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Unfair doctor charge

Discussion in 'Health & Fitness' started by treedee3d, Feb 7, 2013.

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  1. Edward 96GTS

    Edward 96GTS F1 Veteran
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    Nov 1, 2003
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    vinney,
    at least now i know your sources :)
    if you ever sue a doctor, play the clip where you accept lifetime lattes in exchange of a settlement, healthcare costs will decrease dramatically ;)
    ed
     
  2. drgek

    drgek Formula 3

    Jun 21, 2004
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    Gary
    Please, fill me in via PM. At least tell me what it was you do that you were the best in. Your answer has all the transparency of the cost of hip surgery. Perhaps I am very well informed in that field.

    No one is saying healthcare isn't broken, but I wonder where you seek your care?
     
  3. drgek

    drgek Formula 3

    Jun 21, 2004
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    Gary
    The observation of someone who describes himself as very well informed.
     
  4. ylshih

    ylshih Shogun Assassin
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    Mar 21, 2004
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    Yin
    This is the tried and true internet argument gambit. "Trust me, I know what I'm talking about; unfortunately if I told you who I was, I'd have to kill you!" ;)

    It wins arguments all the time. :cool:
     
  5. Under PSI

    Under PSI F1 Rookie

    May 13, 2005
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    He apparently studies saw palmetto and prostate gland issues:

    http://www.ferrarichat.com/forum/142020718-post11.html
     
  6. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910
    I always consult the Maestro. Seriously, I practice what I preach and am in rather great health considering everything. Proactive is better than reactive.




    If you want some sober reading see these NYT articles I read last year ............... http://www.nytimes.com/2011/10/01/health/01hip.html?ref=business and http://www.nytimes.com/2011/12/28/business/the-high-cost-of-failing-artificial-hips.html?_r=0
     
  7. Scotty

    Scotty F1 Veteran
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    One of the problems is this. For any physician service in the insurance world, that service has been relatively valued (versus all other possible services) based on the "typical" patient. So, whether you are talking about freezing a wart, reading an x-ray, having a lap apply, or 1 hour of psychotherapy, every value is based on the typical (or average) patient difficulty.

    It is vaguely similar to "book time" for car repairs. Sometimes they can be done faster, and sometimes they can be done slower, and it can depend on the particular car, if it was worked on before, the skill of the tech, the availability of specific tools, and so on. But the book time is the average amount of time the service can be done in (but not often is the exact "average" situation replicated).

    But many procedures (say a hip replacement in the hospital) are actually the amalgam of many different services, each priced individually (the surgeon's fee, the anesthesia fee, the charge for a bag of IV fluid, etc.), aka fee for service medicine.

    In one sense, this is very fair. Assuming every health care person is doing only what is needed, acting ethically, following evidenced based treatment guidelines (where they exist), respecting patient wishes, etc. then you are only paying for the resources that are needed to treat you. This is an advantage if you are young, healthy, and have no complications.

    It also illustrates why it can be so difficult to quote a price--no one has a crystal ball to "know" exactly how you will do, what drugs you might need, etc. In our office I can give anyone an exact quote for a specific procedure, but I don't always know what will be needed.

    Let me give an example from my specialty. Lets say you come to see me with a mole that is changing. I can quote you an exact price for the biopsy, and an exact price for the basic pathology. From there "It depends". On what? Well, let's say your mole is very unusual. It might need extra staining or testing by the pathologist to establish the correct diagnosis. Lets say it is a melanoma--then it will need a further excision and further pathology.

    Now, you might ask, why not take enough tissue at the start so that nothing more need be done. The reason is that the amount of tissue taken on a melanoma excision depends on its measured depth, which you can't know until it is removed. And other tests (sentinel lymph nodes, imaging studies, etc.) might be needed, again depending on its depth. And taking too much tissue to start can interfere with the quality of those subsequent tests.

    So, if someone asks me "how much to remove this mole" I can give an exact answer. If someone asks me "how much to treat this suspicious mole" there is no way to know.

