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Doctors Are Creating Too Many Patients

Soulskill posted more than 3 years ago | from the no-patience-for-whiny-patients dept.

Medicine 566

Hugh Pickens writes "H. Gilbert Welch writes in the LA Times that the threshold for diagnosis has fallen too low, with physicians making diagnoses in individuals who wouldn't have been considered sick in the past, raising healthcare costs for everyone. Part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. 'But part of the explanation is behavioral: We look harder for things to be wrong. We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease (a fasting blood sugar of 130 was not considered to be diabetes before 1997; now it is).' Welch says the problem is that low thresholds have a way of leading to treatments that are worse than the disease. 'We are trained to focus on the few we might be able to help, even if it's only 1 out of 100 (the benefit of lowering cholesterol in those with normal cholesterol but elevated C-reactive protein) or 1 out of 1,000 (the benefit of breast and prostate cancer screening),' writes Welch. 'But it's time for everyone to start caring about what happens to the other 999.'"

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There's still a lot to do in medicine (0)

x*yy*x (2058140) | more than 3 years ago | (#36056208)

Part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. 'But part of the explanation is behavioral: We look harder for things to be wrong.

I wish this was true. I just spend 3 months in hospital after getting some disease in Asia. You want to know what disease? So would I know and probably the countless amount of different specialized doctors that were trying to figure out what I've got. I was unable to walk, even unable to move in bed first, I passed out for a week because I couldn't get oxygen and was put in to machines. They were sure that was the end of it and even called my relatives to come, because they were thinking I wont wake up. I of course don't remember any of it, I just remember that they plugged something on my neck when everything was hazy already and then I woke up one week later. I spent the next 2 months in bed, trying to get my legs working little by little. After 3 months I got out of hospital, but I still have pain in legs and my back and walking is a problem. I still have many hospital visits to come because my heart, lungs and liver are all destroyed. I sometimes get blood lines coming out of my head when my head hurts. And it's weird, because there's no any cut or anything, but it just comes through skin. They've finally diagnosed several diseases now, but it took them a long time and many, many painful tests and hundreds of blood tests. And yet they still don't know what caused all of them and still have to see whats wrong with my heart, lungs and liver too.

Maybe the story is right for everyday diseases, but when you spend a long time in a hospital, unable to walk, unable to move in the bed, and the doctors just say they don't know what you've got and aren't really that sure how it's going to affect you rest of your life, you sure as hell aren't thinking "I wish they would diagnose and know less".

WOOOOOOOOSH (2, Informative)

RedK (112790) | more than 3 years ago | (#36056230)

That's the sound the point of this story made when it flew past your head. Maybe you missed the part about "diagnosing people with no symptoms".

Anyway, we're all sorry for you and we'll all cry ourselves tonight hugging our loved ones thanks to your heartfelt tale, but it has nothing to do with what is being discussed here. Maybe you should submit this to your doctors : Reading Comprehension fail might be another symptom.

Re:WOOOOOOOOSH (-1)

Anonymous Coward | more than 3 years ago | (#36056284)

Couldn't have said it any better.
WOOOOOSH indeed!! LOL :)

Re:WOOOOOOOOSH (0, Troll)

captain_sweatpants (1997280) | more than 3 years ago | (#36056572)

Wow. Your complete lack of empathy for a human being who has endured so much disgusts me. As does the actions of the morons who decided your comment was informative. In case you didn't realise this article was actually on the topic of misdiagnosis. As you point out, it was specifically on over diagnosis. However, what you failed to realise is the seriously ill person you so cruelly attacked was actually speaking about misdiagnosis in terms of failing to recognise the significance of symptoms. Which is very much on topic and a completely valid and reasonable point to make on the subject at hand. Your attitude clearly demonstrates you have never had a serious illness in your life and have absolutely no concept of the profound effect it has on your life. Doctors are actually aware of this and guess what, they tend to err on the side of caution, because unlike you they actually care about the welfare of other human beings. I certainly hope you never suffer from a serious illness, because I have a feeling that the people in your life (if there are any) will have a similar response to the one you did now, and if they do, you will deserve it.

Re:There's still a lot to do in medicine (0)

Anonymous Coward | more than 3 years ago | (#36056236)

I'm sorry for your troubles, but I really think you've missed the point of the article with your conclusion. With you, something was obviously wrong and treatment really couldn't make it much worse. That's not what this is about.

Re:There's still a lot to do in medicine (4, Insightful)

Moryath (553296) | more than 3 years ago | (#36056266)

You were demonstrably sick.

Here's what generally happens in the US of ADD. Someone comes in to the doctor's office overtired. They have a cold because they overworked themselves and shot their immune system to hell through fatigue.

The doctor then proceeds to order up bloodwork, EKG, MRI... a thousand useless tests. Even worse is the "full body scan" crap advertised on Right Wing Wacko Radio lately. Spend thousands of dollars getting scanned, followed by thousands of dollars fixing the 3-4 "abnormalities" it finds in every human that are of no danger to your life whatsoever.

Y'know what would have worked equally well? Send them home with a doctor's note, have them get some fucking rest, and while we are at it, reinstitute actual worker protections so that they weren't burning the candle at 5 ends at their job taking home 50+ hours of work home each week on top of the 60 they already spend in the office including "working through lunch" out of fear that thanks to the the Retardicans fucking up the economy they're going to get downsized or replaced or their job sent to India.

Re:There's still a lot to do in medicine (1, Insightful)

DevConcepts (1194347) | more than 3 years ago | (#36056410)

DAMMIT!!! I want my mod points!!! +5

Bingo! (1)

gbutler69 (910166) | more than 3 years ago | (#36056428)

We have a WINNER!

Re:There's still a lot to do in medicine (1)

hedwards (940851) | more than 3 years ago | (#36056566)

That's not common. For one thing there's no way in hell that insurance would cover all that testing, and for another, there's only so many tests a doctor can talk a patient into for a minor malady.

Re:There's still a lot to do in medicine (1)

Anonymous Coward | more than 3 years ago | (#36056366)

Did you tell the doctors about the shemales? That may fit into the puzzle.

Re:There's still a lot to do in medicine (1)

x*yy*x (2058140) | more than 3 years ago | (#36056378)

Not specifically about shemales, I don't think that matters. However my patient papers does say I had countless amount of sex with both locals and local prostitutes, so I did tell that.

Re:There's still a lot to do in medicine (0)

Anonymous Coward | more than 3 years ago | (#36056508)

but when you spend a long time in a hospital, unable to walk, unable to move in the bed

Those symptoms sound pretty "detectable" to me, so you haven't been "overdiagnosed".

and the doctors just say they don't know what you've got

It probably wouldn't make any difference: most diseases that are treatable also have good diagnostic tests. For the rest, they can only treat the symptoms and let your body heal itself (which it usually will).

Re:There's still a lot to do in medicine (0)

Anonymous Coward | more than 3 years ago | (#36056558)

Well, it's most likely not Lupus

Re:There's still a lot to do in medicine (0)

Anonymous Coward | more than 3 years ago | (#36056704)

Weren't you the guy who claimed he was sophisticated for sleeping with shemales in Asia? And now you add prostitutes to the list.

I'm glad I'm not sophisticated. I might catch some deadly strain of VD.

Title (5, Insightful)

turkeyfish (950384) | more than 3 years ago | (#36056214)

Perhaps the title of the article should read lawyers and doctors create too many patients.

