This commentary is pretty much everything I've said here about practicing medicine

[MrFun]

Whenever I get a cold, sinus infection, or something else, I usually take care of it on my own. Sometimes, I take over counter medicine without seeing a doctor, or I don't take any medicine at all. I just let it go away on its own without any medicine.

[Hauldren Collider]

If only we had a system which incentivized people to only consume goods and services to the extent that the value of these goods and services (to them) was greater than the cost of those same goods and services...

This, people. Make it cost money.

More accurately, make the cost fall directly on the consumer.

[Al B. Sure!]

What about the culture where people are afraid to go to the doctor for anything? Don't males (of all races) and minorities tend to do the opposite?

[Al B. Sure!]

http://yourlife.usatoday.com/health/medical/menshealth/story/2011/03/Study-Half-of-men-dont-go-to-the-doctor/45453184/1

About half of men ages 18 to 50 don't have a primary-care physician, and a third haven't had a checkup in more than a year, a new survey shows.

"It's a stereotype about men that they don't like to go to the doctor, that they'd rather just go when there's a problem," says Ryan D'Agostino, articles editor for Esquire. "We had hoped it wasn't this true," he says, but the survey found 45% don't even have a primary-care doctor.

[Aeson]

More accurately, make the cost fall directly on the consumer.

No more vaccinations for freeloading babies

[Jon Miller]

This doesn't have to do with public health.

It has to do with how one pays for health care. Our current system is terrible.

Either the government should be the purchaser (and then we will have government rationing), or it should be private individuals. The first works (sorta) in europe (where you get rationing), the second doesn't work all that well in South Africa... but we aren't South Africa and I expect it would work better here than our current system.

It isn't the cost of vaccinations for babies which is increasing at an unreasonable rate.

JM

[Aeson]

This doesn't have to do with public health.

Yes it does. If you require consumers to directly pay the cost of care some of them will be unable or unwilling to pay for that care regardless of whether it's an issue of public health or not. At that point either someone steps in to provide assistance or incentive and the consumer is no longer directly paying for it (to whatever extent), or it goes undone.

[OneFootInTheGrave]

http://www.epmonthly.com/columns/in-...88579453742608

Treating a Nation of Anxious Wimps

by Thomas Doyle, MD on December 8, 2009



In a single night I had patients come in for the following complaints (all brought by ambulance): “Smoked marijuana and got dizzy”, “stung by a bee and it hurts”, “got drunk and have a hangover”, “sat out in the sun and got sunburn”, “ate Mexican food and threw up”, “picked my nose and it bled, but now it stopped”, “just had sex and want to know if I’m pregnant.”

Looks like you need to improve education system in the country first.

[rah]

This from yesterdays Tribune.

It was a tiny spot in the middle of my back. I couldn't even see it, but my wife, whose late husband died of skin cancer, bugged me to have it checked out.

The dermatologist's "hmmm" as she closely examined my back said it all, but she explained that the spot looked suspicious. She took a biopsy.

The results were positive and she recommended a skin surgeon for what she described as a "simple outpatient procedure" to remove the spot. Simple was a completely accurate description of my office visit with the surgeon. His nurse had me take off my shirt, lie on my stomach and she prepped the area with an antiseptic scrub. She gave me several shots of a local antiseptic to numb the area, then laid out the maestro's surgical instruments — scalpel, needle and sutures. Prep took 10 minutes, max.

The surgeon made short work of excising the spot. "Got it," he announced triumphantly. "Now, we'll just do a quick biopsy to make sure we got it all and you're done." The "surgery" was five minutes, tops.

The biopsy came back negative and three simple stitches later, we were done. Total elapsed time maybe 45 minutes, give or take.

I was delighted and relieved to have that little session behind me. My wife pitched in by removing the sutures two weeks later, thereby saving me a second visit to the doctor. Little did I know how much that would save me besides time and inconvenience.

Thank goodness I didn't have to go back for another visit. In that doctor's office, time really is big, big money.

A few weeks after the procedure, I received a shocking statement from Medicare. What started out as the simple excision of a tiny spot from my back almost culminated in a massive heart attack when I saw the bill of $11,688 for the surgery.

What a staggering rip-off. It's little wonder our Medicare program is going broke and so many uninsured Americans have been forced into bankruptcy by an unexpected medical emergency.

