Modern Medicine does little to extend life

[DrCommonSense]

Elsevier: Article Locator

Great article discussing how life is really only extended through smoking cessation, physical activity, stress reduction, weight control and good sleep.

CABGs, Stents, Statins, etc have done almost nothing to extend life despite spending 100s of billions to trillions on this stuff.

Interesting to think about.

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[willabeast]

Elsevier: Article Locator

Great article discussing how life is really only extended through smoking cessation, physical activity, stress reduction, weight control and good sleep.

CABGs, Stents, Statins, etc have done almost nothing to extend life despite spending 100s of billions to trillions on this stuff.

Interesting to think about.

another way to look at this is that the medical profession acts as "enablers" for people who refuse to adopt a healthy lifestyle.
for example rather than tell obese adult onset diabetics to lose weight we place them on insulin. instead of back exercises we do facet interventions. if you argue with the patients they complain and your supervisor wants to know why your patient happiness scores are so low.

The doctor sees all the weakness of mankind; the lawyer all the wickedness, the theologian all the stupidity.
Arthur Schopenhauer

 

[Ducttape]

are you implying that we should approach chronic pain in the same way...

 

[willabeast]

are you implying that we should approach chronic pain in the same way...

only if that does not affect your bottom line

 

[Ducttape]

actually... it doesn't affect it too much

 

[DrCommonSense]

are you implying that we should approach chronic pain in the same way...

Probably should just salary docs across the board with little differential in pay and have them mostly counsel patients towards better health habits as the "best" solution in an "ideal" world.

However, we don't live in this world.

Also, I doubt most patients would change bad behavior patterns anyway.

In terms of a pure purist sense, health habits >>>>>>> all of procedural medicine.

 

[clubdeac]

That's how I'm paid and it really ain't bad...granted they can pay us a reasonable, fair base - which no hospital or insurance company wants to do.

 

[DrCommonSense]

That's how I'm paid and it really ain't bad...granted they can pay us a reasonable, fair base - which no hospital or insurance company wants to do.

I think the fee for procedure model is why there is such skewed compensation differences between "specialists" and everyone else.

Lets be honest, most of the docs who are paid the MOST are NOT helping the society at all.

The reality is that specialist care really doesn't do much since the vast majority of procedural medicine is not helpful.

Salary with slight bonuses that keep most fields around the same would make docs actually go into stuff they liked since there would be little gradient in salary. There would be little incentive to do procedures as well.

But I don't see this happening.

Most likely, they will just SCREW DOCS, limit procedures but keep med school debt extreme and try to make them serfs of MBAs in the future.

Also, its ALL RELATIVE. Since doctors come from the TOP student pool, if salaries drop too much, they will get top MBAs or do other fields.

 

[Ducttape]

you do recognize the irony (or keen self awareness) making this statement, since you are an interventional pain doctor...

 

[DrCommonSense]

you do recognize the irony (or keen self awareness) making this statement, since you are an interventional pain doctor...

I recognize this in ALL of medicine not just IPM

For some reason, this doesn't click with your brain.

I have always said this across the board.

The PROBLEM I have is picking on IPM EXCLUSIVELY without looking at the BIG picture of EVERY procedural field. IPM like EVERY OTHER FIELD THAT IS PROCEDURAL has INCREASED UNNEEDED PROCEDURES DRAMATICALLY to maintain higher salaries. There are MANY fields that are WORSE than IPM including Orthopedics, Back Surgeons (Neuro, Ortho), Inteventional Cardiologists (Stents, Ablations), CV surgeons, Urologist in prostectomies, etc in terms of a cost basis and morbidity basis towards society in terms of excessive unneeded procedures.

Anesthesiologists are also very guilty for facilitating many unnecessary procedures while exposing patients to general anesthesia at geriatric ages.

However, this is ALSO a societal problem where docs are UNDERPAID with just a salary so are pressured into doing procedures as well. Docs should be WELL COMPENSATED considering their time involvement and top student status and changing the game halfway on them is immoral as well to drop salaries dramatically.

My defense of IPM is towards people like that clown on the Anesthesiology board who is trying to make a case that IPM are just evil people that just do narcs for interventions only while ignoring his little involvement in doing mostly unnecessary fusions, TKRs, arthroscopies, etc while exposing patients to toxic anesthetics or maintaining a higher salary by "noncompetitive practices" with CRNAs.

Everyone lives in glass houses in medicine.

