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OT: in favour of gradualism

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  OT: in favour of gradualism bill.sloman@ieee.org - 2017-02-03 03:39 -0800
    Re: OT: in favour of gradualism Winfield Hill <hill@rowland.harvard.edu> - 2017-02-03 04:21 -0800
      Re: OT: in favour of gradualism bill.sloman@ieee.org - 2017-02-03 04:57 -0800
        Re: OT: in favour of gradualism Jon Elson <elson@pico-systems.com> - 2017-02-03 11:38 -0600
          Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-04 07:21 -0800
            Re: OT: in favour of gradualism krw@notreal.com - 2017-02-04 10:42 -0500
              Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-04 08:15 -0800
                Re: OT: in favour of gradualism krw@notreal.com - 2017-02-04 11:36 -0500
                  Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-04 09:40 -0800
                    Re: OT: in favour of gradualism krw@notreal.com - 2017-02-04 13:52 -0500
                      Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-04 11:50 -0800
                        Re: OT: in favour of gradualism krw@notreal.com - 2017-02-04 20:31 -0500
              Re: OT: in favour of gradualism Jon Elson <elson@pico-systems.com> - 2017-02-04 18:04 -0600
                Re: OT: in favour of gradualism krw@notreal.com - 2017-02-04 20:33 -0500
      Re: OT: in favour of gradualism jurb6006@gmail.com - 2017-02-03 05:00 -0800
        Re: OT: in favour of gradualism bill.sloman@ieee.org - 2017-02-03 09:03 -0800
      Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-03 09:35 -0700
        Re: OT: in favour of gradualism bill.sloman@ieee.org - 2017-02-03 09:10 -0800
        Re: OT: in favour of gradualism tabbypurr@gmail.com - 2017-02-03 17:18 -0800
        Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-04 07:24 -0800
          Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 12:34 -0700
            Re: OT: in favour of gradualism tabbypurr@gmail.com - 2017-02-04 12:04 -0800
            Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-04 12:07 -0800
              Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 14:15 -0700
                Re: OT: in favour of gradualism John Larkin <jjlarkin@highlandtechnology.com> - 2017-02-04 14:02 -0800
                  Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 15:19 -0700
                    Re: OT: in favour of gradualism "tom" <tmiller11147@verizon.net> - 2017-02-04 17:36 -0500
                      Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 15:46 -0700
                        Re: OT: in favour of gradualism Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-02-04 14:56 -0800
                          Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 16:17 -0700
                        Re: OT: in favour of gradualism "tom" <tmiller11147@verizon.net> - 2017-02-04 18:22 -0500
                          Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 16:55 -0700
                          Re: OT: in favour of gradualism John Robertson <spam@flippers.com> - 2017-02-04 18:22 -0800
                            Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 21:26 -0700
                  Re: OT: in favour of gradualism "tom" <tmiller11147@verizon.net> - 2017-02-04 17:35 -0500
                    Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 15:44 -0700
                      Re: OT: in favour of gradualism "dcaster@krl.org" <dcaster@krl.org> - 2017-02-04 17:42 -0800
                      Re: OT: in favour of gradualism krw@notreal.com - 2017-02-04 20:56 -0500
                Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-05 08:14 -0800
                  Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-05 11:56 -0700
                    Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-06 14:35 -0800
                      Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-06 16:43 -0700
                        Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-06 17:12 -0800
                          Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-06 18:59 -0700
                            Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-07 07:40 -0800
                          Re: OT: in favour of gradualism tabbypurr@gmail.com - 2017-02-07 12:16 -0800
                      Re: OT: in favour of gradualism krw@notreal.com - 2017-02-06 21:11 -0500
                  Re: OT: in favour of gradualism tabbypurr@gmail.com - 2017-02-05 12:43 -0800
            Re: OT: in favour of gradualism krw@notreal.com - 2017-02-04 20:42 -0500
        Re: OT: in favour of gradualism John Larkin <jjlarkin@highlandtechnology.com> - 2017-02-04 10:05 -0800
          Re: OT: in favour of gradualism Joerg <news@analogconsultants.com> - 2017-02-04 10:24 -0800
          Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 12:45 -0700
            Re: OT: in favour of gradualism "dcaster@krl.org" <dcaster@krl.org> - 2017-02-04 17:54 -0800
              Re: OT: in favour of gradualism Don Y <blockedofcourse@foo.invalid> - 2017-02-04 21:45 -0700

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#445922 — OT: in favour of gradualism

Atul Gawande has written another impressive piece for the New Yorker

http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care

It is mainly a plea for better primary-care medicine - what your own doctor does for you at your local practice - but it includes a reference to the 1967 collapse of the Silver Bridge across the Ohio River, which was due to a failure in inspection and maintenance, making the point that while doing heroic operations and building new bridges are both extremely glamorous, the cost-benefit analysis says that it's better to spend time on making sure that what's working stays working, and perhaps improve it a bit from time to time. Development rather than a new design from scratch.

