on figuring out what was wrong with your daughter. Taking your story at face value, you appear to be a good example of what I am talking about elsewhere on this thread: a good diagnostician, albeit without the paper credentials legally required for medical practice.
Conversely, your physicians, as described by you, appear to be another sort I discussed elsewhere on this thread: perhaps not such great diagnosticians, despite having the credentials.
Kudos to you. I hope others reading this thread get what appears to me to be the take home message: good medical care depends on knowledge and talent, which are NOT the same as papers and certificates.
That said, I can’t help but be curious about your daughter’s condition. Two years without a proper diagnosis? A diagnosis that you made from an internet search? What was this diagnosis? I really want to know, in order to keep in mind so that I don’t miss someone else with whatever disease your daughter had.
Pardon me for being unimpressed with the imperial, and imperious medical establishment. Because if it’s not generally accepted medical procedure, it’s ignored by the vast majority of canker mechanics. .
I’m an engineer: I simply kept researching and keeping my mind open. The nurse, and eventually the doctor who finally helped my daughter were in an Osteopathic practice.
But it was a fairly straightforward diagnosis. . . once you realized ALL the symptoms, and did some research. I had 2 doctors telling me her problem was psychosomatic, and 3 others who had NO idea what the real problem was (It was a fungal infection of the digestive tract, BTW). Yes, it was wierd, and not what you’d expect in a young adult female. But they couldn’t be bothered, and the one who COULD have figured it out didn’t want her as a patient, the case was not “sufficiently interesting” to earn his erudite attention.
So color me unimpressed by most of the medical profession: even when WE had the answer, our next-to-last doctor pooh-poohed it. Because I couldn’t POSSIBLY understand complex biochemistry, and my wife was only an LPN: we lacked sufficient understanding to make a diagnosis. Except we did, and finally got someone to do the test required. . . and sure enough, Gastric candidiasis was confirmed. .
Your points are well taken.
Huh? If you get a bill for your gall bladder surgery, the surgeon's fee and the anesthesiologist (if you don't have a nurse anesthetist) is the easiest to find. Then you start sifting through what is charged for the preparation for surgery, Operating ROOM, the nurses and other technicians, recovery ROOM--this is the cost of using the infrastructure, the cost of the machinery the surgeon uses. All that will dwarf what the doctor charges as a fee. He does not collect on the other parts of the hospitalization bill.
It's not a doctor bill at all. I wish all I had to worry about was a doctor's bills. What is scary are the bills the hospital sends you for the use of their very expensive facilities.
So, yes, we need more doctors. But that is not as easy as the dismissive posts I read here suggest. If it was cheap to train physicians, we wouldn't import them. It's cheap to import.
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