How to improve treatment of patients?

[Kas]

How to improve treatment of patients in medical care?

I have read some posts in here about not right treatment in hospitals and generally in healthcare.
It never happened to me in a way described, but I have been once treated roughly and pretentious in a way that was very uncomfortable to me. I wonder what can be done to cause more productive doctor-patient ; nurse-patient relations and build some sort of partnership, how to limit mistreatments… Could any changes in medical education or social actions cause betterment in this regard?

Where do you think the situations come from? Resources, time, neglect, disagreement or bad intentions? I think the first one isn’t that important because it’s easy to understand and that’s the human factor that can be most hurtful. It’s the last one that bothers me.
What could be done to prevent or limit such factors? Is psychological evaluation in medical school good idea? I know in Mexico they have psychological tests, mostly to catch people with anti-social personality, or destructive tendencies, but I think these may be easy to fool or they may easily misjudge someone (personally I don't find it a good idea). Maybe there could there be more classes about doctor/nurse- patient relation, more ethic class... Could it cause some improvement? Or maybe some more practice that would require more sensitivity with patient as in palliative care clinic, to show that not only the cure matters, but also human dignity? Two ideas that come to my mind.

Any thoughts or potential solutions?

 

[Tellenbach]

The biggest improvement would be to eliminate government subsidized healthcare because it puts a separation between the caregiver and the patient. If the patient is not the person paying the bill, what reason is there for the hospital to treat that person with dignity and respect? If on the other hand, the patient is paying the bill, then the patient becomes a customer and all businesses compete for customers so patient care will improve.

We learned from the Veterans Affairs hospitals that patients were regularly forced to wait weeks or months to receive treatment; their calls weren't returned and they were basically ignored. This is because the patient isn't the customer; he/she isn't paying the bill. Remove the separation and the patient becomes the customer once again.

 

[Kas]

The biggest improvement would be to eliminate government subsidized healthcare because it puts a separation between the caregiver and the patient. If the patient is not the person paying the bill, what reason is there for the hospital to treat that person with dignity and respect? If on the other hand, the patient is paying the bill, then the patient becomes a customer and all businesses compete for customers so patient care will improve.

We learned from the Veterans Affairs hospitals that patients were regularly forced to wait weeks or months to receive treatment; their calls weren't returned and they were basically ignored. This is because the patient isn't the customer; he/she isn't paying the bill. Remove the separation and the patient becomes the customer once again.

Would you suggest the system where individual health is divided from the public health- generally everyone is paying for their treatment and government is taking care for the poorest? Or do you think it should work as any different services? I don't think the second is fully possible.

 

[Tellenbach]

Would you suggest the system where individual health is divided from the public health- generally everyone is paying for their treatment and government is taking care for the poorest?

I would prefer that charities take care of the poorest but if the government were involved, they should let the individual manage the money. This could be done with medical savings accounts. The individual is still the customer and still gets to decide where to use the money.

 

[Kas]

I would prefer that charities take care of the poorest but if the government were involved, they should let the individual manage the money. This could be done with medical savings accounts. The individual is still the customer and still gets to decide where to use the money.

I actually like the idea about saving accounts. But how with financing the unconscious patients and all connected with emergency care?

Sorry that I keep asking questions. It's just that as usually I'm for the privatisation in sector of healthcare it's difficult to me to see this work. I'm not saying I wouldn't go for it, just I would need to see the model that could actually work.

 

[ceecee]

How to improve treatment of patients in medical care?

I have read some posts in here about not right treatment in hospitals and generally in healthcare.
It never happened to me in a way described, but I have been once treated roughly and pretentious in a way that was very uncomfortable to me. I wonder what can be done to cause more productive doctor-patient ; nurse-patient relations and build some sort of partnership, how to limit mistreatments… Could any changes in medical education or social actions cause betterment in this regard?

