Tuesday, September 25, 2018

Can Blockchain Unscrew the Medical Records World?

Let me back up for a minute.  I may not know what I'm talking about, but my perspective as a patient is that the medical records associated with me are perpetually screwed up, so therefore I expect everyone's medical records are perpetually screwed up and by extension all medical records are screwed up to some degree.  Every doctor I see wants a complete list of everything I'm taking; easy peasy - there's not all that much.  Then they go through a list that they have, saying "are you still taking.. XXX" where XXX is prescription that I had for two weeks ten years ago, took them and never saw another one.  Or maybe it was one that a doctor said, "try this and see if it works for you"; it didn't and we tried another similar drug.  Repeat for maybe 20 entries in their list.

No matter what I say to the tech or person checking the list, it never seems to get fixed or get better.  I fully expect that if I end up in the hospital for some sort of emergency - like when I had my gall bladder out in June of '16 - they're going to read that I'm taking ... I don't know, something ... and treat whatever I have wrong because of that kind of lingering misinformation.

I'm not in that line of work, so maybe I'm talking out of my butt, but it's the case both for Mrs. Graybeard and I.  That sneaking suspicion that it's all wrong got my interest when I saw a headline, "Would You Trust an App to Protect Your Medical Records?" in Machine Design.  The emphasis, though, isn't unscrewing our records, it's securing their privacy.

Blockchain is most associated with cryptocurrencies; it's how they work.  Blockchain is an encrypted ledger of digital transactions, a group of these transactions is a block, distributed across a chain of multiple nodes through a peer-to-peer network.  Part of the distributed nature of the blockchain is that it leaves an auditable log trail of the events taking place.  Every entry in the ledger is irrevocable, tamper-proof, and shared among authorized parties in a transparent manner.  I can see the usefulness here, but in the case of my mangled history of prescriptions, the issue isn't things being added without authorization, it's inappropriate things being added - or appropriate things being added that shouldn't be permanent.

Machine Design adds this:
The technology allows every member that can submit information to have their own copy of the ledger, rather than having all the data hosted on one centralized location. Nevertheless, no new transaction can be input, or data committed, without the majority of nodes agreeing that it is indeed accurate.

This could impact the healthcare industry greatly, as often every such organization has its own version of a patient’s records, and it is common for these entities to have differences between each record without streamlined verification. Therefore it is often the case that if a patient visits several different healthcare providers, each and every record they have can be different from one another, which could create massive complications for their personal health. [Note: emphasis added - SiG]
Bingo!  Now you're talking.  This bold text is exactly what I'm talking about.  

The article then goes on to give a brief overview of a few companies trying to create this medical blockchain industry, MediBloc, Dentacoin and Medicalchain.
MediBloc aims at putting patients in charge of managing their own medical records, enabling them to exercise ownership and control over their data, as well as who has access to it. Users have full access to their data and can make a conscious choice over who is authorized to view and edit it—from individuals to research institutions and private corporations.
Dentacoin, as you might guess, is aimed at dental records. Dentacoin is a decentralized dental health database which stores patient data in a secure and reliable way. It is fully controlled by the users; only they can decide what to store in the database and who has access to it.
The database, developed by Medicalchain, allows users to give permission to medical professionals (doctors, hospitals, labs, pharmacists, insurers, and so on) to access the data they have entered on the platform. Each and every access of the data is logged—making it auditable, transparent, and secure—by having it recorded as a transaction on the Medicalchain’s distributed ledger. The patient’s privacy is protected throughout the entire duration of this process.

The article uses the rhetorical question, "would you trust an app to protect your medical records".  I can't say that I particularly trust the medical professionals that have custody of them now, but I don't know this is any better.  I also don't know if it's any worse (as always, the internet meme works here: "when I said 'how bad can it get', that wasn't meant as a challenge). 

The problem is that I don't see much in what they're talking about that specifically addresses the text I emphasized above
... if a patient visits several different healthcare providers, each and every record they have can be different from one another, which could create massive complications for their personal health.
The closest is Medicalchain allowing users to correct their records and allow the medical professionals to view their records.  The thing is, Blockchain and that whole system isn't needed for this.  We could do it now if the medical practices allowed patients to correct the information.  But the medical professionals always know more than you and won't allow you to modify your records. 

