patrick.net

Meccos says

91% believed they....

Please check again your use of the word "they." The survey asked respondents to speculate about the behavior of physicians in general, it did not ask them to report their own experience.

Which brings me back to my question, which you have not answered. What area of medicine do you practice, and do you order up extra tests and procedures as defensive medicine?

curious2 says

BTW, what area of medicine do you practice, and do you order up extra tests and procedures as defensive medicine?

Yes, me and every one of my colleagues have admitted to ordering things unnecessarily. Unfortunately, I would not be surprised if EVERY single physician in this country has done this. Rather I would be surprised if one physician has NEVER done this.

Almost always, the decision to do this is based on the patient. You may never know, but many patients often demand these tests and even THREATEN lawsuits...

curious2 says

Please check again your use of the word "they." The survey asked respondents to speculate about the behavior of physicians in general, it did not ask them to report their own experience.

Which brings me back to my question, which you have not answered. What area of medicine do you practice, and do you order up extra tests and procedures as defensive medicine?

They are "physicians" and since all these people are physicians, i wrote "they". What is the point of even commenting on this? If you have nothing better to say, just dont say it. Distraction is pointless.

Also give me more than 3 minutes to respond... why so anxious for my responses?

Curious.

Let me ask you something serious. Why are you so resistant in believing that defensive medicine exists and it adds to the cost of health care???
Especially when someone like myself and hundreds of others in the industry admit that we have experienced this.

one other thing... you know I am a physician. Just so I know what your background is and where you get your info from, what do you do and where?

The question, "Do you believe that Physicians..." invites the respondent to speculate about the behavior of others, not to report their own behavior. If it were a study of physicians' own behavior, it would ask, "Do you do this..." not do you think other people do.

Why are you so resistant to disclosing your area of practice? If you were proud of it, you would disclose it, since you boast endlessly about how much $$$ you make at it. I have a guess...

curious2 says

The question, "Do you believe that Physicians..." invites the respondent to speculate about the behavior of others, not to report their own behavior. If it were a study of physicians' own behavior, it would ask, "Do you do this..." not do you think other people do.

Hahahahh pointless for me to keep going. Even if i give you evidence you wont accept it.

Obamacare will need to cost a lot to pay for all the useless "healthcare" including the $$$ Meccos boasts of:

"The total cost of treating back pain in the United States has risen 65% in the last decade, but after all the pricey treatments, many people are still left with an aching back and an increasingly empty wallet, U.S. researchers said Tuesday.

They said treating spine problems in the United States costs $85.9 billion a year, rivaling the economic burden of treating cancer, which costs $89 billion.
***
Yet, for all of the spending, they found people with spine problems actually felt worse."

In health, there is very little correlation between spending and results.

Meccos says

That article you quote is an LA times article. Hardly credible research. Even if this were true, im not a spine surgeon. Try a little harder next time. BTW you gonna respond to any of my previous posts or will you continue to distract everyone by going off topic?

I'm inclined to believe that the LA Times article is understating the health care spending problem in that it's not just back treatment spending that is ineffective and way more expensive than it used to be.

Meccos says

one other thing... you know I am a physician

So I am guessing that you like Obamacare since it's essentially more welfare for doctors?

Meccos says

Hahahahh pointless for me to keep going. Even if i give you evidence you wont accept it.

Just like you.

Meccos says

Curious.

Let me ask you something serious. Why are you so resistant in believing that defensive medicine exists and it adds to the cost of health care???

Especially when someone like myself and hundreds of others in the industry admit that we have experienced this.

So you are agreeing that the lawsuit reform can save way more than the 2.4% number cited above?

Battle of the trolls. LOL.

Meccos says

Why are you so resistant in believing that defensive medicine exists and it adds to the cost of health care?

Because the claim has been investigated and refuted. To be fair, I don't say it doesn't exist at all or that it doesn't add anything, but the evidence shows that "tort reform" (taking away patients' right to sue when they are injured or killed by malpractice) does not on balance reduce costs. To the contrary, it increases costs. When there is no accountability, the incentives are all one way: more. More unnecessary and injurious procedures (e.g. useless back surgery that carries a risk of paralysis), more prescriptions, more more more, because the fee-for-service model creates myriad opportunities for revenue and kickbacks without accountability as reported from Texas and elsewhere. Consider the unnecessary and injurious coronary bypass operations reported in Redding, for example. When you take away accountability, you take away "defensive medicine", but you don't reduce costs; they increase. Every unnecessary bypass operation adds a cost of $10k/year for the remaining life of the patient, if nothing else goes wrong, i.e. if the patient doesn't die on the table. When a hospital amputates the wrong leg, what kind of person says the hospital shouldn't even be required to buy a prosthetic for the person whose leg they cut off? By far the largest cost associated with malpractice is the cost of the malpractice itself, including a hundred thousand Americans killed by hospital-acquired infections each year. And Obamacare responds to all this by requiring even more of the same, everybody mandated into the same system, with unlimited upside for hospital corporations ("No lifetime caps! We can all be Terry Schiavo now! Yay!") at the expense of every other priority.

