what do you think is the biggest problem in healthcare

[yoyohomieg5432]

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trying to think about how to prep for this question. I haven't had an interview since obamacare started. I used to say lack of access to affordable healthcare for 40 million americans, but not that obamacare out that problem will be solved eventually. what are some other ones? I was also thinking lack of investment into early and preventative care

 

[Ace-Co-A]

We remain the country that spends the most on healthcare, but with diminishing returns...

 

[QuinnTheEskimo]

We remain the country that spends the most on healthcare, but with diminishing returns...

I don't like the way the data is reported in that article. They are focusing on average life expectancy.

I have a friend who gave birth in a European country. Baby was born with birth defects, but alive and breathing. Hospital whisked baby away and told her "it's not worth it. you are young enough to have another child."

Things are different here when dealing with extremely sick people, which plays a role in raising costs.

 

[Ace-Co-A]

I don't like the way the data is reported in that article. They are focusing on average life expectancy.

I have a friend who gave birth in a European country. Baby was born with birth defects, but alive and breathing. Hospital whisked baby away and told her "it's not worth it. you are young enough to have another child."

Things are different here when dealing with extremely sick people, which plays a role in raising costs.

Your posts always leave me with more questions than answers. But I agree... life expectancy is not the best metric for determining efficacy of the healthcare system. This article was just at hand.

 

[QuinnTheEskimo]

Your posts always leave me with more questions than answers. But I agree... life expectancy is not the best metric for determining efficacy of the healthcare system. This article was just at hand.

lol what posts. i rarely post on serious topics here

 

[AquiVoy13]

trying to think about how to prep for this question. I haven't had an interview since obamacare started. I used to say lack of access to affordable healthcare for 40 million americans, but not that obamacare out that problem will be solved eventually. what are some other ones? I was also thinking lack of investment into early and preventative care

-many people will have access to basic insurance packages but will still remain underinsured and won't be able to access all the care that they need
-ACA doesn't cover undocumented immigrants, so there will still be regions in country where a lot of people don't have access to care

 

[Ace-Co-A]

lol what posts. i rarely post on serious topics here

Just trying to be funny. 😛

 

[joonage]

This thread gun get out of hand. I can sense it.

Anyway, my short and sweet answer - Lack of focus on preventative health. Much of our "burden" is due to people going to the ED for case that could have been prevented with early detection and maintenance. The ACA is fortunately moving towards that provided co-pays for preventative procedures which is awesome. I told my interviewer that it's better to spend minimal money early on with insurance and preventative medicine than spend maximal money with no insurance and the emergency room.

 

[QuinnTheEskimo]

-many people will have access to basic insurance packages but will still remain underinsured and won't be able to access all the care that they need
-ACA doesn't cover undocumented immigrants, so there will still be regions in country where a lot of people don't have access to care

Do you think that undocumented immigrants should have access to care?

I don't know what the best way to handle this would be. It seems that treating a huge number of undocumented immigrants would put awful financial strain on the system.

Obviously there are always free clinics, but I am thinking more about emergency room costs, etc.

 

[AquiVoy13]

Do you think that undocumented immigrants should have access to care?

Yes, but I'm not gonna discuss/argue about it over the internet

 

[QuinnTheEskimo]

Yes, but I'm not gonna discuss/argue about it over the internet

Ok, just curious. I don't have any strong opinions either way. I see both sides of the argument.

 

[Mad Jack]

Obesity, no pun intended.

 

[joonage]

Obesity, no pun intended.

I still chuckled .... lol ...

 

[QuinnTheEskimo]

I think the biggest problem is the expenditure (and lack of humanity) during the last 6 months of life, especially in elderly people. Invasive tests on people over the age of 80 = ridiculous, costly, most likely do more harm than good.

Way too many people are kept alive with 24 hour care, respirators and feeding tubes.

I think this problem is going to get a lot worse as the boomers get older.

 

[TooMuchResearch]

trying to think about how to prep for this question. I haven't had an interview since obamacare started. I used to say lack of access to affordable healthcare for 40 million americans, but not that obamacare out that problem will be solved eventually. what are some other ones? I was also thinking lack of investment into early and preventative care

Will the ACA fix the uninsured problem? If it does, what primary care will these millions of new insured see?

 

[Chipster.]

InB4 Ruralsurg4now

Enjoy this reasonable discussion while you can, people...

 

[Pacna]

You could always guarantee a rejection by saying "maybe we should release the physician monopoly on drugs."

For instance, why is Zofran prescription only? It's safer than Tylenol.

 

[QuinnTheEskimo]

You could always guarantee a rejection by saying "maybe we should release the physician monopoly on drugs."

