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Author Topic: Medical Ethics and Patiant Economics  (Read 2444 times)

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Offline RubySlippersTopic starter

Medical Ethics and Patiant Economics
« on: October 06, 2006, 12:46:39 PM »
I wanted to bring this up since it hit me recently in the hospital. My uncle was in there with a heart attack and he's long term unemployed and has no significant assets. Now the doctor came in and gave him a huge list of drugs, diabetic testing supplies and i know he couldn't afford them. He knew he couldn't afford them. Then we told the doctor to pick drugs off the Walmart list and handed it to him. He was shocked and refused to change the drugs including Coreg and Plavix even if generic these are not inexpensive at all. The testing supplies for his diabetes with the insulin was over $100. He then fought with the floor doctor at the hospital about this and I backed him up.

Now here is my question what are the ethics here for the medical profession. I view this as they must treat to the best of the ability of the patiant to afford the treatment and to try drugs second after diet and fitness techniques. I pointed out to the doctor just have him cut out fats and salt and sugars from his diet to a great degree and see what happens. THEN consider drugs. Or at least keep the drugs minimally required some basic ones like Lovistatin and other cheaper drugs. After all I am a Type I diabetic and with a careful diet I don't take insulin much. I do take it on occassion though Thanksgiving is still a bit much to ignore.

I then asked the doctors around the hospital if they were ever instructed in school how to trim a treatment program to the budget of the patiant. For example what if they cannot AFFORD a test or a drug were they instructed in doing a program that can be afforded. NONE were in the United States or in the West this included Harvard Medical School and others. The one doctor that was trained in that was educated partially in INDIA. So why is this?

I pointed that out to the liason person at the hospital when he complained and the doctor wanted him talked to like a child. It was simple with family help he can afford $50 a month for drugs, testing supplies and follow-up care that means four or five $4 drugs from Walmart and one doctor visit every six months to a primary care doctor. With tests of a low cost in there. They were in a shock that he would not get the customary treatment based on having no budget restraints.

I don't know why I'm rabbling here save at some point I want to get into a talk about this. Should doctors have to take a formal part of their training if fitting treatments offerings to the budget of the patiant to offer the best possible treatment within that budget? Seems to me it should be mandatory especially in a free market system where the patiant has to pay out of pocket as well as training in how to access drug assistance programs for patiants and in general care for those on limited budgets. And I mean the American Medical Association should INSIST on a in-depth program for this in every medical program in the United States and all foreign doctors working in the United States.

What do you think about these issues?

Offline Lyria

Re: Medical Ethics and Patiant Economics
« Reply #1 on: October 06, 2006, 01:09:51 PM »
I normally stay out of this section of the boards, but just thought I would interject one point.

There is free and affordable health care in the United States if people take the time and make the effort to find it. There are free and reduced cost clinics and pharmacies all over the place if your income meets it, and the income guidelines are not that unreasonable.

Call you local DHS. Tell them you need to find a clinic or doctor's office that offers free/reduced cost healthcare. They give you a list.

Should it be the doctor's responsibility to adjust a treatment plan according to the patient's income? I don't think so. They did not go to school to become financial planners. In some cases, maybe. 

Doctor's already have a lot of responsibility. They work constantly to simply keep up their knowledge of all of the new drugs and treatment methods coming out and the possible interactions among them all. Generics are not the exact same chemical make up as a non-generic. Substitution questions should be made to a pharmacist. Most times they can substitute without a call to the doctor, and if they can't, they will call the physician for permission.

The doctor is trying to save his life, the best way he knows how. If it were me, I would take the treatment plan, and then take the responsibility on myself to make it work, to find other places to get the prescriptions filled. I would go to the local clinic with the treatment plan, and often times they will write their own prescriptions for the same plan, and shred the other prescriptions.

 Not only would I do it, but I have done it. It just takes some personal responsibility to take control of a situation and make it better.

Offline robitusinz

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Re: Medical Ethics and Patiant Economics
« Reply #2 on: October 09, 2006, 03:53:13 PM »
Just wanted to make a few random points.