-- 
Bill Sloman, Sydney

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#445926

bill.sloman@ieee.org wrote...
>
> Atul Gawande has written another impressive piece for the New Yorker
>http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care
>
> It is mainly a plea for better primary-care medicine - what your
> own doctor does for you at your local practice - but it includes
> a reference to the 1967 collapse of the Silver Bridge across the
> Ohio River, which was due to a failure in inspection and maintenance,
> making the point that while doing heroic operations and building
> new bridges are both extremely glamorous, the cost-benefit analysis
> says that it's better to spend time on making sure that what's
> working stays working, and perhaps improve it a bit from time to
> time.  Development rather than a new design from scratch.

 Would that we could snap our fingers and get a doctor like that.


-- 
 Thanks,
    - Win

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#445927

On Friday, February 3, 2017 at 11:21:27 PM UTC+11, Winfield Hill wrote:
> bill.sloman@ieee.org wrote...
> >
> > Atul Gawande has written another impressive piece for the New Yorker
> >http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care
> >
> > It is mainly a plea for better primary-care medicine - what your
> > own doctor does for you at your local practice - but it includes
> > a reference to the 1967 collapse of the Silver Bridge across the
> > Ohio River, which was due to a failure in inspection and maintenance,
> > making the point that while doing heroic operations and building
> > new bridges are both extremely glamorous, the cost-benefit analysis
> > says that it's better to spend time on making sure that what's
> > working stays working, and perhaps improve it a bit from time to
> > time.  Development rather than a new design from scratch.
> 
>  Would that we could snap our fingers and get a doctor like that.

Cultivate your medical friends. They know who is good - though it would be unethical of them to say so explicitly. The English formulation was "You'll get on with him (or her)". The Australian formulation was a lot more direct - but we had known that particular medical friend for a very long time.

-- 
Bill Sloman, Sydney

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#445978

bill.sloman@ieee.org wrote:


> Cultivate your medical friends. They know who is good - though it would be
> unethical of them to say so explicitly. The English formulation was
> "You'll get on with him (or her)". The Australian formulation was a lot
> more direct - but we had known that particular medical friend for a very
> long time.
> 
No, all of our doctors were quite happy to recommend others.  We got a 
recommendation for a pediatrician who was decidedly "old school" from my 
wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when 
our earlier pediatrician said "Oh, they all get that" when we had a kid who 
had persistent ear infections.  Like the car dealer who says "Oh, they all 
make that noise."  The Dr. recommended by her doctor jumped right on it, and 
figured out **I** was a staph carrier and was infecting the whole family.

So, while doctors might be careful not to bad-mouth other doctors by name, 
they will happily tell you who they think are good.

Jon

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#446087

On 2017-02-03 09:38, Jon Elson wrote:
> bill.sloman@ieee.org wrote:
>
>
>> Cultivate your medical friends. They know who is good - though it would be
>> unethical of them to say so explicitly. The English formulation was
>> "You'll get on with him (or her)". The Australian formulation was a lot
>> more direct - but we had known that particular medical friend for a very
>> long time.
>>
> No, all of our doctors were quite happy to recommend others.  We got a
> recommendation for a pediatrician who was decidedly "old school" from my
> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
> our earlier pediatrician said "Oh, they all get that" when we had a kid who
> had persistent ear infections.  Like the car dealer who says "Oh, they all
> make that noise."  The Dr. recommended by her doctor jumped right on it, and
> figured out **I** was a staph carrier and was infecting the whole family.
>
> So, while doctors might be careful not to bad-mouth other doctors by name,
> they will happily tell you who they think are good.
>

Around here they usually don't. When our dentist closed his practice for 
health and age reasons nobody there would give us a clear 
recommendation. We had to do the long slog through reviews and asking 
people, like usual.

-- 
Regards, Joerg

http://www.analogconsultants.com/

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#446094

On Sat, 04 Feb 2017 07:21:37 -0800, Joerg <news@analogconsultants.com>
wrote:

>On 2017-02-03 09:38, Jon Elson wrote:
>> bill.sloman@ieee.org wrote:
>>
>>
>>> Cultivate your medical friends. They know who is good - though it would be
>>> unethical of them to say so explicitly. The English formulation was
>>> "You'll get on with him (or her)". The Australian formulation was a lot
>>> more direct - but we had known that particular medical friend for a very
>>> long time.
>>>
>> No, all of our doctors were quite happy to recommend others.  We got a
>> recommendation for a pediatrician who was decidedly "old school" from my
>> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
>> our earlier pediatrician said "Oh, they all get that" when we had a kid who
>> had persistent ear infections.  Like the car dealer who says "Oh, they all
>> make that noise."  The Dr. recommended by her doctor jumped right on it, and
>> figured out **I** was a staph carrier and was infecting the whole family.
>>
>> So, while doctors might be careful not to bad-mouth other doctors by name,
>> they will happily tell you who they think are good.
>>
>
>Around here they usually don't. When our dentist closed his practice for 
>health and age reasons nobody there would give us a clear 
>recommendation. We had to do the long slog through reviews and asking 
>people, like usual.

