Doctor's Fees...A Rant!

[RiaX]

RiaX why do you find it so easy to put a $ price on human health?

I work in the sector. I understand the variables quite well. Just because its your health that doesnt magically make the cost vanish. To develop a drug costs money. To transport the drug costs money. To store the drug costs money. Therefore it cannot be free simple.

If everything was cheap and free then pharmaceutical companies will not have money to continue research. The drugs you take for granted for example antibiotics come for these companies, they the only ones in the world that can do this type of work and manufacture on a global scale. If things where cheap and R&D shuts down, its game over. If we had only penicillin and nothing else we be doomed. Imagine how many people wouldve died from AIDS if ARVs werent researched and produced. Only money makes this possible not your bull**** compassion and sensitivity. MONEY BRAINS and HARD WORK.

Don't you think that that is a bit immoral, to profit out of someone's poor health?

Well its a damn shame someone is sick, medical professionals take their work quite seriously but you cant buy bread with smiles and thank yous. There are a lot of homeless people, do you spare change to everyone ? or do you volunteer to feed them? or have you help in any sort of community project ever? have you given a car guard a R2 everytime they help you? where this attitude you have for the hawkers on the side of the road?

Suddenly we all super compassionate and loving people when see the doctor's bill and expect money to become an unethetical issue. What rubbish

There is a reason that only the USA and ZA follow the model of private provision and private purchasing of healthcare. How do you feel about how this system excludes the vast majority of our population from quality healthcare?

Having worked in the government sector myself, I can tell you I would rather stay at home than be admitted. Dont get me wrong the government provides well, however for my personal liking I do not like the low quality medicines they use. The attitude of "get the job done at the lowest cost" is not something I like when it comes to my health.

I do not wish to be limited on analgesia to save cost if im hurt. I want that pain to go away, and for that you have to pay up. Until our government hospitals can even compare to that of the UK the private sector in SA is required. Our government hospitals were built in 1950s and still are the same.

The private sector however has world class facilities - which our corrupt government cannot provide.

The government also doesnt assign enough money to health care here. I worked in a pharmacy that had 210 items out of stock for over 3 months. Needless to say i resigned because a pharmacy with no drugs is pointless. I didnt even have panado ..... a major government facility had no panado for 3 months (lets not even start with the insulin, antihypertensives or antibiotics) apparently the BEE government only cares about HIV and ARVs (no its not racist its observational fact - look at the health strike. If you had diabetes you werent allow to get insulin if you hiv positive you were allowed to get ARVs). So ya with our brain dead state I rather cough up for the private sector thanks

 

[AlmightyBender]

I work in the sector. I understand the variables quite well. Just because its your health that doesnt magically make the cost vanish. To develop a drug costs money. To transport the drug costs money. To store the drug costs money. Therefore it cannot be free simple.

If everything was cheap and free then pharmaceutical companies will not have money to continue research. The drugs you take for granted for example antibiotics come for these companies, they the only ones in the world that can do this type of work and manufacture on a global scale. If things where cheap and R&D shuts down, its game over. If we had only penicillin and nothing else we be doomed. Imagine how many people wouldve died from AIDS if ARVs werent researched and produced. Only money makes this possible not your bull**** compassion and sensitivity. MONEY BRAINS and HARD WORK.



Well its a damn shame someone is sick, medical professionals take their work quite seriously but you cant buy bread with smiles and thank yous. There are a lot of homeless people, do you spare change to everyone ? or do you volunteer to feed them? or have you help in any sort of community project ever? have you given a car guard a R2 everytime they help you? where this attitude you have for the hawkers on the side of the road?

Suddenly we all super compassionate and loving people when see the doctor's bill and expect money to become an unethetical issue. What rubbish



Having worked in the government sector myself, I can tell you I would rather stay at home than be admitted. Dont get me wrong the government provides well, however for my personal liking I do not like the low quality medicines they use. The attitude of "get the job done at the lowest cost" is not something I like when it comes to my health.

I do not wish to be limited on analgesia to save cost if im hurt. I want that pain to go away, and for that you have to pay up. Until our government hospitals can even compare to that of the UK the private sector in SA is required. Our government hospitals were built in 1950s and still are the same.

