Critical Thinking Not Fear Based

TenderIsOurMight

Here are the qualifications required to be selected:

Qualification Requirements: The mission of the USPSTF is to produce
evidence-based recommendations on the appropriate screening,
counseling, and provision of preventive medication for asymptomatic
patients seen in the primary care setting. Therefore, in order to
qualify for the USPSTF, an applicant or nominee must demonstrate the
following:
1. Knowledge and experience in the critical evaluation of research
published in peer reviewed literature and in the methods of evidence
review;
2. Understanding and experience in the application of synthesized
evidence to clinical decision-making and/or policy;
3. Expertise in disease prevention and health promotion;
4. Ability to work collaboratively with peers; and,
5. Clinical expertise in the primary health care of children and/or
adults, and/or expertise in counseling and behavioral interventions for
primary care patients.
Some USPSTF members without primary health care clinical experience
may be selected based on their expertise in methodological issues such
as medical decision making, clinical epidemiology, behavioral medicine,
and health economics.
Consideration will be given to individuals who are recognized
nationally for scientific leadership within their field of expertise.
Applicants must have no substantial conflicts of interest that would
impair the scientific integrity of the work of the USPSTF including
financial, intellectual, or other conflicts. (http://edocket.access.gpo.gov/2008/E8-11191.htm)

 1.The mission of the USPSTF is to produce evidence-based recommendations on the appropriate screening, ...for asymptomatic patients seen in the primary care setting.

How can you produce evidence based recommendations on breast cancer screening if you don't include the diagnostic and treating physicians themselves: i.e., radiologists, surgeons and oncologists? Breast cancer screening knowledge doesn't exist in a vacuum of primary care providers alone. If anything, a panel omitting diagnosing and treating physicians (radiologists, surgeons and oncologists) may lead to bias (under-weighing of benign presentations of cancer seen by diagnosing and treating physicians limiting discussion of same).

2. Clinical expertise in... primary health care :do not breast surgeons and radiologists perform breast exams and screening mammograms to a good percentage of women in addition to ob-gyns, internists and fps? Certainly screening mammograms are 100% performed by radiologists, so why leave them off the task force?

3. Consideration will be given to individuals who are recognized
nationally for scientific leadership within their field of expertise.

How can you form a task force discussing national screening mammograms for breast cancer and conceivably omit the experts of breast cancer surgeons, breast specialty radiologists and oncologists? Isn't the "field of expertise" on the table to be discussed breast cancer pickup by mammograms, hence the input of breast surgeons, radiologists and oncologists mandatory?

4. No conflict of interest: This study was conducted by the Oregon Health & Science University Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality.

How can it not be a conflict of interest to start the process with an Evidence-Based Practice Center as well as omit practicing cancer specialists from national Guidelines production on screening mammograms? It's a tad like putting the cart before the horse, isn't it?

These are questions which are basic and obvious. That they were not addressed as long ago as 1984 nor as recently as the last backlash on the USPSTF Screening Mammogram Guidelines in 2002 is asking for repeat trouble and suggestive of looking the other way on the matter with intent. Welcome to 2009 everyone. A year of great confusion, political strife, greater backlash, and bad timing with the production of USPSTF Screening Mammogram Guidelines.

Not very defensible and very predictable, 

Tender

 

mke

How about conflict of interest?  If you had a panel of radiologists and surgeons would it not be possible that there could be a real or percieved conflict of interest if they recommended more mammograms, scans, biopsies, etc?

I was puzzled by the make up of the panel at first too, but they are analyzing data from a statistical perspective.  They could only operate from published data so the personal experience of an individual participant is irrelevant.  At least that's how I understand it, but I could be wrong because I know nothing about these groups.

AnnNYC

Tender, I agree with you about having primary care physicians reviewing questions about cancer screening.  I have been shaking my head about this for two weeks -- in a certain way, I don't even think cancer screening is a "preventive service."  Recommendations about car seats, injury prevention, fall prevention, vaccination, putting babies to sleep on their backs, diet, exercise, screening for pre-diabetes and "metabolic syndrome", tuberculosis tests and other screening to prevent spread of communicable diseases...  Those things seem appropriate to the USPSTF concept -- but breast cancer detection really doesn't seem appropriate. 

