Obama: Forgo surgery, take painkillers to 100+ year old woman.

[271559]

[YOUTUBE]http://www.youtube.com/watch?v=8WnxsuVqSo8[/YOUTUBE]

Obama: Forgo surgery, take painkillers to 100+ year old woman.

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[grabbinsumpeels]

Obama: Forgo surgery, take painkillers to 100+ year old woman.

Wow, not only was this not Obama's main point (he was discussing the difficulties involved in end-of-life care decisions), he was presenting a hypothetical dealing with eliminating wasteful spending on unneccessary procedures (if a certain procedure has been shown to be ineffective for elderly patients presenting with a particular condition, palliative care should also be considered).

 

[Quadratic]

Wow, not only was this not Obama's main point (he was discussing the difficulties involved in end-of-life care decisions), he was presenting a hypothetical dealing with eliminating wasteful spending on unneccessary procedures (if a certain procedure has been shown to be ineffective for elderly patients presenting with a particular condition, palliative care should also be considered).

It's hard for people to analyze when they have an agenda.

But in any case, I'd be worried about performing surgery on a 100 yr old heart too. The risks are incredible and I'm sure the paperwork is too.

 

[Greonis]

Wow, not only was this not Obama's main point (he was discussing the difficulties involved in end-of-life care decisions), he was presenting a hypothetical dealing with eliminating wasteful spending on unneccessary procedures (if a certain procedure has been shown to be ineffective for elderly patients presenting with a particular condition, palliative care should also be considered).

I agree, that quote was taken grossly out of context.

The core of his response is that we rethink our approach to end-of-life care, that we understand that it is not always best for a patient in his or her last days to receive certain types of treatment. Given how many healthcare dollars are spent each year keeping humans alive who really should have been allowed to pass on naturally, it is quite a valid point, and I'm glad that it is finally being talked about. For as much as we want to blame static entities for the problems in our healthcare system (the government, the free market, etc...), a lot of positive change could also be effected by simply reevaluating our mindsets when it comes to those at the end of their days.

 

[xanthomondo]

I think a more alarming video clip of Obama is here:

[YOUTUBE]ZhNeGYYPgIE[/YOUTUBE]

For those who don't want to watch, Obama basically says that doctors are greedy and will perform unnecessary procedures that are not in the patient's interest just to line their wallets.

"Taking out tonsils instead of diagnosing allergies"

...and what was so great about this clown that everyone voted?

 

[Pianoman32]

I agree, that quote was taken grossly out of context.

The core of his response is that we rethink our approach to end-of-life care, that we understand that it is not always best for a patient in his or her last days to receive certain types of treatment. Given how many healthcare dollars are spent each year keeping humans alive who really should have been allowed to pass on naturally, it is quite a valid point, and I'm glad that it is finally being talked about. For as much as we want to blame static entities for the problems in our healthcare system (the government, the free market, etc...), a lot of positive change could also be effected by simply reevaluating our mindsets when it comes to those at the end of their days.

And tell me oh wise one, how do we know when it is ones final year of life?

 

[Bacchus]

There's no reason to perform surgery on a 100 year old. Like we said in other threads, learn when enough is enough. And here, clearly enough is enough.

 

[Pianoman32]

There's no reason to perform surgery on a 100 year old. Like we said in other threads, learn when enough is enough. And here, clearly enough is enough.

I've seen 100 year olds look like they are 65 and 65 year olds look like they are 100.

 

[theroadtomed]

I think a more alarming video clip of Obama is here:

[YOUTUBE]ZhNeGYYPgIE[/YOUTUBE]

For those who don't want to watch, Obama basically says that doctors are greedy and will perform unnecessary procedures that are not in the patient's interest just to line their wallets.

"Taking out tonsils instead of diagnosing allergies"

...and what was so great about this clown that everyone voted?

For one, I actually had that happen to me...so it's not completely unrealistic. Two, have you never heard of the studies in cardiology of doctors racking up money in procedures they know are probably unnecessary, or almost always choosing the more expensive procedure. You would be extremely naive to think that there aren't plenty of doctors out there right now that choose procedures based on how much money they'll make from it. This is especially true when many pay systems now are set up so that a physician is payed more based on what procedure they do (if they're not in private practice). Think ER physicians, who are payed more based on procedures, not time spent with patients, etc.