The private sector however has world class facilities - which our corrupt government cannot provide.

The government also doesnt assign enough money to health care here. I worked in a pharmacy that had 210 items out of stock for over 3 months. Needless to say i resigned because a pharmacy with no drugs is pointless. I didnt even have panado ..... a major government facility had no panado for 3 months (lets not even start with the insulin, antihypertensives or antibiotics) apparently the BEE government only cares about HIV and ARVs (no its not racist its observational fact - look at the health strike. If you had diabetes you werent allow to get insulin if you hiv positive you were allowed to get ARVs). So ya with our brain dead state I rather cough up for the private sector thanks

I know that there are costs. My issue is with how those costs are determined and how those cost are funded. Me in my individual capacity have zero bargaining power when it comes to how healthcare is procured. If government was the sole purchaser then they have massive bargaining power and and keep costs down. This is the Canadian model.

Even better is where government both supplies and purchases healthcare. This is the British and Cuban model. This removes as much profit from the equation as possible. I'm happy for society to cover the costs of healthcare, but it is immoral to profit from it in my opinion. Same with drugs, even though there are huge costs in developing these.

I think it is immoral that 80% of the healthcare resourses in this country are on 20% of the population. That is the reality of a completely private model and it only perpetuates inequality and poverty.

However, are either of the above possible in our lifetimes in South Africa? No, our government is a complete balls up. But what if the DA were in power...
Will I continue to use private medical aid? Yes, I have no choice
Should healthcare in this country continue fleecing the rich and ignoring the poor? I really hope not and I fear that if all healthcare practitioners share your attitude then there is no chance for something better.

 

[Humberto]

http://www.aafp.org/online/etc/medialib/aafp_org/documents/press/charts-and-graphs/median-income-by-specialty.Par.0001.File.tmp/MedianIncome2008FINAL.pdf

 

[Messugga]

I know that there are costs. My issue is with how those costs are determined and how those cost are funded. Me in my individual capacity have zero bargaining power when it comes to how healthcare is procured. If government was the sole purchaser then they have massive bargaining power and and keep costs down. This is the Canadian model.

Even better is where government both supplies and purchases healthcare. This is the British and Cuban model. This removes as much profit from the equation as possible. I'm happy for society to cover the costs of healthcare, but it is immoral to profit from it in my opinion. Same with drugs, even though there are huge costs in developing these.

I think it is immoral that 80% of the healthcare resourses in this country are on 20% of the population. That is the reality of a completely private model and it only perpetuates inequality and poverty.

However, are either of the above possible in our lifetimes in South Africa? No, our government is a complete balls up. But what if the DA were in power...
Will I continue to use private medical aid? Yes, I have no choice
Should healthcare in this country continue fleecing the rich and ignoring the poor? I really hope not and I fear that if all healthcare practitioners share your attitude then there is no chance for something better.

Health care is relatively high risk and requires an appropriately high reward for people to actually want to go into it. I know of several doctors who started working with only the best intentions, but by the second or third attempted lawsuit, they become jaded and start chasing the money. Coupled with risk of HIV exposure - I know a couple of doctors that were exposed via prick and urine to the eye respectively - and diseases like hepatitis, even significant salaries aren't enough motivation for people to enter or stay in the medical field.

 

[RiaX]

If government was the sole purchaser then they have massive bargaining power and and keep costs down

The government here does that. Anyone is allowed to go to a state facility. Its your pride that prevents you, you a tax payer go. You want nice services like delivery to door and multiple brands to choose from then you gotta pay for the luxury service.

Even better is where government both supplies and purchases healthcare. This is the British and Cuban model

Dont use rich first world country models and expect them to be applicable to us or a communist state. Do you really trust OUR government to be honorable ?

it is immoral to profit from it in my opinion.

What do you do for a living ? and why you think its immoral? is this some random sense of blind and warped "good" ?

Lets see what would have if its non profitable. People wont become doctors they will go into engineering law ect and your brightest of the generation will deviate away from medicine (you cant be dof to get into medical school well when it was done properly - BEE thats all). Your healthcare for the nation will drop, because your medical schools are pushing out stupid doctors (same affect as BEE quota systems).