I do question the whole existence of this task force, since they mostly seem to say "not enough evidence of the value of" whatever they've been assigned to study -- although given what I know about the "quality" movement, maybe the USPSTF keeps the AHRQ in check, because the "quality" movement has used testing as an indicator (or "surrogate marker") of quality of care -- which tends to lead to overtesting, thoughtless testing -- rather than actually measuring outcomes.

Breast cancer is an anomaly, as far as the USPSTF goes: the fact that it affects so many women puts it in the "public health" arena, but the complexity of its detection and treatment would seem to put it beyond the realm of the USPSTF.  The field I'm really familiar with is rheumatology/musculoskeletal disease -- it occurred to me that diseases like lupus, scleroderma, and even rheumatoid arthritis would similarly be too complex for guidelines by the USPSTF (even if they affected more people than they do) -- and in fact, when I checked, I saw that the only musculoskeletal diseases the USPSTF has commented on are back pain and osteoarthritis.

Kathy044

All I can say is that the U.S. Preventive Services Task Force got it right a lot sooner than several other groups about the risks and benefits of hormone replacement therapy at menopause back in the 1990's. I even remember claims that women were going to die from these guidelines too, or at least to die sooner. Remember?

Blundin2005

Good morning all,

Kathy044--Thanks I'll look that up.  I'm not familiar with it. 

 About the focus of the discussion on task force and their qualifications, I read Pill's post first (repeated by Tender).  I agree that there is a great deal of expertise in that list.

   Tender-did AHRQ omit bc surgeons, radiologists and oncologists or were they consulted.  My thought is that the premise to use evidence-based research is what physicians screamed to be used (it's their language) since the 80's.  It is evidenced-based (quality patient outcomes) that they argue for payment of their services http://www.uft-a.com/.  Is it possible to site unpublished or yet unproven research or even refer to it in Guidelines?  My instincts say they were consulted.

  AnnNYC-I was encouraged to read the panel focus and term limits.  I don't agree though that using evidence-based research is a mistake.  Egos aside, specialists were in the driver's seat of this health care cart for a long time now.  It was an organic movement in the industry as research money, both private and public was pumped into clinical improvements.  This brought us to these findings by the WHO in their study:

   The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th . Several small countries - San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy

The World Health Organization's ranking

of the world's health systems.  http://www.photius.com/rankings/healthranks.html

Source: WHO World Health Report - See also Spreadsheet Details (731kb)

 

The World Health Organization's ranking of the world's health systems was last produced in 2000, and the WHO no longer produces such a ranking table, because of the complexity of the task.

 

See also: Preventable Deaths By Country

See also: Healthy Life Expectancy By Country

See also: Health Performance Rank By Country

See also: Total Health Expenditure as % of GDP (2000-2005)

See also: Main Country Ranks Page

   My intuition tells me that this might be the reason for the shift in focus.  Not because the specialists didn't achieve results in some areas, but because the cost outstripped the outcomes.

   I agree fully with your rationale that guidelines may be inappropriate for illness such as breast cancer. You said, "Breast cancer is an anomaly, as far as the USPSTF goes: the fact that it affects so many women puts it in the "public health" arena, but the complexity of its detection and treatment would seem to put it beyond the realm of the USPSTF.  The field I'm really familiar with is rheumatology/musculoskeletal disease -- it occurred to me that diseases like lupus, scleroderma, and even rheumatoid arthritis would similarly be too complex for guidelines by the USPSTF (even if they affected more people than they do) -- and in fact, when I checked, I saw that the only musculoskeletal diseases the USPSTF has commented on are back pain and osteoarthritis."

  My comment is that when DRGs were implemented and insurance companies followed on the heals of Medicare's implementation, the negotiators arrived to bundle services, using clinical pathways and best practice models, then averaged costs.  This is an actuary's thinking pattern.  I understood their language and culture but it didn't speak to the real world of medicine as I understood it to be...the science AND art.

 The average approach created outliers-these outliers soon became rejection letters for services, increased administrative costs borne by the medical service providers. So prices rose in direct proportion to decrease reimbursement by insurance companies. Then they began to track "complications" or "events" to further deny payments.  It is my belief that the devil is in this detail.  

  When doctors were vilified in the mainstream press in the 80's (some were deserving) the public shifted their trust over to number crunchers and lawyers and a whole new industry grew drawing more money out and away from the delivery of care.  Their trust remained there until they realized that the responsibility of payment as well was shifted to them.  Ever so slowly over time the payment choked everyone.