Kind of agree... (5, Insightful)

Anonymous Coward | more than 3 years ago | (#36056250)

As I understand the current situation:

1) If they don't do the tests and catch a problem, the doctor and hospital will be sued.

1a) The results of a trial may put licenses at risk, depending upon the State Board's agressiveness.

2) If they due the tests either tax subsidized insurance or a Medicare type program will pay for the tests and treatment.

Conclusion: How could the situation any different.......

Re:Kind of agree... (1)

Dachannien (617929) | more than 3 years ago | (#36056260)

Well put. Also, a diagnosis may be necessary to convince insurance to pay for the cost of the doctor's visit, so a diagnosis makes for a happy customer.

Re:Kind of agree... (5, Interesting)

hedwards (940851) | more than 3 years ago | (#36056590)

This.

It's more common in some areas of medicine than in others. But I know that in psychiatry if they don't make a diagnosis then the insurance company definitely won't pay. Whereas if they do suddenly the patient gets crap treatment and most of their medical complaints blamed on mental illness.

What's worse is that the area of psychiatry is hardly one where diagnoses are clearly separable from other options, and doctors usually get the difference between insomnia and depression wrong leading to patients being prescribed antidepressants when bed rest would do more good. Antidepressants usually interfere with sleep leading to often times even worse sleep.

Re:Kind of agree... (4, Informative)

0100010001010011 (652467) | more than 3 years ago | (#36056344)

My girlfriend, a doctor, agrees. I just texted her the article and her response:

"We make more patients bc we practice defensive medicine. No one wants to be sued".

Mod up (1)

Fujisawa Sensei (207127) | more than 3 years ago | (#36056448)

Someone with mod points mod this fucking AC up!

Re:Kind of agree... (1)

MoonBuggy (611105) | more than 3 years ago | (#36056552)

As I mentioned in a post further down, this seems plausible, but the one thing I haven't seen is actual figures on the risk of litigation. I'm not saying I have any reason to doubt your premise, but I also don't have anything to support it beyond anecdotal evidence about all the lawsuits that are apparently being brought against doctors.

The evidence does seem to suggest that doctors are behaving in this manner, and it also implies that the reasoning is fear of litigation; what's the actual chance of a hospital being successfully sued, though? Could it be the case that doctors are behaving in this manner not because there is a significant chance of them being sued, but because of a (statistically unfounded) fear of being sued?

Re:Title (0)

Anonymous Coward | more than 3 years ago | (#36056292)

This whole process seems profit driven on all levels.

Re:Title (0)

Anonymous Coward | more than 3 years ago | (#36056356)

Based on one paragraph in the article? The legal profession is cause of many ills, but you appear to be grinding an ax while looking at a lawyer tree and ignoring the forest. (It's Mixed-Metaphor Morning.)

Re:Title (1)

Opportunist (166417) | more than 3 years ago | (#36056646)

Dead on.

Consider this situation: You have a patient with symptoms that might fit a disease that never occured in the area and that is virtually unknown out of some very remote area the patient hasn't even heard about. You will get sued if the patient for some odd coincident has the disease, but if you test uselessly for it, nothing bad will happen. Quite the opposite, if you happen to detect it, you might get to travel the country and hold talks about it.

Will you "waste" the money for the test? I mean, it ain't like it's your money, is it?

Stop the suit-craze and make docs accountable for useless tests. And do it IN THIS ORDER!

Symptomatic (5, Insightful)

nuggz (69912) | more than 3 years ago | (#36056226)

So we should wait till everyone is symptomatic?
Many conditions can be treated more effectively and cheaply if they're detected early.

Some conditions dont' even become symptomatic until significant damage is done.

The question really is how to balance the best treatment with the financial constraints.

Re:Symptomatic (5, Interesting)

Dunbal (464142) | more than 3 years ago | (#36056304)

And also to treat the patient and not a set of lab results. This happens all too often in my country.

For example my father in law, who has never been symptomatic, was being treated for gout because he had a uric acid score slightly greater than 7. Since I am also a physician I ordered a few tests to rule out other conditions that could result a slightly abnormal uric acid result, took him off the allopurinol and told him to eat all the red meat he wants. He is still not symptomatic, has no kidney trouble, and will be dead in 10 years from his prostate cancer anyway.

Why label him as a "gout" sufferer and even worse, treat him for it, if he doesn't actually manifest the disease? Doctors must remember that the way we determine what "normal" values are is by fitting large samples to a bell curve, chopping off the ends at 1 or 2 standard deviations, and calling the middle "normal". There are perfectly healthy people on either end of the curve, however. We need to use our clinical skills to figure out who needs treatment and who doesn't, otherwise you might as well not have doctors at all and leave medicine to some giant, complex algorithm.

Re:Symptomatic (1)

Moryath (553296) | more than 3 years ago | (#36056326)

otherwise you might as well not have doctors at all and leave medicine to some giant, complex algorithm.

You now realize the goal.

Everything has to be "standardized." Nevermind that even the "standard body temperature" fluctuates a decent amount throughout the day, and varies from person to person. Everything has to be peggable to a chart such that it can be fed into a computer, printed back, and the "answer" just read off.

Paging Doctor Lexus... [youtube.com]

Re:Symptomatic (3, Insightful)

MoonBuggy (611105) | more than 3 years ago | (#36056512)

Why label him as a "gout" sufferer and even worse, treat him for it, if he doesn't actually manifest the disease? Doctors must remember that the way we determine what "normal" values are is by fitting large samples to a bell curve, chopping off the ends at 1 or 2 standard deviations, and calling the middle "normal". There are perfectly healthy people on either end of the curve, however. We need to use our clinical skills to figure out who needs treatment and who doesn't, otherwise you might as well not have doctors at all and leave medicine to some giant, complex algorithm.

Using your discretion necessitates taking responsibility for the diagnosis. The eight people you saved from unnecessary and potentially damaging medication will be better off, as will the ninth who you gave a valid prescription to, but the family of tenth guy who died without being medicated might sue.

If you just followed the guidelines, you might end up unnecessarily medicating six of those ten, and one or more of them may still die, but if it goes to court you just need to compare the numbers on the patient records to those on the guidelines and that's that - you have proof that you "did the best you could".

The whole issue is based on the fear of litigation. That's been said before. The thing I haven't seen any analysis on, though, is whether that fear is founded. We all have some anecdote about an unjust lawsuit that we read about in the news, but I haven't seen any real figures on whether it's the actual risk of litigation that's prohibiting doctors from taking (necessary) risks, or whether it's the unfounded fear of litigation that almost certainly won't actually happen. An interesting Ph.D thesis for someone, perhaps...

Re:Symptomatic (2)

demonlapin (527802) | more than 3 years ago | (#36056642)

the unfounded fear of litigation that almost certainly won't actually happen

Almost is a pretty important word there. Statistics apply to populations; for an individual doctor, either you are sued or you aren't - and if you are, all that the plaintiff's attorney and his expert have to do is convince the jury that the patient would have been better off without you. The fact that you have prevented minor (but not fatal!) harm to dozens of other people by avoiding carrying out tests that turned up normal, prescribing medications that probably weren't necessary, etc., doesn't matter.

Re:Symptomatic (1)

Moryath (553296) | more than 3 years ago | (#36056660)

Regarding risk of being sued: why do you think that medical malpractice insurance [nysun.com] is so high?

