Quality of Healthcare

[Serephino]

A conversation with my roommate this morning made me feel ranty again.  There seriously needs to be a better standard of getting a medical license in the US.  I suppose I can't exactly blame the doctors for this, but the good ones go to big cities to work in large hospitals that can afford to pay them the most.  I live in a little rural area with a local hospital that can't pay a high salary, and we get the bottom of the barrel, the doctors that bigger hospitals took one look at their credentials and tossed their resumes in the shredder.  I won't say they are all like this, but it seems like a lot of them got their medical degrees, and then suffered massive brain damage.  It's really not fair.  I'll use what happened to my father as a prime example because that is what is making me the most angry at the moment.

When I was 7 or 8 he was diagnosed with bladder cancer.  Not much was told to me directly, but you know, people have a habit of getting involved in their conversations and they don't notice that little ears are within hearing range.  From what I remember, the original recommendation was to remove his bladder, and he'd have an external bag.  He really didn't want that, macho pride and all...  The local oncologist caved to that, and decided to do radiation therapy.  Now, it worked.  The tumor did eventually go away.  However, he then started having a lot of trouble pooping.

Over 2 years it got worse and worse, but was just told repeatedly he needed more fiber in his diet.  Finally it got so bad he forced the local gastroenterologist to listen to him and take him seriously.  Tests were done, including a CT scan and a colonoscopy.  The doctor was stumped, everything looked fine to him.  So my parents got frustrated and decided to get a second opinion from a highly respected specialist from Pittsburgh.  That doctor requested the very same CT scan the local doctor looked at and said whatever the original doctor was smoking he wanted some.  It was glaringly obvious something wasn't right.  His colon was very narrowed.  After reviewing my dad's medical history, his best guess was that the radiation therapy for the bladder tumor caused scarring in the colon.  That section of colon needed to be removed.

The surgery was done by the guy in Pittsburgh.  So pretty much my dad ended up in the end with what he didn't want, only worse.  Not only was a large section of colon removed and he had an external bag, but for some reason he had a feeding tube that went right into his stomach.  He was in the Pittsburgh hospital for about a week and they sent him home.  He was home about 4 days I think when he started really not feeling good.  We took him straight to the local ER.  Now at this point I'm a 10 year old kid, and I had to witness walking into the ER, and while my mom was explaining to the receptionist what was wrong, my dad collapsed.  They left him just lie on the floor while they searched for an orderly to find a wheelchair to take him back.  Seriously???  A few hours later it turned out when he collapsed his heart had stopped, but fortunately somebody back there had half a brain because they managed to bring him back.

He was admitted, and a doctor was assigned to him to figure out what was wrong.  Lots of poking, prodding, and testing was done.  That doctor was stumped too, but over the 4 days he was there they kept forcing liquid nutrition into him through the feeding tube.  My mom said he looked about 5 months pregnant, and she said screw this shit, life flight him to Pittsburgh.  That was done, and it took the doctor there about 5-10 minutes to figure out that the problem was his system had gone into shock.  He looked pregnant because his digestive system wasn't moving anything, and his stomach was pumped immediately.

The Pittsburgh doctor and nurses did everything they could, but sadly he also had severe heart disease, and with all the trauma his heart just gave up.  So he was pronounced dead on October 29th, 1995, 3:47am.  I don't know why, but a few years later my mom started thinking about a lawsuit.  She turned to her sister, who I can proudly say is a lawyer with a very good law firm in Philadelphia.  Her expertise is not in that area, but she put my mom in touch with a colleague of hers that did deal with medical lawsuits.  The guy had doctors in Philadelphia review everything.  The oncologist there wondered if the local one was retarded.  He said that radiation therapy should have been the absolute last resort, if done at all, because even though it did take care of the tumor, any doctor with 2 brain cells to rub together should've foreseen that because of the size and location of the tumor, what did happen was going to.  When my dad said he wanted to keep his bladder, the oncologist should've told him tough shit, it was the best option.  The gastroenterologist that reviewed the case, the only conclusion he could come to was the local one got his medical degree out of a cracker jack box and had glaucoma. 