 

[Pianoman32]

For one, I actually had that happen to me...so it's not completely unrealistic. Two, have you never heard of the studies in cardiology of doctors racking up money in procedures they know are probably unnecessary, or almost always choosing the more expensive procedure. You would be extremely naive to think that there aren't plenty of doctors out there right now that choose procedures based on how much money they'll make from it. This is especially true when many pay systems now are set up so that a physician is payed more based on what procedure they do (if they're not in private practice). Think ER physicians, who are payed more based on procedures, not time spent with patients, etc.

Most ER physicians don't work for the hospital, they work through a contracted agency on a yearly salary.

 

[red10]

I think a more alarming video clip of Obama is here:

[YOUTUBE]ZhNeGYYPgIE[/YOUTUBE]

For those who don't want to watch, Obama basically says that doctors are greedy and will perform unnecessary procedures that are not in the patient's interest just to line their wallets.

"Taking out tonsils instead of diagnosing allergies"

...and what was so great about this clown that everyone voted?

I don't totally disagree with him. I mean of course we'd like to think that every doctor has our best interest at heart etc etc and I doubt a doctor is going to pop someone's tonsils out instead of trying an allergy med first, but the reality is that there are doctors out there who will write a Rx for the more expensive drug while an older one works just as well because they get more money for giving out the newer drug.

I know someone who's aging mother has been on the same medicine for years, it works great and is cheap because its an older drug. When the mother went in to get a new Rx written, the doctor tried to give her a newer drug, not because it was any more effective or had less side effects, but because it was newer and he was getting $$ for giving it out.

Also some doctors will have multiple tests done even though they pretty much know the tests will come back negative to a)cover their butts and please the patient and b) get more money

not every doctor is bad but not every doctor is good either

 

[TexasFight]

I don't totally disagree with him. I mean of course we'd like to think that every doctor has our best interest at heart etc etc and I doubt a doctor is going to pop someone's tonsils out instead of trying an allergy med first, but the reality is that there are doctors out there who will write a Rx for the more expensive drug while an older one works just as well because they get more money for giving out the newer drug.

I know someone who's aging mother has been on the same medicine for years, it works great and is cheap because its an older drug. When the mother went in to get a new Rx written, the doctor tried to give her a newer drug, not because it was any more effective or had less side effects, but because it was newer and he was getting $$ for giving it out.

Also some doctors will have multiple tests done even though they pretty much know the tests will come back negative to a)cover their butts and please the patient and b) get more money

not every doctor is bad but not every doctor is good either

While I haven't met as many doctors as the average med student or resident, in my experience, it seems like doctors tend to prescribe the them the drug with the bigger kickback if the patient has insurance. Nearly in all cases, the doctor would take into consideration who was paying for the meds. If it was coming out the patient's pocket, I felt he/she would prescribe the cheaper and just as effective or nearly just as effective med instead. Otherwise, screw the insurance company that has been screwing him/her for years.

 

[Rendar5]

Think ER physicians, who are payed more based on procedures, not time spent with patients, etc.

Umm...actually we get paid per patient, per acuity level, or paid on a simple yearly salary, not by procedure. Procedures actually slow us up from seeing more patients. We only do them if we feel they're necessary to rule something out or because the patient expects them and we dont' want to get sued in case we miss something (not a good reason, but it's done that way by some people). Not to mention that if people dont' want to pay, a lot of times they just don't pay the bill they receieve.

ER doctors deal with a population that comes in for emergencies, so we have to look for any and all life-threatening issues. If we order extra tests it's either to do this, or because we are worried that we will be sued for missing something (again, not a good reason, and i dont' believe anyone that says capping malpractice will fix this attitude). I'm trying to train to be one of those who orders the minimum tests and performs the minimum number of procedures, but it is still hard.

EDIT: btw to the op, I'm not a big fan of Obama's proposals, and I didn't view that video, but if he proposes conservative management for someone over 100, he actually proposed something good for healthcare. Now obvious if this is a 100 year old who's still active, golfing, and has full cognitive function, this doesn't apply, but that is rarely the case, and I see tons of ppl seeking inappropriate life-saving care for parents they can't let go of instead of seeking more proper palliative and hospice care.

 

[drzing]

obama sucks

 

[red10]

EDIT: btw to the op, I'm not a big fan of Obama's proposals, and I didn't view that video, but if he proposes conservative management for someone over 100, he actually proposed something good for healthcare. Now obvious if this is a 100 year old who's still active, golfing, and has full cognitive function, this doesn't apply, but that is rarely the case, and I see tons of ppl seeking inappropriate life-saving care for parents they can't let go of instead of seeking more proper palliative and hospice care.