But the size of the bill isn't the most telling part of this sad story of modern medical practice. While the amount billed was $11,688, Medicare approved only $1,277.45, so that's what the doc was paid. The rest was "written off." And, best of all, I paid zero. But, when you are eyeball to eyeball with the need for surgery, price is hardly the first concern.

It's reassuring that Medicare officials have a sense of cost-containment and value of services and won't be fleeced by overpriced doctors. It's particularly comforting in light of scandalous stories of government purchases of $400 hammers and $2,000 toilet seats.

So, neither Medicare nor private insurers will pay the billed amount for the surgery, but what about uninsured patients? Are they the only ones expected to pay the $11,688 billed amount? What a cruel irony that those least able to pay the full rate will be the only ones on the hook for the full amount of a surgeon's bloated charges.


Health care cost in this country is out of control. Some say Obamacare will solve all our health care problems. Others say the insurance mandate is unconstitutional. Republican presidential candidates make various promises on the campaign trail ranging from complete repeal to selective enforcement.

Populist politicians are quick to blame insurance companies and malpractice claims for skyrocketing health care cost. They surely share some of the blame. But, my tiny, very expensive spot shows that there are other villains in this national crisis. Shameless billing practices of some physicians play a major role in the runaway escalation of health care cost.

Whatever the causes of the price spike, we need health care cost control and reform, and we need it now. A $12,000 per hour charge for a brief outpatient surgical procedure is an outrage that shouldn't be tolerated.

Simple removal of that tiny spot is symptomatic of a national crisis that urgently needs a fix.

Gerald D. Skoning is a Chicago lawyer.

[Lorizael]

Guynemer, I've recently acquired the ability to crack my chest like I crack my knuckles. Is that bad?

[The Mad Monk]

Body Culture of the Nacirema

Most cultures exhibit a particular configuration or style. A single value or pattern of perceiving the world often leaves its stamp on several institutions in the society. Examples are "machismo" in Spanish-influenced cultures, "face" in Japanese culture, and "pollution by females" in some highland New Guinea cultures. Here Horace Miner demonstrates that "attitudes about the body" have a pervasive influence on many institutions in Nacirema society.

