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Heart Surgery In a couple hours

Discussions related to the physiological and psychological effects of peak oil on our members and future generations.

Re: Heart Surgery In a couple hours

Postby wisconsin_cur » Mon 31 Aug 2009, 08:54:07

We have gone to a hospitalist model in my department @ my hospital. On the whole I have found it an improvement esp in two areas.

1)Intake knows exactly how many pts each MD can take on any given night so there is no guessing and fewer angry MDs in the middle of the night or in the morning.

2) Frankly, they seem to be more professional and nicer to those of us who are not MDs since we are more directly employees of one boss. While management is still differential to them (they do not want to drive them away) there are a few more levers to deal with bad behavior on the part of the MD.

There are probably downsides but from where I sit I do not experience them.
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Re: Heart Surgery In a couple hours

Postby smallpoxgirl » Mon 31 Aug 2009, 10:24:40

$this->bbcode_second_pass_quote('wisconsin_cur', 'T')here are probably downsides but from where I sit I do not experience them.


The major downside is the loss of continuity of care. The model of family medicine is supposed to be one doctor that knows you, knows your family, knows your community, knows your values, knows your medical history, and can sort of help guide you through the morass that is modern medicine and try to keep you out of some of the pot holes. The problem is that model is falling apart mostly because of RBRVS. Family doctors are over booked, over worked, and generally not doing a very good job at the above tasks. They tend to look at hospital admissions as one more straw on the camel's back. In the current climate, I agree that hospitalists are an improvement. They're only necessary though because the system is severely broken.
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Re: Heart Surgery In a couple hours

Postby HeckuvaJob » Mon 31 Aug 2009, 11:46:38

T.R. Reid: Looking Overseas For 'Healing Of America'

Excellent 30min interview on Fresh Air. Clarifies lots of the terminology and offers an overview of several different countries' systems. The author tours the globe seeking relief from his frozen shoulder. I was surprised in which country he experienced the best results.Definitely worth a listen. I'd love to see some feedback here.

$this->bbcode_second_pass_quote('', 'J')ournalist and author T.R. Reid set out on a global tour of hospitals and doctors' offices, all in the hopes of understanding how other industrialized nations provide affordable, effective universal health care. The result: his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.

Reid is a foreign correspondent for The Washington Post — in whose pages he recently addressed five major myths about other countries' health-care systems — and the former chief of the paper's London and Tokyo bureaus.

Reid was the lead correspondent for the 2008 Frontline documentary Sick Around the World, which examined five other capitalist democracies, looking for lessons on health-care delivery. His books include Confucius Lives Next Door: What Living in the East Teaches Us About Living in the West and The United States of Europe: The New Superpower and the End of American Supremacy.
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Re: Heart Surgery In a couple hours

Postby steam_cannon » Mon 31 Aug 2009, 11:56:54

Aaron, thank you for sharing and I'm glad your family has given you strength. Here's a picture, I saw it and thought: You have many friends, like a roof over your head and possibilities that stretch to the horizon on the road before you.

Image

Best wishes.
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Re: Heart Surgery In a couple hours

Postby Aaron » Sun 06 Sep 2009, 10:33:03

$this->bbcode_second_pass_quote('steam_cannon', 'A')aron, thank you for sharing and I'm glad your family has given you strength. Here's a picture, I saw it and thought: You have many friends, like a roof over your head and possibilities that stretch to the horizon on the road before you.

Image

Best wishes.


Thanks much... still mending.

It's an interesting thread so far... very timely discussion.

I'm happy to share my own experiences especially when it encourages meaningful conversation on medical reform topics.

It's a difficult topic... at once very personal, as well as societal. It just somehow seems wrong to apply free market concepts to healthcare... basically making money from people suffering & dying. On the other hand, we can't hope to "boil the ocean", and meet everybody's needs by socializing it. And is it fair to ask those who contribute real value to the world's institutions and systems, to support those who don't?

