
Unnecessary medical care is harming patients physically and financially - goodJobWalrus
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
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dwolfson
I find it slightly disingenuous to write a comprehensive article on wasteful
medical care and yet barely mention the extremely litigious environment that
doctors face.

It's not just doctors that remember that one patient that didn't get scanned.
Lawyers do, too.

~~~
jobu
The legal complications around malpractice and malpractice insurance are
unfortunate, but they only reinforce the already perverse financial incentives
that doctors have for ordering more tests and procedures.

The theme for the article was that doctors need to slow down and spend more
time listening to patients. If anything that should reduce the legal risks of
inadequate or inappropriate care.

~~~
rebootthesystem
The disconnect between ideology and reality in some of these discussions is
sometimes remarcable. This "perverse financial objective" you talk about is
imaginary. My wife is a doctor. She sometimes lives in fear of not having
ordered this or that test. What she pays for insurance could probably support
the royal family of some small countries. It's absolutely infuriating that
doctors in the US can't focus on patient care and have to worry about being
sued out of existence. Imagine if you, as a coder, had to exist under similar
conditions.

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puzzlingcaptcha
> For instance, cancer screening with mammography, ultrasound, and blood
> testing has dramatically increased the detection of breast, thyroid, and
> prostate cancer during the past quarter century. We’re treating hundreds of
> thousands more people each year for these diseases than we ever have. Yet
> only a tiny reduction in death, if any, has resulted.

I take issue with that. Here are the statistics for breast cancer and prostate
cancer (new cases and deaths) by year:
[http://seer.cancer.gov/statfacts/html/breast.html](http://seer.cancer.gov/statfacts/html/breast.html)
[http://seer.cancer.gov/statfacts/html/prost.html](http://seer.cancer.gov/statfacts/html/prost.html)

The incidence of thyroid cancer has in fact increased, but it was hardly a
killer in the first place.

I find the 'turtles-and-rabbits' analogy to be misleading. Plenty of 'turtles'
can undergo a transformation and become much faster (at killing you).

~~~
dhimes
Remember, the new cases curve is roughly the _slope_ of the total cases curve.
I read your data as more-or-less supportive of the author's claim.

~~~
puzzlingcaptcha
If you want to consider that the statement "We’re treating hundreds of
thousands more people each year for these diseases than we ever have" refers
to total cases then well, that's always going to be true.

Besides, I am more interested in the statistics of mortality.

~~~
dhimes
> well, that's always going to be true.

unless they die

> I am more interested in the statistics of mortality

"Death rates have not changed significantly over 2002-2012"

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puzzlingcaptcha
Routine screening for breast cancer started in the 80's.
[http://seer.cancer.gov/statfacts/html/ld/breast.html](http://seer.cancer.gov/statfacts/html/ld/breast.html)

~~~
dhimes
Sorry, I really want to understand your point but I am unable. You disagree
with the thesis that more intensive screening and identification of these
health issues (since the '90s) have increased the number of people diagnosed
with the disease, but has not significantly impacted the mortality rates. This
seems to be aligned to the stats you quoted. What am I missing?

~~~
puzzlingcaptcha
I don't disagree with the increase in the total number of diagnosed cases,
there is nothing to disagree with. I disagree with calling a reduction in the
number of deaths since the 90's by half (prostate) and by a third (breast) "a
tiny reduction, if any".

~~~
dhimes
OK, but understand that you are also disagreeing with the site you linked
itself. Look at the 'data trend' link.

Not trying to be inciteful- kind of a personal issue with me atm, perhaps with
you, too.

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brohee
Honest question : how much of the unneeded testing is CYA against ambulance
chasers?

~~~
clavalle
If someone compared a state with low caps on medical malpractice like Texas
($250,000), with other states that don't have such caps you could probably get
a fairly straightforward answer.

I don't know how that shakes out. But I do know that various testing companies
give kickbacks to doctors in the form of leasing office space from them at far
above the market rate so their people can give on-premise 'consultations' on
which tests need to be done. Among other abuses.

At any rate, I think the financial incentives that exist in the medical sector
and how those incentives align with the patient need, desperately, to be
addressed as forthrightly and quickly as possible. But there seems to be a
taboo around suggesting that doctors are human and are susceptible to the
influence of money as anyone else.

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sandstrom
The US has excellent medical research, advanced technology, etc. But also
extremely inefficient system, about 2x the cost of comparable countries.

\-
[http://www.theguardian.com/news/datablog/2012/jun/30/healthc...](http://www.theguardian.com/news/datablog/2012/jun/30/healthcare-
spending-world-country)

\-
[https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_\(PPP\)_per_capita)

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goodJobWalrus
I find this article interesting in the light of recent passing of Dave
Goldberg, when most of the commentators got on to "please folks see your
doctor", even if you are healthy, bandwagon.

~~~
tsotha
There are good reasons to see your doctor periodically even if you feel fine.
It's a lot easier to treat diabetes and hypertension before they become
symptomatic than it is to find you a new kidney.

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emodendroket
The current world is medicine is kind of frightening. How many of us would
just dig into writing a program after a 15-minute conversation with a client?

~~~
bigchewy
It's more akin to spending 8 to 10 years writing a program (med school +
residency +....) and then it takes 15 minutes to run the program for the
individual instance

~~~
emodendroket
But the article describes (and my own experience has been similar) patients
being ignored because the doctor's made up his mind and it's on to the next
patient without any time to stop and look at this particular patient's
circumstances.

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xkcd-sucks
Sweet, now we can also file malpractice suits against the doctors that order
tons of covering-their-asses tests!

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joshuaheard
A third-party payer system, such as Medicare, has no incentive to keep costs
low.

~~~
mmastrac
That's an absolutely ridiculous statement. As a Canadian myself, we are
constantly seeing the struggle to reduce the cost of providing health care as
a proportion of the taxes we pay.

I don't know where this myth comes from -- is it just a misunderstanding of
how public health care works, assuming that it's an infinite money pit?

~~~
Frondo
It comes from buying into the anti-government propaganda that the hard right
has been pumping out for decades.

Once you buy into that, you start applying that faulty reasoning to the real
world, and you come up with afactual claims like the original poster did.

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tsotha
As someone who has had to fight to get tests which later turned out to be
critical, I can't help but wonder we're seeing more articles like this one
just as the government, having assumed much more control of the health care
system, is desperate to find places where costs can be reduced.

