Reasons to get rid of the admission interview

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Ordering lots of diagnostics is all about reducing the risk of malpractice in an excessively litigious society.

I doubt that, in any case I wasn't speaking only of diagnostic tests, but all medical procedures. Some estimates say that 1 in 3 procedures in America have no medical value. American physicians feel entitled to do whatever necessary to make money, and that attitude comes from the type of people selected for medical schools and their training.

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This has everything to do with how the business of medicine operates, and little to do with individual physician quality.
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Agreed. Our healthcare system is in shambles, but not due to quality, but due to trying to provide too much health care to not enough people. Our physicians are top notch, our diagnostic equipment and procedures are top notch. However because of the need to practice defensive medicine to avoid getting sued, and the fact that insurance companies somewhat dictate the course of treatment based on what they will reimburse and what they will not, you end up with the insured segment of the population getting "overtreated" and the uninsured having to wait until their ailments become significant enough to go to the ED.

Life expectancies tend to be worse in this country due to non-physician related things such as diet (we are among the most obese countries in the world, and with obesity comes heart disease, diabetes, stroke, pulmonary hypertension and a host of other issues that shorten people's lives), homicide rates, drug abuse. As well as the fact that a significant segment of our population lacks access to adequate healthcare due to our insurance structure (not a physician fault, but an access to physician fault).

I don't think anyone ever would suggest that the physician selection and training in the US isn't quite high caliber, as you are doing. The healthcare system is not driven by physician quality as much as it is the insurance industry and governmental money. Which is part of the problem.
 
...Some estimates say that 1 in 3 procedures in America have no medical value. American physicians feel entitled to do whatever necessary to make money, and that attitude comes from the type of people selected for medical schools and their training.

There is no factual basis in such statements. In fact there are people exploiting the system in every system, but they are always the small minority. There is no way that 1 in 3 procedures have no value (although some things are done for defensive reasons that may not dictate treatment). More like 1 in 100. And even then it is not driven so much by greed but because (1) if you don't do the test and the patient is injured by something that test would have revealed, you get sued, and (2) the insurance companies, who drive this train, effectively tell you to do this test by paying for it. It's not greed or corruption by doctors to get a CT where other countries systems would not, it has everything to do with the fact that if the patient dies of something that would very clearly be seen on a later CT, you are SOL. Other countries just shrug their shoulders, say the CT was not indicated, and that the patient dies from something that would have been caught on such a test is irrelevant. So in the US the doctors do more, cost more, and save more people from non-indicated things than elsewhere, because they have to do a few more studies in their workup. Better for the patients who are insured, not suggestive of bad doctoring at all. Simply the system we live in. But don't peg US doctors as greedy or crooked for working within a system not of their design. There are crooked people everywhere, even in Berlin, but they are always the minority and not worth mentioning in these discussions.

US doctors are well trained and do a good job. The society they work in is full of obese, hypertensive diabetic drug abusing people not seen elsewhere in the developed world in such percentages, so outcomes are only as good as can be reasonably expected of such a population. And the system as currently set up doesn't cover everyone, so many people lack the primary care they need to keep them out of the ED. And we have a system that requires a certain amount of defensive medicine, which is better for some percentage of the patients because it catches things early that a patient in another country, such as Germany, would never find out about until too late, but is too expensive for the long run.

I think you are confused by the notion that the US healthcare system is in shambles due to unsustainable costs, and trying to extrapolate that onto the doctors, which is unreasonable. The doctors do the best that can under the system they work in. Foreign doctors who come to the US often struggle because of the very different practices, as well as the focus on medicine being a service industry, rather than an erudite science. It's a different system, and you have to realize that the physicians are incredibly well polished pieces being poorly utilized in a near broken machine, not look at them as broken as well. That's where your warped view seems to be missing the mark. You see we have a global problem, and are trying to extrapolate it down to one of the parts, and focusing on the wrong one. The litigation system in the US is a problem with our system. The obesity and other issues of the populous is a problem with our system. The insurance industry being too involved to the point that they dictate care (too much in many cases, none for others), and the fact that uninsured people use the ED as their primary care facilities, all result in a healthcare whose costs are absurdly unsustainable. Quality of doctors was never the US issue, and never will be. Quality of healthcare providers may become an issue as more and more of the lesser trained DNPs jump into the mix, but that is not a physician fault.
 
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By the way, I might add that Brown Med usually admits their kids through a BA/MD program called PLME from high school. I haven't read the article, but I have to mention that PLME currently does not conduct medical school-style interviews on its candidates.

You're a little outdated on your info. For years now Brown has been shrinking down the PLME program while increasing the standard/AMCAS admit portion of the class. The AMCAS route does the standard med-school interview, and there is a local interview for the PLME program.
 
Berlin dude, you have no clue what the hell you are talking about.

I agree with everything that L2D has stated. There's a lot of "unnecessary tests" as you so eagerly pointed out because lawyers are quick to sue anything that would earn them some money. Bogus malpractice suits is more like the norm than the exception today. Also, one thing that L2D did not mention to the lower health rate of the US population is that there are more specialists (2/3) practicing than PCPs (1/3). Other countries, the numbers are reversed. Studies have shown that more PCPs = increased health of the general population. More specialists actually means that the quality of the doctors are even better, with increased specialized knowledge in certain disease like Crohns, cardiovascular, neurology etc. Unfortunately, it doesn't translate to the general populace. This is not a function of physician greed but because the insurance companies don't compensate worth **** to PCPs for the amount of hours and patients that they see. Some are actually working at a loss. Coupled on top of that the 200-300k of debt from medical school and you can see why PCP is not attractive.

Personally, I think you're just spouting of some random BS with no substantiation behind it. Also, if you hate the field so much why the hell are you wanting to enter it?
 
nothing ever is....

I'm not saying "nothing ever is". But I'm saying this particular poster is way off the mark in suggesting that physician quality or greed is what's causing the healthcare problems in the US. He's misinformed. There are absolutely things US physicians could be doing better, but in terms of quality and training they are top notch, and they are working in a system that, as it's set up, is too expensive. That's it.
 
... Bogus malpractice suits is more like the norm than the exception today. ...

