On 3/31/2022 11:15 AM, AMuzi wrote:
> On 3/30/2022 8:46 PM, John B. wrote:
>> On Wed, 30 Mar 2022 20:21:56 -0500, AMuzi <am@yellowjersey.org> wrote:
>>
>>> On 3/30/2022 6:01 PM, John B. wrote:
>>>> On Wed, 30 Mar 2022 07:33:01 -0500, AMuzi <am@yellowjersey.org> wrote:
>>>>
>>>>> On 3/30/2022 3:05 AM, John B. wrote:
>>>>>> On Tue, 29 Mar 2022 23:37:56 -0700 (PDT), "russellseaton1@yahoo.com"
>>>>>> <ritzannaseaton@gmail.com> wrote:
>>>>>>
>>>>>>> On Tuesday, March 29, 2022 at 7:57:00 PM UTC-5, John B. wrote:
>>>>>>>> On Tue, 29 Mar 2022 14:22:58 -0700 (PDT), "russell...@yahoo.com"
>>>>>>>> <ritzann...@gmail.com> wrote:
>>>>>>>>
>>>>>>>>> On Tuesday, March 29, 2022 at 12:51:18 PM UTC-5,
>>>>>>>>> cycl...@gmail.com wrote:
>>>>>>>>>> On Tuesday, March 29, 2022 at 8:40:22 AM UTC-7,
>>>>>>>>>> timoth...@gmail.com wrote:
>>>>>>>>>>> This is one of those rare occasions where I have to partially
>>>>>>>>>>> side with Tom.
>>>>>>>>>>>
>>>>>>>>>>> When you need a neurologist you need a good one, and my
>>>>>>>>>>> experiences had me shopping a bit to find one that was a good
>>>>>>>>>>> fit. The first one was totally useless - perhaps he would
>>>>>>>>>>> have been good if my symptoms had been different but for me
>>>>>>>>>>> he was the wrong one.
>>>>>>>>>>>
>>>>>>>>>>> That said, lining one up ahead of time seems unlikely to
>>>>>>>>>>> work. You don't know what your problem is going to be, and as
>>>>>>>>>>> has been pointed out bicycle injuries are not the majority of
>>>>>>>>>>> reasons to see one; add to that by the time you need one the
>>>>>>>>>>> local guy will have retired or been bought out.
>>>>>>>>>>>
>>>>>>>>>>> The strategy I recommend is first trust your primary care to
>>>>>>>>>>> recommend someone, then if you have the slightest doubt
>>>>>>>>>>> demand a second opinion. That's what I did and it worked out
>>>>>>>>>>> well.
>>>>>>>>>> Well you're correct that some neurologists are not good. They
>>>>>>>>>> mostly treat various forms of dementia and entirely forget
>>>>>>>>>> treating concussion. But knowing where a couple of
>>>>>>>>>> neurologists are is important if you need a good one. I was
>>>>>>>>>> initially sent to a very bad one by my MD and he didn't know
>>>>>>>>>> anything. And then my MD refused to look any further. Thanks
>>>>>>>>>> to my friend he got me to a good one at Stanford (I suppose
>>>>>>>>>> having football team members there doesn't hurt).
>>>>>>>>>>
>>>>>>>>>> I showed how many head injuries there are each year and while
>>>>>>>>>> fewer of those are concussions than football causes that is
>>>>>>>>>> STILL a considerable number of serious concussions. Apparently
>>>>>>>>>> the "group of 5" don't believe in being prepared.
>>>>>>>>>
>>>>>>>>> Tell us Tommy boy, have you researched and lined up a doctor
>>>>>>>>> for the following much more likely physical problems:
>>>>>>>>> 1. Orthopedist for osteoporosis.
>>>>>>>>> 2. Rheumatologist for arthritis.
>>>>>>>>> 3. Cardiologist for heart attack.
>>>>>>>>> 4. Proctologist for hemorrhoids.
>>>>>>>>> 5. Podiatrist for foot problems.
>>>>>>>>> 6. Ophthalmologist for eye problems.
>>>>>>>>> 7. Nephrologist for your kidney disease.
>>>>>>>>> 8. Hematologist for blood clots.
>>>>>>>>> 9. Otolaryngologist for hearing loss.
>>>>>>>>> 10. And last but certainly not least, actually this is the most
>>>>>>>>> important doctor of all for you Tommy to research and find a
>>>>>>>>> really good one, a PSYCHIATRIST for all of Tommy boy's mental
>>>>>>>>> irregularities. And Tommy, add in a Psychologist too. They are
>>>>>>>>> not medical doctors, but your problems are far more mental than
>>>>>>>>> physical, so a Psychologist will be able to help you a lot.
>>>>>>>>>
>>>>>>>>> Tommy, if you have not researched and found a good doctor for
>>>>>>>>> all of these likely issues, then you are just lying and yipping
>>>>>>>>> and yapping about your neurologist. These are more likely to
>>>>>>>>> occur and much higher up on the list of doctors for you to
>>>>>>>>> research. Get to it Tommy boy. Report back when you have every
>>>>>>>>> one of these doctors on your speed dial.
>>>>>>>> But, how does one select a "good" doctor? Do doctors publish their
>>>>>>>> grades in Medical school? Do doctors publish win/loss scores for
>>>>>>>> patients cured/died? How does one pick a "good" doctor?