Exactly.
Problems come from people who expect better medicine means cheating death a little longer, instead of seeing it as an improved quality of life for the time they have.
I forget the statistic but the money we pay for healthcare (talking life prolonging treatments) for patients in their last year of life is ridiculously high.

 

[Rendar5]

Exactly.
Problems come from people who expect better medicine means cheating death a little longer, instead of seeing it as an improved quality of life for the time they have.
I forget the statistic but the money we pay for healthcare (talking life prolonging treatments) for patients in their last year of life is ridiculously high.

Had a patient came in whose dad was unresponsive for the last month since a catastrophic bleed, was sent home with a hospice nurse. On the 2nd day home, the patient developed difficulty breathing and had a death rattle (I think that's what it was called), it should've been the patient's final day, at home, with his family. The son coudln't deal with it, brought his dad into the ED, they put him on CPAP, restored his breathing, and began some antibiotics. The patient's son was better than most and realized there wasn't going to be a good outcome after a couple days on the floor, and allowed us to move him to a palliative floor. We just left him on the CPAP, with an antibiotic drip, spending 30 more days in the hospital before his death. Now that situation could've been better, the patient should've been allowed to die at home instead of coming to the hospital and racking up the costs associated with 30 days of "relatively" conservative management.

It is commonly worse than that, though. Most families would not have been as accepting of the impending death and asked for/demanded more agressive therapy for their unresponsive father. They would've wanted their father intubated, they would've wanted CT scans, they would've wanted blood culture results and used the most expensive antibiotics availalbe for any resistant bacteria, and with a much more expensive service, the patient woudl've remained unresponsive for maybe 2 months before dying.

 

[Excelsius]

[YOUTUBE]8WnxsuVqSo8[/YOUTUBE]

Obama: Forgo surgery, take painkillers to 100+ year old woman.

You are watching too much Fox. Once in a while you should also watch some news, and better yet, read some.

 

[Excelsius]

I think a more alarming video clip of Obama is here:

[YOUTUBE]ZhNeGYYPgIE[/YOUTUBE]

For those who don't want to watch, Obama basically says that doctors are greedy and will perform unnecessary procedures that are not in the patient's interest just to line their wallets.

"Taking out tonsils instead of diagnosing allergies"

...and what was so great about this clown that everyone voted?

And you know that this is not the case? Ok, I am sure that some doctors do this due to greed; however, I think that what is more prevalent is ignorance. I know a lot about allergies because they hit close to home. One doctor who specialized in allergies told me that mostly surgeons cut, but you can't cut out an allergy.

You also conveniently seem to ignore the other part of the speech that is actually good for doctors - he says that he wants to make sure that it is the doctor who is making the decision about a procedure, not the insurance company. Now if he thought that all doctors were greedy, he wouldn't say that. You're just wrong. On everything.

 

[Aljazera]

You are watching too much Fox. Once in a while you should also watch some news, and better yet, read some.

But that was ABC....

and jessep was making a comment based solely on what Obama said in that ABC televised speech...

 

[redsquareblack]

Umm...actually we get paid per patient, per acuity level, or paid on a simple yearly salary, not by procedure. Procedures actually slow us up from seeing more patients. We only do them if we feel they're necessary to rule something out or because the patient expects them and we dont' want to get sued in case we miss something (not a good reason, but it's done that way by some people). Not to mention that if people dont' want to pay, a lot of times they just don't pay the bill they receieve.

ER doctors deal with a population that comes in for emergencies, so we have to look for any and all life-threatening issues. If we order extra tests it's either to do this, or because we are worried that we will be sued for missing something (again, not a good reason, and i dont' believe anyone that says capping malpractice will fix this attitude). I'm trying to train to be one of those who orders the minimum tests and performs the minimum number of procedures, but it is still hard.

EDIT: btw to the op, I'm not a big fan of Obama's proposals, and I didn't view that video, but if he proposes conservative management for someone over 100, he actually proposed something good for healthcare. Now obvious if this is a 100 year old who's still active, golfing, and has full cognitive function, this doesn't apply, but that is rarely the case, and I see tons of ppl seeking inappropriate life-saving care for parents they can't let go of instead of seeking more proper palliative and hospice care.

I agree. There seems to be a great deal of discomfort with the idea that sometimes, the best (and most humane) approach is to do nothing.

Also, the doctor probably realized that even if he OK'd the surgery, the Anesthesiologist would say "Bull****".