For instance, why is Zofran prescription only? It's safer than Tylenol.

I am curious why you think this would guarantee a rejection.

 

[joonage]

You could always guarantee a rejection by saying "maybe we should release the physician monopoly on drugs."

For instance, why is Zofran prescription only? It's safer than Tylenol.

I accidentally straight up said in my interview that physicians and hospitals were too much for profit. Don't spend enough time with patients and hospitals try to churn out as many as they can ...

Didn't mean it exactly like that but I was nervous ... Still haven't gotten rejected .................................. aha.... *knockonwood*

(I do agree that Big Pharma is shady as ****)

 

[Pacna]

I am curious why you think this would guarantee a rejection.

Physicians have a knee jerk reaction to this because having solely doctors with the key to almost all drugs makes the profession much more profitable. Imagine if people could order antibiotics online or go to the pharmacy and get some IV compazine.

It's just natural to want to protect your bottom line. I think it's a discussion worth having, but not in an interview. You'll likely just get that knee jerk reaction.

 

[BlueLabel]

Physicians have a knee jerk reaction to this because having solely doctors with the key to almost all drugs makes the profession much more profitable. Imagine if people could order antibiotics online or go to the pharmacy and get some IV compazine.

It's just natural to want to protect your bottom line. I think it's a discussion worth having, but not in an interview. You'll likely just get that knee jerk reaction.

Somehow I'm not too keen on having any kind of discussion about giving laypeople the keys to the antibiotic supply. Let's not be too hasty here, many of these substances are controlled for a reason. And in the case of antibiotics, careful management of their distribution and use is critical to prevent the development of resistance. Hence why it's terrifying the quantities of it they dump into animal feed...

 

[Pacna]

Somehow I'm not too keen on having any kind of discussion about giving laypeople the keys to the antibiotic supply. Let's not be too hasty here, many of these substances are controlled for a reason. And in the case of antibiotics, careful management of their distribution and use is critical to prevent the development of resistance. Hence why it's terrifying the quantities of it they dump into animal feed...

I agree that seeing your physician before taking these substances is an INCREDIBLY good idea. However, I'm not willing to throw people in prison for making medical decisions on their own. Antibiotic resistance is not a reason to use violence against people.

Think about what you just said - farmers have free access to this for their CATTLE.

 

[BlueLabel]

I agree that seeing your physician before taking these substances is an INCREDIBLY good idea. However, I'm not willing to throw people in prison for making medical decisions on their own. Antibiotic resistance is not a reason to use violence against people.

Think about what you just said - farmers have free access to this for their CATTLE.

But people shouldn't be making medical decisions on their own. Think about it. You can't just "decide" you need a knee replacement and go have that done. Moving forward with a treatment program requires the approval and supervision of a medical professional. Obviously the patient has the autonomy to accept or reject the conclusions of individual providers and seek a different opinion, but I see no reason why the layperson needs unlimited access to high-tech medical weaponry (in a manner of speaking). Further, I mentioned cattle ranching to highlight an example of egregious mismanagement of a controlled substance, with uncertain and potentially devastating consequences for the continued efficacy of antibiotics. It's an area that needs significantly more oversight and control, not a model for prescription drug reform.

 

[Pacna]

But people shouldn't be making medical decisions on their own. Think about it. You can't just "decide" you need a knee replacement and go have that done. Moving forward with a treatment program requires the approval and supervision of a medical professional. Obviously the patient has the autonomy to accept or reject the conclusions of individual providers and seek a different opinion, but I see no reason why the layperson needs unlimited access to high-tech medical weaponry (in a manner of speaking). Further, I mentioned cattle ranching to highlight an example of egregious mismanagement of a controlled substance, with uncertain and potentially devastating consequences for the continued efficacy of antibiotics. It's an area that needs significantly more oversight and control, not a model for prescription drug reform.

So you support throwing people in prison for ordering their own drugs online?

You can make all of the justifications that you like (and I agree with most of them), but if you support "controlling" drugs, that means you're willing to do violence against people who do not go to a doctor for their medications. That goes directly against "do no harm." I think surgery is a fine example of when people would be wise to seek a trained medical professional, but I wouldn't throw them in jail if they wanted to do it themselves. I'd just see them in the ER.

 

[BlueLabel]

So you support throwing people in prison for ordering their own drugs online?

You can make all of the justifications that you like (and I agree with most of them), but if you support "controlling" drugs, that means you're willing to do violence against people who do not go to a doctor for their medications. That goes directly against "do no harm." I think surgery is a fine example of when people would be wise to seek a trained medical professional, but I wouldn't throw them in jail if they wanted to do it themselves. I'd just see them in the ER.