    This is not justification for how difficult it can be to get straight answers regarding fees out of the health care system, because even my wife and I (both docs) occasionally have trouble, and one would think we would at least have a clue what to ask. It just is intended to explain things a bit more.
     
  8. Edward 96GTS

    Edward 96GTS F1 Veteran
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    Nov 1, 2003
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    scotty,
    according to vinney, you are just a pimple popper, md.
    i bet he's also an antidentite :)
    ed
     
  9. Scotty

    Scotty F1 Veteran
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    But who doesn't enjoy popping a ripe one?

    Actually, my practice is limited to Mohs surgery (which will likely get me even more grief).
     
  10. craterface

    craterface Formula Junior

    Apr 14, 2011
    620
    Sanibel Island, FL
    Interesting thread. Everything DrGek and Scotty have said is spot on. If a doctor talks to you for 20 minutes, then he is going to charge a fee for that. He does not own the lab and does not profit from the test in this case, as far as I can tell. If he is assuming liability for the outcome of a baby who may or may not have down's he is worth every penny of $140.

    Vinny, you lament the fact that medicine is no longer an "avocation". "Avocation" means hobby, something you do on the side. "Vocation" means calling, occupation, etc. I believe that is the word you intend.

    Name another vocation that demands you study for 11-16 years (4 years of college, four years of medical school, and three to eight years of residency/fellowship) and then demands you stay awake and work for 36 hours straight on a routine basis for many years as part of that training.

    Is medicine expensive? Yes. Is medicine better than it was 50 years ago? Absolutely. Fifty years ago, if you had cancer, they cut you open to find out what was wrong, looked and sighed, sewed you up and gave you morphine until you died. Now, people with stage IV cancer actually live for years. CT scan (1975), MRI (1981), lasers for eye surgery, joint replacements, etc are all new advances that improve quality of live and cost money. This stuff isn't free.

    I agree with greater price transparency, but I am not sure what happened in this case of tree3. Someone screwed up by not telling him he would seee the MD and have a consult, since his Canadian doctor can't order a lab test in the US. I doubt it was malfeasance.
     
  11. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910
    I had decided I was done with this thread but craterface brings up some good topics.

    I am usually quite specific and if I open my "internet" mouth on a topic it is usually because I know something about it. In this thread I have been lamenting about "the hospital system" moreso than doctors as individuals though i did say they and insurance companies were somewhat complicit.

    It is the hospital system that charges these outrageous prices for the most part. See the CBS report. AVOCATION in my post referred to the original entities that built and ran hospitals. Most hospitals before say 1970 were started and run by religious institutions or local governments, which was an avocation for those institutions. Churches main business was religion and local govt.s main business was law & order. They both created hospitals, NOT to make money but as an outreach of their beliefs.

    So it was an avocation for those entities to create the hospital system not for money but for the betterment of society.
     
  12. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910
    I believe I named a few other professions that have similar requirements and perhaps even greater responsibilities, not to mention the military or even the special forces branches of the military.

    I was specifically thinking of that staying awake stuff a few days ago and have heard it discussed in the past. To me kinda like the final tests that certain elite military units do in order to say we are apart from this other bunch. If it is still done the questions is WHY? I do not want anyone making crucial decisions to be tired or off their game.

    I also want medicine to be more like dorito's when Jay Leno says have all you want, we'll make more. I want a lot more doc's created, more med schools or larger classes or both. I want a lot more doc's. I really don't think it is a quality issue. Maybe it is a supply/demand constraint imposed by the AMA.
     
  13. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910
    #88 Vinny Bourne, Feb 16, 2013
    Last edited: Feb 16, 2013
    Well there have been great advances in electronics and computers which have made it possible to create great tools for medicine, but that credit does not belong to doc's or hospitals.

    Despite all the headlines you hear every once in a while, like CNBC touting cancer was cured in 98 when anti-Angiogenesis was the new thing, our medicine is not all that great. Bacteria seem to be winning the battle against anitbiotics with some super bugs out of control. I think we just had the first cases of an STD once thought eradicated that is now resistant. And don't forget antibiotics came about by accident.