Typical MD lack of logical/critical thinking. To learn how to conduct an argument, here is a list of intellectually honest and dishonest debate tactics

http://www.johntreed.com/debate.html

Typical MD tactic: My resume’s bigger than yours. All the more reason why you ought to be able to cite specific errors or omissions in my facts or logic, yet still you cannot........Got tons of relatives just like you

Peer approval of subjective opinion: “Proving” correctness of a subjective statement by citing the approval of political allies in the same subject—so-called peer review in academia. Peer approval has value when it relates to objective standards like those in mathematics, chemistry, and physics. Such peers check the accuracy of calculations, the cleanliness of laboratories, and whether they can replicate the results in their own experiments. But peer review is of little probative (proving) value when it relates to subjective areas like sociology, economics, or women’s studies where the peers in question, and indeed the whole field or large portions of it, have a particular political agenda. What is considered correct academic teaching in high schools is determined by long-term, circular, self-reinforcing, peer group-think unaffected by results achieved by their students........I will add: medicine often falls short of this standard (esp psychiatry)

JAMA, Annals of Internal Medicine, is often a circle-jerk. Lot of articles don't properly disclose their potential and absolute sources of conflict of interest. Also, based on your speaking style on this forum, it's also probably the only thing you've read in last 20 years also while proclaiming to be an expert. Try reading pubmed more often. And when you come across articles that prove your point, post them here so we can read them.

I have 30 uncles, first cousins and second cousins in medicine and I'm gunning for 2015 residency. So what is your point?

Meccos says

Just so I know what your background is and where you get your info from, what do you do and where?

But radiologists sure do. It seems like they make the money they make not as a value-add, but just to help doctors practice CYA medicine. One estimate (can't remember where) was that it was about 4.4 billion dollars a year.

Meccos says

yet the physicians do not benefit financially in these cases. This is an unnecessary added costs clear and simple.

Certainly provides a lot of leeway for abuse in the system. Also, it seems like obamacare did not effectively address this systemic issue.

Meccos says

Unfortunately there will always be physicians who are unethical. However, make no mistake, the threat of malpractice DOES change practices of HONEST physicians and WILL increase costs.

Meccos says

one other thing... you know I am a physician. Just so I know what your background is and where you get your info from, what do you do and where?

What do you specialize in (or GP)? Just curious (not related to this discussion).

curious2 says

since you boast endlessly about how much $$$ you make at it.

Um, I made one or two sarcastic responses to you since you always claim physicians make too much money... care to link my "endless" boasts?

curious2 says

"The total cost of treating back pain in the United States has risen 65% in the last decade, but after all the pricey treatments, many people are still left with an aching back and an increasingly empty wallet, U.S. researchers said Tuesday.

They said treating spine problems in the United States costs $85.9 billion a year, rivaling the economic burden of treating cancer, which costs $89 billion.

***

Yet, for all of the spending, they found people with spine problems actually felt worse."

That article you quote is an LA times article. Hardly credible research. Even if this were true, im not a spine surgeon. Try a little harder next time. BTW you gonna respond to any of my previous posts or will you continue to distract everyone by going off topic?

Meccos says

I made one or two sarcastic responses to you since you always claim physicians make too much money... care to link my "endless" boasts?

Perhaps you were being sarcastic in one or two of your responses, but there's little point digging up a lot of links for you because you don't read them anyway. I suggest instead you should re-read your comments and mine in a different thread that was actually about whether doctors are overpaid, you seem to confuse me with someone else. If you read my comments, you will see that I do not "always claim physicians make too much money." To the contrary, in my opinion doctors are mispaid, i.e. payment does not correlate with value, and I have even said that some (e.g. GPs) can be underpaid, while others (e.g. Homefool's pushers and you) are overpaid for conferring little or no value. Other people have said doctors are overpaid, I have hewed to a more nuanced opinion of the subject, and if you re-read it paying attention to who said what I think you'll see the difference. As you read the thread I linked to, you might find the link I posted where GPs are suing the AMA over misallocation of Medicare funds; obviously I do not use "AMA" and "doctors" interchangeably, as I have often said the AMA represents less than 20% of doctors. You accuse me of "hating" doctors, but not everyone who disagrees with you hates you, let alone doctors in general.

