A prescription can be written for as much as you want. Typically the pharmacies won't fill them if they're over a year old, but there's really no reason you couldn't prescribe someone a 30 year supply of Lescol if you wanted. I certainly wouldn't have someone in the office every month just because they're on Lescol. OTOH, I would want them in the office every 6 months at a minimum to check on their liver and make sure that's not being adversely affected. Birth control pills, patients that are stable on antidepressants, that sort of thing, I almost always write a year at a time. About the only patients that I expect to have in the office every month are those that are on coumadin(blood thinners) or are somehow medically unstable. If I'm trying to find the right dose of a medicine I might have a patient back every couple of weeks to couple of months while we fiddle with the dose.

And you treat depressed people without seeing them also/?

I hade a severe concussion in august. They did some kind of brainscan checking for bleedings in my head, among other things. Was hospitalised fore about 24 hours, mostly asleep. Cost for me to pay, 300 SEK (45 USD)

IF it had been some of my kids, there would have been nothing for me to pay, it would have been free.

I pay via the tax-bill. That is socialised medicin for you.

Like many other systems of modern society, the Medical industry suffers from the evolution of too much complexity. Too many interdependent parts with often conflicting interests. The Pharmaceutical Industry, the Insurance Industry, the Legal Industry, the Goobermint and of course the AMA itself all are huge bureaucracies now.

At its core, the Medical profession was about a knoweldgeable Medicine Man treating a Patient in need. As the profession developed, you added in Nurses as Helpers to do routine tasks, freeing up the Doctor to see more patients. As the technology improved, Doctors couldn't do as good a job without the evolution of the Hospital that had capital intensive machines the individual doctor could not afford. The Hospital of course then needed Accoutants to figure out how many patients they needed to serve to afford a CAT Scanner, and then as the costs went up an Insurance industry grew to try to spread the risk for more and more costly and energy intensive care through the population.

Actuarially speaking, the whole Medical Profession and Industry as it evolved is like all the other ones, based on infinite growth. This includes infinite growth in expectation of what the industry can deliver in terms of extended life and better health for the population. While we grew in the presence of virtually unlimited energy, the medical industry was able to cover these costs, but no more. Now the bureaucracy which grew up around Medicine is like a lead weight sinking it rapidly to the bottom.

Its not surprising Doctors are ready to quit here, but just what are these folks going to do as an alternative? Go out and drive a truck? In the past, there were alternatives for these well trained and marginally intelligent technicians like working for a Pharmaceutical company or advising Lawyers in consulting, etc. However, as the industry as a whole collapses, there are not alternatives. They are in the short term as screwed as everyone else here, as screwed as the Auto worker who no longer has an auto factory to work in.

Doctors are better off than most though, because when the monetary system collapses, the knowledge they have can be bartered for food. People will always be getting sick, and doctors can sometimes help with this problem. However, they will have to help mostly without any drugs and mostly without any complex diagnostic equipment they have come to rely on. A stethoscope, palpitation,talking with the patient to gather up the symptoms to make a diganosis will be once again the way a doctor figures out what to do to help a patient. If he or she is good at this, keeps someone alive to be productive to the society, said doctor will be given a chicken or a goat. No complex Insurance forms, no huge staff of Accountants and technicians. Back tot he basics.

It will be a tough adjustment in downward mobility though, because the doctor is just a part of the society with not that much more value than a good sanitation worker or domestic. Anyone who works to keep the environment people live in clean will be doing just as much if not more to maintain the health of the population than a doctor does. On a social level, you are far better off training domestics to do the basic task of maintaining a clean environment that expecting doctors to cure diseases which mostly come from a corrupted environment.

The lifespan extension we achieved using the thermodynamic energy of oil is coming to a close. It was rare before Big Oil came to rule the world that people lived much past 60, that is why we established 65 as a retirement age and figured Social Security could cover it. You EXPECT most people will be DEAD by 65, and in the absence of modern medicines based on oil they WOULD be.

We will return to a world where most people are born, grow to reproductive age and live long enough to see their children thru to independence. Those with genetic problems will die young, they won't reproduce. Medicine Men and Women will still be around to help a few, set broken bones and drain cysts and ease the transition into death with extractions from a Poppy plant. However, the myth that we can extend the lifespan through medicine will go the way of the Dinosaur, as Big Oil fades into history.

Reverse Engineer

I think that's a pretty good summary RE. The other big problem facing medicine right now is diminishing returns. In the US we've actually reached a point where the incremental return on extra dollars spent on healthcare is negative. We're spending so much on healthcare at this point that incremental dollars get spent on unnecessary test and unnecessary surgeries that end up shortening people's lives rather than prolonging them. There's a great graph from the World Health Organization, I'll try to find it. It compares life expectancy vs. per capita health costs by different countries. We're way off at the top in terms of expenditures, but our life expectancy is below that of countries that are on the sweet spot.

Couldn't that be related though to the health of the population? No amount of money in the world can save a person's life (or prolong it) if that person continues to smoke, drink, eat shit and no exercise. Given that we're probably the least healthy (pre-medical visit) nation on Earth and we have a high crime rate and high vehicular death rate per capita, it's not a shocker that we spend more on health care while we have a "bad" life expectancy. And again, we shouldn't forget about the costs associated with our lawyer epidemic in this country. Most other nations don't have that problem.