If the pharmaceutical industry didnt turn a profit you can say buy to a healthy life and a good quality of life, when you ask "where is the treatment for cancer" when you get it they will simply respond "we had no money so we didnt bother looking into it, too bad"

Next look at all the support staff that are employed by that sector. Cutting its profits isnt going to just hurt the doctors, it will hurt everyone related to the field, and thats EVERYONE. A society and its economics are dependent on energy, banking and health (primarily pharmaceutical.). Go on cut the profits and see what happens, every action has a reaction.

Same with drugs, even though there are huge costs in developing these.

So how you expect medicine to progress? you think 5c in a tin can at the supermarket is going to cut it ? you welcome to grow your own willowbark and extract the salicyclic acid and crystalise it ect. As for me I rather pay for a filtered, developed, regulated and standardised asprin tablet.

I think it is immoral that 80% of the healthcare resourses in this country are on 20% of the population

Invalid arguement. This is a smokescreen used by the ANC in particular to push out the NHI. If 80% of your health rescource is privately funded then thats something the people need to assess with their state and not the practioner.

perpetuates inequality and poverty.

Life isnt fair get over it. People arent equal. Medicine is about realistic fact not idealism.

But what if the DA were in power

They would not disrupt the health sector, the amount of tax renevue gained from it is very valuable, not to mention the amount of people the sector employs. Reps, techs, Drs, pharms, nurses, secretaries, debt collectors, accountants, cleaners, transport ... the list is endless.

Will I continue to use private medical aid? Yes, I have no choice

The is a choice, downgrade to hospital plan only go goverment facility for your chronic medications. Start a nest egg using fixed deposit interestes (guaranteed capital safe investments) for a rainy day. Will this option be as good as a premium medical aid ? no of course not but if you battling and there is absolutely no where else to make cuts backs then this can be an option, only if you in good health. Like a controlled asthmatic patient that requires an inhaler once every 2 - 4 months

Should healthcare in this country continue fleecing the rich and ignoring the poor?

Who says we ignore the poor ? i've worked in government hospitals. Ive done community service beyond my minimum standard hours. Ive driven 100km in MY OWN car with MY OWN petrol at MY OWN COST to fetch emergency medications for the patient in the ward.

All medical practioners have done MORE than their fair share of giving back to the community. You have never been on a 72 hour call in a rural hospital like every single qualified doctor ever has done. All medical professionals have given back more than you know what have you done ?

Have you ever sat in a hospital in disguise during strikes to aid the wards, one doctor went outside and bought a homeless man's clothes went back in as a vistor and sat in his ward to supervise and care for his patients ... ALONE. Can you do this ? would you? and when they finally leave this to join the private sector you think they scum that dont deserve it? ... how sad. Oh not to mention the private sector top dogs still go to medical school and state hospitals to train the next generation.

Dont forget the hospital groups like netcare stabilize and provide ambulence and EMRS free of charge if you cant afford it.

yes they are totally greedy .... shame on them for expecting something out of their hard work after 10 years of study.

Health care is relatively high risk

HIV isnt so bad. The killer is TB .... the doctors are dying like flies. My friend has MDR-TB and a couple Drs I know have XDR-TB. XDR are as good as dead and they arent even 30 yet. Dont forget the psychotic patients, i got attacked by one myself when i was having a smoke break simply because I had a white coat on - i know they said smoking is bad for my health but i dont think in that way rofl

 

[Humberto]

HIV isnt so bad. The killer is TB .... the doctors are dying like flies. My friend has MDR-TB and a couple Drs I know have XDR-TB. XDR are as good as dead and they arent even 30 yet. Dont forget the psychotic patients, i got attacked by one myself when i was having a smoke break simply because I had a white coat on - i know they said smoking is bad for my health but i dont think in that way rofl

Tell us more please.

I went to a doctor the other day with a cough and was startled when she raised the possibility I might have TB. She ended up excluding TB based on my symptoms but when I went on the internet I read that one quarter of the population in the USA have TB.

As I understand it, many of us (one quarter to one third of the population) are infected with latent TB which can become acute if our immune systems are weakened. All you need is a person with acute TB to cough in your presence. Medical workers and people who work in crowded places are at greater risk.

