Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

[Kepler]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

I disagree to the extent the Internet has led to a general mistrust of experts and the concept of expertise in general. "That (doctor/lawyer/engineer/mechanic/professor) doesn't know what he's talking about; look what I found after a 2 minute Google search."

Healthy skepticism had been replaced by outright disbelief.

My guess is that is nothing new. It just used to be that the day you shipped off to college -- if you were lucky, the day you moved into the honors track in high school -- you left these people behind forever except when you wanted to one night the cuter ones (JFC, use protection!!!). There were plenty of these people in my high school. University admissions ended my involvement with them. But now you still hear from them if you go on the internet. Every meeting now has 8-year olds at the back who think they're clever. And they're as loud -- really, louder -- than the adults.

The cumulative stupidity of the species continues to decrease and will as long as access to a good diet and information improves and military personnel are the majority of major war fatalties. What's changed is public discourse used to be a gated community that you gained access to with education (or, to be fair, money). There was a public discourse of the stupid in the bloids or the bars or High Weirdness by Mail, but it was very easy to ignore.

Now, public discourse is close to a democratic mob where in Asimov's words "my ignorance is just as good as your knowledge." At some point the smart people will need to secede into our own gated community again.

[WisconsinWildcard]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

If they were really that much of a minority, then the distrust of doctors would not be so high. Just want to point that out.

Most of the distrust of people have a source. And in this case, it's the doctors not being THAT trustworthy.

Bad experiences get much more exposure than good experiences. It only takes a small minority given that the inherent trust in doctors has to be very high by the nature of the work they do. I can tell you the far majority of the physicians as well as other health care workers I work with are hard working, compassionate, and trustworthy. I know a few that I would not let care for a pet bird.

I am basically on your side. I think there should be no tolerance for what you are describing. But there is also a lot of nuance to individual situations and without medical training and a complete set of facts, it can be extremely challenging to determine if there is blame to be had.

[5mn_Major]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

My original thought was that there should be a more broadbased approach to healthcare than what sometimes occurs - heart surgery and other serious internal medicine conditions/procedures should always recommend a broadbased, detailed, personalized lifestyle consultation (diet, water, exercise, stress evaluation based on bloods, etc). It doesn't matter what the strategic framework is or how its executed that gets the system there.

Can everyone afford that? No. But that doesn't mean that you just leave a patient with out the means to actually solve the underlying causes long term.

I disagree to the extent the Internet has led to a general mistrust of experts and the concept of expertise in general. "That (doctor/lawyer/engineer/mechanic/professor) doesn't know what he's talking about; look what I found after a 2 minute Google search."

Healthy skepticism had been replaced by outright disbelief.

And frankly, that's overall a good thing. Yes, it does make conducting healthcare somewhat more challenging - but overall, more effective. For every doctor who's incorrectly challenged/wrongly mistrusted...there is a doctor who is corrected or whose diagnosis is improved. The downside of challenge is greatly outweighed by the cases where the diagnosis/treatment are improved or possibly even corrected.

[WisconsinWildcard]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

My original thought was that there should be a more broadbased approach to healthcare than what sometimes occurs - heart surgery and other serious internal medicine conditions/procedures should always recommend a broadbased, detailed, personalized lifestyle consultation (diet, water, exercise, stress evaluation based on bloods, etc). It doesn't matter what the strategic framework is or how its executed that gets the system there.

Can everyone afford that? No. But that doesn't mean that you just leave a patient with out the means to actually solve the underlying causes long term.

The ones that have a good evidence base like heart failure this does occur at most health institutions.

But for the most part that is not realistic. Evidence is very poor in most nutrition fields (not their fault entirely, just very difficult to study in a clinically meaningful sense). I know you like Mayo and a year or two ago they had a good series of articles describing the state of crisis the field was in. If there is no evidence, insurance sure as hell not going to cover it. And for the most part, people are not going to want/be able to pay out of pocket for these things so in the end...they are on their own. The system needs to be fixed but it will have to start at a much higher lever. I am not optimistic as politicians do not get it or don't give a ****.

And frankly, that's overall a good thing. Yes, it does make conducting healthcare somewhat more challenging - but overall, more effective. For every doctor who's incorrectly challenged/wrongly mistrusted...there is a doctor who is corrected or whose diagnosis is improved. The downside of challenge is greatly outweighed by the cases where the diagnosis/treatment are improved or possibly even corrected.

People asking good questions is the best part of my job. I love an engaged patient. But you overestimate the average medical education of a patient. The vast majority of my time answering questions are things like explaining over and over again to a family why they cannot feed someone who is recently paralyzed on half their body. People with argue about how medications work, have no idea how to pronounce it or its mechanism of action, yet still with 100% confidence disagree. I spend much, much more time and effort on the Dunning-Kruger side of patient interaction than on the side of engaged, thoughtful questions.