I think this may be the graph you are thinking of (but not by the WHO):


If one were to add a linear fit, it actually shows a greater expenditure on costs per capita leads to increasing life expectancy. Of all of the nations, the US is the only that falls off of that trend greatly (we should have a life expectancy in the mid to upper 80's if not higher).

I think the collapsing health care "system" (more like a bowl of spaghetti) will lead to social unrest and eventually violence. There can be no nastier a social division than between people who have access to affordable and competently delivered health care and those who do not.

Last week something like 500,000 people lost their jobs, and therefore their health insurance. Their employment prospects going forward are grim, as are their prospects for health care access. As the mass of unemployed grows, you could see more and more scenarios in which people rob pharmacies at gunpoint or break into doctors' homes demanding care at gunpoint.

It's gonna get ugly. This will be another way people will be fighting for survival.

Pleaze enter, modern day stress into the equation.

Stopping smoking, drinking, junk foods..... these are good starts...

I'm fairly new to the site and a lurker and learner for the most part.

No matter how you turn the current health care system - it's done. Stick a fork in it.

What happens next to the common people without doctors?

This has probably already been covered on another thread. I apologize....

Learn, learn, learn about natural solutions to as many problems as possible!

Most prescriptions are based on isolated plant chemicals.

But watch your information sources. Foreign scientist are doing more research on natural health options and finding out they work. The foreign scientist make fun of our scientist because they choose cheap extracts or weak formulas... and then find they don't work - DUH!

Which has to do with 'follow the money' here in America.

Remembering that our Government supports tobacco growing knowing that it kills us.....

Let's use soy as an example. Soy is not on the GRAS (Generally Recognized As Safe) list in America. It's approved for cardboard boxes, but it's in most of the foods in America. Soy harms the thyroid - making people fat, tired, and depressed. Sound familiar?

Coconut oil is one of the healthiest oils on earth. Easy on the liver and inspires the thryoid.

Farmers tried using coconut oil with their animals and the animals got thin and healthy. Not a good idea for making money.

They changed to soy and the animals got fat. Just like us.

Soy is also on of the top Genetically Modified foods.

And it's in everything!

It's fasinating and scary - the things allowed in our food supply. Most of it isn't food at all.

No surprise.

But, in my humble opinion - learning all you can about your local plants and growing your own meat just makes sense with the doctors about to exit the scene.

I will PM you (thanks), but did want to say the following in open forum:

1. I'm not insulted, because I DON'T know what I'm doing (clearly - or I would have gotten this mess straightened out), but this points to a BIG problem in the system ... Small-time, solo practice can't afford billing guru, doesn't have time to figure out the hell-maze herself/himself, ends up not getting paid. Without meaning to sound paranoid, one wonders if there isn't some design in place to make small-timers like I was (I gave up that private practice and now contract to the State of Idaho) throw up their hands in disgust AND EXHAUSTION. Bottom line - patients got treated - payors did not have to pay. (I.E. Medicare/Medicaid).

2. My biggest problem by far was the coordination (HAH!!!) between the two Big M's. If a person is on both Medicare and Medicaid, Medicare pays first, then the rest is billed to Medicaid. But navigating the Medicare mess was the problem. So the claims never got paid by them ... and thus never got paid by 2nd payor, Medicaid.

3. Someone mentioned electronic filing. Yeah. Great idea, because I am a computer freak - so I like the idea in theory. Except for the HIPPA thing. ARGHHHHHHHHH! And the cost of setting up (lots of up front $$). Solo practices in rural areas and/or primary care where the $$ are the lowest are going to have trouble putting together what it takes to file electronically.

Lumpy

Doctors can't treat people without machines anymore. They can't read sysmptoms holistically from body signs visually, by hearing and feel. They are computer technicians reading charts and we are modern cars/machines. Doctors have to be switched out for a neww batch of witch doctors or shamans or something similar.

This is the graph:

link



Sure. My only point is that money and resources invested in healthcare doesn't fix it. In all likelihood other things could help.



I think the truth is more along the lines of no amount of money can save a person's life. Period. We're all going to die. There are some conditions that can be reasonably diagnosed and treated to prolong a person's life. There are a lot that can't. Once you've invested adequately to deal with the treatable, all the added spending, all the high tech treatments, and "medical breakthroughs" don't add appreciably to people's lives.

Truth beknown the largest factor in the increase in life expectancy in America was the advent of public water supplys, wastewater treatment and the pure food and drug act. Its better to not catch cholera in the first place than to treat it with drugs. Even post peak oil the knowledge of how to avoid whole groups of diseases through sanitation and vaccinations should keep our life expectancy well above what it was in say 1940.

That's a fascinating graph spg, thanks. I'd be curious to see which countries those other points along the top represent.

Just what is it about our government that insists on doing everything the hard, expensive way?

Thus I put "or prolong it [one's life]" in parentheses after saying to save the life.



True but the problem I had with what you had said earlier stemmed from this:



You were saying that adding more dollars decreasing life expectancy when your own graph says the opposite. That's what I was getting at but then I digressed.

If we had an intelligent and well-fit population, then I do think that we'd have a higher life expectancy than we do now. Not by much and not a great return but it wouldn't be negative or neutral. So then while our populations would be similar (to say Japan or Sweden), we'd be spending more (roughly twice or more) and getting a slightly greater life expectancy.