I found this article interesting. Note: I'm not posting it to brag about the Canadian medical system. It has lots of issues. I do think that the U.S. healthcare system has major issues, some of which are covered in this survey.

http://chealth.canoe.ca/channel_health_news_details.asp?channel_id=131&relation_id=1883&news_channel_id=131&news_id=17770

One item I found particularly amusing.

"There was one area where Americans fared better than Canadians. Despite being less healthy and having less access to a vastly more expensive health-care system, Americans are happier with their care than Canadians are."

i blame the preponderance of lumberjacks as the cause for Canada's stastically higher healthiness rate.

I don't know if this has anything to do with the disparity in care but it was interesting nonetheless:

Medical Guesswork (http://www.businessweek.com/magazine/content/06_22/b3986001.htm?campaign_id=search)

Just a snippet of a rather long article of what I had been coming to suspect for a long, long time... doctors know diddly squat:


Medical Guesswork
From heart surgery to prostate care, the health industry knows little about which common treatments really work

The signs at the meeting were not propitious. Half the board members of Kaiser Permanente's Care Management Institute left before Dr. David Eddy finally got the 10 minutes he had pleaded for. But the message Eddy delivered was riveting. With a groundbreaking computer simulation, Eddy showed that the conventional approach to treating diabetes did little to prevent the heart attacks and strokes that are complications of the disease. In contrast, a simple regimen of aspirin and generic drugs to lower blood pressure and cholesterol sent the rate of such incidents plunging. The payoff: healthier lives and hundreds of millions in savings. "I told them: 'This is as good as it gets to improve care and lower costs, which doesn't happen often in medicine,"' Eddy recalls. "'If you don't implement this,' I said, 'you might as well close up shop."'

The message got through. Three years later, Kaiser is in the midst of a major initiative to change the treatment of the diabetics in its care. "We're trying to put nearly a million people on these drugs," says Dr. Paul Wallace, senior adviser to the Care Management Institute. The early results: The strategy is indeed improving care and cutting costs, just as Eddy's model predicted.

For Eddy, this is one small step toward solving the thorniest riddle in medicine -- a dark secret he has spent his career exposing. "The problem is that we don't know what we are doing," he says. Even today, with a high-tech health-care system that costs the nation $2 trillion a year, there is little or no evidence that many widely used treatments and procedures actually work better than various cheaper alternatives.

This judgment pertains to a shocking number of conditions or diseases, from cardiovascular woes to back pain to prostate cancer. During his long and controversial career proving that the practice of medicine is more guesswork than science, Eddy has repeatedly punctured cherished physician myths. He showed, for instance, that the annual chest X-ray was worthless, over the objections of doctors who made money off the regular visit. He proved that doctors had little clue about the success rate of procedures such as surgery for enlarged prostates. He traced one common practice -- preventing women from giving birth vaginally if they had previously had a cesarean -- to the recommendation of one lone doctor. Indeed, when he began taking on medicine's sacred cows, Eddy liked to cite a figure that only 15% of what doctors did was backed by hard evidence.

Fascinating article on Eddy.

As for the Canadian-American comparison study, the study itself may or may not have been properly conducted, but the conclusions being quoted in the news are exemplars of fallacious reasoning.

Related:
http://www.boston.com/news/nation/articles/2006/05/31/us_health_behind_canadas_study_finds/

James Smith, a RAND Corporation researcher who co-authored the American-English study, said, however, that his research found that England's national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.

``To me, that's unlikely," he said of the idea that universal coverage explains international differences.

Fascinating article on Eddy.

Perhaps yes.

Perhaps no.

What does he really mean by 'simple regimen'? Many of the drugs which he says are simple, are still expensive.

Madie will have better infos than I, but CC and ICU nurses spend at least 25 percent of their time just doing documentation(from my own informal polling of them), instead of actual healthcare. It is a conservative estimate that 50 percent of what healthcare workers do is prophylactic just against lawsuits, instead of actual treatment.

Eddy liked to cite a figure that only 15% of what doctors did was backed by hard evidence.
And a good 75% of the rest is due to some doctor previously getting sued, for doing something or not doing something. And for most people that is usually HARD enough.

Regarding the Canadian article.

It would be interesting to find out nursing and doctor to population(s) ratios.

Also total cost per person coverage ratios. How much does Canada spend per person? How much per active patient? Versus America.

The newest trend over the past 2 years or so, is to practice what is called "Evidence Based Nursing". It sounds simple enough, policies and procedures are based on proven evidence that they work.

The problem is, there is so much anedotical nursing, that it is difficult at times to get physicians to understand that just because something has always been done a certain way, doesn't mean its the best or safest practice.

Nurses (and doctors) do spend a huge amount of time documenting. And I agree with Fy'yr that it is usually because of some lawsuit, or more realistically, some government agency that says, you have to prove that you have done something. The oldest cliche in nursing is, "if it isn't written, it wasn't done."