There is a more basic issue with your comments though. This is a thread about the costs of Obamacare, which are becoming increasingly apparent as the time horizon approaches. It isn't about you personally, except the federally mandatory prepayment for your services whether wanted or not. As another comment put it, welfare for doctors, though I would call it mandatory redistribution primarily to PhRMA, AHA, AMA, and AHIP. If in a free market with open pricing and honest work, you made more or less than you do, I would have no comment about whether the number is too high or low or what you choose to say about it. The problem is the mandatory Obamacare, which makes everything cost more and requires everyone to submit to the whole takeover whether they want it or not, including Homefool's disproved pills etc.

curious2 says

Perhaps you were being sarcastic in one or two of your responses, but there's little point digging up a lot of links for you because you don't read them anyway.

You know very well I was being sarcastic... And of course you will say there is no point in digging them up because you cant and will not find any other examples. If you can find my "endless boasts" please post them to prove me wrong.

curious2 says

If you read my comments, you will see that I do not "always claim physicians make too much money."

perhaps not always, but you regularly do make this suggestion in several others posts.

curious2 says

This is a thread about the costs of Obamacare, which are becoming increasingly apparent as the time horizon approaches.

You are right, this WAS about costs of Obamacare, in which ironically we seemed to in agreement about. However along the way you hijacked this thread and began to refute that the costs of malpractice also contribute to the overall costs of healthcare. Even when faced with evidence that physicians practice defensive medicine (although even a little common sense will tell you it occurs) will obviously increase costs to health care spending, you are in denial.

zzyzzx says

Meccos says

one other thing... you know I am a physician

So I am guessing that you like Obamacare since it's essentially more welfare for doctors?

Zzyzzx... you would think so based on what curious2 says. HOwever I challenge you to go to physicians and see what they say about Obamacare. I will guarantee you that the overwhelming # of physicians are against Obamacare.

zzyzzx says

Meccos says

Curious.

Let me ask you something serious. Why are you so resistant in believing that defensive medicine exists and it adds to the cost of health care???

Especially when someone like myself and hundreds of others in the industry admit that we have experienced this.

So you are agreeing that the lawsuit reform can save way more than the 2.4% number cited above?

I dont know how much it would save, but it will likely save some money.

curious2 says

Because the claim has been investigated and refuted.

by who? you cant give me anecdotal evidence... well not even evidence, but opinions from a few physicians quoted in some news paper article.

curious2 says

To the contrary, it increases costs.

really? evidence?

curious2 says

More unnecessary and injurious procedures (e.g. useless back surgery that carries a risk of paralysis), more prescriptions, more more more, because the fee-for-service model creates myriad opportunities for revenue and kickbacks without accountability as reported from Texas and elsewhere.

CUrious2. Again the problem you have is that you confuse defensive medicine with plain fraud. LIke I said in previous posts, you will always have fraud...regardless of tort reform or not. However my point has always been this. Defensive medicine exists and it DOES carry a cost to health care. The physicians who perform unnecessary procedures are not the ones doing it because of defensive medicine... they are doing it to make money. However there are thousands of physicians who may order a test or a procedure JUST in case to protect their butts when in reality the symptoms and presentations of a patients do not warrant a test or a procedure. In most these cases, there is no financial gain or ordering these test, rather is a prevention of financial loss due to lawsuits....hence defensive medicine.

Meccos says

You are right, this WAS about costs of Obamacare, in which ironically we seemed to in agreement about. However along the way you hijacked this thread and began to refute that the costs of malpractice also contribute to the overall costs of healthcare.

If you read this thread, you will see that the subject was changed from Obamacare to malpractice by someone else, just yesterday in fact, and his numbers were off by a factor of four. I corrected that, and you got defensive as usual. What I find curious is, when other people say something you dislike, you attribute their comments to me, as if I occupy somehow a disproportionately large and nebulous place in your head. You seem to need to get the last word, which is ok if you will please say something that is demonstrably correct and hopefully relevant, e.g. we both agree that Obamacare will cost a lot of money.

MMR says

But radiologists sure do. It seems like they make the money they make not as a value-add, but just to help doctors practice CYA medicine. One estimate (can't remember where) was that it was about 4.4 billion dollars a year.

Meccos says

yet the physicians do not benefit financially in these cases. This is an unnecessary added costs clear and simple.

