I blame the insurance companies and big pharma.
USCHO Fan Forum
This is a sample guest message. Register a free account today to become a member! Once signed in, you'll be able to participate on this site by adding your own topics and posts, as well as connect with other members through your own private inbox!
-
The USCHO Fan Forum has migrated to a new plaform, xenForo. Most of the function of the forum should work in familiar ways. Please note that you can switch between light and dark modes by clicking on the gear icon in the upper right of the main menu bar. We are hoping that this new platform will prove to be faster and more reliable. Please feel free to explore its features.
Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
- Thread starter joecct
- Start date
- Status
I blame the insurance companies and big pharma.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I believe youre right and youre right.
The outward rationale is that it 'helps domestic production and creates jobs'. Never mind that at best case its neutral on both, while making products and svcs more expensive for consumers and likely resulting in a trade war in an unrelated industry. But likely his real rationale is to deal a blow to alternatives and give the fossils a leg up.
From an environmentally friendly standpoint, its of course the right thing to continue to drive alternatives. But the purely economic reason...is that it keeps American innovation focused on a whole technology frontier. It gives us a sandbox to play in. And it is US innovation that is a cornerstone of what keeps us at the forefront of global competition.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I believe youre right and youre right.
The outward rationale is that it 'helps domestic production and creates jobs'. Never mind that at best case its neutral on both, while making products and svcs more expensive for consumers and likely resulting in a trade war in an unrelated industry. But likely his real rationale is to deal a blow to alternatives and give the fossils a leg up.
From an environmentally friendly standpoint, its of course the right thing to continue to drive alternatives. But the purely economic reason...is that it keeps American innovation focused on a whole technology frontier. It gives us a sandbox to play in. And it is US innovation that is a cornerstone of what keeps us at the forefront of global competition.
ScoobyDoo
NPC
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
And going back to a fossil fuel focused Government is going to send all our scientists to other nations. We'll be the "dirty" country.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
And going back to a fossil fuel focused Government is going to send all our scientists to other nations. We'll be the "dirty" country.
At least we don't have athletes puking and wearing masks because the air was so foul due to pollution as it was last month in Delhi. (Yet?)
ScoobyDoo
NPC
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
We're working on it. We passed laws to prevent that years ago but the new deregulations have thrown those out.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
We're working on it. We passed laws to prevent that years ago but the new deregulations have thrown those out.
WisconsinWildcard
The plural of anecdote is not data
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
A not so infrequent occurrence that we like to joke about is when you tell something to a patient that is not what they want to hear and they reply "Well that is just your opinion."
I always stay professional on the outside but on the inside I am always saying "Isn't that the whole **** point of you coming to this appointment?"
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
A not so infrequent occurrence that we like to joke about is when you tell something to a patient that is not what they want to hear and they reply "Well that is just your opinion."
I always stay professional on the outside but on the inside I am always saying "Isn't that the whole **** point of you coming to this appointment?"
ScoobyDoo
NPC
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I'm in the 34%. I would never do that to a professional. Ever. I may get another opinion, depending on what it is, but I would never do that.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I'm in the 34%. I would never do that to a professional. Ever. I may get another opinion, depending on what it is, but I would never do that.
WisconsinWildcard
The plural of anecdote is not data
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I very frequently offer a second opinion in those cases. What it turns out to be is they just want me to tell them what they have already concluded/want, not that they think that I am wrong.
It is pretty demoralizing to have a decade of formal education thrown aside by someone who googled something. Or someone who "knows their body" who is forgetting that it is my job to know everyone's body. I often wonder if other professionals have this? I do not find myself arguing with my dentist, mechanic, lawyer, insurance salesman etc.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I very frequently offer a second opinion in those cases. What it turns out to be is they just want me to tell them what they have already concluded/want, not that they think that I am wrong.
It is pretty demoralizing to have a decade of formal education thrown aside by someone who googled something. Or someone who "knows their body" who is forgetting that it is my job to know everyone's body. I often wonder if other professionals have this? I do not find myself arguing with my dentist, mechanic, lawyer, insurance salesman etc.