Tough Topic.
The problem is, of course, that not only is economics bankrupt, but it has always been nothing more than politics in disguise... economics is a form of brain damage.

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Re: Heart Surgery In a couple hours

Postby Pretorian » Tue 08 Sep 2009, 16:15:51

here is a simplified system: you are a rich guy, you hire yourself a doctor full-time. When you are ok doctor gets paid and doesnt even show up at work, goes fishing, whatnot. When you get sick doctor stops being paid... for as long as you are sick...
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Re: Heart Surgery In a couple hours

Postby Aaron » Tue 08 Sep 2009, 17:23:51

$this->bbcode_second_pass_quote('Pretorian', 'h')ere is a simplified system: you are a rich guy, you hire yourself a doctor full-time. When you are ok doctor gets paid and doesnt even show up at work, goes fishing, whatnot. When you get sick doctor stops being paid... for as long as you are sick...


Why not a hybrid...

Groups of patients who hire groups of doctors... the more healthy patients they can maintain, the more money they all make.
The problem is, of course, that not only is economics bankrupt, but it has always been nothing more than politics in disguise... economics is a form of brain damage.

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Re: Heart Surgery In a couple hours

Postby Pretorian » Wed 09 Sep 2009, 09:55:09

$this->bbcode_second_pass_quote('Aaron', '')$this->bbcode_second_pass_quote('Pretorian', 'h')ere is a simplified system: you are a rich guy, you hire yourself a doctor full-time. When you are ok doctor gets paid and doesnt even show up at work, goes fishing, whatnot. When you get sick doctor stops being paid... for as long as you are sick...


Why not a hybrid...

Groups of patients who hire groups of doctors... the more healthy patients they can maintain, the more money they all make.


well, sure- the situation i decribed was used when there were no specialists, by old Chinese emperors.
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Re: Heart Surgery In a couple hours

Postby Auntie_Cipation » Wed 09 Sep 2009, 11:16:46

$this->bbcode_second_pass_quote('Aaron', '')$this->bbcode_second_pass_quote('Pretorian', 'h')ere is a simplified system: you are a rich guy, you hire yourself a doctor full-time. When you are ok doctor gets paid and doesnt even show up at work, goes fishing, whatnot. When you get sick doctor stops being paid... for as long as you are sick...


Why not a hybrid...

Groups of patients who hire groups of doctors... the more healthy patients they can maintain, the more money they all make.

However, then you have a situation where the doctor declines to be hired by anyone who doesn't appear to be really healthy... kinda like being offered any job where you only get paid while things are working well -- you shy away from the jobs where it seems like there'll be troubles, and compete for the jobs that look like things hardly go wrong...

It's a good idea on the face, until the human "workaround" psychology is taken into account... :(
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Re: Heart Surgery In a couple hours

Postby Pretorian » Wed 09 Sep 2009, 18:33:15

$this->bbcode_second_pass_quote('Auntie_Cipation', '')$this->bbcode_second_pass_quote('Aaron', '')$this->bbcode_second_pass_quote('Pretorian', 'h')ere is a simplified system: you are a rich guy, you hire yourself a doctor full-time. When you are ok doctor gets paid and doesnt even show up at work, goes fishing, whatnot. When you get sick doctor stops being paid... for as long as you are sick...


Why not a hybrid...

Groups of patients who hire groups of doctors... the more healthy patients they can maintain, the more money they all make.

However, then you have a situation where the doctor declines to be hired by anyone who doesn't appear to be really healthy... kinda like being offered any job where you only get paid while things are working well -- you shy away from the jobs where it seems like there'll be troubles, and compete for the jobs that look like things hardly go wrong...

