Your Thoughts on the Future of US Health Care?

[SurfingDoctor]

Anyone who fails a student for disagreeing with him/her politically is intellectually and emotionally weak

The believe that providing healthcare to people is politics is precisely the problem. From my perspective, it is not politics, it is ethics. I suppose not everyone does separate the two.

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[bronx43]

The believe that providing healthcare to people is politics is precisely the problem. From my perspective, it is not politics, it is ethics. I suppose not everyone does separate the two.

Politics, ethics, morality. Different faces of the same cube. All are rooted in opinions, and lack an objective foundation. Please define "ethics," then define "politics."

 

[SurfingDoctor]

Politics, ethics, morality. Different faces of the same cube. All are rooted in opinions, and lack an objective foundation. Please define "ethics," then define "politics."

Fair enough. I suppose everyone does not have the same moral goals. However, based on this thread, it appears medical schools should teach more courses in ethics. I know most medical organizations would not agree with the "politics" of providing worse care to people from lower incomes, but then again, I would bet most people in this thread think the AMA, AAP, etc. are FOS. All I can say is I feel sorry for them.

 

[DubVille]

The believe that providing healthcare to people is politics is precisely the problem. From my perspective, it is not politics, it is ethics. I suppose not everyone does separate the two.

I agree that emergency care should be provided regardless of ability to pay, but there has to be a limit. There are not enough resources to give everyone "top of the line" care. How can you fail someone with a different political opinion? You are assessing their ability to be a physician? If they ignored reality ($) and proclaim that everyone is entitled to the latest and greatest, I'd be concerned with their reasoning skills (but wouldn't fail them if they perform as a student.)

 

[bronx43]

Fair enough. I suppose everyone does not have the same moral goals. However, based on this thread, it appears medical schools should teach more courses in ethics. I know most medical organizations would not agree with the "politics" of providing worse care to people from lower incomes, but then again, I would bet most people in this thread think the AMA, AAP, etc. are FOS. All I can say is I feel sorry for them.

So, basically you're admitting that you are all about pushing your own opinions on others. Good to know. How academic of you.

 

[SurfingDoctor]

I agree that emergency care should be provided regardless of ability to pay, but there has to be a limit. There are not enough resources to give everyone "top of the line" care. How can you fail someone with a different political opinion? You are assessing their ability to be a physician? If they ignored reality ($) and proclaim that everyone is entitled to the latest and greatest, I'd be concerned with their reasoning skills (but wouldn't fail them if they perform as a student.)

Yes, maybe "Fail" was too harsh a term. However, I surmise that few of people on this thread actually knows what goes into a clinical rotation grade. It is usually derived from the 6 parts of ACGME competency. They are:

Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Medical Knowledge
Residents must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.

Professionalism
Residents must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems-Based Practice
Residents must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

In the case of declaring that poor patients deserve worse care, that is a 0/5 for patient care, practice-based learning, systems-based practice and improvement and professionalism. The rest would remain to be seen.

 

[FiveOClock]

Fair enough. I suppose everyone does not have the same moral goals. However, based on this thread, it appears medical schools should teach more courses in ethics. I know most medical organizations would not agree with the "politics" of providing worse care to people from lower incomes, but then again, I would bet most people in this thread think the AMA, AAP, etc. are FOS. All I can say is I feel sorry for them.

Most medical organizations are in shambles and worthless now because academic medicine has destroyed them. By stuffing far-left wing dogma down all physicians' throats, the AMA has managed to reduce its membership to less than 1/5 of all physicians. Academicians seem to all believe that because they are poorly compensated for their work, everyone should be equally poorly compensated. They pass this sinister impulse off as empathy for the masses. In reality, it is simply the green-eyed monster rearing its ugly head. Universal health care means more money for academic centers because there will be no substantial private system to speak of. Only the "top-tier" insurance or cash only hospitals/offices which will be off-limits to the middle class. All universal health care will do is assure that the middle class receives WORSE healthcare with less access than they have now with more rationing and more waiting. All in the name of helping very few poor Americans who could be aided in other ways. However, universal healthcare puts healthcare in control of Democrat politicians forever, so it is the holy grail for statists.

In the case of declaring that poor patients deserve worse care, that is a 0/5 for patient care and professionalism. The rest would remain to be seen.

