Maybe the best way to fix our health-care system is to fix our educational system first.
It's more philosophical than whether or not people are smart enough though. I think people should be able to choose. If I make a mistake in my own health care and I die, then that is okay. I could fall off my roof while I'm trying to fix that too or repair my car's brakes wrong.
Doctors make mistakes in patient care too and they are still allowed to practice medicine.
I also think we should fix our educational system and one way would be to allow students to break free from the lowest common denominator factors that are also ruining our health.
Of course. I know more than one person who was forced to diagnose themselves and then insist on the tests that would prove it to the doctor. People know more about themselves than their doctors do, and have a much higher incentive to get it right.
What makes this even more ironic -- as a patient, she has a very difficult time communicating with doctors. When she was in graduate school, she did studies on disparities in health care based on race. Somehow she gets caught up in those mechanisms without seeing the patterns she once studied in grad school. (She's African American, and she constantly has problems convincing doctors that she's not exaggerating the degree of her pain, and at the same time constantly disregarding her doctor's instructions. A couple of days ago, I did a double-take and said, "OMG, a little voice in my head is yelling 'African American Health Disparities!' Do you realize you're living a stereotype?")
Then you haven't had them enough to get to know them well. Get something often enough and you don't need a doctor to tell you which it is, you learn from experience to know exactly which it is.
It seems very simple to me to understand how to eat/exersice properly and how to not poison myself. All the information is readily available to anyone who needs it. Now if so many people can not even get this bit right, what chance is there that they would be able to diagnose more complex cases?
I say this, by the way, as an obese guy with a roommate who smokes, if that matters. :)
I know I'm guilty myself - I need to make 2-3 visits to the dentist to fill some cavities, but I tend to delay this because of time issues, financial cost and pure laziness ... and I think I care about my health reasonably well compared to the majority.
The first case was a woman suffering from prolonged, heavy menstrual bleeding. I don't mean an extra few days a month. I mean 45 days in a row with maybe a week between periods. The bleeding was enough to cause anemia, itself requiring medical treatment. The response of doctors was always the same: birth-control pills. At first they worked, but eventually they didn't. Certain pills, I don't remember which, made it significantly worse.
She finally insisted on alternate treatment. The doctor insisted on another month on yet another pill, certain that her problem was polycystic ovarian diseas despite having found no cysts or other matching symptoms in an examination. It didn't work, so he decided the problem must be uterine polyps and scheduled a dilation and curettage - essentially scraping out the inside of the uterus. He could see no polyps during the procedure, but insisted that they're sometimes too small to see.
It worked for a month. After that, the bleeding was back just as bad as ever. I came along to the doctor's office to help insist on a hormone test. He resisted, but eventually gave in. He resisted more when we wanted a copy of the results sent to us directly - in Florida, it's illegal for a test lab to deliver test results to anybody, including the patient without the doctor's permission. A couple weeks later, the results came in. All the levels were within the normal range, though luteinizing hormone was near the top of what seemed to be a rather wide range. A quick trip to Wikipedia made it clear this was part of the problem[1].
I went looking for a way to reduce the LH level, and quickly found that supressing the activity of another hormone called GNRH would do the trick, and that there are prescription drugs to do so. We brought the test results to an endocrinologist and first waited to see if she saw what I did. She didn't, so I told her. She agreed and wrote the prescription. With a retail price of around $60,000 an ounce, nafarelin acetate is the single most expensive substance I've interacted with, but it beats bleeding to death.
In the second case, I found a treatment simply by talking to the patient on IRC. He had a seizure disorder. The actual cause wasn't and still isn't known, but he had been seeing a neurologist. At one point, the neurologist prescribed gabapentin, a drug that acts an an analog of the inhibitory neurotransmitter gamma-aminobutyric acid. This was effective for about a week, but the patient quickly built up a tolerance. After reading what gabapentin was, and how GABA itself is made in the body, I asked the patient if he noticed a decrease in seizures when he ate foods high in MSG. It turns out that he did. He has been taking glutamine in pill form for about two months now, almost completely suppressing the seizures.
So, is everyone smart enough to care for themselves? Of course not. Are doctors necessarily smarter? At least some of the time, the answer appears to be no. I think most people should see a doctor for treatment of most medical conditions, but the idea of laws that prevent people from treating themselves seems like a fundamental violation of the rights of the individual.
[0] The actual cause of repeatedly coming up with wrong answers may be any number of biases, incorrect uses of heuristics or otherwise bad decision-making rather than a lack of intelligence.
I have nothing against the DIY option. The problem is, there are laws in place to prevent it. In Florida, it's illegal for a lab to collect a blood sample and run tests on the patient's say-so, or even give the results to the patient without the doctor's permission. It's illegal to obtain the drug the patient needed without a doctor's prescription.
There were workarounds available in this case: labsafe.com will have a doctor order any test a patient wants, though they recently quadrupled their prices (other options still exist). GNRH agonists are available without a prescription for research purposes, but they're still absurdly expensive, and not provided in a form that's easy to use as a drug.
[0] Assuming such a test is available and affordable, as it is for female reproductive hormones.