    We really don't know *****. Stem cell tech is still new. Just watch the ads on HULU for new drugs for all the side effects, who would take these drugs with all those possible consequences. I believe I was negatively affected by one of these new drug classes some 15 years ago. A family member is dealing with DV and when I read about I find out we know almost nothing about it, just that it is a western disease whereas Asia and Africa don't have it. So they GUESS it has something to do with diet.

    Why do some drugs in trials cure some but don't affect others? We don't know.

    Now some med schools are going in the direction of inflammation as a cause of many problems. The med community is finally thinking about nutrition and a mind/gut connection. this was posted in another thread in this section and I agree with most of this;

    It wasn't that long ago that all ulcers were believed caused by worry, know we now about H pylori. Medical knowledge is in its infancy, maybe 200 years from now we will be able to say that the medical field has great knowledge but it won't come from staying up for 36 hours fo no good reason. It will come from the very few in labs who make discoveries built upon other discoveries. Ever see that show that explained how helpful technologies came to be?

    this show
    [ame]http://www.youtube.com/watch?v=ZFfdjCc8IeQ[/ame]
     
  14. ScuderiaWithStickPlease

    ScuderiaWithStickPlease F1 World Champ

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    #89 ScuderiaWithStickPlease, Feb 16, 2013
    Last edited by a moderator: Feb 16, 2013
    When medical schools considered expanding in the '90s, Clinton [*** deleted P&R comment ***] talked them out of it (paid some or all of them not to do it.)

    His "thinking"?

    He was hearing that a lot of healthcare was unnecessary, so he assumed cutting back on the number of doctors would eliminate this sort of thing, keeping costs down.

    (You know things are bad when Americans think the way to fix the medical system is to drop the standards we hold perspective doctors to (if anything, they should be ever-rising.) No calls for deregulation, ending care redistribution, returning the power of the purse to the patient, tort reform, denouncing the myth of equity, etc.)
     
  15. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910
    You should read those. I already said previously in this thread being pro-active is way better than being reactive. Lifestyle choices and education will result in a better life and more efficient society. The smokiest room I was ever in was the doctor's/nurse's cafeteria at a local hospital back around 1980 or so working part time on a job during school vacation. How's that for irony?
     
  16. ScuderiaWithStickPlease

    ScuderiaWithStickPlease F1 World Champ

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    What does the fact that x% of doctors smoke, or smoked, Y number of cigarettes/week have to do with anything?
     
  17. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910
    I couldn't quite understand your whole point, but anytime I hear Bill Clinton I think

    Clinton's legacy -- stopping Brooksley Born
     
  18. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910
    #93 Vinny Bourne, Feb 16, 2013
    Last edited: Feb 16, 2013
    They more than anyone knew the horrific consequences that that habit did lead to in a great % of it's users. You come to a fork in the road path A is potholes and ditches and path B is smooth and fast, even has pictures posted, which do you choose?

    And with our "great medical knowledge", why do some smokers get lung cancer, emphysema, ..... and some do not?



    Stories like this that I read when it was first reported are a step in the right direction -- http://articles.philly.com/2012-12-11/news/35728627_1_university-of-pennsylvania-gene-attack-b-cells-t-cells
     
  19. ScuderiaWithStickPlease

    ScuderiaWithStickPlease F1 World Champ

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    #94 ScuderiaWithStickPlease, Feb 16, 2013
    Last edited: Feb 16, 2013
    What does it prove if someone derives pleasure by incorporating such behaviors in his life even though he understands there's a potential downside?

    Nothing.

    How does the fact that people in healthcare may smoke, overeat, eat badly, or engage in all kinds of destructive behavior negate either their insistence that these behaviors are bad or their ability to diagnose and treat ailments?

    It doesn't.

    If I have you correctly, you're engaged in a common straw man, one in which contradicting what you advise somehow negates the validity of your advice.

    This is another straw man, in that we don't need to be able answer that Q in order for warnings against the potential downside of smoking to be valid.