Poor patients do not deserve worse care. They receive worse care (in the status quo) because they cannot afford better care. People who have resources do not necessarily "deserve" better care, they simply receive it because...economics.

 

[vendtex]

To answer your specific questions, yep I was talking about infant mortality rates as one of many metrics of quality of healthcare as an industry. And to answer your other question, I've had my children hospitalized in the US hospitals and they received fine care. Doesn't mean we shouldn't strive to make it better. If other countries have better outcomes, we should try to learn what they are doing right, not belittle them because we have to think the US is best at everything.

Infant mortality rate isn't a very good metric of the quality of healthcare for a lot of reasons, ironically many of which were mentioned in the articles you linked regarding India's healthcare.

 

[SurfingDoctor]

If you contribute nothing to the country, why are you entitled to health care in the first place?

Poor patients do not deserve worse care.

Which is it?

 

[SurfingDoctor]

Infant mortality rate isn't a very good metric of the quality of healthcare for a lot of reasons, ironically many of which were mentioned in the articles you linked regarding India's healthcare.

Great. Now that I've answered your question, can you answer the question that I asked earlier:

As a pediatrician, you agree with a lower standard of care for poor patients and their children?

 

[PL198]

Yes, maybe "Fail" was too harsh a term. However, I surmise that few of people on this thread actually knows what goes into a clinical rotation grade. It is usually derived from the 6 parts of ACGME competency. They are:

Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Medical Knowledge
Residents must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.

Professionalism
Residents must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems-Based Practice
Residents must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

In the case of declaring that poor patients deserve worse care, that is a 0/5 for patient care, practice-based learning, systems-based practice and improvement and professionalism. The rest would remain to be seen.

maybe you should check out your own ethics dude and how easily you are knocked off your game by someone who disagrees with you

 

[vendtex]

Great. Now that I've answered your question, can you answer the question that I asked earlier: "As a pediatrician, you agree with a lower standard of care for poor patients and their children?"

In an ideal world, no. But we don't live in an ideal world. Can you name a single situation in which the care given to all in a population is truly equal? I can't think of any. The reality is that when the patient calls back and says they can't afford the X-ray or the antibiotic or other medication then you do the best you can under the circumstances, but having practiced in the military which is the closest to single payer I've experienced, that system was not immune to varying levels of treatment either.

 

[SurfingDoctor]

So, basically you're admitting that you are all about pushing your own opinions on others. Good to know. How academic of you.

Hey, I can admit when I'm wrong. As for grades, I follow the ACGME competency requirements. I try to be objective as possible, though I admit, I'm not perfect.

 

[SurfingDoctor]

In an ideal world, no. But we don't live in an ideal world. Can you name a single situation in which the care given to all in a population is truly equal? I can't think of any.

The PICU. Whether you have no insurance, Medicaid or Aetna, you still get the opportunity to be treated equally and fairly. In fact, I honestly never look at the demographic sheets of patients. But different strokes for different folks I guess. I do sympathize where you are coming from, I just don't empathize with it.

 

[vendtex]

The PICU. But different strokes for different folks I guess. I do sympathize where you are coming from, I just don't empathize with it.

I have my doubts about that.

 

[bronx43]

Hey, I can admit when I'm wrong. As for grades, I follow the ACGME competency requirements. I try to be objective as possible, though I admit, I'm not perfect.

You actually aren't following ACGME competency requirements. You are simply allowing your own prejudices to influence your grading of the student. Please show us where the grading requirement states explicitly that a student must hold the certain views. If you are going to point to the word "ethical," then please define the term. Then, provide evidence that ACGME agrees with your definition.

 

[vendtex]

The PICU. Whether you have no insurance, Medicaid or Aetna, you still get the opportunity to be treated equally and fairly. But different strokes for different folks I guess. I do sympathize where you are coming from, I just don't empathize with it.

You are further removed from the patient and being confronted about the bill. Unless you are completely unaware of the financial status of the patient the reality is that you probably aren't even aware of any bias or differences in the the treatment they may receive. That's why the ideal is a double blind study because the truth is even subconscious factors may play a role whether or not you chose to acknowledge them.

 

[SurfingDoctor]

You actually aren't following ACGME competency requirements. You are simply allowing your own prejudices to influence your grading of the student. Please show us where the grading requirement states explicitly that a student must hold the certain views. If you are going to point to the word "ethical," then please define the term. Then, provide evidence that ACGME agrees with your definition.