I think there is a big difference.  Doctors will recommend doctors in
other specialties but usually not in their own.  My family doctor
recommended many others to me (cardiologist, orthopedist,
rheumatologist, etc.) but when he changed his practice to concierge
medicine, he didn't give recommendations to all of his patients to go
to someone else.  This may have been seen as a conflict of interest.

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#446102

On 2017-02-04 07:42, krw@notreal.com wrote:
> On Sat, 04 Feb 2017 07:21:37 -0800, Joerg <news@analogconsultants.com>
> wrote:
>
>> On 2017-02-03 09:38, Jon Elson wrote:
>>> bill.sloman@ieee.org wrote:
>>>
>>>
>>>> Cultivate your medical friends. They know who is good - though it would be
>>>> unethical of them to say so explicitly. The English formulation was
>>>> "You'll get on with him (or her)". The Australian formulation was a lot
>>>> more direct - but we had known that particular medical friend for a very
>>>> long time.
>>>>
>>> No, all of our doctors were quite happy to recommend others.  We got a
>>> recommendation for a pediatrician who was decidedly "old school" from my
>>> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
>>> our earlier pediatrician said "Oh, they all get that" when we had a kid who
>>> had persistent ear infections.  Like the car dealer who says "Oh, they all
>>> make that noise."  The Dr. recommended by her doctor jumped right on it, and
>>> figured out **I** was a staph carrier and was infecting the whole family.
>>>
>>> So, while doctors might be careful not to bad-mouth other doctors by name,
>>> they will happily tell you who they think are good.
>>>
>>
>> Around here they usually don't. When our dentist closed his practice for
>> health and age reasons nobody there would give us a clear
>> recommendation. We had to do the long slog through reviews and asking
>> people, like usual.
>
> I think there is a big difference.  Doctors will recommend doctors in
> other specialties but usually not in their own.  My family doctor
> recommended many others to me (cardiologist, orthopedist,
> rheumatologist, etc.) but when he changed his practice to concierge
> medicine, he didn't give recommendations to all of his patients to go
> to someone else.  This may have been seen as a conflict of interest.
>

Ok, but when they clearly shut down their office in order to retire, 
what's the point? I am now at a stage myself where I gradually begin to 
slow down my consulting so I have more time for volunteering, cycling, 
brewing and so on. I helped some clients find suitable other engineers, 
either as consultants or employees (sometimes conducting interviews).

-- 
Regards, Joerg

http://www.analogconsultants.com/

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#446105

On Sat, 04 Feb 2017 08:15:37 -0800, Joerg <news@analogconsultants.com>
wrote:

>On 2017-02-04 07:42, krw@notreal.com wrote:
>> On Sat, 04 Feb 2017 07:21:37 -0800, Joerg <news@analogconsultants.com>
>> wrote:
>>
>>> On 2017-02-03 09:38, Jon Elson wrote:
>>>> bill.sloman@ieee.org wrote:
>>>>
>>>>
>>>>> Cultivate your medical friends. They know who is good - though it would be
>>>>> unethical of them to say so explicitly. The English formulation was
>>>>> "You'll get on with him (or her)". The Australian formulation was a lot
>>>>> more direct - but we had known that particular medical friend for a very
>>>>> long time.
>>>>>
>>>> No, all of our doctors were quite happy to recommend others.  We got a
>>>> recommendation for a pediatrician who was decidedly "old school" from my
>>>> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
>>>> our earlier pediatrician said "Oh, they all get that" when we had a kid who
>>>> had persistent ear infections.  Like the car dealer who says "Oh, they all
>>>> make that noise."  The Dr. recommended by her doctor jumped right on it, and
>>>> figured out **I** was a staph carrier and was infecting the whole family.
>>>>
>>>> So, while doctors might be careful not to bad-mouth other doctors by name,
>>>> they will happily tell you who they think are good.
>>>>
>>>
>>> Around here they usually don't. When our dentist closed his practice for
>>> health and age reasons nobody there would give us a clear
>>> recommendation. We had to do the long slog through reviews and asking
>>> people, like usual.
>>
>> I think there is a big difference.  Doctors will recommend doctors in
>> other specialties but usually not in their own.  My family doctor
>> recommended many others to me (cardiologist, orthopedist,
>> rheumatologist, etc.) but when he changed his practice to concierge
>> medicine, he didn't give recommendations to all of his patients to go
>> to someone else.  This may have been seen as a conflict of interest.
>>
>
>Ok, but when they clearly shut down their office in order to retire, 
>what's the point? I am now at a stage myself where I gradually begin to 
>slow down my consulting so I have more time for volunteering, cycling, 
>brewing and so on. I helped some clients find suitable other engineers, 
>either as consultants or employees (sometimes conducting interviews).

