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The Importance of Getting a Second Opinion, and a Third.

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  • The Importance of Getting a Second Opinion, and a Third.

    Our US healthcare system is based on a fee-for-service payment model where services and procedures are paid for separately by the patient's insurer, or the patient themself, often both. This model gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. There is not much room, if any room at all, in the model for practicing preventative care which brings little to no revenue into the institutions.,

    Doctors are closely judged by the medical groups they are affiliated with. The receive frequent "report cards" with Relative Value Units (RVU). It's based not so much on quality but rather how much revenue they can generate for their institution by performing procedures and services. The less revenue a doctor generates the more likely they may not have longevity with their institution. Sometimes procedures like stenting, bypass, left atrial appengade occlusion, ablation, catheterizations, MRI's, which are huge sources of revenue, are recommended to patients but they are not always justified.

    I think most institutions are pretty ethical, but sometimes they are not. Moral of story: Seek a second and third opinion anytime a provider recommends a high price, expensive and sometimes risky service or procedure.

    Here is a story in Milwaukee where the desire for profit got in the way of prudent medical judgement. Both the doctor, his superiors and his institution were named in a criminal case. It's a long read, but a fascinating one.

    "Medical College of Wisconsin knew doctor was accused of performing unnecessary surgery"

  • #2
    Unfortunately it is way too common. And we ( the IS federal CMS) created that environment with fee-for-service.


    • #3
      This is long, but very good I think. Older people really don't need to lower their cholesterol.....second half of the video.


      • #4
        David Diamond's videos are a bit myopic for my taste. Yes, not all people need to lower their cholesterol, but yet there are certain groups that do need cholesterol lowering. He unfortunately gets into statin-bashing all too often and his message gets lost.

        There is another side to his argument and that is the pleiotropic effects of statins. Irrespective of lowering cholesterol, the right statin can lower arterial inflammation, improve endothelial function, stabilize plaque making it less vulnerable to rupture, along with a number of benefits. Statins are not for everyone but they do offer benefit for many people.



        • #5
          Hello, I've been recently diagnosed with heart disease. Very good cardiac surgeon analysed the tests, liked him very credible. But agree with the subject topic, think it's important to get a second opinion. Less on the diagnostic itself, more on the way forward. Have been watching Dr Brewster's videos, they strike a chord.

          But, beside that his practice isn't taking new clients, it would be quite far away, as I'm in Sydney, Australia. Was wondering if anyone could recommend a professional that follows a similar line in my neck of the woods.

          Thank you


        • #6
          I have been thoroughly impressed by the many presentations of Drs Paul Mason and Doron Sher. If I lived in Sydney, I'd get their opinions on how to treat my heart disease and change my lifestyle.


          • #7
            Yes. I think they are related to the Low Carb Down Under series. It's good. I was just asking the question re: how much salt for low carb. There is a great video on it here.