The Big Lie

Snoozin' Bluezzz wrote:

NightHawkeye wrote:Recently, there have even been charges of “practicing medicine without a license” here on this forum; this being, of course, just another example of the “Big Lie”,

Thanks Bill, that statement you quoted stuck in my craw as well but in the interest of civility and "non-flaming" chose to forgo comment. I suppose that if I gave rein I could develop some quite vituperative rhetoric expressing my opinions about the statement and possible underlying motives in issuing it but I'll let it rest with by offering my agreement with your summary of the utter BS that can make up the "Big Lie" and saying that I think the "Big Lie" is almost always created and perpetuated by a set of proprietary interests.

Thanks again.

David

Likewise for me, I've always thought, if you want to find the reasons of a statement: Follow the Money. It will give you a good idea of how much slant is put on things, and then you are in a better position to know wither to try to hold on to a idea, or jump off and let it go, Jim

Tumbleweed,

SInce you brought up your profession, I'll throw in my 2 cents worth on that.
As of March of last year, I am "pet-less' (and plan to stay that way). However, of the 6 vets I used over the last 32 years, only ONE of them (the last one I used for 14 years) was worth a darn.....excellent in fact. And, in my opinion, a couple of them shouldn't have been practicing. For most of them, the majority of their business was large-animal practice and they seemed to have trouble diagnosing and treating canine problems....and didn't seem to care, either. I won't go into details, but my point is that my experience is ONE out of SIX with veterinarians.

I hope you're in that minority of good ones.

Best wishes,

Den

Hey, I need a good Vet.

Why does my Jack Russell Terrier have horrible breath? (and yes, his teeth and gums are healthy and get regular checkups and cleanings).

Now, that's a great mystery to me. .........

Linda,

How old is it? When my wife got her beagle puppy in '92, it had horrible breath. WOW!!!
It eventually went away, but in the mean time it was tough to deal with.

Hope you find a GOOD one.

Den

Actually, we only have one vet within 30 miles of us, so I'm stuck. I have surfed the internet looking for cures, but to no avail. And I hate to admit to the extremes we've gone to to try to sweeten his breath.

Talk about a "mouth breather".!!!!!!!!!!!!

Dude is 8 years old now, but we got him as a puppy. And yes, he's had bad breath the whole time. . He's lucky he's loved.

Snoredog wrote:

Doctors Are The 3rd Leading Cause of Death in the US, Causing 225,000 Deaths Every Year

DEATHS PER YEAR:
12,000 - unnecessary surgery (8)
7,000 - medication errors in hospitals (9)
20,000 - other errors in hospitals (10)
80,000 - infections in hospitals (10)
106,000 - non-error, negative effects of drugs

Source:
http://www.healingdaily.com/Doctors-Are ... the-US.htm

I have a few responses to the original post, and some points to ponder about the above stats:

Unnecessary surgery - if you actually look at the info, many of them are surgeries that the patients themselves are advocating for - gastric bypass being an example. People who don't quite fit the insurance criteria, yet still manage to find a way to convince somebody to go through with it. Just something to keep in mind.

Hospital-acquired infections - the truth is - even if staff follow EVERY procedure TO-THE-LETTER - people will STILL get sick. It's the nature of the beast - you house sick people in close quarters, you're dealing with microscopic enemies.....the only thing you can expect a professional to do is to follow procedure to begin with, and be alert to the symptoms if something does happen, so it gets nipped in the bud. Not every infection is the result of staff negligence.

Bottom line - you're dealing with human beings treating human beings.

My mother's a seasoned critical care nurse who truly knows her stuff. Some of the stories she shares about the baby docs (new grads - not obgyn) is scary. But she knows the ones who end up being fabulous docs are the ones who ask the most questions, pay attention to what nursing staff has to say, and admit when they need help.

I basically agree with the original post to a certain point. When you're dealing with long-term chronic disease that has components that are manageable and only need occasioal "tweaking" (asthma, diabetes, etc.) - the patient can be the stronger partner in managing their own care.

But "tweaking" isn't the only thing a doctor does. They're responsible for thinking far enough ahead to foresee risks that frankly most people don't have the resources available to educate themselves about. Specifically when dealing with multiple conditions, multiple meds.