Unless they sell their practice to another doctor, suggesting that
they go to some _one_ else suggests a kick-back.  My doctor going
concierge is essentially the same thing.  Very few of his patients
will follow.  We would have if we could (insurance).

Medical practice is quite different than engineering consulting.

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#446115

On 2017-02-04 08:36, krw@notreal.com wrote:
> On Sat, 04 Feb 2017 08:15:37 -0800, Joerg <news@analogconsultants.com>
> wrote:
>
>> On 2017-02-04 07:42, krw@notreal.com wrote:
>>> On Sat, 04 Feb 2017 07:21:37 -0800, Joerg <news@analogconsultants.com>
>>> wrote:
>>>
>>>> On 2017-02-03 09:38, Jon Elson wrote:
>>>>> bill.sloman@ieee.org wrote:
>>>>>
>>>>>
>>>>>> Cultivate your medical friends. They know who is good - though it would be
>>>>>> unethical of them to say so explicitly. The English formulation was
>>>>>> "You'll get on with him (or her)". The Australian formulation was a lot
>>>>>> more direct - but we had known that particular medical friend for a very
>>>>>> long time.
>>>>>>
>>>>> No, all of our doctors were quite happy to recommend others.  We got a
>>>>> recommendation for a pediatrician who was decidedly "old school" from my
>>>>> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
>>>>> our earlier pediatrician said "Oh, they all get that" when we had a kid who
>>>>> had persistent ear infections.  Like the car dealer who says "Oh, they all
>>>>> make that noise."  The Dr. recommended by her doctor jumped right on it, and
>>>>> figured out **I** was a staph carrier and was infecting the whole family.
>>>>>
>>>>> So, while doctors might be careful not to bad-mouth other doctors by name,
>>>>> they will happily tell you who they think are good.
>>>>>
>>>>
>>>> Around here they usually don't. When our dentist closed his practice for
>>>> health and age reasons nobody there would give us a clear
>>>> recommendation. We had to do the long slog through reviews and asking
>>>> people, like usual.
>>>
>>> I think there is a big difference.  Doctors will recommend doctors in
>>> other specialties but usually not in their own.  My family doctor
>>> recommended many others to me (cardiologist, orthopedist,
>>> rheumatologist, etc.) but when he changed his practice to concierge
>>> medicine, he didn't give recommendations to all of his patients to go
>>> to someone else.  This may have been seen as a conflict of interest.
>>>
>>
>> Ok, but when they clearly shut down their office in order to retire,
>> what's the point? I am now at a stage myself where I gradually begin to
>> slow down my consulting so I have more time for volunteering, cycling,
>> brewing and so on. I helped some clients find suitable other engineers,
>> either as consultants or employees (sometimes conducting interviews).
>
> Unless they sell their practice to another doctor, suggesting that
> they go to some _one_ else suggests a kick-back.


They did not sell but closed down. These guys would never do the 
kick-back thing, we know the family quite well.


>                                             ... My doctor going
> concierge is essentially the same thing.  Very few of his patients
> will follow.  We would have if we could (insurance).
>
> Medical practice is quite different than engineering consulting.
>

It shouldn't be. Let's see what the next health law will bring. I sure 
hope they follow through with health savings (we already have that) and, 
therefore, more transparency WRT to billing. Tort law reform would be 
nice now that the Dems are out but I still doubt it's going to happen.