Where do you think the situations come from? Resources, time, neglect, disagreement or bad intentions? I think the first one isn’t that important because it’s easy to understand and that’s the human factor that can be most hurtful. It’s the last one that bothers me.
What could be done to prevent or limit such factors? Is psychological evaluation in medical school good idea? I know in Mexico they have psychological tests, mostly to catch people with anti-social personality, or destructive tendencies, but I think these may be easy to fool or they may easily misjudge someone (personally I don't find it a good idea). Maybe there could there be more classes about doctor/nurse- patient relation, more ethic class... Could it cause some improvement? Or maybe some more practice that would require more sensitivity with patient as in palliative care clinic, to show that not only the cure matters, but also human dignity? Two ideas that come to my mind.

Any thoughts or potential solutions?

Part of The Affordable Care Act of 2010 has to do with something called standards of care. These are metrics put in place to see how well hospitals are doing when it comes to customer service, delivery of service, nursing care, the care given by physicians, pain management, discharge and so on. The usual data collection methodology is Hospital Consumer Assessment of Healthcare Providers and Systems ( HCAHPS) and the one most people will encounter when they go to a hospital. If a hospital is not up to snuff, they are fined and get no federal money.

Private insurance companies are doing the same thing - reimbursement will align with patient satisfaction. There is a lot of teeth in this portion of the ACA. To succeed, facilities need to work as a team to care for patients. From the admissions department to discharge. This is improving, culture is improving and care nationwide is improving. I see these numbers all the time, it's very encouraging.

The VA does not come under any of these standards of care, they don't use HCAHPS as far as 2014. They are overseen by the Dept. of Veterans Affairs, they are run entirely independent of the centers for Medicare and Medicare and any private insurance. Why do you think their care was so horrific? The problem is that vets can't do the common sense thing like - seeing any doctor, going to any hospital and the VA reimbursing like any other coverage. That's why the waits are so long and vets are dying. It's senseless.

A far as more classes on ethics, patient relations and so on - I took 6 classes in college and 2 more after on these topics. And I'm not a nurse or a doctor. Health IT and I work with patients only occasionally. I can only imagine how many providers are taking. So it's not a lack of focus on those things by universities or facilities.

 

[Tellenbach]

But how with financing the unconscious patients and all connected with emergency care?

Most patients have family and friends who'd help out but for those who don't have any resources (a homeless person), I would not object to a local tax (probably a sales tax) to pay the costs. When the person is healthy, he/she can work off the expenses by picking up trash along the highway or some other community service.

With illegal immigrants, I'd send the bill to their nation of origin and if they don't pay it, you raise tariffs on their goods entering the country.

 

[Kas]

Part of The Affordable Care Act of 2010 has to do with something called standards of care. These are metrics put in place to see how well hospitals are doing when it comes to customer service, delivery of service, nursing care, the care given by physicians, pain management, discharge and so on. The usual data collection methodology is Hospital Consumer Assessment of Healthcare Providers and Systems ( HCAHPS) and the one most people will encounter when they go to a hospital. If a hospital is not up to snuff, they are fined and get no federal money.

Private insurance companies are doing the same thing - reimbursement will align with patient satisfaction. There is a lot of teeth in this portion of the ACA. To succeed, facilities need to work as a team to care for patients. From the admissions department to discharge. This is improving, culture is improving and care nationwide is improving. I see these numbers all the time, it's very encouraging.

The VA does not come under any of these standards of care, they don't use HCAHPS as far as 2014. They are overseen by the Dept. of Veterans Affairs, they are run entirely independent of the centers for Medicare and Medicare and any private insurance. Why do you think their care was so horrific? The problem is that vets can't do the common sense thing like - seeing any doctor, going to any hospital and the VA reimbursing like any other coverage. That's why the waits are so long and vets are dying. It's senseless.

A far as more classes on ethics, patient relations and so on - I took 6 classes in college and 2 more after on these topics. And I'm not a nurse or a doctor. Health IT and I work with patients only occasionally. I can only imagine how many providers are taking. So it's not a lack of focus on those things by universities or facilities.

That’s interesting what you wrote, honestly I know a little about US system. I'm happy there is ongoing improvement.
I think that generally outside control of hospitals in most countries is decent.