The Philadelphia doctors, they all concluded that the Pittsburgh doctors, awesome job, they did everything that could be done at the time.  The local doctors... they were all flabbergasted at the sheer stupidity.  It was decided that if my parents had said screw the local doctors and just gone straight to Pittsburgh, there was a 65% chance he would've still been alive.  The chances would've been a lot higher if not for the degree of his heart disease.  The case would've been open and shut, and the only reason my family is not rich right now is because when the lawyer looked into getting the paperwork started the statute of limitations had run out 7 months before.

The level of care has not gotten a lot better locally.  A few years ago my roommate was having a problem where when he moved his one arm a certain way there was a loud popping sound and his chest bone really hurt.  After this had gone on nearly a month I talked him into going to the local ER.  The doctor that saw him insisted it was muscle pain.  When my roommate looked him in the eye and said, so a muscle can make a loud popping sound, he said yes, it was just muscle pain.  Months later my roommate actually ended up getting into a chat on a game with a guy who was a doctor, and that doctor explained what it probably was.  I guess in the right conditions ribs can crack just like any joint, who knew...  That wasn't anything serious, but if it had been it would've been my dad all over again. 

So yeah...  I worry about my own health a lot, because when local doctors look me all over and say I'm fine, I don't completely trust it.  Can you blame me?         

[TheGlyphstone]

Not to blame at all, that's awful.

As far as the radiation therapy goes, though...a doctor legally can't order treatment against a patient's expressed wishes. So if the doctor did propose surgery and your dad refused, the doctor would have to comply with what he wanted, even if it wasn't in his best interests. A lot would depend on how well said doctor explained the options, but without being a fly on the wall back in time I can't make a call there.

[Iniquitous]

Something to keep in mind (beside what Glyph mentioned about doctors being unable to force patients to do procedures they don’t want).  Doctors are humans.  They don’t know everything and they make mistakes.

An ER doctor is not a specialist.  A family care doctor is not a specialist.  They refer out to specialists.   And even specialists make mistakes - I am scarred living proof of that.  It is entirely possible that the doctor who looked at the scans truly didn’t see what the other doctors did.  Could be he was tired, overworked, frustrated, or just not that experienced.

The other thing to keep in mind, especially these days.  A doctor working in a hospital does not make the money doctors use to.  You can’t judge a doctor by his location and what you think is a big money job - I was nearly killed by a doctor in a big city University hospital who was a specialist in his oncology field.  Two of the best speciality surgeons I ever had were small town doctors.

I could have chose to sue the gynecological oncologist that damn near killed me (put me in the hospital for 3 solid months before I could be released home and then still had recurring stints back in the hospital for another 9 months) but I didn’t. Why?  Because he is a human and mistakes happen.  I am not perfect so I sure as hell cannot expect anyone else to be.

[Serephino]

The thing is, both the doctor in Pittsburgh, and the one who reviewed the case, neither could understand how a competent doctor could not tell something was up.  It wasn't minor scarring.  The doctor who reviewed the case, he looked at the pictures taken of the colon after it was removed.  He said the scarring was so severe, and everything was so tight, that he was quite sure they probably had trouble getting that little probe they use through.  A second year med student worth his salt would've at least had a clue that what he was looking at was not normal. 

Maybe it's just this small town that attracts the idiots.  But the Philadelphia doctors looked over every note and test result, and they just could not believe it.  They were like how the hell did these doctors even get a license to practice some of them made calls that were that stupid.  I guess this area just isn't that attractive.  I mean, the family practice I was going to, the one there when I was a kid was kind of an idiot, but then the practice was bought out from the local hospital by a bigger nearby one, and they sent a guy there that I loved.  He was a really good doctor.  The surgeon he sent me to for my gallbladder, I didn't care for his bedside manner, but he didn't kill me.  He removed the right thing and didn't screw up, and for this area that's a major win.  The good doctor was there for like 12 years, then retired.  His replacement was too bad either.  But then she decided to move, and they couldn't find anyone willing to relocate to that tiny town, so the practice was closed, and I had to find a new PCP.  I went to one a friend and her family go to she said was great, and so far so good.