1151 words, not including notes


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[503 begins ->]
The anthropologist has become so familiar with the diversity of ways in which different people behave in similar situations that he is not apt to be surprised by even the most exotic customs. In fact, if all of the logically possible combinations of behavior have not been found somewhere in the world, he is apt to suspect that they must be present in some yet undescribed tribe. The point has, in fact, been expressed with respect to clan organization by Murdock (1949: 71).[2] In this light, the magical beliefs and practices of the Nacirema present such unusual aspects that it seems desirable to describe them as an example of the extremes to which human behavior can go.
¶ 1
Professor Linton [3] first brought the ritual of the Nacirema to the attention of anthropologists twenty years ago (1936: 326), but the culture of this people is still very poorly understood. They are a North American group living in the territory between the Canadian Cree, the Yaqui and Tarahumare of Mexico, and the Carib and Arawak of the Antilles. Little is known of their origin, although tradition states that they came from the east.... [4] ¶ 2
Nacirema culture is characterized by a highly developed market economy which has evolved in a rich natural habitat. While much of the people's time is devoted to economic pursuits, a large part of the fruits of these labors and a considerable portion of the day are spent in ritual activity. The focus of this activity is the human body, the appearance and health of which loom as a dominant concern in the ethos of the people. While such a concern is certainly not unusual, its ceremonial aspects and associated philosophy are unique. ¶ 3
The fundamental belief underlying the whole system appears to be that the human body is ugly and that its natural tendency is to debility and disease. Incarcerated in such a body, man's only hope is to avert these characteristics through the use of ritual and ceremony. Every household has one or more shrines devoted to this purpose. The more powerful individuals in the society have several shrines in their houses and, in fact, the opulence of a house is often referred to in terms of the number of such ritual centers it possesses. Most houses are of wattle and daub construction, but the shrine rooms of the more wealthy are walled with stone. Poorer families imitate the rich by applying pottery plaques to their shrine walls. ¶ 4
While each family has at least one such shrine, the rituals associated with it are not family ceremonies but are private and secret. The rites are normally only discussed with children, and then only during the period when they are being initiated into these mysteries. I was able, however, to establish sufficient [504 begins ->] rapport with the natives to examine these shrines and to have the rituals described to me. ¶ 5
The focal point of the shrine is a box or chest which is built into the wall. In this chest are kept the many charms and magical potions without which no native believes he could live. These preparations are secured from a variety of specialized practitioners. The most powerful of these are the medicine men, whose assistance must be rewarded with substantial gifts. However, the medicine men do not provide the curative potions for their clients, but decide what the ingredients should be and then write them down in an ancient and secret language. This writing is understood only by the medicine men and by the herbalists who, for another gift, provide the required charm. ¶ 6
The charm is not disposed of after it has served its purpose, but is placed in the charmbox of the household shrine. As these magical materials are specific for certain ills, and the real or imagined maladies of the people are many, the charm-box is usually full to overflowing. The magical packets are so numerous that people forget what their purposes were and fear to use them again. While the natives are very vague on this point, we can only assume that the idea in retaining all the old magical materials is that their presence in the charm-box, before which the body rituals are conducted, will in some way protect the worshiper. ¶ 7
Beneath the charm-box is a small font. Each day every member of the family, in succession, enters the shrine room, bows his head before the charm-box, mingles different sorts of holy water in the font, and proceeds with a brief rite of ablution.[5] The holy waters are secured from the Water Temple of the community, where the priests conduct elaborate ceremonies to make the liquid ritually pure.
¶ 8
In the hierarchy of magical practitioners, and below the medicine men in prestige, are specialists whose designation is best translated as "holy-mouth-men." The Nacirema have an almost pathological horror of and fascination with the mouth, the condition of which is believed to have a supernatural influence on all social relationships. Were it not for the rituals of the mouth, they believe that their teeth would fall out, their gums bleed, their jaws shrink, their friends desert them, and their lovers reject them. They also believe that a strong relationship exists between oral and moral characteristics. For example, there is a ritual ablution of the mouth for children which is supposed to improve their moral fiber. ¶ 9
The daily body ritual performed by everyone includes a mouth-rite. Despite the fact that these people are so punctilious [6] about care of the mouth, this rite involves a practice which strikes the uninitiated stranger as revolting. It was reported to me that the ritual consists of inserting a small bundle of hog hairs into the mouth, along with certain magical powders, and then moving the bundle in a highly formalized series of gestures.[7] ¶ 10
In addition to the private mouth-rite, the people seek out a holy-mouth-man once or twice a year. These practitioners have an impressive set of paraphernalia, consisting of a variety of augers, awls, probes, and prods. The use of [505 begins ->] these objects in the exorcism of the evils of the mouth involves almost unbelievable ritual torture of the client. The holy-mouth-man opens the client's mouth and, using the above mentioned tools, enlarges any holes which decay may have created in the teeth. Magical materials are put into these holes. If there are no naturally occurring holes in the teeth, large sections of one or more teeth are gouged out so that the supernatural substance can be applied. In the client's view, the purpose of these ministrations [8] is to arrest decay and to draw friends. The extremely sacred and traditional character of the rite is evident in the fact that the natives return to the holy-mouth-men year after year, despite the fact that their teeth continue to decay. ¶ 11
