Why Doctors Hate Science

[paximperium]

Pax -- Are you coming to TAM? I can at least throw rose petals at your feet...

Sorry, I just got back from Vegas a week back followed by a trip to LA for a friend's wedding...my liver will not survive another drinking binge.

I'll be happy with e-prayers.

 

[BillyJoe]

Skeptigirl,

I think it's time to give up.
Ivor has shown no interest in responding to the alternative explantions offered.
I believe he has his mind made up.



BJ

 

[dudalb]

That is SOP for Ivor.
Ivor seems to have a great many "unusual" ideas. His "Doctors are corrupt" kick is just the latest.

 

[paximperium]

That is SOP for Ivor.
Ivor seems to have a great many "unusual" ideas. His "Doctors are corrupt" kick is just the latest.

It isn't all that new. I've already noticed a general anti-doctor/pharmaceutical industry tone from previous posts.

Now it seems to be significantly more unreasonable than I first thought.

 

[Ivor the Engineer]

Do you believe homoeopathic remedies really do cure colds in less than a week for most people?

The evidence which indicates otherwise can't rule this possibility out.

 

[Ivor the Engineer]

It isn't all that new. I've already noticed a general anti-doctor/pharmaceutical industry tone from previous posts.

Now it seems to be significantly more unreasonable than I first thought.

Do humans respond to incentives?

Are physicians human?

 

[Ivor the Engineer]

That is SOP for Ivor.
Ivor seems to have a great many "unusual" ideas. His "Doctors are corrupt" kick is just the latest.

I smell straw.

 

[BillyJoe]

Do humans respond to incentives?
Are physicians human?

This is your proof?

As I said, here in Australia you can wait a week for an appointment. Where is the incentive to overservice in this situation where the doctor is booked out for a week? Consider the alternative explanations, Ivor, they are at least as legitimate as yours.

None [bad experiences with doctors] that are relevant to the issue of SID. Quite the opposite in fact.

I have had only five doctor experiences in my life.
- tonsillectomy at age 4 because my brother had an attrack of tonsillitis (that's what they did in those days apparently!)
- malingering illness to get out of school picked up by doctor called in for a home visit by concerned parents (I should have been an actor)
- torsion of testicle misdiagnosed as infection (I told him, I was still a virgin!)
- sinus infection spreading into the eye socket correctly diagnosed and successfully treated with antibiotics - before I died of meningitis (Okay, exaggerating a little).
- laceration sutured by a medical student (it was that or wait another hour) in emergency department of local hospital.
A mixed bag for me.

BJ

 

[T.A.M.]

Do you believe homoeopathic remedies really do cure colds in less than a week for most people?

The evidence which indicates otherwise can't rule this possibility out.

evidence which indicates otherwise cannot rule out radio waves as a possibility either, can it? The fact is that the common cold, as you well know, will be gone regardless of treatment, in about a week for most people. If that was your point, well ok, but what of it.

Do humans respond to incentives?

Are physicians human?

Yes we respond to incentives, and yes we are human. Do you believe that the majority of the police force is corrupt? Do you believe that anyone who is susceptable to incentive is corrupt? Doctors have a moral code. Are there exceptions, people who will compromise care or ethics for extra dollars? of course.

Where I practice, the idea of Doctor Driven Demand is ridiculous, as there are not enough doctors to keep up with the demand as it already exists.

I smell straw.

I smell chicken soup.

TAM

 

[T.A.M.]

This is your proof?

As I said, here in Australia you can wait a week for an appointment. Where is the incentive to overservice in this situation where the doctor is booked out for a week? Consider the alternative explanations, Ivor, they are at least as legitimate as yours.

See my above post to Ivor. Similarly here in Canada, there already exists demand far exceeding supply. I think his argument, if there is a valid one to start, might have to apply to the USA.

I have had only five doctor experiences in my life.
- tonsillectomy at age 4 because my brother had an attrack of tonsillitis (that's what they did in those days apparently!)
- malingering illness to get out of school picked up by doctor called in for a home visit by concerned parents (I should have been an actor)
- torsion of testicle misdiagnosed as infection (I told him, I was still a virgin!)
- sinus infection spreading into the eye socket correctly diagnosed and successfully treated with antibiotics - before I died of meningitis (Okay, exaggerating a little).
- laceration sutured by a medical student (it was that or wait another hour) in emergency department of local hospital.
A mixed bag for me.

BJ

1. Torsion is a tough call. Epididymitis often presents similarly, as does a torsion of the Appendix testes if acutely inflamed. My approach is to assume it is a torsion if it is Red and swollen, get them to the ER for an emergency u/s, and if I am wrong, I don't mind taking the flack from the ER doc.

2. While meningitis caused by an untreated sinusitis gone periorbital cellulitis is rare, it does happen.

TAM

 

[Belz...]

You've only got yourselves to blame; there's way too much red on your flag.

No such thing.

 

[Dancing David]

WTF?!

What on earth are you talking about?

Linda

Two small bussiness owners in Canada, Windsor ONT specifically said that they have income caps. Both ran resteraunts we ate in and they said that their income was limited to $250,000. Now that could have been an urban myth or how they interpreted tax law. I don't know.

 

[BillyJoe]

T.A.M.,

Yeah, I'm not really knocking them. My father had great care during his final illness due to lung cancer, as has my son with his infected thyroglossal cyst, and my wife with her misscarriage and four subsequent pregnancies.

B.J.

 

[Dancing David]

Because it's not true.

