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Is there a "Medical Mafia"?
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archangle Offline
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Post: #1
Is there a "Medical Mafia"?
(06-21-2013 04:24 AM)DocWils Wrote:  Ya know, we don't have a cartel - just science to back us up (I know science is a dirty word in some parts of the US) and laws to protect the people from quacks and snake-oil salesmen (which I see is still a massive industry in the US).

We should start another thread if you want to discuss this further, but I think you're mistaken.

I agree, most of the anti "western medicine" stuff is mostly anti-science, pro-witchcraft stuff.

The "medical mafia" idea is about doing things that are to the benefit of the medical "old boys club" but not in the best interest of the patient. They may not do anything outright "harmful" in their own mind, but they make choices that a fully informed patient wouldn't.

The Medical Mafia (MM) prescribes a new drug that costs 5 times as much as the old drug even though it doesn't work any better.

The MM refuses to look at the data collected every single night by good CPAP machines during actual therapy, and forces the patient to repeatedly spend thousands of dollars and an uncomfortable night to get data from a few hours of disturbed sleep, in a different sleeping position, in a PSG sleep test. Then it ignores the possibly valuable data from the CPAP machine and works based on the PSG with no REM sleep, sleeping on the back instead of the normal sleep position, etc.

The MM declares that a doctor must not criticize an incompetent colleague.

The MM insists on expensive and profitable tests and consultations that may be of some theoretical use, but aren't worth the cost/risk/pain/effort vs. benefit for the patient.

The MM acts like asking about the cost of procedures is crass and crude. They make it difficult to find out the cost before hand. They often bill more than they were supposed to. They slip in extra charges. They overcharge and then take months to refund money. Even "in network" providers outsource tests to full price "out of network" labs or specialists without informing the patient and the patient gets screwed by the insurance, but their "old boy network" colleague makes a big extra profit.

The MM is about selling medical procedures. For instance, the stereotypical "chop happy" surgeon who wants to give every apnea patient a UPPP operation.

The MM is about keeping the patient ignorant and believing "doctor knows best."

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06-22-2013 03:31 PM
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DocWils Offline

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Post: #2
RE: Daytime Apnea?
archangle,

I understand your frustration, but it does belong on another thread, off-topic most likely. I have seen bad apples in this profession like in any other, but for the most part, we're in this to help people, and I think you are painting with a wide brush, even in the US. Actually, especially in the US. There are a lot of dedicated doctors in your country, many of them ham strung by a payment system that is totally verrucht. And yes, in many cases, we DO know better, but not in all. We are trained to know better. Its our job and we work really hard at it. In fact, we lose our license if we don't continue to work hard at it and show proof of that hard work. Oh, and with so many doctors out there, there is no old boy's club, not even close, and we are merciless with constantly incompetent doctors. I do not know about the US, but here, the pharmacists have to offer both generic and name brand versions of prescription drugs, and if we insist on only the name brand (or the generic), it has to be for a very good reason ( I often find myself prescribing a generic version of a certain PPI because some of my patients tolerate it better than the name brand (an atom spins left rather than right or something in the generic version, anyway they react better)). That said, let's take this to the off-topic from here on in, okay?
06-22-2013 06:52 PM
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SuperSleeper Offline

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Post: #3
RE: Is there a "Medical Mafia"?
Hi Guys - I split these two posts off so the discussion can be continued here in the Off-Topic Forum.

Thanks... please proceed - I think this is a valid discussion for us all.

Eat-popcorn

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06-22-2013 08:15 PM
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Post: #4
RE: Is there a "Medical Mafia"?
Money corrupt, Doctors just anybody else succumb to corruption and not vaccinated against it either
06-22-2013 08:32 PM
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Sleepster Offline
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Post: #5
RE: Is there a "Medical Mafia"?
I place most of the blame on the insurance companies. Because of the way they have successfully lobbied the legislature, the legal regulations are set up to maximize the profits of the insurance companies. Doctors work to help patients, but they are also working to make a profit.

In my opinion we need a system where the costs of medical services is advertised. We should know ahead of time how much we're going to have to spend before we make the appointment. And there needs to be an incentive for the patient to shop around for the best prices. A patient-centered approach is what's needed rather than the insurance-centered approach we now have.

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06-22-2013 08:41 PM
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Post: #6
RE: Is there a "Medical Mafia"?
DocWils you are certainly an exceptional physician to even spend time here posting.
I admire that. Smile
I realized that in Switzerland the medical field is likely more well designed for the patient.
By contrast in the U.S. the industry mostly serves itself *at the expence of the patient*
This is a horrible tragedy in that a lot of folks can never get the treatment they need.
I agree with Sleepster, the Health Insurance Mafia has taken over the territory.

In the US you have the situation where little old ladies must sometimes decide whether to
get medications on time or not eat.

As long as the health insurance companies are running the show the only ones to benefit will be them.