I wouldn't say bogus is the norm. I would say that expectations of the infallibility of physicians are held to a much higher standard in US courts than elsewhere, and that there is some sentiment that doctors can be sued not only for what they did do, but also for what could have been found on tests they did not do. This is very different than in other parts of the globe, and that drives the cost of medicine up in the US in ways other nations cannot fathom. In some ways it also makes the level of care higher than other nations cannot fathom, because you get worked up for things in the US that in Europe they would simply dismiss as not worth spending the money. US doctors become experts in ruling out the unlikely in addition to the diagnosing and treating of the run of the mill ailments, because they have no choice under our system. That doesn't mean the suits are unwarranted -- in the vast vast majority of all malpractice suits, the individual was in some way actually harmed, and so "bogus" isn't the appropriate word. And there are severe fines and penalties for lawyers who bring "frivolous" claims, as this term is used in the law (not as folks use it on SDN). But certainly the system is set up here such that the expectations of how physicians conduct themselves, and to what extent they are expected to work up every red herring, are significantly more oppressive than elsewhere on the planet.

Part of it is the jury system, which over time has developed a bias against "rich doctor" defendants. Part is that folks in the US are paying for healthcare (rather than having it subsidized) and so they expect better results than those folks who have it subsidized (eg veterans who get their treatments free at the VA complain a lot less and have much lower expectations). Part of it is that technology has gotten so good that it has become the norm to expect physicians to find evidence of disease early enough to cure it, even if the cost as a screening tool is prohibitive. Part of it is that the insurance industry, through reimbursements, is running the show, dictating what gets paid for and what doesn't, which results in physicians tailoring their practices to correspond. In other countries, where medicine is government subsidized, and where medmal suits are minimal, there is no real need to practice defensive medicine, and you can simply practice according to the local standard of care. In the US, you are expected to do more, because not only are you treating the patient, but you are also treating the jury system and the insurance industry every time you care for a patient -- everybody has to be happy with how you conduct yourself in the process. It's a balancing act that US doctors do quite well, but it sure drives up the cost of the system. Not much you can do about it from the physician end, but certainly can be adjusted from the system end.
 
In 1982 the Brown University Program in Medicine eliminated the personal interview from its process of selecting applicants for admission to medical school. This study compares the 113 M.D.-program students admitted to the first three classes (entering between 1983 and 1985) without an interview with the 67 students in the previous three classes admitted with an interview. The students' characteristics were essentially the same with respect to the preadmission variables, the proportions of women and minority students, course performances, scores on Parts I and II of the National Board of Medical Examiners examinations, and evaluation scores from residency program directors. This study offers additional evidence that the selection interview, as practiced in most U.S. medical schools, does not contribute to the predictive validity of the admission process.

http://journals.lww.com/academicmed..._school_and_residency_performances_of.12.aspx

(C) 1991 Association of American Medical Colleges

My observations:
- Many European schools select students only on the basis of standardized tests and their doctors are better than ours in many respects

- Almost all PhD programs, who select our nation's professors and scientists, never require an admissions interview.

- the admission interview is usually used as an argument to reject qualified minorities who don't have minority status (e.g. Chinese, Koreans, East Indians, etc). Prejudices come into play.

None of these sound like reasons to me. They rather sound like excuses. Nothing in life is perfect, so get used to it.
 
US doctors are well trained and do a good job. The society they work in is full of obese, hypertensive diabetic drug abusing people not seen elsewhere in the developed world in such percentages, so outcomes are only as good as can be reasonably expected of such a population. And the system as currently set up doesn't cover everyone, so many people lack the primary care they need to keep them out of the ED. And we have a system that requires a certain amount of defensive medicine, which is better for some percentage of the patients because it catches things early that a patient in another country, such as Germany, would never find out about until too late, but is too expensive for the long run.

That's exactly the attitude I'm talking about. Blame the patient, blame the lawyers, blame the insurance companies. Physicians can do no wrong, they are the best in the world, etc. It really is delusional. Physicians are part of the healthcare system, they share the blame.

And I checked the percentage of medically unnecessary tests, most studies estimate it is from 1 in 3 to 1 in 5 as I claimed. That is to be expected when you feel entitled to rip off others.
 
That's exactly the attitude I'm talking about. Blame the patient, blame the lawyers, blame the insurance companies. Physicians can do no wrong, they are the best in the world, etc. It really is delusional. Physicians are part of the healthcare system, they share the blame.

And I checked the percentage of medically unnecessary tests, most studies estimate it is from 1 in 3 to 1 in 5 as I claimed. That is to be expected when you feel entitled to rip off others.

BerlinDude, are you a physician yet? If not, I suggest you stop assuming as to what actually goes on in a hospital setting. Law2Doc actually has both sides of the spectrum covered - being a lawyer and then a physician - and everything he is saying is true. He is not "blaming" anyone, but simply stating fact. We ARE an obese country, so there are a lot of other health issues that can stem from that.

Before I decided to go into pre-med, I worked for an insurance company. I have a certificate in health claims and coding. I know from experience the BS that insurance companies put everyone through. They always want to know why a test is relevant, and if it isn't, they won't pay for it, but if the physician doesn't do the test that could have revealed something, he gets sued by the family for a wrongful death, or whatever happens. A physician is essentially between a rock and a hard place for many of the decisions they make. And if you have not had any experience in any one of those fields - insurance or physician - then you have no clue what you're talking about.
 
BerlinDude, are you a physician yet? If not, I suggest you stop assuming as to what actually goes on in a hospital setting. Law2Doc actually has both sides of the spectrum covered - being a lawyer and then a physician - and everything he is saying is true. He is not "blaming" anyone, but simply stating fact. We ARE an obese country, so there are a lot of other health issues that can stem from that.

There is that attitude again - only physicians know what is really happening, everyone else must be an idiot. Just last week a friend of mine bumped his head, got a cut, and went to the doctor for stitches. The doctor wanted to do an MRI - for a small cut. Are you going to suggest the doctor was worried about getting sued?

I don't want to hijack the thread, the point is that everything I've seen tells me foreign doctors, selected purely on numbers, do a BETTER job than American doctors. The argument that the interview selects better doctors just isn't backed up (as the study posted by OP shows).
 
There is that attitude again - only physicians know what is really happening, everyone else must be an idiot. Just last week a friend of mine bumped his head, got a cut, and went to the doctor for stitches. The doctor wanted to do an MRI - for a small cut. Are you going to suggest the doctor was worried about getting sued?