My friend's wife is a doctor (OB/GYN), specializes in at-risk pregnancies and neonatal care in rural settings. By "gross earnings" she makes around $200k/year (remember, rural = not rich people, so she can't charge as much). After you take out taxes, the hospital's cut, the insurance company kickbacks and "reductions", and malpractice insurance she's lucky to clear 60k in a good year. Oh, and remember that to make that much she's now paying back on a few hundred thou in student loans built up through the getting of a medical doctorate followed by time spent in residency in order to get licensed.

Admittedly anecdotal evidence. But she seems fairly representative of her field. Someone working urban might gross 1/3 more than she does but there's a corresponding increase in the hospital's take, insurance "adjustments", and malpractice insurance cost on that anyways.

Re:Symptomatic (1)

MoonBuggy (611105) | more than 3 years ago | (#36056738)

I knew that malpractice insurance was significant, but I didn't realise the figures were that high. I'd still hesitate to take my data from companies whose interests are directly served by inflating the problem, but it certainly does suggest the risks are non-negligible. I don't know, maybe legal reform is the only option.

Re:Symptomatic (0)

Anonymous Coward | more than 3 years ago | (#36056670)

Exactly! And it goes the other way too. My wife suffered with debilitating health issues for almost 10 years while doctors ran blood test after blood test, scans, etc. The only abnormal test was ignored because it was believed that the disease it tested for would produce symptoms she didn't have (according to the "standard case"). Several tests were very border-line low and we were always told -- it's within the normal range. We finally had to do some research on our own & talk with others on message boards to find that many of her symptoms were in fact pretty consistent with people who had similar results on the one test. We argued a case and finally convinced a doctor to treat her. Since then she's back to herself again. I really think it's because doctors are so reliant on blood tests and generally don't trust what the patient is telling them. I think they are too afraid of hypochondriac's and also afraid of law suits for mis-diagnosing something.

Re:Symptomatic (0)

Anonymous Coward | more than 3 years ago | (#36056668)

Preventive medicine is NOT cheaper, despite what politicians say. Costs are calculated as dollars spent per year of patient lives saved. ie it costs money to save lives. The more we save, the more it costs. That is how costs go up as well.

Re:Symptomatic (0)

Anonymous Coward | more than 3 years ago | (#36056674)

Part of the article was about expanding the definition of being sick. I've been through it myself where a doctor tried to claim I had high blood pressure but another doctor said my blood pressure was normal. I was under a lot of stress and in pain from another condition so my blood pressure was briefly on the high side of normal but the first doctor was ready to put me on blood pressure medication for a slight increase. My blood pressure has been normal since so the medication would have been pointless and risked side effects not counting the expense. They rationalize it out as being for our own good but the truth is it's about money. By the time they are 50 most people are taking some kind of medication and by the time they are 65 they are taking a fist full of pills a day. 30 years ago the norm today would have been considered a hypochondriac. Oddly enough drug company profits have mirrored the increase in people being over medicated. Most of the real ills in the world always come back to corporate profits. Healthy people don't make drug companies money so the surest way to increase profits is to increase the number of people considered "sick". A similar thing has happened with weight. Yes there are far too many people grossly over weight but they have also changed the definition of over weight and threw out the idea of body type. I'm a big guy, lumber jack big not fat yet I'm told anything for my height over 165 is fat. I'd have to cut off a limb to get down to 165. We've got to stop trying to force people into cookie cutter molds and treat them individually. It may not be as efficient but we aren't robots and one size or one health type doesn't fit all.

Doctors Are Creating Too Many Patients (5, Funny)

tverbeek (457094) | more than 3 years ago | (#36056228)

You'd expect doctors to know how to use contraceptives to prevent this.

Testing is addictive (2)

penguinchris (1020961) | more than 3 years ago | (#36056240)

You know, when it comes to testing... you have to do more and more to reach that payoff...

Diabetes? Bad example (4, Informative)

MisterBuggie (924728) | more than 3 years ago | (#36056244)

Diabetes is something you're never cured from. No matter what such and such a diet might say, it may greatly improve things, but the diabetes is still there. Fasting blood sugar over 126 is a sign that something is up. Starting lifestyle changes and/or beginning treatment early on helps slow down the progression, and avoids later complications. In this case it actually reduces the number of patients with severe complications... It's not a case of declaring people diabetic who aren't really. It's a case of getting it under control before it progresses too much. Because if you hit 130, without at least diet changes, the diabetes is most definitely going to get worse.

depends (1)

rubycodez (864176) | more than 3 years ago | (#36056656)

healthy pregnant women can have 130 and be fine

This is just stupid (5, Insightful)

rsilvergun (571051) | more than 3 years ago | (#36056246)

Study after study shows people with access to more health care live longer. I'll point out John McCain and Earvin "Magic" Johnson as too people that'd be dead w/o the extensive and highly personalized healthcare they receive. This sounds like another conservative shill trying to convince the poor they don't need to see doctors like their rich people do, but than again the author could be another one of those Homeopath loons/Charlestons...

Re:This is just stupid (-1, Flamebait)

Moryath (553296) | more than 3 years ago | (#36056286)

Study after study shows people with access to assloads of cash live longer.

There, fixed that for you.

And don't worry. It fits right in with the Retardican plan. Right now the goal is to make sure all the "little people" no longer live long enough to retire, or only live a couple years after it. That way they can get expenditures down enough that they can justify their Tax Breaks For Billionaires, Fuck The Poor mantra of the past three decades.

Re:This is just stupid (0)

Anonymous Coward | more than 3 years ago | (#36056390)

Money you can get, beg, steal and kill for it, sure, but if your country doesn't have the doctors or the hospitals to treat you, then the only alternative is going abroad, which can cause delays (never a good thing) and greatly increase the costs.

Those that don't have either do the only thing they can, buy booze, the ultimate painkiller and wait for the reaper.

I agree. TFA has an anti-prevention subtext. (1)

Burz (138833) | more than 3 years ago | (#36056308)

He'd prefer people to get really sick before they get significant medical attention.

Re:This is just stupid (5, Informative)

Christoph (17845) | more than 3 years ago | (#36056468)

I agree.

My late brother's doctor told him his swollen lymph nodes were nothing -- he had no symptoms, and a routine white count showed no infection.

That's how lymphoma presents. The next year he was in the ER due to wheezing, and was diagnosed with stage 3 Hodgkin's lymphoma, which eventually killed him (photos of his last years) [gregerson.org] . He had a bone marrow and stem cell transplant...not looking for lymphoma in someone asymptomatic turned out to be pretty expensive as well as fatal for the patient.

This story is not rare, either. After speaking to a handful of other Hodgkin's patients, they all had similar experiences. And those were the survivors.

Simple solution. (-1)

Anonymous Coward | more than 3 years ago | (#36056254)

There is a simple solution. Sterilize all the black welfare mammies who are shooting out a kid almost every 10 months so by the time they are 30 they have 8 kids from at least 6 different men.

Never ask the barber (1)

Anonymous Coward | more than 3 years ago | (#36056264)

if you need a haircut! -Warren Buffett

Too many trivial diagnostics raising costs (1)

lsatenstein (949458) | more than 3 years ago | (#36056274)

If the doctor determines that the reported problem is trivial, he has to protect himself from a lawsuit. That means, the avoidance of a lawsuit takes precedence over trivial problems that would go away on their own. So, put limits on what can be sued for medical reasons, and that will result in better diagnosis for non-trivial stuff.