 

[Ducttape]

seems like few of those posters come to the pain boards to post about evil IPM.

most of the posts on this forum about how IPM does not work is about some "new study" disparaging IPM. I see most of us then gather the wagons around and critique the study and its participants, most of whom have preconceived biases against IPM (as a starter, almost all these studies use the null hypothesis that "injections don't work", so it is extraordinarily easy to "prove" what they do not believe).

I personally don't come on the pain boards to look at how other professions are faring. Pain is a very embattled profession right now, and I suppose that I look to this forum for moral support - along with intellectual honesty - regarding this profession and our treatment options and how we can help people, in light of how many people do disparage Pain Medicine outside of any forum, even while disagreeing with some on some aspects of pain medicine and on the business side of medicine.



I guess I should waste time browsing the anesthesia forums for these threads to reinforce the negative impression that others have of Pain, but that might be very disheartening.

 

[VA Hopeful Dr]

I guess I should waste time browsing the anesthesia forums for these threads to reinforce the negative impression that others have of Pain, but that might be very disheartening.

If its any consolation, as long as you're not a 100% procedure-only pain practice, us PCP types really do appreciate what you do. Even if its just telling a patient "opioids aren't the right treatment for you", that gives us a reason to wean/stop them.

 

[DrCommonSense]

seems like few of those posters come to the pain boards to post about evil IPM.

most of the posts on this forum about how IPM does not work is about some "new study" disparaging IPM. I see most of us then gather the wagons around and critique the study and its participants, most of whom have preconceived biases against IPM (as a starter, almost all these studies use the null hypothesis that "injections don't work", so it is extraordinarily easy to "prove" what they do not believe).

I personally don't come on the pain boards to look at how other professions are faring. Pain is a very embattled profession right now, and I suppose that I look to this forum for moral support - along with intellectual honesty - regarding this profession and our treatment options and how we can help people, in light of how many people do disparage Pain Medicine outside of any forum, even while disagreeing with some on some aspects of pain medicine and on the business side of medicine.



I guess I should waste time browsing the anesthesia forums for these threads to reinforce the negative impression that others have of Pain, but that might be very disheartening.

Actually, that guy has posted on this forum as well.

Its just a glass house issue.

Seems like Ortho has been the most recent whipping boy in the medical journals in recent months with multiple "studies" showing that TKR are cost ineffective, arthroscopic surgeries don't work, labral shoulder surgeries don't work, etc.

The recent COURAGE study extended out to 10 years also attacked STENTS pretty aggressively saying they do nothing to extend life.

So I think the anti procedural attacks are going across the board these days.

Hell, they even had some kind of meta analysis that attacked stem cell "studies as being biased".

The only group that appears to have enough money to pay off editors/consultants/etc are Big Pharma who seems to get their studies published in the medical journals.

 

[Promethean]

another way to look at this is that the medical profession acts as "enablers" for people who refuse to adopt a healthy lifestyle.
for example rather than tell obese adult onset diabetics to lose weight we place them on insulin. instead of back exercises we do facet interventions. if you argue with the patients they complain and your supervisor wants to know why your patient happiness scores are so low.

The doctor sees all the weakness of mankind; the lawyer all the wickedness, the theologian all the stupidity.
Arthur Schopenhauer

Lots of doctors have told me to lose weight. Very very few have done anything meaningfully to help me or support me in that at all, or taken into account socioeconomic and biological factors that might have been hindering my attempts.

It is faster to prescribe for symptoms than to provide patient teaching, encouragement, accountability. It is much simpler to assume that a patient's problems derive from moral failures on their part ("refusal to adopt a healthy lifestyle") than to consider whether there might be systemic factors that could be adapted in order to improve the patient's opportunity to succeed with a lifestyle based plan of care.

I'm not saying that patients don't hold the ultimate responsibility for their own decisions and outcomes. We are just here to support them in their work to improve their health, and we cannot do it for them. But I have heard so many physicians bemoaning noncompliance with plans of care that they assigned to the patient... but they had never solicited buy in from the person who actually had to do the complying. After all, how likely are you to do a thing that someone else tells you is good for you, especially if following that advice is difficult, expensive, and unpleasant, unless you are convinced that it will serve your goals for yourself? Especially when desirable results may not be obvious at first, if ever.

 

[DrCommonSense]

Lots of doctors have told me to lose weight. Very very few have done anything meaningfully to help me or support me in that at all, or taken into account socioeconomic and biological factors that might have been hindering my attempts.

