Hacker News Reader

I hate this line of reasoning. It can be unjustly applied to everything.

Your programmer's incentive is to do a half-assed job, so you are more reliant on them for bug fixes and so on. Therefore, no programmer is going to be trying to do a good job or take pride in their work. Everyone is 100% motivated by financial gain.

His doctor may indeed suck, but he should get a new doctor, not write it off as the whole system being stacked against him.

I think you just discovered that when you apply the same line of reasoning to everything everywhere, you get nonsensical results.

That's usually why it is best to apply reasoning sensibly. For instance: Your programming example is missing the traditional loans from the cost-of-medical school. It is also missing the middle-man problem of insurance billing. It is also missing the incestuous role that pharmaceutical companies play in "helping" doctors to learn how to diagnose little-understood diseases such as UC.

It is better to apply the line of reasoning I gave above to situations where they apply.

And I think your perspective says more about your personal motivations in your daily life than anything else.

There are always going to be some people motivated by money (like perhaps yourself), some by helping others, some by some other measure of personal satisfaction.

To say all physicians work on the incentive of personal money is a paranoid view which, in my experience, is grossly simplistic. There are good doctors, and there are bad doctors. It's equally (in)valid to say that everything anyone does in any profession is entirely motivated by financial gain.

As seems to be usual on HN these days, you're vastly overreacting. Nowhere did he "say that everything anyone does in any profession is entirely motivated by financial gain". He said "you need to evaluate your doctors' incentives". The fact that someone has an incentive to do X does not mean it's their primary motivation, or even that they're taking it into account. I have a dopamine incentive to eat bacon, but it's not motivating any of my actions today. You're not helping anyone by being unreasonable or putting words in others' mouths.

Just to add to this - I know others who have grown disillusioned with the system. With a complex condition the chance that the sufferer has seen just the one doctor is almost zero. A dozen may be an underestimate. If the patient is no better, its hard not to become skeptical as the cost falls only on the sufferer and their family.

> As usual, you need to evaluate your doctors' incentives.

I would question their background even more. Think about how they were trained, and think about what are likely to be considered "best practices" in the medical field. Doctors tend to err on the side of caution (and usually with good reason). From that viewpoint, it's not surprising that something relatively new and seemingly radical is not likely to be recommended.

Seems like it's a branding problem. "Fecal transplants" might get a lot more traction if we called them something a little more benign-sounding like "stool infusion." Transplant makes it sound like you're moving an organ around rather than just some fungible bodily excretion. A transplant also doesn't sound like something anyone ought to do daily...

Intestinal flora exchange. Remove the reference to feces as that's incidental anyway.

Maybe used food recycling?

Repoop?

You laugh, but there's a study out there called RePoopulate. My preferred term was "Intestinal Recolonization".

'Gut Flora-dation'?

'Biome rotation'?

'Intestinal re-endowment'?

YouPoop

InstaGut?

iPooh

> As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it.

Incidentally, this is one of the many benefits of services like the NHS. Our doctors aren't thinking about their profit margins!

I signed up to post to correct this comment.

My wife was nearly killed twice this year by NHS bean counting:

Firstly they missed a strangulated hernia because they wanted to cut back on x-ray usage in A&E. Then after five visits to A&E and threats of being sued, they did one and booked surgery on the "oh shit" moment the consultant noticed it. She was dragged in each time paralysed with pain in an ambulance, which took at least an hour to arrive each time.

Secondly, after the surgery, they left her without any post-op checks for 17 hours due to staff shortages leading to a collapsed lingular, pneumonia and a massive internal bleed which took additional surgery.

My wife now requires full time care as her immune system has collapsed from the repeated infections and started attacking her body which has pretty much fucked me as the NHS won't foot the bill so I have to work full time at home dangling off an RDP connection (thankfully I write software rather than fix cars or something) and look after her.

This is also problematic as I have a disabled daughter who requires full time care, who incidentally receives precisely fuck all care of any significance.

And they cut our child benefit because I earn too much but I have to pay a huge rent to keep a job that pays enough to live on in London which leaves me -£100 every month.

Fortunately I found a solicitor to work for free on this case.