I don't want to hijack the thread, the point is that everything I've seen tells me foreign doctors, selected purely on numbers, do a BETTER job than American doctors. The argument that the interview selects better doctors just isn't backed up (as the study posted by OP shows).

Your posts of constant rage and your inability to reason on any of the points presented before you are comical to read. You came into this thread with the explicit desire to drive this message home and it is very clear you had no intention of listening to anyone's points or considering the merits and folly of your own position. It's disappointing to see.
 
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So, let me get this straight. You think that you do not have a fair chance in any interview because you are Native American? Unless, of course, you are being interviewed by black professors (maybe you are being sarcastic here)?

You can be candid in an interview without sacraficing your ideals. If you cannot figure out how to do this, then you are just not good at interviewing.

That's what I've been saying to him the last day or so. :thumbup:

obvious troll is very obvious.

No, I think he is just an idiot.

:thumbup:

Every thread I read that you start, OP, is about how you have a disadvantage in social situations (ie interviews) solely because you are Native American and "white people" don't like what you have to say. I have no idea what you're saying to piss people off, but I am also Native American. Yes, my culture came up in interviews. My interviewers were genuinely interested about my involvement with Native American communities because my interest in serving this underserved population was obvious. I only felt discriminated against once- and my interviewer was African American. She asked, "Now, it's not like you need to wear a feather on your head, but you don't look Indian, why not?" She asked these types of questions for around 45 minutes straight.

I have had a lot of experience with many different tribes, and if they had anything in common it was that they were proud of their heritage. They wanted to educate others about why our people are great. They will never forget what happened to their ancestors when Europeans came to North America, but they know that it's history. We have never focused on blame, but on education and friendship. Maybe you should remove the giant chip from your shoulder and reinvent the way you convey your thoughts about your culture to others.

Thank you. This is what the OP needs to do. This idiot's self-righteous threads are bugging the crap out of me.
 
There is that attitude again - only physicians know what is really happening, everyone else must be an idiot. Just last week a friend of mine bumped his head, got a cut, and went to the doctor for stitches. The doctor wanted to do an MRI - for a small cut. Are you going to suggest the doctor was worried about getting sued?

I don't want to hijack the thread, the point is that everything I've seen tells me foreign doctors, selected purely on numbers, do a BETTER job than American doctors. The argument that the interview selects better doctors just isn't backed up (as the study posted by OP shows).

Notice how I said I am not a physician, but I have worked in insurance, and so I know exactly what is going on as well. Obviously, you're just going on reports, and not actual experience, and that is why your argument is invalid. You know nothing of what truly goes on unless you experience it, and NOT as a patient or through hearsay from a friend. Furthermore, why in the hell are you on this forum? If you hate the aspect of all of this so much, why are you going to be a physician?
 
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I don't want to hijack the thread, the point is that everything I've seen tells me foreign doctors, selected purely on numbers, do a BETTER job than American doctors. ...

And the point we are trying to make, is that you havent SEEN squat, and yet you are quick to make bold claims about quality. Until you have practiced as a US physician, you have no clue. I'm sorry but you don't. You make bold statements like "1 in 3 procedures have no medical value", which is simply not accurate, and you pretend that this is somehow "knowledge". Foolish.

I think that US physicians have a much better vantage point as to this argument than some "Berlin dude" on a premed board who makes unsupportable statements about the quality of foreign doctors and the lack of quality of US doctors. In fact, having been in the thick of it, I can tell you that the training is quite good for what is involved in the practice in this country, and that US physicians have to deal with quite a lot of issues, both medical and societal, that simply don't exist in European healthcare settings. I can also tell you from direct experience that quite a few foreign trained doctors struggle when they try to apply their home experience to the US medical landscape. Why? Because our training here is actually superior with respect to what the practice involves here, and the things we need to manage here. It's an unfortunate healthcare landscape we work in, but we are well trained to navigate it. Other nations' grads I'm sure do well in their own settings, but it's like training to play soccer competitively and then coming here to suit up against the N.O. Saints --it's a different ballgame, with scarier things coming at you. Sorry, but it just is. And that's not attitude, that's experience. Of which you appear to have none.

You can't look at a population filled with sicker people and compare them to a population of healthy people and say, "Gee the doctors who took care of the sicker people don't do as well because more of them died". Yet that's exactly what you are doing.

The US is faced with health issues not seen in Europe. We are fatter, take more drugs, and suffer from far more diabetes, hypertension etc than the rest of the modern world. This is the legacy of the fast food and soft drink industry, perhaps, which we have embraced as our national past-time. At the same time, our population is aging faster than most, as a consequence of our baby boomer generation coming of geriatric age. So while in a European setting, you are dealing with a younger, thinner, healthier population, in the US we are dealing with older fatter diabetic, hypertensive piles of goo. Guess which group does more poorly, even with far more tests being run on them thanks to our defensive practices? The US. Is this reflective of US doctoring. Not a lick. We see this because the folks who emigrate here having been doctors elsewhere do at least as poorly.

It's only because US doctors are well trained that the numbers aren't devastating. Your problem is that you are falling into a "true, true and unrelated" argument. The results don't tell the big picture. You take an apple, compare it to an orange and fault the grocer for not being able to make the former into orange juice. But no, it's not the grocer's fault. It's the apple being an apple. You can spin it as "attitude" or whatever you want, claiming that he's just a bad grocer, and that he's just saying you don't get it because you aren't a grocer, or that "1 in 3" apples actually can be turned into orange juice, etc., but at the end of the road that doesn't make an apple an orange, it just makes you sound all the more ignorant.
 
- Almost all PhD programs, who select our nation's professors and scientists, never require an admissions interview.

How is it that you now so much about every PhD program in every field that offers the degree? You may not find "interview required" in big bold letters on some school's website but at most places the advisors accepting new students have already had numerous communications and/or meetings with the people they take on.

- the admission interview is usually used as an argument to reject qualified minorities who don't have minority status (e.g. Chinese, Koreans, East Indians, etc). Prejudices come into play.

No, its to make sure you're not a socially inept boob.

Is this the follow-up to your related thread from earlier that you claimed was a joke?
Sounds to me like someone has a really good MCAT score and nothing else to support their application.
 