Radiologist dont order the studies. My quote was taken out of context. My point was that the physicians ordering these tests do not benefit financially. If a blood test was ordered, the lab and the lab technicians make money correct? Well if an x-ray was ordered, the radiologist would make money also.

If you are going so far as to claim that a radiologist have no added value, then you should really back up with evidence or your reasoning. Keep in mind radiologist function mainly with diagnosis. If you feel that making a diagnosis adds no value, then I could see your argument. However, most if not all, patients and clinicians would argue that diagnosis is the first step in any treatment.

MMR says

Certainly provides a lot of leeway for abuse in the system. Also, it seems like obamacare did not effectively address this systemic issue.

Meccos says

Unfortunately there will always be physicians who are unethical. However, make no mistake, the threat of malpractice DOES change practices of HONEST physicians and WILL increase costs.

There is always and likely will always be abuse in the system... no one has refuted or denied this. We can make similar arguments in many other fields.. financial system, government bureaucracies, even the local mechanics can abuse your lack of automobile mechanics.

mell says

Meccos says

one other thing... you know I am a physician. Just so I know what your background is and where you get your info from, what do you do and where?

What do you specialize in (or GP)? Just curious (not related to this discussion).

Spine specialists, which is why curious felt he needed to spend the time to link those articles...purely to try to bring me down. unfortunately he thought I was a surgeon and thus linked articles on spine surgeries... im not a spine surgeon however.

curious2 says

If you read this thread, you will see that the subject was changed from Obamacare to malpractice by someone else, just yesterday in fact, and his numbers were off by a factor of four. I corrected that, and you got defensive as usual.

Well if anyone got defensive I would say it was you. The only point I have been trying to make for the past day was that physicians practice defensive medicine and that is an added cost to health care. You do not want to believe this and will go to extremes to refute this fact, although most would agree that even just a little bit of common sense would lead you to this fact.

MMR says

I have 30 uncles, first cousins and second cousins in medicine and I'm gunning for 2015 residency. So what is your point?

Meccos says

Just so I know what your background is and where you get your info from, what do you do and where?

I dont get it... what is your point? So you have relatives in medicine and you are going into medicine. ok... so?? instead of saying you are gunning for residency in 2015, why dont you just talk like a normal person and say you are a med student?

Is MMR = Curious? otherwise why is MMR answering for curious..

zzyzzx says

Meccos says

Hahahahh pointless for me to keep going. Even if i give you evidence you wont accept it.

Just like you.

stop liking my post then...

Meccos says

curious2 says

Because the claim has been investigated and refuted.

by who? you cant give me anecdotal evidence... well not even evidence, but opinions from a few physicians quoted in some news paper article.

Curious always does this. He's a true example of the internet generation. He really believes that if he googles enough people who's opinions are the same as his then the point is proven. I really don't believe he has a clue the difference between opinion and analysis. Gathering data, developing methodology, doing an analysis then presenting it all so people know how you derived your numbers is so old school. Who bothers with that stuff any more? You can just interview a few people instead.

bob2356 says

I really don't believe he has a clue the difference between opinion and analysis.

I don't think he has a clue, period.

Homeboy says

I really should visit your universe sometime. It seems very interesting. In fact, I am pretty much the ONLY one on this forum who has any fucking clue what's in the law. The rest of you are just ranting about nothing. The level of ignorance is astounding.

So basically you're saying, you're fine with the destruction of what is left of the middle class and no hope of America ever returning to a high standard of living. You've basically given up on America and have resigned to sit it out and wait for the day, that the youth get old enough to realize just how fucked they really are.
Do you have your outfit picked out for bloody Sunday yet?

Homeboy says

Really? Because they're actually the ones being taxed. The healthcare industry and rich people are the only ones being taxed for this. And that suits me just fine. Taxes on the wealthy have gotten lower and lower for the past 100 years. What's wrong with them finally paying their fair share for a change?

You'll still be saying then when a loaf of bread is $10 and a gallon of gas, will be one of those situations, where "If you have to ask, then you probably can't afford it."
But the only problem for you will be, there still wont be no fucking high speed bullet train. And if there was, do you really think anyone will be able to afford a fucking ticket?

Why don't you Liberals just strong arm rob every rich republican in this country, then give all of their money to the IRS.
Can you explain, how that will benefit people that are actually trying to earn a living? That would be "Oh happy days!" for the welfare class, but the rest of us, will be shit canned from our jobs because it is the RICH in this country that hires people.