First, you really can't expect any one doctor to know everything.  It's just impossible.  Medicine is just such a broad field that even specialists have varying degrees of knowledge in certain sub-sections of their chosen field.  The daughter of one of my family friends had to go to two doctors and two more specialists before she was diagnosed with lupus.  Her particular symptoms were part of such a rare form of lupus that it took all that running around to discover what it was.  It'd be wrong to say that any of those doctors were incompetent, they just didn't have ALL of the knowledge required, but eventually one did.  If you can't get a doctor to fit into your budget, just get a second opinion...maybe the doctor treating you (general) just doesn't know any alternatives, which some other doctor may.

Second, I think that there are insurance and liability reasons as to why a doctor won't prescribe "budget treatment".  Maybe I'm wrong on this one, but doctors just get sued left and right for any small mishap or indiscretion with a patient.  Most people assume that their doctor is giving them the optimal treatment, not a treatment catering to their budget.  If your relative ends up dying because the doc prescribed a sub-optimal treatment, there's grounds for a sue there somewhere. 

Offline RubySlippersTopic starter

Re: Medical Ethics and Patiant Economics
« Reply #3 on: October 09, 2006, 06:29:59 PM »
We are not talking life saving treatment his heart is stented and strong it seems. We are talking long-term care treatment. I pointed out to the doctor that perhaps trying diet first might bring down his cholesterol and blood sugar and perhaps after doing that consider drugs using older medications that are commonly known to aid blood-pressure and the like might be better. There seems no reason to jump in ordering Coreg a drug that is expensive and has problems if he has to stop taking it for financial reasons until we see what can be done with natural means like a good diet. Even on a stricter diet he can still have treats we are not talking bread and water, maybe more fitness like walking etc.

I'm not talking budget treatment just minimal drug therapy which is common in most of the world as far as I can tell taking medication after other steps are not enough. And there are many good low cost drugs that are good maintenance medication. Then working with the doctor and pharmacist might come up with a good treatment program that is not overly expensive.


Offline Elvi

Re: Medical Ethics and Patiant Economics
« Reply #4 on: October 09, 2006, 07:04:21 PM »
With the greatest respect Ruby, I seem to remember being here and having this conversation before.

And the answer is simple.
You go to a doctor because they are the ones who are trained, if you are not happy with what that doctor has told you, then you go to another one.

I am not American, so I cannot comment upon the standards that you and your family recieve as far as medical treatment and can only speak in general terms.
Yet when someone who can and does contribute gives good and sound advice and makes valid points, you choose to ignore it completely.
You have not even acknowledged Lyria's points and advice and have just reiterated your first post when Robitsunz posted.

Everything seems to be a lecture with your topics, not a discussion.
 




Offline Lyria

Re: Medical Ethics and Patiant Economics
« Reply #5 on: October 09, 2006, 07:09:09 PM »
A healthy diet is always a wonderful thing for anybody, and will help with cholesterol and blood sugar. But, until the benefit of diet kicks in, drugs may be necessary to alleviate current systems. Plus, I am assuming your uncle is over forty? The chance of someone over 40 permanently altering their diet is slim. It happens, my dad did it, but it is rare. The doctor can not count on 'what ifs' to save your unlce's life. 'What if he diets?' is not a sound treatment plan.

But, not being a doctor, I can not say what is best prescribed. I take it you are not a doctor either.

Offline RubySlippersTopic starter

Re: Medical Ethics and Patiant Economics
« Reply #6 on: October 09, 2006, 07:55:13 PM »
There is another point he has no recourse he has used up the county benefits and has to rely on his own resources assisted by the family and that is $1000 a year. We did what Lyria suggested and did a cost analysis with a doctor at the nearest charity clinic and with the drug costs at the generic level, specialst visits and tests they would expect its way over that amount. Even if we get drug cost help and there are programs the tests and medical care above the primary care is going to be too much.