Ex: I'm asthmatic, obese, now know I have apnea, and I have a skin condition that requires prescription meds. Having been asthmatic since the age of 3 - I have a pretty good idea of what my triggers are, what meds I need in a flare-up, and what the numbers mean when I'm given different tests and tasks. I also now have a pretty good idea of what my apnea symptoms are and do what I can to stay compliant with my Vpap.

But how those two conditions and their treatments affect one or the other? Even with a superstar nurse in the family and my own smarts - I still need a doc's opinion on how my conditions and treatments "fit together." Despite one or more of my docs having a style or personality that rubs me the wrong way.

So - yah, it's frustrating, but I'm with the group that feels that seeing a doc is still a necessary evil, even when you show up already knowing what will come out of their mouth regarding your trreatment. Even when you know there are political and economic strings attached to the presription brand they write for you.

I know this might sound crazy - and there are exceptions to this, I'm sure - but I don't believe doctors enter the profession to simply earn a paycheck and punch out. There are easier ways of getting rich with less-expensive forms of training, if that was "everyone's" concern.

Fromaginator, you bring up some issues worth discussing. However, I'll stick with my main point.

Fromaginator wrote:But "tweaking" isn't the only thing a doctor does. They're responsible for thinking far enough ahead to foresee risks that frankly most people don't have the resources available to educate themselves about. Specifically when dealing with multiple conditions, multiple meds.

Sadly, one could only hope this were true. Just another example of the "Big Lie", unfortunately. When a physician doesn't have time to deal effectively with the simple here-and-now problems which bring a particular patient in for treatment, why in the world would anyone believe that physician has an uncanny ability to resolve numerous complex and inter-related problems down-the-road. In fact, I would argue that just the opposite is true, the physician is so mired in the here-and-now that he has almost no ability to effectively resolve anything long-term.

The statement you've made sounds good, but is merely a self-serving example of the exact the sort which prompted my original post. It's a "Big Lie". On the surface it sounds good, but in actuality is simply untrue.

Fromaginator wrote:I basically agree with the original post to a certain point. When you're dealing with long-term chronic disease that has components that are manageable and only need occasioal "tweaking" (asthma, diabetes, etc.) - the patient can be the stronger partner in managing their own care.

And here is yet another example of the "Big Lie". The patient can be the stronger partner? Excuse me? Implicit in this statement is a belief that a healthcare provider somewhere is constantly watching out for this one particular patient as a real partner would. Patently untrue!

Such reasoning is insidious throughout the healthcare industry. Worse, those within the healthcare industry repeat these mantras so frequently that many of them actually begin to believe them rather than recognizing them for what they are. If they at least realized what they were saying, maybe they'd stop.

Regards,
Bill

Again, I think Nighthawk is spot on.
An interesting movie that exemplified this was Patch Adams starring Robin Williams.

Docs insulate themselves from their patients in a very peculiar way that they never question and use it to perpetuate their aura.

Ever notice docs walking down halls and never looking at the common folks. This is part of it.
It is called the border problem that non dare violate. Keep your distance from patients!!

Patch Adams said it best when asking one of his mentors in med school. "What happens if you get too close to a patient, Do you explode?"
This supposedly and theoretically insulates them from their patients to maintain objectivity.
I say this is pure BS. Any professional should be able to be involved with a patient to a certain degree and develop a genuine concern.

Ain't gonna happen the way they are being trained today.
Same for many pharmacists today. They have absolutely no clue on patient contact and are nothing but technicians who are incapable of anything but counting and pouring. Not all, but far too many.

I started this reply before several others came in but I’ll leave it as is.
To sum up, I believe that the particular "Big Lie" that Bill was discussing was that the Health Care industry has your interests at heart. He says no, you can do much of what they want to charge you, or your insurance companies, exorbitant sums for just as well which is "manage your care". In my experience even the good practitioners, for a variety of reasons, do a rotten job of managing an individual's care and I, as a patient, have to be extraordinarily vigilant at every turn because there is potential incompetence and life threatening error looming all the time. This can be frightening and exhausting. The particularly pernicious part of the "Big Lie" are the parts that both well meaning, and not so well meaning folks, subscribe to or perpetuate because it protects and re-inforces their employment, status, sense of self worth, privileges and most importantly - "the cash" flow. Most of us know this and the "Big Lie" is particularly offensive when those folks who pass it on either display their ignorance of the "Big Lie", assume we are ignorant of the "Big Lie" or want us to ignore its existence. The “Big Lie” is not accidental and it is not circumstantial. It is deliberately created in board rooms, planning conferences, industry seminars, advertising, political lobbies, legislatures and participants minds. It is refined, defended, extended and augmented. It touches all parts of the business supply chain and regardless of how much we want to insist that it doesn’t – it can corrupt all who participate in it.