[5mn_Major]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

The ones that have a good evidence base like heart failure this does occur at most health institutions.

But for the most part that is not realistic.

If there is no evidence, insurance sure as hell not going to cover it. And for the most part, people are not going to want/be able to pay out of pocket for these things so in the end...they are on their own. The system needs to be fixed but it will have to start at a much higher lever. I am not optimistic as politicians do not get it or don't give a ****.

There are many other conditions (i.e., kidneys, etc) where lifestyle consultation is not the norm.

Not blaming you...but the fact that its considered not 'realistic' is part of the problem. Too often people just assume 'we can't fix it' perfectly and so do absolutely nothing to improve it. Also the fact that patients are sometimes not willing to pay out of pocket...does not mean that the physicians shouldn't have a full custom lifestyle as a recommendation and option available. Afterall, lifestyle changes are in fact recommended practice in these health outcomes...there's just no follow through to help keep the patient from coming back into the hospital a year later.

People asking good questions is the best part of my job. I love an engaged patient. But you overestimate the average medical education of a patient.

So again this is not directed at you...and I know you know this but...

What matters here is not the doctor...rather its the patient outcome. The patients health we're talking about...and ultimately they are the customer and they foot the bill. Patients are often wrong - but the resulting outcome is anywhere between patient feedback that improves the diagnosis...to at minimum doctors that are continually challenged to stay on top of their game. Not ultimately wonderful for doctors...but better overall for quality of healthcare.

[WisconsinWildcard]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

What matters here is not the doctor...rather its the patient outcome. The patients health we're talking about...and ultimately they are the customer and they foot the bill. Patients are often wrong - but the resulting outcome is anywhere between patient feedback that improves the diagnosis...to at minimum doctors that are continually challenged to stay on top of their game. Not ultimately wonderful for doctors...but better overall for quality of healthcare.

Patient outcome is what matters. Unfortunately, we are reimbursed based on quantity not quality. I am not a surgeon, therefore my RVUs are much harder to come by and people in my field need to see many more patients just to keep their job.

Doctors are challenged all of the time by other doctors. These are probably the most useful interactions in improving quality. Academic centers are challenging in a very good way. You want to order a test? The first question will be how does it change management. The docs I worry most about are those on their own or in small groups where they can slowly drift away from best practice. But then again, that is why we have robust continuing education requirements, reboarding etc.

Here are a few things:
Happy (satisfied) patients, for the most part, have worst outcomes
VIPs, for the most part, have worst outcomes

There is a customer element to healthcare but the trends in the literature have been showing that when the customer is right, outcomes are worse.

[5mn_Major]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

Patient outcome is what matters. Unfortunately, we are reimbursed based on quantity not quality. I am not a surgeon, therefore my RVUs are much harder to come by and people in my field need to see many more patients just to keep their job.

Doctors are challenged all of the time by other doctors. These are probably the most useful interactions in improving quality. Academic centers are challenging in a very good way. You want to order a test? The first question will be how does it change management. The docs I worry most about are those on their own or in small groups where they can slowly drift away from best practice. But then again, that is why we have robust continuing education requirements, reboarding etc.

Here are a few things:
Happy (satisfied) patients, for the most part, have worst outcomes
VIPs, for the most part, have worst outcomes

There is a customer element to healthcare but the trends in the literature have been showing that when the customer is right, outcomes are worse.

I might also believe that the outcome of 'when the customer is right, outcomes are worse' comes from doctors caving. What a doctor should do is rather stick to their guns when they are confident they are correct...there's no question that a patient can be wrong.

And again, while I can believe everything you say above as correct...it doesn't mean an educated patient is not a good thing for the overall quality of healthcare.

[unofan]

I might also believe that the outcome of 'when the customer is right, outcomes are worse' comes from doctors caving. What a doctor should do is rather stick to their guns when they are confident they are correct...there's no question that a patient can be wrong.

And again, while I can believe everything you say above as correct...it doesn't mean an educated patient is not a good thing for the overall quality of healthcare.

The problem is the Dunning Krueger effect, the patients/clients/whatever who think they're the most educated tend to actually be the least.

[5mn_Major]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

The problem is the Dunning Krueger effect, the patients/clients/whatever who think they're the most educated tend to actually be the least.

Sure...but does the costs of that outweigh the benefits of a knowledgeable patient. I would argue no.

A knowledgeable consumer pushes a product/service provider to produce better offerings and do it with better service/support. This is the case whether you're ordering food at a restaurant, buying a dishwasher, booking a hotel or receiving healthcare. If you're the provider getting pushed, it makes your life more difficult...but the resulting improved offering makes for a better marketplace overall and improves quality of life for all.

[WisconsinWildcard]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

I might also believe that the outcome of 'when the customer is right, outcomes are worse' comes from doctors caving. What a doctor should do is rather stick to their guns when they are confident they are correct...there's no question that a patient can be wrong.

