{"id":50704,"date":"2014-10-14T20:44:17","date_gmt":"2014-10-15T00:44:17","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=50704"},"modified":"2014-10-14T20:44:17","modified_gmt":"2014-10-15T00:44:17","slug":"evidence-based-medicine-some-evidence","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/10\/14\/evidence-based-medicine-some-evidence\/","title":{"rendered":"«evidence-based medicine» some evidence<\/em>…"},"content":{"rendered":"\n

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In my medical lifetime, I’ve watched medicine turned into a business enterprise. I was fortunate to be able to hide in the cracks and mostly evade that myself – haunting places like training programs, academia, military service, a solo practice off the grid, a charity clinic. It’s not that I’m averse to systems. I’m just specifically wary of systems for-profit<\/em> being involved with anything that purports to give care<\/font><\/strong><\/em>. And I’m wary of systems not-for-profit<\/em> that are funded as start-ups<\/em> that are slated to later carry the ball on their own. The best medical system I ever worked in was an overseas military hospital. The worst was everything else. These are all acquired feelings at the end of a career, not something I started with.<\/div>\n

The top graph tells the story. The relative cost of medical care<\/font><\/strong><\/em> in the United States has doubled [since the days I first heard of Managed Care<\/font><\/strong><\/em> around the late 1970s]. And the reasons are obvious everywhere you turn. Fee churning Emergency Rooms in for-profit<\/em> Hospital Corporation owned facilities; Direct-to-Consumer ads increasing drug sales six-fold; inflated guidelines fueling unnecessary testing and treatment; controlling Managed Care<\/font><\/strong><\/em> monitors demanding evidence of efficacy but giving no evidence of their own [efficacy]; abusive pharmaceutical advertising and pricing; the constant whirr of the MRI machines in the background pouring out normal studies. The sick and those of us who treat them are a captive audience with no clear alternatives in sight. We’ve been an easy mark for decades. And it’s as if there’s an inertia from a more benevolent time, memories of a different ethic – something that keeps us naive about the impact that the business·i·fi·ca·tion<\/em> of medicine has had on our lives and our healthcare<\/font><\/strong><\/em>. And speaking of evidence, the bottom graph is one of the many that make the same indictment – it hasn’t been worth it.<\/p>\n

It’s funny, the cynicism in that last two paragraphs is evanescent. I can get to feeling it in spades, work myself up into a righteous froth – and then watch it evaporate within minutes. It happened today. I hadn’t worked in a couple of weeks – weddings, funerals, other things – but when I went to the clinic today, the cynical gloom lifted and I had fun. Maybe that’s not the right word. I got into the problems that came my way and did what I’ve learned to do. Some might say I wrote too many prescriptions. Others might say I didn’t write near enough. Some would say I didn’t need all those years of training to do what I actually spent my time doing today. Since I don’t get paid, it would be hard to say I didn’t earn my keep. My point is that I felt none of that uncomfortable cynicism I can feel at other times. The Licensed Professional Counselor I worked with and I saw several cases together we pass back and forth in our version of Collaborative Care<\/em>, the same with the Internist and the Nurse Practitioner. <\/p>\n

After work, I came home and saw those graphs up there on my desktop, prepared before I left town for the weekend. They seemed far away from the morning’s activities. It took a bit to recall why I’d hunted them down. I’ll get back to that I’m sure. But right now, I think I’ll just let the good feeling linger…<\/div>\n","protected":false},"excerpt":{"rendered":"

In my medical lifetime, I’ve watched medicine turned into a business enterprise. I was fortunate to be able to hide in the cracks and mostly evade that myself – haunting places like training programs, academia, military service, a solo practice off the grid, a charity clinic. It’s not that I’m averse to systems. I’m just […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-50704","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50704","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=50704"}],"version-history":[{"count":20,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50704\/revisions"}],"predecessor-version":[{"id":50724,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50704\/revisions\/50724"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=50704"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=50704"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=50704"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}