The best example is the use of restraints. Currenlty, you must document that you have tried several alternative measures, like re-orientation, staff observation, medication, removing temptation from the patient, before you can legally justify tying someone down. Sounds reasonable, I mean I know I wouldn't want to be tied to a bed without the proof that I needed to be. The problem is that the paperwork required for this, currently, is so cumbersome, that it literally steals time from other patient's as the nurse documents and documents and documents.

Doctors and nurses have had to get into the practice of "proving" reasons for everything they do, that many are frightened of doing something that goes against tradition. Like the mention of the VBAC (Vaginal Birth After Cesarean). It was believed for many years that having a C-Section, weakened the uteran wall to the point that if the mother tried to have a vaginal birth after, the wall would rupture, killing the mother and possibly the baby. Obviously, that is not the case for every woman. Could it happen? Yes. Has it happened? Yes. That is what scares most doctors about suggesting it as a possibility for women.

American's have been so sue happy, that unfortunately, it is a major driving force in medicine today. Research is all well and good, and we, as medical professionals, can offer our best guess as what treatments should work for your condition/ailment. But every single person is different, has different reactions to medications and treatments. If what is suggested for you doesnt work, who gets blamed/sued?

That is why "evidence based practice" is the best practice today. Unfortunately, there is a high lack of definitive evidence for many of the common practices, because it has always been assumed that the doctors/nurses did things because they knew they worked. But getting the hard evidence has shown to be challenging.

Another example of this is the whole "nurse/patient" ratio debate. Do nurses know that the fewer patients they have, the better the care the patient's will get? Yes! How do you prove that? Well, you need evidence that the nurses are able to deliver better quality care, make less med errors, have fewer patient complications (falls), and have happier patients. Unfortunately, there is little hard data to back that up. There are thousands, if not millions of antedotical stories. But hard evidence that patients benefit from more RN's, less non-licensed personell, and more highly educated nurses, is lacking.

With all of that said, there is some good news. There are some doctors that realize that we as humans do make mistakes, and that those mistakes can cause patients harm. As I posted in another thread, the IHI has started a campaign called the 100,000 lives campaign. It was started by physicians who realized that there are certain standards, that if followed, could possibly save 100,000 lives each year. Their website (http://www.ihi.org/IHI/Programs/Campaign/) has more info, and it is a start in the right direction, one that hopefully will move us to a safer medical community.

The newest trend over the past 2 years or so, is to practice what is called "Evidence Based Nursing". It sounds simple enough, policies and procedures are based on proven evidence that they work.

I agree with that sentiment. Each insurance company has has its own forms and if there are multiple insurance companies involved, the health care company has to apply to each. Then a health care falicility has to use their new machines... which are new because a lawyer could point out that they were not using the newest stuff available. Each test should have a profit margin associated with each and the insurance company picks up the costs of tests without question.

The question that would have to be raised with national health care would be if individuals would be able to sue the governement for inaduquate care and then the government would be picking up the tab for normal failures. Failures such as a normal birth gone bad.. or someone dying on the sugrical table...

I think an interesting litmus test will happen in Massachusetts. Once the universal health care program has been in play for a few years statistics should start showing trends. It will be interesting to see how things look pre and post down the road.

Failures such as a normal birth gone bad.. or someone dying on the sugrical table...

No birth is normal. If they were normal and risk free, everyone would be just having them in their homes.

People die on the surgical table all the time(or afterwards more generally). Cutting open your body and exposing your insides to the outsides is always a risky thing to do. Always.

No birth is normal. If they were normal and risk free, everyone would be just having them in their homes.

Births are normal. It is only a modern medical practice to take women into hospitals to give birth. Many women still do give birth at home. No births are risk free.

They really aren't.

I can't give birth. Most people either can't or don't give birth, a percentage size-ably and notably less than half provide for most of the actual breeding. Most children can't give birth, none of the male ones can. Old women generally can't for instance, post menopausal.

Now that really was not the poster's meaning, either, I inferred that the meaning of normal (having nothing to do with statistics) that they are somehow risk free. That normal 'meant' safe.

Women would not go to hospitals to give birth unless it decreased the NORMAL risks of giving birth.

If I were a woman, and could breed, and give birth with the same risks at home or wherever, and at a hospital; I would chose home or wherever. A really nice spa would be best, I suppose, with cucumbers on my eyes and servants massaging my feet.

A really nice spa would be best, I suppose, with cucumbers on my eyes and servants massaging my feet.
From what I gather, that would be totally wasted on a woman in labor.

I think an interesting litmus test will happen in Massachusetts. Once the universal health care program has been in play for a few years statistics should start showing trends. It will be interesting to see how things look pre and post down the road.
Yeah! It will be very interesting.

Ack! Pan agreed with me!

/em looks at the calendar 6/6/06

/em hides under the desk.

LOL! Hey, fix your signature, you rotten Republican.