Bike Forums

Bike Forums (https://www.bikeforums.net/forum.php)
-   Road Cycling (https://www.bikeforums.net/forumdisplay.php?f=41)
-   -   Addiction LXXVIII (https://www.bikeforums.net/showthread.php?t=1197210)

Heathpack 04-12-20 03:09 PM


Originally Posted by Velo Vol (Post 21413936)
It's raining.

I shall not be riding.


https://cimg6.ibsrv.net/gimg/bikefor...a1d881943b.png

I rode. It did not rain.

Heathpack 04-12-20 03:22 PM


Originally Posted by datlas (Post 21413980)
I am going to get on my high horse. JUST for a minute.

One of the reasons why I am close to walking away from medicine is the vast majority of patients want/need/like TESTS. They do NOT trust the doctor's judgment. It's incredibly frustrating for me, but this is my age showing.

Classic example:

A newly turned 50 year old male comes in to see me. Says he wants to get his heart "checked" including an EKG and a stress test, since he has friends that have had heart attacks and stents etc. I ask him about any symptoms? No, doc, I just ran a 10K and did really well. His heart and lung exam are fine. His BP is normal, he is a nonsmoker and cholesterol numbers are not ideal but acceptable.

He does NOT need a stress test. OR an EKG even. However, if I tell him this, he will be very angry. Even if I explain that tests like these will NOT predict who will have a heart attack in the future. He KNOWS he needs to get this done.

His identical twin brother goes to a NP, not a doctor. Asks for the same thing, of course the noctor says "yes" because nurses care more than doctors. Guy goes to cardiologist, gets EKG, heart monitor test, echocardiogram, and nuclear treadmill test. Oh, and to be safe a check on his carotid arteries. The whole pricetag for this workup is about $8,000, but it's covered by insurance. Everything looks ok.

The twin is very happy and satisfied that he got a 100% clear bill of health from the cardiologist. He thinks his brother needs to stop seeing me and see his NP instead.

Everyone is happy. The cardiologist made a lot of $$$, the patient was reassured, and the NP saw the patient in 5 minutes, while I spent 30 minutes trying to explain to the patient why he does not need all the testing etc.

This is part (only part) of why our healthcare system is really good and a terrible rip-off when it comes to value.

/end rant

Lol my clients don’t want to run tests, they want me to make my best guess from the clinical symptoms, I spend a hour fully discussing all the drawbacks to guessing in the absence of tests, and they think fair recompense for that should be around $85. Oh yeah, and can you call and go through all that with my brother, because I neglected to tell you this isn’t even my dog.

kidding/not kidding

PS I am old school too. I like tests when they make a difference to what I’m gonna do. I don’t like tests when they don’t change what I’m going to do, put my patients at risk and cost a lot of money. I get frequent referrals “for an MRI”. Um, yeah. An MRI is indeed indicated to diagnose the patients condition. But the patient is an 18 year old Pekingese who has been in heart failure three times in the past 6 months. And we need to anesthesize him to do an MRI. How about we think twice about anesthetizing that dog at all? Let alone to diagnose a brain tumor which would require surgery or radiation therapy to treat, neither of which is practical in a dog with severe heart disease (due to the need for more anesthesia), not to mention is not curative. Oh yeah. And pretty darn expensive.

MoAlpha 04-12-20 03:28 PM


Originally Posted by phrantic09 (Post 21414594)
replaced with provider capitated risk arrangements? Bundles? Mix of both?

I donít know. I am not very well informed, but I have heard arguments and experience for and against. Itís also itís easy for me to say, working in an economically unconstrained setting. All I know is that the perverse incentive to over-test and over-treat has to be removed. Another related beneficial effect of capitation-based systems is price transparency.

MoAlpha 04-12-20 03:31 PM


Originally Posted by Heathpack (Post 21414611)
Lol my clients donít want to run tests, they want me to make my best guess from the clinical symptoms, I spend a hour fully discussing all the drawbacks to guessing in the absence of tests, and they think fair recompense for that should be around $85. Oh yeah, and can you call and go through all that with my brother, because I neglected to tell you this isnít even my dog.

kidding/not kidding

PS I am old school too. I like tests when they make a difference to what Iím gonna do. I donít like tests when they donít change what Iím going to do, put my patients at risk and cost a lot of money. I get frequent referrals ďfor an MRIĒ. Um, yeah. An MRI is indeed indicated to diagnose the patients condition. But the patient is an 18 year old Pekingese who has been in heart failure three times in the past 6 months. And we need to anesthesize him to do an MRI. How about we think twice about anesthetizing that dog at all? Let alone to diagnose a brain tumor which would require surgery or radiation therapy to treat, neither of which is practical in a dog with severe heart disease (due to the need for more anesthesia), not to mention is not curative. Oh yeah. And pretty darn expensive.