What scares me about this is that many health conditions can leave us defenseless in front of the "Big Lie" because we don't know enough about our various different sets of problems, and their interrelationship, when we enter the system because we are ignorant, overwhelmed, helpless because of illness, trauma or age. Here is where the front line medical practioners could do us the greatest service, and often do us the greatest disservice. When they go along with the "Big Lie" we can't trust them and we may be too ignorant to defend ourselves and too sick to get "unignorant". Most of us are fortunate in confronting OSA because we have this forum, most of us seem to be reasonably bright and still have our wits about us and we are invested in our own care and well being. When we become dependent on others, as most of us will at some point in time, we can really be screwed because even those who folks who love and care for us deepely (those lucky enough to have such people) will not be as invested in our own well-being we would be on our own behalf.

The system sucks. It is clear, and has been self-evident, that it does not work well on behalf of the people requiring care. This does not mean that there are not thousands, even tens of thousands, of folks that care about providing quality, compassionate care but they are swimming upstream against a set of vested proprietary interests that are not very concerned about enabling them to do their job better. That is the truth as I see and experience it.

The “Big Lie” exists everywhere, not just in the health care business but that business is where the folks on this forum get to experience it very intimately.

David

Some comments and a couple recommendations.

Where's the beef? The beef is that many of those deaths were unnecessary. They were not medically fragile people who would have died within a short period. Statistics might make you think only 1 person died every __ minutes-statistics won't mean squat if you are the one out of 10,000 that dies.

There was a comment to the effect that physicians understand the complex interactions between different diagnoses people have-that is not my experience.
The sleep docs referred me to ENT for turbinate reduction and sinus problems. During the ENT evaluation for my sinuses I gave an ENT complaint of vertigo-I was told by the ENT that I would have to see an otoneurologist for that complaint-as for the sinuses that was allergy related and I would have to see an allergist. And I don't need turbinate reduction. And I still have vertigo. But my allergies are under the best control of my life (due to meds, self prescribed irrigations and filtered/humidified CPAP air).

So now there is my internist, ENT, otoneurologist, dermatologist, orthopedist, sleep doc, allergist, and psychologist who sees me for insomnia (then there is a dentist and a pharmacist). I would make the pharmacist the head of the team, she is not one of Tomjax's pill counters. After one of my allergy pills led to a very expensive cardiac workup she helped me set up a hypertension & allergy regimen that does not fit any of the protocols-but which works for me. Can she diagnose or understand the interactions of my conditions? No but she does understand the interactions/pharmacokenetics of the drugs. And I know how i feel after taking the medications. So one recommendation in dealing with the growing fragmentation in health care is; use the MD's to diagnose and before filling the RX's go talk to a good pharmacist-who knows all the meds you are taking. Unfortunately it is harder to find a new pharmacist than it is to find a new doctor.

Another recommendation is getting a 5X8 calendar-make a notation when you start any new med, change dosages, change xPAP settings, etc., then a brief note about any effects those changes made or new symptoms. You don't have to write a lot-if there is nothing to say-don't say it. Don't expect any doctor to read it-this info is for you to see connections. Sometimes you will tell your MD about something-as when you react poorly to a medication.

I've been to Russia, heard from friends living in England, & taken classes with nurses from all over the globe. I'll take USA health care any day. It is great at major acute illnesses and trauma. No one is great at chronic illnesses-but I'll still take USA health care for those too. Yes there are complications-some caused by doctors, some by nurses, & some by other health care providers. Many are caused by patients who are noncompliant-don't speak up when they don't understand something-and who don't educate themselves about their conditions. There is a growing recognition that cultural differences can lead to bad outcomes as when a culture prohibits women from exposing their breasts for cancer screening. Illiteracy causes bad outcomes. Unpredictable drug reactions can occur just because you are a unique individual. Homophobia can prevent gay men from being truthful about their HIV risk. Bias against obese people can lead to poor health care. The knowledge of that bias can lead an obese person to not seek health care because they think that they will just be told to lose weight. The point of my rambling is that poor outcomes are not just because of doctors.

Brava KROUSSEAU!!! Excellent and thoughtful post.