Yes I know, it’s not like there aren’t classes like this. Where I live it’s 2 classes strictly about ethic and next 2 about psychology and sociology with patient relations. Also elements in different classes. 2 courses during internship and residency.
Still I was thinking what may have positive influence on young mindset.

 

[Kas]

I was told recently that decisive when one is trying to get into medical university should be interview where they would proof they have needed qualities. I think this would be rather invitation for nepotism and I don’t think interview could proof much. But does anyone agree with this? If so why?

 

[ceecee]

I was told recently that decisive when one is trying to get into medical university should be interview where they would proof they have needed qualities. I think this would be rather invitation for nepotism and I don’t think interview could proof much. But does anyone agree with this? If so why?

I don't think it's necessary. Medical school and residency is going to show their character and qualities on its own.

 

[nonsequitur]

I've blogged before in detail about my experiences with dealing with doctors and surgeons. It's a bit different from my side because of my profession. I get given the information straight, my opinion is respected, I don't get talked down to. The difference in tone between when I first meet a doctor and when they read what I do in my file is huge.

I'm very very passionate about healthcare, preventative and personalised medicine, and could probably write a tome based on my personal experiences and my interactions with colleagues and collaborators. But others have already done so with a lot more eloquence and insight than I could ever manage. This is essential reading about how to humanise healthcare: Breaking bad news | Mosaic

There's the late Dr Paul Kalanithi's story as well. Their experiences and observations gel strongly with my own, and I firmly believe that to get better standard of care, we need to stop expecting doctors to be perfect, advocate strongly for a collaborative relationship between doctor/patient and make basic healthcare affordable.

I would like to share my personal experiences with public healthcare. In Singapore we have a mixed private/public system. Everyone is covered under the public system and pays for it in an age-graded and needs-based fashion. When I was diagnosed with a heart condition, my employer-sponsored health plan did not cover me because it was congenital. This condition was picked up in the pre-employment screen and I forked out over $700 out-of-pocket (this was already a subsidised cost) over a year to check out a basic heart murmur with echocardiograms and a trans-esophageal echo. That was how I got my diagnosis - over multiple visits and follow ups, because I take personal responsibility for my own health.

Because I was a public patient, my consults with a cardiologist only cost $30/visit. This is in contrast to $200/consult for a private patient. When the time came that I needed to have open heart surgery, the preliminary cost (at a public, university hospital) was $35,000 for a B2 non-air-conditioned 6-bed ward, package deal, quoted upfront (disclaimer that additional fees might be added with longer stays and complications). With our forced-savings scheme for medical issues "medisave" in combination with public insurance "medishield", I ended up paying $1,500 nett for the surgery, in-house medication plus hospital stay.

If I had not had surgery, the chances of me suffering heart failure, stroke, pulmonary hypertension etc. by age 37 was approximately 75%. That would've incurred more cost to the taxpayer (unless I died from it). If I had not made a commitment to taking care of my body and been willing to pay out-of-pocket for peace of mind, I would never have found the problem. It's usually found only when patients turn up in the ER with the above complications. If there was no public healthcare, there is no way that I could've afforded surgery - I'd only just started work after graduate school. A place in an air-conditioned "private" B1 4-bed ward with 2 nurses does not qualify for government subsidy, so I chose a B2 ward with 5 nurses covering 24 beds.

If I had needed to get heart surgery (say, a triple bypass) for lifestyle reasons, ALL of the cost would've been covered under my employer's health and hospitalisation cover, and I would get a bed in a private ward. But because I had the luck to be born with a problem that hits 1/10000 individuals, I am financially liable. The good thing is that post-surgery, my follow ups are down to a couple of times a year, and I can now live as a normal person. But what about people who have chronic conditions that require constant monitoring and treatment?

Given the state of the patent system and vulture-like big pharma (so many examples of over-charging life-saving drugs), I am glad to have a national healthcare system that can bargain down the cost of drugs to keep treatment affordable. I have no faith in a market system to correct and compete down price. Given my personal experiences, I have zero interest in arguing the theories of a free market making treatment affordable - I have never ever seen that happen here in the private sector.

