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#41 Fireballer

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Posted 13 September 2018 - 03:39 PM

I didnt say that, but they are costly overkill. The ER always orders at least one, even though ultrasound can make the diagnosis without radiation exposure. But truth be told, you can usually diagnose stones based on a good history, exam and urinalysis - it wouldnt surprise me if the CT was ordered before his urine was even collected.

Cloacas case is a perfect example of the problems with our healthcare system. He got an ultrasound to exclude testicular torsion (an uncommon diagnosis in middle aged men), then a CT to diagnose stones, and his urologist has suggested a second, more high tech CT to tell what type of stone. Or he doesnt even care, because more kidney stones = more urologic procedures = more $$$. And he got two prescriptions, one for an addictive pain medication which may slow stone passage, and a second which has been shown NOT to alter the natural history of the disease. https://first10em.com/meltzer-2018/

But Cloaca cant be expected to know any better, and probably thinks he received excellent care. His insurance will pay the lions share of the egregiously overpriced, largely unnecessary work up, he doesnt feel any immediate effects from the unnecessary radiation, and hell continue to take medications which arent helping the situation, all leading up to a urologic procedure(s).

Meanwhile, TBB is probably getting more appropriate care in a developing world country, and we wonder why we spend ~18% of our GDP on healthcare.

All of this 1000%. Its almost like Im talking to my buddy wh is an ER doc.

I refused a CT my last trip to the ER. And they absolutely wanted it before urinalysis. No blood in urine,no signs of infection in urine. The torodol had done its job and the stone was out of the ureter. I followed up with my doc and he gave me torodol to keep at home for the next one.

Also, the one time I took Flomax, it actually took the longest to pass the stone. Also, it gave me retrograde ejac. No good.

#42 peenie

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Posted 13 September 2018 - 03:55 PM

....yet no one wants universal healthcare. They want to keep lining the pockets of the insurance companies and doctors.


Peenie gives good thread. -MedStudent
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#43 Kanil

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Posted 13 September 2018 - 04:01 PM

. Also, it gave me retrograde ejac. No good.

 

I'm almost afraid to ask wtf that is.



#44 Fireballer

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Posted 13 September 2018 - 04:12 PM

 
I'm almost afraid to ask wtf that is.




#45 Fireballer

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Posted 13 September 2018 - 04:12 PM



#46 peenie

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Posted 13 September 2018 - 04:17 PM

He's cute

Annoying accent

Dumb clothes

But cute none the less...


Peenie gives good thread. -MedStudent
Sometimes, you really are the best poster here, Peenie. -Me_2006

#47 Cloaca du jour

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Posted 13 September 2018 - 05:36 PM

Couple things...i thought it was a torsion because my right nut was on fire...like a constant kick in the nuts. No back pain..usually associated with a kidney stone which I have had before. They were following up the torsion based on my symptoms i told them.

#48 Cloaca du jour

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Posted 13 September 2018 - 05:40 PM

You make great points pen..definately

#49 penultimatestraw

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Posted 13 September 2018 - 05:48 PM

....yet no one wants universal healthcare. They want to keep lining the pockets of the insurance companies and doctors.

I don't know that universal healthcare solves many of those problems. Our culture promotes unnecessary tests/procedures and overmedication - patients demand it, and doctors are so scared of being sued they accommodate them.

 

I think centralized healthcare is a no brainer, but also believe patients need more price transparency and some (more) financial skin in the game. The price of care is so opaque at this point most doctors and almost no patients have any idea what things cost.



#50 penultimatestraw

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Posted 13 September 2018 - 05:50 PM

Couple things...i thought it was a torsion because my right nut was on fire...like a constant kick in the nuts. No back pain..usually associated with a kidney stone which I have had before. They were following up the torsion based on my symptoms i told them.

Please don't misunderstand me; the testing may have been appropriate. I don't have all the details of your case, but know the way most (all) ERs and subspecialists work. 



#51 penultimatestraw

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Posted 13 September 2018 - 06:01 PM

All of this 1000%. Its almost like Im talking to my buddy wh is an ER doc.