 

[riceman04]

[YOUTUBE]http://www.youtube.com/watch?v=8WnxsuVqSo8[/YOUTUBE]

Obama: Forgo surgery, take painkillers to 100+ year old woman.

I am just wondering if you are planning to list all of your interviews in your signature. If so, why?

 

[bamtuba]

There's no reason to perform surgery on a 100 year old. Like we said in other threads, learn when enough is enough. And here, clearly enough is enough.

I don't disagree with this statement.

However, as to what the OP posted and the ensuing debate, I want to just chime in with what really gets me about this whole deal:

One's PHYSICIAN should be helping to make this choice with THE FAMILY.

THE GOVERNMENT has no right to be making this call, as will happen very soon.

Once employers have the opportunity to drop privatized coverage in favor for a "no-cost" alternative, very few, if any will be able to have non-gov. coverage.

This=really bad idea.

Flame away guys.

 

[jkurtz02]

I don't disagree with this statement.

However, as to what the OP posted and the ensuing debate, I want to just chime in with what really gets me about this whole deal:

One's PHYSICIAN should be helping to make this choice with THE FAMILY.

THE GOVERNMENT has no right to be making this call, as will happen very soon.

Once employers have the opportunity to drop privatized coverage in favor for a "no-cost" alternative, very few, if any will be able to have non-gov. coverage.

This=really bad idea.

Flame away guys.

I agree with you that it should be the physician and family should be the ones making the decision, but what family is going to say "you are right keeping my mother alive this way is no quality of life for her and we should use palliative care until she passes in peace", and not even House (I know fictional character, but it actually works here) would be obnoxious enough or dumb enough to open themselves up to a lawsuit by telling the family I don't think your mother needs this to keep them alive...So while I agree it should be that way realistically it can't be and the only people who be a big enough d*ck to say this would be the government.

 

[red10]

But that was ABC....

and jessep was making a comment based solely on what Obama said in that ABC televised speech...

watching too much fox is a good way to learn how to think like the people on Fox. You end up catastrophizing and not listening very well, IMO

 

[Bacchus]

I've seen 100 year olds look like they are 65 and 65 year olds look like they are 100.

The heart is still a hundred years old. It is going to fail, probably soon. There are always outliers. However, sustaining a 100 year old's life is futile.

 

[Greonis]

And tell me oh wise one, how do we know when it is ones final year of life?

I have no idea. That is a question that should be handled on a case-by-case basis between each patient and those close to him or her (including the physicians).

Still, I feel that in many (but not all) cases, people have unrealistic views of how their loved ones should be cared for after said loved ones can no longer have a quality of live that enables them to be cognizant, functional human beings. Because of a gamut of different reasons - from physicians being too fearful to bring the topic up, to families putting too much stock into the capabilities of the health care system, to families having little to no financial obligations - it is often demanded that those who would be better off receiving palliative care instead be kept alive using all of the resources at physicians' disposal.

And what is gained from these incessant, costly endeavors? Certainly not the satisfaction of recovery, since people whose minds have left them can almost never recover their former selves. Rather, this preservation of a shell has become a form of evasion, to stall the pain of losing a loved one to what should (in most cases) be a natural death from old age. That is why so many turn to nursing homes, for they will take responsibility for the living bodies and allow the families to live with quixotic notions of their loved ones recovering and being as they used to be. If only it could be realized that facing death for what it is - a natural part of the life cycle - would ease the internalized pain of the families (no doubt something that constantly hovers over any family with relatives receiving some sort of end-of-life care) and allow them to say goodbye to their loved ones with dignity (instead of, say, in a hasty, undignified manner after a complication during one of many ER visits). Not to mention, when you consider that the government foots the bill for the majority of these nursing home cases, you can see why so many are so willing to turf their responsibility and why addressing this issue would be beneficial to society in an economical sense as well.

In an ideal world, I would be all for keeping everyone alive with the hopes of them being able to make miraculous recoveries. But we do not live in such a world, and to continue our current trends is to maintain that which is both unsustainable and impractical. Moreover, in addressing the question within the quote above, I would be one of the first to admit that it is very difficult to determine when an individual should no longer receive treatment, and when their "humanity" has truly left them for good. But, it is my belief that society having a better understanding of the intricacies of end-of-life care will help the majority of families make the best choices for themselves, their loved ones, and the whole community when it becomes necessary to do so.

 

[red10]

And tell me oh wise one, how do we know when it is ones final year of life?