There are other issues associated with the way that the "system" treats the individual, but yeah.. I have no intention of writing a book so I'll just end this here.

 

[Tellenbach]

There is a myth that big pharma and the government are at odds and that the government helps keep drug costs down. Far from it, the government actually shuts down competition that would reduce prices. The US FDA went after a Canadian drug seller because Americans were getting drugs at a reduced cost through a website. It was revealed that the FDA pursued this action at the behest of the drug company. The FDA also protects big pharma through the drug approval process. By making it extremely expensive to approve a drug, the FDA all but ensures that only big pharma can bring products to market. If a scientist discovers a cancer cure today, he'd have to sell it to big pharma because he wouldn't be able to bring that to market and he wouldn't be able to give it away.

 

[ceecee]

There is a myth that big pharma and the government are at odds and that the government helps keep drug costs down. Far from it, the government actually shuts down competition that would reduce prices. The US FDA went after a Canadian drug seller because Americans were getting drugs at a reduced cost through a website. It was revealed that the FDA pursued this action at the behest of the drug company. The FDA also protects big pharma through the drug approval process. By making it extremely expensive to approve a drug, the FDA all but ensures that only big pharma can bring products to market. If a scientist discovers a cancer cure today, he'd have to sell it to big pharma because he wouldn't be able to bring that to market and he wouldn't be able to give it away.

Since you aren't including specifics, are you talking about the 1600+ organized crime pharmacies, none of which were in Canada or stocked with Canadian drugs? The ones not selling cheap generics but true counterfeits?

 

[Tellenbach]

Since you aren't including specifics, are you talking about the 1600+ organized crime pharmacies, none of which were in Canada or stocked with Canadian drugs? The ones not selling cheap generics but true counterfeits?

FDA moves to shut down cheap Canadian drug supply

Americans have long flocked to Canada to fill prescriptions that can cost less than half the drugs' U.S. price. What began with patients crossing the border to buy their own drugs, however, has developed in the past year into a booming Internet and mail-order business that supplies Americans who never leave home.

That practice is illegal, and the FDA opposed the legislation Congress is considering that would allow drug reimportation from Canada.

U.S. Moves to Shut Down Websites Owned by Canada Drugs

Also as part of the Canada Drugs probe, beginning in February dozens of doctors in 29 states who bought drugs from the company's wholesale arm have been warned by the FDA that the products may be tainted or otherwise illegal. The FDA said it sent a fresh batch of letters to U.S. doctors in September saying they may have bought unapproved versions of osteoporosis drugs Prolia, made by Amgen Inc., AMGN 1.17 % and Aclasta, made by Novartis AG.

The FDA said those drugs weren't counterfeit, but were made for sale in other countries and diverted to the U.S. An Amgen spokeswoman said the company wasn't aware of any harm to patients related to the diverted Prolia. A Novartis spokeswoman said the company is cooperating with the investigation.

Importer of Canadian drugs shut

A federal judge granted the government’s request Thursday to shut down a Tulsa, Ok.-based pharmacy chain which helped Americans to buy cheaper prescription drugs imported from Canada. The U.S. District Court judge said the firm operating as Rx Depot breaks the law and the quality of the drugs may be unreliable.

The ruling was a victory for the U.S. government, which had asked the court to stop Rx Depot from helping Americans purchase discounted prescription drugs from Canada. The FDA has warned that drugs from other countries do not have the same assurances of safety as those regulated by the United States.

But it was also seen as a blow to customers who use the company to purchase less expensive medicines. It also could affect cities and states nationwide that are considering allowing employees to import drugs in order to cut rising prescription costs.

The 'Canada has lower standards' excuse is just that - an excuse. These are the identical drugs prescribed in the US, made by the same drug companies, but sold in other nations. Americans are forbidden to buy these drugs because it hurts big pharma's bottom line.