Now my point is simple a doctor in my opinion should provide the best treatment the patiant can afford. Why because the alternative to me is to provide a treatment program they won't do at all. Is it ethical to provide treatment that is not treatment at all because the program is beyond the budget of the patiant. Fortunately for my uncle the charity clinic doctor was much more practical and selected five drugs from Walmart the drug list that will cost $20 a month and try a good diet.

But here is a question what good is modern medicine when the best treatments are out of the ability of the uninsured in many cases to pay for?

Offline Elvi

Re: Medical Ethics and Patiant Economics
« Reply #7 on: October 10, 2006, 02:44:52 AM »
As has been said Ruby, a Doctor is there to treat a patient and to give them the best treatment he possibly can.
Unfortunately not all doctors can afford the time to be thier patient's financial planners, so you go to one that has, which your Uncle has done.

There are cost restrictions upon everything, the doctors in the UK also have to be mindful of cost and always work out if there is another cheaper alternative. In my experience, they tend to start with the cheaper more generic drugs first and if they don't work they carry on until they find the one that does.

(For example, my father was having very serious joint pain, all other medications were not working, so he got the one that would, the drug cost over 10 per dosage, which he takes twice a day. He still pays the standard prescription charge for whatever he is prescribed.)

I'm not saying our national health service is perfect, doctors are often infuriated because they know there are drugs or treatments, that could benefit a patient, yet they are not allowed to prescribe them because of the cost.

However, to answer your question, what good is modern medicine when the best treatments are out of the ability of the uninsured in many cases to pay for?

The answer is simple, those who can pay more will get better treatment than those who cannot and in a society where money is the all important factor, then it is wieghted against the poorer of that society from the start.

Offline Pumpkin Seeds

Re: Medical Ethics and Patiant Economics
« Reply #8 on: October 10, 2006, 04:09:38 AM »
I haven't posted in elliquiy in awhile, mainly due to irl issues regarding time, school, and work.  So maybe it's just my close relationship to medicine or my desire to release some frustration that spurns me to do so now.  Ruby from your words and argument, it seems you want doctors to be morally responsible for locating and recommending the cheapest medical care they can while at the same time providing the highest quality care.  Now this sounds very nice in theory and I'm sure we would all love our doctors to do vast amounts of research into generic drugs, alternative treatments, and be able to provide us a full report.  Unfortuantely, you fail to grasp the sheer amount of data that there is to deal with here.  For instance your suggestion of seeking a diet to help your family member is a wonderful idea, but you go see a nutrientionist for that.  Maybe you think the doctor should be familiar with nutrition, but I'd ask you to go to a book store and memorize the diet section while still doing your own studies.  Medicine is very specialized for a reason.

Also, what would happen if that doctor did the research for you and gave you a list of some nice generic drugs to use.  These drugs, for whatever reason, had an ill effect on your family member and they worsened.  Whose ass is now sitting in the hot seat because you wanted cost effective medicine?  That doctor is putting 12 years of schooling, plus whatever ass he had to kiss on the line because you will not do the research yourself.  Holding a list of drugs in front of a doctor and saying change them out is no way to even approach him on the subject.  That is like going to a mechanic and saying, "Well I can't afford the safe brakes so it's your job to recommend me the cheaper set but take full responsibilty if they go out and I die in a car crash."  That mechanic is going to tell you flat out NO.  You are placing way too much responsibility on an already stressed out physician. 

If you have a problem with the cost of healthcare then I congradulate you on waking up to the modern problem of medicine.  When US pharamceutical companies can sell drugs to Canada cheap enough that they are sold back to US customers at half the cost, there is a problem.  When there are scanners that can detect cancer cells before they turn cancerous, but no hospital can afford to use them...you have a problem.  Don't turn on the doctor and say its his fault that he can't find you cheap medicine, try looking to your government.

