Previous
|
Next
american healthcare
May 26, 2008 07:03PM
- 3 comments
Tags:
Tags:
being a UK doc recently signed up to this site, i have quickly learnt how different the US model of healthcare is and i really dont think its doing many people any good....
In the UK we are trained to take thorough history and a complete physical examination. then, you request investigations. Right from the start of medical school, when a tutor asks you which investigations you would do for a patient, you have to justify each and every one. the rule is - if the result of the test will not affect your management, do not do it. This essentially means that all tests are thought about before sending, and means we do not send off a battery of tests.
The problem with doing many tests is that you find out alot of information. sounds odd right? that thats a bad thing? but the problem is - alot of the info you get you never needed and now its just thrown you off course. Normal ranges for tests are based on the gaussian distribution curve which is marked with an upper and lower limit of 2 standard deviations from the mean. ie they are ARBITRARY.
in addition, having a tax payer funded national health service means that somewhere in our thinking we have to be wary of wasting money on unnecessary tests. this means we only CT when needed, and if you need an MRI you really must truly need one.
Reading alot of the posts on here from the US members has made me think that alot of the time you the patient deiide what tests you want, the often when you post results for other members to see, theres jhust an enormous amount of data and it seems everybody gets CT and MRI like they were a freebie!
is no one bothered about the excess ionising radiation from CT scanner?! theyre not just an investigation to be taken lightly!
i just get the feeling that you physicians arent really thinking about what disease process is going on but merely sendinf off for every investigation under the sun and making a diagnosis purely on the results, instead of sing them to back up signs and symptoms of the patient.
what do you guys think?
In the UK we are trained to take thorough history and a complete physical examination. then, you request investigations. Right from the start of medical school, when a tutor asks you which investigations you would do for a patient, you have to justify each and every one. the rule is - if the result of the test will not affect your management, do not do it. This essentially means that all tests are thought about before sending, and means we do not send off a battery of tests.
The problem with doing many tests is that you find out alot of information. sounds odd right? that thats a bad thing? but the problem is - alot of the info you get you never needed and now its just thrown you off course. Normal ranges for tests are based on the gaussian distribution curve which is marked with an upper and lower limit of 2 standard deviations from the mean. ie they are ARBITRARY.
in addition, having a tax payer funded national health service means that somewhere in our thinking we have to be wary of wasting money on unnecessary tests. this means we only CT when needed, and if you need an MRI you really must truly need one.
Reading alot of the posts on here from the US members has made me think that alot of the time you the patient deiide what tests you want, the often when you post results for other members to see, theres jhust an enormous amount of data and it seems everybody gets CT and MRI like they were a freebie!
is no one bothered about the excess ionising radiation from CT scanner?! theyre not just an investigation to be taken lightly!
i just get the feeling that you physicians arent really thinking about what disease process is going on but merely sendinf off for every investigation under the sun and making a diagnosis purely on the results, instead of sing them to back up signs and symptoms of the patient.
what do you guys think?
There are several items in play here...
Under the US system, the doctor is a consultant that works for the patient, just like a lawyer or accountant. Doctors spend very little time with each patient, because they are paid by the procedure they perform.
Each company that pays for health care, which could be the government, could be a private insurance company, or it could be a non-profit insurance company, has a list of rules that determine what they will pay for and when. These rules are quite complex, but basically, it is they which keep a person from ordering too many tests.
These companies say that they will pay for something that is "medically necessary." Such a term is loaded with controversy. You may have seen the news of the girl who was denied a liver transplant by one of the major health insurers because the company decided that she was not likely to be helped by the procedure. She was 17, had leukemia, and complications from a bone marrow transplant caused her liver to fail. After the company's decision, there was a public outcry. They reversed, but it was too late, as the girl died shortly thereafter. It would be interesting from your perspective how in the UK such a case would have been handled.
Finally, the malpractice system encourages larger numbers of tests. If you, as a physician, miss even a very rare thing, you could be held liable.
Under the US system, the doctor is a consultant that works for the patient, just like a lawyer or accountant. Doctors spend very little time with each patient, because they are paid by the procedure they perform.
Each company that pays for health care, which could be the government, could be a private insurance company, or it could be a non-profit insurance company, has a list of rules that determine what they will pay for and when. These rules are quite complex, but basically, it is they which keep a person from ordering too many tests.