Don't mean to argue, but it is common knowledge that the US healthcare system is the worst or among the worst of all industrialized countries. We spend more per capita on healthcare than any nation on Earth, and the outcomes are lower than many third world countries. (In terms of life expectancy, infant mortality rates, etc, America is ranked between 40-50). How could America's physicians NOT be at least largely responsible for that?
Lifestyle, demographics, and a lot of other factors. There are huge disparities within the US, so it's not really fair to compare a country of 300 million whites/Asians/Hispanics/blacks/other to a country of several million of the same race. For example, the infant mortality among white babies is comparable to those of other industrial nations (with largely white populations). It's when you compare the infant mortality of black babies with the other numbers that you see where the disparity lies.

Most of the other countries are also more aggressive in their legislation about banning things that curtail your life expectancy anyways, like smoking.
 
That's exactly the attitude I'm talking about. Blame the patient, blame the lawyers, blame the insurance companies. Physicians can do no wrong, they are the best in the world, etc. It really is delusional. Physicians are part of the healthcare system, they share the blame.
It's not delusional when it's true. You wouldn't say Jason Bourne suffers from paranoid delusions that he is being watched and followed.

And I checked the percentage of medically unnecessary tests, most studies estimate it is from 1 in 3 to 1 in 5 as I claimed. That is to be expected when you feel entitled to rip off others.
And the link to your studies?
 
And the point we are trying to make, is that you havent SEEN squat, and yet you are quick to make bold claims about quality. Until you have practiced as a US physician, you have no clue. I'm sorry but you don't. You make bold statements like "1 in 3 procedures have no medical value", which is simply not accurate, and you pretend that this is somehow "knowledge". Foolish.

The US is faced with health issues not seen in Europe. We are fatter, take more drugs, and suffer from far more diabetes, hypertension etc than the rest of the modern world. This is the legacy of the fast food and soft drink industry, perhaps, which we have embraced as our national past-time. At the same time, our population is aging faster than most, as a consequence of our baby boomer generation coming of geriatric age. So while in a European setting, you are dealing with a younger, thinner, healthier population, in the US we are dealing with older fatter diabetic, hypertensive piles of goo.

Guess which group does more poorly, even with far more tests being run on them thanks to our defensive practices? The US. Is this reflective of US doctoring. Not a lick. We see this because the folks who emigrate here having been doctors elsewhere do at least as poorly.

Two points:
1. The idea that Europeans are racially superior to Americans, while flattering, is ridiculous.
2. Nowhere did I say anything about Europe, the US healthcare system delivers worse outcomes than countries throughout the world - Europe, Canada, East Asia, etc...
3. Are you so delusional that you actually people delivering A. Higher costs B. More procedures and C. Lower outcomes are better(?!) than those that have lower costs and better outcomes? And that the people delivering healthcare in America have "not a lick" to do with outcomes?!!

Please stop wasting time and space with your nonsense. I'm done.
 
Two points:
1. The idea that Europeans are racially superior to Americans, while flattering, is ridiculous.
2. Nowhere did I say anything about Europe, the US healthcare system delivers worse outcomes than countries throughout the world - Europe, Canada, East Asia, etc...
3. Are you so delusional that you actually people delivering A. Higher costs B. More procedures and C. Lower outcomes are better(?!) than those that have lower costs and better outcomes? And that the people delivering healthcare in America have "not a lick" to do with outcomes?!!

Please stop wasting time and space with your nonsense. I'm done.

(1) Um I didn't say that Europeans are racially superior to Americans. I said they had a better diet, were younger as a group, and had earlier access to primary care thanks to the difference in systems and thus are simply more healthy. There's nothing genetic or racial in that -- I think there are numerous case studies of emigrants to the US who succumbed to our diet and lifestyle and ended up with clogged arteries.
I think you need to reread the post if you somehow got a racial superiority notion out of that. Or maybe that was already your notion when you suggested that doctors were better elsewhere. Sorry but you missed the mark. If you are German, you come from a fairly undiverse gene pool thanks to racial cleansing efforts prior to WWII, as a result you are probably genetically inferior -- you lack a lot of beneficial genes that are out there. But you will live longer thanks to a leaner diet, working fewer hours, getting more sleep, etc. If you start eating McDonalds and KFC 5 times/week and drinking 2L of Pepsi each day, odds are you won't do as well as your US counterparts.

(2) Your screen name suggests a European basis, which is why I naturally assumed when you were speaking of "other countries" that Europe was your focus. But FWIW, the US healthcare system actually doesn't deliver worse outcomes than, say, East Asia -- a fairly poor set of nations with tons of incurable diseases. If you say the facts support this, you are making this up. As for the other nations you list, it's again an apples and oranges comparison -- you have rationed socialized healthcare to a healthier younger population in the rest of the world. And FWIW, I don't think I ever said it had worse outcomes, I responded to YOUR statement that the US had worse outcomes by suggesting that if that's the case, it's because the approach is quite different. The US system is actually superior in what it accomplishes, which is far more detailed workups that meet the litigation "reasonableness" sniff test, and taking care of a far less healthy population than most European nations have. It simply delivers more, but the patients are too far gone to benefit. Again the health differences are based on diet, population age, and earlier access to primary care thanks to socialized medicine systems. So yeah the US does an AMAZING job with a much more sick and aged population. If you suggest that outcomes are worse, then there's your reason, and it has little to do with medical education and training. But again I'm taking your word for it that outcomes are all that different, not making that claim. In some countries people come to the doctor to have their one prescription adjusted. In the US they often have 5-10 daily medications, all of which need tweaking to address their multiple co-morbidities. And with the in-house legal breathing down your neck making darn sure you don't miss something or neglect checking something. It's simply a different game.

(3) Again I think you are not able to comprehend my prior post. I'm saying that US doctors are working under a series of impediments, and taking care of a far more difficult population healthwise, and thus their results far exceed what another group in similar circumstances might do. Outcome has to be driven by what you start with. If you have a basically healthy group of people and they stay healthy, that doesn't necessarilly constitute good doctoring any more than an unhealthy group of people succombing to their bad health. The bottom line is, yes the US doctors do an extraordinary job working within this framework. You unfortunately have no perspective on this -- you are looking at some raw data you found somewhere and trying to compare apples to oranges. I'm trying to explain to you the best apple in the world is going to be dismissed by you because it's not an orange. But that doesn't mean it's not the best. Just that you aren't evaluating it rationally. Because you simply lack the firsthand knowledge needed to evaluate the system and the players. The foreign doctors who move to the US and try to function under our system probably get it -- I have seen many struggle firsthand.