I'm going to swag that something like this might be coming.  If you have a personal issue with your medical records being on a computer on the network, that ship sailed long ago.  In principle, it's a really good idea that any doctor who sees you should get access to important things about you, especially should you be unconscious in an Emergency Room.  My biggest issue is that the information really needs to be right. 


  1. Can Blockchain Unscrew the Medical Records World?


    For once, I'm not so wordy. But no, it can't. Which is your point, really.

  2. I've gone 'round and 'round with my girlfriend (RN) about this issue. My position now? Forget it Jake, it's Chinatown...

    I don't expect this to be resolved in any meaningful way in my lifetime.

  3. Pharmacies are the same way. When we moved here we switched from Walgreen's to CVS because there wasn't a close Walgreen's.

    ALL our prescriptions were screwed up, and I've spent 12 months trying to unscrew them.

    Auto refills that never did, stuff I took 10 years ago getting refilled (WTF?!?), refills being refused even though the label showed "3 remaining", etc, ad nauseum.

  4. It's been my experience that medical agencies hate providing records to patients. They'll happily fax the records to any number you provide. (FAX! wth, is this the 90's?) The idea of giving access to the patients themselves is a non-starter.

    And of course, the medical industry is only slightly ahead of attorneys in adopting technology for their documentation.

  5. You say:
    My biggest issue is that the information really needs to be right.

    My question back to you is:

    What makes you think THAT is going to happen???

    Have you still not noticed how technology is used today? Do you REALLY think it is being used for YOUR benefit???

  6. I know a thing or two about medical and dental records, about pharmaceuticals, and about medical technology. None of it matters!

    The problem is that healthcare providers now spend all their time collecting and entering data, rather than practicing hands-on, one-one-one medicine.

    Most doctor visits do not even require a computer. Just a knowledgable doctor with enough time to observe, palpate and ask questions.

    All the "digital records" stuff is for the government and insurance providers, to give them something to control.

    As for the reality of digital records, the data should stay and travel with the patient, not the doctor. The one constant is the patient. Heck, put a darn chip into the patients' forearm. Problem solved.

    1. They say that about 1/6 of the US economy is healthcare costs. Likewise, I've read that about a quarter of that cost is providers and insurers arguing about what's covered - which is almost always arguing over a code that checked off improperly on some form. Arguing over medical codes has become an industry.

      With doctors averaging (I think) 7 minutes with a patient, the doctor is getting hammered to be more efficient and the way the insurers and the various.gov agencies are pushing that is to make everything they do less efficient.

    2. from Aesop:
      "Collecting and entering data, rather than practicing hands-on, one-on-one medicine."
      I realize I'm old, but once upon a time, collecting and entering data used to go by the clever word "science".
      I'm pretty sure I may have even taken a class or three where they covered that.

      I think I know what you think you meant to say there, but words mean things.

      You're aware, perhaps, that the demarcation between medieval witch doctory, and what we consider the dawn of modern medicine, circa 1800ish, was when doctors stopped hoarding information, and instead began collecting and entering data on patients, and suddenly had a sciencey reason why bathing wounds with clean water reduced infections, while rubbing dogshit into them wasn't a great idea.

      If you want voodoo, there are homeopathic quacks on every corner. Please, patronize them instead; my waiting room is full 24/7/365. As a bonus, when you die from that, you'll be helping keep Social Security Ponzi scheme solvent a wee bit longer, perhaps until I can get a little out bit out from what I've kicked in.

      Meanwhile, the data entry thing has gotten so bad (or good) that the brighter hospitals have taken to hiring minimum-wage "scribes" (if you're familiar with Babylonian and Egyptian history, stop me if you've heard this one) whose entire function is to devote themselves to literally checking the boxes as doctors do and hear things, which improves accuracy, generates better care (and the all-important billing), and lets doctors be doctors again instead of secretaries for insurance companies.

      If a scribe catches one thing that was getting missed, (and they do much better than that) they can pay for their whole shift in about 3 minutes, not to mention create a more accurate patient care record, and actually improve care from that point onwards.

      No word yet on when nurses are going to get our own paperwork/computer bitches, but since we only do the other 95% of medical care, it's not yet a high priority for the health care system, at any level.

