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Thursday, October 4, 2012

52 reasons we need a health system do over

Here are a whole bunch of reasons we need to start over with our healthcare system, and I'm referring to the entire healthcare system, not just the one in the U.S., or Canada, or Britain:
  1. Common sense is better than dogmatism
  2. Medicine is an art based on common sense, pharmacology is a science
  3. The hypoxic drive theory was never proven, and neither were many other theories used 
  4. Such as the one that states all shortness of breath must be treated with a beta adrenergic
  5. Lab, x-ray and respiratory therapists should be respected as professionals
  6. Doctors should be treated as equals
  7. Medicines, tests and procedures should be ordered when needed, not just because
  8. Order sets should be a list of recommendations, not mandates
  9. Protocols should encourage competence
  10. Smoking cessations should be recommended for patients who smoke, non makdated for all
  11. We should not be encouraged to chart that of which we did not do just to meet criteria for reimbursement, i.e. smoking cessation, vaccinations, etc.  
  12. Computer charting updates should be improvements and make charting easier
  13. Medicine shouldn't be prescribed by men in suits sitting in leather chairs in capitols
  14. Medicine should be prescribed at the point of patient care, i.e. by those at the bedside
  15. Guidelines should help guide decision making, not mandate it
  16. Doctors should not be saluted
  17. Doctors should have to work a year or two as a nurse or respiratory therapist or EMT to get hands on experience and to learn how to work with people, like nurse practitioners and physicians assistance 
  18. HMOs have been an utter failure.  They have increased needless procedures, and increased the cost of medicine, instead of the opposite.  
  19. At present insurance companies get a discount on medicine, while private payers pay the full price
  20. The government and HMOs pay a flat fee for hospital visits and services
  21. HMOs have made it so asthma rates skyrocketed 180% between 1980 and 1995 (i.e. for medicare to pay for PFTs, an asthma diagnosis is indicated)
  22. Private payers should pay the same for medicine as all others
  23. Third payer systems eliminate patient questions like: "Do I really need this?"
  24. Free medicine increases the cost to those who pay
  25. Free medicine inundates emergency rooms, thus turning them into glorified doctor's offices
  26. If it's free people will come, with their penile warts, simple cough, acne, overgrown toenails, and their common sniffles and sneezes, and aches and pains
  27. There's no incentive to stay home and tough it out like grandma and grandpa did
  28. Medicine should be a pay as you go service, and a start over would significantly lower the price so even the poorest among us could pay for it
  29. Physicians shouldn't have to order procedures just to make sure the patient meets qualification for admittance (i.e. automatic IVs, hourly neuro checks, breathing treatments, etc.)
  30. Pneumonia is the most reimbursable diagnosis, and therefore the most commonly diagnosed disease.  Ah, you see so many fake pneumonia diagnosis's that you can only imagine how skewered the statistics are.
  31. With smoking cessation charted for every patient, statistics are skewered.  
  32. Most pharmacology studies are funded by pharmacologists
  33. Albuterol is a bronchodilator
  34. Xopenex is a bronchodilator
  35. Albuterol is safe enough to be an over the counter medicine
  36. Xopenex is Albuterol
  37. Advair will not kill you if you take an extra puff
  38. Symbicort will not kill you if you take an extra puff, it's actually used as a rescue inhaler in Britain
  39. Eurpoeans have access to more medicines
  40. Americans should have access to new unapproved medicines to use at their own risk
  41. People should be encouraged to not smoke, eat right, bathe, brush their teeth and exercise, not forced to
  42. Studies should be interpreted correctly (i.e., 100 post op patients were given Albuterol and they were all eventually discharged, so now all post op patients are given Aluterol?  Huh? Or, new studies show those who used excess salt live longer.  Hugh?)
  43. A 1960s doctor speculated Albuterol prevents post operative pneumonia, so now albuterol is automatically ordered via order sets on all pneumonia patients.  
  44. In the 5th century B.C. Hippocrates speculated all dyspnea is asthma and should be treated as asthma.  What has changed?
  45. Cardiac asthma is not asthma and is treated completely different
  46. All that wheezes is treated as asthma
  47. All wheezes are not bronchospasm
  48. Upper airway wheezes are not bronchospasm
  49. Audible wheezes are not bronchospasm
  50. Dyspnea on exertion is heart failure, not asthma
  51. Hospitalized patients should not need an order for 
  52. One size fits all medicine does not fit all

1 comment:

Sam H. said...

Good idea Rick.
One small problem though. Since Doctor's call the shots on what we can and can't do (legally) they will always be the kings we have to suck up to get an order we already know will help our patient. And if we let patients call the shots instead of the insurance companies we wouldn't have anymore q4evers that keep us our jobs :)