The PPACA Thread Part III - Let's have a healthy debate!

[brookyone]

Re: The PPACA Thread Part III - Let's have a healthy debate!

It should be noted I am not blaming it on the ACA it is a problem that existed before and will for quite some time. I am saying the ACA did nothing to fix an obvious problem and just because a few of my fellow Lefties refuse to see it doesnt make it any less true

We incentivize people to do things all the time. You are telling me the Government cant find a way to convince a nice hospital and some doctors and staff to move to Bumphuck, IA? We have programs that convince teachers to work in schools in pretty bad parts of major cities and yet none of us can think of ways to convince doctors with massive amounts of debt to go to places with less competition for service? We cant find a way to convince say, Fairview or Mayo to open up a satellite hospital closer to these towns...where land is often unused and probably cheap?

Here...in case I was too vague offer doctors loan forgiveness for moving to the sticks and working for X amount of years and find some tax break or federal subsidy you can offer the big hospitals (along with cheap land rates) to open up in more rural areas. That took all of 3 minutes for me to cook up.

That's fast but as far as actually working and correcting the issue I remain skeptical.

[dxmnkd316]

Re: The PPACA Thread Part III - Let's have a healthy debate!

For the record, the government (maybe just Minnesota, I don't know) does try to increase the number of doctors in rural areas.

Loan forgiveness programs are available for underserved areas. That includes the poor, urban areas as well as rural. If you become a doctor and move to an underserved rural area, you can have a fairly large chunk of your med school loans forgiven if you stay for a certain number of years.

Edit: D'oh. I see handy already pointed this out.

[5mn_Major]

Re: The PPACA Thread Part III - Let's have a healthy debate!

One more note for those of you approaching decisions regarding serious health care.

1. Learn whether your condition is urgent or not...and serious or not. It may be time sensitive and not serious...or vice versa. And take steps accordingly.

2. If you have the time and usually you do, do your research. Take the time to learn about your condition. Learn about treatments. Learn about doctors. And yes, learn about hospitals. Take in all data points - regardless of supposed flaws - and make the decisions of where to go and who to see for the best health care for you. Would you not research a car or a house...why would you not take all the necessary precautions in identifying the appropriate care for yourself.

3. Ignore others who posted here...and don't limit yourself to your geographic proximity. Odds are better than 50/50 that the best treatment is in fact is hours from your house.

I am not a general practitioner. I'm a research and decision consultant for executives of major companies and have been through a three day Mayo executive check up with over a dozen specialists. I have 4 medical specialists in serious fields, two pharma researchers and the head of a major specialty department at a top hospital in my immediate family.

I have had basic kidney failure and have been through terrible times that few have ever experienced. I have spent years in and out of specialists and spent that time researching every aspect of my condition. I am basically as normal as can be expected because of the steps I personally have taken...and I will never accept 'I can't' or 'good enough' for something important ever again.

And no. Not all health care for serious conditions is the same.

[FadeToBlack&Gold]

I am not a general practitioner. I'm a research and decision consultant for executives of major companies and have been through a three day Mayo executive check up with over a dozen specialists. I have 4 medical specialists in serious fields, two pharma researchers and the head of a major specialty department at a top hospital in my immediate family.

I have had basic kidney failure and have been through terrible times that few have ever experienced. I have spent years in and out of specialists and spent that time researching every aspect of my condition. I am basically as normal as can be expected because of the steps I personally have taken...and I will never accept 'I can't' or 'good enough' for something important ever again.

Christ, this is like arguing law with unofan. So you stayed at a Holiday Inn Express last night?

[walrus]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Christ, this is like arguing law with unofan. So you stayed at a Holiday Inn Express last night?

Except Unofan happens to be a lawyer.

What the heck is basic kidney failure anyway

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Christ, this is like arguing law with unofan.

Not wise to "argue" with people over topics in their field when it's not one's own.

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

You poo poo some of the best methods we have of choosing quality health care for ourselves. When I say one may need to travel to get the best health care for themselves...you disagree.

You did not say one may need to travel to get best health care. You said if you cannot be bothered...it is not serious. That is a big difference. There is a lot of nuance to "best health care" that will be missed in an online conversation. I am calling into question what you call "best methods" from an insider perspective. I attend around 50 morbidity and mortality conferences a year, with about 100 or so physicians in a room discussing a difficult case. I am trying to provide a different perspective than one outside of this environment.

When in response I raise the fact that there are significant ramifications to making bad choices in serious health care...you say informing people about this is reckless.

In response you quoted a BMJ article that is controversial to say the least. You committed a common error of taking one article and not putting it into context with the prior literature. It also poisons the well of our conversation, which we can get into further if you show good faith in this discussion. Articles do not exist in a vacuum. Have you read the article? I am not trying to be petty but did you read the whole article, not just a summary? Like I said I am more than willing to talk about medical errors but I will only do it if you are willing to put a little honest effort in on your side.

Here are some things that will help me. How do you define a medical error? How do you correct for the wide variety of surgical and medical situations that fit your definition of a medical error? What limitations do you see in the article you quoted?