 

[nonsequitur]

Since you aren't including specifics, are you talking about the 1600+ organized crime pharmacies, none of which were in Canada or stocked with Canadian drugs? The ones not selling cheap generics but true counterfeits?

It goes beyond pharma.

In healthcare, what is "best" for the patient is often a question mark and highly debatable. The idea of "paying more to choose your doctor" because he "provides the best care" is incredibly stupid because often, patients are willing to pay more just because the doctor appears to be doing more (in terms of ordering tests or giving prescriptions). This creates a huge rise in healthcare costs because doctors that order more stuff are more popular. These doctors charge (often blind) costs to the insurers. Because there's lack of group bargaining in a private system pharma can charge more (as opposed to a public system where pharma has to come to the table to negotiate with a government agency or lose a large market), and so in the end insurance premiums go up.

There's a debate currently about whether additional treatments actually improve lifespan and quality of life, and whether (even in the case of cancers) active monitoring might be an alternative to surgery and additional medication. Between a doctor who says "the outcomes are the same whether you have surgery and chemo to remove the cancer or not" and one who advocates for maximum treatment, patients will feel that the latter is the "better" doctor. People act emotionally, and (not addressing the myth of "making decisions on complete information" that was the basis of the argument of market self-regulating cost above) will ALWAYS prefer action over inaction. This is the same with doctors who feel that they are acting in their patient's best interest. There's a confounding factor of the placebo as well - it's often talked about as a negative thing, but obviously if doctors exploit it to maximise patient wellbeing that's a good thing.

Taking for example, my personal experience with having to fork out money ahead of diagnosis for scans to figure out what was wrong. The doctor did not order these scans, which is reasonable because heart murmurs are harmless most of the time. But I prioritised my health and paid money for my own peace of mind. The cost of a basic trans-thoracic echocardiogram here is $400. My mom was very upset that I only found out about it now, and screamed over why "the government" didn't just screen everyone from birth since it's non-invasive. This same heart condition has led to the sudden deaths of soldiers and athletes. But at $400 per patient, who is going to cover that cost? It has a frequency of 1/1000 live births (mine is the more complicated version which is rarer) so how much will we pay to detect the problem and save a single life in mass screens? At the same time, I recognise that not everyone is like me and privileged enough to be able to afford the money for the scan. I was very very lucky, and in a way, my socioeconomic privilege gave me a selective advantage. Is that fair? These are all issues that are being considered.

This is similar with mammograms (which has the complicating factor of being radiation and having a high rate of false positives; exposure is associated epidemiologically with increased risk of cancer) and is the reason why doctors are now telling women that mammograms are only necessary if you are in a certain risk group.

These subjects about what is "best for the patient" is further complicated by the fact that most drug studies are conducted in males, people respond differently to different medication, and doctors can be arrogant SOBs who don't listen. Also when things go badly wrong, it's not like the patient can complain if he/she's dead and the family is too poor to sue for malpractice. When we talk about making decisions based on statistics for a single individual, monetary value and quality of life, demanding that there is market self-regulation is beyond unhelpful.

... and this is just the healthcare side of things, not even the pharma/broken patent side of things.

 

[Kas]

I've blogged before in detail about my experiences with dealing with doctors and surgeons. It's a bit different from my side because of my profession. I get given the information straight, my opinion is respected, I don't get talked down to. The difference in tone between when I first meet a doctor and when they read what I do in my file is huge.

I'm very very passionate about healthcare, preventative and personalised medicine, and could probably write a tome based on my personal experiences and my interactions with colleagues and collaborators. But others have already done so with a lot more eloquence and insight than I could ever manage. This is essential reading about how to humanise healthcare: Breaking bad news | Mosaic

There's the late Dr Paul Kalanithi's story as well. Their experiences and observations gel strongly with my own, and I firmly believe that to get better standard of care, we need to stop expecting doctors to be perfect, advocate strongly for a collaborative relationship between doctor/patient and make basic healthcare affordable.