You operate in a real market! Think it would work for humans if everyone started the game with enough chips?

Heathpack 04-12-20 03:32 PM


Originally Posted by datlas (Post 21414589)
Hey Heathpack in spite of the rip-off price we are considering letting Heidi go to USC. We have never even been to Southern California.

Any comments?

Itís a great school adjacent to a dicey area. If sheís interested in film though youíve got to argue that LA is the place to be.

LA is full of cool interesting stuff, sheíd meet a lot of unique people, and the weather is great.

It would be pretty tempting to go for it.

Velo Vol 04-12-20 03:40 PM


Originally Posted by Pirkaus (Post 21414583)
Duh! Dogs of course.

Goats make funny noises, though.

Originally Posted by MoAlpha (Post 21414590)
Fee for service has got to go and no one should be allowed to graduate from medical school without demonstrating a basic understanding of statistics, particularly Bayesian ones.

???

How is this a problem?


Originally Posted by Heathpack (Post 21414596)
I rode. It did not rain.

UPDATE:


https://cimg1.ibsrv.net/gimg/bikefor...e36c56175.jpeg

big john 04-12-20 03:42 PM


Originally Posted by ls01 (Post 21414545)
So are you out now or just on a break?

I've been out 1 year this month. My smog license and ASE certs are all expiring. If I ever go back it will be out of desperation.

sfrider 04-12-20 03:45 PM


Originally Posted by datlas (Post 21414302)
I think I finally solved my pump problems: Kuwahara Hirame head plus Lezne CNC pump.

Thank you! I have a Lezyne CNC pump but absolutely hate the stock head. Ordered the Hirame...

datlas 04-12-20 03:48 PM


Originally Posted by sfrider (Post 21414641)
Thank you! I have a Lezyne CNC pump but absolutely hate the stock head. Ordered the Hirame...

Youíre welcome. The internet says you need a clamp but mine worked fine without.

MoAlpha 04-12-20 03:51 PM


Originally Posted by Velo Vol (Post 21414635)

How is this a problem?

A lot of docs are shockingly poor at evaluating facts and prone to follow recipes mindlessly or fall victim to biases.

LAJ 04-12-20 03:52 PM


Originally Posted by Velo Vol (Post 21414551)
Mini survey

Which is a better animal to own: goats or dogs?

Silly mouse with sillier questions.

Heathpack 04-12-20 03:52 PM


Originally Posted by MoAlpha (Post 21414621)
You operate in a real market! Think it would work for humans if everyone started the game with enough chips?

Im not sure what youíre asking.

The thing that makes what I do an no-go for humans, I think, is that thereís some things that we donít treat at all due to costs but we have the option for euthanasia, or sending to a GP who might be able to do something with lesser expertise, or maybe cutting corners that really shouldnít be cut. Thereís not tons of that in Neuro because almost nobody besides a neurologist feels ok about treating Neuro cases.

But some things should really not be done in a general practice setting. A dog with a hemoabdomen from a ruptured splenic mass for example- that dog benefits from the ability to cross match, from having whole blood on hand for a transfusion, from pressor drugs and the expertise in using them, from 24 hr icu care, from a surgeon who can dog that surgery fast. Some GP vets have all those things, but most donít.

So itís really expensive to do those cases right, but if owners canít afford it, we in specialized vet med can euthanize or try to stabilize and send to a cheaper place and hope for the best. We (as boarded specialists) are ethically/legally held to a higher standard of care so we canít really just do less ourselves (well we can but thereís serious limits).

What do you do if thatís your cousin Joe with that hemoabdomen and he doesnít have the $7000-$10000 on hand at that exact moment to pay out of pocket (yeah thatís about what it would cost, and the owners likely will have had no forwarding of a problem)? You canít euthanize Cousin Joe. And you canít send him somewhere to get lower quality care at a cheaper price. So the vet med model doesnít really work for humans. Maybe you could take some elements of it and apply it to human medical care.

Plus I cannot tell you how much time is spent in our practice talking about money. Maybe 15% of the time? Itís not a very good use of a medical professionalís time actually. But I do need to be personally involved in it, because if people canít afford option A, Ive got to have a back and forth conversation with them about the alternatives and what that would cost and so on.

kissTheApex 04-12-20 03:58 PM

seedsbelize

I’ve read “On the Beach” based on your mention a couple of weeks back. It is definitely an interesting book and like you said, “fitting to the times”... Thanks

Heathpack 04-12-20 04:04 PM

I came here to post about my ride.

I wanted to do a long one but my legs were tired from yesterday’s kinda hard ride. So a la bigjohn I decided to ride to Acton.