I think this is part of the problem: Americans seem to actually believe this stuff, even the ones with enough education and intelligence who I think should be grounded in enough common sense to know better.

The fear is based on incredible, widespread, consumer misinformation. I'm not sure how to get around that. I suspect part of it is also jingoism: some people in any country enter cognitive dissonance when exposed to evidence that other countries could be doing better in even a trivial way.

Wow, I don't know about 'fear', 'jingoism', 'cognitive dissonance ' or what the fred you think I said. Maybe you should re-examine your prejudice. This was said to me by two owners of resteraunts in Windsor, ONT. They said that they could not earn more that $250,000/year.

Now as to why they said that I don't know. It could be tax law, I am not the one who made the statements to me.

To you and Linda!

Wow, did I hit a nerve, I am sorry but yo two are not reacting to me, but something that I am not. I support 'socialized medicine', 'single payor' and all sorts of things that the Canadians do, I grant that our US system wastes money in the private insurance game to the tune of 24% or something like that, as opposed to Cnada which is 6-8% administrative costs of insurance.

Just so you now, I am not jingoistic, I lived in Mexico for four years in my youth, as in really lived there, with Mexicans and every thing, not in some gringo colonia. I am a reformed socialist and if you spent any time reading my past threads in Current Events and Politics you might know that your assesment is way off base.

Shhesh, if I am wrong I am wrong, no big deal. I can give you the name of one of the bussinesses if you wish and you and Linda can contact the owner and browbeat him about it.

 

[Dancing David]

That is SOP for Ivor.
Ivor seems to have a great many "unusual" ideas. His "Doctors are corrupt" kick is just the latest.

Not so new, this has different flavors and tones, there are many variations as well.

 

[Dancing David]

I smell straw.

Maybe you should wash it off?

 

[fls]

Two small bussiness owners in Canada, Windsor ONT specifically said that they have income caps. Both ran resteraunts we ate in and they said that their income was limited to $250,000. Now that could have been an urban myth or how they interpreted tax law. I don't know.

Maybe it was a "This Hour Has 22 Minutes" episode.

http://en.wikipedia.org/wiki/Talking_to_Americans

Linda

 

[fls]

Now as to why they said that I don't know. It could be tax law, I am not the one who made the statements to me.

While they may have been having one over on you (it is kinda a national pastime ), I suspect they were referring to being taxed at a different level or something like that.

To you and Linda!

Wow, did I hit a nerve,

More like astonishment. I find the stereotype of the clueless American kinda cute and funny myself.

Does it not occur to you to check on something like that before you starting spreading it around?

Linda

 

[Ivor the Engineer]

evidence which indicates otherwise cannot rule out radio waves as a possibility either, can it? The fact is that the common cold, as you well know, will be gone regardless of treatment, in about a week for most people. If that was your point, well ok, but what of it.

What I'm being asked to provide is impossible to achieve in practice. There will always be sufficient wiggle room to claim any difference in cost and/or amount of treatment can be explained by other factors, even cases such as this one:

Perhaps the most notable evidence is the result of a random control trial which ‘converted’ Charles Phelps, one of the most trenchant critics of SID (see Phelps 1997 p254). In this, doctors at a university hospital clinic were randomised to receive income by salary or a fee for service. Patients attending the clinic were randomly assigned to doctors. The result was that fee-forservice doctors scheduled almost 30 percent more return visits than those on salary. Most of the discrepancy was attributable to a 50 percent greater scheduling of (medically doubtful) well care visits (Phelps 1997).

Fee for service provides an obvious temptation to exploit asymmetry of information.

Yes we respond to incentives, and yes we are human. Do you believe that the majority of the police force is corrupt?

In the UK it is required by law for the police to make audio recordings of interviews with suspects. Video recordings are currently optional.

Perhaps governments should try 'fee for arrests' remuneration for their police officers. What do you think might be the result of such a scheme?

Do you believe that anyone who is susceptable to incentive is corrupt?

I believe anyone is corruptible given the 'right' incentive(s).

Doctors have a moral code. Are there exceptions, people who will compromise care or ethics for extra dollars? of course.

Every group has a moral code. What makes doctors' moral code more robust than any other groups' moral code?

Where I practice, the idea of Doctor Driven Demand is ridiculous, as there are not enough doctors to keep up with the demand as it already exists.

<snip>

That does not mean what is being demanded is not being influenced by physicians.

 

[Ivor the Engineer]

This is your proof?

As I said, here in Australia you can wait a week for an appointment. Where is the incentive to overservice in this situation where the doctor is booked out for a week? Consider the alternative explanations, Ivor, they are at least as legitimate as yours.

<snip>

Do all treatments suggested by a physician result in the same remuneration to him/her?

If not then there is an incentive to recommend expensive treatments that are no better (as far as the patient is concerned) than cheaper alternatives.

An interesting fact is that as the number of GPs in an area increases, so does the demand for their services. E.g., figure 2 page 10.

The real significance of these two figures is twofold. First, they demonstrate the possibility of Supplier Induced Demand: such a correlation is an almost necessary, if not a sufficient condition for the existence of SID.

Secondly, it is possible that GPs locate their practices in areas of high autonomous demand. It is for this reason that a serious statistical analysis of cross-sectional data must attempt to take account of reverse causation and endogenise the GP supply. The importance of reverse causation could, however, be overstated. Age/sex standardization does not reduce the variation in either the 1976 or 1996 data significantly. Price, income and socio-economic variation are also insufficient to explain a significant part of the variation.