Universal Healthcare in the USA

[fskimospy]

That's what I don't understand. We're always told how satisfied are veterans with the VA, yet virtually all of those I know hate it.

Satisfied vet here. All my interactions with the VA were perfectly fine.

My guess is that we should trust empirical surveys over "I heard a guy said this", though. I'm sure there are people who have had horrible experiences with the VA, but again, that's why you trust stats and not anecdotes.

 

[TheVrolok]

You're saying nurses don't know that xrays are used to diagnose chronic coughing?

You over generalize because you don't understand. What is chronic coughing? When is a CXR appropriate in chronic coughing? What steps should be taken prior to ordering a CXR? What are the risk features that you make a CXR an earlier or later study? No, I don't think nurses know the answer to these questions. What you're suggesting would be a system where, "You have a cough, you get an xray," is the standard, which is incredibly wasteful and damaging.

As you jokingly suggest, yes, 100% of my dad's cancer was handled by an oncologist. 100% of my mom's cortisone shots are done by a guy who only does orthopedic stuff. It would be awesome if a family doctor would give those cortisone shots, but that's not the situation. The doctors around here don't even treat things like depression. I had to get a referral to a psychiatrist just to get fluoxetine. I've been taking that for years and it's still 100% handled by a psychiatrist. It's absurdly expensive, but that's the system. I'm left wondering if family doctors actually do anything.

It's unfortunate then, that your extremely limited anecdotal evidence has poorly colored your view of "how it really works," because that isn't the rule, it's the exception. General practitioners around here have no issue managing depression (in the vast majority of cases, unless specific therapies are needed as a result of resistant disease, ie ECT), nor diabetes, nor doing knee/shoulder/SI/finger/wrist injections. Certainly some doctors won't, all live within their personal comfort zone, but many do.

btw I'm in Spokane. Move to Spokane if you are qualified to prescribe mundane things and give cortisone injections. The metro area has about half a million people. Housing is relatively cheap because population is spread out. The climate is pretty nice. Never too hot, never too cold.

No thanks, I live in a similar region on the east coast that I like just fine.

 

[Meghan54]

You're saying nurses don't know that xrays are used to diagnose chronic coughing?

Actually, nurses generally know that Chest X-rays, or cxr's as Vrolok noted, aren't routinely ordered for chronic coughs, because the underlying cause of the cough could well be something that doesn't need a cxr to diagnose properly. A good history and physical would be some of the determining factors in ordering one.





*Retired RN

 

[glenn1]

Actually, nurses generally know that Chest X-rays, or cxr's as Vrolok noted, aren't routinely ordered for chronic coughs, because the underlying cause of the cough could well be something that doesn't need a cxr to diagnose properly. A good history and physical would be some of the determining factors in ordering one.

*Retired RN

He's missing the forest for the trees by coming up with a specific use case like this. The larger point which still stands is that you can provide medical care with the lowest qualified provider and use referrals as needed. For a clinic where the majority of cases are going to be colds/flu, minor wounds, etc you could have a team of RNs or Nurse Practioners doing the work and being overseen by a MD, perhaps even remotely. You can work out the support ratios but I'd bet for a typical clinic it could be large, on the order of an MD supervising 10, 15, 20 or even more lower qualified providers.

tl;dr Many if not most routine MD duties should be delegated to lower-trained professionals wherever possible since an MD is grossly overqualified compared to the need.

 

[TheVrolok]

He's missing the forest for the trees by coming up with a specific use case like this. The larger point which still stands is that you can provide medical care with the lowest qualified provider and use referrals as needed. For a clinic where the majority of cases are going to be colds/flu, minor wounds, etc you could have a team of RNs or Nurse Practioners doing the work and being overseen by a MD, perhaps even remotely. You can work out the support ratios but I'd bet for a typical clinic it could be large, on the order of an MD supervising 10, 15, 20 or even more lower qualified providers.

tl;dr Many if not most routine MD duties should be delegated to lower-trained professionals wherever possible since an MD is grossly overqualified compared to the need.

The problem here is an error in logic. "Common things" can't be diagnosed/managed by "the lowest common denominator" because they won't know that they're not looking at a "common things." Unfortunately, medicine is far more complicated than any of you seem to think. I suppose if you're comfortable with many conditions being misdiagnosed and all of the mortality/morbidity associated (without being able to sue for such errors), then sure, great system.

tl;dr You don't know what you don't know, and health is of too much value to make those mistakes.

 

[brycejones]

My guess is that we should trust empirical surveys over "I heard a guy said this", though. I'm sure there are people who have had horrible experiences with the VA, but again, that's why you trust stats and not anecdotes.

Stats don't drive viewership or radio listeners.

 

[Hayabusa Rider]

The problem here is an error in logic. "Common things" can't be diagnosed/managed by "the lowest common denominator" because they won't know that they're not looking at a "common things." Unfortunately, medicine is far more complicated than any of you seem to think. I suppose if you're comfortable with many conditions being misdiagnosed and all of the mortality/morbidity associated (without being able to sue for such errors), then sure, great system.

tl;dr You don't know what you don't know, and health is of too much value to make those mistakes.

People also think in terms of aggregate statistics so regulators punish providers for not treating a patient in a particular way although it might be bad medicine. Insurance companies likewise. You and I know that people are unique, but practitioners are under increasing pressure to do what is not in the best interest of the patient.

It's been painfully obvious, to us at least.

 

[TheVrolok]

People also think in terms of aggregate statistics so regulators punish providers for not treating a patient in a particular way although it might be bad medicine. Insurance companies likewise. You and I know that people are unique, but practitioners are under increasing pressure to do what is not in the best interest of the patient.

It's been painfully obvious, to us at least.

Certainly. As you're well aware there are things that are good for the population at large, and things that are good for individuals. Unfortunately, they are not always the same.