This is a maybe 27 mile slight uphill ride and then a 27 mile slight down hill coming back. Normally it’s a headwind out/tailwind back but today the weather pattern was reverse. You could realistically do an pretty steady effort both out and back.

I never get assigned from coach the long zone 2 ride but I have heard LAJ kvetch about them, so I figured here was my chance to see what was up with that. Now cycling wise, I don’t find LAJ to be a complainer but how hard could a zone 2 ride be?

I spent 2:15ish pedaling constantly (pretty much) in zone 2 going out. Jeez why was that so hard. I was really happy when I got there, and took a little socially distant break on the side of the road eating my raisins.

Then back at it going home into that headwind. Another hour of steady zone 2, wow this is tiring!

Thankfully I got a flat when I got back into town. Too tired to really investigate and I didn’t bother to take my sunglasses off so I neglected to realize my tire was cut, I just saw a drop of sealant and thought I might be able to limp it home by putting more air in the tire. “Limping it home” was a valid excuse for respite from the endless zone 2 pedaling. I had to stop and top off my tire twice more and finally called for a pick up 30 min later.

So the moral of the story is: yes a long constant zone 2 effort is weirdly taxing in a way that it logically seems like it shouldn’t be.

Bah Humbug 04-12-20 04:05 PM


Originally Posted by MoAlpha (Post 21414590)
Fee for service has got to go and no one should be allowed to graduate from medical school without demonstrating a basic understanding of statistics, particularly Bayesian ones.

We really should push everyone to learn statistics instead of shoving everyone towards calculus, which is almost useless for most people. I took AP stats in high school, which was one of the biggest and best in CT, and the teacher didn't even understand it. Now here I know people who don't understand that you can in fact draw conclusions about huge populations from a sample of 5000, if it's well-selected. He just refuses to believe it, and simultaneously says he's a "numbers guy".

Not surprisingly, he also doesn't understand the concept of flattening the curve. And still calls himself a "numbers guy".

Trsnrtr 04-12-20 04:18 PM


Originally Posted by MoAlpha (Post 21414463)
I took about 25 min of incoming, mid ride. Extra hardass points.

:thumb: Those are the ones we remember. Kudos.

LAJ 04-12-20 04:36 PM


Originally Posted by Heathpack (Post 21414675)
I came here to post about my ride.

I wanted to do a long one but my legs were tired from yesterdayís kinda hard ride. So a la bigjohn I decided to ride to Acton.

This is a maybe 27 mile slight uphill ride and then a 27 mile slight down hill coming back. Normally itís a headwind out/tailwind back but today the weather pattern was reverse. You could realistically do an pretty steady effort both out and back.

I never get assigned from coach the long zone 2 ride but I have heard LAJ kvetch about them, so I figured here was my chance to see what was up with that. Now cycling wise, I donít find LAJ to be a complainer but how hard could a zone 2 ride be?

I spent 2:15ish pedaling constantly (pretty much) in zone 2 going out. Jeez why was that so hard. I was really happy when I got there, and took a little socially distant break on the side of the road eating my raisins.

Then back at it going home into that headwind. Another hour of steady zone 2, wow this is tiring!

Thankfully I got a flat when I got back into town. Too tired to really investigate and I didnít bother to take my sunglasses off so I neglected to realize my tire was cut, I just saw a drop of sealant and thought I might be able to limp it home by putting more air in the tire. ďLimping it homeĒ was a valid excuse for respite from the endless zone 2 pedaling. I had to stop and top off my tire twice more and finally called for a pick up 30 min later.

So the moral of the story is: yes a long constant zone 2 effort is weirdly taxing in a way that it logically seems like it shouldnít be.


I'm sorry about the flat, but it sounds like it was opportune, in a sense. Nice ride, regardless!

Like you say, how hard can 71% be? When you don't coast, hard as hell. I have stages of endurance rides.

Stage 1. My legs are tired from the last week of on the bike work, and I have no idea if I can get 4.5-5 hours out of them.

Stage 2. In the groove. Heck, I can hammer this out with energy to spare. Only 3 hours to go.

Stage 3. 1.5 hours of this garbage left? Holy crap. I wonder if Mrs. LAJ can find me in the middle of this hell, if I were to give her a call.

Sage 4. I got this. Only 45 minutes to go. Who put this hill here?

big john 04-12-20 05:08 PM


Originally Posted by Heathpack (Post 21414675)
I came here to post about my ride.

I wanted to do a long one but my legs were tired from yesterdayís kinda hard ride. So a la bigjohn I decided to ride to Acton.

That ride can vary so much depending on the wind. You are exposed to it more than on some rides where you get a respite because of hills or turns. My friend lives in Canyon Country and he is good at reading the wind predictions by the hour because they do tend to switch direction mid day.