It's a harder system, tries to do more, is more costly. This provides better care. But a lot of this care is wasted on a population that is too sick to save. IMHO that's better healthcare to the individual than in a foreign country where healthcare is rationed and doctors don't do that extra study that might reveal some unsuspected disease because the study was too costly. In the US that study gets done, not because it is medically indicated, but because it is defensively indicated. And that's better for the patient. But so costly it breaks the system in the long run. Which is what happened. Longer trained doctors, more expensive studies and everyone getting worked up for too many things. That's BETTER healthcare for the individual, but unsustainable as a system. Get it? Outcome is irrelevant -- I already told you that the US patients as a group are sicker and older and won't do as well regardless. But they continue to live longer with those diseases in the US than anywhere else in the world (which in turn adds to that problem) because our healthcare is too good.

I think this debate is pointless because you have an agenda, and choose not to actually read what others are trying patiently to explain -- that you are starting from a shaky starting point, that outcomes are somehow better elsewhere, that healthcare in multiple countries attempts to do the same thing as in the US (in fact noplace else does healthcare seek to do as much for as many, driven by the legal system here), and that somehow doctors who manage to navigate this screwed up system aren't actually doing impressive work (which they clearly are). Sorry but you are wrong from the get go, and unless you are willing to read and learn that maybe you are far off the mark, I think you will not do so well in this system.

I think it's you who needs to stop wasting time and space with your nonsense, which I think I've pretty extensively explained. Glad you are done, hope you actually took the time to learn something (but I doubt it). Best of luck in whatever endeavor you try because an unwillingness to listen and understand tends to be a fatal flaw when going into a service industry like medicine.
 
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Law2Doc, I think I love you! <3
 
Law2Doc:
I understand your points perfectly. You are basically saying America has a worse legal system, healthcare bureaucracy, fat and lazy population, etc, which are all responsible for the bad healthcare outcomes in this country. In short, you blame everything and everyone except those actually delivering healthcare, who you think are doing a great job.

It reminds me of the saying, a poor workman blames his tools. Unfortunately, I think your attitude is typical of most US physicians.
 
Law2Doc:
I understand your points perfectly. You are basically saying America has a worse legal system, healthcare bureaucracy, fat and lazy population, etc, which are all responsible for the bad healthcare outcomes in this country. In short, you blame everything and everyone except those actually delivering healthcare, who you think are doing a great job.

It reminds me of the saying, a poor workman blames his tools. Unfortunately, I think your attitude is typical of most US physicians.

You're such a debbie downer and you keep trying to discredit L2D's posts. Just give up and gtfo.
 
Reading this thread makes me so grateful that medical schools conduct in-person interviews. Just sayin'.
 
Law2Doc:
I understand your points perfectly. You are basically saying America has a worse legal system, healthcare bureaucracy, fat and lazy population, etc, which are all responsible for the bad healthcare outcomes in this country. In short, you blame everything and everyone except those actually delivering healthcare, who you think are doing a great job.

It reminds me of the saying, a poor workman blames his tools. Unfortunately, I think your attitude is typical of most US physicians.

He is not completely exempting US physicians from blame. However, in your original post, you said US physicians are "largely responsible" for the healthcare problem in the US. The majority of the problem lies within the infrastructure US physicians have to work in. Physician greed may contribute slightly to the current state of healthcare, but it is foolish to assume that this is where the majority of the problem lies. It is also foolish to think that med schools only accept people who will become money laundering physicians or that residency actually trains doctors to become greedy.
 
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It reminds me of the saying, a poor workman blames his tools. Unfortunately, I think your attitude is typical of most US physicians.

Except that when the doubter finally realizes that the tools are, in fact, broken he has to eat crow, and realize that that person isn't a "poor workman" at all -- he may be the best workman, but his results will be poor. To paraphrase Freud, sometimes a cigar is actually a cigar. You come on here with an agenda that US doctors aren't good (are "poor workmen"), and you are unwilling to accept the notion otherwise, even when it's painstakingly explained to you that other things are at play. Your arguments would be good if your premise was correct -- that US doctors weren't among the best and that they were trying to justify themselves by passing the blame. But you neglect to appreciate that (1) the legal system is very different here, (2) the patients have more comorbidities here. These two facts undo your basic premise. The tools are broken. In fact they do an amazing job here with broken tools. Comparing a great workman with broken tools to a passable workman with simpler tools is the apples and oranges point we've been trying to make to you. Your ears are closed though so it's a waste of typing. Good luck with this.
 
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Law2Doc:
I understand your points perfectly. You are basically saying America has a worse legal system, healthcare bureaucracy, fat and lazy population, etc, which are all responsible for the bad healthcare outcomes in this country. In short, you blame everything and everyone except those actually delivering healthcare, who you think are doing a great job.

It reminds me of the saying, a poor workman blames his tools. Unfortunately, I think your attitude is typical of most US physicians.

BerlinDude, you're either a troll or just plain dumb. I have a case that perfectly illustrates L2D's point.

I just was involved in the care of a gentleman in his 30's who immigrated from Germany in his late teens. This man is an avid IV drug user, and subsequently has hep A, B, and C, HIV, and even syphilis (which I have never seen). He is homeless and continues to use IV drugs, despite being warned numerous times. Last year, he developed a case of mitral valve endocarditits (he got bacteria on one of his heart valves because of his IV drug use). He was admitted to the hospital and was put on 6 weeks of antibiotics. Since he was homeless, he had to stay in the hospital, since there was no way of giving him his antibiotics as an outpatient. Of course, he had no insurance and this was all financed by the tax payer's dime. He was told that if he used IV drugs again, he would probably destroy the valves on his heart and this could lead to his death.

He came in to the ED about a week ago, with shortness of breath and episodes of syncope (passing out). Low and behold, what do you think was wrong with him? Another case of endocarditis; his mitral valve needed to be replaced. He admitted that he had been doing IV drugs again. On top of that, he hadn't been taking his HIV medications (because he didn't like the way they made him feel). Of course, being the bad doctors that we are, we went ahead and replaced his mitral valve, and he got another free 6 week stay (because he needs another 6 week course of IV antibiotics, and he can't be sent home with a PICC line because he's going to run IV drugs through them) . And of course, being homeless, your tax dollars financed the whole thing.