-- 
Regards, Joerg

http://www.analogconsultants.com/

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#446133

On Sat, 04 Feb 2017 09:40:20 -0800, Joerg <news@analogconsultants.com>
wrote:

>On 2017-02-04 08:36, krw@notreal.com wrote:
>> On Sat, 04 Feb 2017 08:15:37 -0800, Joerg <news@analogconsultants.com>
>> wrote:
>>
>>> On 2017-02-04 07:42, krw@notreal.com wrote:
>>>> On Sat, 04 Feb 2017 07:21:37 -0800, Joerg <news@analogconsultants.com>
>>>> wrote:
>>>>
>>>>> On 2017-02-03 09:38, Jon Elson wrote:
>>>>>> bill.sloman@ieee.org wrote:
>>>>>>
>>>>>>
>>>>>>> Cultivate your medical friends. They know who is good - though it would be
>>>>>>> unethical of them to say so explicitly. The English formulation was
>>>>>>> "You'll get on with him (or her)". The Australian formulation was a lot
>>>>>>> more direct - but we had known that particular medical friend for a very
>>>>>>> long time.
>>>>>>>
>>>>>> No, all of our doctors were quite happy to recommend others.  We got a
>>>>>> recommendation for a pediatrician who was decidedly "old school" from my
>>>>>> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
>>>>>> our earlier pediatrician said "Oh, they all get that" when we had a kid who
>>>>>> had persistent ear infections.  Like the car dealer who says "Oh, they all
>>>>>> make that noise."  The Dr. recommended by her doctor jumped right on it, and
>>>>>> figured out **I** was a staph carrier and was infecting the whole family.
>>>>>>
>>>>>> So, while doctors might be careful not to bad-mouth other doctors by name,
>>>>>> they will happily tell you who they think are good.
>>>>>>
>>>>>
>>>>> Around here they usually don't. When our dentist closed his practice for
>>>>> health and age reasons nobody there would give us a clear
>>>>> recommendation. We had to do the long slog through reviews and asking
>>>>> people, like usual.
>>>>
>>>> I think there is a big difference.  Doctors will recommend doctors in
>>>> other specialties but usually not in their own.  My family doctor
>>>> recommended many others to me (cardiologist, orthopedist,
>>>> rheumatologist, etc.) but when he changed his practice to concierge
>>>> medicine, he didn't give recommendations to all of his patients to go
>>>> to someone else.  This may have been seen as a conflict of interest.
>>>>
>>>
>>> Ok, but when they clearly shut down their office in order to retire,
>>> what's the point? I am now at a stage myself where I gradually begin to
>>> slow down my consulting so I have more time for volunteering, cycling,
>>> brewing and so on. I helped some clients find suitable other engineers,
>>> either as consultants or employees (sometimes conducting interviews).
>>
>> Unless they sell their practice to another doctor, suggesting that
>> they go to some _one_ else suggests a kick-back.
>
>
>They did not sell but closed down. These guys would never do the 
>kick-back thing, we know the family quite well.

What they would do and what they did are irrelevant.  What's relevant
is what others (including lawyers) will conjure up.
>
>
>>                                             ... My doctor going
>> concierge is essentially the same thing.  Very few of his patients
>> will follow.  We would have if we could (insurance).
>>
>> Medical practice is quite different than engineering consulting.
>>
>
>It shouldn't be. Let's see what the next health law will bring. I sure 
>hope they follow through with health savings (we already have that) and, 
>therefore, more transparency WRT to billing. Tort law reform would be 
>nice now that the Dems are out but I still doubt it's going to happen.

Of course it should be.  I have no interest in paying 100% of my
salary in malpractice insurance.

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#446138

On 2017-02-04 10:52, krw@notreal.com wrote:
> On Sat, 04 Feb 2017 09:40:20 -0800, Joerg <news@analogconsultants.com>
> wrote:
>
>> On 2017-02-04 08:36, krw@notreal.com wrote:
>>> On Sat, 04 Feb 2017 08:15:37 -0800, Joerg <news@analogconsultants.com>
>>> wrote:
>>>
>>>> On 2017-02-04 07:42, krw@notreal.com wrote:
>>>>> On Sat, 04 Feb 2017 07:21:37 -0800, Joerg <news@analogconsultants.com>
>>>>> wrote:
>>>>>
>>>>>> On 2017-02-03 09:38, Jon Elson wrote:
>>>>>>> bill.sloman@ieee.org wrote:
>>>>>>>
>>>>>>>
>>>>>>>> Cultivate your medical friends. They know who is good - though it would be
>>>>>>>> unethical of them to say so explicitly. The English formulation was
>>>>>>>> "You'll get on with him (or her)". The Australian formulation was a lot
>>>>>>>> more direct - but we had known that particular medical friend for a very
>>>>>>>> long time.
>>>>>>>>
>>>>>>> No, all of our doctors were quite happy to recommend others.  We got a
>>>>>>> recommendation for a pediatrician who was decidedly "old school" from my
>>>>>>> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
>>>>>>> our earlier pediatrician said "Oh, they all get that" when we had a kid who
>>>>>>> had persistent ear infections.  Like the car dealer who says "Oh, they all
>>>>>>> make that noise."  The Dr. recommended by her doctor jumped right on it, and
>>>>>>> figured out **I** was a staph carrier and was infecting the whole family.
>>>>>>>
>>>>>>> So, while doctors might be careful not to bad-mouth other doctors by name,
>>>>>>> they will happily tell you who they think are good.
>>>>>>>
>>>>>>
>>>>>> Around here they usually don't. When our dentist closed his practice for
>>>>>> health and age reasons nobody there would give us a clear
>>>>>> recommendation. We had to do the long slog through reviews and asking
>>>>>> people, like usual.
>>>>>
>>>>> I think there is a big difference.  Doctors will recommend doctors in
>>>>> other specialties but usually not in their own.  My family doctor
>>>>> recommended many others to me (cardiologist, orthopedist,
>>>>> rheumatologist, etc.) but when he changed his practice to concierge
>>>>> medicine, he didn't give recommendations to all of his patients to go
>>>>> to someone else.  This may have been seen as a conflict of interest.
>>>>>
>>>>
>>>> Ok, but when they clearly shut down their office in order to retire,
>>>> what's the point? I am now at a stage myself where I gradually begin to
>>>> slow down my consulting so I have more time for volunteering, cycling,
>>>> brewing and so on. I helped some clients find suitable other engineers,
>>>> either as consultants or employees (sometimes conducting interviews).
>>>
>>> Unless they sell their practice to another doctor, suggesting that
>>> they go to some _one_ else suggests a kick-back.
>>
>>
>> They did not sell but closed down. These guys would never do the
>> kick-back thing, we know the family quite well.
>
> What they would do and what they did are irrelevant.  What's relevant
> is what others (including lawyers) will conjure up.