Sorry about the tire.

MoAlpha 04-12-20 05:16 PM


Originally Posted by Bah Humbug (Post 21414676)
We really should push everyone to learn statistics instead of shoving everyone towards calculus, which is almost useless for most people. I took AP stats in high school, which was one of the biggest and best in CT, and the teacher didn't even understand it. Now here I know people who don't understand that you can in fact draw conclusions about huge populations from a sample of 5000, if it's well-selected. He just refuses to believe it, and simultaneously says he's a "numbers guy".

Not surprisingly, he also doesn't understand the concept of flattening the curve. And still calls himself a "numbers guy".

Agree. Most people live by their biases and ****ty intuitions and failure to understand probability is almost universal. Daniel Kahneman got a Nobel prize for showing what hard wired dopes we are. Stats is a way of and seeing the world as it actually is and those who learn and practice it come out way ahead. I suck at the mechanics, but I do understand the principles.

datlas 04-12-20 05:20 PM


Originally Posted by MoAlpha (Post 21414774)
Agree. Most people live by their biases and ****ty intuitions and failure to understand probability is almost universal. Daniel Kahneman got a Nobel prize for showing what hard wired dopes we are. Stats is a way of and seeing the world as it actually is and those who learn and practice it come out way ahead. I suck at the mechanics, but I do understand the principles.

You mean I should not follow my gut???

:innocent:

sfrider 04-12-20 05:50 PM

All this trainer riding has been great for my power numbers, but not having done anything much over 2 hours for a while really has me worried about my endurance. Planning to do 65 hilly miles tomorrow...

MoAlpha 04-12-20 05:59 PM


Originally Posted by datlas (Post 21414783)
You mean I should not follow my gut???

:innocent:

You donít have a gut, flaco. I have heard that the three most dangerous words in medicine are, ďin my experience.Ē

Bah Humbug 04-12-20 06:00 PM


Originally Posted by datlas (Post 21414783)
You mean I should not follow my gut???

:innocent:

What gut, beanpole?

MoAlpha 04-12-20 06:11 PM


Originally Posted by Heathpack (Post 21414656)
Im not sure what youíre asking.

The thing that makes what I do an no-go for humans, I think, is that thereís some things that we donít treat at all due to costs but we have the option for euthanasia, or sending to a GP who might be able to do something with lesser expertise, or maybe cutting corners that really shouldnít be cut. Thereís not tons of that in Neuro because almost nobody besides a neurologist feels ok about treating Neuro cases.

But some things should really not be done in a general practice setting. A dog with a hemoabdomen from a ruptured splenic mass for example- that dog benefits from the ability to cross match, from having whole blood on hand for a transfusion, from pressor drugs and the expertise in using them, from 24 hr icu care, from a surgeon who can dog that surgery fast. Some GP vets have all those things, but most donít.

So itís really expensive to do those cases right, but if owners canít afford it, we in specialized vet med can euthanize or try to stabilize and send to a cheaper place and hope for the best. We (as boarded specialists) are ethically/legally held to a higher standard of care so we canít really just do less ourselves (well we can but thereís serious limits).

What do you do if thatís your cousin Joe with that hemoabdomen and he doesnít have the $7000-$10000 on hand at that exact moment to pay out of pocket (yeah thatís about what it would cost, and the owners likely will have had no forwarding of a problem)? You canít euthanize Cousin Joe. And you canít send him somewhere to get lower quality care at a cheaper price. So the vet med model doesnít really work for humans. Maybe you could take some elements of it and apply it to human medical care.

Plus I cannot tell you how much time is spent in our practice talking about money. Maybe 15% of the time? Itís not a very good use of a medical professionalís time actually. But I do need to be personally involved in it, because if people canít afford option A, Ive got to have a back and forth conversation with them about the alternatives and what that would cost and so on.

Oh, it was just a provocative question. As you know, the orthodox conservative critique of the US health care system is that government intervention and lack of competition have destroyed the market for care and that restoration of personal responsibility, competition, and transparency will drive prices down to the point where care will be affordable. I always thought that concept was a bit like the market for veterinary care.

Of course, even Friedrich Hayek thought health care should be govít subsidized.

Sorry. No more politics.

Heathpack 04-12-20 06:27 PM

Omg I am so hungry.

Glazed ham is out of the oven, resting.

Scalloped potatoes are in the oven, cooking.

Biscuit dough ingredients are ready to go.

House smells really good.

I am drinking a glass of wine, as an apertif.


All times are GMT -6. The time now is 01:56 AM.


Copyright © 2024 MH Sub I, LLC dba Internet Brands. All rights reserved. Use of this site indicates your consent to the Terms of Use.