Occam's razor... (1)

geekmux (1040042) | more than 3 years ago | (#36056282)

"We look harder for things to be wrong..."

If seeking an answer, it is best summarized in my sig.

Re:Occam's razor... (0)

Anonymous Coward | more than 3 years ago | (#36056632)

Tell your doctor if you experience bleeding from an Occam's razor cut..

Big Pharma is a hungry beast (0)

Anonymous Coward | more than 3 years ago | (#36056294)

It needs lots of food

Prescription Correlates + to # of Prescribers (4, Interesting)

retroworks (652802) | more than 3 years ago | (#36056296)

This is very worrisome, glad to see it being discussed. According to the USA Bureau of Labor Statistics, health care employment accounts for (by far) most of the growth in jobs in the USA http://www.bls.gov/oco/cg/cgs035.htm [bls.gov] . What happens when a new sport surgeon opens an office in your county? What happens when a urologist opens an office in a town of 10,000 residents? The free market says that when people take employment providing a "service" which they themselves are empowered to prescribe, that prescription rates increase proportionately to the wages.

I realized this when I broke my arm in almost precisely the same place, in almost exactly the same way. The first time it was a reset, an X-ray, and a cast. The second time, a new Osteopath building had been opened in town, with two new very smart and very nice doctors. Good people. Outcome was surgery, metal plates, screws, therapy, etc. My insurance paid for both treatments, but I got to see the bills. The second broken arm was over $10,000 more expensive than the first time. And when I read about the dangers of putting people under anesthesia, I really wonder how the risk was weighed against the benefit of making payments on the new doctor's office. I'm not grossly cynical about the health industry, but whenever a field of the economy becomes too respected (think Catholic Church), people begin to assume the best, and that's a recipe for problems.

By the way, there is a new Urologist in my town of 10,000, with a lovely office. He just told my wife that both our sons need teen circumcision, under anethesia. What is really worrisome is that the USA's aging population makes for an almost infinite number of diagnostic tests, etc., for these people to fill. If the government paid for car repairs, we'd have lots of mechanics and lots of repairs.

Re:Prescription Correlates + to # of Prescribers (2)

Anonymous Cowar (1608865) | more than 3 years ago | (#36056442)

If the government paid for car repairs, we'd have lots of mechanics and lots of repairs.

That's a really long way to go for a car analogy.

Re:Prescription Correlates + to # of Prescribers (4, Insightful)

DrgnDancer (137700) | more than 3 years ago | (#36056472)

The second broken arm was $10,000 more than the first, but the first "treatment" resulted in your arm breaking in exactly the same way a second time. Don't get me wrong, there are a ton of factors involved in the location and severity of a bone break, and it may well have been inevitable that your arm would break the same way when you injured yourself in a similar manner; *but* it's also arguable that the less elaborate and complete first treatment resulted in the bone healing weaker and more likely to rebreak.

Regardless of whether the first break contributed to the second, it's also not inconsiderable that getting such a similar injury in nearly the same place caused the doctors to have to take much more care in the second treatment. Having two healed breaks, practically on top of each other, is almost certain to weaken the bone; the addition of some titanium plated for support of such a weakened bone might have been prudent caution.

You also mention therapy, which is certainly a not inconsiderable expense but can significantly increase the pace of recovery. It may not make you any stronger or healthier in the end, but the "end" might be 8 weeks instead of 12.

I'm not a doctor of course, and I don't know the details of your case, but in my mind your having had two such similar breaks is an excellent argument for the second being more expensive. Now the urologist thing does seem a bit suspect, but again, it's hard to say. Is your son experiencing some sort of symptoms that such an operation might alleviate?

Re:Prescription Correlates + to # of Prescribers (2)

tkprit (8581) | more than 3 years ago | (#36056628)

I've seen the phenomenon when a local specialist merely upgrades his office with new diagnostic testing equipment. Suddenly everyone needs a bone scan, or a 'routine' endoscopy, &c silly ass tests that have nothing to do with why the hell you went in to the specialist. (Of course the specialist says it's a "service" for his/her patients, so we don't have to drive 20 mts away to have a 'beneficial' test done. But I bet you the specialists recommend the testing a lot more after they install the new equipment in their offices.)

Actually, I've seen the same phenomenon in veterinarians offices as well. "We do routine BONE SCANS on our PATIENTS" [to catch and prevent the possible spread of cancer, arthritis, or I suppose make sure they're getting enough CALCIUM SUPPLEMENT].

(Yes, I got SUCKERED into getting my middle-aged chihuahua a freaking bone scan because he had a funny bump that I expressed concern about. I thought it was an x-ray until I saw the bill. They recommended I get pet health insurance. The funny bump turned out to be a benign growth; ie, a funny bump.)

I stay the hell away from doctors, vets, dentists, and car mechanics as much as possible. And I try to select the ones with the LEAST in-office equipment possible.

Re:Prescription Correlates + to # of Prescribers (1)

demonlapin (527802) | more than 3 years ago | (#36056688)

He just told my wife that both our sons need teen circumcision, under anethesia

They're obviously having some sort of problem - else why would you have gone to see him? Mechanical problems with urine flow require mechanical solutions.

I've seen lots of patients who've been subjected to defensive medicine, and some that were definitely subjected to a wallet biopsy. But what you're describing is actually pretty good medicine - first minor break, attempt a conservative, nonoperative solution; second break, seek definitive treatment.

Absolutely (3, Insightful)

sunilhari (606555) | more than 3 years ago | (#36056310)

Doctors have a much lower threshold for diagnosis of "sick people" because if they miss anything, they can get sued for malpractice (founded lawsuit or not). Even if the lawsuit is completely without merit, most lawyers will settle instead of clearing the doctor with a full trial due to cost. So when the threat of lawsuit is over a doc's head, good medicine goes out the window and lawsuit-preventing medicine goes into full effect.

I realize not every doctor is actually good, and that they can make egregious errors and need to be corrected. Enact tort reform, cap damages, and actually encourage preventative medicine instead of paying lip service to it and you'll get lower costs and better yield for the non-sick 999.

I don't expect a doctor to start caring about the other 999 until that 1 possibly sick person can't sue him and take everything he owns.

Lawyers (5, Informative)

Anonymous Coward | more than 3 years ago | (#36056314)

In a court of law the question to be asked "Was there a test to determine the problem with my client's husband that would have saved his life if you had done it?" That single question is the reason for all of this, because if the answer is "yes", which is always is even if there were no legitimate reason to run said test, then the doctor is guilty of malpractice. He does that three times, he is no longer a doctor.

Stop blaming the people trying to help you, who have to protect themselves from the lawyers. Blame the root cause.

So where's the evidence? (3, Insightful)

EdwinFreed (1084059) | more than 3 years ago | (#36056316)

TFA makes a lot of assertions about unnecessary treatment and increased costs with no associated benefits, but doesn't present or link to a single piece of actual peer-reviewed data. In the specific case of changing the cutoff of blood glucose levels from 140 to 130, the appropriate question to ask is whether or not treating the many side effects of diabetes sooner saves more than it costs.