"Professionalism is demonstrated through a foundation of clinical competence, communication skills, and ethical understanding, upon which is built the aspiration to and wise application of the principles of professionalism: excellence, humanism, accountability and altruism."

"To properly fulfill their professional responsibilities, residents must understand the systems in which they function, and the interprofessional nature of health care. Thus, the Task Force emphasized the regular, meaningful involvement of residents in program and institutional quality improvement and patient safety initiatives. Such an expansion of the educational model should have the benefit of an immediate focus on ensuring patient safety; it also sets the stage for lifelong behaviors directly toward enhancing patient care through improving the systems for health care delivery."

"It is felt that these standards are in keeping with the broader principles already espoused by the medical profession. In addition to reasonable limits on resident work hours, there is a new emphasis on immersing residents in all aspects of patient care including diagnosis and treatment of disease, and inculcating in them a commitment to care for patients as human beings. This should result in a more altruistic physician and set the stage for a lifetime of highly professional behavior."

https://www.acgme.org/Portals/0/PDFs/jgme-11-00-47-51[1].pdf

 

[DubVille]

Yes, maybe "Fail" was too harsh a term. However, I surmise that few of people on this thread actually knows what goes into a clinical rotation grade. It is usually derived from the 6 parts of ACGME competency. They are:

Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and

Yes, maybe "Fail" was too harsh a term. However, I surmise that few of people on this thread actually knows what goes into a clinical rotation grade. It is usually derived from the 6 parts of ACGME competency. They are:

Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Medical Knowledge
Residents must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.

Professionalism
Residents must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems-Based Practice
Residents must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

In the case of declaring that poor patients deserve worse care, that is a 0/5 for patient care, practice-based learning, systems-based practice and improvement and professionalism. The rest would remain to be seen.

I dont see anytbing in there that gives permission to pass judgement on thoughts or beliefs of residents/students. It mentions acting in an ethical manner, which I interperate as a physical act. Was this rotator refusing care, or voicing opinions? Big difference.

 

[vendtex]

The PICU. Whether you have no insurance, Medicaid or Aetna, you still get the opportunity to be treated equally and fairly. In fact, I honestly never look at the demographic sheets of patients. But different strokes for different folks I guess. I do sympathize where you are coming from, I just don't empathize with it.

Another point is that not being treated exactly "equally" is not the same as providing a lower quality of care.

 

[bronx43]

"Professionalism is demonstrated through a foundation of clinical competence, communication skills, and ethical understanding, upon which is built the aspiration to and wise application of the principles of professionalism: excellence, humanism, accountability and altruism."

"To properly fulfill their professional responsibilities, residents must understand the systems in which they function, and the interprofessional nature of health care. Thus, the Task Force emphasized the regular, meaningful involvement of residents in program and institutional quality improvement and patient safety initiatives. Such an expansion of the educational model should have the benefit of an immediate focus on ensuring patient safety; it also sets the stage for lifelong behaviors directly toward enhancing patient care through improving the systems for health care delivery."

"It is felt that these standards are in keeping with the broader principles already espoused by the medical profession. In addition to reasonable limits on resident work hours, there is a new emphasis on immersing residents in all aspects of patient care including diagnosis and treatment of disease, and inculcating in them a commitment to care for patients as human beings. This should result in a more altruistic physician and set the stage for a lifetime of highly professional behavior."

https://www.acgme.org/Portals/0/PDFs/jgme-11-00-47-51[1].pdf

Did you even read this? Where does it say that a student who performs actions that fulfill their professional responsibilities fails because of holding a viewpoint?

 

[SurfingDoctor]

Well, I can take a hint when I'm not welcomed. Best of luck to you all and remember, if nothing else can be learned from this thread, reality (and healthcare reform) is harsh.

 

[bronx43]

Well, I can take a hint when I'm not welcomed. Best of luck to you all and remember, if nothing else can be learned from this thread, reality is harsh.

Riiight... except you're the one living in a fantasy world where your opinions are absolute truth, ACGME rules are objective only as you interpret it, and everyone can receive all medical care all the time despite finite resources.
No wonder you're a pediatrician.

 

[vendtex]

Did you even read this? Where does it say that a student who performs actions that fulfill their professional responsibilities fails because of holding a viewpoint?

I think he was reacting to his on comment suggesting that treating differently based on ability to pay was equivalent to pulling a ventilator from a patient.