For some background on me, I am a published physician scientist. Most physicians are very poor at assessing the medical literature (because it is not emphasized in medical school) and frankly, you can be an excellent physician without knowing how to critical assess primary literature. There also is just not enough time to learn everything and if you are not tested on it (they are not sufficiently) and are not passionate about it (most are not, believe me), you just do not pick it up. I teach medical students and residents basic evidence based medicine (and its limitations) and it is a difficult subject, with no real right answers.

[walrus]

Re: The PPACA Thread Part III - Let's have a healthy debate!

For some background on me, I am a published physician scientist. Most physicians are very poor at assessing the medical literature (because it is not emphasized in medical school) and frankly, you can be an excellent physician without knowing how to critical assess primary literature. There also is just not enough time to learn everything and if you are not tested on it (they are not sufficiently) and are not passionate about it (most are not, believe me), you just do not pick it up. I teach medical students and residents basic evidence based medicine (and its limitations) and it is a difficult subject, with no real right answers.

Get back to us when stay at a Holiday Inn

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Get back to us when stay at a Holiday Inn

It has to be a Holiday Inn Express, the regular ones just don't cut it on knowledge-by-osmosis these days.

[brookyone]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Except Unofan happens to be a lawyer.

What the heck is basic kidney failure anyway

I've had chronic kidney failure (alport syndrome) my entire life with ESRF since the early nineties. I know chronic and acute...don't know what basic is.

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I've had chronic kidney failure (alport syndrome) my entire life with ESRF since the early nineties. I know chronic and acute...don't know what basic is.

If my ten weeks as a medicine intern on a nephrology team count for anything...I never heard that term used. Either AKI (acute kidney injury) and CKD (chronic kidney disease). AKI turns into CKD when glomerular filtration rates (GFR) do not rebound within a relatively variable amount of time. You can have AKI on CKD. CKD is divided into stages 1-5 (5 being the worst). There is no real distinction between CKD stage 5 and end stage renal disease (ESRD) except that a nephrologist has made the decision to initiate dialysis (and are obligated to continue it). That is different from dialysis initiated in the setting of severe AKI (or a few other indications remembered by the mnemonic AEIOU) which patients are expected to recover from and thus no longer need dialysis. There are rare examples of patients being deemed ESRD and being able to come off of dialysis months or years down the road although if a patient were doing well on dialysis, one would need a very compelling reason to try to wean them off.

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

People who impress me solely based on their jobs:

1. Mathematicians and theoretical physicists at 1st tier universities
2. Any doctor
3. ... Nah, that's basically it.

I just cannot fathom how you folks are able to store and use that much insanely complicated information, in a rigorously logical context, with f-cking death on the line.

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

People who impress me solely based on their jobs:

1. Mathematicians and theoretical physicists at 1st tier universities
2. Any doctor
3. ... Nah, that's basically it.

I just cannot fathom how you folks are able to store and use that much insanely complicated information, in a rigorously logical context, with f-cking death on the line.

Don't give me that. He's got it all cribbed on the palm of his hand.

[brookyone]

Re: The PPACA Thread Part III - Let's have a healthy debate!

If my ten weeks as a medicine intern on a nephrology team count for anything...I never heard that term used. Either AKI (acute kidney injury) and CKD (chronic kidney disease). AKI turns into CKD when glomerular filtration rates (GFR) do not rebound within a relatively variable amount of time. You can have AKI on CKD. CKD is divided into stages 1-5 (5 being the worst). There is no real distinction between CKD stage 5 and end stage renal disease (ESRD) except that a nephrologist has made the decision to initiate dialysis (and are obligated to continue it). That is different from dialysis initiated in the setting of severe AKI (or a few other indications remembered by the mnemonic AEIOU) which patients are expected to recover from and thus no longer need dialysis. There are rare examples of patients being deemed ESRD and being able to come off of dialysis months or years down the road although if a patient were doing well on dialysis, one would need a very compelling reason to try to wean them off.

I did a decade of dialysis combined between a first transplant and a 2nd. During that time several fellow dialysis patients suffering from acute failure came and then went for having recovered kidney function. Never heard of anyone being able to come off dialysis with chronic failure. Every Nephrologist I've ever had has told me function per chronic failure never returns to allow a patient coming off dialysis. Never witnessed that happening in those ten years. I have only known one reason a fellow patient stops coming to dialysis. Make that two...including transplant recipients.

I put off starting until I was too sick...not starting wasn't an option any longer, when my Nephrologist said it's time in no uncertain terms. I had fought him on it for quite awhile.

[brookyone]

Re: The PPACA Thread Part III - Let's have a healthy debate!

People who impress me solely based on their jobs:

1. Mathematicians and theoretical physicists at 1st tier universities
2. Any doctor
3. ... Nah, that's basically it.

I just cannot fathom how you folks are able to store and use that much insanely complicated information, in a rigorously logical context, with f-cking death on the line.

There are some doctors who aren't that impressive. I've had a few. Mostly I agree on doctors...especially surgeons. A special, gifted breed who can do those things. the folks who well deserve the big bucks in my opinion.

The vast majority in the medical field are the most caring, compassionate people you'll ever meet.