The Back to School Thread

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ZyyzYzzy

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Im sorry, are you a medical professional? Do you know that these practices you speak of are always wasteful and a money grab? Probably not, it's just easier to call people greedy because they work at certain places. References for these places using MRIs for wrist sprains. Also, the hand/wrist area is very complex and can require high resolution imaging to properly identify the cause of a problem.
 

Ambiturner

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So is it normal in Finland to kidnap someone who's wrist hurts from playing golf and force an MRI on them?

You really come off sounding like you have no idea what you're talking about.
 
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Im sorry, are you a medical professional?... hand/wrist area is very complex and can require high resolution imaging to properly identify the cause of a problem.
So you did not read my posts? Where I think out loud on the merits of going to med school? The point was to show the conflict of interest between a private health care provider and the patient, not to discuss how to treat something, but quick googling gave me:http://noelhenley.com/1310/fairwaysandgreens/This is a 'board-certified orthopaedic hand and upper extremity surgeon practicing in northwest Arkansas' writing on wrist pain in golfers who says that 'If your pain is lasting longer than one or two weeks, find a wrist specialist.'

Probably not, it's just easier to call people greedy because they work at certain places. References for these places using MRIs for wrist sprains.
So is it normal in Finland to kidnap someone who's wrist hurts from playing golf and force an MRI on them?
The point is thathttp://uta32-kk.lib.helsinki.fi/bits...pdf?sequence=1at least in Finland, patient consumers do not have the same amount of knowledge as the physician treating them. This is known in economics as an information asymmetry. This means that the patient is not as qualified to weigh the costs and benefits of different diagnosis methods and treatments as the physician.

Do you guys understand this? That patient consumers and private sector physicians have what is known as an agent relationships? Assuming you do: since the principal has less information than the agent, there is a risk that the agent will try to benefit at the expense of the principal. I won't even bother to link this, everyone knows that this is a thing.

We also know that marketing will stimulate demand. Marketing of <service> will stimulate demand for <service and other goods associated with service>.

Since patient consumers are targets of marketing,andthey lack the know-how to decide what options are the best justified, medically speaking, it follows that someone somewhere will not question a private health care provider when they are offered a <service>. How much is a matter of empirical research and edit: I think fairly off-topic for this thread. And before you go all autistic and obsess about empirical data: what's the point? We all know businesses will try to stimulate demand and patient consumers no different from other target markets in this regard.

It's not rocket science. You guys are just reading and responding in bad faith.

edit: I spent my 20s in international exports and did my BBA & MBA stuff back then. I have both theoretical and practical understanding of making profit. Jesus, guys, you are acting like businesses are philantropists. They are not and I'm not saying they evencouldbe.
 

ZyyzYzzy

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So, you are saying that all these individuals who work for private providers are greedy and exploit all their patients? None of them work in these places to offer and provide patients a greater degree of treatment with additional capabilities not found within state run facilities?
 
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So, you are saying that all these individuals who work for private providers are greedy and exploit all their patients? None of them work in these places to offer and provide patients a greater degree of treatment with additional capabilities not found within state run facilities?
Naah. Some of them are probably greedy. I do think it's more admirable (andmorallymore worthy) to work underpaid and overworked in the public sector and more admirable still to join the Red Cross and work pro bono in Africa. Or in the USA helping the disadvantaged. If you're a greedy individual you'll have to either hog tons of working hours in the public sector (although if you're not neglecting other obligations then I think the only wrong you're committing is increasing likelyhood of accidents from exhaustion) or go over to the private sector where it's mostly well-off late middle-aged people lamenting their lack of erections or sagging boobs or golf injuries. Because that's the stereotype here, and the empirical data looks to uphold it. As I've said, different story from the US, where regular people use private health care.

In the end, private health care providers are in the business to generate profit. Patient well-being is, at best, secondary to this goal.
 

Kuriin

Just a Nurse
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Last I checked, nurses =! physicians. Nor do we require a patient to come into a hospital when they sprain their wrist. If a patient comes in the emergency department with a suspected fracture, you bet your fucking ass we are going to xray it. If we didn't, you know how easy it would be to get sued without proper support and documentation?

I am sorry; but, you are coming across a complete asswipe to the people who selflessly -- yes, I said SELFLESSLY -- take care of people. You know how many times I've almost been assaulted by patients because they were psychologically impaired in some way? Too many to count. Or the verbal abuse that we (the nurses) get from patients as well as physicians?
 
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I went over some papers in healthcare and economics and it looks like it's a much more complex subject than I thought. I don't think the fundamental tension between caring for patients vs. marketing to stimulate demand goes away, but I admit I completely overlooked the inefficiencies that result from organisation size. Does nothing for the conflict of interest, though.

Still, looking at the utility side of things, it's less clear that private sector involvement necessarily means utility loss than I thought. Economics research does suffer from inability to run tests -- it's hard to know if Nordic countries would be even more efficient with more privatisation.
 