He's been in the hospital for about a week now, and instead of being grateful for the fact that we saved his life, he just complains about how we won't let him smoke and how cruel we are for making him piss into a plastic container to keep track of his urine output.

I was talking to him about his plans once he was discharged, and he said he was going back to Germany because "the healthcare f-ing sucks here and these doctors have no idea what they are doing." Right, the same healthcare system that has paid for his 12 week hospital stay, his heart surgery, and his HIV medications (that he refuses to take). I just smiled and told him that it was a wonderful idea.

So ya BerlinDude, I totally see your point of view. I guess if I was part of a socialist society where there was no individual accountability, I would blame my doctors, too. It's the doctor's fault that this guy was using IV drugs, and it's certainly the doctor's fault if he uses again and needs another surgery. I hope you and this patient go back to the welfare state that you call Europe and suck up all the healthcare dollars you can, then blame the doctors who give you that care for your crappy outcomes because you didn't have the common sense to take care of yourself.

Give me a break.....the biggest problem we have in this country is that we don't hold patients accountable for anything.
 
He came in to the ED about a week ago, with shortness of breath and episodes of syncope (passing out). Low and behold, what do you think was wrong with him? Another case of endocarditis; his mitral valve needed to be replaced. He admitted that he had been doing IV drugs again. On top of that, he hadn't been taking his HIV medications (because he didn't like the way they made him feel). Of course, being the bad doctors that we are, we went ahead and replaced his mitral valve, and he got another free 6 week stay (because he needs another 6 week course of IV antibiotics, and he can't be sent home with a PICC line because he's going to run IV drugs through them) . And of course, being homeless, your tax dollars financed the whole thing.

Do you think there are no drug users in Germany? Are drug users only found in America? Are patients abroad all healthy and happy and do everything the doctor tells them? What is the point of this story?

This attitude is exactly what I am talking about. If you can't accept responsibility and are always trying to pass the blame, even onto patients, how do you intend to improve?

By the way, what's this " being the bad doctors that we are?". You're a medical student, not a doctor, and as such, you haven't replaced anyone's mitral valve...
 
Do you think there are no drug users in Germany? Are drug users only found in America? Are patients abroad all healthy and happy and do everything the doctor tells them? What is the point of this story?

This attitude is exactly what I am talking about. If you can't accept responsibility and are always trying to pass the blame, even onto patients, how do you intend to improve?

By the way, what's this " being the bad doctors that we are?". You're a medical student, not a doctor, and as such, you haven't replaced anyone's mitral valve...

I thought you said "I'm done" two posts ago. Your mind is closed to other points of view. Good luck with that. Move along.
 
I think both Berlin and Law2Doc have good points here, although L2D seems to have the rational edge.

Berlin's problem is he is overgeneralizing a problem that exists and prescribing it to the entire system.

Both have very good points though, the tools are a bit messed up and the some of the physicians really aren't game right now. Saying it is either ALL one or ALL the other isn't useful.
 
I thought you said "I'm done" two posts ago. Your mind is closed to other points of view. Good luck with that. Move along.

I'd agree with this too. Some people are going to believe what they want, no matter what evidence is presented. Even if you communicate perfectly, present rational evidence, and make a good argument there are some who just will not be swayed.

Pride and ego are hard to let go of.
 
They have admissions interviews to keep out weirdos and trolls.

People forget that human beings enjoy being around other humans they like. Sometimes it's personality, their voice, a vibe, whatever. We are social creatures.

The ENTIRE application lets them know if you are competent or capable of being a physician. The fact that some research study found that competent doctors were produced with or without interviews is inconsequential. The interview is there to see if they like you as a person.

There are punks who are very capable physicians, but no one wants to be around them.

If you are boring or awkward, then they probably don't want you in their school. It's not racial, it's personal.

The interview is a great tool for adcoms.
 
People forget that human beings enjoy being around other humans they like. Sometimes it's personality, their voice, a vibe, whatever. We are social creatures.

The ENTIRE application lets them know if you are competent or capable of being a physician. The fact that some research study found that competent doctors were produced with or without interviews is inconsequential. The interview is there to see if they like you as a person.

There are punks who are very capable physicians, but no one wants to be around them.

If you are boring or awkward, then they probably don't want you in their school. It's not racial, it's personal.

The interview is a great tool for adcoms.

As nerve wracking as it usually is, I'd say its also a good tool for the students to evaluate the school and their own fit within it. Most schools look good on paper. It wasn't until I actually attended some of my interviews that I realized I wouldn't be happy there.
 
Do you think there are no drug users in Germany? Are drug users only found in America? Are patients abroad all healthy and happy and do everything the doctor tells them? What is the point of this story?

This attitude is exactly what I am talking about. If you can't accept responsibility and are always trying to pass the blame, even onto patients, how do you intend to improve?

By the way, what's this " being the bad doctors that we are?". You're a medical student, not a doctor, and as such, you haven't replaced anyone's mitral valve...

Please explain to me what else the doctors could have done in this situation when a patient who goes against the doctor's advice and risks his life? Please refer to this specific situation and don't generalize.
 
Do you think there are no drug users in Germany? Are drug users only found in America? Are patients abroad all healthy and happy and do everything the doctor tells them? What is the point of this story?

This attitude is exactly what I am talking about. If you can't accept responsibility and are always trying to pass the blame, even onto patients, how do you intend to improve?

By the way, what's this " being the bad doctors that we are?". You're a medical student, not a doctor, and as such, you haven't replaced anyone's mitral valve...

And since you haven't confirmed your status, we can assume that neither have you.
 
Do you think there are no drug users in Germany? Are drug users only found in America? Are patients abroad all healthy and happy and do everything the doctor tells them? What is the point of this story?

This attitude is exactly what I am talking about. If you can't accept responsibility and are always trying to pass the blame, even onto patients, how do you intend to improve?

By the way, what's this " being the bad doctors that we are?". You're a medical student, not a doctor, and as such, you haven't replaced anyone's mitral valve...