You'd have to prove kick-back to make a case out of it. To me this is 
not irrelevant anyhow, I prefer to deal with professionals who have good 
ethics.


                                            ... My doctor going
>>> concierge is essentially the same thing.  Very few of his patients
>>> will follow.  We would have if we could (insurance).
>>>
>>> Medical practice is quite different than engineering consulting.
>>>
>>
>> It shouldn't be. Let's see what the next health law will bring. I sure
>> hope they follow through with health savings (we already have that) and,
>> therefore, more transparency WRT to billing. Tort law reform would be
>> nice now that the Dems are out but I still doubt it's going to happen.
>
> Of course it should be.  I have no interest in paying 100% of my
> salary in malpractice insurance.
>

Exactamente. In engineering it's the same, except it's worse. I cannot 
even obtain PL insurance because of exposure to med-tech and aerospace. 
Got turned down by just about any underwriter despite never having had 
any claims. If I was a leaky oil tanker I guess they'd gladly insure me.

-- 
Regards, Joerg

http://www.analogconsultants.com/

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#446201

On Sat, 04 Feb 2017 11:50:22 -0800, Joerg <news@analogconsultants.com>
wrote:

>On 2017-02-04 10:52, krw@notreal.com wrote:
>> On Sat, 04 Feb 2017 09:40:20 -0800, Joerg <news@analogconsultants.com>
>> wrote:
>>
>>> On 2017-02-04 08:36, krw@notreal.com wrote:
>>>> On Sat, 04 Feb 2017 08:15:37 -0800, Joerg <news@analogconsultants.com>
>>>> wrote:
>>>>
>>>>> On 2017-02-04 07:42, krw@notreal.com wrote:
>>>>>> On Sat, 04 Feb 2017 07:21:37 -0800, Joerg <news@analogconsultants.com>
>>>>>> wrote:
>>>>>>
>>>>>>> On 2017-02-03 09:38, Jon Elson wrote:
>>>>>>>> bill.sloman@ieee.org wrote:
>>>>>>>>
>>>>>>>>
>>>>>>>>> Cultivate your medical friends. They know who is good - though it would be
>>>>>>>>> unethical of them to say so explicitly. The English formulation was
>>>>>>>>> "You'll get on with him (or her)". The Australian formulation was a lot
>>>>>>>>> more direct - but we had known that particular medical friend for a very
>>>>>>>>> long time.
>>>>>>>>>
>>>>>>>> No, all of our doctors were quite happy to recommend others.  We got a
>>>>>>>> recommendation for a pediatrician who was decidedly "old school" from my
>>>>>>>> wife's Ob-Gyn.  She asked who he took HIS kids to!  We were concerned when
>>>>>>>> our earlier pediatrician said "Oh, they all get that" when we had a kid who
>>>>>>>> had persistent ear infections.  Like the car dealer who says "Oh, they all
>>>>>>>> make that noise."  The Dr. recommended by her doctor jumped right on it, and
>>>>>>>> figured out **I** was a staph carrier and was infecting the whole family.
>>>>>>>>
>>>>>>>> So, while doctors might be careful not to bad-mouth other doctors by name,
>>>>>>>> they will happily tell you who they think are good.
>>>>>>>>
>>>>>>>
>>>>>>> Around here they usually don't. When our dentist closed his practice for
>>>>>>> health and age reasons nobody there would give us a clear
>>>>>>> recommendation. We had to do the long slog through reviews and asking
>>>>>>> people, like usual.
>>>>>>
>>>>>> I think there is a big difference.  Doctors will recommend doctors in
>>>>>> other specialties but usually not in their own.  My family doctor
>>>>>> recommended many others to me (cardiologist, orthopedist,
>>>>>> rheumatologist, etc.) but when he changed his practice to concierge
>>>>>> medicine, he didn't give recommendations to all of his patients to go
>>>>>> to someone else.  This may have been seen as a conflict of interest.
>>>>>>
>>>>>
>>>>> Ok, but when they clearly shut down their office in order to retire,
>>>>> what's the point? I am now at a stage myself where I gradually begin to
>>>>> slow down my consulting so I have more time for volunteering, cycling,
>>>>> brewing and so on. I helped some clients find suitable other engineers,
>>>>> either as consultants or employees (sometimes conducting interviews).
>>>>
>>>> Unless they sell their practice to another doctor, suggesting that
>>>> they go to some _one_ else suggests a kick-back.
>>>
>>>
>>> They did not sell but closed down. These guys would never do the
>>> kick-back thing, we know the family quite well.
>>
>> What they would do and what they did are irrelevant.  What's relevant
>> is what others (including lawyers) will conjure up.
>
>
>You'd have to prove kick-back to make a case out of it. To me this is 
>not irrelevant anyhow, I prefer to deal with professionals who have good 
>ethics.