What a great way to tank the Press-Ganey score and cause your hospital to lose money. You do that frequently enough and you will have 2 or 3 administrators so far up your ***...

The system is broken. Doctors and patients have poor advocacy for themselves. Politicians do not give a **** or listen to the profit makers in medicine over patients and health care professionals.

[WisconsinWildcard]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

Sure...but does the costs of that outweigh the benefits of a knowledgeable patient. I would argue no.

A knowledgeable consumer pushes a product/service provider to produce better offerings and do it with better service/support. This is the case whether you're ordering food at a restaurant, buying a dishwasher, booking a hotel or receiving healthcare. If you're the provider getting pushed, it makes your life more difficult...but the resulting improved offering makes for a better marketplace overall and improves quality of life for all.

Here is the point you are having trouble getting. Being knowledgeable about a dishwasher is much different than being knowledgeable about healthcare.

[5mn_Major]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

What a great way to tank the Press-Ganey score and cause your hospital to lose money. You do that frequently enough and you will have 2 or 3 administrators so far up your ***...

The system is broken. Doctors and patients have poor advocacy for themselves. Politicians do not give a **** or listen to the profit makers in medicine over patients and health care professionals.

There are some hospitals that are better and some that are worse. Like any other profession, unfortunately that means that workers need to make a change to another workplace to improve things. And like any other profession, typically workers take a worse job in a less effective organization because the money is better.

There are better hospital systems and worse ones...but you may say its 100% systemic. Now, I'm smart enough to be dangerous on some of this stuff, but I know something about markets. I'm pretty sure the reason hospitals are not profitable is because insurance companies are squeezing profits out of them. That is ultimately the top problem that I know of. And that is beyond anyone's control at this point.

Here is the point you are having trouble getting. Being knowledgeable about a dishwasher is much different than being knowledgeable about healthcare.

But the principles apply in both cases. I think both you and UNO's point is that its bad to have a patient who is wrong in their knowledge. I would propose for quality of healthcare...a wrong patient is better than a patient who knows nothing and doesn't provide a modest challenge to the system. The human race is what we are because of millennia of learning, debate, resolution, learning and improvement. Physicians just need to stick to their guns when patients are wrong. That is the way it should be. The trick is to make sure physicians have the time/resources to beef up for that discussion...because that process of preparation is what makes you better.

[unofan]

a wrong patient is better than a patient who knows nothing and doesn't provide a modest challenge to the system.

My client is a government agency. When my client is wrong, either consumers or the regulated industry is harmed, not me (except to the extent I may also be a consumer). Challenging the system makes for a great soundbyte but neglects consideration of injury to innocent third parties.

[5mn_Major]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

My client is a government agency. When my client is wrong, either consumers or the regulated industry is harmed, not me (except to the extent I may also be a consumer). Challenging the system makes for a great soundbyte but neglects consideration of injury to innocent third parties.

Can't speak to your unique situation. But in the vast majority of situations, the only way the industry is harmed is if the relevant provider either doesn't care or caves in to consumers. That's on the provider. The far greater risk for society is that the consumer is ignorant and continues buying whatever youre pushing.

[WisconsinWildcard]

Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2

There are better hospital systems and worse ones...but you may say its 100% systemic. Now, I'm smart enough to be dangerous on some of this stuff, but I know something about markets. I'm pretty sure the reason hospitals are not profitable is because insurance companies are squeezing profits out of them. That is ultimately the top problem that I know of. And that is beyond anyone's control at this point.

You are correct, you are just smart enough to be dangerous

There are plenty of reasons hospitals are not profitable. There are laws requiring us to treat who shows up to our ED. Hospitals have to absorb those that do not have insurance and this costs much more than insurance squeezing things. Look around the country and see why hospitals are going out of business. They are usually in rural or underserved areas and have too high a proportion of uninsured. If uninsured goes up in the US, more hospitals will close.

The hospital systems that are successful are usually not because they have better outcomes. They control their market better and do so at the cost of humanity. They have administrators that are good at altering the numbers to make them look good. If you took the top 10 hospitals in US news whatever...they all do this. Did you know that you can "erase" a bad outcome if you flip a patients bed from an inpatient bed to a hospice bed after a bad outcome on a surgery? It looks like they were discharged alive to the numbers that matter for rankings but they could have died minutes after that clerical trick. The "top" hospitals are doing this.

Did you know that Cleveland Clinic makes every effort to hide their emergency room to avoid serving the very poor community that their campus is in (which they had to have in order to continue in the community)? Did you know that Mayo and other profitable systems take preference for private insurance over medicare and medicaid? Why are some of the worst/underserved neighborhoods in Baltimore around Johns Hopkins?

You can make a hospital system profitable but that does not translate to better outcomes. You can also lose the purpose of healthcare in the process. You are not serving the community, you are hurting those most in need in the name of profits. These profitable systems abandon the most needy in their communities and represent part of what is wrong in our system.