A Nation of Anxious Wimps

[ERCougar]

http://www.epmonthly.com/index.php?option=com_content&task=view&id=626&Itemid=63

[tooblue]

http://www.epmonthly.com/index.php?o...=626&Itemid=63

Very interesting article and perspective.

In a single night I had patients come in for the following complaints (all brought by ambulance): “Smoked marijuana and got dizzy”, “stung by a bee and it hurts”, “got drunk and have a hangover”, “sat out in the sun and got sunburn”, “ate Mexican food and threw up”, “picked my nose and it bled, but now it stopped”, “just had sex and want to know if I’m pregnant ...”

.. At a time when we have an unprecedented obsession with health – Dr. Oz, The Doctors, Oprah and a host of daytime talk shows make the smallest issues seem like apocalyptic pandemics – we have substandard national wellness. This is largely because the media focuses on the exotic and the sensational and ignores the mundane. Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes and breast implants when we really should worry about smoking, drug abuse, obesity, cars and basic hygiene. If you go by pharmaceutical advertisement budgets, our most critical health needs are to have sex and fall asleep.

While I'm a big proponent of universal health care I'm an even bigger proponent of improved education about a great many things and at all levels. But where do you begin and who should take the lead?

[Soccermom]

http://www.epmonthly.com/index.php?o...=626&Itemid=63

That was a very good article. I am actually surprised at how many people I know who just up and go to the doctor at the drop of a hat. The only times I can recall ever going to the ER were when my oldest son could not breathe. Who enjoys waiting hours in a waiting room just to be told it is the flu?

I am glad that the school district we are in has finally stopped requiring doctors notes for absences longer than two days. Sometimes a kid is just sick with a fever for a while and needs longer than two days to heal, just as the article said, the body is really good at healing itself.

[UtahDan]

This is an interesting article and no doubt true from his perspective. I have to wonder, however, if this is a little bit like cops eventually thinking that everyone lies because almost everyone lies to them. IOW, I don't think he is actually describing most people. I think he is describing a very small minority of people who he sees in his ER and who are causing a disproportionately large problem.

The idea that most people are overagressive in treating their health issues is the opposite of my experience in life. I'm sure someone will tell me if I have erred.

[SeattleUte]

I have a friend who's a policeman. He says he spends much of the day being asked by parents to raise their kids for them.

[Soccermom]

This is an interesting article and no doubt true from his perspective. I have to wonder, however, if this is a little bit like cops eventually thinking that everyone lies because almost everyone lies to them. IOW, I don't think he is actually describing most people. I think he is describing a very small minority of people who he sees in his ER and who are causing a disproportionately large problem.

The idea that most people are overagressive in treating their health issues is the opposite of my experience in life. I'm sure someone will tell me if I have erred.

I think there is some truth to what you say. I actually remember reading an article once (I'm too lazy to try and find it now) where doctors were quoted as saying they just assumed parents were lying to them. I think it was about pediatricians. So I wouldn't be surprised if there is some truth to what you wonder.

[ERCougar]

This is an interesting article and no doubt true from his perspective. I have to wonder, however, if this is a little bit like cops eventually thinking that everyone lies because almost everyone lies to them. IOW, I don't think he is actually describing most people. I think he is describing a very small minority of people who he sees in his ER and who are causing a disproportionately large problem.

The idea that most people are overagressive in treating their health issues is the opposite of my experience in life. I'm sure someone will tell me if I have erred.

I think you're absolutely right. While I won't dispute his lineup of ambulance visits--I've had nearly identical nights numerous times--there is a certain "venting" air to his article.

However, the reality is that even if these people don't represent the average American, they are using large amounts of our healthcare dollars, so I'm not sure it changes his point too much. This customer-service-driven model without constraints of cost-bearing is the chief cause of our financial woes, IMO.

[CardiacCoug]

However, the reality is that even if these people don't represent the average American, they are using large amounts of our healthcare dollars, so I'm not sure it changes his point too much. This customer-service-driven model without constraints of cost-bearing is the chief cause of our financial woes, IMO.

This is true.

Health care in this country is characterized by over-testing, over-medicating, and too many operations and procedures with limited proven benefit. Concern for liability by doctors is a major contributing factor for these problems. Fee-for-service payments to doctors based on total volume of procedures performed is another major contributing factor. Poor information systems and poor communication between hospitals is another problem because tests are repeated unnecessarily.

The way that medical practice is a business in which the patient must be satisfied that they are receiving substantive medical treatment or will seek other providers is another contributing factor. Some cardiologists have all their patient undergo stress tests every year, for example -- this is completely unsupported by any data and expensive, but many patients have come to expect it. If people aren't given antibiotics for their viral infections or don't receive MRIs for their joint and back pain (both of which are entirely unnecessary), they will often go find a doctor who will do these unnecessary things. Unlike in a regular business, in medical decision-making, the customer is often wrong. More (and more expensive) medical care is not necessarily better medical care.

[Hallelujah]

http://www.epmonthly.com/index.php?o...=626&Itemid=63

What percentage of these patients don't have health insurance? Your best guess.

My guess would be that if it doesn't cost them anything, they are more inclined to come into the ER. If they have a deductible, they are less inclined to make that knee jerk reaction.

[Hallelujah]

This is true.