BrutulTM

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Private industry requires competition. Where the trouble comes in is when there is a private entity whose customers don't have the ability to go somewhere else if they find the service unsatisfactory or too expensive. When you make profit the motive then you need the competition so the providers keep each other honest. You can remove the profit aspect to get rid of the incentive to screw over customers, but you also remove the incentives to work hard, innovate, and provide exceptional service. The health care industry is further complicated by the liability aspect and the fact that there are people who don't have the money to pay for services that they nevertheless need badly.

If there was a simple answer then we wouldn't have to argue about it all the time.
 
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Last I checked, nurses =! physicians. Nor do we require a patient to come into a hospital when they sprain their wrist. If a patient comes in the emergency department with a suspected fracture, you bet your fucking ass we are going to xray it. If we didn't, you know how easy it would be to get sued without proper support and documentation? I am sorry; but, you are coming across a complete asswipe to the people who selflessly -- yes, I said SELFLESSLY -- take care of people. Just because we may get paid, does not make us greedy.
It's about ethics in health care. I was not talking about hitman. No, wait, I was talking about hitman.

Never said nurses are physicians nor that all physicians and nurses working in private sector were greedy. Just that greedy nurses would likely work in private sector, because the salaries go way up. The physician angle came in because I had to argue to some people that businesses primarily want to make money.

Look, it was a bad example and if I'd thought for a moment, I would not have used the wrist. Still, that hand specialist wrote on his marketing web page that if you got wrist pain from playing golf, waiting a week before seeing a doctor was ok, even advisable. What was the point of the example was that when you have a patient consumer who doesn't know anything about medicine, it's really easy to sell them all the imaging you can do and some that you can't, and they'll think they are getting excellent treatment when in fact there are more cost effective ways to go about it.

As I wrote earlier, no such thing as suing doctors for money here. Sure, intentional, or negligent enough to be nearly intentional (show up drunk, prescribe leeching, suckle a patient's breast) malpractice gets disciplinary action from the national medical association and the authority, but the patient gets compensated from State funds. Takes a ton of unnecessary pressure off doctors.

I suppose my ex-wife's opinion of the guys in her year who went private sector and crowed about the money, The Money, THE MONEY, (incidentally, they had displayed the least concern over patient wellbeing during clinical training. Totally unrelated, I'm sure.) may have influenced my opinion too much. But... I don't know. I wrote how much better it is to help people get better, not get even and you read 'health care professionals are greedy?' You gotta admit that choosing easier patients for more pay over less fortunate (i.e. the poor and the homeless) patients and lower pay does sound like choosing easier working conditions and more money, right?

None of the nurses and doctors I personally know work in private sector precisely because they know they are more needed in the public sector. Only 17% of nurses and doctors work private here in Finland. It's a core fucking value to all of them to treat people regardless of whether they can pay, are out of work, or in fact smell of both old and new vomit. So they work in public sector, not private. That, to me, is the more selfless and more admirable choice.
 
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You can remove the profit aspect to get rid of the incentive to screw over customers, but you also remove the incentives to work hard, innovate, and provide exceptional service. ... liability aspect...
Just a really quick reply.

None of the nurses and doctors I personally know need pecuniary incentives to work hard. Sure, they need money like everybody else (until the coming of the glorious barter economy :p ) but it's a severe mischaracterisation of the typical nurse or doctor to say that if they aren't paid well, they won't work as hard. Heck, the ex-wife didn't want to know money existed. That is, I think the typical nurse or doctor is entirely un-motivated by money over what they need to sustain a reasonable standard of living and may even be from the economics point of view irrational in that they'll report MORE satisfaction when the conditions are difficult. Will have to look into that.

As I said, the liability aspect is a matter of legislation. Change the legislation and it's gone.
 

Tenks

Bronze Knight of the Realm
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I don't go to the general forum so I don't have to read bullshit like this. Can a mod move this and rename it or can we stop this derail?
 

BrutulTM

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Just a really quick reply.

None of the nurses and doctors I personally know need pecuniary incentives to work hard. Sure, they need money like everybody else (until the coming of the glorious barter economy :p ) but it's a severe mischaracterisation of the typical nurse or doctor to say that if they aren't paid well, they won't work as hard. Heck, the ex-wife didn't want to know money existed. I think people working with animals and children miiight be less motivated by money than health care dudes and dudettes, but I don't know. Will look at relevant sociology papers.

As I said, the liability aspect is a matter of legislation. Change the legislation and it's gone.
If you ask any individual if they are doing what they do for the money they will say no. That said, the whole study of economics is based on the idea that people respond to incentives and it's pretty reliable in real life. Working hard is relative, but the vast majority of people will work harder if there is a personal incentive for them to do so. It's not a knock on the person, it's just human nature. In a perfect world that wouldn't be true, but as your username implies, the world isn't perfect.
 
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Right, but Ibelievea more important incentive than money would be choosing to live like good doctor, or that your colleagues think you a good doctor.

edit: found some empirical studies.