Ask a doctor who has told someone they have 5 months to live.

Although some people die suddenly, when we're talking 100 year old people, chances are you see a decline and think "I'll be surprised if the live to see next christmas." If you've ever had a grandparent die of old age, its often the case that you can see the end is near. My boyfriend's grampa has started having more and more health problems lately, his mental capacity has suddenly dropped and you can just tell he won't be around much longer. Even HE knows.

 

[niranjan162]

You are watching too much Fox. Once in a while you should also watch some news, and better yet, read some.

those sneaky fox bastards, disguising themselves as abc and CNN. What will they do next?!?!?!

 

[Tabeeb12]

I think a more alarming video clip of Obama is here:

[YOUTUBE]ZhNeGYYPgIE[/YOUTUBE]

For those who don't want to watch, Obama basically says that doctors are greedy and will perform unnecessary procedures that are not in the patient's interest just to line their wallets.

"Taking out tonsils instead of diagnosing allergies"

...and what was so great about this clown that everyone voted?

read the Cost Conundrum by Atul Gawande in the New Yorker.

 

[vokey588]

I don't disagree with this statement.

However, as to what the OP posted and the ensuing debate, I want to just chime in with what really gets me about this whole deal:

One's PHYSICIAN should be helping to make this choice with THE FAMILY.

THE GOVERNMENT has no right to be making this call, as will happen very soon.

Once employers have the opportunity to drop privatized coverage in favor for a "no-cost" alternative, very few, if any will be able to have non-gov. coverage.

This=really bad idea.

Flame away guys.

The point is to not to stop doctors from intervening late in life, but to take away a direct incentive to overtreat at the end of life. It is still the doctor's decision but Obama's changes allow the doctor to make a more objective decision.

Also, it is expected that the Senate's healthcare bill may wean the country off of employer-provided insurance by creating a health insurance exchange that makes it easier for families to pick a health insurance plan on their own without getting bogged down in very confusing details. I have a feeling that the final bill will not include the fine on employers for not providing health insurance.

 

[niranjan162]

And you know that this is not the case? Ok, I am sure that some doctors do this due to greed; however, I think that what is more prevalent is ignorance. I know a lot about allergies because they hit close to home. One doctor who specialized in allergies told me that mostly surgeons cut, but you can't cut out an allergy.

You also conveniently seem to ignore the other part of the speech that is actually good for doctors - he says that he wants to make sure that it is the doctor who is making the decision about a procedure, not the insurance company. Now if he thought that all doctors were greedy, he wouldn't say that. You're just wrong. On everything.

all he says is a bunch of two faces nonsense, I dont know how people fall for it.

Thats like me saying "with all due respect, youre an *******"

its doesnt mean anything. O yea lets give doctors the ability to make the decision, but we cant trust their decisions.

 

[xanthomondo]

And you know that this is not the case? Ok, I am sure that some doctors do this due to greed; however, I think that what is more prevalent is ignorance.

This is NOT what Obama said. He said that a doctor will choose to remove tonsils rather than treat allergies when looking at the pay schedule

He stated that doctors will go against what they believe is best for the patient, simply because what is best for the patient won't get the doctor enough money.

I know a lot about allergies because they hit close to home. One doctor who specialized in allergies told me that mostly surgeons cut, but you can't cut out an allergy.

You also conveniently seem to ignore the other part of the speech that is actually good for doctors - he says that he wants to make sure that it is the doctor who is making the decision about a procedure, not the insurance company. Now if he thought that all doctors were greedy, he wouldn't say that. You're just wrong. On everything.

I just have to laugh at this. Sure, Obama says that he wants the doctors to make the decisions (that sounds great!). But how many of his other talking points did he back down on? Do you think he'll suddenly change and keep his promises? My beef with his statement says that doctors intentionally perform malpractice if it's best for their wallets

Just keep blindly loving Obama

 

[xanthomondo]

For one, I actually had that happen to me...so it's not completely unrealistic. Two, have you never heard of the studies in cardiology of doctors racking up money in procedures they know are probably unnecessary, or almost always choosing the more expensive procedure. You would be extremely naive to think that there aren't plenty of doctors out there right now that choose procedures based on how much money they'll make from it. This is especially true when many pay systems now are set up so that a physician is payed more based on what procedure they do (if they're not in private practice). Think ER physicians, who are payed more based on procedures, not time spent with patients, etc.

Again, you're looking at this from a patient's perspective, so you don't really know what the doctor is thinking when he prescribes or does something. Do you have a link to the cardiology studies?