 

[RiaX]

Tell us more please

sarcasm ?

 

[Humberto]

sarcasm ?

No, it's a serious question.

 

[MagicDude4Eva]

I think statistically you will find about the same amount of incompetent medical practitioners as in any other profession. I do consider doctors (regardless of it's specialisation) however an "expert skill" (similar to a legal professional) and I think people like Riax are the exception.

It is no different than working in IT and having to deal with lazy, incompetent people.

 

[Nerfherder]

Tell us more please.

I went to a doctor the other day with a cough and was startled when she raised the possibility I might have TB. She ended up excluding TB based on my symptoms but when I went on the internet I read that one quarter of the population in the USA have TB.

As I understand it, many of us (one quarter to one third of the population) are infected with latent TB which can become acute if our immune systems are weakened. All you need is a person with acute TB to cough in your presence. Medical workers and people who work in crowded places are at greater risk.

You probably do have TB... most of us do. The thing is that you need to be immuno compromised to develop the sickness.... ie you need to be really sick like have AIDS... or live in a sewer.

Pretty easy for the doc to eliminate TB.

 

[RiaX]

he thing is that you need to be immuno compromised to develop the sickness

No not true. Anyone can contract TB and any varient. Generally speaking it is the immunocompromised that get it but its not requirement.

latent TB is basically when the mycobacterium is in a state of stasis or its been isolated in the body by the immune system (foci - kinda like a membrane encapsulation of the TB bacilli, when you immune system drops this can "rupture" causing active TB. Sometimes you can be exposed to a virulent form of TB then even if you not immunocomprimised you will contract the disease).

All it takes is a sneeze from an undiagnosed patient with active TB. It needs to reach deep into the lung as well, TB bacilli are non motile and the mucosa usually protects healthy people. For you to get active TB an active bacilli needs to be phagocytosed by aveolar macrophages. In these cells TB begins to replicate and the bacilli are presented to lymphocytes and it enters lymphatic circulation spreading the bacilli across the body.

Patients on treatment arent a threat as they cannot transmit the disease after 2 weeks of treatment (academically - we take it as an unofficial 5 days). The danger is those that dont know they have TB.

so latent TB can switch to active TB by introduction of an active organism or being immunocompromised or both.

 

[Humberto]

If you have latent TB, is your immune system constantly fighting it to prevent acute TB infection?

You know, some people believe that conditions like fibromyalgia, depression, and chronic fatigue syndrome, are caused by latent infection that taxes one's immune system.

 

[RiaX]

Its not constantly fighting it actively as you thinking. Its maintaining it, its very difficult to explain if you dont understand the immune system cascade and that is very complex (even I battle to follow the immune system)

This would serve you well. Its 10 years old however the answers you looking for are here. The only thing thats outdated is the actual protocols we follow in management of active TB.

http://www.kznhealth.gov.za/chrp/do...tional/Tuberculosis/SA TB Guidelines 2004.pdf

if you really interested in how the body interacts with TB you need to search for a review article on TB. Look into aveolar macrophages as this is the cell the bacilli interacts with first in the lung.

interesting articles: (unforunately I cant source them because I use a subcription journal site that does it for me - some of them may be free)

British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children

http://cmr.asm.org/content/21/2/243#ref-list-1

 

[Humberto]

There are qualified medical doctors in this world who practise on the fringes of conventional medicine. They are sometimes dismissed as quacks by their colleagues. Some of these doctors believe that conditions like depression, chronic fatigue syndrome, and fibromyalgia, are caused by latent infection. The internet has many testimonials from patients who were miraculously cured of these sorts of conditions following aggressive prolonged treatment with antibiotics. They say that if you have a condition like depression, fibromyalgia or chronic fatigue syndrome, and you experience a temporary improvement in your condition when you get treated with antibiotics for another illness, then you may benefit from aggressive prolonged antibiotic treatment to kill the latent infection that lurks within you, constantly placing stress on your body and immune system.