Man when I first came to this board, I had no fucking idea just how demented Liberals really are. I thought every republican that called Liberals "Libtards" and said Liberalism is a mental disease was just being mean spirited. I don't know if you extremist weirdos gravitate to Patnet or the new Liberals and Democrats really are a bunch of pinko fascist.The only thing the Liberals have going for them, is the constant, that "Young and Dumb" are synonymous. As the liberals keep finding new youngins to lie their fucking ass off to, so they can get these Monsters elected.

CaptainShuddup says

it is the RICH in this country that hires people.

God, how many times do we have to test that theory before you right wing nuts let go of that one? Bush already TRIED giving everything away to the rich. What was the result? The complete collapse of the banking system, millions of people losing their homes, 4 years of depression, and the largest disparity of wealth in this country's history. Between Bush and Obama, literally trillions of dollars were given away to the rich. How are those unemployment numbers as a result? When are you dim right wingers going to get that when you give money to a rich person, he KEEPS it. Trickle down economics should have died in the 1980s, but you dumb asses keep trying to resurrect it.

CaptainShuddup says

So basically you're saying, you're fine with the destruction of what is left of the middle class and no hope of America ever returning to a high standard of living. You've basically given up on America and have resigned to sit it out and wait for the day, that the youth get old enough to realize just how fucked they really are.

Do you have your outfit picked out for bloody Sunday yet?

Nice strawman. Have you stopped beating your wife yet?

The middle class was destroyed by the policies that YOU advocate. When you let the top 1% control a third of the wealth, that doesn't leave much to have a middle class.

Fuck... Who says I advocate some fantasy made up entity that no one has managed to put a face to, but several have gone on record, to say..."Gosh I'm not one of them, and why I wish they would tax me more..."

But nobody has explained how that top 1% managed to get everyone's money, but there's not one company that has been tied to this fictitious 1% entity pile of Bullshit. How in the fuck are the 1% getting so much goddamn money, if they aren't anyone that you can point at. How are they employing everyone, if there is one to point a finger at. How are they getting customers, to go to their businesses, to spend money, so they can pay their employees nothing, while they make piles of money and give everyone else the shaft.

How is all of this even happening?

All of the "1%" fear mongering, and not one Liberal will provide one fucking name of a company associated with this fictitious lot. So everyone can boycott them and drive them out of business if they are so bad.

It's manufacturing decent to push the socialist agenda pure and simple. Every commie dictator started out by bashing the rich and business people. This book never ends well.
America would have never survived a century, had the coming to the new world had been about escaping the 1% oppression instead of monarchy.

It comes back to what I said about intellectually dishonest debate tactics; you're in violation of the 'my resume is bigger than yours tactic.' Thanks for taking things out of context to the point that it misrepresents my original position. ; Also, feel free to ask patrick if curious and I have the same IP address. Curious provides links unlike you, usually high quality.

I noticed that you make assertions without providing research, but use anecdotes to explain you position, but when others provide links, you just say they are wrong without providing alternate links. Seems rather intellectually dishonest. When you and anyone else who wants to refute can provide different links then it would be interesting to read.

Other than JAMA, Annals of Int Med, and Archives of Int Med and NEJM, what else do you read to stay up-to-date?

By the way, on an unrelated topic, why do you whine about people deleting your links? Since you're a physician who uses this site often, why are you too cheap to donate 5 bucks for a premium account to Patrick, who is running this site at a loss?

Meccos says

MMR says

I have 30 uncles, first cousins and second cousins in medicine and I'm gunning for 2015 residency. So what is your point?

Meccos says

Just so I know what your background is and where you get your info from, what do you do and where?

I dont get it... what is your point? So you have relatives in medicine and you are going into medicine. ok... so?? instead of saying you are gunning for residency in 2015, why dont you just talk like a normal person and say you are a med student?

Is MMR = Curious? otherwise why is MMR answering for curious..

MMR says

It comes back to what I said about intellectually dishonest debate tactics; you're in violation of the 'my resume is bigger than yours tactic.' Thanks for taking things out of context to the point that it misrepresents my original position.

MMR the biggest problem to your argument is that I never tried to trump anyone's argument based on my resume. I never used the prestige of my schooling/education, job, etc as the basis for my arguments as you suggest.
Rather it is you who boasts about your relatives in medicine, as if that has anything to do with you. You think having relatives in medicine gives you any credibility? Furthermore you try to overstate your position by saying "you are gunning for residency in 2015" rather than saying you are a second or third year medical student". Keep in mind, that I never stated what I did or what my background was, until curious asked me. So how could I possibly do what you accuse me of doing?

BTW, you'll learn about projection soon enough (yes now I am talking down on you).