I don't totally disagree with him. I mean of course we'd like to think that every doctor has our best interest at heart etc etc and I doubt a doctor is going to pop someone's tonsils out instead of trying an allergy med first, but the reality is that there are doctors out there who will write a Rx for the more expensive drug while an older one works just as well because they get more money for giving out the newer drug.

I know someone who's aging mother has been on the same medicine for years, it works great and is cheap because its an older drug. When the mother went in to get a new Rx written, the doctor tried to give her a newer drug, not because it was any more effective or had less side effects, but because it was newer and he was getting $$ for giving it out.

Again, this is a personal anecdote, coming from the patient's perspective. You really have no idea what the doctor is thinking when he prescibes the new medication. How do you know he didn't believe that it would be better for the patient? Even if it's the same, this isn't what Obama was talking about. What Obama says is that a physician will give out drugs with MORE side effects than other treatments, simply because the doctor will pocket more money.

Also some doctors will have multiple tests done even though they pretty much know the tests will come back negative to a)cover their butts and please the patient and b) get more money

not every doctor is bad but not every doctor is good either

That has really nothing to do with this conversation, but remember, Obama has stated before that he is not interested in reforming malpractice. Covering their butts has nothing to do with making $$.

I think you throw "to get more money" in there simply for the sake of argument, you really have no proof or evidence of that.

While I haven't met as many doctors as the average med student or resident, in my experience, it seems like doctors tend to prescribe the them the drug with the bigger kickback if the patient has insurance. Nearly in all cases, the doctor would take into consideration who was paying for the meds. If it was coming out the patient's pocket, I felt he/she would prescribe the cheaper and just as effective or nearly just as effective med instead. Otherwise, screw the insurance company that has been screwing him/her for years.

Again, this is not an example of what Obama was talking about. He mentions that doctors think about what is best for the patient, but does not pursue it because it is not in the best interest of the doctor's paycheck.

 

[xanthomondo]

When I see Obama's approval ratings, I always wonder who is still in love with this guys. I guess I can see it now.

Do we also have no problem with him calling the MA police officer stupid? Is that OK because he apologized today?

Are we going to forget that Obama immediately jumped to conclusions, took sides, and blamed race for the entire incident, despite that not being the case?

 

[chocolaterie]

There will always be faults with our leaders... we are human.

My question is, what are the intentions of people when they speak, type or write?

I don't believe the OP had the best intentions when he decided to post this thread with the current title. Of course, maybe I am wrong.

Obama sees a lot of areas that need reform in this country. That does not mean every single person will benefit. This is a sad reality, we won't all be happy with the changes.

As future physicians we need to consider the quality of life of our patients. Yes, we want them to live longer, but at what cost?

 

[45408]

And tell me oh wise one, how do we know when it is ones final year of life?

After just a little while on the wards, you'll start getting an idea. One of the patients on my service right now is 85 years old, and she just got a trach and a G-tube. She's on her last year of life, I'll tell you that now. I did another case, in which we did a iliac-SMA bypass graft to save a patient with mesenteric ischemia. I could've told you he was on his last week (he was). I could identify so much waste in such short order....

I've seen 100 year olds look like they are 65 and 65 year olds look like they are 100.

I've never seen a 100-year old look 65, and like they say, "If you don't look your age before the surgery, you will afterwards."

 

[45408]

While I haven't met as many doctors as the average med student or resident, in my experience, it seems like doctors tend to prescribe the them the drug with the bigger kickback if the patient has insurance. Nearly in all cases, the doctor would take into consideration who was paying for the meds. If it was coming out the patient's pocket, I felt he/she would prescribe the cheaper and just as effective or nearly just as effective med instead. Otherwise, screw the insurance company that has been screwing him/her for years.

Yeah, that's a criminal act. I doubt you've actually seen this.

 

[Chemdude]

Are you the same people that still think Obama's birth certificate is not authentic?

I'm no Obama-lover, but it's pretty sad when people start bashing Obama for every little thing he says...

Obama is human; he's not God.

 

[xanthomondo]

Are you the same people that still think Obama's birth certificate is not authentic?

I'm no Obama-lover, but it's pretty sad when people start bashing Obama for every little thing he says...

Obama is human; he's not God.

I think it's fair to bash the President of the United States when he tries to implement his healthcare system based on spreading blatantly false allegations.