'job satisfaction was more frequently associated with achievement, recognition, characteristics of the work, responsibility, and advancement.'http://gradworks.umi.com/34/23/3423955.html

'The findings contribute to a deeper understanding of the internal desire of health professionals to engage in teaching 'https://www.ijme.net/archive/3/the-i...n-to-teach.pdf

'being able to work in accordance with the physician's ethic is strongly correlated with job satisfaction and the motivation of public service'https://tampub.uta.fi/handle/10024/98003

'health care professionals have a high degree of public service motivation, with leftists, public sector workers, women, and senior professionals having highest levels'http://www.labour.fi/ty/tylehti/ty/t...inenTaimio.pdf

But also 'The choice of payment mechanisms is not a neutral decision and has significant policy and practice implications. The extent to which these factors influence care patterns depends on the interplay of financial incentives/disincentives, urgency of patient need and the doctor?s value system'http://www.who.int/hrh/en/HRDJ_3_2_05.pdf

?the ways we are paid often distort our clinical and moral judgement and seldom improve it? Woolhandler S, Himmelstein D. Extreme risk - The new corporate proposition for physicians. New England Journal of Medicine 1995; 25: 1706-1707

I do NOT think it's reasonable to conclude that the typical health care professional is motivated by money.

What I have difficulty understanding is, why are so many guys defending businesses when profit motive seems to me to be in obvious conflict with the public service motive that is typical of health care professionals?
 

BrutulTM

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Maybe so, but money doesn't hurt
smile.png
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Vanderhoof

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I'm a nurse practitioner, not a physician. When I was on the floor as an RN, I've nearly been shit on (literally), I've seen patients throw a standing scale into the nurses station at another nurse and I was regualrly screamed and cursed at. Kuriin is correct, nursing is a selfless job and nurses deserve every penny they earn.
 
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I'm a nurse practitioner, not a physician. When I was on the floor as an RN, I've nearly been shit on (literally), I've seen patients throw a standing scale into the nurses station at another nurse and I was regualrly screamed and cursed at. Kuriin is correct, nursing is a selfless job and nurses deserve every penny they earn.
When I worked in a hospital, my colleague got shit spat on him. Yup, the patient, not content with slathering themselves in shit all over, had hidden shit in their mouth just in case we'd restrain her arms. Thing is, here in Finland the patients that can afford private health care are well-off people who can't be arsed to wait in line or, even worse, have anurseof all things triage them. Can't the simpleton see that their lack of erection at age 65 isclearlymore critical the missing leg of an alcoholic?
 

ZyyzYzzy

RIP USA
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When I worked in a hospital, my colleague got shit spat on him. Yup, the patient, not content with slathering themselves in shit all over, had hidden shit in their mouth just in case we'd restrain her arms. Thing is, here in Finland the patients that can afford private health care are well-off people who can't be arsed to wait in line or, even worse, have anurseof all things triage them. Can't the simpleton see that their lack of erection at age 65 isclearlymore critical the missing leg of an alcoholic?
What is the problem with more affluent people payig more for health care? What is the problem with people being offered higher wages in private health care if people are willing to pay more for it? I don't get why you seem so intent ob demonizing this type of thing. You make it sound like these places are forcing people into media care they don't need.

Maybe the vast majority of nurses/physicians in private health care in Finland were higher in their classes and have more difficult specializations, are more in demand and thus take higher paying jobs. I just don't get your argument. Private or public they both get to practice medicine and care for patients. Why not be paid more in the process?
 
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What is the problem with more affluent people payig more for health care? What is the problem with people being offered higher wages in private health care if people are willing to pay more for it? I don't get why you seem so intent ob demonizing this type of thing. You make it sound like these places are forcing people into media care they don't need.
Well, the businesses use marketing to create needs. And it's been well researched in marketing that even when we think we haven't been influenced by marketing, we've been influenced by marketing. Chilling stuff. Yeah, I'm pretty much in opposition to marketing existing in the world. Creates needs and makes some people (arguably, those who would need more protection from marketing) spend money they don't have. But you are spot on in that affluent people ought to pay more.

I think working in business / going to a business school and seeing the all-consuming maw of Mammon devour natural resources (I worked in extractive industry) and shit out pollution and filthy lucre broke me. French sociology and the analysis of society from poststructuralist pov was the last straw. Bourdieu.

Maybe the vast majority of nurses/physicians in private health care in Finland were higher in their classes and have more difficult specializations, are more in demand and thus take higher paying jobs. I just don't get your argument. Private or public they both get to practice medicine and care for patients. Why not be paid more in the process?
From what I've heard, the best med students, when they graduate, get to work in the most demanding public health care jobs and finish their specialisation the soonest. I'm sure some take on private patients when they complete their specialisation. However, the best surgeons work public sector jobs. The most difficult operations don't generate enough profit, so the public sector takes care of those.

See, the Finnish health care businesses like to take on the easy patients with easy ailments, because that's where the profit is. This makes the public sector look worse for those who don't know how the patients are stratified. And this makes Finnish physicians appreciate those who work public sector more: more difficult stuff, more responsibility, helping those whose life the sickness or accident will royally fuck over. The well-off can compensate the loss of quality of life with money, while those who are less well off get ill and have more accidents and have far less capability to compensate if they don't recover completely.
 

chaos

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Turned in my last assignment, that's it, done with my MS. First person in my family to get an MS that I know of. I thought I would care more but I'm already on to other things.
 
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