# Simplicity the key to overhauling health care?



## ffemt8978 (Feb 29, 2012)

http://arstechnica.com/science/news/2012/02/could-fixing-healthcare-be-as-simple-as-a-checklist.ars


> This produces doctors that are trained to be cavalier and strongly individualist—cowboys of a sort. And thanks to movies and television, we idealize the arrogant cowboys, doctors who are capable of spotting the 1-in-1,000 exception to a standard diagnosis. But that, according to Gawande, is the wrong model to idealize.  "We have trained, hired, and rewarded people to be cowboys," he said. "But it’s pit crews that we need."



To me, the article reads like we need to stop eliminating every zebra scenario during diagnosis, and focus on the horses instead.


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## Veneficus (Feb 29, 2012)

ffemt8978 said:


> To me, the article reads like we need to stop eliminating every zebra scenario during diagnosis, and focus on the horses instead.



Unfortunately, it isn't so simple.

Many doctors don't require all of the exclusion diagnostics to vome to a diagnosis. 

They do require them to ward away the attorneys.

Most of what I see in US medicine is to protect the doctor, hospital, etc. Not to treat the patient.

As for the zebras, that is what a doctor is for. 

The purpose of a doctor is to treat the patient, If you are just going to run check lists, your average paramedic will do. 

It would eliminate the need for any educated provider. 

Which I guess is economically sound, but probably not what you want when you don't respond to the checklist or its treatments.

I have some solutions. We could get rid of all the overpaid "mid level providers" and save a bunch of money.

Then we could make nurses do bedside nursing and eliminate the need for the endless amount of techs. (which will save a bunch of money)

We could finish it off by training more doctors and making them work a minimum of 50-60 hours a week and reduce nursing scope to force them to put more time in at bedside care where they belong instead of a "healthcare manager."

We could even do things like put caps on the cost of medical education. If doctors borrow less, they can be paid less.

Then we could put a maximum markup on medical manufacturers and pharm companies. (say 200% over cost)

Get rid of the FDA entirely. That'll save a bunch of money.

Oh and maybe even make malpractice awards reasonable and not like hitting the lottery.

I would say lost wages and the cost of related treatment would be fair. 

If you really wanted to bowl for a strike limit malpractice insurance premiums too.

I also like the idea that all specialists must be GPs first and rather than 20 specialists treating a patient, 1 or 2 doctors do from soup to nuts.


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## mycrofft (Feb 29, 2012)

Yes.

Our GP's/family medicine practitioners in many places are just triageurs sending pts to specialists elsewhere in their corporate systems. 

Just the savings in deleted basic office visit fees would hire or redirect more docs to take on the majority of care.

Specialists used to be propelled by passion, now it is either money, or because they don't want to be front man or woman for their employer's slice of Big Medicine.

And PEMS would be back to EMT-A and EMT-P, and PA's if we move more care out into the community.


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## mycrofft (Feb 29, 2012)

I posted as Vene did, didn't see his.

Good points too, but we need a FDA of some sort. Otherwise we could still buy laudanum, cocaine and radium at RiteAid. And X-ray our feet at Kenney Shoes.

And don't cap awards, but cap attorney's fees and cut the class action nightmare back to reasonable (thanks, Mr Grisham).


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## Veneficus (Feb 29, 2012)

mycrofft said:


> I posted as Vene did, didn't see his.
> 
> Good points too, but we need a FDA of some sort. Otherwise we could still buy laudanum, cocaine and radium at RiteAid. And X-ray our feet at Kenney Shoes.



Just give the surgeon general authority to regulate it. Just like a ministry of health in a parlimentary system.

Sure he will need a staff, but much cheaper than the out of control and corrupt FDA bureaucracy.


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## jwk (Feb 29, 2012)

Veneficus said:


> Just give the surgeon general authority to regulate it. Just like a ministry of health in a parlimentary system.
> 
> Sure he will need a staff, but much cheaper than the out of control and corrupt FDA bureaucracy.



You do understand the surgeon general is a politician/bureaucrat, right?


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## Veneficus (Mar 1, 2012)

jwk said:


> You do understand the surgeon general is a politician/bureaucrat, right?



So is a minister for health, but it does seem to work somewhat.


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## johnrsemt (Mar 1, 2012)

To save money on medical training;  we could do what they do/did (this is 8 year old information) in West Africa:  Surgeons trained for 1 thing;  1 yr of specialized training.   
  A friend and co-worker who was working as a Paramedic in the US; used to be a surgeion there:  he was a Cleft Palate specialist; nothing else.  He had one year of education above High School, plus 9 months of surgical training.

  That would save alot of expense for education


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## Veneficus (Mar 1, 2012)

johnrsemt said:


> To save money on medical training;  we could do what they do/did (this is 8 year old information) in West Africa:  Surgeons trained for 1 thing;  1 yr of specialized training.
> A friend and co-worker who was working as a Paramedic in the US; used to be a surgeion there:  he was a Cleft Palate specialist; nothing else.  He had one year of education above High School, plus 9 months of surgical training.
> 
> That would save alot of expense for education



Yea on education.

Would be more than happy to have you be the first to have your triple bypass done by one of these guys.


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## jjesusfreak01 (Mar 2, 2012)

Veneficus said:


> Yea on education.
> 
> Would be more than happy to have you be the first to have your triple bypass done by one of these guys.



There is something to be said for having a more highly educated provider, were something to go wrong during surgery, but you have to admit that a surgeon that literally only performs 1 type of operation day in and day out, regardless of underlying education, is probably going to get quite good at it. 

Again, I know this isn't ideal, but when you can't justify sending someone to 10 years of school for minimum pay, you do what you can.


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## Veneficus (Mar 3, 2012)

jjesusfreak01 said:


> There is something to be said for having a more highly educated provider, were something to go wrong during surgery, but you have to admit that a surgeon that literally only performs 1 type of operation day in and day out, regardless of underlying education, is probably going to get quite good at it.
> 
> Again, I know this isn't ideal, but when you can't justify sending someone to 10 years of school for minimum pay, you do what you can.



Sounds like most hyperspecialized surgeons


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