On the contrary, I believe the physicians have demonstrated much more cost effectiveness in their practices, in terms of using accountability and evidence-based medicine to guide best practices. Years ago, a hospital could charge $10 for a Tylenol tablet, with the excess monies covering less well re-imbursed (or indigent) care. Now the vast majority of indigent care is funded by the entire population through the CMS (Centers for Medicare and Medicaid). As a result of this increased cost awareness, physicians do have to be more attentive to the bottom line. With that comes the need for greater efficiency. I feel it in my own practice. This is not a greed-driven issue. The end result is that we as physicians no longer have the luxury of sitting with patients for an hour to discuss multiple medical and social issues. We are tightly scheduled and this efficiency feels less personal, less touchy-feely than what our parents knew from their physicians. In fact one of the qualities taught in medical school is to remain objective. The more emotionally involved one is with their patients, the less objective they are in making proper medical decisions or recommendations.
The entire face of healthcare is changing. In 1900 it took 20 years to double the world's knowledge. Currently it doubles every 18 months. That is a tremendous amount of information to assimilate and apply to healthcare. And with that comes the cost of research, much of which is funded by healthcare dollars. Do abuses exist? Of course, and they always will. However, comparing the healthcare provision now to even 25 years ago is impossible.
There is an economic reality to medical practice. Especially in the US where obesity, smoking, and heart disease are epidemic, the number of patients needing specialized care continues to grow. And people are demanding tests, treatments, and opinions which may have no scientific basis. For example, how many of you go to your physician demanding antibiotics for viral illnesses (colds, sinus problems, etc)? Scientific investigation tells us that the common cold will resolve in 7 days, but if you take antibiotics it will get better in just a week! And the overuse of antibiotics, be it doctor or patient driven, has led to the appearance of super-bugs like MRSA. But many physicians relent to the pressure from patients because it takes 2 minutes to write a Rx but 20 minutes to explain the rationale for not treating. I'm not pointing fingers, but you know who you are.
Thus, much of the overspending on healthcare dollars is not solely physician or hospital driven. I believe we take better care of patients now than at any other time in history.
And with respect to JennyB and this thread, it seems we are unanimous in our belief that refusing to provide an interpreter is unconscionable.
its a nice post,i especially liked your writing of the historical and knowledge aspects - fascinating- however, there are a few things I still beg to differ 'about greed-driven" factor. Yes, it may not be every doctors but perhaps a few "chosen ones" being promised of lavish promotions such as heading the surgery units, or become HODs of certain departments, this gets tied in 'sponsoring' from large drug companies (they're the greedy ones). You mentioned
As a result of this increased cost awareness, physicians do have to be more attentive to the bottom line. well, that is true, however this is the very thing we're talking about, its not just the doctors (looking like stand-offish and getting paid or rather they were forced to, (as you said). I agree there, but i dont agree its not really called for a defense to doctors, this thread did'nt really have this in the crux, alongside with everything else you said wonderfully (no sarcaism intended) about many factors, your examples of how knowledge boom is outstripping our ability to keep up with which is true, and is astonishing at the least, I believe it.
The real crux is this wholeness, the whole combination of the entirety of the health sector in society, reluntectly to repeat with adammomma words- "it's administration, finance, research, drug companies, insurance companies, support staff etc...they have changed their practices and not always for the best. <(adamsmomma's, save from repeating)
It is understandable which you have explained that even in Med school teaches you about objectiveness, linking work ethics to moral ethics still seem to outweighted by economic rationales. So right there i digress to say this what happens is - they are reinforcing in med school; "dont ask question why, but time is precious, time costs hospital, we are expected to be experts to draw up decisions quickly as possible since medical treatment are expensive so time consideration comes first - this yeild an implication which decree time is money, so - it should be carefully administered" and of course they would!, after all they want to make sure doctors knows where's the cut-off point, again i dont imagine every doctor/students - doctors would agree but nonetheless they have to. Probably in similar ways that the police officers might know the person commited a crime is a victim of circumstances but nonetheless they have to arrest even as much they dont want to. So with this in view, it is not difficult to understand this dilemma must pound down alot of weight and probably also despair. Afterall many join police force in intend to help people but get let down by the system, irregularities and extraordinary circumstances. Taking better care of paitents now better than ever is debatable. Its just llike politics, you cant please everyone, and given what you say about the hasten pace of learning against the exponential of knowledge bases expansion, it is difficult to apply all of which into every medical cases approach but while the bottom line is becoming increasingly a priority (economic), the objective to provide treatment tend to digress away - that is worrisome. This thread highlights not only the rights being violated but also the pressure of quick decisions, maintaining the 'orders' of their departments (as along with lack of appreciation that d/Deaf people
do have a real reliance on interpreters for clarity of their medical situations. What is concerns me is that the climate that stress accountability which imply the question of who to pay for interpreters becomes a nuisence that prolongs this 'ignorance issue'. So, in this day of where awareness of d/Deaf people having demand to use interpreters is raising in the public's attention is one thing, however its seems to fall behind in getting attention of the adminstrators of such institutes (ie. hospitals) to allow this quick connection to bring interpreter to be available immediately or soon as, just as so they do with (community) police officers or social workers as extraneous workers in hospitals. With this mentality of 'hospital doesnt pay for this' being over emphasised, it clouds this judgement and hence this bad decision were made. With younger generations, hmmmm i dunno, i think at this rate of hastened learning and dumbed down medias i think its going to continue to get worse, people know more but understands less. This is where it is heading, the maps of schemes representing knowledge have become more complex and harder to read so alot of 'different' things /situation quickly become irrelevent so its not surprising ignorance is making a comeback.