  This system also created infighting between medical service providers of every type, less sharing of information and less medical services delivered to the patient.  The insurance companies leveraged that fight to their advantage (Darwin).

   The system is no different than our own bodies, interdependent, and sustained by healthy nutrition and lifestyle, thrives in security and peace--nothing less.  The current system may be in need of stents in some areas due to blockage from years of excessive diet and lifestyle, followed by a regimen of improved nutrition and respect.  And like our bodies, this process will require realignment of cells that will stress for some time.  It is what we breast cancer survivors and others facing illness, live every day of our lives, don't you agree?

Best wishes to all as always,

Marilyn 

Ps.  Sorry for the format problem.  Can someone PM me and tell me what I'm doing wrong? 

ktym

Kathy, yes I do remember. I also remember when approximately 9 years ago the Cochrane review issued the same edicts about the available evidence that resulted in recommendations for a discussion about the risk and benefits of mmg 40- 50.  None of this information about small benefit and variable quality of information is new.  Its just been interpreted differently over the years.  The explanation I got from the head of a task force yesterday regarding why they're not changing their recommendations and why they're disagreeing with the USPTF is that they want things to stay the same and "not confuse women at a time when some already aren't following the guidelines".  That's pretty paternalistic and bad reasoning IMHO.  From what I've seen, few are disputing the data USPTF used, its all in the interpretation.  I just don't see why recommending a discussion of the issue with your doctor is such a bad recommendation. They didn't say don't do it, they didn't say do it, they just said discuss it.   

Anonymous

otter - I just now saw your post a few pages back in response to my post. I am so glad you understood my point. I just wish everyone would take a few minutes and think about it. And your analogy was GREAT. Although it's sad to think that sports teams can figure out effective, proven strategy, but those who are supposedly looking out for our best and safest interests, have not. It's all about business mentality and that mentality has proven to be effective.

Blundin2005

LauraGTO - 

About the business model and analogy to a sports team--what I envisioned was the average day in the life of a group of anesthesiologist who managed 17,000 procedures/yr. 1416/month 354/week and 70/day.

The daily schedule included Preadmission evaluations, 7:30 a to 4 p surgical specialties of ENT, Neuro, Cardiac, Orthopedics, Plastics/Reconstruction, Urology, General Surgery, Gyn, high risk obstetrics, post op recovery, Level II Trauma Center, Same Day Unit, 24 hour call, documentation followups.  If they were lucky the left between 5 and 6 p, those that weren't in house for Call.  

Once I invited a member of the accounting department for a tour during working hours so that they would appreciate what I was conveying on the budget requests.  I brought info, medical records, purchasing (inventory control), admissions together in a room so each could appreciate the other's needs to resolve patient flow issues from admissions to OR....especially when same day admissions were implemented. And I didn't do this alone....I worked with physcians and nurses to meet their needs for patient care...that is why we were there.  I liked the people I worked with and I was fortunate to work with good professionals. 

Specialization is important and much appreciated...especially in and operating room. Many of our doctors were double board certified anesthesiology and....cardiac....internal medicine....pediatrics.....dental surgery.....neurology....obstetrics.....pain management.  They conferred with each other on cases.  That said, my preference is a general practitioner for a patient gate keeper to manage access to these critical resources instead of an insurance company's Medical Director.   

I watched the team work in the OR.  It was as deliberate as each step in a ballet.  They worked together like a life depended on it.

That is not to say they were all darlings or things didn't go wrong.  We are all human.  And they dealt with that too in the midst of it all.   

About the business model...GAAP apply.  Think of the revenue streams for a sports team and a hospital and then imagine how to allocate those funds.  Do you allow OB to go out of business because there weren't enough babies born that month to pay the salaries of the staff ready to receive them.  If the ratings drop in orthopedics because not enough people injured themselves this week, how do you cover the cost of services waiting.

Believe me when I tell you that it takes a lot of skill in hospital management to bring that margin close without under or over staffing and projecting for the year.  

It drains me now just to remember those days.  I noticed your post a few pages back too.  I felt the frustration come through.  I wanted to respond to tell you that I understand that frustration.  It draws my energy and thoughts back. Just to say.....