I refused a CT my last trip to the ER. And they absolutely wanted it before urinalysis. No blood in urine,no signs of infection in urine. The torodol had done its job and the stone was out of the ureter. I followed up with my doc and he gave me torodol to keep at home for the next one.

Also, the one time I took Flomax, it actually took the longest to pass the stone. Also, it gave me retrograde ejac. No good.

I work as a hospitalist, so I'm often doing damage control after ER docs have ordered unnecessary tests and/or treatment. To be fair, their job is really tough, but many fall into habits which create more problems than they solve, and cost $. A good ER doc is worth her weight in gold, but in my experience maybe ~20% really try to do the right thing. Hospital admin don't like them because a stepwise, more methodical work up takes time, often conflicts with patient's expectations and slows ED throughput. Compounding matters, ED doctors don't receive enough training in outpatient medical care, so they are quick to admit people even when outpatient management will suffice. This all feeds the hospital revenue stream, where insured patients offset the financial losses caused by uninsured/underinsured people, many of whom abuse the system.



#52 titans&bucs&bearsohmy!

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Posted 13 September 2018 - 06:21 PM

I work as a hospitalist, so I'm often doing damage control after ER docs have ordered unnecessary tests and/or treatment. To be fair, their job is really tough, but many fall into habits which create more problems than they solve, and cost $. A good ER doc is worth her weight in gold, but in my experience maybe ~20% really try to do the right thing. Hospital admin don't like them because a stepwise, more methodical work up takes time, often conflicts with patient's expectations and slows ED throughput. Compounding matters, ED doctors don't receive enough training in outpatient medical care, so they are quick to admit people even when outpatient management will suffice. This all feeds the hospital revenue stream, where insured patients offset the financial losses caused by uninsured/underinsured people, many of whom abuse the system.


The problem with stepwork methodical approach in America is that generally creates multiple appointments. Often, its hard to get worked in to your doctors schedule 3-4 times. I hate being $300 and three appointments in and still not know what the problem is.

In both China and the Philippines, you just walk in to the hospital and get an answer right then generally for a fraction of the cost.

#53 The PosterFormerlyKnownAs

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Posted 13 September 2018 - 06:53 PM

Kidney stones (even much smaller than 8mm!) are so so painful. But until there is a fever or infection or stopped urination, the basic modus operandi is wait and piss it out. Perfect example of time when we need a super quick easy painkiller prescription option ... but that has more societal downside than the upside ... so a trained ER may be worth its weight in gold. Just gotta cut back on the tests that run up the bill, clog the system etc.

#54 titans&bucs&bearsohmy!

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Posted 13 September 2018 - 06:59 PM

Kidney stones (even much smaller than 8mm!) are so so painful. But until there is a fever or infection or stopped urination, the basic modus operandi is wait and piss it out. Perfect example of time when we need a super quick easy painkiller prescription option ... but that has more societal downside than the upside ... so a trained ER may be worth its weight in gold. Just gotta cut back on the tests that run up the bill, clog the system etc.


I think he said mine was less than 2mm. Ive been taking the Meds for over a month, and havent really felt anything. Although, today I am feeling a shooting pain in my groin area. Maybe its passing.

I find it odd that my urine flow was impeded by such a tiny stone. Apparently, it was though. Since Ive been taking the meds, Im p!ssing more normally. One stream instead of a shotgun dribble.

#55 penultimatestraw

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Posted 13 September 2018 - 07:46 PM

The problem with stepwork methodical approach in America is that generally creates multiple appointments. Often, its hard to get worked in to your doctors schedule 3-4 times. I hate being $300 and three appointments in and still not know what the problem is.
In both China and the Philippines, you just walk in to the hospital and get an answer right then generally for a fraction of the cost.

You touch on two problems:

1. The follow up appointments are often nonsense, as the data can be reviewed and subsequent testing be arranged over the phone. This takes time, of course, and unlike lawyers, doctors dont bill strictly based on time - I wish we did, as this would eliminate a lot of insurance issues and discourage high maintenance, hypochondriacal patients.