How tall are you?  3'4"?

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#446185

krw@notreal.com wrote:


> I think there is a big difference.  Doctors will recommend doctors in
> other specialties but usually not in their own.
OK, may well be!

> My family doctor
> recommended many others to me (cardiologist, orthopedist,
> rheumatologist, etc.) but when he changed his practice to concierge
> medicine, he didn't give recommendations to all of his patients to go
> to someone else.  This may have been seen as a conflict of interest.
Ahh, but sending out a recommendation to 3000 patients to go see Dr. X could 
really cause some problems.  So, I can easily see why they would not want to 
do that.

Jon

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#446202

On Sat, 04 Feb 2017 18:04:50 -0600, Jon Elson <elson@pico-systems.com>
wrote:

>krw@notreal.com wrote:
>
>
>> I think there is a big difference.  Doctors will recommend doctors in
>> other specialties but usually not in their own.
>OK, may well be!
>
>> My family doctor
>> recommended many others to me (cardiologist, orthopedist,
>> rheumatologist, etc.) but when he changed his practice to concierge
>> medicine, he didn't give recommendations to all of his patients to go
>> to someone else.  This may have been seen as a conflict of interest.
>Ahh, but sending out a recommendation to 3000 patients to go see Dr. X could 
>really cause some problems.  So, I can easily see why they would not want to 
>do that.

...and recommening someone less than the best *is* a conflict.

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#445928

>" Would that we could snap our fingers and get a doctor like that."

Yeah and as soon as they step out of the office they order a club sandwich with double bacon and extra mayo, light a cigarette with a filter that is more deadly than the tobacco, then get on at least four prescription drugs that are destroying their liver and kidneys. 

My Grandfather never drank, he got a new doctor and he asked "How long did he drink ?". the drugs they gave him destroyed his liver. 

You cannot rehab this society, the only thing to do is to let the dumb die off and work with what is left.

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#445966

On Saturday, February 4, 2017 at 12:00:08 AM UTC+11, jurb...@gmail.com wrote:
> >" Would that we could snap our fingers and get a doctor like that."
> 
> Yeah and as soon as they step out of the office they order a club sandwich with double bacon and extra mayo, light a cigarette with a filter that is more deadly than the tobacco, then get on at least four prescription drugs that are destroying their liver and kidneys. 

My youngest brother doesn't act like that, nor any of my medically qualified cousins. On the other hand, you aren't the kind of patient I'd wish on them.
 
> My Grandfather never drank, he got a new doctor and he asked "How long did he drink ?". The drugs they gave him destroyed his liver.

There are drugs that do that - to some people. I'm on one of them. They checked my liver function every month for the first six months I was taking it, and annually thereafter. 
 
> You cannot rehab this society, the only thing to do is to let the dumb die off and work with what is left.

Pessimistic. There's a drug for that.

