Decline of Family Medicine

[8744]

Intuitively, I think the total lifetime cost for the insured patient with access to healthcare would be exponentially more. Most medical complaints get better within 3 weeks. The insured patient is in his doctor's office by day 3. The uninsured usually is willing to wait. Of course medical costs would be more for an insured patient, especially one with an inflated sense of entitlement.

Well, that's my point, sort of. Universal access to primary care would be very expensive and wouldn't result in the massive societal benefits that its proponents tout. It might be cheaper to say "to hell with it," pay for your own damned health care and if you can't, we'll see you in the Emergency Room or the ICU where you have no one to blame but yourself for your lifestyle choices which landed you here.

Believe me, most of what I see in the hospital is the result of some lifestyle choice or another. It was almost refreshing to have a COPD patient the other day who didn't smoke, tried to take good care of himself, but inhaled some ammonia during an industrial accident 20 years ago. If I could I'd put him to the head of the lung transplant list.

It's usually some variation of a 100 pack-year-history.

Preventative care works but only if you avail yourself of it which many who can do not.

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[deleted87716]

I ask why they didn't see their pcp they say"they have no appts for 5 weeks". I used to think this was bs until I started calling around to the practices to arrange f/u and was told"the soonest we can see mr jones is 4-6 weeks". at that point you basically don't have a pcp

Correct. These people need to find another doctor.

 

[deleted87716]

Preventative care works but only if you avail yourself of it which many who can do not.

Dude, seriously...this is like arguing against having seatbelts as standard equipment in cars based on the fact that many people don't wear them.

I still hate car analogies, but I can't stop myself.

 

[flighterdoc]

Dude, seriously...this is like arguing against having seatbelts as standard equipment in cars based on the fact that many people don't wear them.

I still hate car analogies, but I can't stop myself.

Cost of seatbelts, installed on the line in Detroit? About $35.00 (full set, 5 seats).

Cost of a lifetime of Prev Med? $hellalot more

There is a difference - glad you don't like car analogies.

 

[deleted87716]

Cost of a lifetime of Prev Med?

You can have a hell of a lot of visits to your primary care doctor for the same cost as a single trip to the ED.

 

[flighterdoc]

You can have a hell of a lot of visits to your primary care doctor for the same cost as a single trip to the ED.

Oh, no doubt - I was just pointing out that your analogy was completely ridiculous.

But, if you want to maximize the value of health care dollars figure out a way to make patients compliant. How many diabetics have we all seen who are non compliant - yet compliance doesn't cost anything, and would have minimized their subsequent pathologies and morbidities.

 

[deleted6669]

Correct. These people need to find another doctor.

if only 3 practices in town take medicaid and that's what you have you don't have any other choices but overloaded pcp's ....oh yeah, the er.....

 

[deleted87716]

Oh, no doubt - I was just pointing out that your analogy was completely ridiculous.

Not in the context of my original comment, which was simply that prevention is worthwhile even if there are people who don't take advantage of it.

if you want to maximize the value of health care dollars figure out a way to make patients compliant.

Yeah, good luck with that. I'll take world peace along with it.

compliance doesn't cost anything

Actually, it usually does...time off work, medications, doctor visits, etc. frequently wind up costing patients quite a bit. Of course, they ideally should look at it as investing in their health, but lots of people don't fear a silent killer until it's too late.

 

[deleted87716]

if only 3 practices in town take medicaid and that's what you have you don't have any other choices but overloaded pcp's

Oh, Medicaid...yeah, they're pretty much screwed, then.

 

[Tn Family MD]

"Rumors of my demise have been greatly exaggerated."

--Family Medicine

 

[flighterdoc]

Not in the context of my original comment, which was simply that prevention is worthwhile even if there are people who don't take advantage of it.



Yeah, good luck with that. I'll take world peace along with it.



Actually, it usually does...time off work, medications, doctor visits, etc. frequently wind up costing patients quite a bit. Of course, they ideally should look at it as investing in their health, but lots of people don't fear a silent killer until it's too late.

Actually, most compliance with good health is avoidance of behavior that is harmful - overeating, drinking, especially smoking. All of which not only doesn't cost, it actually SAVES the patient money.

It's only after pathology is established that compliance becomes costly.

But I don't think it's going to happen any time soon, either....

 

[deleted87716]

Actually, most compliance with good health is avoidance of behavior that is harmful

You can stretch the definition, I suppose, but when most people in medicine speak of "compliance" (or the more-politically-correct-but-personally-more-annoying term "adherance") they're referring to compliance with treatment of some sort, not simply health behaviors and lifestyle choices. That's what I assumed when you used the term, anyway.

That being said, I tell patients all the time that it would cost them a lot less in the long run to just take better care of themselves. Most of them know this already, but ingrained behaviors are hard to change.

 

[deleted87716]

Here's link to a relevant article:

"Study of Factors Influencing Medical Students in Their Choice of Family Practice as a Specialty (Arizona Study)"
http://www.aafp.org/online/en/home/aboutus/specialty/specialtychoice.html

 

[Faebinder]

Here's link to a relevant article:

"Study of Factors Influencing Medical Students in Their Choice of Family Practice as a Specialty (Arizona Study)"
http://www.aafp.org/online/en/home/aboutus/specialty/specialtychoice.html

Read the article and I understand your point but...IMHO I think it's garbage.... The concept of "If you build it, they will come." It being the specialty.... if you build Family Medicine to define itself as a specialty instead of depending on others... then you will get students to come.

If the demand (student applicants) is ailing...you fix what you are supplying first (the specialty) before you advertise/inform (which is what this article is sorta doing). Make sure your product (the specialty) is desirable by the demand (the student applicants).

My 2 unimportant cents.

PS... I love this article you quoted.

 

[deleted87716]

Read the article and I understand your point but...IMHO I think it's garbage.... The concept of "If you build it, they will come." It being the specialty.... if you build Family Medicine to define itself as a specialty instead of depending on others... then you will get students to come.

There were actually half a dozen articles contained in that link. I can't imagine that you read them all thoroughly in the less than 20 minutes that transpired between my post and your reply. Even the overview page didn't support your interpretation, nor did any of the linked articles. Before any of us can really discuss something, we need to be talking about the same thing.

You can have your two cents back.

 

[Faebinder]

There were actually half a dozen articles contained in that link. I can't imagine that you read them all thoroughly in the less than 20 minutes that transpired between my post and your reply. Even the overview page didn't support your interpretation, nor did any of the linked articles. Before any of us can really discuss something, we need to be talking about the same thing.

You can have your two cents back.

I was speaking of the overview page.... again.. I stand by my point.. *fine I'll keep the two cents... i might need them for my dream harley davidson when i am 60 and dont have money saved from this career.*

 

[Trail Boss]

I like it.

HOw about general practice, oh, wait...