Europe

[DaveinElma]

http://news.yahoo.com/nearly-40-pct-europeans-suffer-mental-illness-230827577.html

[EasternOHBillsFan]

I'll see that 40% and raise you 10%, buddy.

 

http://yourlife.usatoday.com/health/medical/mentalhealth/story/2011-09-05/CDC-Half-of-Americans-will-suffer-from-mental-health-woes/50250702/1

[DC Tom]

I'll see that 40% and raise you 10%, buddy.

 

http://yourlife.usatoday.com/health/medical/mentalhealth/story/2011-09-05/CDC-Half-of-Americans-will-suffer-from-mental-health-woes/50250702/1

 

Conicidentally, about half the country is Republican...

[EasternOHBillsFan]

Conicidentally, about half the country is Republican...

 

Take 50% of those 50% Republicans to remove the deranged extremists, and then taken 50% of the other 50% of Democrats to remove their deranged extremists, and send them all to Indonesia so they can fight it out in a caged match. Then, Obama will be voted out, we'll have a capable President, lobbying will be made illegal in Congress, and then we can go over the hill like in that Coca-Cola commercial.

 

Edited September 6, 2011 by BmoreBills

[OCinBuffalo]

Uh, has anybody considered:

1. 90% of doctors practice defensive medicine, so, it's better to go ahead and diagnose somebody and give them the pills, rather than be wrong? This also has the added benefit of extra money and that annual free golf week from the pharma companies.

2. We have let the Jenny McCarthy types/hypochondriacs...and more importantly, their lawyers....run wild for far too long? All of them need to be told to get a life. Or, in the lawyer's case, get a job that produces something.

3. 50% of people have such a high image of themselves, that anything that contradicts that image, makes them "crazy"? How else do you explain people thinking that we care about what they are doing at any given point in the day? When their loserdom is confirmed, it's a big fall.

4. The average European can drink the average American under the table with ease? If your every day lunch consisted of 4 pints of Guiness and a hard roll w/butter, you might struggle with "alcohol dependence" too.

 

But most of all: these people have been living a lie they were psychologically committed to since WW2. That lie is rapidly falling apart. It's bound to cause some dissonance. It's bound to cause some "holy F, not only am I wrong, but, I have basically been acting like a d-bag to Americans for the last 20 years thinking I was superior...and that's depressing" moments.

Edited September 6, 2011 by OCinBuffalo

[BillsFanM.D.]

Uh, has anybody considered:

1. 90% of doctors practice defensive medicine, so, it's better to go ahead and diagnose somebody and give them the pills, rather than be wrong? This also has the added benefit of extra money and that annual free golf week from the pharma companies.

 

90% is not realistic if the implication is that they do this all the time. More like all doctors do this a small percentage of the time. Certain personalities, family members, circumstances, threats, prior litigation etc. will drive most docs to do an extra test/evaluation periodically out of fear of 'consequences.' I sincerely doubt, however, that 90% of all medical encounters are defensive. It does exist, however, and comes at a huge cost burden which is a whole other discussion.

 

Diagnosing someone with mental illness has huge ramifications for the patient. Ultimately, any person's records are 'recoverable' given the correct life circumstances. The stigma alone, although unfair, is significant. Even if the doc is not taking a true interest in the patient and would rather 'just diagnose them' as you say, they are still putting themselves at risk of being wrong. Plenty of patients have 'taken the meds' and had ill/fatal results.

 

Lastly, the 'added benefit of extra money???' Where do I sign up? What you prescribe for a patient has essentially zero impact on your bottom line. A few managed care entities have incentives (which are hardly noticeable) for providers who limit drug costs. This is more geared towards preferential use of equivalent generics than 'not prescribing.' There are no kickbacks unless someone is doing something blatantly illegal.

 

Free golf? Not happening. Big Pharma self imposed regulations in 2001 that limit encounters and any sort of gifting. Essentially, you can have lunch provided in your office provided there is a presentation on a topic (i.e. their drug) and dinner meetings can still be done provided there are at least two physicians present. No spouses allowed. It is really pretty lame. Unfortunately for me, I got out of residency right as they were killing the golden goose. Again, I am sure there are those that circumvent this but it is nowhere near as widespread as it used to be.

