Preventing unnecessary medical care

Health, Fitness, Insurance, ...
Post Reply
jacob
Site Admin
Posts: 11158
Joined: Fri Jun 28, 2013 8:38 pm
Location: USA, Zone 5b, Koppen Dfa, Elev. 620ft, Walkscore 73
Contact:

Preventing unnecessary medical care

Post by jacob » Tue Jul 23, 2019 9:52 am

https://ideas.ted.com/prevent-unnecessa ... ons-first/ (11min talk)

Here's my own experience from long ago --- http://earlyretirementextreme.com/a-tal ... tists.html --- in which I got railroaded in a dentist office (and then later in a second one) until I got wiser. Having an old pug has also resulted in some useful experience wrt to the "vet industry". The trick, as some commenters on the blog post also point out, is in finding a doctor/dentist/vet who is compatible with your philosophy. "Conservative treatment" doctors do exist in the US and it was unfair of me to see the entire US health care system as almost purely callous and profit-driven---I was overextrapolating from my first two experiences in my original blog post.

When it comes to dentists and vets, what has subsequently worked for us has been either an older doctor (near retirement), alternatively an immigrant doctor who was educated outside the US, who runs smaller and reasonably established mom&pop type shop, that is, the total employment rooster is maybe the doc, a nurse, and a secretary.

That provides a good combination of more experience, no student loans, and less of a CYA/overtesting culture.

The way I explain my "treatment philosophy" w/o coming across as too rude is essentially to give an example of that one time (or two) where I felt I was railroaded and how I prefer to avoid treatment that is not necessary (see TED talk). Having had a couple of bad experiences where I felt unnecessarily fleeced or overtreated was in a sense a kind of tuition money(**). It's really hard to know and I hate the idea that patient input is now so important to the process. I yearn for the "good old days" when you just followed doctor's orders w/o fear that they weren't just using you to pay off their student loan.

(**) If you don't have any of your own, I think you can also talk about experiences of someone you know. I have a couple of ankle stories in my repository. One cost $15 ... then other cost 1000x as much, for essentially the same problem.

User avatar
Ego
Posts: 4169
Joined: Wed Nov 23, 2011 12:42 am

Re: Preventing unnecessary medical care

Post by Ego » Tue Jul 23, 2019 10:19 am

Are you saying that you explain your treatment philosophy to the doctor/vet/dentist before being treated? If so, I'd be interested to hear how you bring it up and what you actually say.

FIRE 2018
Posts: 127
Joined: Fri Jul 19, 2019 7:32 am
Location: Florida

Re: Preventing unnecessary medical care

Post by FIRE 2018 » Tue Jul 23, 2019 10:27 am

Jacob has got some good points and his upfront honest approach to a dentist is on point. There is a huge opportunity for dentists to really take in the $$ with recommending more work be done to a person's mouth. It is up to the customer to say yes or no or I will think about it is always a nice way to stop their sales pitch. An established dentist who has been working a long time in a small set up is someone I would trust instead of a newcomer dentist getting started and he or she perhaps heavily in debt from dental school costs or the brand new European sports car or SUV he or she is cruising around in.

prognastat
Posts: 1000
Joined: Fri May 04, 2018 8:30 pm
Location: Texas
Contact:

Re: Preventing unnecessary medical care

Post by prognastat » Tue Jul 23, 2019 10:51 am

It is rare to come across a vet that doesn't make me feel liked I'm being fleeced by the time I leave their office. It seems like they try to sell you every possible service under the sun and if you question them they tend to try to make you feel like you are being irresponsible for not spending all your disposable income to ensure your pet's as well cared for as a rich person's child.

As for the dentist I have definitely seen the difference between Europe and the US in that every time I have gone to a new dentist they insist on an X-ray. I had wisdom teeth coming in when I was still in the Netherlands and pretty much the dentist told me to keep an eye on it and if they started bothering me to let them know, but in the US every dentist starts talking about surgery when I first see them despite them having come in almost 9-10 years ago and still not having bothered me so far.

jacob
Site Admin
Posts: 11158
Joined: Fri Jun 28, 2013 8:38 pm
Location: USA, Zone 5b, Koppen Dfa, Elev. 620ft, Walkscore 73
Contact:

Re: Preventing unnecessary medical care

Post by jacob » Tue Jul 23, 2019 10:57 am

@Ego - "So we've been looking to find a new [...] because we just moved/changed insurance. Our last [...] was great. It was this little office on the corner a block from where we lived---BTW, we live right over there---who had been there for years. They never went overboard with their treatments. I haven't gone to the [...] as much as maybe I should have, but the reason is that when I first came to the US, I just walked into the nearest random office and they basically prescribed the entire kitchen sink(*) whereas the [...] I had previously had just told me to hold off or wait and see... and that worked fine for years and years. Whereas I'm not sure if [all those treatments] were actually good for me. So basically, I'm really just looking for the basics, you know, so conservative stuff. No teeth-whitening. Kind of like country farm vet style ... not Los Angeles plastic surgeon, right... not looking to hit the ER just because I have the flu."