2. Americans are impatient, demanding results immediately, even if it doesnt meaningfully impact their care. This attitude takes away from those with truly emergent conditions, and promotes VIP care which has shown to result in worse outcomes.

#56 titans&bucs&bearsohmy!

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Posted 13 September 2018 - 10:09 PM

You touch on two problems:

1. The follow up appointments are often nonsense, as the data can be reviewed and subsequent testing be arranged over the phone. This takes time, of course, and unlike lawyers, doctors dont bill strictly based on time - I wish we did, as this would eliminate a lot of insurance issues and discourage high maintenance, hypochondriacal patients.

2. Americans are impatient, demanding results immediately, even if it doesnt meaningfully impact their care. This attitude takes away from those with truly emergent conditions, and promotes VIP care which has shown to result in worse outcomes.


Yeah. a lot of doctors like to churn appointments. One appointment where they send me to a diagnostic place for a test we both knew I was gonna need before I ever saw him. Maybe a few days to get in there. Then another for him to tell me the result and send me to a specialist. Then I wait two weeks to a month to get an appointment over there.

Seems like everywhere else Ive been, medicine is more one stop shopping. Need a test? Go over there and get it. Need a specialist? Theyre over there, go talk to one. You get answers and on to the treatment phase much faster and cheaper that way.

#57 naomi

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Posted 13 September 2018 - 11:40 PM

2. Americans are impatient, demanding results immediately, even if it doesnt meaningfully impact their care. This attitude takes away from those with truly emergent conditions, and promotes VIP care which has shown to result in worse outcomes.

 

Initially when I read this earlier (quickly) I thought it contradicted the dynamic of patients just going along with each suggested step because they don't know better (which is understandable), and doctors intentionally milking the situation as the journey unfolds.

 

But I guess you can have both happening.

 

>Our culture promotes unnecessary tests/procedures and overmedication - patients demand it, and doctors are so scared of being sued they accommodate them.

 

Which is the more prevalent dynamic? If you can discern one.. Patients going along with things out of ignorance and doctors milking, or demanding patients and doctors giving in? 



#58 penultimatestraw

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Posted 14 September 2018 - 12:23 AM

 

Initially when I read this earlier (quickly) I thought it contradicted the dynamic of patients just going along with each suggested step because they don't know better (which is understandable), and doctors intentionally milking the situation as the journey unfolds.

 

But I guess you can have both happening.

 

>Our culture promotes unnecessary tests/procedures and overmedication - patients demand it, and doctors are so scared of being sued they accommodate them.

 

Which is the more prevalent dynamic? If you can discern one.. Patients going along with things out of ignorance and doctors milking, or demanding patients and doctors giving in? 

I think excess testing is driven more by doctors, as many patients are willfully ignorant of their care. Sometimes physician's are "milking it" (particularly if the doctor owns the testing equipment) , but a lot of it is promoted by the system, especially in the hospital. Throughput is highly valued, so doctors tend to shotgun tests to get things done quickly, even if it's wasteful. And a big portion results from liability/malpractice concerns.

 

Medication is a different matter. Antibiotics, muscle relaxants, anxiolytics/sleep aids and opioid pain meds are often prescribed just to appease patients, as there is almost always an expectation that the Dr. do something rather than watchful waiting. 



#59 drobeski

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Posted 14 September 2018 - 09:26 AM

....yet no one wants universal healthcare. They want to keep lining the pockets of the insurance companies and doctors.

the sad attempt at universal healthcare by your hero did just that.

#60 naomi

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Posted 14 September 2018 - 11:55 PM

I think excess testing is driven more by doctors, as many patients are willfully ignorant of their care. Sometimes physician's are "milking it" (particularly if the doctor owns the testing equipment) , but a lot of it is promoted by the system, especially in the hospital. Throughput is highly valued, so doctors tend to shotgun tests to get things done quickly, even if it's wasteful. And a big portion results from liability/malpractice concerns.
 
Medication is a different matter. Antibiotics, muscle relaxants, anxiolytics/sleep aids and opioid pain meds are often prescribed just to appease patients, as there is almost always an expectation that the Dr. do something rather than watchful waiting. 