 

And that's all I have to say about that...unless I find out I've been lied to for the last decade.

[DC Tom]

Uh, has anybody considered:

1. 90% of doctors practice defensive medicine, so, it's better to go ahead and diagnose somebody and give them the pills, rather than be wrong? This also has the added benefit of extra money and that annual free golf week from the pharma companies.

 

Yeah, I question that too. If only because "90% of the doctors" sounds too much like "90% of the time".

 

Medications do tend to be over-prescribed, though (some, like SSRIs, pretty heavily over-prescribed). Worse, quite a few tend to be mis-prescribed by PCPs, when they should be prescribed by specialists. Good reason for that - managed care providers save money prescribing pills over referrals to specialists. That's not "defensive medicine," though...just bad medicine.

[Alaska Darin]

Yeah, I question that too. If only because "90% of the doctors" sounds too much like "90% of the time".

From a study I made up for this post.

[OCinBuffalo]

90% is not realistic if the implication is that they do this all the time. More like all doctors do this a small percentage of the time. Certain personalities, family members, circumstances, threats, prior litigation etc. will drive most docs to do an extra test/evaluation periodically out of fear of 'consequences.' I sincerely doubt, however, that 90% of all medical encounters are defensive. It does exist, however, and comes at a huge cost burden which is a whole other discussion.

I meant it like you said it, and, I said it that way(EDIT: as far as you knew ) . If 90% of doctors did it all the time, then the number would be more like 80%, not 40%.

 

And, it appears you are new to this part of the board. HINT: I do the hyperbole thing sometimes(used to do it a lot more) because we have some posters(used to have a lot more) on PPP who get their info solely from Huffington Post/MSNBC, and are severely undereducated on economics, statistics, business, law, Constitution, war, diplomacy, science...basically everything you need to hang on this part of the board. Therefore, they obviously don't know when I am doing it, and that makes me . They are fun to play with....especially when their ignorance means I can argue "their" positions better than they can. Doubly so when they latch onto something I say...that mostly....isn't.

 

EDIT: As you can plainly see above, we also have posters here who spend inordinate amounts of time trying to catch the smallest detail, treat it as a massive mistake, and then be the first to say "you're an idiot". It's also fun to tweak their radar as well But understand, it's like the opposite of taxes, the more you do it, the more of it you get.

Diagnosing someone with mental illness has huge ramifications for the patient. Ultimately, any person's records are 'recoverable' given the correct life circumstances. The stigma alone, although unfair, is significant. Even if the doc is not taking a true interest in the patient and would rather 'just diagnose them' as you say, they are still putting themselves at risk of being wrong. Plenty of patients have 'taken the meds' and had ill/fatal results.

I am well aware of the problem. But, given what I do, I see this problem as already solved, because we solved it, years ago. PM me if you want to know how. Also, the premise here is Europe...not here. The doctors don't have the same responsibility. In the European Utopia, this is more likely to be the state's problem. tiny bit of hyperbole, mostly accurate tho...

Lastly, the 'added benefit of extra money???' Where do I sign up? What you prescribe for a patient has essentially zero impact on your bottom line. A few managed care entities have incentives (which are hardly noticeable) for providers who limit drug costs. This is more geared towards preferential use of equivalent generics than 'not prescribing.' There are no kickbacks unless someone is doing something blatantly illegal.

 

Free golf? Not happening. Big Pharma self imposed regulations in 2001 that limit encounters and any sort of gifting. Essentially, you can have lunch provided in your office provided there is a presentation on a topic (i.e. their drug) and dinner meetings can still be done provided there are at least two physicians present. No spouses allowed. It is really pretty lame. Unfortunately for me, I got out of residency right as they were killing the golden goose. Again, I am sure there are those that circumvent this but it is nowhere near as widespread as it used to be.

 

And that's all I have to say about that...unless I find out I've been lied to for the last decade.