The reason is financial (2)

Chemisor (97276) | more than 3 years ago | (#36056318)

The reason is neither technological nor behavioural. It is purely financial. Pharmaceutical companies and hospitals need to make money. To make money they must offer drugs and services, the more expensive, the better. Since people really are healthy most of the time, they can avoid paying for health care at all, which naturally is unacceptable. Hence doctors try very hard to create more sick people to create more income. Whether it is by selling hypertension drugs to people with 140/90 (which was considered perfectly normal 50 years ago), cholesterol drugs to everybody, unnecessary vascular stents (which, according to studies, temporarily relieve pain but have no effect on longevity), unnecessary screenings, unnecessary surgery, unnecessary psychoactive drugs, and heck, heaps of drugs of all kinds. The average american is from birth convinced that he is sick all the time and that without health care he will die. What better incentive to buy medical services?

Re:The reason is financial (0)

Anonymous Coward | more than 3 years ago | (#36056492)

You're absolutely right. Amazes me how people is naive and don't realize this type of behavior is purely driven by financial reasons.

Their job is (2)

zoomshorts (137587) | more than 3 years ago | (#36056320)

Doctors and other medical professionals HAVE to find something wrong, and then , to overmedicate.
Such is life. It is sad that actual diagnosis, falls by the wayside when the pressure is to find the
problems that can be medicated.

My parents, deceased, had DOZENS of contradictory medicines prescribed to them. When a
real doctor took them off the additional meds, they improved, sadly it was all to late. This is
basically unacceptable. Such is life in the big pharma theory. Old age is simply old age, not
something to combat!!!

Sounds about right. (0)

Anonymous Coward | more than 3 years ago | (#36056322)

Yearly sinus infection. Needs a $8 bottle of keflex to get rid of it.

So i goto the doctor. ($80) And go home with 4 perscriptions. None of which are keflex. ($280)

What used to cost me 8 bucks to get rid of... Now costs $300+

Re:Sounds about right. (1)

hawguy (1600213) | more than 3 years ago | (#36056380)

Yearly sinus infection. Needs a $8 bottle of keflex to get rid of it.

So i goto the doctor. ($80) And go home with 4 perscriptions. None of which are keflex. ($280)

What used to cost me 8 bucks to get rid of... Now costs $300+

Maybe you just need a new doctor? When I've told my doctor what treatments have worked in the past for me, she generally goes along with it (unless there's a medical reason not to) and gives me what I want.

Re:Sounds about right. (1)

f16c (13581) | more than 3 years ago | (#36056432)

Counterpoint:

Wife went to the doctor. Doctor proscribed an antibiotic ($20 to doctor and $5 to the pharmacy). Wife got worse and went to a clinic on a weekend. $80 for doctor and two medications that included an antiviral for a rash on her nose. It worked but the process took three weeks of misery for my favorite person in the world.

We have medical coverage through my employer. Why did your trip to the doctor cost so much? My wife and I go through the same thing every spring and we do sort of wonder when the doctor is going to figure this out.

Re:Sounds about right. (2)

HornWumpus (783565) | more than 3 years ago | (#36056720)

You do realize that antivirals are basically useless and your wife's immune system is what cleared the virus?

Both the doctors gave you pills knowing they would do nothing but also knowing they had to do something to get you to leave.

Not news for news. Doesn't matter. (0)

Anonymous Coward | more than 3 years ago | (#36056328)

This is not news for nerds. This is aging population concerned with health problems magazine selling bullshit.

Closest thing to nerdiness is the fraction 1 out of 100, which is also bullshit.

Re:Not news for news. Doesn't matter. (2)

hawguy (1600213) | more than 3 years ago | (#36056388)

This is not news for nerds. This is aging population concerned with health problems magazine selling bullshit.

Closest thing to nerdiness is the fraction 1 out of 100, which is also bullshit.

Slashdot's early adopters (and its editors) are starting to move into that aging population demographic...

Mental health too; perhaps even moree. (2, Insightful)

ron_ivi (607351) | more than 3 years ago | (#36056334)

Seems every personality trait (inability to pay attention to boring teachers; enjoying math more than people; shyness; risk-taking extroverts; etc) are being labeled with some mental condition that shrinks like to charge a lot for.

Where are these doctors? Can I see them, please? (0)

Anonymous Coward | more than 3 years ago | (#36056362)

My family's experience with doctors is almost 180 degrees the opposite of what this article claims. They constantly miss issues that should have been easy to detect. Their default mindset is that all patients are hypochondriacs and that nothing is actually wrong unless they can see blood gushing out of an open wound. Running tests with no symptoms? Heck, just running tests at all? Not unless we raise a stink to insist that they do.

In short, I'd like to know where these doctors are that the article talks about.

In terms of being too expensive, definately. But that has nothing to do with creating patients. Drugs et al are big business here in the states and they have political connections to keep it that way. There have been multiple studies that concluded that the US health system costs its patients more than other countries and does not actually provide the best level of health services. But when doctors make multiple 100's of thousands of dollars a year and drug companies negotiate with insurance companies to force patients to use their drugs, that is not going to change.

John Mcdougall's perspective (1)

gwstuff (2067112) | more than 3 years ago | (#36056376)

Besides advocating a fairly narrow theory on how to live healthily, this lecture by John Mcdougall talks about the questionable (non-positive) benefits of medication for chronic problems. It was an eye-opener for me, as someone who used to blindly follow his doctor's guidance for all health-related issues. https://ssl.sonic.net/mcdsite/free/DLV04-V01.zip [sonic.net] Warning: It's about 80 minutes long - so probably better saved for a rainy day.

Well (1)

canajin56 (660655) | more than 3 years ago | (#36056382)

TFA might have a point. But I wouldn't bother reading to find out with a bullshit summary like that. Really, prostate screening isn't worth the horrendous cost to those 999 out of 1000 people who don't have cancer. Oh yes, the one person who doesn't die of cancer is greatly outweighed by those other 999 who had to get a finger up the ass FOR NO REASON, THEY WEREN'T EVEN SICK! Won't somebody think of those poor unfortunate souls? Seriously, did Peter Griffin write the summary?

Re:Well (2)

blackpaw (240313) | more than 3 years ago | (#36056434)

No its for the percentage who get painful damaging life altering treatment for the false positives that prostrate screening generates. Or the women get cancer from excessive breats scans that have minimal increases in detection rates.

Or the immense amount of resources it consumes for diminishing returns, when said resources could be way more effectively applied elsewhere, saving more peoples lives.

Capitalist medical systems create waste... (0)

Anonymous Coward | more than 3 years ago | (#36056400)

In other news, a recent study done by graduate students at UC Berkley found that bears crap in the woods.

From a doctor (5, Interesting)

deuist (228133) | more than 3 years ago | (#36056414)

I'm an ER doctor. I can't create patients as they come to me with symptoms. I will say that people come to me with minimal symptoms such as cough and fever and then demand blood work, X-rays, and antibiotics, even though the majority of the time their symptoms are caused by a virus and will get better all on their own. Somehow, our society has become so weak that every cough, scraped knee, or hangnail requires a visit to the hospital. And somehow we think that physicians can't diagnose anything without a thousand dollars worth of painful tests. Whenever I try to explain to someone, "You have a cold. You're going to be fine," that's not a good enough explanation. I've even had a few people demanding admission to the hospital---which, if you didn't have a life-threatening disease before, you can certainly pick one up during a hospital stay. This problem is societal in nature and has been made worse with television shows such as House and ER where lay think that every problem requires specialists and lots and lots of tests. Don't blame me; I'm just a cog in the wheel.