These companies say that they will pay for something that is "medically necessary." Such a term is loaded with controversy. You may have seen the news of the girl who was denied a liver transplant by one of the major health insurers because the company decided that she was not likely to be helped by the procedure. She was 17, had leukemia, and complications from a bone marrow transplant caused her liver to fail. After the company's decision, there was a public outcry. They reversed, but it was too late, as the girl died shortly thereafter. It would be interesting from your perspective how in the UK such a case would have been handled.
Finally, the malpractice system encourages larger numbers of tests. If you, as a physician, miss even a very rare thing, you could be held liable.
i see your point about the malpractice law suits. fortunately here we dont have that problem! i do think though that keeping private companies such as insurance companies out of healthcare is the way to go. mixing financial interest of the companies to health interest of the doctors is just asking for trouble. the motto of our NHS is "healthcare free at the point of delivery". i cant think of anyone that isnt eligible for free treatment here, and because the nhs is somewhat the monopoly of healthcare in the uk it means it has to be the best. sure there are private hospitals, but even the consultants (attendings) that work there have to maintain a set number of wekly hours in the NHS.
i know its nothing you can really change, your health care is one of the best in the world and is probably the most high tech owing to the fact it is highly privatised.
the case of the girl with leukaemia. this could never happen. anyone, and i mean anyone who is in need of life saving treatment gets it unless they have the mental capacity to refuse or have written a living will stating they would not want to be saved should such a sitation arise. even paracetamol overdoses get liver transplants immediately, when there are people with chronic liver disease waiting years. the basis of this is that most overdose patiens regret what they did and are thankful they were saved.
the only thing that really happens here is doctors have to go to the hugh courts to get permission to treat a minor when their parents say no.
ocassionaly, when a brand new anti cancer drug comes out which costs a fortune, we have problems. patients want the drug but the local NHS office says no (the NHS shares out money between "trusts" which comprise a few hospitals within an area, the the trust is responsbile for how they spend their allocated budget in the hospitals the trust is comprised of). the most common outcome of this is that the patient goes to the press, gets alot of support and the trust gives up and funds the medication. the downside to this is that it comes out of their budget, which means another service or treatment will have to suffer in some way.
the vast majority of the time everthing works well and in clinical practice we never say we cant do something beause of money. doctors are not taught to worry about the money, but we are taught a responsibilty not to abuse or waste it.
i know its nothing you can really change, your health care is one of the best in the world and is probably the most high tech owing to the fact it is highly privatised.
the case of the girl with leukaemia. this could never happen. anyone, and i mean anyone who is in need of life saving treatment gets it unless they have the mental capacity to refuse or have written a living will stating they would not want to be saved should such a sitation arise. even paracetamol overdoses get liver transplants immediately, when there are people with chronic liver disease waiting years. the basis of this is that most overdose patiens regret what they did and are thankful they were saved.
the only thing that really happens here is doctors have to go to the hugh courts to get permission to treat a minor when their parents say no.
ocassionaly, when a brand new anti cancer drug comes out which costs a fortune, we have problems. patients want the drug but the local NHS office says no (the NHS shares out money between "trusts" which comprise a few hospitals within an area, the the trust is responsbile for how they spend their allocated budget in the hospitals the trust is comprised of). the most common outcome of this is that the patient goes to the press, gets alot of support and the trust gives up and funds the medication. the downside to this is that it comes out of their budget, which means another service or treatment will have to suffer in some way.
the vast majority of the time everthing works well and in clinical practice we never say we cant do something beause of money. doctors are not taught to worry about the money, but we are taught a responsibilty not to abuse or waste it.
I am not trying to be arbitrary but the amount of radiation from a ct scan is really not that much.
I also know people from all over the world come to the states for health care.I don;t see them going to England.I know Canadians who wait for their vacations to come to our Dr.s for tests when at home it may take 6 months to a year.
I dont know of any of my Dr.s who have performed unnecessary tests.
I am now 8 weeks post transplant with only 6 days in hospital and doing rather well.
Bob
I also know people from all over the world come to the states for health care.I don;t see them going to England.I know Canadians who wait for their vacations to come to our Dr.s for tests when at home it may take 6 months to a year.
I dont know of any of my Dr.s who have performed unnecessary tests.
I am now 8 weeks post transplant with only 6 days in hospital and doing rather well.
Bob
Post a Comment