Maybe it's just that hospital and their hiring practices.  I mean, my roommate worked with a few girls that were studying to become nurses, and of course doing their part time internships at that hospital.  They would not give details, only say that some of the things they've seen go on make them determined to find another hospital to get hired at when they get their degrees because they didn't want to be caught up in that shit.  Really makes me wonder.  And doctor muscle pain is no longer there because I saw in the local news he did something so incredibly stupid that killed someone that the hospital had to fire him to avoid being a part of that lawsuit.

I've nearly been killed by a psychiatrist who doesn't know what the fuck he's doing.  He made really nasty comments about me not having health insurance at the time, and he gave me a medication that made me incredibly suicidal.  Later we found out that medication has been decommissioned because it tends to do that to a lot of people.  It's only still on pharmacy shelves because it works on about 1% of patients who have tried everything else on the market.  It's supposed to be tried last, but he tried it first.  My neighbor where I used to live, I had to call 911 for her one day because she was acting really funny.  Turns out the very same guy prescribed her 2 medications that have a lethal interaction.  How is he still practicing?  It is very well known that he only meets with the patient himself the first appointment.  After that, you only see his nurse, who relays information back and forth.  I know this is true because that's how it was before I quit seeing him.  Then when he fucks up he throws his nurse under the bus.  He denies ever having given that order, it was the nurse who screwed up, and she gets fired and loses her license.  And of course the nurse can't prove a damn thing because it was only the 2 of them in the room when the order was given.  You'd think the higher ups would notice the pattern, because I've been told he goes through a new nurse about every year.  But no, they keep him.

I can only praise the powers that be that someone who knows what the hell she is doing came to the program.  She's only in on Fridays, but most of the time I see her and not her nurse.  I really don't know what the hell, but I am seriously angry and frustrated that if I want decent healthcare and need to go to the ER I have to drive a little over 30 minutes to a city hospital to get it.   

[elone]

Also live in a very rural area with a tiny hospital nearby. I came here from a major metropolitan area and was used to top notch doctors from renown medical schools. I had surgery once from a doctor who was world renowned in the field.

Now I feel like I am at the mercy of incompetents whose medical degrees come from Jamaica, Mexico, or other countries. I assume this is because they could not get into a good US Med school. Many come from the military and my experience with those when in service was that they were not exactly top notch. I may be wrong, but that is the way it seems.

Rural areas suffer not only from lack of competent medical personnel, but also from lack of hospitals able to deal with complex situations. I am sure it is all a matter of finance.

Our current insurance situation is of no real help. I was limited to certain physicians, only those who belong to or participate in the plan. My doctor was dropped from the insurance company because they apparently could not come to agreement on fees.

I really think we need a level playing field and every aspect of our health care in the US needs to be examined. Fees are absolutely outrageous for many tests and procedures. Many times what is payed for in other countries for the same care. Equally bad are the prices we pay for pharmaceuticals. I currently order drugs through Canada because the savings is well over 50%. In some cases even more.

Not sure what the answer is to getting bad doctors out of the system and getting good doctors to practice in rural areas. It is really bad where I live, they can not even keep any doctors here. For example, for a long time there was no Obstetrician anywhere here, there is currently no dermatologist anywhere within 50 miles. It is like that for most specialties. The one hospital is cutting out Intensive Care and cutting hours for ER. WTF.

The supposed most prosperous country in the world cannot even provide health care for its people.

We need a single payer system, get rid of the insurance companies that add billions to our costs. Ask any medicare patient if they are happy with their healthcare and you will find an overwhelming answer of yes.

Whether people realize it or not, if they have employer based health care, they are paying for it through suppressed wages. Let all pay for government health care and get health care for everyone. Support Bernie Sanders.

[RedRose]

I've always been puzzled about the (lack of?) quality of healthcare in USA... That said rural areas suffer in every place. My country is resorting to hiring foreign doctors, or paying an apartment to doctors from big cities to settle into the countryside. Hospitals are closing or downsizing. Just to be clear I have nothing against foreign doctors - as long as they understand me, and I understand them, and their training isn't subpar. Years ago I had that awful lady I barely understood, and who was spewing such old school nonsense debunked years ago... Later I learned those beliefs were typically from where she was trained.