It's a good idea on the face, until the human "workaround" psychology is taken into account... :(


Thats where loads of medical schools producing swarms of doctors join the game... Some countries have doctors serving a very certain area where they are called if someone gets sick. Several hundreds of apartments or so each. One of them spent half a night with me when my T was 107.24
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Re: Heart Surgery In a couple hours

Postby Aaron » Wed 09 Sep 2009, 22:53:45

$this->bbcode_second_pass_quote('Auntie_Cipation', '')$this->bbcode_second_pass_quote('Aaron', '')$this->bbcode_second_pass_quote('Pretorian', 'h')ere is a simplified system: you are a rich guy, you hire yourself a doctor full-time. When you are ok doctor gets paid and doesnt even show up at work, goes fishing, whatnot. When you get sick doctor stops being paid... for as long as you are sick...


Why not a hybrid...

Groups of patients who hire groups of doctors... the more healthy patients they can maintain, the more money they all make.

However, then you have a situation where the doctor declines to be hired by anyone who doesn't appear to be really healthy... kinda like being offered any job where you only get paid while things are working well -- you shy away from the jobs where it seems like there'll be troubles, and compete for the jobs that look like things hardly go wrong...

It's a good idea on the face, until the human "workaround" psychology is taken into account... :(


How about one large, nation-wide group?
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Re: Heart Surgery In a couple hours

Postby smallpoxgirl » Wed 09 Sep 2009, 23:14:41

$this->bbcode_second_pass_quote('Aaron', 'H')ow about one large, nation-wide group?


Yeah. Sort of like the IRS. We'll just spend all day telling the patients that they aren't sick and raking in the bucks. :roll:

How bout we reintroduce the idea of people paying for their own medical care so that they have some incentive not to seek care they don't need and they pressure their doctors for alternatives to the care they can't afford?
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Re: Heart Surgery In a couple hours

Postby WildRose » Fri 11 Sep 2009, 12:42:29

$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('Aaron', 'H')ow about one large, nation-wide group?


Yeah. Sort of like the IRS. We'll just spend all day telling the patients that they aren't sick and raking in the bucks. :roll:

How bout we reintroduce the idea of people paying for their own medical care so that they have some incentive not to seek care they don't need and they pressure their doctors for alternatives to the care they can't afford?


Medical education (preventive medicine) would go a long way to helping the system in the USA, Canada, everywhere, if everyone could get excited about it. That, and looking to the treatments our grandmothers or great-grandmothers used instead of seeking antibiotic treatment when something has been left too long. Also, if people felt free to stay home and rest when they're under the weather - that would save a lot of health care dollars. A friend of mine from the Netherlands remembers that it was customary for someone with the flu to stay home and rest for 10 days or more - they could do so without fear of losing their job. How many people can do that? That measure alone would greatly decrease the numbers of people falling ill. If more people got adequate rest all of the time, well, I'm sure you can imagine the reduction in stress-related or induced illnesses.
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Re: Heart Surgery In a couple hours

Postby smallpoxgirl » Fri 11 Sep 2009, 13:26:44

$this->bbcode_second_pass_quote('WildRose', 'M')edical education (preventive medicine) would go a long way to helping the system in the USA, Canada, everywhere, if everyone could get excited about it.


Maybe, but it would take an entirely different type of medical education that doesn't currently exist, and really it would take a different outlook on medicine. All of the education that's currently available to lay people is built on the idea of "this is what you do until you can get them to a real doctor." It's all focused on the idea of a massive medical industry and you're teaching the lay person how to interface with the medicine factory. What would be really useful is medical education that was focused on how to stay well and not need the medicine factory. Believe it or not, I'd have to say the best thing going in that realm right now is Crossfit. They've done an excellent job of distilling down the existing research on fitness and nutrition into a useable form. Of course the ultimate would be a movement of people learning to care for lesser health problems without the medicine factory. The medical establishment would fight hard against such a movement. The best historical example I know of such a movement is the Jacksonian Populists back in the early 1800s. They managed to get all the medical licensure laws in the US thrown out and for about 50 years there was a real flurry of different holistic medical disciplines. The allopaths eventually formed the AMA and teamed up with the robber barrons to quash it. Another example is the organization "Jane" which trained lay practitioners around Chicago to perform abortions in the early 70's before Roe.
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