The point of the story is to illustrate the environment in which doctors work in...an environment where they suggest a treatment, the patient doesn't follow that treatment, and then the patient blames the doctor for their outcomes. Obviously reading comprehension is not your strength.

You've blown a lot of hot air with a bunch of generalized, unverifiable statements. You claim that 1 in 3 medical tests are pointless, but you have yet to site a study backing up your claim. But I'll throw you a bone, I agree with you. In some cases, I would argue all diagnostic studies are pointless, but that's the system we have. You fail to understand that we have an extremely litigious society in which a doctor can be sued for tests that he or she did NOT order. In the case of your friend, yes the MRI (and it was probably a head CT, not an MRI) was a huge waste of money and time, but I can totally understand the rationale behind the doctor's decision. What if your friend had a epidural or subdural hemorrhage from hitting their head? How does the doctor know that the patient didn't lose consciousness....in any case of suspected lost consciousness, a head CT is absolutely 100% indicated, even if the patient looks absolutely fine. Even if your friend insisted that he or she didn't lose consciousness, you have to realize that doctors deal with patients who forget facts or blantantly lie all the time. If for some reason, your friend did have an intracranial hemorrhage from their head trauma, and the doctor missed it, he would get the pants sued off of him and lose everything.

And please explain to me how physicians make money off ordering tests. If I'm in private practice and I order an X-ray, unless I own the X-ray machine myself, I'm sending you somewhere to get it done. I don't get any money off of that. Ditto for labs and other things. Unless it's a procedure or something I can do in the office, I'm usually not making money off of that. So your argument reeks of someone who has no idea how the system works.

You argue that health outcomes are the worst here out of any industrialized country, but you fail to explain the fact if you correct for trauma (motor vehicle accidents, gunshots etc), that we have the longest life expenctancy out of any industrialized country, despite having the most obese population in the world. How is it physician's fault that our patients insist on stuffing themselves with McDonald's and Burger King all day? How is it physician's fault that our population refuses to exercise? How is it physician's fault that our population keeps getting more and more obese?

And I have no idea what attitude you're talking about. Every day during medical school and residency, medical students and doctors are constantly scrutinized and evaluated. I get feedback from every single resident and physician that I deal with, and my interaction with patients is evaluated as well. A great deal of private hospitals and many public insitutions now keep track of patient satisfaction, so I really have no clue what you mean when you say "physician's attitudes".

And one more thing; Your absolutely right I'm not a doctor yet, but I'm a lot closer than you are, which is why I actually know what I'm talking about. I haven't replaced anyone's mitral valve, but you don't need an MD to realize that repeatedly using IV drugs despite warnings from multiple doctors probably isn't the greatest idea in the world.

I'm not saying physicians here are perfect...absolutely not, but you have yet to give one concrete example as to why physicians here are part of the problem? What specifically do you think physicians should do to improve health outcomes?
 
The point of the story is to illustrate the environment in which doctors work in...an environment where they suggest a treatment, the patient doesn't follow that treatment, and then the patient blames the doctor for their outcomes. Obviously reading comprehension is not your strength.

You've blown a lot of hot air with a bunch of generalized, unverifiable statements. You claim that 1 in 3 medical tests are pointless, but you have yet to site a study backing up your claim. But I'll throw you a bone, I agree with you. In some cases, I would argue all diagnostic studies are pointless, but that's the system we have. You fail to understand that we have an extremely litigious society in which a doctor can be sued for tests that he or she did NOT order. In the case of your friend, yes the MRI (and it was probably a head CT, not an MRI) was a huge waste of money and time, but I can totally understand the rationale behind the doctor's decision. What if your friend had a epidural or subdural hemorrhage from hitting their head? How does the doctor know that the patient didn't lose consciousness....in any case of suspected lost consciousness, a head CT is absolutely 100% indicated, even if the patient looks absolutely fine. Even if your friend insisted that he or she didn't lose consciousness, you have to realize that doctors deal with patients who forget facts or blantantly lie all the time. If for some reason, your friend did have an intracranial hemorrhage from their head trauma, and the doctor missed it, he would get the pants sued off of him and lose everything.

And please explain to me how physicians make money off ordering tests. If I'm in private practice and I order an X-ray, unless I own the X-ray machine myself, I'm sending you somewhere to get it done. I don't get any money off of that. Ditto for labs and other things. Unless it's a procedure or something I can do in the office, I'm usually not making money off of that. So your argument reeks of someone who has no idea how the system works.

You argue that health outcomes are the worst here out of any industrialized country, but you fail to explain the fact if you correct for trauma (motor vehicle accidents, gunshots etc), that we have the longest life expenctancy out of any industrialized country, despite having the most obese population in the world. How is it physician's fault that our patients insist on stuffing themselves with McDonald's and Burger King all day? How is it physician's fault that our population refuses to exercise? How is it physician's fault that our population keeps getting more and more obese?

And I have no idea what attitude you're talking about. Every day during medical school and residency, medical students and doctors are constantly scrutinized and evaluated. I get feedback from every single resident and physician that I deal with, and my interaction with patients is evaluated as well. A great deal of private hospitals and many public insitutions now keep track of patient satisfaction, so I really have no clue what you mean when you say "physician's attitudes".

And one more thing; Your absolutely right I'm not a doctor yet, but I'm a lot closer than you are, which is why I actually know what I'm talking about. I haven't replaced anyone's mitral valve, but you don't need an MD to realize that repeatedly using IV drugs despite warnings from multiple doctors probably isn't the greatest idea in the world.

I'm not saying physicians here are perfect...absolutely not, but you have yet to give one concrete example as to why physicians here are part of the problem? What specifically do you think physicians should do to improve health outcomes?

You make excellent points, here. :)

However, what I find funny is the way it seems healthcare has changed, particularly because of the bolded statement. When I was about 8, I fell off a fence and banged my head pretty hard on the sidewalk. I passed out for a bit, I was bleeding, throwing up, passing out, etc. When I went to the hospital, all I got was stitches. There was no head CT to rule out anything. That was back in '94. It's amazing how much everything has changed, because had that happened today, I probably would have had that head CT.
 
