- Del Meyer, MD - http://delmeyer.net -

Biases, Priorities or Cultural Differences

Lynn Payer, author of Medicine & Culture: Varieties of Treatment in the US, England, W. Germany, and France, observes that these four countries have similar life expectancy rates, yet medical treatment differs greatly from country to country. She notes that although congestive heart failure is diagnosed and treated much more frequently in Germany than in the US, American physicians favor aggressive treatment whereas their counterparts in other countries often prescribe gentler approaches. She attributes the reason to the fact that medical diagnoses and decisions are greatly influenced by national character, culture, and philosophy. Susan Tannen, Editor of the new “Journal of Care Management,” in her review in the AMWA Journal quotes Payer, “What I think I have discovered is that the range of acceptable treatments for most diseases is much wider than that admitted in any one country, and a wider view of such acceptable treatments would better serve both doctors and patients… I also hope I have shown how our medical biases cause us to accept certain treatments and reject others, or to accept some too quickly and others not quickly enough. A better understanding of these biases should help to illuminate our past mistakes and perhaps avoid future ones.” Quoted by Susan Tannen in AMWA Journal

Humana sold their hospitals to Hospital Corporation of America in order to concentrate on financing Healthcare delivery. They had a contract to provide managed care for Medicaid patients, otherwise known as Medi-Pass in Florida. The State of Florida mandated that as of July 1, 1995 each Medicaid Managed Care patient had to have a complete history, physical exam, immunizations, and appropriate lab work within three months of signing up. Failure to do so made the carrier subject to a $1000 fine and a 1% assessment of profits for each occurrence. A Humana administrator in Florida stated that they withdrew from Medicaid Managed Care on July 1, 1995. They couldn’t figure out how to force compliance from either doctor or patient.

Panic: Abdominal tenesmus while stalled in a traffic jam and realizing that you had a couple of bran muffins and two cups of coffee for breakfast.

Folsom Dam’s mangled spillway gate number three is being repaired and the other seven 50 x 42 foot steel gates are being “upgraded” before the fall winter rains. Inspectors have been urging the Bureau of Reclamation to make repairs since 1988, but other government departments had higher priority. The fact that nearly a million people live below the dam did not change the government’s priority.

The UN Fourth World Conference on Women in Beijing highlighted some of the atrocities occurring, not only to grown women but also to baby girls. Because of the governmental regulation of family planning, newborn girls are being abandoned at orphanages in such magnitude that many die. Instead of crying rooms, the orphanages have dying rooms.

The AMA & Lonnie Bristow MD have had major spreads in both Sacramento and San Francisco papers recently. Dr. Bristow also spoke to our Comstock Club outlining the AMA position. We have to be cautious, however, when we recommend a $20 payment to a medicaid patient who doesn’t make an ER visit for a calendar quarter. That’s not unlike when France paid pregnant girls for obtaining prenatal care. Many held out for more money and carried the ultimate hostage. Micro-managing is not implementing marketplace forces. In fact, the Medicaid patient who understands the market would hold out for at least half the cost of the average $600 ER visit. “Pay me $300 if you want me to save you $600.”

The Calif Nurses Assn hosted a health workers’ march in SF to protest hospital cost cuts as the American Hosp Assn was meeting at the Moscone Center. The union representing “aides, orderlies, & janitors” sided with the RN’s, lamenting the discharge of patients to nursing homes for post op care. “Our workers are horrified,” stated the union president Sal Rosselli. “They have no clue how to take care of these people… their health care is at risk.”

Nurses aide’s response to RN supervisor checking on why the ventilator was turned off: “It’s so much easier to do my job when that thing isn’t going on all the time. After all, I only turn it off 10 or 15 minutes twice a shift.”