I find this Big Lie nonsense to be frightening. Blatant dogma sprinkled with unsubstantiated glittering generalities. Sort of like Mein Kampf, when you come to think about it.

Chuck

GoofyUT wrote:I find this Big Lie nonsense to be frightening. Blatant dogma sprinkled with unsubstantiated glittering generalities. Sort of like Mein Kampf, when you come to think about it.

Chuck

Rather than develop a reasoned thoughtful response I believe you just likened me, Bill, Tomjax, Fromaginator (partially), Wulfman, Goofproof, harikarishimari to Nazi's (sorry if I missed any qualifiers, it's good company to be in) and called us nonsensical.

Nice, touch! This could be construed as a typical "Big Liar" response. Talk about going out on the edge - "Mein Kampf" - right!

You obviously don't believe it is about the $$. OK, that's fine. You have your opinion and I have mine but don't call me a Nazi (you have no idea how wacked out that is!).

David

GoofyUT wrote:Brava KROUSSEAU!!! Excellent and thoughtful post.

I find this Big Lie nonsense to be frightening. Blatant dogma sprinkled with unsubstantiated glittering generalities. Sort of like Mein Kampf, when you come to think about it.

I agree with you about, Krousseau's post, Chuck, but I don't follow your logic on the rest. Krousseau's post was very well thought out and accurate. What Krousseau advocates is taking direct responsibility and control of one's own health care. Krousseau's position places her largely in opposition to that being espoused with the "Big Lie", which I'll repeat yet again.

NightHawkeye wrote:I refer to statements of the sort that only a doctor is capable of treating you, as only a doctor has the necessary training and skills.

Regards,
Bill

The better we educate ourselves about our own health issues helps us to communicate more effectively to the MD's and assist then in making a proper diagnosis in a shorter time frame. ie. I saw my doctor for my short temper and moodiness but failed to see the importance of telling him I was always tired until my wife told me that I stopped breathing when I slept. Therefore my symtoms were treated for GAD and Depression which are were a result of my sleep apnea and it went untreated for 4 more months. Anyway, we should all research and educate ourselves to gain a better undersanding of our conditions to help us heal and help the MD's help us.

krousseau wrote:The point of my rambling is that poor outcomes are not just because of doctors.

I agree completely and appreciate Krousseau's thoughtful, reasoned, considered and compassionate response. Thanks for not likening me to a Nazi Krousseau.

Her post also outlines how complicated and fraught the entire system is and any let down of vigilance, any breakdown in monitoring can lead to real serious problems and "poor outcomes". Once again, in my experience, the folks that are there to help, supposed to help, are not truly enabled to provide that help. Often the very best practitioners have to break one rule or another, or defy conventional wisdom to provide the care they think is best. Anyone who can not take charge of their treatment for whatever reason - incompetency of various forms, is truly, truly at risk.

I was sent on the Internist/Sleep/ENT merry-go-round and never did any of those three doctors consult with one another on my condition, prognosis and treatment. The sleep doctor did slam the ENT in my presence. Each one of the doctors struck me as competent, fairly knowledgeable and interested in helping but not too interested in approaching the issue as an entire fabric, which it is. I was left to analyze and decide - surgery or not. One prescribed Steriodal spray, the other a nasal antihistamine which the first questioned and the third questioned both prescriptions. The forum helped me make a decision about what may work for me, not the MDs or other health care professionals. The ENT was eager to do the surgery, too eager in my estimation. From talking to friends, co-workers, colleagues, reading the paper and reading this forum my experience is pretty much the norm. The charges are enormous, my meds cost a surprising amount for what amounts to pretty minimal treatment and questionable efficacy.

I also agree with Krousseau in that for all its flaws this system is probably the most effective there is and folks, who can afford it, from all over the work seek care in the states but it is about $$ and this does not mean it does not have serious and profound flaws and it is ridiculously far from cost effective or efficient.

So, this is not dogma and it is not hysterical. What stands in the way of reform? Why can't it be made better? Why do my insurance costs and drug costs (and I have pretty good coverage benefits) go up so much every year and little changes? Why does any movement towards change and accountability provoke immediate and expensive reactions from various lobbies? Because it is about the $$, what else could it be?

This is why the "Big Lie" exists and is convenient. If we take charge, as we attempt to, then someone can't charge for their participation in the process, someone's rice bowl is threatened.

David