I would like to share my personal experiences with public healthcare. In Singapore we have a mixed private/public system. Everyone is covered under the public system and pays for it in an age-graded and needs-based fashion. When I was diagnosed with a heart condition, my employer-sponsored health plan did not cover me because it was congenital. This condition was picked up in the pre-employment screen and I forked out over $700 out-of-pocket (this was already a subsidised cost) over a year to check out a basic heart murmur with echocardiograms and a trans-esophageal echo. That was how I got my diagnosis - over multiple visits and follow ups, because I take personal responsibility for my own health.

Because I was a public patient, my consults with a cardiologist only cost $30/visit. This is in contrast to $200/consult for a private patient. When the time came that I needed to have open heart surgery, the preliminary cost (at a public, university hospital) was $35,000 for a B2 non-air-conditioned 6-bed ward, package deal, quoted upfront (disclaimer that additional fees might be added with longer stays and complications). With our forced-savings scheme for medical issues "medisave" in combination with public insurance "medishield", I ended up paying $1,500 nett for the surgery, in-house medication plus hospital stay.

If I had not had surgery, the chances of me suffering heart failure, stroke, pulmonary hypertension etc. by age 37 was approximately 75%. That would've incurred more cost to the taxpayer (unless I died from it). If I had not made a commitment to taking care of my body and been willing to pay out-of-pocket for peace of mind, I would never have found the problem. It's usually found only when patients turn up in the ER with the above complications. If there was no public healthcare, there is no way that I could've afforded surgery - I'd only just started work after graduate school. A place in an air-conditioned "private" B1 4-bed ward with 2 nurses does not qualify for government subsidy, so I chose a B2 ward with 5 nurses covering 24 beds.

If I had needed to get heart surgery (say, a triple bypass) for lifestyle reasons, ALL of the cost would've been covered under my employer's health and hospitalisation cover, and I would get a bed in a private ward. But because I had the luck to be born with a problem that hits 1/10000 individuals, I am financially liable. The good thing is that post-surgery, my follow ups are down to a couple of times a year, and I can now live as a normal person. But what about people who have chronic conditions that require constant monitoring and treatment?

Given the state of the patent system and vulture-like big pharma (so many examples of over-charging life-saving drugs), I am glad to have a national healthcare system that can bargain down the cost of drugs to keep treatment affordable. I have no faith in a market system to correct and compete down price. Given my personal experiences, I have zero interest in arguing the theories of a free market making treatment affordable - I have never ever seen that happen here in the private sector.

There are other issues associated with the way that the "system" treats the individual, but yeah.. I have no intention of writing a book so I'll just end this here.

Thanks for response. That's a lot of money you needed to pay.

It’s a little different in Poland. We have public/private system as well. Everyone needs to pay medical insurance and so everyone has provided medical procedures and specialists (well all the procedures that system agreed to pay for, but it’s mostly everything). The disadvantages are that there are queues , sometimes long; also that people are angry they have to wait for some procedures while a person who doesn’t pay taxes and falls on the street (usually homeless drunk) has CT or MRI (it’s an examination which potentially can save life then). Those who want go to the doctor quicker need to go to private sector.

I would like to hear what you have to say about individual treatment too, if you want to write about it and have time, because I know that you've already said plenty

 

[nonsequitur]

Thanks for response. That's a lot of money you needed to pay.

It’s a little different in Poland. We have public/private system as well. Everyone needs to pay medical insurance and so everyone has provided medical procedures and specialists (well all the procedures that system agreed to pay for, but it’s mostly everything). The disadvantages are that there are queues , sometimes long; also that people are angry they have to wait for some procedures while a person who doesn’t pay taxes and falls on the street (usually homeless drunk) has CT or MRI (it’s an examination which potentially can save life then). Those who want go to the doctor quicker need to go to private sector.