Got it. Thanks for the explanation :cheers:

#61 Cloaca du jour

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Posted 15 September 2018 - 04:18 AM

Regardless.. it still hurts lije hell and hasnt moved regardless of flowmaxx and drinking tons of water. The only thing that gives relief is a heating pad..or the percocet which make me tired and non functional. Missed 2 days of work. Nurse practitioner says...come back in a month..if u havent passed it we will do the lithotripsy thing

#62 Cloaca du jour

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Posted 15 September 2018 - 04:20 AM

Hospital doc said its 8mm...urologist said its 5x4mm

Have em in both kidneys...I hace no idea how I can wait a month

#63 titans&bucs&bearsohmy!

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Posted 15 September 2018 - 05:10 AM

Hospital doc said its 8mm...urologist said its 5x4mm

Have em in both kidneys...I hace no idea how I can wait a month

 

Seems to me they should blast those fockers ASAP. You have hydronephrosis too? (blocked urine flow). Mine is just on the right side. I think I may have already passed it. Had some shooting pain the other day, very briefly. Mine were supposedly tiny though.



#64 peenie

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Posted 15 September 2018 - 05:17 AM

Geez, what are you guys eating?
Peenie gives good thread. -MedStudent
Sometimes, you really are the best poster here, Peenie. -Me_2006

#65 Cloaca du jour

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Posted 15 September 2018 - 05:47 AM

No blocked urine...no painful urine..just feels like being stabbed in the back all day

#66 titans&bucs&bearsohmy!

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Posted 15 September 2018 - 06:02 AM

No blocked urine...no painful urine..just feels like being stabbed in the back all day

 

See, mine is very different I guess.

 

I went to my urologist in the states over a year ago, complaining of urinary problems. I had to pee constantly, but hardly anything came out. Had some pain in that general region. Thought it might be a holdover or reoccurrence of the hernia I had had a year before. His lazy ass did nothing. Prodded me a little, said there is no hernia, and gave me a script for flomax.

 

Flomax did nothing to help, and I stopped taking it. Just figured it was a getting older thing. Then, I had my annual health check for my chinkland visa. It indicated I had a kidney stone, and hydronephrosis. Went to a doc in the phils over the summer, he confirmed after a CT, and put me on some pills. When I finish those, I'll go have another ultrasound or CT, and see if its gone. I am peeing better though. I've also made a point to drink water like there's no tomorrow, maybe thats helped.



#67 trumpurethra

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Posted 15 September 2018 - 06:52 AM

Nice but as stated above, sh!t is no joke. Had a few friends go down because of perco. Had one buddy shootin up within a year after getting the scrip. No idea what he doing now, hope he made it out the other side, this was some 20++ years ago.

 

Watch that stuff man.



#68 penultimatestraw

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Posted 16 September 2018 - 01:01 AM

Hospital doc said its 8mm...urologist said its 5x4mm

Have em in both kidneys...I hace no idea how I can wait a month

This is an important distinction...~2/3 of stones 5mm or less pass on their own, while less than half between 5 and 10mm do. 10mm mandates a procedure, while anything less is watchful waiting if you aren't infected, obstructed or experiencing unrelenting pain. The stones in the kidneys are less important than the ones which have migrated to your ureters, the plumbing which connects from your kidneys to your bladder. The latter cause pain and can ob struct the flow of urine.



#69 penultimatestraw

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Posted 16 September 2018 - 01:40 AM

Nice but as stated above, sh!t is no joke. Had a few friends go down because of perco. Had one buddy shootin up within a year after getting the scrip. No idea what he doing now, hope he made it out the other side, this was some 20++ years ago.

 

Watch that stuff man.

Most people who take opioids don't become addicts, but they certainly have potential for abuse. Moreover, they aren't the preferred analgesic for stones - NSAIDS like ibuprofen, naproxen and Toradol are. On top of everything else, opioids may slow the passage of stones.



#70 penultimatestraw

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Posted 16 September 2018 - 01:43 AM

Geez, what are you guys eating?

This is why he needs to know what type of stone, as some (most?) can be prevented with dietary changes.