It is faster to prescribe for symptoms than to provide patient teaching, encouragement, accountability. It is much simpler to assume that a patient's problems derive from moral failures on their part ("refusal to adopt a healthy lifestyle") than to consider whether there might be systemic factors that could be adapted in order to improve the patient's opportunity to succeed with a lifestyle based plan of care.

Doctors barely make anything from an office visit. They DEFINITELY can't afford to hold your hand to help you through this process or they would be broke and out of business.

Until the insurances/Medicare wants to pay a good wage for this, then docs rightfully won't do it.

 

[Promethean]

Doctors barely make anything from an office visit. They DEFINITELY can't afford to hold your hand to help you through this process or they would be broke and out of business.

Until the insurances/Medicare wants to pay a good wage for this, then docs rightfully won't do it.

Oh, there are definitely problems with how healthcare is funded.

Insurance companies will pay outrageous sums for the stroke, MI, amputation, etc. downstream, while balking at the much more modest compensation that would have funded prevention.

And yet, that doesn't change the fact that prevention is far more cost effective both in terms of health care dollars, human misery, years of life lost, etc.

Maybe I am super naive and the practice model that I envision is really inherently not feasible. But I don't think that is true, because there are doctors doing it. It may mean breaking from maladaptive structures, trying unconventional approaches, lobbying for compensation for effective, efficient care models. But I am prepared to risk going bankrupt trying to find a way to actually help people, yes with a little hand holding where needed, than just shrug and blame the patients for their inability to extract more value out of a rushed 5-10 minute visit.

How is it possible to expect anyone to buy into a plan of care, under those circumstances? If we don't give ourselves time to do anything more than write for more Lantus at bedtime, then it isn't their fault for not sparing us the need to give them that, at least. All medicine becomes triage, at that pace.

I don't blame docs for feeling crushed by the current assembly line system. I just have to believe that there are alternatives to settling for that. Slash overhead, explore novel payment models, etc. I think that it is counterproductive to offload blame onto those who are already most harmed by a broken health care system. (Those being both physicians and patients.)

 

[Promethean]

Fresh Food By Prescription: This Health Care Firm Is Trimming Costs — And Waistlines

What isn't extending lifespan is late intervention. We know very well that prevention at every stage does produce cost effective enhancement in quality and quantity of life. There are folks trying to focus in on what does work. This program at Geisinger estimates $24k in savings in trade for $1k in nutritious food, education, and handholding.

So, we just have to figure out how to get paid for doing these right things.

 

[epidural man]

Fresh Food By Prescription: This Health Care Firm Is Trimming Costs — And Waistlines

What isn't extending lifespan is late intervention. We know very well that prevention at every stage does produce cost effective enhancement in quality and quantity of life. There are folks trying to focus in on what does work. This program at Geisinger estimates $24k in savings in trade for $1k in nutritious food, education, and handholding.

So, we just have to figure out how to get paid for doing these right things.

Our functional restoration pain program is basically hand holding for 8 weeks - and it works phenomenally well. The program will likely get cut however because the leaders currently in charge don't care about outcomes, but care about RVU production. It's sad.

 

[epidural man]

I have really enjoyed this thread. Thanks.

I do think that modern medicine prolongs some people's life. It did to all those people I took care of when I was an intern. There was a physician who took care of 100's of little old, gorked out, contracted, non-communicative ladies in nursing homes. They were so neglected and should have died years before from their non-functioning brain, but the physician kept them alive from g-tubes and frequent hospital visits where I would correct their 160 sodiums, and 1000 mg/dl of sugar. What's crazy is after I would correct the sodium and blood sugar, they looked exactly the same! My point is, they should have all died years before from naturally causes, but I kept those bastards alive.

 

[DrCommonSense]

I have really enjoyed this thread. Thanks.

I do think that modern medicine prolongs some people's life. It did to all those people I took care of when I was an intern. There was a physician who took care of 100's of little old, gorked out, contracted, non-communicative ladies in nursing homes. They were so neglected and should have died years before from their non-functioning brain, but the physician kept them alive from g-tubes and frequent hospital visits where I would correct their 160 sodiums, and 1000 mg/dl of sugar. What's crazy is after I would correct the sodium and blood sugar, they looked exactly the same! My point is, they should have all died years before from naturally causes, but I kept those bastards alive.

lol

wow