...and believe it or not, people can criticize him for legitimate reasons and not be labeled as a "crazy right-wing fear monger"

 

[niranjan162]

Are you the same people that still think Obama's birth certificate is not authentic?

I'm no Obama-lover, but it's pretty sad when people start bashing Obama for every little thing he says...

Obama is human; he's not God.

I dont expect him to be god, but i do want him to learn from his mistakes.

He tried to rush the bailout situation and what did we end up with? CEO's getting 20 million (was it billions? I cant even remember anymore the way the government is burning through cash) in bonuses for driving their companies into the ground. Unemployment increased and banks arent any closer to giving out more loans, while they are also asking for more money.

Healthcare is way more complex and much more important, we cant afford to have them try to rush this through and make it worse.

People say we need to do something, how bout a step by step approach. target a few things like health insurance pulling benefits or torte reform and work your way up. Why cant we make sure we get one thing right before we move on to the next?

 

[grabbinsumpeels]

But that was ABC....

jessep was making a comment based solely on what Obama said in that ABC televised speech...

Again:

Wow, not only was this not Obama's main point (he was discussing the difficulties involved in end-of-life care decisions), he was presenting a hypothetical dealing with eliminating wasteful spending on unneccessary procedures (if a certain procedure has been shown to be ineffective for elderly patients presenting with a particular condition, palliative care should also be considered).

 

[TexasFight]

Yeah, that's a criminal act. I doubt you've actually seen this.

Well that sucks. lol

I never said I actually saw that, I've only actually seen a pcp help out an elderly neighbor with medications she could actually afford.

I don't want to sound like I'm making up stories. I suppose I just assumed the doctor wouldn't care if the patient isn't the one paying.

 

[Bacchus]

Well that sucks. lol

I never said I actually saw that, I've only actually seen a pcp help out an elderly neighbor with medications she could actually afford.

I don't want to sound like I'm making up stories. I suppose I just assumed the doctor wouldn't care if the patient isn't the one paying.

Like TP said, its illegal. Don't forget there is new legislation as well that forbids giving perks (all the way from pens to vacations) to physicians based on them using your products.

 

[bunnity]

For those saying that doctors never order the more expensive procedure, I have to wonder how much time you've spent in a hospital.

I worked in a cardiology testing center for four years. Two of our tests were stress echos and nuclear stress tests. They both have pros and cons (if you really want me to elaborate I will) but both are testing for stress induced ischemia. Nuclear stress is a lot more expensive. Now originally we did about half our stress patients as stress echo and half as nuc-stress, and nuclear images were read by (and billed by) radiology (not the ordering cardiologist). Things changed and the ordering cardiologists were allowed to read (and bill for) their own nuclear scans. All of a sudden the cardiologists were ordering nuclear stresses almost exclusively. Kinda makes you wonder.

I don't think anyone should be loving Obama blindly. I don't think anyone should be idealizing the "Doctors" blindly either.

The other thing you'll see once you're working in a hospital is that there are a lot of old people having a lot of procedures that they don't want. I've had so many patients tell me they didn't want an EKG and that they were ready to die and they wished the doctors would just let them die. Now if you don't want an EKG, you don't want anything - it's about the least painful test ever. It's very sad to see, and it's because the family won't let the patient go, the patient doesn't have an accurate living will, or the doctor is afraid to let them go for fear of the family's reaction. It's partly a problem with the legal system and partly a problem because no one is sitting down and saying "What does this person really want? Are they ready to go? What exactly do chest compressions / intubation / feeding tube entail? How many times is it OK to revive this person? Three? Ten?" These conversations aren't happening enough, and it's sad not only for the person being kept alive when they're ready to go, but it's also sad that the money is being spent there instead of on people that need procedures they can't afford.

 

[Parts Unknown]

He tried to rush the bailout situation

Identify this quote: "I'm a strong believer in free enterprise, so my natural instinct is to oppose government intervention, but these are not normal circumstances. The market is not functioning properly. There has been a widespread loss of confidence. Without immediate action by Congress, America can slip into a major panic."

Why cant we make sure we get one thing right before we move on to the next?

In a word, inertia. Health care is such a contentious issue that even incremental changes meet with headstrong opposition. Periods where there is both popular support and political courage come along infrequently.

 

[Nilf]

I think a more alarming video clip of Obama is here:

[YOUTUBE]ZhNeGYYPgIE[/YOUTUBE]

For those who don't want to watch, Obama basically says that doctors are greedy and will perform unnecessary procedures that are not in the patient's interest just to line their wallets.