      Just a random request, and I know it's a novel concept, but if the fuckers who wrote and designed EMR programs would actually talk to providers, first, and then listen to the responses, they might not keep foisting such kludgy craptastic monumental piles of shit on us to have to beat into submission with crowbars.
      Alternatively, I'd be happy to beat the programmers into submission with crowbars.
      I'm pretty sure either approach would work better than the current "here's a pile of shit, everyone eats two scoops" approach used at all times to date, but the latter solution I suggested would be a lot more personally satisfying, in a flying blood and gray matter sort of way.
      But I'm sentimental like that.

    3. Anonymous..Aesop: I am pretty sure we see eye-to-eye on EMRs, but, when I see a "healthcare provider" (or a lowly "scribe") entering "data" into a computer during a typical doctor-patient encounter, there's no science happenening. Perhaps, in the case of a clinical trial. Otherwise, it's just data entry.

    4. That's like a guy looking at a campfire burning wood, and telling me he doesn't see any chemistry happening.
      Perhaps you're not clear on the concept.

      If you aren't collecting data, you aren't doing science.
      That's what it is.

  7. The problem with medical records isn't technology related. It is doctor related.

    The reason that NHS, and every other medical hack has taken place is at least in part due to the fact that you can't tell doctors anything. You can't tell them their screens will lock after 10 minutes of inactivity. They will detail a nurse to make sure that 10 minutes never happens. (Or they will give the PW to the nurse so if it should lock, they can unlock it.) THEY ARE DOCTORS! You can't tell them how to do their work!

    And when it comes to spending money on anything, they won't spend it on anything they don't understand, and (even though they won't admit it) they don't understand technology.

    Probably 98% of the medical devices in hospitals are on open WiFi, with hard-coded admin user IDs and passwords. That means they can be hacked. Trivially. Hackers can change the amount of drugs given patients. The intensity/duration of X-rays. All kinds of things.

    Most insulin pumps can have their firmware flashed with no security check. You can change the amount of insulin given a patient. Which can kill people. No security.

    There are more critical problems to solve before we get to the "is all the patient data 100% correct?" stage of the game.

    "The information needs to be right" OR The information on file needs to be ignored, and anything critical needs to be verified. (For example. I doubt that they would look at your medical records to determine your blood type, when they can type your blood in minutes, and getting it wrong could kill you.)

    1. The problem with medical records isn't technology related. It is doctor related.

      The reason that NHS, and every other medical hack has taken place is at least in part due to the fact that you can't tell doctors anything.

      Bingo. Exactly right.

      "The information needs to be right" OR The information on file needs to be ignored, and anything critical needs to be verified. I think this is what they're relatively good at, and it's why serious accidents happen less often than they otherwise might. Although with medical mistakes/accidents responsible for something like a third of deaths in the country, they really need to get better at this.

      This actually happened: two years ago, my wife was in the hospital for surgery. They started to prepare her for the wrong procedure, because someone else with the same first name was in for that procedure the same day. They started out by asking her if she had done some preparation the other woman was supposed to do. They never looked at the name tag on her wrist and compared the name to the chart. How long have hospitals been putting name tags on patient's wrists? How many times have those workers been told to match the name on the wrist band to the name on the chart?

    2. from Aesop:
      Take a wild guess how many patients I've looked straight in the face at breath smelling distance, who've answered to the wrong name, spoken at them repeatedly, in multiple languages.
      To the point of medical errors being performed.

      When you're too stupid to know your own name, I can't fix that.
      (But if they'd let me use a suitable therapeutic ball peen hammer, I'm pretty sure I could adjust reliability upwards, given a free hand.)

      So even with a name band, when I ask you your name to confirm it, if you still don't know it, even in your native language, it kind of undermines the whole "two identifiers" reliability scale, doesn't it?

      Maybe if the Vital Records Department and DMV could use a red-hot branding iron...

    3. from Aesop:
      I can't speak to things on the socialized medicine side of the pond, but hereabouts, you get typed and screened for correct blood type every effing time we need to do that since ever. (At least for any value of "ever" in the last 50 years, and any point in the foreseeable future.)
      And it takes minutes, all right: about 30 of them - half an hour, on average. 10-15 in critical trauma cases, who move to the front of the line on the lab worker's list of things to do.
      Because getting the wrong blood type can kill you.

      I'm not 100% positive, but I think we've been onto that since Charles Drew.

      If someone's not doing that, they're either complete morons, or they practice medicine with a bone through their nose and spend a good percentage of their time warding off evil spirits. Take your pick.