ScoobyDoo
NPC
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I'm told I'm an idiot by people all the time who have no idea what I do. It's not just Doctors. Google has really put a dent in what it means to be an expert in any field.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I'm told I'm an idiot by people all the time who have no idea what I do. It's not just Doctors. Google has really put a dent in what it means to be an expert in any field.
unofan
Well-known member
Yeah, because even older Republicans knew we had to deal with things like LA's smog. Hence Nixon creating the EPA.
Today's GOP crew, and those who support them, don't believe in protecting the environment. So get ready to go back to 1970's air quality.
unofan
Well-known member
Ditto. And fellow lawyers make for the worst clients.
Jimjamesak
Already insane, UAA making it worse
Quake kinda sorta woke me up, it was a faint rumbling that lasted a few minutes, no big deal. Now, the EAS alert on my cell phone for the Tsunami warnings jolted me up pretty quick. No real big waves and the alerts got cancelled by 4 am but people in Kodiak and Homer had rough nights.
Kepler
Cornell Big Red
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Good. This is a species feature.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Good. This is a species feature.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
The one knock against some medical experiences is that they don't bring a 360 degree look...when a 360 degree look is helpful.
For example, I was treated for an internal medicine condition that required specialist attention. The second specialist did a great job (the first was not direct enough...and so I didn't know my problem was serious). But I had to request a simultaneous diet and physical exam regiment at the same time - the doctors did not do that. My insistence turned out to be a key aspect of the whole recovery.
Every medical provider should have a complete solution tree from the top down for designated hospitalization conditions...and a referral on a personalized diet and exercise regimen should be a default.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
The one knock against some medical experiences is that they don't bring a 360 degree look...when a 360 degree look is helpful.
For example, I was treated for an internal medicine condition that required specialist attention. The second specialist did a great job (the first was not direct enough...and so I didn't know my problem was serious). But I had to request a simultaneous diet and physical exam regiment at the same time - the doctors did not do that. My insistence turned out to be a key aspect of the whole recovery.
Every medical provider should have a complete solution tree from the top down for designated hospitalization conditions...and a referral on a personalized diet and exercise regimen should be a default.
FadeToBlack&Gold
Kettle Medallion
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Hey, I trust my doctor. It's just that I like eating junk food, and sleeping in instead of going to the gym, as much as my fellow Americans.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Hey, I trust my doctor. It's just that I like eating junk food, and sleeping in instead of going to the gym, as much as my fellow Americans.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
+ a lot.
A similar story with relatives I know- where an original "accident" was ignored, and just the easy button for the symptoms were treated. It was finally looked at closer over a month later, which lead to immediate surgery. A month earlier would have made the recovery easy. A month later, and death due to a totally missed, but pretty obvious, injury.
It's hard to trust people who don't listen and don't pay attention.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
+ a lot.
A similar story with relatives I know- where an original "accident" was ignored, and just the easy button for the symptoms were treated. It was finally looked at closer over a month later, which lead to immediate surgery. A month earlier would have made the recovery easy. A month later, and death due to a totally missed, but pretty obvious, injury.
It's hard to trust people who don't listen and don't pay attention.
WisconsinWildcard
The plural of anecdote is not data
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Absolutely. Every experience is different, but it is not always the practitioners fault. I think a good physician has to be able to read a room. You have to know what level to speak at to be understood but not insulting. You need to assess what to focus on, in an efficient manner. The more things you tell someone they should be doing, the less likely they are to do them. People forget about 80% of what you tell them and often misinterpret the rest. Not that you used it but I do hate the term "holistic" as I think every good physician should be taking the whole patient into account, regardless of the specialty.
That is really unrealistic. It vastly underestimates the complexity of the patient. It can work for certain conditions that are more amenable for "cook book" medicine initially like chest pain or straightforward stroke but that approach can lead to trouble. You need to take into account many variables, resources at hand, etc and use prior plausibility based on your available clinical information to properly treat a patient, and there is no way you can have a complete solution tree for "designated hospitalization conditions." I think you also underestimate the click box fatigue of an EMR. If I admit 5-10 patients a day, I am clicking several hundred click boxes. The more you add, the more likely they are auto piloted. Bloat of EMR is a huge problem and it is not getting better (remember, the EMR was designed for billing, no clinical efficiency).
