Public reporting? I applaud making treatment outcomes public to help patients understand differences between hospitals. Here's another one needed - in California, the state medical board keeps complaints, investigations and settled malpractice claims confidential. What's the good reason why that's done? Other than the fact that too many doctors don't like anyone to know their conduct led to their being second-guessed or subject to regulartory oversight.

Risk assessments for treatment? That makes sense though it might suck to be on the wrong side of such a decision. Someone we know has a condition that's expected to be fatal within 6 months. Her life might be extendable if a possible surgical procedure were performed but her doctor (at a top medical school) told her that other problems she has makes her a very high risk case and so puts her into a very low priority position on the queue. She's unlikely to be treated. Yes, that sucks, but it makes sense and she (and her family) understand.

Too many doctors are unwilling to accept our mortality.

Every time I see the politicians get talking about people on disability and getting help via other safety net programs, I know they clearly don’t have a clue as to what these people are dealing with or how little they are getting - like these programs are somehow easy to get approval for and even when they do get SSI it’s a fraction of what the rest of us would need to cover shelter and food, let alone save any for the future needs that will only get more expensive.

Doctors have student loans to repay and we need more people to go into the profession, but our system is screwy and it’s going to get a whole lot worse before anything changes for the better. If it ever does. I guess if people die faster that would save money but is that the system we want? I certainly don’t.

"Doctors have student loans to repay"

So what? So too do many who complete undergrad and graduate studies of any kind.

In my area, student loans are minuscule compared to the size of mortgage loans, or even compared to things like practice purchase costs for young dentists that most physicians don't incur. The student loans get paid in good time by docs. The cost of their education is the purchase price for a career of good earnings. It's nothing anyone should give them sympathy for.

"Here's another one needed - in California, the state medical board keeps complaints, investigations and settled malpractice claims confidential."

I had NO idea they were doing this. If you search for a doctor, it says "no records" in the areas where they would report these things. I assumed this meant there were no complaints, etc. I'll bet a lot of other people make this same assumption.

Here's another one for you... In CA, the veterinary medical board no longer publishes information about where veterinarians went to school. It used to be that, when you looked up a license, it would list this information. This has not been the case for a few years now. In the past, you could tell if a veterinarian had gone to UC Davis, that newer school in Pomona (that, imo, is substandard and doesn't even have a teaching hospital), gone to school somewhere in the Caribbean, in India, etc. It's like they're hiding the information now. My thinking is that this is not accidental. I suspect that Banfield had something to do with this, as they have been doing everything within their power to build their influence (including over the veterinary board in CA) and they were highly involved in opening the school in Pomona and they also import quite a few veterinarians from other countries (or who have gone to schools that many consumers would find less desirable when looking for a veterinarian) to work in their clinics (as most veterinarians refuse to work for them).

It's all very manipulative, I think.

I was disappointed to find that the vet I loved had sold his practice and retired not long before our last visit. He was a treasure, the new vet...not so much.

Given how many doctors we’re needing I guess we’re not supposed to complain.

"Medicine" has evolved from what was (naively) a generally respected *profession*. It's now a more obvious business -- at least in the US. I don't think some of the profit aspects are so new, but the realization of them is growing. Today medical services and products are competing with one another exactly like non-medical services and products -- and advertising just like every other commercial enterprise. How uniquely American!

It's not uniquely American from my knowledge and exposure to health care systems and providers in several Commonwealth and Western European countries, all of which have one or two tiered universal coverage but competition among providers all the same.

Well, it tells you something when a hospital games the numbers by treating only the healthiest patients. It means if you are refused care there, you may be in trouble.

Informed decision making is only fair when you are facing bankruptcy to get care.

All the advertising really irritates me. I wish we'd pass some laws that prohibit, or at least severely restrict, this. They're spending a lot of money on advertising.

Kaiser is especially bad with all their ads. They're everywhere...billboards, radio, tv commercial after commercial... Multiple hospitals around here are also doing a lot of advertising. Some of the most disturbing advertising is by drug companies, especially the ads promoting chemotherapy drugs to people with terminal cancer (telling them how they can extend their lives a little with this or that drug). I find those particular ads stomach churning and I write to every drug manufacturer who does this to tell them how reprehensible I find their behavior. In the past, excessive advertising (pretty much anything more than a tasteful yellow pages ad) was considered unethical. There seems to be a huge lack of ethics these days.

Imo, all this advertising money...it's money that should be spent on patient care, either providing better care or reducing the cost of care (or the cost to buy the actual insurance).

Without ads or data on health outcomes, how will we know which to go to? The ads for pharmaceuticals and medical issues specialty firms are currently litigating are mixed with those HSUS ads - I hate all of those, the HSUS only uses one half of one percent of their funds for helping those puppies and kittens in their ads, they don’t operate a shelter and that guy Pacelle gives me the creeps.

You know more about the state of 'medicine' in other countries, Elmer. I appreciate the correction. So...we aren't the only economy balanced on consumer spending, including for medical 'care'?

Jenn: Could we keep this conversation focused on human beings? If you want to discuss animal welfare, maybe you'd start a new thread?

It can be difficult to 'rate' the dozens of services a hospital conglomerate provides. Also, focusing on "Patient Outcomes" is as prone to variables as "Student Achievement" in schools (or percentages of college *admittance* (not success, just 'in the door'). Both depend a lot on who comes in the door, in what state of background and ability to contribute to their healing/learning.

An egregious example of medicine for profit is the Cancer Treatment Centers of America. Like charter schools, they cherry-pick who they accept. At least they have been required to announce in their ads that not everyone will have the same success they brag about.

CTCA ads bother me too, because I can’t help but wonder what about all the people who can’t afford them, how many die because they aren’t the ‘right type’ of patients but still these are human lives - people with families who miss them!

"Without ads or data on health outcomes, how will we know which to go to?"

The ads are manipulative and do not provide anyone with any information they need to choose which insurance plan to buy, which hospital to go to, or which drug is best for them. Do you really believe, for example, all those Kaiser ads talking about how you'll "thrive" with them? It's just a bunch of manipulative garbage.

The health outcome data is also not actually helpful. Some of the best surgeons have, on paper, the worst set of overall patient outcomes. But, this is because they are treating patients who are more sick, plus, they are the surgeons who are actually willing to treat these sorts of patients vs cherry picking patients who are almost guaranteed to have good outcomes. The data do not actually support the conclusions that are drawn from them.

I should have specified that I was being facetious.

Data looked at with consideration to the factors you mentioned can help the person who has the time to do all of that.