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Annual physical exam impractical


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#1 Rogerdodger

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Posted 25 September 2007 - 10:37 PM

The cost and value of that annual preventative health check up
Healthcare News LINK
Published: Monday, 24-Sep-2007

Even though as many as an estimated 63.5 million American adults visit their doctor for a preventive health or gynecological examination each year, the value of such visits is a controversial issue.

According to a new study such visits cost the nation dearly, somewhere in the region of $7.8 billion annually; but preventive health examinations (PHEs) also called periodic health evaluations, for health promotion and screening of disease risk factors and subclinical illness are not recommended by major North American clinical organizations.

However it seems that two-thirds of patients and their doctors do believe it is important for patients to have a yearly check-up.

The researchers from the University of Pittsburgh School of Medicine and RAND Health Pittsburgh, analyzed data from a nationally representative survey of office-based doctors conducted between 2002 and 2004.

Doctors were randomly selected and then completed a one-page form detailing their encounters with each of 30 randomly selected patients during a designated reporting week.

Researcher Dr. Ateev Mehrotra and his colleagues found that over a three year period there were 181,173 visits, of which 5,387 were preventive health examinations and 3,026 were preventive gynecological examinations.

Extrapolated to a nationwide figure this equates to 44.4 million adults (20.9 percent of the population) receiving preventive health examinations and 19.4 million women (17.7 percent of adult women) receiving preventive gynecological examinations each year.

The researchers found the rates of preventive health examinations varied, with individuals in the northeast 60 percent more likely to receive one than those in the west, and also by insurance type; those who were uninsured were half as likely to receive one as those with private insurance or Medicare.

The researchers say preventive health examinations and preventive gynecological examinations are among the most common reasons adults see a doctor and while such visits frequently include preventive services, most of those are provided at other visits.

Many of the preventive health exams in the study included laboratory tests, such as complete blood cell counts or urinalyses, that do not clearly improve patient outcomes.

Dr. Mehrotra says more than a third of annual physicals include potentially unnecessary testing at a cost of more than $350 million a year, which is almost the same as is spent by the state of Massachusetts annually to provide insurance to the uninsured.

Dr. Mehrotra and his team hope that their findings will inform future recommendations about the frequency of preventive exams and the feasibility of providing one to all adults in the United States on an annual basis.

They say if every adult were to receive a preventive physical exam annually, the U.S. health care system would need to provide up to 145 million more visits every year; that in turn would account for an impractical 41 percent of all time spent on direct patient care by primary care physicians.

Dr. Mehrotra says the research underlines the need to find other means of delivering preventive care beyond annual physicals or to advise some patients they can come in much less frequently.

The researchers say their findings provide a foundation for the continuing national debate about the use and content of preventive health examinations and preventive gynecological examinations.

The research is published in the current issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

#2 maineman

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Posted 25 September 2007 - 11:13 PM

darn, turns out I've been wasting everyone's time and money for no reason for the past 25 years... Does "sorry" cut it? :) mm
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#3 colion

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Posted 25 September 2007 - 11:59 PM

There's no mention of age. It's hard to believe that the value of exams as a function of age was not considered. Poor reporting?

#4 Rogerdodger

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Posted 26 September 2007 - 08:52 AM

After seeing the lines for a free prostrate screening all I could think of was:
Just wait until we get "free" health care.
The lines will be long, very long.
Maybe it will work out to 1 year long. :lol:

They say if every adult were to receive a preventive physical exam annually, the U.S. health care system would need to provide up to 145 million more visits every year; that in turn would account for an impractical 41 percent of all time spent on direct patient care by primary care physicians.


LINK
On June 9, 2005, the high court struck down a Quebec law that prohibited people from buying private health insurance to cover procedures already offered by the public system.
"Access to a waiting list is not access to health care," two of the justices wrote in their decision.
George Zeliotis argued his yearlong wait for surgery was unreasonable, endangered his life, and infringed on the charter's guarantee of the right to life, liberty and security.



#5 stocks

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Posted 03 October 2007 - 01:44 PM

Is a CT scan always necessary after your child suffers a bump on the head? Should you think twice before undergoing surgery for lower back pain? Are your elderly parents going to be allowed to die at home, or will they spend their last few weeks in a hospital, hooked up to machines and tubes, subjected to painful, unnecessary procedures?

These are the kinds of questions you may find yourself asking once you’ve read Overtreated. Each year, our medical system delivers an enormous amount of care that does nothing to improve our health or lengthen our lives. Between 20 and 30 cents on every health care dollar we spend goes towards useless treatments and hospitalizations, towards CT scans we don’t need, towards ineffective surgeries—towards care that not only does nothing to improve our health, but that we wouldn’t want if we understood how dangerous it can be. This is the surprising and deeply counterintuitive message of Overtreated.

