Tuesday, February 11, 2014

Sometimes it takes a village idiot to say something useful

Hello AmPol et al. In the midst of a pretty brutal semester of pathophysiology and pharmacology, I came across something that I think this particular crowd should read. http://www.imshealth.com/portal/site/imshealth/menuitem.c76283e8bf81e98f53c753c71ad8c22a/?vgnextoid=12531cf4cc75f310VgnVCM10000076192ca2RCRD&vgnextchannel=5ec1e590cb4dc310VgnVCM100000a48d2ca2RCRD&vgnextfmt=default

Near as I can tell, there is no leftist connection, no worship of King Obama, and no demand for whatever else it is that many of you are afraid of losing to some slacker. It's just some numbers. I've bitched for a long time about non compliance and now as a student and prospective prescription writer someday, this kind of stuff is becoming more important to me. This article actually shows some improvement, which is great, but there is still an enormous amount of waste that has to be  hung on doctors, NP's and PA's, AND PATIENT'S especially when it comes to writing inappropriate prescriptions for things like viral infections. Because our healthcare system is based on consumption and satisfying the "customer", there is little responsibility on the side of the patient and this has bothered me for a long time. I've taken care of countless people in the ICU who had a heart attack who were fat, smoked and had diabetes. Anyhow, it's doubtful I'll be back to see many responses, but I think this article is important information for people to start to understand.


While everyone hates the idea of the government controlling health care and health costs, consider something else, without government agencies that actually do studies and create treatment guidelines that are based on REAL evidence of what is the most effective way to treat something, it is not likely that providers will treat in cost effective ways. Since the early 2000's, when the CDC started to take efforts to curtail inappropriate antibiotic scrips, the number of them written HAS gone down. With this movement, some resistance to antibiotics is also starting to go down. Not every government agency is bullshit. That's not to say we can't do away some.

2 comments:

  1. Good article. You have been sounding the alarm on this particular topic for awhile, Max.

    I watched Bill Maher this week and in his editorial at the end of the show, he threw out some interesting numbers. We as a nation spend an average of about $3000 per year in tax dollars for citizens under 18 while we spend over $25K per year per citizen over 62.

    It brings up a few good points: The first, old people vote (duh) and there's a lot of them.

    Second, and perhaps a topic for another thread, is this really a wise way to spend our taxes to invest in our future? Cutting Head Start programs and school nutrition programs in favor of subsidizing Viagra scrips & penis pumps? Some food for thought ...

    The third, and the one that's adjacently related to your topic, came to light when he broke down how that $25K+ is spent: 50% of that money is spent on health care for the last year of that person's life and 90% of that 50% is spent for that person's last month of life. I don't know if his numbers are accurate, but wow ...

    You did hospice care, Max. I'm interested in hearing your take.

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  2. Hey Funky!

    I do believe that figure is accurate. From what I've read before, 30% of Medicares yearly budget will spent for the last year of care. I've seen it in the ICU and now hospice care, there is an enormous amount of money spent in futility. In the last two plus years I have done hospice care, I have seen a pretty dramatic shift taking place. That shift is that hospice care is becoming a bit of a "dumping ground" for people who really don't fit anywhere else. The hospital tells the family, there is nothing more we can, which basically means there aren't any more procedures to do. The patient is not appropriate for rehab because they aren't going to get better, and the family is angry because they still want to prolong the family member's life as long as possible whether they are awake or not. So, they come to us and the family tells us that they don't want us giving pain meds or treating the delirium because they don't want their family member "too sedated". It frustrates me because I went to hospice care to help try and bring comfort to a dying person or their family. Now, it's becoming like it was in the hospital where my job is to seemingly kiss the ass of the family solely to get a positive survey score from them down the road.

    As I've said before, our current outlook on health care is just another ideological battle. Our current, false premise of using free market principles is really just a sham. Medicare and Insurance companies are denying payment to doctors and hospitals for not satisfying the customer. Which means that basically they are being rewarded for supporting the worst behavior of patients who don't want to take any responsibility for their health. But that's another diatribe.

    Back to your point, I've participated in the delivery of a lot of billable care that neither brought a cure nor even comfort and actually just prolonged the suffering of someone. Basically, this care is given because of selfishness. It's not for the patient, it's for the family, who, for a variety of reasons, cannot let go. I've seen families of hospice patients literally get right in the ear of the dying patient and start yelling, "WAKE UP WAKE UP". I watched the same episode of Maher, after all, I am communist, and I was drawn to the same things you were about where we spend our money. There is a line in Atlas Shrugged where one of the characters says, "Beware the man who says that money is the root of evil for that is the sound of an approaching looter". The modern version of this are conservatives who say, "Think about the burden we are leaving behind for our children" What they really mean is let's not spend any money on them lest they get smart and someday realize how badly we have screwed them.

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