 

[Humberto]

In defense of GPs

An experienced GP cannot be beaten for quality medical care. I believe that many specialists suffer from tunnel vision. If all you have is a hammer, everything resembles a nail. Orthopods for example often prescribe anti-inflammatories with little regard for the effect those anti-inflammatories have on the patient's blood pressure. In the orthopod's world, he has cured the patient and he pats himself on the back for a job well done. In fact, he only cured one aspect of the patient's health, but created a new problem in the process.

I've been cured by GPs on at least two occasions where the specialists' earlier treatments hadn't really worked. GPs face the entire spectrum of disease every day.

 

[RiaX]

Some of these doctors believe that conditions like depression, chronic fatigue syndrome, and fibromyalgia, are caused by latent infection

Can be if there are rich foci present in the subarachnoid space within the CNS, unlikely I would like to see strong research data on this if possible. however I dont dismiss the idea. They are caused by an active infection

The internet has many testimonials from patients who were miraculously cured

This is a the problem with TB, when it goes into the latent state (which is also called the dormant state), its almost undetactable. Most sputum cultures and bacterial cultures will show a negative result. So it gives the impression that the disease is cured (generally its taken as cured)

I just had a lecture by a Professor Siram at K-rith laboratories. The drug they designing is still in its infancy but its designed to attack latent bacilli which at present there is no drug available that does this. The entire line of TB drugs we have are very old (1950s old) and they do not remove these foci. So prolonged agressive treatment is not ment for latent TB, its used because the TB drugs have poor bioavailability and the nature of the mycobacterium species makes it difficult to treat.

An experienced GP cannot be beaten for quality medical care

True, though as all medical practioners they are limited by the science available to them. Currently the science of TB is too complex (like HIV), a good practioner can only go as far as the science and the tools available.

many specialists suffer from tunnel vision

Its not tunnel vision they are specialists they will only look within their field, hence the referal system. Thats why I keep telling people never to skip the GP.

Orthopods for example often prescribe anti-inflammatories with little regard for the effect those anti-inflammatories have on the patient's blood pressure.

One has to assess risk to benefit. If benefit out weighs the risk then there is a rationale to prescribe the drugs. Although some NSAIDs can affect the blood pressure you must remember they wont induce chronic hypertension. Once the drug is removed from the body it will reach equilibrium. Nobody knows why we get primary hypertension all medicine knows it what can accelerate its onset. Primary hypertension is malfuntion of the renin-angiotensi-aldosterone system.

So drug side-effects are not all causative. Some cases can express cancerous genes and cause cells to go rouge (in the case of HRT), though generally once the ligand is removed the side-effect subsides. Again it varies drug to drug and the type of side effect. Of course this is not true for toxic drugs that kill mammalian cells (for exmaple drugs that are said to be cardiotoxic or heptaotoxic can physically damage these tissues). You also got to assess the chance of the side-effect some of them are so rare they are reported to be 1 in a billion cases which is acceptable.

In fact, he only cured one aspect of the patient's health, but created a new problem in the process.

This is a misconception. Yes alot of the times medical procedures induce nasty after effects. Though one must realise that medicine isnt a fountain of youth. All it can do it slightly extend your lifespan by maintaining the body's natural healthy state allowing people to reach the peak of a human life span. It also allows improved quality of life in those that have pathologies. It cant and never will grant you immortality. To be healthy and disease free your entire life is not possible, as the body ages it will degrade in its cellular processes (cell death rates will over take cell renegration rates) and your systems will malfunction. Like a factory if you have a lot of employees that are highly skilled you will produce a quality product, as your factory loses its staff your production will decrease and as your skilled staff get less and less your quality will decrease and eventually your factory will close.

I've been cured by GPs on at least two occasions where the specialists' earlier treatments hadn't really worked. GPs face the entire spectrum of disease every day.

yes because a GP has a broad spectrum of medicine and is extremely experienced in it and deals with it daily. A specialist has a narrow spectrum of medicine but within their field they are generally untouchable. They dont deal with general medicine so their treatments may be old and out dated and their knowledge and skill outside their field may have dimished over the years. This is why the referal system is VITAL if you want quality care.

 

[Swa]

Private ER rooms are normally R1400 just to sit in the bed. Go to public if you cant afford it.

Rip-off. Netcare is about R400. That's the ER and doctor's fee.