It is to be hoped that, when a thorough study of the Nacirema is made, there will be careful inquiry into the personality structure of these people. One has but to watch the gleam in the eye of a holy-mouth-man, as he jabs an awl into an exposed nerve, to suspect that a certain amount of sadism is involved. If this can be established, a very interesting pattern emerges, for most of the population shows definite masochistic tendencies. It was to these that Professor Linton referred in discussing a distinctive part of the daily body ritual which is performed only by men. This part of the rite includes scraping and lacerating the surface of the face with a sharp instrument. Special women's rites are performed only four times during each lunar month, but what they lack in frequency is made up in barbarity. As part of this ceremony, women bake their heads in small ovens for about an hour. The theoretically interesting point is that what seems to be a preponderantly masochistic people have developed sadistic specialists. ¶ 12
The medicine men have an imposing temple, or latipso, in every community of any size. The more elaborate ceremonies required to treat very sick patients can only be performed at this temple. These ceremonies involve not only the thaumaturge [9] but a permanent group of vestal maidens who move sedately about the temple chambers in distinctive costume and headdress. ¶ 13
The latipso ceremonies are so harsh that it is phenomenal that a fair proportion of the really sick natives who enter the temple ever recover. Small children whose indoctrination is still incomplete have been known to resist attempts to take them to the temple because "that is where you go to die." Despite this fact, sick adults are not only willing but eager to undergo the protracted ritual purification, if they can afford to do so. No matter how ill the supplicant or how grave the emergency, the guardians of many temples will not admit a client if he cannot give a rich gift to the custodian. Even after one has gained and survived the ceremonies, the guardians will not permit the neophyte to leave until he makes still another gift. ¶ 14
The supplicant entering the temple is first stripped of all his or her clothes. In everyday life the Nacirema avoids exposure of his body and its natural functions. Bathing and excretory acts are performed only in the secrecy of the household shrine, where they are ritualized as part of the body-rites. Psychological shock results from the fact that body secrecy is suddenly lost upon entry into the latipso. A man, whose own wife has never seen him in an excre- [506 begins ->] tory act, suddenly finds himself naked and assisted by a vestal maiden while he performs his natural functions into a sacred vessel. This sort of ceremonial treatment is necessitated by the fact that the excreta are used by a diviner to ascertain the course and nature of the client's sickness. Female clients, on the other hand, find their naked bodies are subjected to the scrutiny, manipulation and prodding of the medicine men. ¶ 15
Few supplicants in the temple are well enough to do anything but lie on their hard beds. The daily ceremonies, like the rites of the holy-mouth-men, involve discomfort and torture. With ritual precision, the vestals awaken their miserable charges each dawn and roll them about on their beds of pain while performing ablutions, in the formal movements of which the maidens are highly trained. At other times they insert magic wands in the supplicant's mouth or force him to eat substances which are supposed to be healing. From time to time the medicine men come to their clients and jab magically treated needles into their flesh. The fact that these temple ceremonies may not cure, and may even kill the neophyte, in no way decreases the people's faith in the medicine men. ¶ 16
There remains one other kind of practitioner, known as a "listener." This witch-doctor has the power to exorcise the devils that lodge in the heads of people who have been bewitched. The Nacirema believe that parents bewitch their own children. Mothers are particularly suspected of putting a curse on children while teaching them the secret body rituals. The counter-magic of the witch-doctor is unusual in its lack of ritual. The patient simply tells the "listener" all his troubles and fears, beginning with the earliest difficulties he can remember. The memory displayed by the Nacirema in these exorcism sessions is truly remarkable. It is not uncommon for the patient to bemoan the rejection he felt upon being weaned as a babe, and a few individuals even see their troubles going back to the traumatic effects of their own birth. ¶ 17
In conclusion, mention must be made of certain practices which have their base in native esthetics but which depend upon the pervasive aversion to the natural body and its functions. There are ritual fasts to make fat people thin and ceremonial feasts to make thin people fat. Still other rites are used to make women's breasts larger if they are small, and smaller if they are large. General dissatisfaction with breast shape is symbolized in the fact that the ideal form is virtually outside the range of human variation. A few women afflicted with almost inhuman hypermammary development are so idolized that they make a handsome living by simply going from village to village and permitting the natives to stare at them for a fee. ¶ 18
Reference has already been made to the fact that excretory functions are ritualized, routinized, and relegated to secrecy. Natural reproductive functions are similarly distorted. Intercourse is taboo as a topic and scheduled as an act. Efforts are made to avoid pregnancy by the use of magical materials or by limiting intercourse to certain phases of the moon. Conception is actually very infrequent. When pregnant, women dress so as to hide their condition. Parturi- [507 begins ->] tion takes place in secret, without friends or relatives to assist, and the majority of women do not nurse their infants. ¶ 19
Our review of the ritual life of the Nacirema has certainly shown them to be a magic-ridden people. It is hard to understand how they have managed to exist so long under the burdens which they have imposed upon themselves. But even such exotic customs as these take on real meaning when they are viewed with the insight provided by Malinowski [10] when he wrote (1948: 70): ¶ 20
Looking from far and above, from our high places of safety in the developed civilization, it is easy to see all the crudity and irrelevance of magic. But without its power and guidance early man could not have mastered his practical difficulties as he has done, nor could man have advanced to the higher stages of civilization.[11]

https://www.msu.edu/~jdowell/miner.html?pagewanted=al

[Lorizael]

I read, "The anthropologist has..." and knew what the rest was.

[The Mad Monk]

I became aware of it only this morning.

[Lorizael]

I think I first saw it in a history class in high school. Wiki says it's 56 years old.

[Guynemer]

Guynemer, I've recently acquired the ability to crack my chest like I crack my knuckles. Is that bad?

It's either normal, you are on a one-way train headed toward spontaneous thoracic implosion.