Re: Socialized medicine at its best ...

On Sun, 28 Feb 2010 05:17:12 -0800 (PST), CigarBaron wrote:

On Feb 27, 7:42 pm, "Alex W." <ing...@xxxxxxxxxxx> wrote:
 IOW, for every thousand patients who are put into that
tube, how many actual diseases were diagnosed, and how many lives
were saved?-

In my practice, less than 1% I'll guess. But my last cerebral mass
was on a 28 year old woman, and, she'll live. Her kids will thank me
later. So, it took $100,000 of negative testing to find the one
positive. BTW, many of those negative testings gave a whole lot of
piece of mind to those who tested negative. Now, is that worth it?
Ask her kids. The analysts would say "no." Of course, if I had
missed the tumor on the woman, and she died, her kids would've won
millions in the lawsuit. So in the USoA where everyone sues
everybody, that $100,000 saved some insurer millions.
It's very complicated but physicians in the USoA are motivated by good
patient care and fear of lawsuits.

It's an emotive issue, I fully realise that. Of course the woman
and her kids are glad you ordered this test. But that doesn't
help with the hard decisions. Every $1,000 CAT scan not ordered
could fund 200 diabetes tests and save millions more in ling-term
medical costs.

As for peace of mind, depending on the disease the doctor is
looking for, the rate of false positives on a CAT scan can be as
high as 69% (lung cancer), delivering a first-instance death
verdict to the patient and requiring lots of expensive further
testing.

I would be a fool to dispute the obvious and eminent usefulness
of such advanced imaging techniques. But I do question the view
that "more is better", and that the sheer number of these
machines is in and of itself an automatic benefit. You don't
automatically prescribe antibiotics to every patient, do you? So
why do our doctors and hospitals do this with CAT, PET and other
imaging? Where are the clinical considerations in this, and
where is the cost-effectiveness? Medicare alone spends $12
billion a year on imaging, and they estimate that at least a
third of this is wasted -- that's a GODAWFUL lives that could be
saved if those wasted resources could be used more productively
elsewhere.


.

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