I wish had studied for a decade and then sat back and twiddled my thumbs for a R1000 an hour.

I've seen 19 of them in the last year. Only one went beyond a first thumbsuck diagnoses and that was an idiot who for example claimed my symptoms were side effects to the meds despite having them before ever taking the meds!!. I suppose you need a decade of studying medicine to understand that one.

I don't mind paying for service if I actually got the service. If I "worked" like they do I would have been fired long ago.

Yeah that is what some people don't seem to get. Many people work harder for a living and don't get that much in any case. Economies are not dictated by the work you put in so arguments about studying hard for a decade doesn't cut it.

What I found ironic is their reluctance to do tests because of costs. Charge a grand for a consultation but a R200 blood test oh no...

Unless it's the usual run of the mill test something like a full blood count. That is fine even though the 3 previous docs did the same test.

Yeah it would be worth it if they did all the tests they should and none of those they shouldn't. They keep trying to get you to come back for more visits though so doctors don't get my siding on this one.

LOL. The doctor is also a business man get over it. As the medical techniques get more advanced they cost more. The equipment costs more to maintain and to purchase obviously the Doctor is required to pay his own bills and he isnt going to do consultations for free.

Do you know whats the cost of medical equipment ? Lets leave the R&D costs because those are numbers beyond your imagination. Take an MRI for example. It requires specialised software, specialised computers, a liquid helium coolant (which costs about R200 000 per month per machine), the machine itself is going to cost about 10 million, not to mention a couple million to magnetically seal the room the machine is in. On top of that you require highly qualified people to operate it. So the procedure may only last a few minutes (because it has been designed that way to be comfortable for the patient) and you expect it to be cheap ? you think the neurologists equipment is any different ? hell even a scalpel is damn expensive and its just a blade. There are stitches that cost R20 000 why ? because they have been designed to disolve once you healed and its expensive to manufacture sterile equipment.

Now imagine if they didnt have a high consultation fee ? they wouldnt be able to pay their support staff, the electricity bill for these machines and they wouldnt have an income to justify a loan with the banks in order to apply for a loan to make a 15 million rand purchase from general medical or siemans medical for diagnostic machines.

Lets not even start with the cost of drugs. Dont expect a person who has studied 6 years in university to get their degree then done 3 years inservice (internship + com serv) then few years as a normal MO to gain experience to qualifiy to become a registrar which takes another 3-5 years and some extremely difficult tests then be a consultant in state practice in order to get experience to gain access to the private sector.

And you want this specialist doctor to charge what ? R200 ? they not doing something simple like cutting grass. Also the cost of your health is your own fault, you not suppose to be jumping doctors if they dont refer you. When you go to another doctor you suppose to take all your lab works and history with you so the doctor can build a picture of whats going on, if not he IS going to repeat the tests so that he wont have a malpractice lawsuit on his head. If they refering you to every doctor around then your case isnt a simple case of pins and needles and they doing it out of your best interest.

Bloods will be done multiple times depending on your condition because the status of your blood varies and changes over time with respect to diet, drugs and pathology progression.

Why dont you rant about why ferraris are expensive ? or what aeroplanes are expensive ? because you dont need those things. Since when you are entitled for cheap PRIVATE medical care ? if you want entitlement to cheap/free medical care there is the state option which is open to all.

How many more things you've bought that arent important that cost more than the consultation ?

you say he driving a porsche ? so what? he isnt suppose to enjoy the fruits of his labour ? what he suppose to do? take the bus? what car you drive ? and why do you think the doctor isnt entitled to a luxury vehicle ?

Limit the doctors on their consultation and you will have no doctors, the decent ones will just close shop and leave. then what will you do?

And also its not the doctors job to claim from your medical aid, they dont have to. Its your medical aid its your job to sort it out. Most doctors do it because its good business practice that is all it is its not a REQUIREMENT.

Straw man

 

[RiaX]

Lol ok if all clinical guidelines are strawman then I dunno.

 

[Swa]

Lol ok if all clinical guidelines are strawman then I dunno.

Nobody said anything about clinical guidelines being straw men.

 

[RiaX]

Nobody said anything about clinical guidelines being straw men.

then what is ?