Blundin2005

http://www.ted.com/talks/rob_hopkins_transition_to_a_world_without_oil.html

We need to think out of the box. 

SandyAust

Hi Marylin I stopped contributing this thread a little while back but I have been watching with interest.  I have been waiting for a post like the one you made a few hours ago about your role as a health administrator prior to retirement.  I have made the assumption that your views have been driven by your background in the same way that you seem to have assumed (through the title of this thread)  that those who disagree with the guidelines are being overemotional, fearful and lacking in critical thinking.

 You spoke about running a hospital like it is a business, which I recognise in the US it is. However one thing that struck me is that you mentioned so many people in different roles but at no time did I see a mention of the patient.  Where is the patient in this process?  Or in more business like terms, "Where is the customer focus?"

I have stated previously that decisions of this nature invoke considerations of both the economic and social costs.  So far the debate seems to have focused primarily on the economic costs and those matters that can be measured dispassionately with numbers. It is all very well good to go on about things being "evidence-based" but how do you measure social outcomes in scientifically controlled trials?  You can break this down into deaths per thousands etc but there are some variables that cannot be measured through empirical analysis. 

When you are dealing with life and death issues and quality of life issues, the focus needs to be on more than just the numbers.  You cannot put a dollar value on a life.  You cannot put a dollar value on suffering.  All of these variables cannot be separated and measured.  It's like trying to conduct a scientifc study on whether or not we should say please when we ask for something or say thankyou when we receive it.  Morals, manners and the sanctity of human life are the things that make us truly human  The value and importance of these issues can only be determined through human interaction and debate and yes anecdotal evidence plays a role too.  This is healthy and is to be applauded not condemned.

I disagree with guidelines because I think there will be an unacceptable number of lives lost, and lives traumatised.  I believe this even in the light of the money saved.  You cannot say my view is wrong and present scientific studies to disprove it.  The whole point is that these type of issues cannot be measured only by science.  There is a human element here.  It's a hard balance to strike but in order to strike it we need the type of debate that is going on now. It is not hysterical it is essential.

One thing I also noticed about your answer to my posts previously.  The first thing you would do is acknowledge me as important, then acknowledge my views as important and then dismiss my view with a patronising little comment like "emotions need to be kept in check in a crisis" or something of that nature.  I realise that is probably a technique you have learnt in your job.  I respect that. I do however find it condescending.  I prefer to be upfront which is why I have politely stated that I do not agree with you at all.

Kind Regards,

Sandy 

Blundin2005

Good Morning All,

Sandy, Thanks so much for writing.  First I want to say that my intention was never to condescend. I agree with much of what you wrote.  The problem is my writing, how to make clear a vision that is difficult to focus.  For this reason I started with evidence-base as the foundation to a difficult topic.  I wasn't surprised by the responses.  From my view, I welcomed them.

I apologize if you were offended.  It was probably inevitable to offend someone.  It's why I stay off the opinion boards too except for recipes and topics that share previous experience to newbees of this process we all face.  

I left the work as a health care administrator for many of the reasons you mentioned.  When the system changed to consumer driven, customer focused as you said rightly, the patient became less important in the equation not more important.  The patient and public welfare are at the center of the purpose to provide these services.  Human nature what it is, these altruistic motives weren't shared by all, but by most, and the system nurtured this outcome.  When incentives shifted to profit from public service, the shift was subtle, even unnoticed for years by people unaffected or not in need of access to the health system.  When they did access it, they were in shock.

This led me to develop a patient information brochure to help patients navigate both the shock of arriving to an OR and the shock of the insurance experience that would follow.  The patients were less stressed was the outcome.  The surgeons gave it to every patient.  BTW that brochure was subpoena by a large insurance company to defend their position to a patient who sued them that they were informed how to process their insurance!  Pathetic and a desperate reach of the insurance company lawyers (IMHO).

"The Customer" model created exaggerated ego-driven competition for every resource that before was pooled and the cost was driven up to support the sport star compensation and boutique services that "the customer" demanded.  The multiple IPOs on Wall Street that resulted also contributed to the rise in cost. It was inevitable.  The problem was that there were no brakes built into these excesses that imbalance the best of intentions.  It is the same story as the fall of the financial systems.

These are topics for another thread and another day.  

