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(Reuters)   Bad news: you have colon cancer. Good news: you get surgery to remove it. Worse news: New data shows only 38% of U.S. hospitals do recommended post surgery tests to make sure you're cancer-free   (reuters.com) divider line 65
    More: Asinine  
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1958 clicks; posted to Main » on 09 Sep 2008 at 8:55 PM (6 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2008-09-09 07:16:38 PM
Best healthcare in the world, baby
 
2008-09-09 07:42:35 PM
Thank you mainstream media for putting us in panic mode yet again with a one-sided argument that not all physicians agree with.

Link (new window)
 
2008-09-09 07:55:08 PM
Well of course they don't do follow up tests, they're a pain in the ass.
 
2008-09-09 08:30:29 PM
Even worse news: with part of colon removed, intestinal explosion ensues.
 
2008-09-09 08:59:41 PM
;

Yep, still works!
 
2008-09-09 09:01:10 PM
mikemoto: Even worse news: with part of colon removed, intestinal explosion ensues.

Isn't that like SHC?
 
2008-09-09 09:01:57 PM
Cagey B: Well of course they don't do follow up tests, they're a pain in the ass.

I was gonna write something, but this is better
 
2008-09-09 09:02:48 PM
So, go to a hospital that's qualified.

Q.E.D.

38% isn't bad. How many hospitals are even equipped to do the surgery? How many can do heart surgery, or neurosurgery? How many have proper diagnostics? We have something like 40 hospitals within an hour drive of my house, not counting UofM's massive resources, and not counting the many specialists offices (many of them equipped for diagnostics or surgery). It's not hard to pick the best hospital for the specific care regime you need. Got cancer? Two minutes online will probably give you a multitude of good choices that will work with your health care provider.

Seriously, this is just another "everybody panic!" story that ignores practical reality.
 
2008-09-09 09:03:10 PM
They don't tell you about an almost certain death within a couple of years from the same colon cancer spread to lungs & liver. You might earn some time by buying the treatment, but odds are it's not going to be what you'll call quality time.
 
2008-09-09 09:05:20 PM
Saying the NCI recommends something and saying studies have shown significantly better outcomes are 2 different things. While there may be an obvious gain to looking at more lymph nodes, which is detecting spread with more sensitivity, there may be a cost not mentioned by or known to the authors, which may be beyond costs and physicians' time.
 
2008-09-09 09:07:32 PM
Please correct my latter use of "costs" to "financial costs." Sorry for the ambiguity.
 
2008-09-09 09:10:19 PM
Doesn't matter.
It goes from your colon to your liver, and then you really are arse-farked.

Ballgame.
 
2008-09-09 09:10:44 PM
They like to outsource the colon checking these days.

i25.photobucket.com
 
2008-09-09 09:16:22 PM
When will people learn that hospitals are run as a business with a bottom line? They will try and make the most money they can off the most profitable procedures. That is their goal.

There are alot of people in the medical field who want to help others who are suffering. I am not talking about them. But the bottom line for hospitals is how much they have left over once the patient leaves.
 
2008-09-09 09:19:10 PM
Bad news: you have colon cancer.
Good news: you get surgery to remove it.
Worse news: New data shows only 38% of U.S. hospitals do recommended post surgery tests to make sure you're cancer-free
Good news: you win the lottery
Bad news: you only have three weeks to live
Good news: a doctor in Mexico has found an herbal cure for cancer
Bad news: It's fake and you lose all of your lottery winnings
Good news: That girl you had a crush on tells you she's secretly had a crush on you and will make you happy for your remaining time
Bad news: she's a dude
Good news: you don't care
Bad news: you get AIDS
 
2008-09-09 09:22:26 PM
12.fl.oz.: When will people learn that hospitals are run as a business with a bottom line? They will try and make the most money they can off the most profitable procedures. That is their goal.

There are alot of people in the medical field who want to help others who are suffering. I am not talking about them. But the bottom line for hospitals is how much they have left over once the patient leaves.


Talk to the doctors, it's their call. They get paid the same to run a half-assed test as they do to run a proper one. Remember the line from Office Space?