Offline RubySlippersTopic starter

Re: Medical Ethics and Patiant Economics
« Reply #9 on: October 10, 2006, 10:55:47 PM »
Actually I talked to my great grandfather a who practiced medicine since 1942 and tapped him for insights. Yes he is that old. One cannot overlook wisdom that old either. First when he was trained and was a resident it was expected and common place for a physician especially a General Practitioner to be taught to base treatment on the ability of the patiant to afford the treatment. We talked to him about my uncle and what he normally would have done before health insurance was do a diet change and fitness improvements first before any sort of more costly measures. He points out that with modern food and sweetener its far easier to do that now than back then by far. Also due to the widespread use of generic drugs its easier to offer very good treatment at a manageable price, I pointed out your concerns here but with even the Walmart list save for Lovastatin a commonly used cholesterol lowering drug there are many drugs he could offer my uncle all very well known. A major fact he had to point out to refute generics of older drugs are poor they also have well known records and in many ways are less risky than new drugs- take for example Lovastatin is a very established drug with known interactions and side effects. A new drug often has problems in that case. So the odds of a bad drug interaction are very low at this point and in many cases just giving a week of a drug will show any problems then you can try another drug for a week once one is found then do a full prescription- another practice that used to be more common to test for side effects and keep costs down for the patiant.

A principle he was taught was optimal benefit care in simple terms to provide on the budget the patiant had the best optimal result on treatment for example. If one has a modern day laborer and he could afford per month $40 one should use that to get the best result for the money spent to optimize their health. If another person with insurance could afford more than that due to their insurance provide a program on their budget is optimal for them result wise. What was important he was taught was to provide some care that was able to be done is essential for the option is a person not taking any treatment. Also to use drugs and other treatments as needed for care doing the lower cost and more natural methods first- like having a diabetic cut out sugars. Harder back then than now I have to point out. Then offer other options within the budget of the person. The sole exception was life saving surgery or treatment such as for cancer that was not negotiable but back in his day there were many more community and charity hospital programs than today.

So as you see there is a precedent and tradition in medicine of pacing care on ability to afford it, just modern doctors fail to learn how to do it. And in my great grandfathers opinion a doctor need not know more than these four things I wrote them down:

1. Nutrition

2. A list of 200 generic drugs that are well established and also have a low cost.

3. Test control namely requiring tests that are Necessary for the care of the patiant.

4. Minimal application of care, namely how to slowly raise the amount of care from the easiest to do to the hardest for medical conditions. Diet and fitness ALWAYS coming before any other options. Save for LIFE SAVING teatments that MUST be done. But for long term care taking time is often good medicine as well.

Doing this would allow for good quality long term care on a budget that people can afford out of pocket. A vital thing now that health insurance is becoming poorer and less available and more people have to pay out of pocket for treatment.

Offline Zakharra

Re: Medical Ethics and Patiant Economics
« Reply #10 on: October 11, 2006, 02:13:37 AM »
 You forgot a medical education. What today's modern doctor has to know dwarfs what the doctors of the past have had to know. They simply cannot take the time to do a detailed analysis of what can be afforded. Alot of doctors are also limited by what the insurance companies will allow too.

Offline Elvi

Re: Medical Ethics and Patiant Economics
« Reply #11 on: October 11, 2006, 02:55:16 AM »
Yes, everything your Great Grandfather said was correct, for his time asa doctor and even now when you are talking about looking after yourself.
I doubt that any doctor would argue that to remain healthy you need to eat properly and have exercise.
However, a lot has happened to both hospitals, medicine and society's structure in 60+ years.
As the knowledge and the population has increased, so have the fields that Hospital Doctors line of specialisation narrowed.

You were given a plan, from a doctor who I assume, specialises in heart problems.
You took the plan to a doctor who specialised in dealing with people who could not afford to pay for the drugs prescribed, who then looked at it and worked out a suitable alternative.

You have seen doctors who are in different fields and have used their expertease and training to get what was needed.
Surely that is the whole point?



Offline robitusinz

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Re: Medical Ethics and Patiant Economics
« Reply #12 on: October 11, 2006, 09:37:27 AM »
Disclaimer (skip if you don't care):  Alright...I'm gonna take a drastic turn here.  The social darwinist in me is bubbling.  Now, I want to preface everything that follows by saying that in *practice* I am a very humane and caring individual, full of compassion for my fellow man, and were I to see another person suffering and were I able to do something about it, I most certainly would.  So the following is simply an idea, another viewpoint in the discussion, not the codes of life to which I adhere to.  That being said...