 

[vendtex]

No wonder you're a pediatrician.

What's that supposed to mean?

 

[bronx43]

What's that supposed to mean?

Actually it's a poor joke meaning that he lives in a fantasy world just like some of his patients. No offense towards other pediatricians.

 

[DubVille]

In fairness, if i was a NICU doc I would probably be a bit more "liberal" in my views. My patients have not "done" anything to "deserve" their condition and may often be caused by parents choices.







NVM, it would probably just make me want sterilisation enforcements.
I do think caring for kids is a different topic in regards to healthcare allotments.

 

[Wilf]

Yes, maybe "Fail" was too harsh a term. However, I surmise that few of people on this thread actually knows what goes into a clinical rotation grade. It is usually derived from the 6 parts of ACGME competency. They are:


In the case of declaring that poor patients deserve worse care, that is a 0/5 for patient care, practice-based learning, systems-based practice and improvement and professionalism. The rest would remain to be seen.

This is why I don't like when the ACGME releases lists like these. People who are too concrete and lack critical thinking skills have trouble applying them in the correct way.

 

[vendtex]

This is why I don't like when the ACGME releases lists like these. People who are too concrete and lack critical thinking skills have trouble applying them in the correct way.

I think he likes to be provocative.


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[VA Hopeful Dr]

The PICU. Whether you have no insurance, Medicaid or Aetna, you still get the opportunity to be treated equally and fairly. In fact, I honestly never look at the demographic sheets of patients. But different strokes for different folks I guess. I do sympathize where you are coming from, I just don't empathize with it.

Yeah you're right about this. Once you're in the hospital, costs go out the window. If the PICU is anything like the adult ICU, the bed itself runs around $5000/day. Very little testing that we order is going to make a big difference compared to that.

 

[VA Hopeful Dr]

In fairness, if i was a NICU doc I would probably be a bit more "liberal" in my views. My patients have not "done" anything to "deserve" their condition and may often be caused by parents choices.







NVM, it would probably just make me want sterilisation enforcements.
I do think caring for kids is a different topic in regards to healthcare allotments.

I agree. I wouldn't be all that opposed to a public option that's limited to kids for exactly that reason (still have private insurance be an option of course).

 

[vendtex]

I agree. I wouldn't be all that opposed to a public option that's limited to kids for exactly that reason (still have private insurance be an option of course).

What if your tax rate has to go up from 39% to 49% to pay for that?


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[giantswing]

In fairness, if i was a NICU doc I would probably be a bit more "liberal" in my views. My patients have not "done" anything to "deserve" their condition and may often be caused by parents choices.

How are we to quantify who "deserves" what? What about the under employed, works at an animal shelter individual who gets hit by a drunk driver, but doesn't have health insurance? Do they deserve subpar medical care because they can't pay, then a tobacco CEO rolls in the door w an MI after years of smoking and drinking, does he get better care because he has "good" insurance?

It's not our place as doctors to make these calls. We treat the drunk a**hole w the same quality of care (maybe less with less dilaudid) as we do the grandma who raised all grandchildren.

I say this as a cynical jaded B**** who works in an inner city hosptial, where like 99.9% of patients don't have insurance or know the words "thank you."

 

[VA Hopeful Dr]

What if your tax rate has to go up from 39% to 49% to pay for that?


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Well if we're letting me make all the decisions, I can do that without spending much more money than we already do.

 

[DubVille]

How are we to quantify who "deserves" what? What about the under employed, works at an animal shelter individual who gets hit by a drunk driver, but doesn't have health insurance? Do they deserve subpar medical care because they can't pay, then a tobacco CEO rolls in the door w an MI after years of smoking and drinking, does he get better care because he has "good" insurance?

It's not our place as doctors to make these calls. We treat the drunk a**hole w the same quality of care (maybe less with less dilaudid) as we do the grandma who raised all grandchildren.

I say this as a cynical jaded B**** who works in an inner city hosptial, where like 99.9% of patients don't have insurance or know the words "thank you."