[Serephino]

I am actually on Medicare, and not that happy with it.  Maybe it could be that getting a supplement plan was a mistake.  This is what I noticed.  Pre ACA everything was pretty hunky dory.  My deductible was kinda high, but not a lot of stuff actually fell into that pit and it was covered.  For whatever the heck reason, I get a letter in the mail for every claim.  It has a chart to tell me what the provider billed, what their approved price is, what they paid, and what I now have to pay.  My share used to not be that much.  Then the ACA was passed, and I won't argue the law does some good things, but my premium went up a little, my co pays went up, suddenly like everything fell victim to a higher deductible...  When I got the plan it was supposed to cover psychiatric treatment, and my co pay was supposed to be $35.  Now my psychiatric treatment is not covered at all according to the claim letters I get.  They have an approved price of $75, and I get to pay it all.  I was getting over active bladder treatments, and they were covered, but now I owe the doctor's office a shit ton for them because... deductible...  I don't blame the ACA or President Obama, or Democrats.  I blame insurance companies who apparently found what loopholes they could to throw hissy fits.

I get the whole specialist thing too.  We have specialists, but usually only one.  I don't know if it was delayed treatment because of my mother's idiocy in the moment, or that the bone doctor on call that night didn't know how to properly set a broken arm, but I have a bone spur now between my forearm bones in my left arm, and I can't really rotate that arm, hence why I type one handed.  In high school when I had to take typing class my freshman year I tried to explain to the teacher that I type perfectly well one handed, and that using my left arm hurts because it just doesn't want to get into the right position.  He said bring me a doctor note and we'll talk.  So my mom took me to the bone specialist, which is when we found out about the spur.  He said that since I can rotate a little bit nothing needed to be done.  Also, if my keyboard was raised up I'd be fine for typing class.  And so I had to learn to type with both hands with 2 very thick books under my keyboard to elevate it.  My arm still ached a little when I was done.  Now that I'm older my arm will just randomly hurt like hell for a few hours.  I've wanted to see an orthopedic surgeon about it, and there is one here, but I can never seem to scrounge up the $50 co pay.

[Chasing Dreams]

Serephino,

I'm an xray technologist.  Typically after broken bones are reduced(set), xrays will be taken to ensure proper alignment. The second set of xrays will show the doctors if the alignment is good. It's not the ER doctors that determine if a bone is aligned properly. A Radiologist will read the xrays and let the ER doctor know what needs to be done. I also know that patients are supposed to follow up with an orthopedic specialist if the patient doesn't need surgery right away.

I'm sorry you had a bad experience and have problems with your arm from time to time.

[Serephino]

Like I said, I don't know if it was delayed treatment, or the doctor.  In my case the Orthopedic specialist on call was called in to set it for me.  My memory is a little hazy because they gave me pain killers, but a second x-ray might have been taken, and it might have looked fine to the guy. 

It's a complicated thing, but what happened was this...

I was in gym class, it was the last class of the day.  We were starting a gymnastics thing.  After what we would be doing for the next several weeks was explained, the teacher had us doing cartwheels.  I went to do one, and when my weight was on my left arm for whatever reason my body twisted around real hard.  I heard a loud snap, I fell, and my arm hurt really bad.  The gym teacher took me to the office to call my mom to come get me.  She was at work.  She asked the gym teacher her opinion of whether or not anything was really broken, or if I was just being a big baby.  The gym teacher said she didn't think it was broken because my arm was not swelled up, and I could move it a little bit.  (interesting fact, I rarely swell when most people do)  My mom said she was not leaving work for a sprain, and expressly forbid me from bothering my grandpa to come get me.  So I was sent home on a bumpy bus.  The bus ride was about an hour. 

It was another hour or after I finally got home that my mom got home.  She looked at my arm, and noticed that instead of being straight like a normal forearm, there was a pronounced dip.  Then she decided that yeah, maybe we should go get it x-rayed.  Of course, and this is where I can really bitch about insurance companies, the health insurance I had at the time would not cover an ER visit for a non life threatening thing unless my PCP was called first and permission to go was given.  And you wanna know what the real fun thing about that was?  The doctor's office where I went most of my life had just changed doctors.  Only the paperwork for the insurance company hadn't been done yet to put the decision in the new doctor's hands.  So my mom had to call up the office and ask them if they knew how to get in touch with the old doctor.  They did, and the receptionist gave my mom the number for the new office.  By this time it was after hours but the office had an answering service.  So we had to wait while the answering person called the doctor at home to get him to call us.  That whole process took a little over a half hour.