I have heard that...but I have also seen instances of what you say isn't happening, right in front of me, year after year since 2001. I wouldn't describe it as "rampant". I would compare it to basically the same thing we did with clients in other industries...so I never saw much wrong with it, until I got further into this.

 

Also, if you prescribe something, don't they have to keep seeing you? Doesn't that have an impact on your bottom line? Like I said, I am well aware. ...especially if you do it in volume. How wrong is Chris Rock, when he says "They don't cure anything, they treat it...[sic]...it's all about comeback"? Big load of hyperbolic crap designed to provoke...

 

Ok, last time I give you the notes...you are on your own. Don't say ignorant things like "Lincoln would be a Democrat today" or, I will be on you like white on rice.

Yeah, I question that too. If only because "90% of the doctors" sounds too much like "90% of the time".

 

Medications do tend to be over-prescribed, though (some, like SSRIs, pretty heavily over-prescribed). Worse, quite a few tend to be mis-prescribed by PCPs, when they should be prescribed by specialists. Good reason for that - managed care providers save money prescribing pills over referrals to specialists. That's not "defensive medicine," though...just bad medicine.

 

From a study I made up for this post.

90% of doctors isn't 90% of the time. Why do I care what it sounds like to you?....oh, that's right...the hyperbole thing. Neither of you are in my target package because both of you know it when you see it, and both of you certainly aren't ignorance-oriented.

 

However, words do mean things, and I am sure that 90% of doctors eat hamburgers, or whatever, but that few of them do it all the time. So, not only am I right, I am also "not an idiot".

Edited September 7, 2011 by OCinBuffalo

[DC Tom]

I meant it like you said it, and, I said it that way(EDIT: as far as you knew ) . If 90% of doctors did it all the time, then the number would be more like 80%, not 40%.

 

And, it appears you are new to this part of the board. HINT: I do the hyperbole thing sometimes(used to do it a lot more) because we have some posters(used to have a lot more) on PPP who get their info solely from Huffington Post/MSNBC, and are severely undereducated on economics, business, law, Constitution, war, diplomacy, science...basically everything you need to hang on this part of the board. Therefore, they obviously don't know when I am doing it, and that makes me . They are fun to play with....especially when their ignorance means I can argue "their" positions better than they can.

 

EDIT: As you can plainly see below, we also have posters here who spend inordinate amounts of time trying to catch the smallest detail, treat it as a massive mistake, and then be the first to say "you're an idiot". It's also fun to tweak their radar as well

 

I am well aware of the problem. But, given what I do, I see this problem as already solved, because we solved it, years ago. PM me if you want to know how. Also, the premise here is Europe...not here. The doctors don't have the same responsibility. In the European Utopia, this is more likely to be the state's problem. tiny bit of hyperbole, mostly accurate tho...

 

I have heard that...but I have also seen instances of what you say isn't happening, right in front of me, year after year since 2001. I wouldn't describe it as "rampant". I would compare it to basically the same thing we did with clients in other industries...so I never saw much wrong with it, until I got further into this.

 

Also, if you prescribe something, don't they have to keep seeing you? Doesn't that have an impact on your bottom line? Like I said, I am well aware. ...especially if you do it in volume. How wrong is Chris Rock, when he says "They don't cure anything, they treat it...[sic]...it's all about comeback"?

 

 

 

I am prescribing grammar lessons for both of you. 90% of doctors isn't 90% of the time. Why do I care what it sounds like to you?....oh, that's right...the hyperbole thing. Words mean things, and neither of you are in my target package because both of you know it when you see it.

 

However, I am sure 90% of doctors eat hamburgers, but that few of them do it all the time.

 

You're an idiot.

 

 

(Just because I haven't called anyone an idiot today, and it's making me feel antsy.)

[BillsFanM.D.]

 

Medications do tend to be over-prescribed, though (some, like SSRIs, pretty heavily over-prescribed). Worse, quite a few tend to be mis-prescribed by PCPs, when they should be prescribed by specialists. Good reason for that - managed care providers save money prescribing pills over referrals to specialists. That's not "defensive medicine," though...just bad medicine.