Are you a libertarian? Just curious.

I don't want to drag this out too much, because I don't think we'll agree. I just think that there are significant negative consequences to giving laypeople the keys to the drug cabinet, both to the people seeking them and to society as a whole. Nowhere is this more true than the realm of antibiotics. I firmly believe that maintaining physicians and other highly trained and educated medical professionals as the gatekeepers to prescription drugs is not some ploy to keep salaries high, but an important safeguard against personal and societal harm. That said, I understand where you're coming from and respect your opinion.

 

[Pacna]

Are you a libertarian? Just curious.

I don't want to drag this out too much, because I don't think we'll agree. I just think that there are significant negative consequences to giving laypeople the keys to the drug cabinet, both to the people seeking them and to society as a whole. Nowhere is this more true than the realm of antibiotics. I firmly believe that maintaining physicians and other highly trained and educated medical professionals as the gatekeepers to prescription drugs is not some ploy to keep salaries high, but an important safeguard against personal and societal harm. That said, I understand where you're coming from and respect your opinion.

I am not a Libertarian.

I agree 100% that there are negative consequences to legalizing drugs. However, continuing to control them is worse. Think about what you're saying: "I want to protect you from the negative aspects of prescription drugs, so if you try to use them without a prescription, I'm going to throw you in jail." I mean come on. That's you caring about people? I'd hate to see you malicious.

But @ the OP: This is exactly why you shouldn't mention this in an interview. People invested in profiting from the health care system stand to lose a lot from this, and they will fight tooth and nail to keep prescription drugs under their control.

 

[sinombre]

I am not a Libertarian.

I agree 100% that there are negative consequences to legalizing drugs. However, continuing to control them is worse. Think about what you're saying: "I want to protect you from the negative aspects of prescription drugs, so if you try to use them without a prescription, I'm going to throw you in jail." I mean come on. That's you caring about people? I'd hate to see you malicious.

But @ the OP: This is exactly why you shouldn't mention this in an interview. People invested in profiting from the health care system stand to lose a lot from this, and they will fight tooth and nail to keep prescription drugs under their control.

I pretty much agree with everything BlueLabel is saying. I don't think people should necessarily be put in jail for using controlled substances, but I think they should probably be prevented from being able to obtain them (which is an important distinction to make).

 

[QuinnTheEskimo]

I pretty much agree with everything BlueLabel is saying. I don't think people should necessarily be put in jail for using controlled substances, but I think they should probably be prevented from being able to obtain them (which is an important distinction to make).

Antibiotics are one thing, but what about things like birth control pills and fancy face creams?

 

[Pacna]

I pretty much agree with everything BlueLabel is saying. I don't think people should necessarily be put in jail for using controlled substances, but I think they should probably be prevented from being able to obtain them (which is an important distinction to make).

That's not a distinction. That's the same thing. You'll just create an underground market. If you punish people for participating in the market, we're back at square one. If you don't, that's exactly what I'm proposing. Just don't punish people.

 

[sinombre]

Antibiotics are one thing, but what about things like birth control pills and fancy face creams?

Birth control is kind of a complicated issue... not all forms are safe for everyone.

 

[QuinnTheEskimo]

Birth control is kind of a complicated issue... not all forms are safe for everyone.

But can't the same be said for a lot of things that are currently over-the-counter?

 

[TheWeeIceMan]

Too many layers of bureaucracy making everything more time consuming and expensive than it needs to be.

 

[sinombre]

That's not a distinction. That's the same thing. You'll just create an underground market. If you punish people for participating in the market, we're back at square one. If you don't, that's exactly what I'm proposing. Just don't punish people.

It is a distinction. You don't have to punish anyone for taking a substance, but you can still require they have a prescription to obtain it.

But can't the same be said for a lot of things that are currently over-the-counter?

Yes. It's obviously far from a perfect system.

 

[Pacna]

It is a distinction. You don't have to punish anyone for taking a substance, but you can still require a prescription to obtain it.

So if I obtain the substance without a prescription and nothing happens to me, what's my incentive for getting a prescription?

 

[BlueLabel]

I am not a Libertarian.

I agree 100% that there are negative consequences to legalizing drugs. However, continuing to control them is worse. Think about what you're saying: "I want to protect you from the negative aspects of prescription drugs, so if you try to use them without a prescription, I'm going to throw you in jail." I mean come on. That's you caring about people? I'd hate to see you malicious.

But @ the OP: This is exactly why you shouldn't mention this in an interview. People invested in profiting from the health care system stand to lose a lot from this, and they will fight tooth and nail to keep prescription drugs under their control.