   With the advance of modern medicine, the question of who DESERVES what treatment is more important than ever.  Ruby cited her 1940s-trained grandfather as a source of medical knowledge, but the world has revolved many times in 60 years (over 60 times, in fact!).  Back then, there really wasn't much choice in treatment...if you had X problem, you took Y0, Y1, or Y2 drug, or you simply did some sort of homeopathic remedy and hope your problem didn't get any worse, or that you didn't die.  If you were unlucky enough to have mental instability, you got some electroshock, or possibly a lobotomy.  Today, if you have X problem, you can take Y0 to Y100 drug, or have the same alternatives as before. 
   Now, considering that drugs have gotten more and more effective, and what used to be a HUGE problem back in 1940 can be taken care of easily today (penicillin was invented in 1928 and it wasn't until 1942 that it was *first* successfully used on a patient...thank you, wikipedia), you've got to ponder who actually deserves the more expensive, yet effective medicines, and who doesn't.  What exactly is the cost of the "right" to life?  Is there even such a thing as a right to life?  Is medicine something that falls into the basic system of the free market?
  Here's the really evil question, though...if people can't afford medicine, shouldn't they just die?  It's survival of the fittest after all, natural selection.  Those who have the means to should live, while those who don't shouldn't even worry about it.  Today doctors have the option to use insanely expensive drugs and treatments to keep people with failing kidneys and hearts alive.  Who actually "deserves" those treatments?  In 1940, if your kidneys failed, you were screwed.  Today, there's dialysis, quite the expensive procedure.  Now that the option is available, who exactly should exercise it?
  A doctor's job is to simply lay out options.  It's the patient's job to dictate what she's going to do.  Don't want to pay for expensive treatments?  Ok, just die then.  That's what would've happened 60 years ago, since we didn't have all these new-fangled drugs to save your life.  You wanna exercise and diet *NOW*?  Ok...cool...that's your choice.  Go ahead and do that...but, hey, if you're 40+, with a bad heart, you're bordering on "too little, too late".  There are ALWAYS options, the fundamental question is whether or not people *deserve* X, Y, or Z treatments.

My true, personal opinion is that no one DESERVES anything...you work for what you want, and that's that.  If you can't afford medicine, well, too bad.  I *choose* to live my life with compassion however, and even though I don't feel that my neighbors are *deserving* of the air they breathe, I still respect them as individuals and would give them a hand or three if they needed it.  Being alive entitles you to nothing other than the opportunity to do something with said life.  If at some point your health fails and you can't afford the medicines to prolong it, then you've managed to live to the extent of your *natural* life.  Disease and illness is natural...if you're meant to go, you're meant to go.  Medicine just gives us an opportunity to fight against that and prolong our lives...that's not something that everyone simply deserves to be able to do.  If you can afford it, go for it...if not, well, at least try to say goodbye before you go.

Offline Sakujo

Re: Medical Ethics and Patiant Economics
« Reply #13 on: January 07, 2008, 02:54:19 PM »
I know this is an old topic, but I wanted to toss in an opinion slightly on Ruby's side here, since it seems the rest are apologetics of sorts for the doctors. Having dated a recent RN graduate and hearing her stories, what I can tell you i that, sadly, it seems that both nurses and doctors are far less concerned with their patients than the public would like to believe. More or less, they function as a business, and that's why they've gone to school: to make money. Few, from her experience, are truly concerned with the patient and will take extra time to work with them, especially considering the volume of patients they have.

This isn't to say that all doctors are this way, but I can say the same issues showed up int eh last three years when my diabetic grandmother was on the downward slope and eventually went onto dialysis. I'm not saying that this is the norm, but that it's prevalent enough to be a concern.

