Wednesday, May 03, 2006

Doctor's Hand to Your Mouth

Doctors look high and low and very wide for the answer to the mystery of the dying, suffering Americans. We suggest that that the solution is very, very close.

A study paper in the current Journal of the American Medical Association concludes very little. The major finding is that Americans pay twice as much a year for medical care than Brits do. Yet we get shorter, sicker lives.

You can read the abstract of Disease and Disadvantage in the United States and in England (you need a sub or to wait six months for the whole thing). Popular coverage is ubiquitous, including this overview in the International Herald Tribune.

The MDs and PhDs who researched and wrote the study look skyward, into their shirt pockets and at all manner of other studies. They would like to know how the richest nation on the planet can be so sick and bring up the very rear of the longevity train. (Check World Health Organization figures to see how low we are.)

We suggest that they need look no farther than the table where they confer.

They eliminated smoking, weight, alcohol and all the usual bugbears. It must be one really rough day for a medical professional when he can't blame something on obesity, eh?

What they have not mentioned is medical care. We get a lot more and die sooner, sicker. Hmm, what can we learn from this?

One solution is to stay away from doctors. Yet, we are so paranoid that if we do, something terrible will happen very soon. After all, our doctors said so.

It's simple, but not that simple. What the report has not considered are some of the most obvious differences:
  • We die the soonest and are the sickest of First World countries.
  • We spend far more per capital on health care than our peer nations.
  • But, aha, much of that expenditure is prescription drug related.
  • It is quick, easy and profitable for a doctor to treat symptoms with drugs rather than diagnose and treat underlying conditions, which may lead to sickness and death.
Let's put it out there. American doctors are drug pushers. This makes perfect sense. They are under considerable pressure to maintain their own high incomes and the profits of their hospitals and practices. They do this by seeing more patients. They see more patients by spending less time with each. They spend less time with each by using drugs instead of diagnosis, treating a symptom and hoping that this drug or the next will fix something. This also has a good chance of keeping the patients returning for more drugs and for fine-tuning of the levels.

Surprise. Surprise. Surprise.

Imagine instead if a doctor spent an hour rather than seven minutes dealing with your problem. She would ask about what you eat, your bowel movements, and other symptoms, even those you don't think are related.

In this country, they are wont to use the inane BMI chart instead of evaluating your body and health, which would take time. They don't have the time to do their job. They want churn and turn.

From a capitalist/physician standpoint, real diagnosis and treatment are terribly inefficient. Yet it is what they are supposed to be doing. They are allegedly about keeping people healthy and curing disease. Those almost never come from prescribing the most likely drug for a symptom and hopping to the next billable task.

We can cut 18 different ways to Sunday, but we see clear differences in British, Canadian and Israeli treatment.

When my parents-in-law used to visit, each of them would set up pill, tablet and capsule containers across a window sill. Each needed a whole sill.

My wife was appalled to see the array and asked her mother if they were all necessary. My mother-in-law said she asked her doctor the same question. His response was, "What drug?" and wanted her to pick one (rather than dealing with the larger issue). She pointed to one and asked, "What would happen if I stopped taking that?" He said, "You'd die."

That's not an unusual attitude, even if other doctors are not so paternalistic.

American doctors are in a rut, a drug rut. We contend that it is killing us, fast or slowly.

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Anonymous said...

Uhhh your long rant makes little sense.

If you want to show that American docs are not treating patients appropriately, you'd better damn sure have research that proves that Euro docs do better than americans. Until then, your rant is worthless.

You seem to suggest that there are myriads of alternatives to drugs. Doctors use surgery too. If you want acupuncture, docs do that too.

Of course, preventing disease comes down to stuff like losing weight, watching your diet, getting exercise, etc. Are you suggesting that we need to see the doctor to understand how those are important? Why in god's name would you want to go to a doctor's office to learn that exercise is good for you? Thats plain common sense, and a waste of resources for doctors to spend time talking about that stuff.

The study you cite shows that worse health outcomes in the USA had NOTHING to do with health care and EVERYTHING to do with culture/society. Americans are the laziest/fattest SOBs in the world. Thats the reason. It has nothing to do with doctors.

massmarrier said...

Fascinating and extremely emotional and unsupported.

We have lots of stats supporting that U.S. physicians overprescribe. We as a nation consume more prescription drugs than healthier, longer-lived nations.

Getting huffy and crying "culture" neither considers this as a likely contributor nor absolves our doctors.

My logic runs with what we do know and can prove. The tirade in response, by anonymous person, is sad indeed and certainly does not serve as an apology in the classic sense.