"It's a problem of motivation, all right? Now if I work my ass off and Initech ships a few extra units, I don't see another dime; so where's the motivation?"
 
2008-09-09 09:23:23 PM
soooooooooo.


A surgeon opens you up and finds a well contained colon carcinoma that hasn't penetrated through the musculara mucosa. We will stage our imaginary tumor at O or 1. The guy has a 90-95% survival chance at that point. Our surgeon then dutifully biopsy's 8 regional nodes and calls it a day.

has he failed at providing adequate medical care?

fat chance. But according to the NCI "benchmark" he has.

don't panic.
 
2008-09-09 09:24:22 PM
That's sh*tty.

/sorry
 
2008-09-09 09:32:59 PM
tortilla burger: Cagey B: Well of course they don't do follow up tests, they're a pain in the ass.

I was gonna write something, but this is better


THIS
 
2008-09-09 09:36:18 PM
Health care in this country is a sham and makes us look like a third-world country. Hey, I know! Let's not do anything about it. Or let's pretend to do something about it that's nothing but a sad joke, like HSAs.

/don't forget to tip your HMO lobbyist on your way out
 
2008-09-09 09:36:35 PM
beaverfetus: soooooooooo.


A surgeon opens you up and finds a well contained colon carcinoma that hasn't penetrated through the musculara mucosa. We will stage our imaginary tumor at O or 1. The guy has a 90-95% survival chance at that point. Our surgeon then dutifully biopsy's 8 regional nodes and calls it a day.

has he failed at providing adequate medical care?

fat chance. But according to the NCI "benchmark" he has.

don't panic.


i know you meant "succeeded" not "failed".

you are right. however, it is also true that cancer treatment and followup is not anywhere near as consistent as it should be.

for a rare cancer like my wife has (LMS), and sarcomas in general, it seems like substandard treatment is pretty common. the first-tier oncologists just don't see enough of it to really know. even if it's better with more common cancers, it doesn't make me feel comfortable.

i have no idea how we compare to other countries in this. i suspect they don't do better, and it's got nothing to do with private vs universal health care, and much more to do with general wealth levels and size of the health care system.

all i know is we can do better. western medicine needs patient advocates for anything that is serious and/or rare.
 
2008-09-09 09:37:40 PM
Man up and perform your own colon screening.

And for fark's sake, if your a feminist and peeved about manning up, then woman up and get a man to check your colon for you.
 
2008-09-09 09:38:12 PM
I wonder how many people say "well... I can't afford it" and see what happens
 
2008-09-09 09:41:50 PM
sseye: for a rare cancer like my wife has (LMS), and sarcomas in general, it seems like substandard treatment is pretty common. the first-tier oncologists just don't see enough of it to really know. even if it's better with more common cancers, it doesn't make me feel comfortable.

good luck to you and your wife
 
2008-09-09 09:45:05 PM
Hehe. Asinine.
 
2008-09-09 09:46:25 PM
MadAsshatter: 12.fl.oz.: When will people learn that hospitals are run as a business with a bottom line? They will try and make the most money they can off the most profitable procedures. That is their goal.

There are alot of people in the medical field who want to help others who are suffering. I am not talking about them. But the bottom line for hospitals is how much they have left over once the patient leaves.

Talk to the doctors, it's their call. They get paid the same to run a half-assed test as they do to run a proper one. Remember the line from Office Space?

"It's a problem of motivation, all right? Now if I work my ass off and Initech ships a few extra units, I don't see another dime; so where's the motivation?"


To be honest I am just spouting off here. No offense to you. We just went through an ER visit that sent my wife home when she should have been admitted. She has a blood disorder.
 
2008-09-09 09:48:16 PM
Interestingly greenlight. I have been of the impression that overly grim stories don't get greenlit.

/attending two funerals in the next month
//colon cancer victims, one aged 58
///not really amused
 
2008-09-09 09:48:16 PM
My FIL didn't even get the check in the first place, when he was complaining symptoms at the hospital. They just sent him home.

A few months later he found out he has colon cancer.
 