Answering who "deserves" something is a very tough question. I would say in your hypothetical scenario that the animal shelter individual should receive all needed care during her acute period and then unfortunately if needed apply for disability, medicaid, and other forms of govt assistance in place with the help of social workers. It's a terrible scenario, and I understand my opinions are just that.
This individual may not get to see the best in the fields for follow up or undergo the latest and greatest elective procedures, but there is a safety net in existence.
The CEO can pay for the best and greatest if he is using his money. Its crappy, but life is crappy. Healthcare is expensive, as a civilized/advanced country I think we should do our best to prevent total abandonment of the poor, but resources are finite.
I know in our clinics the highest no show rates are by far medicaid patients. They are also the most likely to be late (I realize they have more complicated transportation), and anecdotally are often the least appreciative. Plus, medicaid patients cannot be charged for no-shows. To some extent, I cannot force others to live responsibly and am not willing to indefinitely pay to do so. All while being vilified as an evil 1%er.

Thats just like, my opinion though.

 

[benjamin94559]

We need to do what India does. Have government run hospitals that people can go to for 100% free. Each physician sees approximately 200 pts a day, and there is little oversight for regulations and record keeping. People who really just need a doctor get to see one.

Then there is the private hospital/offices which accept private insurance and cash and are high quality. This way everyone has minimum health-care, but you get what you pay for. No Medicare/Medicaid or any other government programs, just the state hospitals. This is ultimately a more fair two-tiered system than the future public option, which would ruin private health insurance and force everyone into low-quality, high-cost, **** healthcare.

this would be incredibly, politically unfeasible and unpopular.

 

[petrosgp]

I don't understand the cognitive dissonance that most doctors/medical students have when it comes to patient care vs politics.

One of the pillars of our practice is that patient autonomy is paramount. We can recommend the best course of action, and we can try to convince them, but in almost all cases (with some very limited exceptions in mental health care or where children are involved), we can not force them to accept our help, even if we know that will maim or kill them. We offer options, we do not use force to bend people's actions to what we believe is best.

But when it comes to politics, autonomy is forced out of the window. In this thread, I've read about how a lot of posters want to force people to pay for public health coverage they may not want, using the same paternalistic thinking ('it's for your own good') that is a red flag in medical practice. You are not giving people the option to 'opt out' of your ~perfect~ single-payer system. Asking the government to do something does not absolve you of moral responsibility: it's the same as stealing money from diabetics to pay for insulin shots they do not want, except that you do not get your hands dirty.

And that's without even going into how government meddling in healthcare and insurance has been one of the leading causes of soaring costs. Just look up common aid societies and how awesome they were until the government stomped them.

You may look to the systems of Europe as 'perfect', but the harsh reality is that those systems are under severe strain and will most likely collapse within the next few years under the increasing costs of caring for an elderly population without the population growth to support them.

 

[jl lin]

"We cannot provide access to high-quality care for everyone, it is not possible. For examples of how this does not work, see Canada and England where care is rationed for EVERYONE because of their universal health care system" FiveO'Clock, if many are really honest, on some level they sense this; yet they go on w/ the political wave.

This is all about the political undercurrent that is moving things. It's the handwriting on the wall, and people just want to look the other way.

I am seeing this already, and I have other decades from which to compare quality in delivery of care from many different places/systems.

These shifts are moving on the gentler side, but the momentum will build, eventually sending HC to utter hell for most people. Middle Class! LOL! What will that be?

If you try to say anything about it, you are called some extremist, conspiracy theory person. It's the globalist method for shutting folks up.

This is where it's all heading w/ the fervent and growing push toward globalism. Yes. Follow the "logic" of UHC, and "Let's be like everyone else." Abdicate sovereignty, and it's OK if the quality of care drops substantially across the board...gradually and then the momentum builds. It's politics, and they aren't good for USHC. It's terribly disturbing.

 

[jl lin]

Also, I have seen plenty of VIP care. It still exists. The thing is, the blue collar person, who had at one time a decent insurance plan that was not breaking his back, you know, one of the sweaty, hardworking middle class--could get the same top notch neurosurgeon and seriously good care. At the same time, changes weren't made right and left to control costs so that everyone gets less careful treatment. It's happening now. It's growing...it is progressing.

There are ways around care that is lesser by current standards too, and VIPs will continue to have access to those ways. There are ways to get around the lesser care standards on an "as needed" basis.

It's a huge game, where 100% of the middle will lose quality of care right along with the LSE patients, and only the top 1% will get the best. Best practices will become "justified-less best practices," except for the ultra-elites. It's like watching a major train go off the tracks, w/ mass destruction, in slow motion.