-- 
Bill Sloman, Sydney

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#445956

On 2/3/2017 5:21 AM, Winfield Hill wrote:
> bill.sloman@ieee.org wrote...
>>
>> Atul Gawande has written another impressive piece for the New Yorker
>> http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care
>>
>> It is mainly a plea for better primary-care medicine - what your
>> own doctor does for you at your local practice - but it includes
>> a reference to the 1967 collapse of the Silver Bridge across the
>> Ohio River, which was due to a failure in inspection and maintenance,
>> making the point that while doing heroic operations and building
>> new bridges are both extremely glamorous, the cost-benefit analysis
>> says that it's better to spend time on making sure that what's
>> working stays working, and perhaps improve it a bit from time to
>> time.  Development rather than a new design from scratch.
>
>  Would that we could snap our fingers and get a doctor like that.

Why do we EXPECT medical professionals to be more "dedicated"
than any other profession?

I've watched technicians NOT clean the flux from a board they've
just repaired; not inspect the quality of their solder joints
(as if they KNOW their work is "top quality" -- not!); "programmers"
who will only "test" their code at gunpoint; "continuing education"
being little more than reading trade rags; plumbers who don't properly
prep a joint before sweating it (nor cleaning it afterwards!);
painters who just make a token attempt at cleaning their brushes;
or, inflate their rates; etc.

Yet, we seem to expect the medical professionals to be on top
of all the latest research; "take the initiative" to track down
OUR test results (instead of waiting for them to fall into
their laps in the normal course of events); be "on call" and
have ready appointments when we need them; etc.

Last time I checked, they're "just people".  They look forward
to Fridays as much as anyone else.  They have similar motivations
and aren't all rooted in self-actualization, etc.

Next time you "cut a corner", think about the likelihood that
your healthcare providers are behaving similarly -- do you think
YOU cut that corner out of malice, laziness, ignorance, etc.?

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#445970

On Saturday, February 4, 2017 at 3:36:08 AM UTC+11, Don Y wrote:
> On 2/3/2017 5:21 AM, Winfield Hill wrote:
> > bill.sloman@ieee.org wrote...
> >>
> >> Atul Gawande has written another impressive piece for the New Yorker
> >> http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care
> >>
> >> It is mainly a plea for better primary-care medicine - what your
> >> own doctor does for you at your local practice - but it includes
> >> a reference to the 1967 collapse of the Silver Bridge across the
> >> Ohio River, which was due to a failure in inspection and maintenance,
> >> making the point that while doing heroic operations and building
> >> new bridges are both extremely glamorous, the cost-benefit analysis
> >> says that it's better to spend time on making sure that what's
> >> working stays working, and perhaps improve it a bit from time to
> >> time.  Development rather than a new design from scratch.
> >
> >  Would that we could snap our fingers and get a doctor like that.
> 
> Why do we EXPECT medical professionals to be more "dedicated"
> than any other profession?

They can keep us alive if they do their job right, or kills us if they don't. No other profession - bodyguards excepted - carries quite as much responsibility, and they are trained to play up to it, and to give us little hints about how important their performance is, and how seriously they take the job.

In reality, they can't do all that much, but they can do more if we take them seriously, and do what we are told. "Dedicated" is part of the persona they learn to put on.

-- 
Bill Sloman, Sydney 

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#446032

On Friday, 3 February 2017 16:36:08 UTC, Don Y  wrote:

> Why do we EXPECT medical professionals to be more "dedicated"
> than any other profession?

Beliefs acquired as little children. Remarkable how persistent they are.


NT

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#446088

On 2017-02-03 08:35, Don Y wrote:
> On 2/3/2017 5:21 AM, Winfield Hill wrote:
>> bill.sloman@ieee.org wrote...
>>>
>>> Atul Gawande has written another impressive piece for the New Yorker
>>> http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care
>>>
>>>
>>> It is mainly a plea for better primary-care medicine - what your
>>> own doctor does for you at your local practice - but it includes
>>> a reference to the 1967 collapse of the Silver Bridge across the
>>> Ohio River, which was due to a failure in inspection and maintenance,
>>> making the point that while doing heroic operations and building
>>> new bridges are both extremely glamorous, the cost-benefit analysis
>>> says that it's better to spend time on making sure that what's
>>> working stays working, and perhaps improve it a bit from time to
>>> time.  Development rather than a new design from scratch.
>>
>>  Would that we could snap our fingers and get a doctor like that.
>
> Why do we EXPECT medical professionals to be more "dedicated"
> than any other profession?
>

Because we as engineers are dedicated?

[...]


> Next time you "cut a corner", think about the likelihood that
> your healthcare providers are behaving similarly -- do you think
> YOU cut that corner out of malice, laziness, ignorance, etc.?


Some of us don't cut corners.

-- 
Regards, Joerg

http://www.analogconsultants.com/

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