That might be in the US.... (4, Informative)

Windwraith (932426) | more than 3 years ago | (#36056426)

Because where I live, I suffered from a crippling disease for 5 years that almost ended up fatally, and going week after week after week to the medic, treated like a liar or an attention whore, coming back home every day without results.
Until, finally, after years of calamity, they found what it was. About f*cking time if you ask me, it ended up being a serious intestinal disease combined with a esophagus and a circulatory thing and lots of inconvenient little things.

Please take note of the time. 5 years of my life lost without being able to go out of home and unable to work, socialize or well, just about anything that wasn't being yellowish in color.
Because of medics, who could have detected this much earlier, I lost the best years of my life, the ones between young adulthood and proper adulthood. I am like a hermit who just came out of a cave. All because medics didn't want to do a bit of work and do science stuff.

Here, where free healthcare exists, medics are only concerned about getting their taxpayer-founded salary every month, and don't give a crap if the patient dies or not.
After seeing medic after medic and having to hear "it must be psychosomatic" for years, I have very little respect for the medical guys.

A medic like the ones described in the article would have saved me 5 years of my life. That's not something trivial.

Re:That might be in the US.... (1)

xnpu (963139) | more than 3 years ago | (#36056474)

Sorry to hear you went through that. The question is though, are you comfortable asking 999 other people to undergo tests, use unnecessary and potentially dangerous medication, waste their time and feel generally unhealthy if that would give you only a chance at shortening those 5 years?

Re:That might be in the US.... (2)

Windwraith (932426) | more than 3 years ago | (#36056514)

I want my time back, yeah, but I don't really want anyone else to have to live through that in exchange, if that's what you mean. It was painful, it was discouraging, and it was unfair.

What I would ask for, instead, is for at least a little support. I have been healthy for only 4 weeks now, and I don't even know what to do with my life. 5 years of being called liar makes funny things to your head.

Re:That might be in the US.... (1)

Anonymous Coward | more than 3 years ago | (#36056612)

I live in Canada and ran into the same issue. Sick for two years, constant trips to see a range of doctors. Half of them refused to test me for anything and the rest just shrugged it off and advised me to go home. Finally found a doc who would listen for a few minutes, run some tests and try to get to the bottom of things. It's very frustrating to lose years of your life because people aren't willing to do their jobs. And, here at least, we don't have the option of going to private clinics.

Re:That might be in the US.... (0)

Anonymous Coward | more than 3 years ago | (#36056702)

So you had Chagas? If you were in the US we would not have even thought of it.

The "take a pill" culture. (1)

Chas (5144) | more than 3 years ago | (#36056446)

Part of the problem is this whole "sick culture" where people are convinced nowadays that they are all seriously ill but can simply medicate any problem away.

Listen to some of these commercials on television. A good chunk of them have side effects including triggering the things they're supposed to be helping you with. Like antidepressants that can make you MORE suicidal.

My whole response to this is "Are you fucking kidding me?"

Re:The "take a pill" culture. (1)

pspahn (1175617) | more than 3 years ago | (#36056588)

When it comes to anti-depressants, the patient is rarely the one who decides if they are going to take said Rx. Typically it is a loved-one that coerces them into taking it against their will.

The suicide problem shows up after awhile of being on the med. For whatever reason, the patient decides to cold-turkey their anti-depressant, and their brain goes crazy and they decide suicide is a terrific choice.

The way I see it, my maternal grandmother is pushing 80. She has smoked for most of her life and she drinks who knows how much scotch. She doesn't go to the doctor and is happy and (apparently) healthy, all things considered. My paternal grandmother, who has never smoked, never drank, always had plenty of exercise, etc, goes to the doctor regularly and is on a cocktail of meds. She complains about being sore, nauseous, insomnia, and a bunch of other things.

So when I ask myself how I would like things to go if/when I enter AARP status, I think I'll take being happy and feeling fine versus meds and "prolonged health". Quality over quantity.

Re:The "take a pill" culture. (1)

Chas (5144) | more than 3 years ago | (#36056680)

"I think I'll take being happy and feeling fine versus meds and "prolonged health". Quality over quantity."

Exactly.

Re:The "take a pill" culture. (1)

demonlapin (527802) | more than 3 years ago | (#36056728)

Like antidepressants that can make you MORE suicidal.

Not exactly right; I'd not bother explaining except that this is a really cool story. There are two aspects to depression - the positive symptoms (like feeling suicidal), and the negative symptoms (like not having energy). The negative symptoms clear up first when treated with antidepressants, so in a brief period of time, they have energy and will but don't feel better yet. Those are the ones who finally get up the courage to kill themselves, which is why that warning is there.

A lot of the problem can be blamed on Big Pharma (0)

Anonymous Coward | more than 3 years ago | (#36056456)

The big pharmaceutical companies are desperate to keep profits up, so they're constantly looking to make more and more people dependent on maintenance drugs. Doctors are being advised to write far too many prescriptions, "just because".

My last doctor visit was for a basic physical. I had no symptoms or complaints, but did have some concern over a nasty mole and was looking for an educated opinion. All the tests came back clean, but before I left the doc offered to write me prescriptions for everything from anxiety, depression, up to and including sexual dysfunction. He had a laundry list of offerings that was worse than the commercials on late night TV. I swear, it was more like dealing with a pusher than a doctor.

I haven't been back since.

My wife is a doctor... (5, Insightful)

Richard_at_work (517087) | more than 3 years ago | (#36056462)

in the UK for the NHS, and her position on this has always been that patients want you to diagnose them with something, and if you do not then they will re-present either to another doctor at your practice very quickly, or at the local accident and emergency room. And last month she was provided with the best example of this ever...

Ever since I met her, she has complained to me (in a friendly way) that people present to the A&E (she was working A&E minors at the time) with conditions that 30 years ago would have been treated at home, but because the home remedy and care experience isn't being passed down these days, current generations of parents do not know how to care for minor conditions any more and are quick to panic.

One example of this is D&V (diarrhea and vomiting - generally any tummy bug that causes you to crap loads and throw up loads) - patients, or the parents of young patients, will regularly show up to A&E with D&V and expect the doctors to do something. If they were to be admitted, it would remove a bed from use for other more serious reasons, and the only thing they would get would be intravenous saline, and thats not even guaranteed. Seriously, would you rather be crapping and throwing up at home in privacy, or in a hospital in public? Do it at home folks.

Anyhow, on with the example - in this case, she was working as a GP at a practice and a mother presented her 3 year old child with D&V, my wife kindly explained that everything was fine, the kid was not in undue distress, they don't tend to worry that the kids not eating or drinking for at least 5 days, and it was just a case of waiting it out. After a lengthy consultation, the mother and child left.

Four hours later, my wife switched to do a locum shift at the local A&E department - and who was her second patient...? The mother and child. The child hadn't presented any more serious symptoms and had not declined in condition, the mother just wanted someone to do something. So my wife, who had suffered the embarresment of calling the patient in and realising why they were here (the parents faces went bright red when they realised who the doctor was that was calling them apparently), had the job of telling them exactly the same thing again.

To put their minds at ease, she called her senior in who explained the same thing. And then just to top it off, had a paediatrics doctor come down to again reassure them that the only things they could do was to allow the D&V to run its course. After a six hour period in A&E, the parents and child left with no treatment, no medication and essentially nothing gained.

And then my wife finds out, a day later, that the parents had driven the twenty miles to the next major hospitals A&E department and done the same thing there - to be told the same thing and sent home in exactly the same manner.