Health care in this country is characterized by over-testing, over-medicating, and too many operations and procedures with limited proven benefit. Concern for liability by doctors is a major contributing factor for these problems. Fee-for-service payments to doctors based on total volume of procedures performed is another major contributing factor. Poor information systems and poor communication between hospitals is another problem because tests are repeated unnecessarily.

The way that medical practice is a business in which the patient must be satisfied that they are receiving substantive medical treatment or will seek other providers is another contributing factor. Some cardiologists have all their patient undergo stress tests every year, for example -- this is completely unsupported by any data and expensive, but many patients have come to expect it. If people aren't given antibiotics for their viral infections or don't receive MRIs for their joint and back pain (both of which are entirely unnecessary), they will often go find a doctor who will do these unnecessary things. Unlike in a regular business, in medical decision-making, the customer is often wrong. More (and more expensive) medical care is not necessarily better medical care.

With respect to your first paragraph, how much is 'defensive' medicine. Defensive in the sense that some lawyer may show up on the doorstep one day.

[ERCougar]

This is true.

Health care in this country is characterized by over-testing, over-medicating, and too many operations and procedures with limited proven benefit. Concern for liability by doctors is a major contributing factor for these problems. Fee-for-service payments to doctors based on total volume of procedures performed is another major contributing factor. Poor information systems and poor communication between hospitals is another problem because tests are repeated unnecessarily.

The way that medical practice is a business in which the patient must be satisfied that they are receiving substantive medical treatment or will seek other providers is another contributing factor. Some cardiologists have all their patient undergo stress tests every year, for example -- this is completely unsupported by any data and expensive, but many patients have come to expect it. If people aren't given antibiotics for their viral infections or don't receive MRIs for their joint and back pain (both of which are entirely unnecessary), they will often go find a doctor who will do these unnecessary things. Unlike in a regular business, in medical decision-making, the customer is often wrong. More (and more expensive) medical care is not necessarily better medical care.

Just as a follow-up to your stress test example (that i think illustrates the problem well)--how many unnecessary heart caths follow those equivocal or false-positive stress tests that never should have been done in the first place? The cardiologist thus avoids a possible lawsuit and makes a little more money for the additional procedure. Every incentive points in the wrong direction.

I had a great discussion on CG with Cali on this. We eventually got to the point of Cali advising that we just needed to CT everyone in the waiting room. Very enlightening.

[ERCougar]

What percentage of these patients don't have health insurance? Your best guess.

My guess would be that if it doesn't cost them anything, they are more inclined to come into the ER. If they have a deductible, they are less inclined to make that knee jerk reaction.

Of these ambulance calls? I'd guess very few of them are insured. Insurance companies crack down on this stuff pretty quickly (one of the reasons that percent spent on overhead is meaningless as an indicator of efficiency).

However, with regards to overall use of the ER, every study that's looked at it has found that when you insure a population, their use of the ER goes up. Lots of possible explanations for that, but that association is pretty clear. Healthcare reform won't do much to relieve ER overcrowding, and will likely make it worse.

[wuapinmon]

This is true.

Health care in this country is characterized by over-testing, over-medicating, and too many operations and procedures with limited proven benefit. Concern for liability by doctors is a major contributing factor for these problems. Fee-for-service payments to doctors based on total volume of procedures performed is another major contributing factor. Poor information systems and poor communication between hospitals is another problem because tests are repeated unnecessarily.

The way that medical practice is a business in which the patient must be satisfied that they are receiving substantive medical treatment or will seek other providers is another contributing factor. Some cardiologists have all their patient undergo stress tests every year, for example -- this is completely unsupported by any data and expensive, but many patients have come to expect it. If people aren't given antibiotics for their viral infections or don't receive MRIs for their joint and back pain (both of which are entirely unnecessary), they will often go find a doctor who will do these unnecessary things. Unlike in a regular business, in medical decision-making, the customer is often wrong. More (and more expensive) medical care is not necessarily better medical care.

In my pain-free moments, I'm glad I had three doctors in my small town who were willing to tell me "NO!" when I almost demanded they remove my gallbladder. Sure it hurts me a couple of times a week, and sure, I have to take this sub-lingual antispasmodic about once a fortnight, and sure, I get to take narcotics about once every 2-3 months when it hurts so bad I can't stand it. But, the risks of surgery and the knowledge that in cases like mine, people have the surgery and STILL have the pain, means that them telling me "NO!" makes me trust them far more. They're good doctors.

As far as the article goes, that dude needs a sabbatical. It reads like the beginning of Will Self's Book of Dave; imagine how life would be if we let a divorced embittered London cabbie dictate how life should be lived. There is much truth in what that doc is saying, but his tone is that of preaching-to-the-choir-emergency-physicians-monthly-rally-the-troops rhetoric that sours me on his message. UtahDan nailed it.

[ERCougar]

As far as the article goes, that dude needs a sabbatical. It reads like the beginning of Will Self's Book of Dave; imagine how life would be if we let a divorced embittered London cabbie dictate how life should be lived. There is much truth in what that doc is saying, but his tone is that of preaching-to-the-choir-emergency-physicians-monthly-rally-the-troops rhetoric that sours me on his message. UtahDan nailed it.

There's a lot of this kind of stuff in our throwaway journals. It's venting. I used to keep a medical blog that served a little of the same purpose but ultimately quit because I couldn't decide if it was therapeutic or if it was just burning me out more quickly.

[Fiyero]

My ex calls an ambulance every time our 5 year old throws up. No exaggeration; every time.