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4/30/13 questions and discussion

From: Jon A.
Sent on: Wednesday, May 1, 2013 11:29 AM
4/30/13 questions and discussion

1-how do we feel about the predicted loss of all privacy in public places in the next few years?6
2-is this a virtual reality?3
3-is it better that 10 guilty people go free than one innocent person go to prison?5
4-what beliefs are compatible with democracy?6
5-who has more responsibility for our health: ourselves or our doctors?8/7
6-who can we trust?5
7-does having rules of war make it ok?6
8-how can we ever stop the war machine?5
9-what's more dangerous: big business or big government?7
10-what do think of "LesterLand"?8


who has more responsibility for our health: ourselves or our doctors?

Julie: I had a physical today and I was asked to fill out a questionnaire. The questions had to do with how much responsibility I have over my health outcomes, and how much my doctor has. I was confused. I can see it both ways. I don't know how much responsibility we have. The doctors have the knowledge of treatments, drugs, and diagnoses. The internet seems problematic as a resource. If we do our own research and think we can then direct our doctor's care for us, that just can't be good.

Jim: why did your doctor care what you think?

Julie: they want to know if I'm doing what I can do to stay healthy, maybe. 

Steve: a doctor's job is to evaluate health and give advice for its maintenance. To me, responsibility for my health rests entirely on me.

Gina: what about a doctor who's not up on things?

Steve: that's not a responsibility for my health, that's a professional responsibility.

Marla: what about the Affordable Care Act ("ObamaCare")?

Steve: an emphasis there will be switching from service for fee based services to outcome based payments. 

Julie: what about patient compliance?

Stve: that's part of it too. 

Jon: does changing to an outcome-based system change a doctors responsibility?

Steve: it will change the doctors focus. This may not be a conscious change, either.

Meg: the changes will drive our doctor's to push us more because their compensation will be about outcomes. To a point this is good. Everybody also then becomes responsible for everyone else's health. When we see others doing unhealthy things we might think "that guy is wasting my tax dollars!" Or we might feel more personally responsible for our own unhealthy behaviors -- we might feel pressure not to waste other taxpayers' money. We owe it our selves and our communities to listen. Do we need more education about what is healthy/unhealthy?

Julie: I've thought of that. She's right.

Dick: It's my responsibility to get to a doctor. 

Steve: what about diet and exercise?

Dick: those are my responsibilities. The surveys like what Julie took are skewed to make us feel good. Her confusion is due to the doctor's concern via the survey in spite of its emphasis on what her responsibilities may be.

Gina: a high percentage of doctors are paid to promote drugs. That, then, is the doctor's responsibility. The drug studies made by Big Pharma are often inaccurate. It's up to me to eat right, exercise, and to stay up to date with general health issues. The doctor must be willing to tell me what I should do for my health even if it's not "nice." Outcome-based health systems may lead to that kind of interaction more likely. Preventative medicine ought to be given greater emphasis. This is both mine and my doctor's responsibility.

Marla: doctor's don't know everything and know even less if we don't tell them what's going on in our bodies. Doctors know little about drugs, that's for pharmacists to know. There are two kinds of patients. Those who know their bodies, who can reason. The others are those who either have no idea or don't care about their health. Those folk are typically on medical assistance.

Dick: because medical care can be so complex responsibility can move towards the doctor.

Ken: it should be 50/50, but the way things are today, we better assume we are 100% responsible. I sense doctors are too interested in earnings to be entrusted with this responsibility. 

Richard: lots of doctors get burned out too.

Ken: plus the quality of our food is in decline. 

Jon: Ken, would an outcome based system give you more optimism?

Ken: it makes me a little more optimistic but that's what we should be doing anyway!

Mike: my perspective: I grew up in the 1930s. I'm beyond my life expectancy now. I am mostly responsible for my health. In the last year I'm slowing down, my heart is not as strong as it used to be. Getting a second opinion -- my responsibility -- helped me find a mild heart problem.

John: we are more responsible for our health than our doctors are. Calvin Coolidge's son died of a tennis blister! So health care is clearly better now than ever. My concern is if one has a chronic condition the doctor may become too responsible for one's health. Making the doctor 100% responsible is wrong. Intensity of care has increased, doctors do order more and more procedures/tests (in part to maximize medicare $$). But we're the only ones with our bodies all the time, so we bear the lion's share of our health responsibility. Doctors trying to cater to patients' wishes -- via their self-diagnoses -- can not be a good thing in most cases.

Jim: it's confusing to think anyone other than me is more responsible for my health than I am. My wife [with MS] learned that to trust any one doctor is a mistake.

Ken: if we can't control the health value what goes into your body -- food -- how can we be responsible for our health?

Jim: I know when I drink I shouldn't do it, sure. But that responsibility remains mine.

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