Tongue

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06-23-2013 07:06 AM
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DocWils Offline

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Post: #7
RE: Is there a "Medical Mafia"?
(06-22-2013 08:32 PM)zonk Wrote:  Money corrupt, Doctors just anybody else succumb to corruption and not vaccinated against it either

Nice quote, but most doctors aren't coining it at all - in fact, most doctors live under immense debt for the bulk of their practice. The estimated cost of going into private practice in Switzerland is just over $1,000,000.00 (and not all that much lower in the US). Your debt from going to medical school is very high, in private practice you have to pay out of your income for the staff and all costs of the practice. If you stay on at the hospital instead you are ham strung by the bureaucracy there, but at least your salary is your own, and for a very long time is paying off your school debts.

Sure, there are those who guy the system, but there are far fewer than you would think, and the Medical Associations on both sides of the Pond frown on it and are happy to lift licenses when it is found out.
06-23-2013 07:57 AM
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DocWils Offline

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Post: #8
RE: Is there a "Medical Mafia"?
(06-22-2013 08:41 PM)Sleepster Wrote:  I place most of the blame on the insurance companies. Because of the way they have successfully lobbied the legislature, the legal regulations are set up to maximize the profits of the insurance companies. Doctors work to help patients, but they are also working to make a profit.

In my opinion we need a system where the costs of medical services is advertised. We should know ahead of time how much we're going to have to spend before we make the appointment. And there needs to be an incentive for the patient to shop around for the best prices. A patient-centered approach is what's needed rather than the insurance-centered approach we now have.


I agree, although most doctors are just trying to keep their nose above water, thought of profit is out the window.

But I do blame the insurance systems for a lot of the problems. In that sense, the NHS and even the Canadian model are far better choices than either the Swiss or US models, and the Swiss model is infinitely better than the US (and still the insurance companies make a healthy profit here, even when the law mandates they are not allowed to on basic mandatory coverage).

The laws in both the US and here demand that doctors practice patient centred medicine, but alas, the payment systems surrounding them often get in the way of that. And in some cases, it wears the doctors down and they play the game to win. But it is rarer than you think.

As for the more expensive drugs, the doctors aren't behind that, big Pharma is.
06-23-2013 08:02 AM
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Post: #9
RE: Is there a "Medical Mafia"?
(06-23-2013 07:06 AM)Shastzi Wrote:  DocWils you are certainly an exceptional physician to even spend time here posting.
I admire that. Smile

Thenk you. Most kind.


(06-23-2013 07:06 AM)Shastzi Wrote:  I realized that in Switzerland the medical field is likely more well designed for the patient.
By contrast in the U.S. the industry mostly serves itself *at the expence of the patient*
This is a horrible tragedy in that a lot of folks can never get the treatment they need.
I agree with Sleepster, the Health Insurance Mafia has taken over the territory.

In the US you have the situation where little old ladies must sometimes decide whether to
get medications on time or not eat.

As long as the health insurance companies are running the show the only ones to benefit will be them.

Tongue

The situation was no different here fortyfive years ago, or in Canada pre-Tommy Douglas. But both countries decided to find ways to make it better and more affordable for the patients, and remove levels of corruption and bureaucracy in the process. If the US adopted the Swiss system, for instance, there would be little opposition, as the insurance companies would not lose their patents. But the emphasis would be on getting the health care to the patient rather than servicing the system and the debt.

Incidentally, there are cases of "padding the bill" (here it is done by what are called tax-points) - you go to jail for it and lose your license if you are caught, and they ARE caught, since the insurance companies like it as little as the government does.

Having done some work in the US, I was struck by how hard the medical personnel worked to service the patients despite being hamstrung by the insurance industry and hospital regulations. I saw far more doctors and nurses "guying" the system in order to help those who had no insurance than anyone trying to maximise their own profits from it. I felt deeply sorry for them - they were living in a war with the insurers just as much as a war with death and disease.

So, although there are some bad apples, a Medical Mafia there ain't.
06-23-2013 08:15 AM
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archangle Offline
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Post: #10
RE: Is there a "Medical Mafia"?
There are just so many points where it's clear there is a "medical mafia." They may not have actual meetings in sleazy pizza parlors, etc., but there is the "conspiracy" of the "good old boy network," and other unwritten (and written) rules. Those doctors who don't play along suffer the consequences.

Yes, many doctors try to fight the system, but the system eventually beats most of them down.

As one small example, take the question of incompetent doctors. Yes, there are processes in place for some blatant examples like "drug pusher" doctors, but by and large, the incompetent doctors don't suffer any consequences from within the system.

I have heard this from several doctors, but I have one good friend who is a doctor. Call him Dr. X. He testified in a lawsuit against another doctor who he said was 100% unquestionably, inexcusably, wrong in what he had done to the patient. Dr. X said it nearly ruined his career. None of the other doctors would work with him. He had great trouble getting hired.

We had one local high volume doctor who kept botching laser eye surgery. I had one friend who got his vision damaged by the doctor, and heard the same story from several different people who knew some of his victims. If you'd mention laser eye surgery in town, you'd hear don't go to doctor Y. As best as I can tell nothing ever happened to him.

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06-23-2013 04:01 PM
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