Of course, almost everything in our personal experience says just the opposite, that far from delivering too much care, our medical system isn’t giving us enough. Forty-seven million of us don’t have coverage, and even those of us who do have health insurance feel as if our insurers and doctors are continually trying to deny us treatments and tests and drugs that could help us.

Yet as award –winning journalist Shannon Brownlee shows in this remarkable book, much of what we think we know about health care is simply wrong. With probing insight and facinating examples, Brownlee unveils its topsy-turvy economics, where the supply of medical resources—beds, specialists, intensive care units—determines what care we receive, rather than how sick we are and what we actually need.

Overtreated offers a fresh way to think about health care reform. Americans worry about rationing—that any effort to rein in costs will lead to restrictions on treatments that could improve our health. But as Brownlee argues in this compassionate and compelling book, we can improve the quality of American medicine, control costs, and cover the uninsured—all without the limitations and expense that Americans fear. Her humane, intelligent, and penetrating analysis empowers readers to avoid the perils of overtreatment in their own care, while simultaneously pointing the way to a better system.

http://www.overtreat...m/the_book.html


*Starred Review* Award-winning health and medicine writer Brownlee notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices, and tests. What's worse, there are an estimated 30,000 deaths per annum caused by this unnecessary care. The reason for what amounts to a national delusion that more care is better care is rooted, she says, in a build-it-and-they-will-come paradigm that rewards doctors and hospitals for how much care they deliver rather than how effective it is. In a step-by-step deconstruction of America's improvident health-care system, Brownlee sheds light on events, attitudes, and legislation in the twentieth century's latter half that led to this economic nightmare. With the skill of a crack prosecuting attorney, she cites specific cases of physician and hospital fiscal abuse. Her aim is broad but not scattershot as she hits not just docs and hospitals but private insurers, Medicare, patients, medical device manufacturers, and pharmaceutical companies by, for instance, quoting a pharmaceutical salesperson who confesses financing a physician's swimming pool to get the doc to write more prescriptions. She is not all bad news, though, for she posits models that could be adapted to create a nationwide health-care system that conceivably could staunch the current fiscal hemorrhaging. If only.

http://www.amazon.co...e...6781&sr=1-1

The problem is too much government. The solution is apocalypse, and it is coming.

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#6 stocks

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Posted 22 November 2010 - 08:21 AM

An Intuitive (and Short) Explanation of Bayes’ Theorem

Breast cancer affects 0.8% of women over 40. Mammography correctly interprets 90% of the positive tests (when women do have breast cancer) and 93% of the negative ones (when they don't have breast cancer). If you ask a doctor how accurate this test is if you get a positive test, the majority will tell you the test is 90% accurate or more. That is wrong.

the accuracy of the test is 7/(7+70) = 10%. Wow, that is pretty different than the 90% that most doctors believe!

it is only after the third consecutive positive test that you can be over 90% certain that you have breast cancer.


Interesting — a positive mammogram only means you have a 7.8% chance of cancer, rather than 80% (the supposed accuracy of the test). It might seem strange at first but it makes sense: the test gives a false positive 10% of the time, so there will be a ton of false positives in any given population. There will be so many false positives, in fact, that most of the positive test results will be wrong.

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Link

The problem is too much government. The solution is apocalypse, and it is coming.

You know the credit cycle has peaked when the scandals arrive. - Michael Burry


#7 stocks

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Posted 25 November 2010 - 04:48 PM

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer

In 1967, Jack Wennberg, a young medical researcher at Johns Hopkins, moved his family to a farmhouse in northern Vermont.
Dr. Wennberg had been chosen to run a new center based at the University of Vermont that would examine medical care in the state. With a colleague, he traveled around Vermont, visiting its 16 hospitals and collecting data on how often they did various procedures.

The results turned out to be quite odd. Vermont has one of the most homogenous populations in the country — overwhelmingly white (especially in 1967), with relatively similar levels of poverty and education statewide. Yet medical practice across the state varied enormously, for all kinds of care. In Middlebury, for instance, only 7 percent of children had their tonsils removed. In Morrisville, 70 percent did.

Dr. Wennberg and some colleagues then did a survey, interviewing 4,000 people around the state, to see whether different patterns of illness could explain the variations in medical care. They couldn’t. The children of Morrisville weren’t suffering from an epidemic of tonsillitis. Instead, they happened to live in a place where a small group of doctors — just five of them — had decided to be aggressive about removing tonsils.

But here was the stunner: Vermonters who lived in towns with more aggressive care weren’t healthier. They were just getting more health care.


