[threethirtytwo]

Malpractice is deliberate harm by not following standard professional practices or doing deliberate harm.

I’m not talking about that. What I’m talking about is fucking simple. A doctor gives you advice and you pay him thousands for it. That advice is completely fucking wrong.

In what universe does that payment make sense? In what universe is giving wrong information deserving of thousands of dollars of payment for services rendered. It’s bloody simple: it’s not deserved and a refund is in order.

[nradov]

You're generally paying for time and materials, not results. This is common practice in many industries, not just healthcare, so your rhetorical question is silly and displays deep ignorance about how the system works. If you want to pay for results only then you're free to negotiate a cash payment contract with your healthcare providers on that basis. No one is stopping you from doing that so let's not have any lame responses claiming that the system is conspiring against you or something.

[threethirtytwo]

You have got to be kidding me. No one on the face of the earth wants to pay a doctor for time. They want to pay for results.

Nobody is going to pay thousands of dollars for shitty advice or treatments that can potentially kill you... are you kidding me? What human will happily dish out thousands of dollars just to give "time" to the doctor for wrong advice. That has got to be a joke.

>If you want to pay for results only then you're free to negotiate a cash payment contract with your healthcare providers on that basis.

It needs to be law to make it on this basis. Every patient would demand this. The only person who wouldn't demand this is a doctor who's "time" doesn't provide results.

What's going on here is the patient has nowhere else to turn. If every doctor negotiates on "time" and the legal system is set up this way, what other choice does the patient have then to gamble thousands on something that won't work?

Let me explain it to you plainly. The system is set up this way so patients are indoctrinated to accept unfair treatment. They can even be aware of flaws in the system but they still have to accept it because the behavior is so wide spread.

It's similar to North Korea. If everyone in north korea stood up to Kim Jong Un, the sheer number of people getting screwed over vs. people in power is so overwhelming the government would topple immediately. But the system is pervasive. And that is the medical system in the US: Pervasive and systemic. And it goes deeper than just the unreliability of doctors here.

I WANT to negotiate based on results... but thanks to the cartel-like policies of the medical system all together, I can't. Ask any patient... EVERY patient wants this, but none of them can do it. Same as your average north korean... they don't want to starve under an unreasonable regime, but they have no choice.

You may not have realized it but your last sentence was a slip up... Your initial sentences was an attempt to justify time based payment by comparing and contrasting to other occupations like lawyers... but in your last sentence you were essentially (and likely accidentally) telling me to suck it up because I have no choice. That was not something any patient wants to hear.

[nradov]

You seem to be unclear on the basics of how this works. There's no need for any new laws. If you want to negotiate a value-based care agreement with a healthcare provider instead of paying on a fee-for-service basis then you're free to do so. Existing laws allow for that.

As for your absurd assertions about what every patient wants, you're just lying and making things up. Many patients (like me) don't want that or have no strong preference at all. Your comparison to North Korea is just deranged and bears no relationship to objective reality.

[threethirtytwo]

There's a need for law.

The fact nobody negotiates for results based treatment is similar to how everyone really needs insurance to afford medical treatments. It's not law to have medical insurance but basically everyone needs it regardless. The problem is systemic. It's not purely related to law. Side effects and incentives stemming both from law and outside of law force things to be this way.

Stop manipulating the conversation this way. You know what I mean. Any sane person pays for results, not for time and garbage results.

>As for your absurd assertions about what every patient wants, you're just lying and making things up. Many patients (like me) don't want that or have no strong preference at all. Your comparison to North Korea is just deranged and bears no relationship to objective reality.

No it's not a lie. It's obvious to anyone reading. I'm so confident about it that I'll even say you're lying about what you want.

You don't want to pay a doctor thousands of dollars for his time and wrong advice that can potentially kill you. No patient wants this. 800,000 patients per year die or are seriously injured from misdiagnosis. Every single one of those patients wants there money back. That is objectively reality. You're not stupid. You're not delusional. So you know this. At this point you're just arguing and lying.

>Your comparison to North Korea is just deranged and bears no relationship to objective reality.

800,000 patients injured/dead from misdiagnosis. 300,000k of that is deaths. That's equivalent to mass slaughter. One of these persons is my brother, imagine if it was yours.

It's not deranged. You're deranged for thinking it's NOT. The comparison is not only relevant as an analogy but relevant in degree of severity.

[nradov]

You seem to be assuming that a different payment model would reduce diagnostic errors. There is no evidence for that. Anything related to biology is necessarily probabilistic and highly error prone. Some care quality improvements are certainly possible but those aren't necessarily tied to payment models. It's more important to focus on evidence-based clinical practice guidelines.

[threethirtytwo]

>You seem to be assuming that a different payment model would reduce diagnostic errors.

No. The payment model should change to be fair, I never said the payment reduces diagnostic errors. The patient should be informed about the probabilistic nature of the diagnosis. A contract (not in fine print) to protect the doctor from lawsuits from misdiagnosis should be signed by the patient to reflect this. Then the payment should be Heavily reduced to reflect the unreliability of the diagnosis. By heavily I mean becoming a doctor should not be a profession that is associated with extreme wealth because the unreliability of their diagnosis/treatment does not convey that level of value.

>Some care quality improvements are certainly possible but those aren't necessarily tied to payment models.

I don't think it's "some" quality improvements. The US has some of the worst outcomes in the 1st world in terms of quality of care. There are massive improvements that can be made here.

>It's more important to focus on evidence-based clinical practice guidelines.

Agreed, and until the evidence, clinical practice guidelines and effectiveness of doctors rises to the level of significant reliability, both payment and respect should be adjusted to reflect the current level of low reliability.