Okay, so, my arm was broken at a little before 4pm, and when all is said and done we finally get in the car to drive to the hospital at around 7:45pm.  It was about a 20 minute drive to the hospital.  Luckily I did not have to sit in the waiting room for hours, they took us right back and gave me something for pain, because, you know, a broken arm really hurts.  This is where my memory gets a bit fuzzy because hospitals have good drugs.  I think an x-ray was done relatively quickly, and sure enough, the one bone was snapped in 2 places.  Then the ER doctor said they were going to have to call in the Orthopedic specialist to set it.  So I lay in a hospital bed with a still broken arm for a while.  I'm pretty sure I fell asleep at some point because at least I wasn't in pain anymore.  When the right doctor finally got there it was set (which hurt like a mother even with the drugs) and a cast was put on.  Instructions were given, and I was finally discharged.  I do remember swearing I was fine to walk on my own, then getting out into the hallway and right into a wall. 

Finally got home at almost 11pm and went to bed.  The only bright side of that whole thing was that was when we had to climb the rope in gym class, and I had a very good excuse to get out of it.  I hated gym class, and I got out of it for 8 weeks, which was awesome.     

[Iniquitous]

That kind of delay wouldn't cause problems with a broken bone.  How do I know?  Because I broke my ankle while at work at 11am.  I stayed at work till 6pm.  I walked on a broken ankle (granted it wasn't a pretty walk and took me forever to get anywhere) then I drove myself home using the toes of my right foot for the gas and my left foot for the brake (thank the Gods I learned how to drive a standard so I knew how to drive two footed).  Then I hobbled myself into the house, put ice on the golf ball sized swelling on my ankle and waited two hours for my father to show up and take me to the ER.  It was almost 12 hours before I had my ankle set and put into an inflatable cast (couldnt put it into plaster till the swelling went down).  No issues from waiting almost 12 hours.

[Serephino]

Whatever the reason, there's really no way to tell, my body decided to grow a little piece of bone between one of the breaks and the other bone.  So the two bones are connected and fixed to each other, which will not allow the bones to shift in the way they need to for me to put my palm up, type on a keyboard, or anything else that requires any kind of flexibility.  I did not have this problem when I broke my arm from falling out of my crib as a toddler.

[ReijiTabibito]

In the words of Deep Throat:

"Follow the money."

I come from a medical family; both my father and my brother are physicians; my mother was an RN (she worked at the same hospital as Dad, that's how they met).  I seriously considered going to medical school for the last year and a half that I was at university; I only decided against it because I didn't want 4 more years of schooling plus another 3-5 years of being a resident, which is not easy pancakes.

You've probably heard all about student debt, about how it's piling up faster than ever, about how difficult it is for young people who have graduated to find a good job and pay it all off - that you spend the first half of your working life, mid-20s to mid-40s, paying off your debt - and all such things.

In some respects, that's easier and harder for medical students.  I will say that it is easier that everyone who graduates from medical school is more or less promised employment upon graduation - that's what residency is.

On the other hand - they have gone to school for an additional 4 years compared to someone who got their BS or BA and walked out to the job market.  4 more years of going to school, 4 more years of debt, which can roughly double what you need to pay back.  Add to that the 'draft' nature of residency; it's a chain, just like in pro sports.

In pro sports, you do well at the high school level, go to one of the top colleges, do really well there, and then you can move up to the pro leagues, or if you're not QUITE Superman, go to the minors, and either hope there's a eventual spot for you after someone leaves, or you bust your ass and do good work there.

Medical school, you go to a college with a good pre-med or similar program and do well there, go to a good medical school and do really well there, and then the top tier of residency programs follows - and I can tell you as close to firsthand as you might imagine that residency determines your career options from there.

If you're familiar with his work on Public Defenders, what John Oliver had to say about them on LWT is more than a tiny echo of what it's like for medical professionals.