"Taking out tonsils instead of diagnosing allergies"

...and what was so great about this clown that everyone voted?

This video should be promulgated to every physician in the US. Accusing doctors of mutilating children for money is blasphemous. Obama is evil.

 

[Nilf]

For those saying that doctors never order the more expensive procedure, I have to wonder how much time you've spent in a hospital.

I worked in a cardiology testing center for four years. Two of our tests were stress echos and nuclear stress tests. They both have pros and cons (if you really want me to elaborate I will) but both are testing for stress induced ischemia. Nuclear stress is a lot more expensive. Now originally we did about half our stress patients as stress echo and half as nuc-stress, and nuclear images were read by (and billed by) radiology (not the ordering cardiologist). Things changed and the ordering cardiologists were allowed to read (and bill for) their own nuclear scans. All of a sudden the cardiologists were ordering nuclear stresses almost exclusively. Kinda makes you wonder.

I don't think anyone should be loving Obama blindly. I don't think anyone should be idealizing the "Doctors" blindly either.

The other thing you'll see once you're working in a hospital is that there are a lot of old people having a lot of procedures that they don't want. I've had so many patients tell me they didn't want an EKG and that they were ready to die and they wished the doctors would just let them die. Now if you don't want an EKG, you don't want anything - it's about the least painful test ever. It's very sad to see, and it's because the family won't let the patient go, the patient doesn't have an accurate living will, or the doctor is afraid to let them go for fear of the family's reaction. It's partly a problem with the legal system and partly a problem because no one is sitting down and saying "What does this person really want? Are they ready to go? What exactly do chest compressions / intubation / feeding tube entail? How many times is it OK to revive this person? Three? Ten?" These conversations aren't happening enough, and it's sad not only for the person being kept alive when they're ready to go, but it's also sad that the money is being spent there instead of on people that need procedures they can't afford.

I doubt that you've spent any time on the floor. By that I mean mainly ICU. Advance directives should be in every patients' chart, and are straightforward to follow. Occasionally problems arise when there are no advance directives in chart and there is no spouse or family available to make decisions about withdrawing or continuing treatment.

 

[strummin]

Stop watching Faux News, buddy.

 

[vokey588]

That has really nothing to do with this conversation, but remember, Obama has stated before that he is not interested in reforming malpractice. Covering their butts has nothing to do with making $$.

I think you are either forgetting or don't know how the legislative process works. Obama may not be in favor of liability reform but ultimately he cannot dictate what goes into the bill or stays out. Yes, he has veto power but he will absolutely not use it to veto the biggest (and most needed) healthcare reform bill in decades just because of the trial lawyer lobby.

The Senate bill and final bill will probably contain liability reform. Lawmakers' biggest goal is to cut costs and significant malpractice liability does increase costs. The amount of lobbying going on right now is enormous and I am confident that the AMA and AHA will get liability reform language in there.

For those interested in liability reform, the NEJM has a great FREE article about how liability reform is likely to be in the final bill through bundling and compromise: The Role of Medical Liability Reform in Federal Health Care Reform.

Because this giant bill includes SO MANY things, concesions will have to be be made and there is enough power in the Blue Dog and Republican caucases that liability reform will likely be in the final bill. Obama is so desperate for healthcare reform that he will not veto it just because it includes liability reform.

 

[strummin]

When I see Obama's approval ratings, I always wonder who is still in love with this guys. I guess I can see it now.

Do we also have no problem with him calling the MA police officer stupid? Is that OK because he apologized today?

Are we going to forget that Obama immediately jumped to conclusions, took sides, and blamed race for the entire incident, despite that not being the case?

Actually, I'm not in love with Obama, but I would rather have him as president than I-can-see-Russia-from-my-house, I-dont-know-what-I-read, I-love-pro-America-parts-of-the-country, I-love-attending-racist-campaign-events Sarah Palin.

And while I do not agree with Obama on all these issues, I can be assured that I am ALLOWED to disagree with him without being called unpatriotic. And I can also be assured that my president will actually come to all his decisions intelligently, rather than claiming to be "told by God" e.g. GWB - "God told me to end the tyranny in Iraq"

And at least what I will not see from Obama is extreme hypocrisy. The right-wingers love to talk about how hundreds of thousands of "potential human beings" are being aborted, but when will they talk about the hundreds of thousands of people that have died because GWB felt it necessary to invade a country to try to search of non-existent WMD's? Oh, wait, they're brown. They must not count. To republicans, it's only sad if white people die.