But the purpose is to restrict access. The mistake you apparently are making is it seems like you assume everyone who wants a prescription drug without a prescription tries to obtain one (and furthermore gets caught, arrested, convicted, and jailed). In reality, a very very small percentage of prescription-drug seekers end up in jail because of the relative ease of going through the proper channels when your condition is legitimate. This is because the law is working precisely as intended - it's not jailing people with legitimate need; rather, it restricts access to dangerous substances. Indeed, virtually the only people who ever end up in jail for prescription drug use were using them recreationally, not for the legitimate treatment of disease.

So in other words, these restrictions do indeed fulfill the maxim "do no harm", because the net result is public access to prescription drugs is more or less responsibly managed for the vast majority, while a tiny minority of offenders (who in general are recreational users) end up in jail.

But can't the same be said for a lot of things that are currently over-the-counter?

It's true that American drug policy is in many respects incoherent, but that's sort of a different debate. On the balance, we'd be better off maintaining the restrictions on current prescription-only substances than we'd be if we abolished all of them.

 

[sinombre]

So if I obtain the substance without a prescription and nothing happens to me, what's my incentive for getting a prescription?

There is none, other than it is more difficult for most people to do this than to see a physician who can use medical expertise to determine whether or not the medication is actually safe and appropriate to use.

 

[QuinnTheEskimo]

It's true that American drug policy is in many respects incoherent, but that's sort of a different debate. On the balance, we'd be better off maintaining the restrictions on current prescription-only substances than we'd be if we abolished all of them.

I didn't know this until googling just now, but the American College of Obstetricians and Gynecologists actually endorses over-the-counter birth control, in an effort to curb the incidence of unwanted pregnancies.

 

[Pacna]

But the purpose is to restrict access. The mistake you apparently are making is it seems like you assume everyone who wants a prescription drug without a prescription tries to obtain one (and furthermore gets caught, arrested, convicted, and jailed). In reality, a very very small percentage of prescription-drug seekers end up in jail because of the relative ease of going through the proper channels when your condition is legitimate. This is because the law is working precisely as intended - it's not jailing people with legitimate need; rather, it restricts access to dangerous substances. Indeed, virtually the only people who ever end up in jail for prescription drug use were using them recreationally, not for the legitimate treatment of disease.

Jailing people for using prescription drugs for recreation is no more moral than jailing people for using alcohol recreationally. Yes, it's incredibly stupid to use, say, chemotherapy drugs without consulting your doctor, but what harm are you doing to others by this? You might be able to make the case for antibiotics if you imagine some scenario where people abuse them until bacteria are just resistant to everything and people are dropping like flies, but the reasons drugs stay restricted are for personal health concerns (like possible heart affects). Again, drugs like Zofran are safer than Tylenol. You're willing to jail people for obtaining them illegally? Why?

There is none, other than it is more difficult for most people to do this than to see a physician who can use medical expertise to determine whether or not the medication is actually safe and appropriate to use.

Are you unaware of the people who are jailed for narcotic possession without a prescription? Watch the show "Cops" one time if you don't believe me. (or Google it)

 

[SouthernSurgeon]

I love this interview question. It's perfectly designed to weed out candidates who don't buy into the academic medicine groupthink.

 

[QuinnTheEskimo]

I love this interview question. It's perfectly designed to weed out candidates who don't buy into the academic medicine groupthink.

Can you elaborate?

Also, when is buying into "groupthink" ever a good thing???

 

[SouthernSurgeon]

Can you elaborate?

Also, when is buying into "groupthink" ever a good thing???

I was being mildly hyperbolic...

But the leadership of academic medical centers have a notorious leftward shift, and at my school at least never passed up on an opportunity to try and beat a similar mindset into the students.

 

[BlueLabel]

Jailing people for using prescription drugs for recreation is no more moral than jailing people for using alcohol recreationally. Yes, it's incredibly stupid to use, say, chemotherapy drugs without consulting your doctor, but what harm are you doing to others by this? You might be able to make the case for antibiotics if you imagine some scenario where people abuse them until bacteria are just resistant to everything and people are dropping like flies, but the reasons drugs stay restricted are for personal health concerns (like possible heart affects). Again, drugs like Zofran are safer than Tylenol. You're willing to jail people for obtaining them illegally? Why?