A thought about the social research studies .... two came to my mind that you might find of interest.  The Division of Labor in Society by Emile Durkheim and Everything in its Path by Kai T. Erikson.  I was relieved to find this part of the equation taught in business school.  I asked the professor why society has so much difficulty if this knowledge already exists?  He answered that it takes the Will to implement the knowledge.  

Best wishes to all as always,

Marilyn 

SandyAust

Marylin you do not owe me an apology. I probably owe you one for being so honest as to be so blunt.  I also avoid the discussion boards for these reasons.  Although for some reason I have been here for a long time.

I am not American.  I state that again because it is very relevant.  However I believe these types of issues have a global reach, at least in the developed world. When you started talking about insurance, I really can't understand as our medical system is very different to that in the United States.  Both countries however offer world class treatments. Just as medical discoveries in Australia such as the H. pylori bacteria impact medical treatment around the world, changes in guidelines in the US are likely to affect guidelines in other developed countries.

You are much kinder and calmer than I could ever wish to be and I am happy to acknowledge that.  This is why I stay out of debates on this board as usual course of action.

My point however is that just because someone doesn't agree with these guidelines, it does not mean they aren't thinking critically or they are being motivated by fear.  In reality these guidelines will result in an increased loss of life.  I truly believe we all agree on that.  However balancng this there are cost savings and a reduction in stress due to unnecessary biopsies.  Understanding all of this I still believe these guidelines represent a backward step.  We already have screening at 40 and the cost and anxieties associated with it.  We have demonstrated that we can handle the costs both social and economic of the current system.  I think to have a less rigorous system is not worth the increased loss of life.  As I have said before this is a subjective decision, for everyone, values cannot be measured.

I acknowledge my views are affected by the fact that I was diagnosed young.  However I also acknowledge that I was too young for screening under the current guidelines.  One thing that does disturb is that my sister does not see the need for screening even though both her mother and sister were diagnosed under the age of 50, me at 36, mum at 49.  Despite these biases I still believe that we need to keep screening at age 40.  In Australia they actively encourage screening for women aged 50 to 69 (it may be older I would have to check), however medicare does cover screening for women aged 40 to 49.  Medicare in Australia is the national health system.

Kind Regards,

Sandy

Blundin2005

http://www.newyorker.com/talk/comment/2009/12/07/091207taco_talk_lepore

Hope this link works.  This article begins with the healthcare debate since ....1916 .....!!  

  

pip57

That was an excellent article.  Thanks.

gpawelski

The Politics of Mammograms

Rather than explaining the science behind the recommendation, the news media exploited the politics of it. The press has succeeded in sowing seeds of confusion and doubt.

"USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

According to Diana Petitti, MD, MPH, Vice Chair, USPSTF, "You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values."

According to Dr. Steve Woloshin of the Veterans Affairs Outcomes Group, "over a ten-year period, a woman age 40 to 49 has a 0.28% chance of dying of breast cancer if she goes for regular mammograms, and a 0.33% chance of dying of breast cancer if she doesn't. A 40-year-old's chance of developing breast cancer over the next decade is 1.4%, according to the National Cancer Institute.

Mammograms cut your risk of death by breast cancer by 0.5% for women over 40 who have mammograms, and 0.4% for those that do not have mammograms.

Dr. Donald Berry, head of biostatistics at the M.D. Anderson Cancer Center, calculated that a decade of mammograms for a woman in her 40's increases her lifespan by an average of 5 days.

However, these are the numbers that get lost in the media rhetoric, according to Gary Schwitzer, the dean of health care journalism. But thanks to fourty years of instilling breast cancer awareness in the minds of American women, most remain convinced that breast cancer represents a real and imminent danger.

Unfortunately, there has been a failure to recognize the difference between "cost-benefit analysis" (which focuses on costs) and "comparative effectiveness research" (which considers risks and benefits for patients, regardless of cost). The USPSTF is not charged with comparing the benefits of a treatment to the cost, its mission is to compare benefits to risks.

According to Dr. Diana Petitti, "The US Preventive Services Task Force reviewed the evidence without regards to cost, without regard to insurance, without regard to coverage."

And for the nativist out there, the Task Force is an independent panel of private sector experts in prevention and primary care, set up in 1984 by a physician then serving in the Reagan administration. The idea was to fund a group that could operate outside of government to review ongoing research and data in an effort to determine how well certain strategies to combat disease actually worked.

