Fixing health care – some data


Category : Fixing health care

Over the next week or three, I plan to address health care in the United States.  I have not researched the issue; I have lived the issue.  My comments come from the heart and my version of common sense.  Since I am a physician, I will first present the data that I consider the most important.  I will then provide my diagnosis.  Finally in a long series of rants I will provide a variety of solutions.

I start from the assumption that our current health care “mess” has many etiologies.  We have no simple solution, because we cannot blame our current state on one problem.  I invite criticism and will even be delighted to “publish” op-eds on any of my rants.

Some data:

1. Health care is expensive

2. Sometimes it is worth it, but sometimes the expense is unnecessary

3. Our ability to improve quality of life has grown dramatically over the past 30 years

4. Our ability to manage many chronic diseases has grown dramatically over the past 30 years

5. In general we have too high a proportion of medical school graduates entering subspecialties and not enough entering generalist fields

6. Physicians do not spend enough time with patients (i.e., they see too many patients each day)

7. Physicians who do things are paid better than physicians who think through complex problems (again this is a generalization, many physicians who do things think first)

8. We generally prescribe too many drugs, and particularly too many expensive drugs

9. We overuse imaging technology, and do not take the time to take a careful history and do a careful physical examination

10 Patients are frustrated.  Many cannot find a physician (this is especially true for internists and the problem is worsening.)

11. Physicians are frustrated by malpractice, health insurance companies, and performance measurement

12. Everyone desires high quality medical care, but current proposals only include one or two dimensions of a multidimensional problem

13. We are still graduating too few physicians each year in the US

Yet, when pushed, most patients like, respect and trust their physician and most physicians love taking care of patients.

I certainly encourage readers to add to this list, as it is clearly incomplete.  Some will want me to address the underserved.  Clearly that is a problem, and I hope my solutions will address that issue, but even if you exclude that issue, we have great strides to make.

free viagra
buy viagra online
generic viagra
how does viagra work
cheap viagra
buy viagra
buy viagra online inurl
viagra 6 free samples
viagra online
viagra for women
viagra side effects
female viagra
natural viagra
online viagra
cheapest viagra prices
herbal viagra
alternative to viagra
buy generic viagra
purchase viagra online
free viagra without prescription
viagra attorneys
free viagra samples before buying
buy generic viagra cheap
viagra uk
generic viagra online
try viagra for free
generic viagra from india
fda approves viagra
free viagra sample
what is better viagra or levitra
discount generic viagra online
viagra cialis levitra
viagra dosage
viagra cheap
viagra on line
best price for viagra
free sample pack of viagra
viagra generic
viagra without prescription
discount viagra
gay viagra
mail order viagra
viagra inurl
generic viagra online paypal
generic viagra overnight
generic viagra online pharmacy
generic viagra uk
buy cheap viagra online uk
suppliers of viagra
how long does viagra last
viagra sex
generic viagra soft tabs
generic viagra 100mg
buy viagra onli
generic viagra online without prescription
viagra energy drink
cheapest uk supplier viagra
viagra cialis
generic viagra safe
viagra professional
viagra sales
viagra free trial pack
viagra lawyers
over the counter viagra
best price for generic viagra
viagra jokes
buying viagra
viagra samples
viagra sample
generic cialis
cheapest cialis
buy cialis online
buying generic cialis
cialis for order
what are the side effects of cialis
buy generic cialis
what is the generic name for cialis
cheap cialis
cialis online
buy cialis
cialis side effects
how long does cialis last
cialis forum
cialis lawyer ohio
cialis attorneys
cialis attorney columbus
cialis injury lawyer ohio
cialis injury attorney ohio
cialis injury lawyer columbus
prices cialis
cialis lawyers
viagra cialis levitra
cialis lawyer columbus
online generic cialis
daily cialis
cialis injury attorney columbus
cialis attorney ohio
cialis cost
cialis professional
cialis super active
how does cialis work
what does cialis look like
cialis drug
viagra cialis
cialis to buy new zealand
cialis without prescription
free cialis
cialis soft tabs
discount cialis
cialis generic
generic cialis from india
cheap cialis sale online
cialis daily
cialis reviews
cialis generico
how can i take cialis
cheap cialis si
cialis vs viagra
generic levitra
levitra attorneys
what is better viagra or levitra
viagra cialis levitra
levitra side effects
buy levitra
levitra online
levitra dangers
how does levitra work
levitra lawyers
what is the difference between levitra and viagra
levitra versus viagra
which works better viagra or levitra
buy levitra and overnight shipping
levitra vs viagra
canidan pharmacies levitra
how long does levitra last
viagra cialis levitra
levitra acheter
comprare levitra
levitra ohne rezept
levitra 20mg
levitra senza ricetta
cheapest generic levitra
levitra compra
cheap levitra
levitra overnight
levitra generika
levitra kaufen

Comments (7)

DB, great start to the list.

I would like to add the social factors as well. It is very easy to blame doctors, lawyers, politicians, insurance companies, etc. etc.etc…. (all of which are defiantly involved.)
But, we can not ignore our societal problems.

1. Americans demand the very best, but genrally dont want to pay for it.
2. Americans have a high sense of entitlement and a low sense of responsibility
3. Americans are overly sensitive. i.e: We are ready to give up when a few “eggs” crack.

I firmly believe the problem will not be fixed until WE all as society start accepting some responsibility.

thanks for the post.

Great list.

I would only add that doctors need a broad based business knowledge when graduating from medical school.

One of the many surprises I have had in following the medical blogs is that doctors look to pharma, insurance companies, or hospitals for their business models. None of these are really appropriate for the stand alone private practice. Plus, doctors are often taken in by those who put their interest above that of the doctor or their patients.

If I could teach them only one thing, it would be their role as sales managers, in their new profession.

Steve Lucas

I would add that for many treatments, we are dealing in the diminishing returns part of the curve.

Many of the new, expensive treatments and meds don’t add that much to what we were already doing with older proven treatments and generic meds, but we all want “the best” so it becomes the new standard of care. this costs us a ton and gives us relatively little benefit.

The List . . ….

A fellow blogger started a list. Here are just a few of the things on . . . the list….

I agree with your list, but I do not agree with your premise, that our health care system is a mess. In America, you, as a patient can get in to see any physician (you may have to wait) for any procedure at any time you desire. The only impediment is cost. This is a false impediment, as most people would think nothing of spending $20,000.00 on a new car but believe that health care should not cost. As Brian, stated, Americans want the best, but do not want to pay for the best. As someone who has experience “socialized medicine” in the military system, I will gladly pay for the right to control my own medical treatment. Finally, as a medical office manager, our patients demand the best service, but do not want to pay for the services. My solution to the problem is to put the responsibility back where it belongs, the patient. I will be curious to see what your solutions are.

Well said, pcb- Even in a best case scenario, any of our standard of care practices can only expect to benefit a few patients a little bit. And significant amounts of publication bias (described in last weeks NEJM) likely reduces the expected effectiveness of treatments even more. Physicians (and patients) have demonstrated very little ability to distinguish between high-value interventions and low-value interventions for individual patients (or groups of patients). So instead we recommend ALL the possible interventions that might have any impact on health (regardless of the known problems with overtesting, overdiagnosis and overtreatment)
I went to a Merck sponsored lunch last week where the physican presenter (on Merck’s dime) was trying to convice us of the utility of Vytorin. When asked about the expected absolute risk reduction for lowering LDL from 100 to 70, he dismissed the questioner and said “If you looked at ARR, you wouldn’t do half of the things we do in cardiology!”- I couldn’t agree more-


Post a comment