>>>>>>>> --
>>>>>>>> Cheers,
>>>>>>>>
>>>>>>>> John B.
>>>>>>>
>>>>>>> To be honest, I don't think you know they are "good" until after
>>>>>>> you see them for awhile. And I suppose you judge how "good" they
>>>>>>> were by whether you got better.  In my lifetime of doctor seeing,
>>>>>>> I have been fortunate enough to have had some really "good"
>>>>>>> doctors.  And would recommend them to others if I was asked.  But
>>>>>>> it took a number of years for me to decide they were "good".
>>>>>>
>>>>>> But what is good, or what is better? If, for example. you have high
>>>>>> cholesterol, one doctor might recommend that you take LIVALO for your
>>>>>> problem, but another doctor might recommend lower doses of LIVALO but
>>>>>> also strongly recommend that you change your diet, lose weight and
>>>>>> start to exercise.
>>>>>>
>>>>>> Which is the better doctor?
>>>>>>
>>>>>> And which is the doctor that most will recommend to their friends?
>>>>>>
>>>>>
>>>>> That's a complex question.  The brother of a good friend is
>>>>> a suburban GP who says that mothers bring children in with
>>>>> viruses and demand antibiotics. His choice is either to do
>>>>> the right thing and say no, resulting in a reputation as a
>>>>> 'bad doctor' or to prescribe a very low dose of antibiotics
>>>>> with the understanding that most childhood viruses will
>>>>> clear them selves in a few days with rest.
>>>>>
>>>>> And you can double that problem for doctors asked to
>>>>> prescribe morphine and similar. The patient knows that
>>>>> someone else (insurance company or welfare) will pick up
>>>>> most of the office visit and prescription charges, leaving
>>>>> the patient with a saleable item.
>>>>>
>>>>> Add in that few MDs are independent professionals now.
>>>>> They're employees of large entities and capitated, which
>>>>> means time spent with a patient is strongly discouraged.
>>>>>
>>>>> How to approach that problem? Systematize pill pushing!
>>>>> https://www.bloombergquint.com/businessweek/cerebral-app-over-prescribed-adhd-meds-ex-employees-say
>>>>>
>>>>>
>>>>> Define 'good doctor' any way you like but the degradation of
>>>>> the medical industry (from the patient's view, not the
>>>>> revenue side of the industry) continues.
>>>>
>>>> I'm not sure that I agree with you. I have a pacemaker, which keeps my
>>>> heart beating regularly. Not that many years ago there weren't any
>>>> such devices and I'd likely be dead today.
>>>>
>>>> Hardly degradation (:-)
>>>>
>>>
>>> I wrote 'degradation' not 'disappearance'.
>>>
>>> Pacemakers have been around for some 70 years or so (with
>>> regular improvement I might add) which makes them hardly an
>>> exemplar of the current problems.
>>
>> 62 years actually. the first pacemaker was implanted in a human, in
>> 1960, in a 77-year-old man, who lived for 10 months after the surgery.
>>
>> But, I'm still not sure about "degradation" as that implies that
>> medical care is less, or less well done, today then it was in the
>> past, while I'm seeing things done today that would have been
>> considered impossible a generation ago.
>> https://thethaiger.com/news/national/siriraj-hospital-announces-thailands-first-successful-multi-visceral-transplant
>>
>>
>
> My first comments on this subject above were, "It's complex".
>
> Yes, innovation continues apace, as you note. Which is good.
>
> Systemic difficulties continue as well:
> https://newsmantraa.us/healthcare-acquired-infection-market-research-report-size-share-price-trends-and-forecast-to-2025/
>
>
> I touched on a few other negative trends earlier.  A mixed bag at best,
> at great cost both in suffering and in dollars.

Medical care has never been perfect, and never will be perfect. Like
now, it's always been better in some places and worse in others. But as
far as I can tell, the general trend has been toward improvement.

One thing unusual about the current situation is that the nation with
the highest health care cost has far, far from the best outcomes. And
for some reason, people on the right prefer not to change that. But
we've discussed that before.

To focus instead on "degradation":

If you were given a time machine and the ability to go back in time,
what era you would choose to get your medical care?

--
- Frank Krygowski