The NHS is a disaster as is the rest of this country. They are thinking of their budget which is worse than their profit margins.

To hell with it.

Edit: There is a lot of completely un-objective, unrealistic propaganda about the NHS all over the television from documentaries to reality shows (24 hours in A&E for an example). This is all completely detached from reality.

I'm sorry to hear what's happened to you and your family -- it's clearly unacceptable. I'm not going to defend that. But I do want to respond to your last comment, because I don't want you to think I posted what I said from a position of being brainwashed by propaganda. I wasn't. It just happens that my own experiences, and my family's experiences, with the NHS have been positive (so far at least). I'm actually due to have an operation myself next week, one that is more preventative than anything and which could've been deferred had cost been a factor. Hopefully it'll go well. I know it's of little comfort that someone else's experiences have been good, but there it is anyway.

For what it's worth, how would you make things better?

Well, if the eeeeeeevil doctors are really recommending things like x-rays based on profits, her problem would have been caught on the first visit, presumably.

It is entirely up to the luck of the draw unfortunately. The problem being that it shouldn't be at all down to luck.

How would I make things better?

Unfortunately the government seem to think that capitalism can be a host to socialism (i.e. the UK can host the NHS as a socialist concept). This plainly doesn't work as the last few years in particular have proven and ends up creating a dumping ground for the elite, the unionised masses and the worst of all: the incompetent.

The solution is pick capitalism or socialism and all their associated ills, then eliminate the elite, the unions and the incompetent universally.

A secondary problem is that this country is entirely skill-less and the population is growing rapidly. The skilled public workforce isn't growing at all with this.

Can we fix this? Probably not.

> The solution is pick capitalism or socialism and all their associated ills

That sounds like a terrible solution. I'd much rather try to balance bits of capitalism and socialism as necessary. Yes, it's hard, yes, we'll get things wrong, no, that doesn't mean it's not worth trying. 'Be wary of simple answers to complex problems'.

I'm sorry about your experience, however it definitely isn't everbody's experience.

When I was 13 I had a stomache ache, my mother being overly paranoid took me to the hospital after a few hours of it not getting any better. After about an hours wait I saw 3 or 4 doctors in quick succession, was diagnosed with appendicitis and had surgery scheduled for around 7 hours later. I was taken care of excellently and wasn't charged a penny.

Anecdotally, almost everyone I know has only had positive experiences with the NHS. Of course it isn't perfect, but it sure as hell isn't a disaster.

I've had the same experiences myself before with a broken ankle, major surgery on my skull, various minor conditions which have been sorted rapidly.

That doesn't excuse one case of gross incompetence though.

And incompetence is rife: http://en.wikipedia.org/wiki/Stafford_Hospital_scandal

You can't claim incompetence is 'rife' and then link to something which has 'scandal' in the title. If incompetence was rife, it wouldn't be a scandal.

The NHS has its problems, as does private health care. However, I would argue that the problems which the NHS has are almost all directly related to chronic under-funding.

Case in point: my girlfriend's grandfather recently had a stint in hospital. They discharged him, and then 2 days later he was sent back in with a different problem. He was put on a ward directly below the ward he had been on just 3 days earlier. The nurses on this ward had no idea that he had just been in hospital, no idea about his medication, and no idea about the treatment he had received.

The problem here is that due to budget cuts and under-funding, the NHS cannot invest in any kind of consistent or worth-while patient tracking and monitoring system. Everything is on paper in crusty filing cabinets, and what little technology they do have is already outdated and unnecessarily cumbersome.

The NHS is failing because populist politics have crippled it in essentially every single way that matters.

A government medical system that is a disaster for, say, 10% of the population, is a disaster overall.

Anecdotal evidence doesn't change that. And you were charged more than a penny in additional taxes. Government services are not a Free Lunch. The money has to come from somewhere and does.

But a system that kills because you're not covered is a better alternative?

Oh and 10%

[citation needed]

Neither is the right solution, which is the problem.

You pay for both systems. One kills you because you can't afford it and the other kills you because they can't afford to keep you alive.

