[Noah930]

I'll probably give you a long an rambling reply, wd15. Here are a couple thoughts regarding that.

We do a lot of not-entirely-necessary stuff in medicine. We live in a society that values studies more than providers' clinical acumen. Sometimes, a provider has to convince a non-believer of a patient/family/insurance company (I know you have lateral epicondylitis/tennis elbow based upon your presentation and exam, but you don't believe me although you'll believe the $1000 MRI). Sometimes it's to cover legal butts (see example in next paragraph). Sometimes it's because we live in a time of protocols, and the protocol calls for a specific study/treatment before we can proceed with the next step in management, even if the provider knows--based upon years of personal experience--that the first step is a waste of effort.

Example of wasted $$$$: My partner's teenage son recently had appendicitis. Classic case. We knew he had appendicitis. My partner and I have both graduated from general surgical residencies. So my partner took his son to the local ER. ER doc agreed he had appendicitis, as did the general surgeon on call. And they still ordered an ultrasound and CT scan to confirm the diagnosis, before taking him to the OR. The mentality is: that's the standard of care, so it's inexcusable not to do it. To get every study available, before taking action, even when you're pretty sure you know what the study is going to tell you. Is this just defensive medicine? Because it's not necessarily what I'd call "good medicine" (or, at least, medical resources properly utilized).

How did we get to that point? Are doctors mandating the standard of care? Are regulatory agencies like medical boards (which is not the same as the doctors)? Is the public expecting and demanding perfection? Are lawsuits (or even the potential for lawsuits) shaping what's considered the standard of care? Is it the chicken, or the egg? We try to eliminate all risk in medicine--which is noble--but not necessarily medically realistic or financially smart. But it definitely costs money, for which we collectively pay.

We have enormous waste in medicine: for the sake of "safety." Because "safety" is paramount. Just like anti-bullying was last year, and race relations is this year. So there are expiration dates on everything--even on stuff that doesn't expire. More and more instruments are "single-use only." For example, for laparoscopic surgery, there's a little device to irrigate and aspirate/suck. It's battery-powered with something like 8 AA batteries. It's a single-use item. So we toss 8 almost brand-new batteries after every laparoscopic case, let alone the little motorized pump that actually does the irrigating/sucking. OR packs (of drapes and non-instrument disposable supplies) are pre-packaged by a vendor. For inventory reasons, there's bound to be stuff in the pack that you don't use for every surgery, because it wouldn't be practical to have separate OR packs for each procedure for each surgeon. But that means lots of unused drapes and gauze and sponges and syringes and towels (cloth towels are single-use only!) get tossed with each surgery.

There's also a significant waste of man-power resources (again, in the name of "safety"). There's always more paperwork, more bureaucracy, more compliance. So we log and document everything, even when the likelihood that it will ever be necessary is exceedingly low. That's a lot of nursing power (because RNs have to log this stuff) wasted for paperwork reasons; nursing is as much logging data, as it is taking care of patients. Our surgery center has a full-time RN whose job is solely paperwork, and a surgery center is going to be run a whole lot leaner than a hospital.

Medical choice. We love choice in customer-driven America. We've got maybe the greatest commitment to customer service in the world. And part of that is having choices. But that costs money, too. So in a country with socialized medicine, the government may have one (or two) medications on formulary for each class of medicine. If you need an ACE-inhibitor for your blood pressure, they've got one (or maybe two) available. That's one way in which socialized medicine cuts costs. The government goes to the pharmaceutical company and says: we'll buy only your ACE-inhibitor (you get exclusive monopoly of our market), but you need to give us a really low price. But that's not something that would fly in America; a person may have an allergy (whether real or perceived) to one med, but can tolerate another in the same class. So they switch to the other med. But that's not something that might be possible in a socialized situation.