 

I agree with your first statement to the point that I would reword it: Meds ARE overprescribed. One of the first things I do when a patient transfers to me is try to figure out what meds I can stop....and I assure you there is no cost benefit. Polypharmacy has it's own 'defensive' component and sometimes you have to have the gumption to tell a patient that too much is too much. Not to mention, polypharm can be very dangerous.

 

Your premise about PCP's overprescribing meds (to limit referrals) is certainly valid as I'm sure it happens. It really speaks to a bigger issue: docs going beyond their scope of practice and the provider lacking a conscience. In my mind, you have to be dealing with a fairly shady doc to have that occur. I am happy to report that the overwhelming majority of folks I've worked with would never even consider that as a 'decision making factor.' Again, i'm sure it is present as docs are nothing but a cross section of society. SSRI's are widely prescribed as they treat the full spectrum of mood disorders. Historically, depression was treated with antidepressants and anxiety was treated with anxiolytics. In simple terms, SSRI's are 'mood stabilizers' and can treat the full spectrum. Hence, they are very widely prescribed as they are typically the best choice vs older meds. Typcially, 30% of primary care visits are for mental health issues. It is reasonable for PCP's to treat the majority of those but it depends on the patient and the provider's comfort level and expertise. I have referred many to Psych and treated many myself. It just depends. I do not prescribe antipsychotics as PCP, however. There are many who do and, again, they are going to be accountable for their level of care...and it may be excellent.

 

I think the defensive part of prescribing applies more to the specialists. For example, "How can you see a cardiologist and he 'only' put you on a statin, a beta blocker and an ace inhibitor? You had a heart attack in the past and you should also be on x,y and z." The specialists have a bigger burden in terms of having to 'do everything.' Hence, here comes the polypharmacy. Evidence based treatments that will alter life outcomes are welcome but there is a lot of 'voodoo' polypharmacy out there as well.

 

Regardless, we (docs) have to answer to ourselves, our patients, our peers and potentially a jury. This includes answering for what we do (i.e. meds, care etc.) AND for what we don't (in this case the implied nonreferral). Again...there is more than one way to be wrong here. As I mentioned above, if a doc allows money to interfere with his thinking he has bigger issues than his/her bottom line. It's beyond bad medicine....It's bad humanity.

Edited September 7, 2011 by BillsFanM.D.

[OCinBuffalo]

You're an idiot.

 

 

(Just because I haven't called anyone an idiot today, and it's making me feel antsy.)

No, I'm not, see my edit.

 

See, BillsFanM.D.? Tom, lurking, waiting, for any detail, and even when he can't find one...still it's "idiot". However, I wouldn't have DC_Tom be any other way.

 

There is Death, Taxes, DC_Tom saying "you're an idiot" and Alaska Darin hurling insults that on rare occasion spawn classic, HOF threads. Consistency can be comforting.

 

Oh, and M.D.? Ask Darin if he will send you the recipe to retatta sometime.

[BillsFanM.D.]

 

And, it appears you are new to this part of the board. HINT: I do the hyperbole thing sometimes(used to do it a lot more) because we have some posters(used to have a lot more) on PPP who get their info solely from Huffington Post/MSNBC, and are severely undereducated on economics, statistics, business, law, Constitution, war, diplomacy, science...basically everything you need to hang on this part of the board. Therefore, they obviously don't know when I am doing it, and that makes me . They are fun to play with....especially when their ignorance means I can argue "their" positions better than they can.

 

EDIT: As you can plainly see below, we also have posters here who spend inordinate amounts of time trying to catch the smallest detail, treat it as a massive mistake, and then be the first to say "you're an idiot". It's also fun to tweak their radar as well

 

Also, if you prescribe something, don't they have to keep seeing you? Doesn't that have an impact on your bottom line? Like I said, I am well aware. ...especially if you do it in volume. How wrong is Chris Rock, when he says "They don't cure anything, they treat it...[sic]...it's all about comeback"? Big load of Hyperbolic crap designed to provoke...

 

 

 

I thought that bolded statement (you're an idiot) was copyrighted....