You pay significantly less in a single payer regulated system, because everyone pays into it. Often, you pay less for better care. Other than your anecdote, which I could counter with my own that a government run healthcare system is why I can call my dad right now and say 'hi', do you have any real information to back up the government health care system is killing you?

I can find this: America's Healthcare System is the Third Leading Cause of Death http://www.health-care-reform.net/causedeath.htm

Here's a tip about A&E for the future:

While I have had nothing but great experiences with A&E in London over repeated visits (ex wife had several problems that resulted in ambulance visits, as well as managed to hurt her arm badly) as well as ambulance wait times, there are certainly differences between boroughs, both in funding but more importantly in policies.

If you find one A&E is not providing what you want, and ambulance times like that: Drive to another hospital. They are legally obliged to admit you at A&E (just don't tell them you on purpose drove there - it can't stop them admitting you, but it will make some consultants assy). Chelsea and Westminster is a good choice.

Outside rush hour, if you had ambulance waits of an hour you can likely have reached any number of hospitals unless you're far outside the centre.

In terms of budgets, we get what we are willing to pay for, unfortunately. As it is, our healthcare costs us half of what the extremely limited public healthcare funding in the US costs US tax payers (per capita), and for that we get universal coverage. Clearly we could pay more. We don't, because most people are satisfied with what the NHS provides - something we also see in the low takeup of supplemental private health insurance in this country.

Just targets on how many patients they can see etc. Plus good luck booking a same day appointment with a GP.

The only issue I ever have with getting a same day GP appointment is that I have to phone just as they're opening.

If you can never get a GP appointment then maybe try switching GP's?

Switch GP's. Getting a same day appointment does not need to be a problem.

As someone whose dissertation was on the bacterial infection your wife had (I'm not sure why you're suggesting a bacterial infection is somehow easier to treat than some others), C. difficile is far from straightforward and easy to treat.

What was your thesis?

It was particularly difficult a few years ago when recurrent c diff was relatively unknown. At that point, I had to find a compounding pharmacy to get the oral vanco.

When things would recur, docs who clearly did not know what to do next would recommend doing the same thing and surprise! they'd get the same recurrence when done. Idiots.

Finally, I ended digging into the literature in order to make sure that whatever infectious disease doctor we were talking to was up-to-speed. There are few who are. I worked out some population dynamics on my own, but most of the medical community is not diffeq friendly.

As the wife dropped to under a hundred pounds, we found someone who recommended Cholestyramine during the post-vanco phase. It turns out that Cholestyramine binds one of the toxins (B? iirc) which gives the rest of the intestinal flora a fighting chance as the spores germinate. Effectively, it reduces the coupling coefficient in a population dynamical system preventing the c diff population to grow and overcome other populations. Perhaps old news if you did work in this field. At least, I hope things like this are better known than back in 2005.

Anyway, it worked but her health has never been the same.

I'm very sorry to hear about your wife's condition - C. diff is a nasty and unpleasant infection at the best of times, and recurrent C. diff is downright terrible.

There's some new drugs - evidence for example that Fidaxomicin may work better than Vanco, and increasing use of fecal transplant and other techniques.

My dissertation was on the effect of routine fecal transplant in post-CDI patients to prevent recurrence, using some models based on diffeq transmission models (but stochastic rather than deterministic).

Thank you - yes, I agree. Not sure if this is completely relevant, but I found it very interesting:

http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitt...

the way i understand it, from the inpatient side of things, the medicare payment structure is structured so that for each hospitalization, you're paid a certain amount, known as a DRG. Therefore, the hospital is incentivized to boot you out as soon as possible.

C diff infections (for which fecal transplants apparently look extremely promising), cause extended hospitalization, eating into the DRG, and therefore, reducing overall reimbursements.

So fecal transplants aren't as disadvantaged as you might think.

With this whole incentives thing - the incentives of the insurance company (to pay as little as possible) do play a role in all of this.

>You have 24 hours a day to work on your problems, the doctor has about 20 minutes. So if you're not an expert on your particular situation, then you're pretty well screwed.

That sounds reasonable enough.

Yeah. It's called conflict of interest and is very real.