How this specifically relates is in the topic itself, Ethics. I just finished my Ethics course at my university, and then discussed with with my ex, and found out that their course had skipped over some sections that we covered, while going over others, but in both of our classes, the nursing students seemed relatively unconcerned with others and the issues at hand. They were out to cover their asses.

This, I think, is one of the crucial areas that needs help: the Ethics instruction in classes. Isn't this part of why people are required to do real work before practicing for cash? Have some of these people no empathic ability, whatsoever?

I don't expect a doctor to know everything about everything, but I do expect them to do their job well enough, which to me includes caring, to be responsive when issues and requests are brought up.

Offline Elvi

Re: Medical Ethics and Patiant Economics
« Reply #14 on: January 07, 2008, 03:04:34 PM »
Again and especially after recent experiences where my daughter is having to go to see the local GP and hospital specialists, I have to say that thses experiences are not those that I have ever had here....

Offline Swedish Steel

Re: Medical Ethics and Patiant Economics
« Reply #15 on: January 07, 2008, 03:54:06 PM »
That's not the impression I've gotten, but then again, I live in a country far superior in almost every way.  :P
I can tell you that very few in my class is in it for the money, though they sure won't hurt after being a poor student for ages, and I've had the privelige to hang out with quite a few dedicated and brilliant doctors lately. In very few cases the decline of the health care can be blamed on the hospital staff, rather it's the shortsighted politicians and other economic interests that keep demanding that we grab our ancles over and over again.

Offline Elvi

Re: Medical Ethics and Patiant Economics
« Reply #16 on: January 07, 2008, 04:10:22 PM »
That's a deffinite nod of agreement there Swede.
Both my local GP and the Registrar, we saw at the hospital with Beasty, have both been willing to spend time, with a twelve year old, who to all intense and purposes looks fitter than a butcher's dog.

They certainly don't seem jaded or lacking in care and attention both to their patients and their work.
Hell I know how easy it is to become jaded in the work we do, but in the many experiences I've had (and my family), I can honestly say that I have only had one bad experience with a member of the medical profession...

Offline Sherona

Re: Medical Ethics and Patiant Economics
« Reply #17 on: January 07, 2008, 04:19:03 PM »
well I have had 2 really bad experiances with doctors..one I won't go into as I know some men are really squeamish about labor and deliver details, though I did tell that story to S. and Elvi..suffice to say I was in need of 13 extra stitches in a particular area that is quite private :P as well as the male doctor kept referring to that area as my "Muff"...(which incidentally is why I can not call Muffdiver Muff...just can't do it) quite unprofessional slap in the face on top of the trauma I had already endured in the delivery of my first child.

The second was when I went to the doctor complaining of insomnia as well as other private symptoms and the doctor (a different one) wihtou doing any bloodwork..without doing anthing other then asking about how long the symptoms had exhibited themselves told me I was Chronically Depressed and prescribed Welbutrin (which is a anti-depressant with some major side effects including suicidal tendancies) Well I took them as directed and after two weeks I took myself right off them...I was so irritable I was screaming at my husband for chewing his food too loudly, flying off the handle so badly that I had to often call my Mom to come get the kids so I could have a bit of a break (and I have never gotten so upset to do that up to that point, and never have since..) I was crying eveyr five minutes when I wasn't screaming at someone..it was bad...I told the doctor and insteadof working with me she just told me "Well sometimes the cure is worse then the illness"...

Went to a different doctor a year later, (while still enduring ever worsening symptoms) over a simple cold...I was a new patient, so the doctor as a routine thing for her practice drew SIMPLE bloodtest and called me up the day they came back in and told me to get to her office when I could...I went..apparently my thyroid had been kaput for a while as I had none of the hormones present that the thyroid makes...I asked and almost all ofthe symptoms I had complained to the first about was caused by lack of these hormones..so really...simple blood test would have made my life so much easier for a year if the one doctor had bothered to test..

Offline Swedish Steel

Re: Medical Ethics and Patiant Economics
« Reply #18 on: January 07, 2008, 04:23:52 PM »
Ah. Hypothyroidism. You're taking, hmmm, Levoxyl then?