Obstetrician and gynecologist Dr. Peter Klatsky says, "the USPSTF is composed of physicians and scientists whose only motivation is to improve the health and wellness of women nationwide. Being invited onto the USPSTF is a huge honor. These are our best and brightest. They strive to determine what is best for our patients, our community, and our loved ones."

iodine

And exactly when has the media Ever chosen the less political aspect to any story they print/deliver?  It if bleeds, it leads.  Cry and get on camera.  They always go for the most controversial of any aspect of a story.

That's why I try to listen to the least I can that they have to say about most everything except the weather---now those folks really climax with hurricains and snow storms---they get more excited than, well, lots of partners I've seen!

Blundin2005

Iodine -- Ain't it the truth....x's 2.

Best wishes to all as always,

M 

Colette37

Is THIS the kind of "Canadian" Health care that people in the US wants HERE?

http://www.youtube.com/watch?v=q2jijuj1ysw

If I chose between this and what we have here in the US right now, I will take the US right now and leave Canada in the waiting line for the Doctor where they still are at!

konakat

Colette -- such fine journalism on this U-tube video!  I couldn't watch the whole thing it was so ridiculous.  It is 2 bozos wandering around Montreal pretty well having the same experience one would have in the US dropping into emergency or non-urgent care facilities -- yes I had experienced such waits and frustrations in the US.  If the guy booked an appt with his doctor he would get everything he needed.  It is such BS being spread around that has Canadians shaking their heads in disgust, and becoming quite fed up with Americans twisting Canadian healthcare to suit their own political agendas.  Why not post a few videos of people going bankrupt or not being able to get health care in the US, market it as the norm and then call it even.  OK?

By posting information with such poor credibility reflects badly on your own credibility.  Think about it.

Anonymous

Colette - I have seen that you tube. VERY scary indeed. I have heard that waiting in line is called the Can-Can Shuffle. And what's terribly frightening is some Cans who need treatment, have they're names put in a box. Each day four names are pulled out of the box. And those four people are phoned and told they have won the treatment lottery. And then they are awarded a Dr appointment. OH dear gawd...imagine jumping up and down, elated because you've won the treatment lottery. Sad but true. UNTIL Big Gov can develop a sensible, well-thought out system, void of the problems other countries currently face with their national health care, they need to back off and get their Pinnochio noses out it all. PERHAPS VAN JONES should advise Big Gov on this situation. After all - he was fired - but he is still on the legal, taxpaying citizen's payroll. Imagine being fired - and then continue to advise BO AND continue to be paid for it. Yikes...how sweet of a deal is that!

AGAIN - As for the "guidelines"...until a more cost effective, safe, and accurate diagnostic machine is developed...leave well enough alone. It's amazing that guideline changes are recommended, yet an effective/safe option has not been suggested. Waiting until 50 IS NOT an effective/safe option. 

mke

Laura. where do you get these stories?  Names put in a box??  Good grief.  There is no treatment lottery.

I tried to watch the video, but honestly when I got to the part where the guy was pressing the nurse to give him a glove because he wanted to make a rooster head - I quit.  What ER would take these buffoons seriously?

Everyone will believe what they have to believe but I worked in the health care business in Canada for a lot of years and I never even heard of a treatment lottery.

lewing

The title of this thread is "critical thinking not fear based," and it's intended to allow for critical/reasoned discussion of the USPSTF mammogram screening guidelines.  It's not about Canadian health care.

A constructive suggestion: could those of you who want to bash the Canadian health care system maybe start a thread clearly labeled for that purpose, so that the rest of us don't have to wade through your silliness on unrelated threads?

Linda

Anonymous

A constructive suggestion: If one doesn't want to be bashed, one shouldn't bash. lol 

Critical thinking not fear based...I'll stick to the subject. Although I do feel it is all encompassing. In the words of the ever so lovely Dr. Love: "mutilate, poison and burn to give attention to the harshness of the treatment" Talk about critical thinking and not fear. Ouchy!  

Since this topic was addressed by me at this thread, I will respond here and also share it with my fellow Americans at Shirley's thread (although the Cans have and continue to poke their runny noses in). This article is just one of several. I also saw the below taking place in a Can Med facility via a youtube. I'm trying to find it - as I'd love to share it. It showed a nurse - actually pulling names out of the box and then phoning the "WINNERS".