I agree that diet and exercise is probably the most important health factor in the majority of conditions but I disagree that it should be a default (at least in the current system). I think that is a very privileged position to take. I am happy for you that you can afford the time and effort for that but that is not the reality of most Americans. Good dietitians are not abundant nor are they covered by most insurance for many things. People cannot afford to join a gym or exercise if they have a 2 jobs that they are trying to keep to feed their family and they just suffered a medical setback (both in time and financially). Many people cannot afford to get a second opinion because their insurance only covers one network.
Lastly, there are many personalized diet programs that are not at all evidence based. People have dietary ideas for nearly everything but that does not necessarily mean they improve outcomes. If outcomes are not improved, we should not be spending our money on it. The dietary literature is well known to be lacking in rigor, but hopefully this will improve.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Absolutely. Every experience is different, but it is not always the practitioners fault. I think a good physician has to be able to read a room. You have to know what level to speak at to be understood but not insulting. You need to assess what to focus on, in an efficient manner. The more things you tell someone they should be doing, the less likely they are to do them. People forget about 80% of what you tell them and often misinterpret the rest. Not that you used it but I do hate the term "holistic" as I think every good physician should be taking the whole patient into account, regardless of the specialty.
That is really unrealistic. It vastly underestimates the complexity of the patient. It can work for certain conditions that are more amenable for "cook book" medicine initially like chest pain or straightforward stroke but that approach can lead to trouble. You need to take into account many variables, resources at hand, etc and use prior plausibility based on your available clinical information to properly treat a patient, and there is no way you can have a complete solution tree for "designated hospitalization conditions." I think you also underestimate the click box fatigue of an EMR. If I admit 5-10 patients a day, I am clicking several hundred click boxes. The more you add, the more likely they are auto piloted. Bloat of EMR is a huge problem and it is not getting better (remember, the EMR was designed for billing, no clinical efficiency).
I agree that diet and exercise is probably the most important health factor in the majority of conditions but I disagree that it should be a default (at least in the current system). I think that is a very privileged position to take. I am happy for you that you can afford the time and effort for that but that is not the reality of most Americans. Good dietitians are not abundant nor are they covered by most insurance for many things. People cannot afford to join a gym or exercise if they have a 2 jobs that they are trying to keep to feed their family and they just suffered a medical setback (both in time and financially). Many people cannot afford to get a second opinion because their insurance only covers one network.
Lastly, there are many personalized diet programs that are not at all evidence based. People have dietary ideas for nearly everything but that does not necessarily mean they improve outcomes. If outcomes are not improved, we should not be spending our money on it. The dietary literature is well known to be lacking in rigor, but hopefully this will improve.
WisconsinWildcard
The plural of anecdote is not data
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
You have to be careful not to run too far with this idea. Take TIAs (Transient Ischemic Attacks). In the right setting, it is a neurological emergency where you should be admitted and receive an expedited work-up. On the otherhand, certain factors can predict that it is less serious and that the patient can be worked up as an outpatient. Say we use the ABCD2 score https://en.wikipedia.org/wiki/ABCD²_score
Now I have a patient with a score of 1. Their 7 day risk of stroke is 1% and thus is low. I discharge them home for outpatient workup (in the next 2-3 days). Lets say they have good insurance, I should be able to get it done without an issue. That night, they have a large stroke and I look like an incompetent physician. Family and friends now have a story to tell how this heartless and stupid doctor discharged a patient from the ED when they were going to have a massive stroke.
When I discharge that patient, I know their risk, for every 100 patients I do this to, 1 will have a stroke. It is an accepted risk, and it should be discussed with the family. However if I were to admit all 100 of those patients to prevent 1 stroke, I would bankrupt the system. Insurance would not cover the admission...patients would foot the bill. Most patients cannot afford an uncovered hospital admission and the hospital would go unpaid.