No names and no identifiable information because I don't know any - my wife is very good at venting but retaining the pertinent private details so even I can't identify the patients.

Long story short, the patients are more of an issue these days than the medical carers - patients thing the doctor is there to treat them and damn them if they don't.

Plus, of course, its easier to overtreat for a minor condition than it is to defend the non-treatment in court for the one case in a million that goes from "minor, non-worrying condition" to "death or loss of limb". One of the things my wife is frightened about is the one in a million case where a reoccuring headache is actually the brain tumour that everyone suspects - but she cannot refer all thirty patients a week who come in with that complaint to the specialist simply because the money isn't there.

Re:My wife is a doctor... (0)

Anonymous Coward | more than 3 years ago | (#36056494)

I am not a doctor.

Prescribing some oral rehydration liquid for the D&V would have done no harm. It would possibly have prevented them from going into A&E and wasting doctors time. Never mind that you can buy it without prescription or mix your own as they teach people in developing countries.

Re:My wife is a doctor... (1)

Richard_at_work (517087) | more than 3 years ago | (#36056666)

They get told that - but they don't get it prescribed unless they are on income support. The prescription charge here in the UK is north of 7GBP an item, while rehydration salts cost a couple of quid for half a dozen sachets.

But D&V victims usually do not need rehydration drinks, they need to work the bug through their system - most people are nowhere near dehydrated when they think they are.

Really? (3, Insightful)

MaWeiTao (908546) | more than 3 years ago | (#36056470)

I find it rather interesting that this claim is being made when I've found it to be quite the opposite to my experiences overseas, especially in Asia.

In the US, someone gets the cold or even the flu and they just deal it. There's a massive selection of over-the-counter drugs to help deal with so many basic illnesses.

In Taiwan, as an example, feel a bit off and people start insisting you visit the doctor. And why wouldn't they when, thanks to their social healthcare system, it only costs a few dollars for a visit? So people go in constantly for things like simply colds and then get prescribed a ton of medication that aggressively deals with all the symptoms. Of course, the flip side is that their equivalent to our pharmacies are lacking in any real medication.

So doctors end up being overburdened and are underpaid when practicing for the state. Visit those clinics and the routine consists of describing your symptoms, the doctor makes a few assumptions about what you've got and prescribes something for it. I've had visits where they don't even bother measuring heart rate. The expectation is that if you've got something serious it will be apparent when your condition doesn't improve or even worsens. Many doctors open private practices where they can charge whatever they want. It's more expensive but for people willing to spend the money they can get the care they want right from the start.

And it isn't something unique to Taiwan, I've observed similar things in Japan and some parts of Europe. Who the hell isn't going to take advantage of something if it's cheap? In my experience the US is the opposite. Unless you're well-off or have a low co-pay you're going to put a visit off until you really need it.

On the other hand, I have found American doctors to be excessively cautious. But then, I've always attributed that to a fear of lawsuits. They don't want to risk overlooking something that a patient will then come back and blame them for. As always, this is a complicated issue which isn't being properly addressed.

Re:Really? (1)

wsxyz (543068) | more than 3 years ago | (#36056708)

I find it rather interesting that this claim is being made when I've found it to be quite the opposite to my experiences overseas, especially in Asia.

In the US, someone gets the cold or even the flu and they just deal it. There's a massive selection of over-the-counter drugs to help deal with so many basic illnesses.

In Taiwan, as an example, feel a bit off and people start insisting you visit the doctor. And why wouldn't they when, thanks to their social healthcare system, it only costs a few dollars for a visit? So people go in constantly for things like simply colds and then get prescribed a ton of medication that aggressively deals with all the symptoms.

I took my 1-year old daughter to the doctor in Korea last year because she had high fever (40+). They measured her temperature, said it must be swine flu, and prescribed Tamiflu, even though she had absolutely no nose or chest congestion or any other typical signs of a flu.

I called my pediatrician in the U.S. and told him what what going on. He said, given the age, the type of fever, and lack of other symptoms, it was probably roseola, and I should keep my daughter comfortable and wait for a day or two. After a day, the fever broke with a rash and he was proved correct.

Re:Really? (0)

Anonymous Coward | more than 3 years ago | (#36056718)

Where I live, medicine is socialised to a large extent, but if you go to the doctor with a cold, you'll just get told "you'll be fine".
If what you're saying is true, the problem in Taiwan is that the doctors are behaving unprofessionally, and that the state doesn't check up on them, even though the state is responsible for oversight, given that it's financing the system from tax money.
But that's the situation in Taiwan. The article is talking about America, and I've looked around for a bit, and I'm pretty sure there isn't any evidence that what the article says is actually true. The article itself certainly doesn't refer to any peer-reviewed article on the subject.

Smoke and Mirrors (1)

Grindalf (1089511) | more than 3 years ago | (#36056532)

This text contains a series of embedded presupposition based statements designed to make the notion and concept of doctors look good. I don't believe it is designed for any other purpose nor does it contain any other information.

New diseases are made all the time (0)

Anonymous Coward | more than 3 years ago | (#36056548)

Virus mutations, New technology frying your brain, Weapons distoring your body in new ways.

But mostly Slashdot, the leading sympton of Stretched Rectum Syndrome aka Goat of the Sea.

at the root are regular people (2)

fermion (181285) | more than 3 years ago | (#36056570)

Doctors are just technicians who work on people. They get paid a lot because they work on people and the risks are higher than say if they worked on cars or computers. However the ordinary person seems to think doctors are geniuses that can keep a perfectly healthy and that a perfectly healthy person actually is possible. Doctors are screwed because if they tell the truth they can't charge enough to pay off medical school loans.

Likewise, people have been convinced that expensive drugs are the cure all for everything. This leads to, for example, in the US the creation of medicare part D whose purpose is support the drug companies ability to charge higher than market values for drugs. The drug companies has the help of people like this [discovermagazine.com] who laugh at the medicine that has kept the human race healthy for thousands of years, and doesn't seem to understand that difference between marginal statistical efficacy and safety. We may choose to take a drug because it is necessary for our own health or the health of the community, but that in no way means the drug is safe, or the community should not ask for drugs with fewer potential side effects. At the root of this is the idea the inductive reasoning will conclusion that then become necessary conditions of life, rather than things that are probably good for you. This fallacy is promoted because it is useful, and most regular people don't know it is a fallacy.

If we have too many patients, the doctor is only partly to blame. We have an epidemic of cleanliness, kids using hand sanitizer and not getting sick to build up resistance to common bugs. We have people who never eat a real meal of fresh food, rather everything on thier paper plate is processed or synthetic. No one has a Aloe plant around. People are prescribed expensive drugs when, if the laws were tilted to the pharmcos, they could grow what the needed in a pot.

Which is not to say the many people are not genuinely out of kilter. I think the diabetes example might be silly because as we know more, we reset thresholds. Complaining about a new threshold is saying that inductive logic is infallible. In fact, all thresholds are guesses and needs to be reset with new data. In general saying people who were sick in that past are sick now is equally silly. Just because ALS was not written about until the late 19th century and was not widely known in the US until well into the 20th century means we should call these people sick and try to help them? To me this thing is not that doctors have too many patients, but that people do not seem to have a choice to become a patient or not. If you do not subject yourself to the leeches of modern medicine, you somehow are not a respectable person.