Are you unaware of the people who are jailed for narcotic possession without a prescription? Watch the show "Cops" one time if you don't believe me. (or Google it)

I already conceded that drug policy is incoherent. Part of the reason for this is "momentum" - initial attitudes about a substance and the length of time it's been around have an impact on its acceptance within our society and its legal status. I think this explains a lot about alcohol, marijuana, and even Tylenol. You don't need to convince me that drug policy is inconsistent, it needs to be made less so. There are a lot of financial and political hoops to jump through here to change things for the better, but defeating the evil fatcat physicians lining their pockets isn't really one of them. Pharmaceutical companies profit far more than physicians with regards to prescription drugs anyway, although corporate greed is again just a piece of the problem.

The bottom line is, you can have all the ivory tower morality discussions you want, but when it comes to crafting responsible and effective policy, people will turn to the pragmatists - not the philosophers.

 

[sinombre]

Are you unaware of the people who are jailed for narcotic possession without a prescription? Watch the show "Cops" one time if you don't believe me. (or Google it)

When I said "there is none" it was potentially misleading. I didn't intend to claim that there isn't one currently, rather that there would not be if what I had suggested were the case.

Also narcotics are a different beast entirely because of how addictive and abused they are, and the fact that their level of addictiveness and abuse really does impact other people and society as a whole.

 

[TheRobin]

trying to think about how to prep for this question. I haven't had an interview since obamacare started. I used to say lack of access to affordable healthcare for 40 million americans, but not that obamacare out that problem will be solved eventually. what are some other ones? I was also thinking lack of investment into early and preventative care

Medical malpractice/tort reform issues might be something to look into, although I doubt it would come up that much in an interview.

 

[TheWeeIceMan]

I was being mildly hyperbolic...

But the leadership of academic medical centers have a notorious leftward shift, and at my school at least never passed up on an opportunity to try and beat a similar mindset into the students.

They should start using the Steven Colbert question on applicants.

Obama: Great President? Or the greastest President?
ACA: Great legislation? Or the greatest legislation?

 

[Pacna]

When I said "there is none" it was potentially misleading. I didn't intend to claim that there isn't one currently, rather that there would not be if what I had suggested were the case.

Also narcotics are a different beast entirely because of how addictive and abused they are, and the fact that their level of addictiveness and abuse really does impact other people and society as a whole.

To your first point, I see now. Sorry for the misunderstanding. Still, I have already addressed this. You're arguing my point. If you're not going to punish anyone for buying/selling the drugs without a prescription, then you're arguing for deregulation.

Towards your second point, that is a secondary or tertiary moral position. That's like saying "white murderers should be illegal." You're just confusing the issue. Either substances that are highly addictive and easily abused should be illegal (caffeine, alcohol, etc), or they shouldn't.

I already conceded that drug policy is incoherent. Part of the reason for this is "momentum" - initial attitudes about a substance and the length of time it's been around have an impact on its acceptance within our society and its legal status. I think this explains a lot about alcohol, marijuana, and even Tylenol. You don't need to convince me that drug policy is inconsistent, it needs to be made less so. There are a lot of financial and political hoops to jump through here to change things for the better, but defeating the evil fatcat physicians lining their pockets isn't really one of them. Pharmaceutical companies profit far more than physicians with regards to prescription drugs anyway, although corporate greed is again just a piece of the problem.

The bottom line is, you can have all the ivory tower morality discussions you want, but when it comes to crafting responsible and effective policy, people will turn to the pragmatists - not the philosophers.

I think the incoherency surrounding drug policies is just the tip of the proverbial iceberg. They become inconsistent due to odd moral positions (like your own, no offense intended).

I think you're misunderstanding my position. I'm aiming to be a physician, myself. I don't think that they're (or you're) purposefully keeping these drugs illegal for the sake of profit. I'm saying that it's a natural tendency that doesn't have to be an active thought to influence behavior.

This is a moral argument about the justifications behind substance "control." Belittle the position of philosophers all you like, but you'll just keep putting patches on your leaky pipes without a sound philosophical framework for public policy.

 

[buttercup12]

trying to think about how to prep for this question. I haven't had an interview since obamacare started. I used to say lack of access to affordable healthcare for 40 million americans, but not that obamacare out that problem will be solved eventually. what are some other ones? I was also thinking lack of investment into early and preventative care

Probably a bit broad, but I'd say economic inequality as well as the focus of healthcare providers to be more on physiological symptoms/individual health/biomedicine rather than that of the population or its underlying societal conditions.

 

[hat]

I don't know about the biggest problem, but I'd say the lack of integration of mental and physical health care is a big one.

 

[Shjanzey]

This thread is most definitely THE biggest problem in healthcare right now

 

[lobo.solo]

High cost, which is not regulated. The cost of a procedure/service fluctuates significantly depending on the institution.
Health disparities.
No health care access to everyone, as it was mentioned this of undocumented immigrants.
It is no single payer.