You argue that health outcomes are the worst here out of any industrialized country, but you fail to explain the fact if you correct for trauma (motor vehicle accidents, gunshots etc), that we have the longest life expenctancy out of any industrialized country, despite having the most obese population in the world. How is it physician's fault that our patients insist on stuffing themselves with McDonald's and Burger King all day? How is it physician's fault that our population refuses to exercise? How is it physician's fault that our population keeps getting more and more obese?

John Ensign?! Is that you?! I remember that nonsense from the Senate healthcare debate, and since that factually-false claim was discredited and rightly mocked at the time, it is surprising you would bring it up again.

http://www.philly.com/philly/blogs/americandebate/Forget_those_cars_and_guns.html
 
First, I don't think many US doctors will concede that any country does a better job of selecting and educating doctors than the US. Some arguably do as good, but no, "their doctors are NOT better than ours in many respects".

Here's the deal. Other medical systems predated that of the US. The US chose to set up medical schools where people first typically attend a college, and then the med school admission is set up as very difficult and strict so that we didn't have to use a "selection by attrition" approach used by most other nations or fields. Meaning once you are in a US med school, you most probably will end up a physician. Not so in other countries, where they let more people in, only to throw them out later. Further, after seeing other systems and after a series of changes in focus in patient rights and expectations, the admissions process moved away from a very objective one to a partially objective, and partially subjective one. It was agreed by the US profession that there is more to being a doctor than high scores. We want not only high scores, but also folks who bring other things to the table, in terms of experiences, ECs, interpersonal skills. So in our system the interview is huge. Which actually makes sense because you will realize once you are further into this field that it is barely a science, and mostly a service industry. It has more in common with the legal or consulting industry than it does with most PhD science jobs. We intentionally chose this approach because the med schools prior to 1980 were not really cranking out the kind of doctors the profession or patients wanted. So we tweaked it, made non-sci majors a popular option, encouraged women, minorities, and nontrads into the profession, and put emphasis on interpersonal skills and experiences. And never turned back because we liked the end result better than the strictly numbers oriented admissions process that preceded it. So the interview makes a ton of sense in our system because we are looking for folks with interpersonal skills for this service oriented field. That other nations don't have the same view of the field is fine; they presumably are cranking out the kind of doctors that are desired by their local professions. But don't kid yourself into thinking that they are better -- many actually do horribly when they try to come over and integrate into the US system. Our admissions and subsequent training is what makes sense for the field here. And we crank out some of the most talented physicians in the world, who tend to be more dynamic because many have more diverse backgrounds and experiences you get when you don't start med school right out of high school and when you don't select purely based on numbers. It's a better system, at least for the US. If you dislike the system so much, you might actually dislike the field of medicine as it's practiced here because the skills required to interview are also the skills required to be a good clinician. Food for thought.

Funny, over the last month I've spoken with 3 different American trained doctors who did fellowship programs in England and they all said that England is turning out doctors with greater clinical skills.(mind you I didn't bring this up they did) They stated that these skills are honed more sharply because they do not have the luxury of ordering every test twice and so are forced to rely on their clinical diagnosis skills more.
However one chooses to look at it medicine is predominantlsy a science so I don't thing it is right to say it isn't.
Also there are two parts to the practice of medicine 1) diagnosing the disease and formulating an appropriate treatment plan 2)Relaying that information to the patient.
I will bow to the culture of medicine as it is now but if I were a patient I would first want someone who can diagnose me and then i would worry about whether he was holding my hand when he was telling me or not. I have great interpersonal skills and I know that this will come in handy when I practice since this is what people want but I know my dear sister who has two seemingly benign conditions but has remained undiagnosed for 4 years sure wishes she could just get told what is wrong with her even if the person as the other end is not smiling
 
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I honed my personal skills in college, when I drank every friday and met people. I did not hone them spending 2 hours reading this thread. LOTS OF BIG WORDS THROWN AROUND SDN posters. Lots of big words.....
 
Law2Doc:
I understand your points perfectly.
You are basically saying America has a worse legal system, healthcare bureaucracy, fat and lazy population, etc, which are all responsible for the bad healthcare outcomes in this country. In short, you blame everything and everyone except those actually delivering healthcare, who you think are doing a great job.

It reminds me of the saying, a poor workman blames his tools. Unfortunately, I think your attitude is typical of most US physicians.
No, you don't. It reminds me of the SDN saying, "If you can't read for ****, your responses are going to be pretty worthless."
 
You've blown a lot of hot air with a bunch of generalized, unverifiable statements. You claim that 1 in 3 medical tests are pointless, but you have yet to site a study backing up your claim.

The 1-in-3 was a hot piece of semi-technical news cited during the 12 month health debate. For a quick summary, try this AP article.

Or you can peruse the Dartmouth Institute for Health Policy & Clinical Practice, which authored the now infamous 20 year study of Medicare utilization and outcomes (the one Atul Gawande used to seed the now infamous Cost Conundrum article in The New Yorker).

This debate always descends into everyone making valid points, but in the process talking past each other. We probably do have the highest quality medicine in the world, but only if you look at single treatments/procedures. Our overall coordination of care is poor, owing to a piecemeal system and lack of portable electronic health records.

Overall we definitely overutilize health care, but not for a single reason. There is defensive medicine, to be sure, but to date no one has been able to satisfactorily quantify it. Moreover, no one has demonstrated that tort reform alters physician behavior. If you examine some actual data on malpractice claims, it's tilted more to our favor than common perception among doctors would indicate. Even the trial lawyers don't see medical malpractice as a savory way to make a living,* as they lose a lot of cases relative to other personal injury litigation. You don't get rich by losing cases.

The greater problem, I think, is rooted in fee-for-service and the highly maligned incentive structure of our current system. Physicians operate rationally on an individual basis, but the aggregate effect of their actions is dysfunctional. Therein lies the disconnect in this discussion.

*http://www.searcylaw.com/files/Statistics%20Show%20Medical%20Malpractice%20Cases%20Are%20Not%20an%20Easy%20Windfall%20for%20Plaintiffs.pdf.
 
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Health_costs_USA_GDP.gif


I'm with BerlinDude. Clearly the quality of American medical graduates has been in a state of inexorable decline since the 1960s :thumbup:
 
I'm with BerlinDude. Clearly the quality of American medical graduates has been in a state of inexorable decline since the 1960s :thumbup:

Yes, because a chart that just calls it "US Healthcare Spending" without any actual specifics totally makes a point.
 
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