2008-09-09 09:52:40 PM
This headline makes me cry. Subby needs some colon surgery of his own.

/And semi-colon surgery
//And m-dash surgery
 
2008-09-09 09:54:13 PM
beaverfetus:
good luck to you and your wife


thanks. i'm afraid we're well past any luck at this stage - no metastasis, but highly probable incurable recurrence - though we can't say with 100% certainty for another week or so.

i'm still an optimist - i think the glass is half empty, but since it might be half full of piss - half full, half empty, it's a toss-up as to which is better. (never wish for other people's problems)

but i sympathize with doctors the more i experience this shiat. half the horror stories you hear about health insurance and doctors deal with people who were just irresponsible with getting and maintaining health care, or doctors who were making educated guesses when that's all there is to do and getting that odd patient who just can't accept reality. of course, responsible poor people don't make sympathetic stories as much as irresponsible middle class ones, so that's what the press does. and no one sees "crazy patient" as a compelling story even though i've seen quite a few, having spent much time in hospitals.

there are exceptions, and sarcoma care, as a category, is a good example.
 
2008-09-09 09:55:00 PM
I think the article is oversimplifying things when they say checking 12 lymph nodes implies your cancer-free whereas checking 6 means your a ticking time bomb about to explode in a spontaneous fiery cancerous explosion any minute.
 
2008-09-09 09:59:40 PM
hogans: ;

Yep, still works!


OMG, call a doctor! That's only a semi-colon!11
 
2008-09-09 10:04:52 PM
beaverfetus: soooooooooo.


A surgeon opens you up and finds a well contained colon carcinoma that hasn't penetrated through the musculara mucosa. We will stage our imaginary tumor at O or 1. The guy has a 90-95% survival chance at that point. Our surgeon then dutifully biopsy's 8 regional nodes and calls it a day.

has he failed at providing adequate medical care?

fat chance. But according to the NCI "benchmark" he has.

don't panic.


Sounds like an informed comment- thanks.
 
2008-09-09 10:06:11 PM
Dad-in-law had colon cancer removed, and they kept checking his blood for the CA cancer enzyme. He was in single digits for about a year, but they didn't catch it when the CA shot up to 26. And so he died.
 
2008-09-09 10:14:23 PM
Tune in next week when the alarmists let us know that pharmacists make mistakes 50% of the time. By putting in an extra pill. Or something.
 
2008-09-09 10:15:36 PM
DrForrester Health care in this country is a sham and makes us look like a third-world country. Hey, I know! Let's not do anything about it. Or let's pretend to do something about it that's nothing but a sad joke, like HSAs.

/don't forget to tip your HMO lobbyist on your way out


Well, the NCI and its recommendations are part of the health care system in the U.S. So the system as a whole gets credit for improving QA in cancer care.


sseye: for a rare cancer like my wife has (LMS), and sarcomas in general, it seems like substandard treatment is pretty common. the first-tier oncologists just don't see enough of it to really know. even if it's better with more common cancers, it doesn't make me feel comfortable.

If the first-tier oncologist don't really know what to do, then the treatment is not "substandard." The outcomes may be poor because the state of the art is not yet advanced enough to achieve good outcomes, but that's not the same as substandard. The standard itself is currently unsatisfying.


As for the "tests to make sure you're cancer-free" what happens is this: the surgeon performs the operation and submits the specimen(s) to the surgical pathologist. The surgical pathologist examines the specimen and produces the final pathology report. This includes an assessment of the lymph nodes: the total number submitted and the total number that contained any cancer. It is up to the surgeon to submit a proper specimen, and it's up to the pathologist to mash the fat thoroughly enough to find a sufficient number of lymph nodes. There is no other special test that has to be run, so it has nothing to do with the hospital trying to save money. If anything, they'd be MAKING money by adding some other test.
 
2008-09-09 10:17:30 PM
Bad news: you have colon cancer. Good news: you get surgery to remove it. Worse news: New data shows only 38% of U.S. hospitals do recommended post surgery tests to make sure you're cancer-free

Good news: It's a suppository.
 