    (I hope we're not talking past each other . . . )
     
  20. ScuderiaWithStickPlease

    ScuderiaWithStickPlease F1 World Champ

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    #95 ScuderiaWithStickPlease, Feb 16, 2013
    Last edited: Feb 16, 2013
    The point I was hoping to make is that people that insist on a centralized government are so off the mark that mistakes like Clinton's are to be expected. There's no AMA conspiracy, no inherent weakness in free markets that requires us to increase the number of doctors out there through government mandate. (I'd like to see licensing done away with, replacing it with private certification, but I'd like to see this in all professions.)

    And with all due respect, what you and so many others seem to be calling for can't work. I say this because the call for equity contradicts the diversity we see in society, a given that's largely the result of free will, and because there's no way for government to even begin to do what the Invisible Hand makes seem so easy, so tweakable.
     
  21. Piper

    Piper Two Time F1 World Champ
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    I've got an inlaw, pain management MD with a very successful practice. The guy eats like a 3rd grader, nothing but burgers with ketchup with no onions or pickles and french fries, takes lipitor for the hell of it to offset, drinks like a fish, smokes, really cracks me up. He knows. His choice. Who cares. It "is" funny though.
     
  22. Scotty

    Scotty F1 Veteran
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    This thread is getting off topic, which may be okay. To correct one of your statements (and as was already stated) the restriction on "more docs" is federal, not AMA, driven. See this link for a bit of current background: AMA Urges Congress: Retain Funding for Residency Programs, Increase Training Positions to Address Doctor Shortage

    This doesn't deal with the question of what we need more of in a resource limited world--more docs, more PA's, more NP's, etc.
     
  23. Vinny Bourne

    Vinny Bourne Formula Junior

    Nov 25, 2011
    910

    More a question than a statement as I said, "Maybe it is a supply/demand constraint imposed by the AMA." But thanks anyways as it spurred me to do some research that makes it less clear than just blaming the feds --> this was the tune they were singing in the 90's, since then there was a large increase in DO's. The following abridged excerpts explain the rest.





    ( from AMA seeks limit on residents to prevent glut of new doctors Shortage of physicians in inner cities continues - Baltimore Sun )
    March 01, 1997|By NEW YORK TIMES NEWS SERVICE
    WASHINGTON -- The American Medical Association said yesterday that the United States is training far too many doctors and that the number should be cut by at least 20 percent. .......... the federal government should limit the amount it spends on training doctors. Medicare subsidizes training with $7 billion a year to teaching hospitals.





    me;
    Recently the allopathic side feeling the heat/competition from the osteopathic schools has opened a few new schools and expanded class size. They now want more govt. funding for these new grads. It seems competition works, slowly. But since roughly 1/3 of all GME slots were filled by non-US citizens, it is clear that the allopathic schools have not done enough to anticipate and fill the shortages that they say are so clear now but were not even seen by them a little over 10 years ago. Note during this period there were no shortage of applicants to their schools.





    ( from GME funding showdown looms in Washington - amednews.com )
    SHORTAGES are expected to reach 62,900 physicians by 2015 and 91,500 by 2020 .......... Medicare GME funding has been capped since the Balanced Budget Act of 1997, Mostly govt. funds pay for GME. Medicare = about $9.5 billion annually, while Medicaid = $2 billion, ........... Of the Medicare portion, $3 billion for the salaries of residents and supervising physicians, and $6.5 billion to subsidize the costs of running a training program ............ The projected cost of funding 15,000 new GME slots was $1.5 billion




    The more we all know the better and I was not aware of the details of this part of this vast and important subject.
     
  24. Scotty

    Scotty F1 Veteran
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    Yes, to clarify I should have said "current restrictions on physician training are federally driven". The AMA has changed its position.
     
  25. ScuderiaWithStickPlease

    ScuderiaWithStickPlease F1 World Champ

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    . . and it represents a small percentage of physicians (17% when it supported Obamacare.)

    It's just another lobby group, saying what it has to in order to live up to whatever deal it's involved in in this week, month, year, etc. It's an entity that wouldn't even exist if we hadn't dragged government into this crucial field.
     

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