 

Thanks for the 'welcome' to this part of the board. I've lurked here for a while and it's always a good/interesting read. I'm keenly aware of your hyperbole and find it quite entertaining. To borrow from Churchill: "The best argument against democracy is a five minute conversation with the average voter." Regardless of knowledge base, the debate/conversations here are educating and hotly contested. It's great reading and most folks who seem to linger here seem to at least have individual reasons/knowledge for believing what they believe. Much better than the "You can't vote for (blank) because he's stupid" dialogue that is typical of many political discussions.

 

...and yes, they have to 'keep seeing me.' If they come in once, twice or twenty times... I get 10 bucks per member per month. OK...and a copay with each visit (sometimes).

[OCinBuffalo]

I thought that bolded statement (you're an idiot) was copyrighted....

 

Thanks for the 'welcome' to this part of the board. I've lurked here for a while and it's always a good/interesting read. I'm keenly aware of your hyperbole and find it quite entertaining. To borrow from Churchill: "The best argument against democracy is a five minute conversation with the average voter." Regardless of knowledge base, the debate/conversations here are educating and hotly contested. It's great reading and most folks who seem to linger here seem to at least have individual reasons/knowledge for believing what they believe. Much better than the "You can't vote for (blank) because he's stupid" dialogue that is typical of many political discussions.

...and yes, they have to 'keep seeing me.' If they come in once, twice or twenty times... I get 10 bucks per member per month. OK...and a copay with each visit (sometimes).

I get to use "you're an idiot" whenever I want. Because lord knows I am grandfathered in. And, Tom uses "unmitigated moron" whenever he wants...

 

When I first got here, this board was nowhere near what you see now. We had what I am convinced were paid message board spammers, and an assortment of idiots who wished they were. We had people who literally started 20 threads a day. Hence I began my campaign of abuse, making people read long posts, hyperbolic silliness, whatever it took...but always logical...and as funny as I could be...to go on the offensive. I was not alone...no, no. There are many posters here, and mods, from all sides of the political spectrum, that began weeding out the idiots.

 

Each of us did things their own way(see Tom's "idiot" thing, and the hypno-frog's ninja like one sentence kills), and eventually the BushBad spammers were defeated. But it's not one sided: we currently have a BlackPeopleBad spammer that must be dealt with, in as funny a way as possible of course, til he gets banned.

 

On the left we have a guy who knows less than nothing about economics, that keeps posting retarded economics threads. We will reform them, or we will crush them.

 

(Seriously...don't take any of this seriously. This is every bit as grabasstic as the field house in high school...it's just that most of us use bigger words.)

...

 

 

So, you DOOOOO get volume. I am goofing. The only way this works is in something like oncology, and that's not really the same model anyway. I am not kidding about the kickbacks/golf though.

Edited September 7, 2011 by OCinBuffalo

[DC Tom]

I thought that bolded statement (you're an idiot) was copyrighted....

 

Thanks for the 'welcome' to this part of the board. I've lurked here for a while and it's always a good/interesting read. I'm keenly aware of your hyperbole and find it quite entertaining. To borrow from Churchill: "The best argument against democracy is a five minute conversation with the average voter." Regardless of knowledge base, the debate/conversations here are educating and hotly contested. It's great reading and most folks who seem to linger here seem to at least have individual reasons/knowledge for believing what they believe. Much better than the "You can't vote for (blank) because he's stupid" dialogue that is typical of many political discussions.

 

...and yes, they have to 'keep seeing me.' If they come in once, twice or twenty times... I get 10 bucks per member per month. OK...and a copay with each visit (sometimes).

 

You are seriously irony-challenged.

[3rdnlng]

No, I'm not, see my edit.

 

See, BillsFanM.D.? Tom, lurking, waiting, for any detail, and even when he can't find one...still it's "idiot". However, I wouldn't have DC_Tom be any other way.

 

There is Death, Taxes, DC_Tom saying "you're an idiot" and Alaska Darin hurling insults that on rare occasion spawn classic, HOF threads. Consistency can be comforting.

 

Oh, and M.D.? Ask Darin if he will send you the recipe to retatta sometime.

 

I had to research that. Wish I had been around for that thread. Funny schit!