Why is this happening, then?

Above all, it’s the natural outgrowth of our fee-for-service health care system. It turns doctors into pieceworkers, as Ms. Brownlee puts it, “paid for how much they do, not how well they care for their patients.” Doctors and hospitals typically depend on the volume of work for their income, and they are the gatekeepers who decide when work needs to be done. They also worry about being sued if they do too little. So they err on the side of overtreatment.


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The problem is too much government. The solution is apocalypse, and it is coming.

You know the credit cycle has peaked when the scandals arrive. - Michael Burry


#8 stocks

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Posted 07 December 2010 - 11:19 AM

Doctor Faces Suits Over Cardiac Stents

Dr. Mark Midei inserted 30 of the company’s cardiac stents in a single day in August 2008, “which is the biggest day I remember hearing about,” an executive wrote in a celebratory e-mail.

Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home, according to a report being released Monday by the Senate. The dinner was just a small part of the millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore.


“What was going on in Baltimore is going on right now in every city in America,” said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who said he routinely treats patients who have been given multiple unneeded stents. “We’re spending a fortune as a country on procedures that people don’t need.”

Over the past year, St. Joseph has told hundreds of Dr. Midei’s patients that they did not need the expensive and potentially dangerous stents that the doctor inserted because their arteries were not as obstructed as he had claimed. Now, state health officials are investigating other local cardiologists who inserted a suspiciously high number of stents, which are tiny wire mesh devices inserted to prop open clogged arteries in the heart.

After reports about the Midei case and the wider state investigation, the number of stent procedures performed at St. Joseph and other area hospitals plunged, raising doubts about the appropriateness of much of the region’s cardiac care.


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The problem is too much government. The solution is apocalypse, and it is coming.

You know the credit cycle has peaked when the scandals arrive. - Michael Burry


#9 stocks

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Posted 12 December 2010 - 09:43 PM

Medicare incentivizes unnecessary surgeries

Bradley was checked into the hospital right away, and told he could be called into the operating room at any minute. But then, something even more alarming happened.
He says a nurse came in and under her breath said, "Get out!" As Bradley remembers, the nurse continued and said, "I can get fired for saying this, but I don't think you need the surgery."


Director of cardiology, Dr. Chae Hyun Moon, had performed more than 30,000 angiograms and ultrasounds - procedures in which a tube is threaded through a patient's heart to look for clogged arteries.
Based on those tests, he had sent thousands of patients for coronary bypass operations. One patient was Jay Bradley, a 35-year-old father of three. Two years ago, Bradley started having chest pains and went to see Moon. The diagnosis was grim.
"He put the monitor in front of my face, showed me a little artery on there and said, 'Well, this is clogged, and this one's the top front of your heart and there's zero chance of survival.'"

Link


For much of a ten-year period between 1992 and 2002, the cardiac program at this 240-
bed, Tenet-owned hospital in Redding, a small city at the northern tip of California’s
Sacramento Valley, was performing an extraordinarily high number of cardiac
procedures. These eye-catching statistics on catheterizations and coronary bypass
operations were reported annually in the Dartmouth Atlas of Health Care and were well
known to federal and state officials. Yet no agency sought as much as an explanation. It
was not until 2002, when a skeptical heart patient called the FBI that an investigation
began.


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The problem is too much government. The solution is apocalypse, and it is coming.

You know the credit cycle has peaked when the scandals arrive. - Michael Burry


#10 stocks

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Posted 13 December 2010 - 03:03 PM

Eat right and exercise -- die anyway

Nortin Hadler says he would sue any doctor who tried to test his cholesterol. Likewise, his bone density, prostate levels, colon cells, etc. The Harvard-trained doc, now in his sixties and a rheumatologist and professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, says you, too, should avoid these routine tests, as well as most angioplasties, bypass surgeries and routine mammograms. That's because -- contrary to what the medical establishment tells you -- the tests and procedures don't extend most lives, he says; they just convince healthy people they're sick


So if these screenings and procedures don't prolong our lives, what does?


About 85 percent of your mortal hazard lives in two questions: Are you comfortable in your socioeconomic status? And do you like your job? If you say no to either or both of those, that represents some of the most powerful mortal hazards that we are able to document.


So how do you personally deal with all this?


I will die, hopefully on my 85th birthday, and I don't really care which of the diseases that I'm bearing on my 85th birthday does me in. I only care that I made it to my 85th birthday -- plus or minus something -- and on that birthday I can look back and smile.


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The problem is too much government. The solution is apocalypse, and it is coming.

You know the credit cycle has peaked when the scandals arrive. - Michael Burry