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Number of Posts:85
Registered on:2/25/2010
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re: Health care in Great Britain: No surgery for you - 185LSU
NC, yes within a single patient-doctor interaction is what I'm referring, patient shouldnt be able to say, I want this, this is what I get. A patient is and should be free to find another doctor who may or may not do the surgery or extend indications. In our institution, however, we are usually the ...
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re: Health care in Great Britain: No surgery for you - 185LSU
If I see 40 people in a day, there are usually at least 3-5, if not more, that want a surgery that is not indicated or they shouldn't receive (in their current health state). Roger, I take it you are a normal, reasonable person base on your posting. Patients who come to seek orthopedic surgery on...
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re: Health care in Great Britain: No surgery for you - 185LSU
You should be offered a main choice and alternatives. What in saying is that someone shouldn't have to power to come in and say 'I pay my insurance, give me X surgery'. In light of all the things they don't understand about the surgery and complications, this could yield badness. You can choose, ...
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re: Health care in Great Britain: No surgery for you - 185LSU
Rather frequently people are denied a surgery. Sometimes they are offered a surgical alternative and sometime no surgery at all. Medicine is not, and should not be, a market in which the customer gets to choose their good/service. They can be provided with the information but ultimately, only a rel...
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re: Health care in Great Britain: No surgery for you - 185LSU
I should be clear. And I don't want this to get lost in our discussion from a financial perspective. Certainly it would be naive to say that these reimbursement issues and hospital privileges, all this, does not play some role. But most importantly, I feel like it is not in the best interest to o...
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re: Health care in Great Britain: No surgery for you - 185LSU
In our system, it would seem that they are just making the surgeon be the "death panel" by being the person to deny care in certain circumstances. But realistically it the hospital that will eventually tell surgeons they can't do the surgery at their institution if the complication rate is too high....
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re: Health care in Great Britain: No surgery for you - 185LSU
The clinical decision for a lot of surgeons will just be to avoid the complications by not operating on the folks with higher risks. That decision will be based on not wanting to put the patient at risk but when its tied to reimbursement of course that will be in some way part of it. ...
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re: Health care in Great Britain: No surgery for you - 185LSU
No. Complications. But the more complications are directly tied to reimbursement, it will be hard to delineate the weight of each separately playing into the decision making....
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re: Health care in Great Britain: No surgery for you - 185LSU
I would argue that our govt is just going about In a different way. By cutting reimbursement, they are causing surgeons to make a more strict choice. In this case, it is often not a mutual Doctor-patient decision. Many times I've been screamed at or yelled at for not performing a surgery that a pati...
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re: Health care in Great Britain: No surgery for you - 185LSU
Yeah the ortho literature is pretty clear on some of this stuff. What will be interesting to see is how, as the surgeons become more and more selective, the system tries to find ways for those who are 'too risky' to get their surgeries. There are already studies highlighting the disparities in care ...
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re: Health care in Great Britain: No surgery for you - 185LSU
Also, things like pneumonia (or DVT, PE) are going to be these 'never' events that surgeons will receive repercussions if they have too many of. Alterations in their reimbursement from medicare/Medicaid will be a likely effect. How to prevent this? Don't operate on someone with COPD or heavy smoker ...
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re: Health care in Great Britain: No surgery for you - 185LSU
No. Currently the situation here is not rationing per se, but care gets dispensed based on risk factors. In NIH system it is govt body which says you can't do this or that elective surgery on a given patient given certain risk factors. Here, surgeons make that choice. But gradually, as you see re...
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re: Health care in Great Britain: No surgery for you - 185LSU
BMI isn't the best judge of body composition for the general population. That being said, for the population getting total joints, we typically are not seeing a super muscular person whose BMI is skewed by that. The data is there and is convincing that it is related to complications. For smoking ...
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re: Health care in Great Britain: No surgery for you - 185LSU
The relationship that is of most concern is with smoking and post operative complications - pneumonia, aspirations, or surgical site infections. BMI has also been directly linked with higher rates of most complications. BMI cut offs for surgeons performing total joints are already a standard here fo...
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re: Health Care Rationing in England - 185LSU
On the way to our healthcare system but implementation will be by the treating surgeons. As a resident, I've noticed that more people are getting access to care, however, these patients are generally not healthy with multiple medical comorbidities. They want their knee, hip, ankle, etc... elective s...
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Banjo Repair - 185LSU
Was gifted an old Kay banjo that is in a state of disrepair. Needs a tune up, set up, and a new bridge. Anyone you guys could recommend to do that work in NOLA? Thanks in advance....
Posted on Music Board
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re: Luca Falcone Suits Experiences - 185LSU
Very pleasant folks there and great quality stuff. They made my suit and shirt for wedding and I intend to go back for some more items soon. They have a lot of options to pick from and you get to pick every detail for the construction of the suit. They take to time to get all your measurement and...
Posted on O-T Lounge
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re: Trufire Hardcore Release - 185LSU
I assume you mean the Hardcore 4? If so, I have one. Used it heavily over the summer to train and get my shots on point. Love it, worth the cost. Helped me get a nice antelope in WY this year. The ability to change the sensitivity of the trigger and travel, as well as position is great. Can't co...
Posted on Outdoor Board
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Rod repair - 185LSU
Good morning, Messing around in the closet and my favorite rod got stuck in something and the last 1-2inches of tip got broken off. It's a 12 yr old custom rod from my father that is my main 'go-to' . G Loomis blank with purple and gold detailing. I feel sick to my stomach... Where can I ge...
Posted on Outdoor Board
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re: This is why knee surgery sucks (warning graphic) - 185LSU
You would actually be surprised.... Patient came to our office asking about the her hospital bill one day and got into the discussion with the staff. Physician reimbursement is not that big of a portion of the overall bill...1500-2000$. For reference, not really much of a difference in reimbu...
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