(This is while sitting in the chair on the first visit.)

(*) Insert stories about MRIs, telescopes, etc.

I'm basically trying to match expectations on the first (and possibly last) visit. That I'm looking for the minimum treatment to fix whatever problem rather than the "maximum luxury spa"-experience. Also, that my definition of "a problem" would be that I'm in pain or that I can't chew properly and not that I don't have a "beautiful smile" :-P

chenda
Posts: 1119
Joined: Wed Jun 29, 2011 1:17 pm

Re: Preventing unnecessary medical care

Post by chenda » Tue Jul 23, 2019 3:06 pm

@prognastat - A retired doctor once told me back in the 1970s lots of doctors would vaccinate their own pets by buying the vaccine wholesale and avoiding the substantial fee vets charged to stick the needle in. Apparently the veterinary lobby got wind of this and tried to ban the practice, on the grounds doctors were only qualified to vaccinate humans, not puppies and kittens.

User avatar
unemployable
Posts: 360
Joined: Mon Jan 08, 2018 11:36 am

Re: Preventing unnecessary medical care

Post by unemployable » Tue Jul 23, 2019 4:37 pm

You don't need X-rays anywhere near as often as most dentists order them, and can skip them if all you're getting is a cleaning. If the dentist or hygienist orders one, you should ask whether it is truly necessary.

classical_Liberal
Posts: 890
Joined: Sun Mar 20, 2016 6:05 am

Re: Preventing unnecessary medical care

Post by classical_Liberal » Tue Jul 23, 2019 7:14 pm

I've actually considered a consulting business to provide assistance in navigating the US healthcare system. However, it's just not feasible given scope of practice limitations and liability issues associated with telling someone they probably don't need test "x" or procedure "y".

On top of that, most people just don't want to hear that there may not be a definitive answer/fix for that nagging back pain, no matter how much money they throw at testing. Or that 5 year survival for that type of cancer is not good, no matter how many times they put themselves through chemo, radiation, or surgery. Many people view healthcare in a similar vein to other consumption; I pay you, you fix the problem.

It used to be that someone had a good relationship with a PCP and could talk about these things. Now, with insurances forcing regular switches, and ultra-specialization where almost everything is referred away, those relationships are few and far between.

The best thing anyone can do in non-emergent situations (this is most situations, a fact people tend not to realize), is ask questions. Make sure you take as much time as you need from a provider to understand what is going on with your care. No testing, medications, or treatments unless you know exactly why. What are potential adverse effects, what are the alternative(s), what are the odds this will help, what's the entire process (not just this step), what are we hoping to accomplish, etc.

Secondarily, add a good generalist in medical care to your social network, before you get sick. An experienced RN, NP, PA,or MD who can help you, as a friend, understand what to expect. Almost all of these people got into their profession to help, many of them are just as frustrated with the system as you. They will jump at the opportunity to provide you with caring, friendly guidance.

Ontarian
Posts: 16
Joined: Thu Sep 15, 2016 6:33 am
Contact:

Re: Preventing unnecessary medical care

Post by Ontarian » Tue Jul 23, 2019 8:21 pm

I too, classical_Liberal, have considered practicing this kind of patient navigation service. I'm not a regulated health professional but have worked in hospitals much of my life and have helped my awesome RN mom and others navigate the system, being an advocate for them to speak up and effectively word questions to get action. There are networks and businesses of these kinds of 'professionals'. You'll quickly find many in the US and Canada by searching patient navigator, health navigator, and patient advocate.

7Wannabe5
Posts: 4953
Joined: Fri Oct 18, 2013 9:03 am

Re: Preventing unnecessary medical care

Post by 7Wannabe5 » Wed Jul 24, 2019 5:58 am

Another thing to keep in mind is that the results of approximately 2/3s of medical research studies have not been found to be reproducible. So, it's also possible to waste a good deal of money or effort on even preventative health measures if you follow the guinea pig herd too closely.

OTOH, recent experience should have informed me that I am too frugal in this realm, since I have needlessly suffered from ailments that immediately responded to very inexpensive drugs that have been available since like 1927 which were made available to me just by walking in to see nurse-practitioner in booth at pharmacy.

IlliniDave
Posts: 2534
Joined: Wed Apr 02, 2014 7:46 pm

Re: Preventing unnecessary medical care

Post by IlliniDave » Wed Jul 24, 2019 5:58 am

I do have some tension with my MD--she is from the "better safe than sorry" school of wielding her prescription pad. I just see "better safe than sorry" opposite of her: meds w/side effects are best used as a last resort, versus the first approach to things like cholesterol being 10% higher than some guideline built into the new software they are running. She's respectful of my wishes though (while still making her recommendations clear), and has handled everything that needed handling expertly. One of the downsides of moving away will be the demise of that relationship.

Fundamentally though, it's tough to say, "no" to the person with the superior knowledge of the relevant science, especially when it comes to preventive items later in life. Being a natural skeptic and modest cheapskate just might get me killed! :)

Post Reply