"In May of this year, the community of Gander, NF elected to hold a 'lottery' style selection of patients for two newly arrived Family Physicians. Although innovative, this approach is unlikely to help in solving a worsening shortage of doctors nationwide. Gander is a small rural community of approximately 10,000 residents on the northeast coast of Newfoundland, Canada. While normally highlighted by travel magazines for its rugged coastline and small-town charm, it received national attention earlier this year for an odd response to the addition of two new GP's - Dr. Amanda Scott and Dr. Celine Dawson - to their local medical clinic. The call rang out that a 'lottery' would be held, patients queued for hours, at the end 4,000 names were entered into the draw-an astounding 40% of the population. The CBC reported today that the lucky winners would be contacted, beginning Monday, while leaving 50% of those entered into the 'draw' with no GP at the end of the process."

"Canada continues to be held up as a standard of national socialized health care in the global community. It is past time that our true standard of care at least approaches our reputation for it."

http://www.digitaljournal.com/article/257099

crazy4carrots

Oh, I've wiped my nose before responding.  Yes, there have been lotteries in a few under-served communities.  Seems a lot of med school grads want to practice in big cities, and so many efforts have been made to encourage them to go to smaller communities  - my own being one.  Now we have our full quota of docs in my community.  As I understand it, even the U.S. has some underserved communities....

And you might as well stop searching for your little U-tube videos because we could come back atcha with overwhelming stories of Americans losing their homes due to healthcare costs, as well as stories of Americans whose cancers are so far advanced (because they didn't have insurance) that there is no tx available to them.  Do we think that's the norm?  No, and neither should you think lotteries in Canada are the norm.

Anonymous

There's "pros" and "cons" in every country, with every medical system, available treatment, proper staffing, etc.

However...until the majority of the "cons" are reformed and effectively working, I refuse to support change. If America is going to over haul an entire Nation's system, there needs to be reliable proof that overall, the "pros" will far outweigh the "cons". I'm simply not "hearing" that's the case. In fact...the majority of Americans feel the same way. I am not just part of a mere handful who doubt these changes...it's the MAJORITY who doubt these changes.

AnnNYC

I don't see how any "cons" can be reformed without any "change."  I think, Laura, you must have meant you refuse to support the particular changes being attempted on Capitol Hill.  But taken literally, "change" of some sort is by definition necessary to achieve a situation where "the majority of the 'cons' are reformed and effectively working."

covertanjou

As a Canadian I am getting increasingly angry at the outright lies perpetrated about our health care system.  I HAVE NEVER heard of the Can-Can shuffle.  Your ignorance of Canada is astonishing and disgusting.  Canada is a HUGE country.  It is bigger than the US and has many remote areas. In VERY remote areas it may be difficult to find a doctor.  However, that IS NOT THE NORM.  Please stop bringing up misconceptions, lies, and misinformation.  I know you will not believe that I get good care, or that Canadians get good care.  I don't care what you think, but I ask that you keep your b**lsh*t to yourself.  I am really fed up of seeing the same lies throughout this board. 

thenewme

Wow, I'm not sure how this thread got so derailed onto discussing Canada's healthcare, but for sure that Steven Crowder doesn't help any reasonable discussion about anything! For crying out loud, the guy is a comedian, according to his own "about me" section.  I agree with mke - these guys are buffoons, and I can't imagine presenting their video as anything to take seriously. 

This started out as a thought-provoking and civil discussion of differing opinions of the USPSTF recommendations, and I hope we can get back on track. 

Colette37

Ok...I can understand US women coming on these threads and talking about what is happening, but why are Canadians chiming in about something that is happening in the US and is US legislation?

Oh, and I have seen quite a few Canadians that I KNOW are Canadians critisize your health care.  Lexislove is one that I can think of off the top of my head.  My heart goes out to her because she has been waiting for breast surgery.

Laura...I have heard about those lotteries too...this video even proves it.  It is scary that there are those here in the US who wants this here!

AnnNYC...that is your point of view and you are welcome to it.

pip57

Ever watched Jay Leno's "Jaywalking"?  Or Stephen Colbert's interviews?  Or Rick Mercer interviewing Americans about their own country?  Same thing.