Medicine

An Update on healthcare reform.

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Cash medical practice or, in the phrase favored by leftists critics, “Concierge Medicine,” seems to be growing.

Becker is shifting to a new style of practice, sometimes called concierge or retainer medicine. With the help of a company that has been helping physicians make such shifts for over 13 years, he will cease caring for a total of 2,500 patients and instead cut back to about 600. These patients will pay an annual fee of $1,650. In exchange, they will receive a two-hour annual visit with a complete physical exam, same-day appointments, 24-hour physician phone access, and personalized, web-based resources to promote wellness.

The article suggest that all these doctors choosing to drop insurance and Medicare are primary care. Many are but I know orthopedists and even general surgeons who are dropping all insurance.

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness.

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“Do doctors understand test results?”

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The short answer in many cases is “no”:

In one session, almost half the group of 160 gynaecologists responded that the woman’s chance of having cancer was nine in 10. Only 21% said that the figure was one in 10 – which is the correct answer. That’s a worse result than if the doctors had been answering at random.
 
The fact that 90% of women with breast cancer get a positive result from a mammogram doesn’t mean that 90% of women with positive results have breast cancer. The high false alarm rate, combined with the disease’s prevalence of 1%, means that roughly nine out of 10 women with a worrying mammogram don’t actually have breast cancer.
 
It’s a maths puzzle many of us would struggle with. That’s because, Gigerenzer says, setting probabilities out as percentages, although standard practice, is confusing. He campaigns for risks to be expressed using numbers of people instead, and if possible diagrams.
 
Graphic showing “false positives” in mammogram tests
Even so, Gigerenzer says, it’s surprising how few specialists understand the risk a woman with a positive mammogram result is facing – and worrying too. “We can only imagine how much anxiety those innumerate doctors instil in women,” he says. Research suggests that months after a mammogram false alarm, up to a quarter of women are still affected by the process on a daily basis.
 
Survival rates are another source of confusion for doctors, not to mention journalists, politicians and patients. These are not, as you might assume, simply the opposite of mortality rates – the proportion of the general population who die from a disease. They describe the health outcomes of people who have been diagnosed with a disease, over a period of time – often five years from the point of diagnosis. They don’t tell us about whether patients die from the disease afterwards.

The linked article is worth reading despite its implicit pro-NHS boosterism. See also this. The poor education in statistical analysis of doctors, lawyers, journalists and members of other influential groups in our society is a significant problem.

(Via Mangan RT by heartiste on Twitter.)

UPDATE: Gerd Gigerenzer’s Books

Quote of the Day

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From an Instapundit comment thread re genetic testing of newborns to confirm/disconfirm parentage:

Carl Pham
Come on. Who do you think calls himself “an expert in ethics?” Would you? Would I? Of course not. Anybody with a trace of common sense and humility understands that no mere son of Adam can possible be considered competent in ethics, let alone an expert. Isn’t the next article up about Native American torture? And then there’s the one on terrorists murdering five-month olds? No sane member of the H. sapiens species would consider it plausible that any one of us could be a mini-Christ, prepared to judge right from wrong, separate the sheep from the goats.
 
So, ipso facto, who are the “ethicists?” They are those who lack genuine empathy, humility, or any deep awareness of the challege and subtlety of moral judgment. They are the narcissists, the borderline personalities, the grandiose who imagine themselves fit to be the stewards of God. In another age, they would join the Inquisition.

There is something to this argument.

It Is Great, Until It Isn’t

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Living in Madison, I associate with a larger than typical number of lefties, liberals, and others who lean to the left of the political spectrum. Oddly, being a leftist seems to be associated with anti-science and other oddities.

When at parties and having discussions with locals, I always stay out of politics. I always shift the subject. Most of the people I deal with are extremely nice, good folks, but they are true believers, and nothing I say will do anything but make situations uncomfortable. But one subject I never hold back is not getting your kids vaccinated. My wife always cringes if it comes up because she knows the bazooka is coming out.

I use the big words too, like “bullshit”, “nonsense” and interesting catch phrases like “have you ever seen a child with whooping cough?” or “I hope your kids don’t get measles because mine won’t”. It does fall on deaf ears, but with the anti-vaccers (is that a word?) I don’t care.

Separately, my wife, while not a squishy leftist, does have a soft spot for marketing buzzwords like “organic”, “natural” etc. She typically spends more money than need be to offer food choices to my kids that are pesticide free, purchases “safer” chemicals and does other things like that – things that I offer to you are probably nonsensical. However, I have chosen not to “die on that hill”. Besides denting my wallet a bit, I don’t think that it is harming anything, so I let it go. I don’t have many complaints about my wife and I am probably way ahead of most husbands in that department (she puts up with me so that pretty much overrides any of my tiny complaints).

But. Lice. Several years ago, both of my children got lice from school. Fortunately (?) I lost my hair a long time ago so was not in the loop, but my wife was mortified. I will never forget the moment – she said (and I am almost quoting) “get down to Walgreens and get the nastiest, strongest chemical you can find and get back here and help me with this”. I almost fell over and stumbled out to the car in a daze, wondering how my wife could have made such a radical change in the five minutes since my kids came home from school.

But I did learn something. When the excrement hits the air conditioning, people want this crap solved. Now.

Back to the anti vaccination folks.

Everything is great and works until it doesn’t. Today I note this story about a famous anti-vaccination group, the Amish. Funny how one’s religion doesn’t seem that important when your kids contract a terrible disease. All of a sudden, vaccines look pretty good.

More than 135 people crowded into a local woodworking business Thursday where nurses used up every available dose of vaccine — and then ordered 300 doses more, said Pam Palm, a spokeswoman for the Knox County, Ohio, Health Department.
 
“Not getting immunizations has been the way the Amish have felt in the past, but they certainly have responded in this situation,” Palm said.
 
The outbreak was detected this week when four unvaccinated Amish community members showed evidence of measles infection following a March trip to the Philippines to offer humanitarian aid to typhoon victims. More than 20,000 people have caught measles in the Philippines and at least 50 have died in a severe ongoing outbreak.
 

I think this might be a good example of stated preferences vs. revealed preferences. Revealed in a most uncomfortable manner. I assume most of my left leaning friends here in the Madison area would do the exact same thing in the circumstances.

My wife, while succumbing to some of the marketing for organic and natural products, thankfully didn’t fall for the vaccine scares that were prevalent when our children were born.

I think if anyone were going to a third world place that was under duress (like the typhoon ravaged Philippines) that they would be REQUIRED to get boosters for measles, cholera, and whatever else I could think of. And why wouldn’t you anyways? But I guess that is my Midwestern common sense sneaking through again, and heck, what do I know.

I do know this. Kids with measles = parents getting measles vaccines for everyone.

More Obamacare News

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The CMS has a new contractor for Obamacare, not just the web site. The previous contractor, CGI Federal, has been replaced rather suddenly.

“Accenture, one of the world’s largest consulting firms, has extensive experience with computer systems on the state level and built California’s large new health-insurance exchange. But it has not done substantial work on any Health and Human Services Department program.
“The administration’s decision to end the contract with CGI reflects lingering unease over the performance of HealthCare.gov even as officials have touted recent improvements and the rising numbers of Americans who have used the marketplace to sign up for health coverage that took effect Jan. 1.”

CGI Federal is the company connected with Michelle Obama through her classmate, a fellow Princeton alumna.

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