2008-09-09 10:26:51 PM
shanrick: Bad news: you get AIDS

Golf clap. :)
 
2008-09-09 10:27:58 PM
Is this supposed to be a "Our-health-care-system-sucks" article?

What chance do you think you have for a successful follow-up diagnosis in the world of socialized medicine, when they're all free...and whenever they get around to actually doing it?
 
2008-09-09 10:40:39 PM
but i poop from there
 
2008-09-09 10:43:57 PM
RESULTS: Hospitals with the highest proportions of patients with examination of 12 or more lymph nodes tended to treat lower-risk patients and had substantially higher procedure volumes. After adjusting for these and other factors, there remained no statistically significant relationship between hospital lymph node examination rates and survival after surgery (adjusted hazard ratio, highest vs lowest hospital quartile, 0.95; 95% confidence interval, 0.88-1.03). Although the 4 hospital groups varied widely in the number of lymph nodes examined, they were equally likely to find node-positive tumors and had very similar overall unadjusted rates of adjuvant chemotherapy (26% vs 25%, highest vs lowest hospital quartile). CONCLUSIONS: The number of lymph nodes hospitals examine following colectomy for colon cancer is not associated with staging, use of adjuvant chemotherapy, or patient survival. Efforts by payers and professional organizations to increase node examination rates may have limited value as a public health intervention.

Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O, Birkmeyer JD. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA. 2007 Nov 14;298(18):2149-54
 
2008-09-09 10:53:04 PM
Hey, if you do the tests, you might cut down on future profit for the hospital. There's no money to be made in actually curing problems.
 
2008-09-09 11:30:46 PM
Ender's: Best healthcare in the world, baby

Well, 37th best anyway.
 
2008-09-09 11:54:45 PM
Many of these "benchmarks" are based on consensus of a group of academic experts who have not touched a real patient, had their hand wrapped around a cancerous colon, looked at a chest X-ray, seen a person having a heart attack... etc. for years. They became academics because of the modern American aphorism, "those who can do, those who can't teach." Then, those who can't teach get into a higher ivory tower and hand down "guidelines" that may or may not help anyone.

Hospitals expend enormous amounts of money tracking these benchmarks, because they don't get paid if they don't meet them. Therefore guidelines with no scientific foundation become the "standard of care." Doctors get sued when they fail to meet the "standard of care," even if it's not a proven standard. The experts that wrote the guidelines will come and testify in malpractice court about what they believe and how many experts agreed on the standard, and the doctor is hung. Plus, the hospital doesn't get paid, so they get all up in the doctor's shizz to make sure they get paid.

/it's a mess
//won't get better without a revolution
///more government is not the answer
////current system is not either
//slashies because I am confused and frustrated with our system
 
2008-09-10 12:06:57 AM
"Duke's sucks"

medicos will get it.
 
2008-09-10 12:15:47 AM
Boo. (but well played)
 
2008-09-10 12:17:05 AM
How do you have repeat customers if you cure it?
 
2008-09-10 12:17:23 AM
threads like this make me sad at how uninformed the general public is re: healthcare.

our oncology research and treatments are among the best in the world. anybody who states otherwise is a flat out liar or ignoramus. and if you want to gripe that we can't currently cure all types of cancer, you might as well also biatch and moan that we can't prolong life to age 250 since that's about how intelligent you sound.

people act like physicians have all the answers to medical problems but are keeping them secret so that they can profit or something.
 
2008-09-10 12:19:40 AM
Ric Romero reports that people with cancer should use due diligence when selecting a doctor and treatment. Look the shiat up. There is no reason not to.

/cancer survivor
//only realized certain things were chemo-specific, yet treatable, side-effects by looking the shiat up
///likes hot oncology nurses
 
2008-09-10 12:25:17 AM
thegreatmurgatroid: our oncology research and treatments are among the best in the world. anybody who states otherwise is a flat out liar or ignoramus

Um, I don't know that I've ever posted this before...but...

this.

If I'm going to have cancer (again), let me have it in the U.S. The treatment and research is bar none; even if you are poor. Yes, even poor people get cancer treatment.
 
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