I would like to hear what you have to say about individual treatment too, if you want to write about it and have time, because I know that you've already said plenty

It wasn't too bad, considering the circumstances - I essentially had 95% of my hospitalisation/surgery costs subsidised because I don't earn much and had a lower class ward. We all pay medical insurance - it's compulsory. Because of the queue, between when I first got a referral from a public clinic to when I got a first appointment at the heart center took 7 months. Waiting on another appointment for the echo took another month, and once they got the diagnosis it was 2 months to the trans-thoracic echo. It took another 3 months to schedule surgery, and I got bumped at the last minute because the surgeon had another more urgent case (older lady collapsed in the street) and there were no empty beds. All in all, the murmur was detected in May 2014 and I had surgery in late June 2015 - about a year's wait, which was a very anxious time, but I wasn't angry at all because mine wasn't an emergency and I wasn't in any pain.

About treatments for individuals - because it's a public healthcare system, I do understand that doctors/nurses cycle through patients with very little follow through, only relying on the file/history to make snap judgments on treatment. As a patient, I felt as if I was being seen as a collection of symptoms with doctors relying on standard "packages" of medications that might or might not suit my circumstances. Because I'm - me (life scientist with OCD) - I check every single medication that I take to find out the biochemical mechanisms of action, side effects, etc. and it became quite clear to me that there were non-medication alternatives. For e.g. the painkiller tramadol causes constipation, so you prescribe a stool softener.. which causes more problems. Also, every single night they came around to X-ray every patient in their beds as standard protocol.. Given my lungs were clear from fluid I'm pretty sure that it was unnecessary and I don't want to think about the amount of radiation that I was subjected to - both from my own X rays and from everyone else in the ward's. And don't even get me started on how counter-productive the food they served (through an outsourced caterer) would've been to recovery, particularly with most of the ward having had bypasses with the standard trifecta of diabetes/hypertension/high cholesterol...

Essentially - you're treated as a collection of symptoms and not an individual with your own strategy to deal with your condition or recovery. Doctors are generally more willing to speak to me, compromise their standard protocols to work with my goals and answer detailed questions - but only after they hear what I do. I've observed the way that other patients are treated and it's pretty high-handed so the patients abdicate their own personal responsibility for recovery to "follow what the doctor says".

 

[Acyd Thorn]

Mammography, by the way, is a good example of "the myth of "making decisions on complete information."

Contrary to the official narrative (which is based on medical business-fabricated pro-mammogram "scientific" data), there is marginal, if any, reliable evidence that mammography, both conventional and digital (3D), reduces mortality from breast cancer in a significant way in any age bracket but a lot of solid evidence shows the procedure does provide more serious harm than serious benefit (read: 'Mammography Screening: Truth, Lies and Controversy' by Peter Gotzsche and 'The Mammogram Myth' by Rolf Hefti).

IF........ women (and men) at large were to examine the mammogram data above and beyond the information of the mammogram business cartel (eg American Cancer Society, National Cancer Institute, Komen), they'd also find that it is almost exclusively the big profiteers of the test, ie. the "experts," (eg radiologists, oncologists, medical trade associations, breast cancer "charities" etc) who promote the mass use of the test and that most pro-mammogram "research" is conducted by people with massive vested interests tied to the mammogram industry.

Most women are fooled by the misleading medical mantra that early detection by mammography saves lives simply because the public has been fed ("educated" or rather brainwashed) with a very one-sided biased pro-mammogram set of information circulated by the big business of mainstream medicine. The above mentioned two independent investigative works show that early detection does not mean that there is less breast cancer mortality.

Because of this one-sided promotion and marketing of the test by the medical business, women have been obstructed from making an "informed choice" about its benefits and risks which have been inaccurately depicted by the medical industry, favoring their business interests.

Operating and reasoning based on this false body of information is the reason why very few women understand, for example, that a lot of breast cancer survivors are victims of harm instead of receivers of benefit. Therefore, almost all breast cancer "survivors" blindly repeat the official medical hype and nonsense.

 

[ceecee]

Mammography, by the way, is a good example of "the myth of "making decisions on complete information."

Contrary to the official narrative (which is based on medical business-fabricated pro-mammogram "scientific" data), there is marginal, if any, reliable evidence that mammography, both conventional and digital (3D), reduces mortality from breast cancer in a significant way in any age bracket but a lot of solid evidence shows the procedure does provide more serious harm than serious benefit (read: 'Mammography Screening: Truth, Lies and Controversy' by Peter Gotzsche and 'The Mammogram Myth' by Rolf Hefti).

