> what would it take for the healthcare industry to restructure itself to actually function?
I can't quote it precisely, but here's a gist from The Glass Bead Game:
> Intelligence can find its own way, the teacher's job is to address stupidity.
Overlooking the crudeness here, I think it's a good idea, and translates to medicine. Most of us are not qualified to define good care, but we know bad care when we see it.
One example of bad care is when you don't discover how expensive a treatment will be until 3 months after it has occurred.
Another might be cases where medical professionals are expected to work insane long shifts with insufficient sleep time in between.
Whatever the examples are, let's make a list of them. Build consensus around the worst offenders, and then start revoking counts-as-medical-insurance tax status from the insurers who fund the bad behavior. If you want pre-tax-medical-insurance dollars, you must:
- be able to turn a "what if" treatment scenario into a dollar amount in less than 10 minutes
- not have organizations be in-network which create unsustainable working conditions for medical personnel
- [other example of bad care goes here]
...and we add to that list over time. Markets don't do design, they do evolution. We have to kill off the ones we don't like if we want more of the ones we like.
We dont even recognize bad care. People are overweight and suffering from chronic disease , but since they are “alive “ and taking meds we still call that a good outcome
sadly, a lot of patients consider that good care - around me, doctors stopped weighing patients, and don't ever discuss lifestyle changes or dietary changes (patients by and large don't want to hear it) - they just give the patients the pills they want to offset the poor lifestyle choices.
On the flip side: It's so frustrating to go in search of guidance re: lifestyle changes and they don't wanna hear it, instead all that do is recommend drugs.
Maybe we need to remove gatekeeping access to drugs from the primary care physician's job so that they can focus on the other parts.
I think you have that backwards. Gatekeeping (certain) drugs requires expert clinical knowledge to achieve the right results without harming the patient. This is one of the primary focus areas for physician training.
If patients need lifestyle advice then going to a highly paid physician is a waste. Those patients should start with a (cheaper) therapist, personal trainer, dietician, or social worker. We can't reasonably put the entire burden on physicians; it's too much for one profession to handle.
If you go to those people and tell them you have pain and you need to know which muscles to strengthen and which muscles to stretch, whether to rest or work out or get an x-ray, etc. they tell you to go to a physical therapist. But you need a referral for a physical therapist, so you have to go to a primary care physician first. All they do is throw drugs at you so you basically have to lie about taking the drugs because no I don't need painkillers I need answers, and then you can finally get your referral and go to the physical therapist who can help.
I've had this experience once and my wife has had it thrice (different doctors, different injuries).
By asking primary care physicians to gatekeep drugs, we're introducing a bias where when you walk in the door they assume you're after drugs. I don't have a solution for how best to gatekeep drugs, I just wish I could find a doctor who was unencumbered by that task so they could focus on healthcare instead.
You don't need a referral to visit a physical therapist. You can just make an appointment and go.
Certain health insurance plans may require a referral in order be reimbursed but that's not universal.
if this were true, why do the pharmacy rules vary considerably among different countries. In the US the rules are very strict. In Europe moderate and in Mexico very lenient.
Every time you try to change a medical policy the threat is "you'll kill grandma". the fact is that grandma's care is awful and we need radical changes.
i totally agree. the drugs are a huge health problem, but also psychological. Having to care for the elderly I've noticed the drugs serve another more concerning purpose. They create a psychological dependency from the patient onto the doctor / healthcare provider. The patients treat the doctors like magicians because of their control over meds.
Breaking drugs out to pharmacies, Mexican style, would go a long way to interrupt this dependency.