Offline Elvi

Re: Medical Ethics and Patiant Economics
« Reply #19 on: January 07, 2008, 04:26:42 PM »
Unfortunately, no proffesion can be completely blameless, there are those and for many different reasons, are incompitant.
The fortunate thing is that myself and my family (and with a very ill mother, who has been for most of my life), we have not been on the recieving end of.

Of course, yet again, I need to say that I am not in America, I am in the UK where no-one is deprived of treatment or medication.

Offline Sherona

Re: Medical Ethics and Patiant Economics
« Reply #20 on: January 07, 2008, 04:28:40 PM »
Ah. Hypothyroidism. You're taking, hmmm, Levoxyl then?

I believe I take the offbrand of Levoxyl..Leviothrine...will have to go look up the exact spelling and wtih kidlets getting into a locked medicine cabinet is a pain :P Tomorrow when I take my pill I will look.

Offline Swedish Steel

Re: Medical Ethics and Patiant Economics
« Reply #21 on: January 07, 2008, 04:31:17 PM »
Won't tell me much anyway, we don't have the same brands here in Europe. My mother takes Levaxin, I belive. Of course, she had hyperthyroidism, but since they had to remove her thyroid gland she pretty much ended up with something like you got.

Offline RubySlippersTopic starter

Re: Medical Ethics and Patiant Economics
« Reply #22 on: January 07, 2008, 07:15:53 PM »
I found a doctor from Cuba that opened up a practice in the area that is cash only and funny thing HE can do all the general medicine needed. I had an ingrown toehold and guess what he took care of it in the office. That was a first. And I paid only $80 for the visit and $25 for the prcedure. And he has a list of generic drugs from Walmart and Target that are $4 and likes to prescribe from those.

I do get specialists are important but how come he is the first GP that bothered to not refer me to a specialist for a minor procedure, as opposed to a more serious one. My grandfather is seeing him and is getting excellent hands-on care. How come Cuba trains doctors to be so empathic and sensible with a wide range of skills and an American Family Practitioner (board certified) won't and they are supposed to have a broad area of knowledge and skills? It seems to me that a primary care doctor should be able to handle most minor and even more serious cases themselves in-office not requiring surgery or dealing with a more serious condition.


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Re: Medical Ethics and Patiant Economics
« Reply #23 on: January 07, 2008, 08:11:31 PM »
The biggest reason, imho, is the f'ing insurance companies.  We recently had a genetic test done on my 6 year old son to rule out something that the geneticist said could have been a possibility and we had to pay for it because the insurance company didn't deem it necessary.  How the hell are doctors supposed to do their jobs when they're second-guessed by some asshole pencil-pusher who checks a spreadsheet?!  If you can't tell, this REALLY pisses me off.  I work, my husband works, we have good insurance, and we still have to put up with subpar care, not because of the doctors but because of the insurance company.

Let a GP give you advice on something that's specialized... and later, if it doesn't work, you can sue him.  It sucks, but it's true, and he'd be crazy to risk that.  The fact is sometimes medical treatments work and sometimes they don't... some drugs work for some people and not others... my heart breaks for people who suffer, but I can't expect my doctor to be psychic.  If I don't like his/her diagnosis I can get a second opinion.  Of course that's outrageously expensive if the other doctor isn't in my insurance plan... *growl*

Rubyslippers, I'm surprised by many of your sentiments here... they're pretty diametrically opposite the views you expressed regarding survival of the fittest in the global warming thread.

Offline RubySlippersTopic starter

Re: Medical Ethics and Patiant Economics
« Reply #24 on: January 07, 2008, 09:02:20 PM »
Not really its a free market position a patient is a CUSTOMER and if I get a haircut I know how much something costs up front, if I hire a taxi I can get a good idea of the price and if I see a physician they should have simple pricing and be expected to treat minor conditions. Specialists are important but its clear most GP's are glorified nurses they don't seem to want to practice medicine. And I'm not saying a GP must do everything but simple in-office care should be in their skill range.