IF........ women (and men) at large were to examine the mammogram data above and beyond the information of the mammogram business cartel (eg American Cancer Society, National Cancer Institute, Komen), they'd also find that it is almost exclusively the big profiteers of the test, ie. the "experts," (eg radiologists, oncologists, medical trade associations, breast cancer "charities" etc) who promote the mass use of the test and that most pro-mammogram "research" is conducted by people with massive vested interests tied to the mammogram industry.

Most women are fooled by the misleading medical mantra that early detection by mammography saves lives simply because the public has been fed ("educated" or rather brainwashed) with a very one-sided biased pro-mammogram set of information circulated by the big business of mainstream medicine. The above mentioned two independent investigative works show that early detection does not mean that there is less breast cancer mortality.

Because of this one-sided promotion and marketing of the test by the medical business, women have been obstructed from making an "informed choice" about its benefits and risks which have been inaccurately depicted by the medical industry, favoring their business interests.

Operating and reasoning based on this false body of information is the reason why very few women understand, for example, that a lot of breast cancer survivors are victims of harm instead of receivers of benefit. Therefore, almost all breast cancer "survivors" blindly repeat the official medical hype and nonsense.

Are you a radiologist or oncologist?

 

[Kas]

It wasn't too bad, considering the circumstances - I essentially had 95% of my hospitalisation/surgery costs subsidised because I don't earn much and had a lower class ward. We all pay medical insurance - it's compulsory. Because of the queue, between when I first got a referral from a public clinic to when I got a first appointment at the heart center took 7 months. Waiting on another appointment for the echo took another month, and once they got the diagnosis it was 2 months to the trans-thoracic echo. It took another 3 months to schedule surgery, and I got bumped at the last minute because the surgeon had another more urgent case (older lady collapsed in the street) and there were no empty beds. All in all, the murmur was detected in May 2014 and I had surgery in late June 2015 - about a year's wait, which was a very anxious time, but I wasn't angry at all because mine wasn't an emergency and I wasn't in any pain.

Considering what you wrote, the waiting time doesn't sound so long as well (I mean comparing to what I see where I live)

About treatments for individuals - because it's a public healthcare system, I do understand that doctors/nurses cycle through patients with very little follow through, only relying on the file/history to make snap judgments on treatment. As a patient, I felt as if I was being seen as a collection of symptoms with doctors relying on standard "packages" of medications that might or might not suit my circumstances. Because I'm - me (life scientist with OCD) - I check every single medication that I take to find out the biochemical mechanisms of action, side effects, etc. and it became quite clear to me that there were non-medication alternatives. For e.g. the painkiller tramadol causes constipation, so you prescribe a stool softener.. which causes more problems. Also, every single night they came around to X-ray every patient in their beds as standard protocol.. Given my lungs were clear from fluid I'm pretty sure that it was unnecessary and I don't want to think about the amount of radiation that I was subjected to - both from my own X rays and from everyone else in the ward's. And don't even get me started on how counter-productive the food they served (through an outsourced caterer) would've been to recovery, particularly with most of the ward having had bypasses with the standard trifecta of diabetes/hypertension/high cholesterol...

The bolded seems very weird to me indeed. Definitely the unnecessary procedures and examinations should be reduced. And patients treated individually.

I think the diets are improving. In most places there is a number of basic diets and it's getting more common for hospitals to have nutritionists.

Essentially - you're treated as a collection of symptoms and not an individual with your own strategy to deal with your condition or recovery. Doctors are generally more willing to speak to me, compromise their standard protocols to work with my goals and answer detailed questions - but only after they hear what I do. I've observed the way that other patients are treated and it's pretty high-handed so the patients abdicate their own personal responsibility for recovery to "follow what the doctor says".

That's something I observed too. Everyone talks about partnership with patient, but I think in many places it is and it will be difficult to make the paternal kind of doctor-patient relationship disappear.