The system is complex but you have to be careful. For most people, an anecdote can trump significant amounts of data. We all remember that patient we missed something on when following the standard of care. However we have to take into account what is best for the patient, best for the system, and best for society. Extensive work-up is often harmful. False positives are frequent when you test multiple things. You have to take into account prior plausibility to make clinically meaningful decisions.
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
You have to be careful not to run too far with this idea. Take TIAs (Transient Ischemic Attacks). In the right setting, it is a neurological emergency where you should be admitted and receive an expedited work-up. On the otherhand, certain factors can predict that it is less serious and that the patient can be worked up as an outpatient. Say we use the ABCD2 score https://en.wikipedia.org/wiki/ABCD²_score
Now I have a patient with a score of 1. Their 7 day risk of stroke is 1% and thus is low. I discharge them home for outpatient workup (in the next 2-3 days). Lets say they have good insurance, I should be able to get it done without an issue. That night, they have a large stroke and I look like an incompetent physician. Family and friends now have a story to tell how this heartless and stupid doctor discharged a patient from the ED when they were going to have a massive stroke.
When I discharge that patient, I know their risk, for every 100 patients I do this to, 1 will have a stroke. It is an accepted risk, and it should be discussed with the family. However if I were to admit all 100 of those patients to prevent 1 stroke, I would bankrupt the system. Insurance would not cover the admission...patients would foot the bill. Most patients cannot afford an uncovered hospital admission and the hospital would go unpaid.
The system is complex but you have to be careful. For most people, an anecdote can trump significant amounts of data. We all remember that patient we missed something on when following the standard of care. However we have to take into account what is best for the patient, best for the system, and best for society. Extensive work-up is often harmful. False positives are frequent when you test multiple things. You have to take into account prior plausibility to make clinically meaningful decisions.
walrus
Wind up workin' in a gas station
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I do a specialized diet for Colitis, My GI says diet doesn't matter. I say he should start reading the research Seattle Childrens, Rush University and Umass Boston have been doing.
WisconsinWildcard
The plural of anecdote is not data
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I am not an expert in GI so I will not directly comment on the research. But as long as the diet does not seem to present a harm or interfere with treatment, they should be OK with it. Sometimes research is preliminary and your GI is right to be skeptical. They could also be behind the current literature and are wrong to be skeptical. I think the most important thing is to be able to have an open conversation, and to not shame patients for doing their own research or trying things. The worst case in that situation is to come off as arrogant* or make the patient feel stupid and then stifle dialog. I have plenty of patients doing things that I do not think there is strong evidence for. If I think it is not efficacious but not harmful, I usually tell them but in a way that is hopefully non-judgmental and respects their autonomy. If I think it is harmful, I am a bit more forceful in my recommendation.
*I do recognize the irony that I probably come off as arrogant at time on here but know this: 1. None of you are my patients 2. Everyone has a different tone in person vs online and 3. Like many physicians with blogs (respectful insolence, neurologica, etc) or comment sections, I do use this as a break from the madness of medicine and as a way to vent
Re: Science: Everything explained by PV=nRT, F=ma=Gm(1)•m(2)/r^2
I am not an expert in GI so I will not directly comment on the research. But as long as the diet does not seem to present a harm or interfere with treatment, they should be OK with it. Sometimes research is preliminary and your GI is right to be skeptical. They could also be behind the current literature and are wrong to be skeptical. I think the most important thing is to be able to have an open conversation, and to not shame patients for doing their own research or trying things. The worst case in that situation is to come off as arrogant* or make the patient feel stupid and then stifle dialog. I have plenty of patients doing things that I do not think there is strong evidence for. If I think it is not efficacious but not harmful, I usually tell them but in a way that is hopefully non-judgmental and respects their autonomy. If I think it is harmful, I am a bit more forceful in my recommendation.
*I do recognize the irony that I probably come off as arrogant at time on here but know this: 1. None of you are my patients 2. Everyone has a different tone in person vs online and 3. Like many physicians with blogs (respectful insolence, neurologica, etc) or comment sections, I do use this as a break from the madness of medicine and as a way to vent
- Status