What about ADD and other ABC soup? (2)

metalmaster (1005171) | more than 3 years ago | (#36056582)

Im in my 20's so i guess it started with my generation, but it seems like anyone I went to school with who wasnt interested in the subject matter or had too much pent up energy was put on Ritlin or one of its many alternatives. Instead of letting those kids expend their energy by running around it was just easier to cram a pill down their throat 3 times a day.

Re:What about ADD and other ABC soup? (1)

rubycodez (864176) | more than 3 years ago | (#36056672)

big pharmy "practices medicine" for the purposes of enriching their profits, and they put doctors in their pockets. health insurance industry is the other huge entity that practices medicine by denying proper treatment

'Do no harm' (4, Interesting)

Duncan J Murray (1678632) | more than 3 years ago | (#36056584)

It might not be common knowledge that blood test 'normal ranges' (i.e. the range in which the quantity measured is said to be normal) were determined by taking thousands of healthy volunteers and performing the test - but creating the range based on the middle 95% of normal values. Therefore, even before we started testing people, we deemed 1 in 20 healthy people to be 'abnormal'.

Counting on my fingers, we do a minimum of 22 blood tests on patients admitted to our hospital. Statistically, even if you are well (though that is unlikely given you presented to the hospital, and were assessed and deemed unwell enough to be admitted) at least 1 of these blood results should be abnormal. And I haven't even started on your ECG, radiograph, blood pressure, pulse, oxygen saturations, respiratory rate, temperature etc etc etc. And if just one CT scan were performed, that looks at so many metrics, that several are bound to be abnormal to some degree (so called 'benign incidentalomas').

Part of being a good physician is knowing what abnormal results are significant, and what are red herrings. Ignoring a result is a difficult thing to do in medicine (the article has some good reasons why) and takes a good knowledge of the context, as well as plenty of experience, to be confidently able to say 'that is a red-herring'.

I disagree with the writer suggesting that thresholds should simply be raised. This is a stupid and dangerous way of dealing with this problem! The problem isn't how _far_ above threshold the value is, but whether it is or it isn't. Raising the threshold does not eliminate false-positive results, but will undoubtedly result in false-negative results. Tests in medicine are assessed to measure their 'positive predictive value' (see wikipedia), which, simply put, is about choosing a threshold that will find a balance between limiting false-positives, and limiting false-negatives. Instead of blanket raising of thresholds, doctors should be basing their decisions on the _evidence base_ - i.e. research done looking at how patients with these values fare with and without treatment. Only then will we know whether what we are doing is helpful or not.

The writer is writing in a public journal, and I think it is dangerous of him to suggest that some people don't really need treatment for diabetes - a condition that is hard enough to demonstrate to patients the dangerous long-term consequences. I wonder how many people reading this article have decided 'I don't really have diabetes - this person says so! And I thought I felt well, too!' and chucked their meds out the window. And yet, there is very strong research and evidence that shows that people diagnosed with diabetes (whatever their blood sugar) do much better if their blood pressure and glucose levels are kept below certain levels. And by 'doing much better' I mean, have less heart attacks, less strokes, go blind less, have less kidney failure, have less neuropathy and die less. All these things are real-world problems which damage peoples health. We are not just treating a number! (but we only know this from the evidence).

The other side to this argument is social. Here in the U.K. we are proud of having a largely non-private system. With all the cost and time pressures on the NHS, it means that we don't investigate or treat unless we feel it would benefit the patient. If an NHS doctor in the U.K. says you have a health problem, it's something you should probably listen up to, because he is not paid to do that. Of course some would argue that the flip-side is that patients may not get investigated or treated enough, which may be balanced somewhat by the law courts. I'm not saying it's good that doctors say 'well because this person has come in with a,b and c, and even though I don't think it is 'x', we can't justify in a law court not doing investigation 'y', but it does provide a counter balance.

Doctors should try to good, be very careful not to do harm, and base their decisions on rational arguments backed up by evidence.
(the article's suggestion of simply raising the thresholds is idiotic)

Disconnect Between Patients and Payments (1)

osgeek (239988) | more than 3 years ago | (#36056686)

There's no incentive for doctors to be judicious in testing since they send the bills to the insurance company. There's no incentives for the patients to undergo less testing, since they never see the bills.

Do patients know what the charges are for various tests before they get them? No. They can't participate in any meaningful way in the whole process.

Only when doctors start putting costs in front of patients and when patients have to make decisions about how they spend their health care dollars will this entire situation begin to be reined in.

Doctors secretive billing practices and the whole Insurance company tied to your job model are to blame for this mess.

I am a doctor and I agree (2)

Invicta{HOG} (38763) | more than 3 years ago | (#36056696)

He makes a lot of good points in his article. Obviously the length of the article limits how much detail he can go into and how much of data he can reference, but there is definitely a lot of tests and procedures which are likely causing more harm than good. He makes note of one good example (prostate cancer screening) that we know causes more harm than good in certain populations. In older men, detection of prostate cancer is far more common but the chances of symptoms from the prostate cancer is low. We actually know that in these men we cause more harm than good due to morbidity from biopsies and from unnecessary surgeries/procedures.

It is unfortunate that he mentions the lower cut-off for diabetes - even if he thinks that 130 is too low, we actually know that even people with fasting sugars of 100 are at increased risk for diabetes and, thus, for death. If the intervention is more intensive couseling of lifestyle changes, then there's not a lot of downside to increasing the diagnosis of diabetes and prediabetes.

But his central point still stands - if the US is going to tame its healthcare costs then it needs to look at overdiagnosis and its causes. In some cases, expert committees and professional societies (with their own biases) are to blame. In other cases, malpractice lawyers, the pharmaceutical industry, greedy doctors, and patients who cannot live with uncertainty are to blame. Luckily, there are entire journals devoted to this aspect of healthcare policy and it has not been ignored by mainstream medicine and those who wish to improve it.

forwarding patients to the ER (1)

android.dreamer (1948792) | more than 3 years ago | (#36056706)

Twice in the past two weeks I went to see a doctor at my primary care office. I first went in with severe back pain. Instead of taking an x-ray, and then putting me on pain killers and on an anti-inflammatory, my doctor wants to rule out Meningitis. I don't have symptoms for the disease that would include a significant high fever, but I did have neck pain and a headache. So for the lumbar puncture, they had to send me to the ER for everything. I was not treated at the primary care office. This was on 4/27 this month. They ended up not doing a lumbar puncture at all in the hospital and instead, a simple blood test. They put me on Oxycodone and since it didn't really relieve my pain, they decided to admit me to the Hospital (where they added a muscle relaxer, neurotin, and valium). I then spent the next 3 days as an inpatient waiting a full day to take an MRI, receive the results, and wait another day to meet with an inpatient physical therapist to get evaluated. It turns out just to be muscle pain, as I originally thought and I was about to be released. This all could have been done as an outpatient. But instead, I got a high fever and got pneumonia which I caught from staying as an inpatient in the hospital. I am released 2 days later, and receive an antibiotic. Two days after that, I get pharyngitis. I go back to the primary care office, Instead of taking a throat culture, puting me on a liquid painkiller and antibiotics, he sends me back to the ER. They do exactly that in the ER and they keep me overnight. Doctors in primary care offices seem to be sending more and more patients to the ER for things they can take care of in their offices, because they want to rule out something more dangerous. Is this absolutely necessary for medical care?

What's new? (1)

CaptainAmerica1941 (689079) | more than 3 years ago | (#36056730)

Chiropractors have been doing this for years. Hang on - I think one of my legs is longer than the other!
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