  8. In small towns, the local MD knew patients. There were house calls because all medicine practiced was done so on a personal basis. Now, it's assembly line medicine and as others have pointed out eloquently, the tech systems that underpin the practice are nearly unknowable to practitioners.

    Adding block chain even as an invisible component won't change anything that people are complaining about.

  9. from Aesop:

    1) Sorry to piss on anyone's parade, but they're not "your" records.
    You can bark at the moon too, but you can't change reality with noise.
    You accepted that the day you singed up to let someone else pay for things. If you're one of the 0.000000000000000000000001% of people anywhere anywhere who pays cash-in-pocket for everything since turning 18, feel free to bitch in comments.

    2) They have the meds you took once, for that thing, 30 years ago, because by definition, those are part of the record. (Cleverly, the specialty-jargon word "record" might be a help to those of you with some facility with the English language.) If this is news to you, you're not tall enough for the Internet.

    3) No, the last person I want with input and editing access to your medication list is you, the patient, for any value of that word. Shock! Horror!
    Lemmesee, 5,000,000 med-seeking junkies wiping all records of the 37 active prescriptions they've shopped for opioid pain relievers in five neighboring counties this month alone can now suddenly wipe out all the digital tracks that allow us to cut them off in 0.2 seconds now; what could possibly go wrong with that idea??
    Thanks for playing, and we have some lovely parting gifts for you.
    Sorry all the kids who started getting wasted in junior high school 40 years ago f**ked it up for everyone, but those are the breaks.

  10. from Aesop:
    4) If you have more than two meds currently active, and haven't written the current list down, including strength and frequency, don't know exactly what they're prescribed for, and don't provide that up-to-date list to every doctor taking care of you, your pharmacy, and have a copy in your own possession and that of any significant other in your life, you're simply an idiot.
    There's no way to soften that blow.
    Own it.

    5) If something happens to you, and you can't play "Twenty Questions" while having a heart attack or stroke, or while unconscious, nor can you're stress-panicked relative either, why in blistering f**k can't you take the thirty seconds it would take while conscious and sober and healthy to make that list, and then put that behind your ID in your wallet? Think I might want to know the answers when you and you S.O. can't give them...???
    How bad do you want to live?

    6) NOT on a memory stick
    (I.T. won't let us plug your personal virus-uploader into our system - imagine that!).

    An actual 19th century, ink on paper, hard copy.
    Here's an amazing thing from 1989: you can edit that every time your meds change, and print out a new copy for about $0.01,@, using the word processing program included free on every computer sold after the Commodore 64k. You can even put the date on it, so we know how current the list is.
    It a friggin' modern MIRACLE!

    7) If you were really smart, you'd put your doctor(s) name(s) and phone numbers on the page too.
    And the list of all actual medical diagnoses you have (not the things you read about in People magazine and the National Hypochondriac Society's webpage, and think you have).
    And any significant surgeries and procedures, going back to having your tonsils out at age 7, and where you had them done.
    And anything you're actually allergic to, and the reaction they cause(d).
    And, if you know it to a metaphysical certainty (and we're STILL going to triple-check this) your actual blood type.

    All that will fit on a single typewritten letter-sized sheet. For most folks, you can fit in on a folded 3"x5" index card, trimmed down to the same size as your driver's license.

    That's actually news I can use when minutes count.
    The pharmacists will cream their shorts when we pluck it out and hand it to them.(And relax, we'll put it back, m'kay?)
    You could, y'know, actually look at the bottle labels and spell the names correctly, so you don't confuse Zantec with Xanax and Zithromax, or Dilaudid with Dilantin. (Ask me how I know you do this).

    8) If you want rock-star status, you could actually have a farking clue about why you take what you take, like 0.5% or so of you actually do, instead of expecting everyone else to know, or telling us "I take it because my doctor told me to" or the even-more popular "I dunno".
    I know, I'm getting into world-peace-and-a-pony territory with that one, but I can dream.

    200 competing electronic medical records aren't the problem, bad as that is in and of itself.
    People who take better care of the warranty cards on their toasters than their own health information is the problem, because there aren't 200 versions of that, there are 300M of them in this country alone.

    FFS, Don't Be That Guy.

    1. To Aesop:

      You didn't get what I said about that list. The thing that annoyed me was the "are you still taking X", not that they have record of me having taken it 10 years ago. To echo your approach, "past tense, present tense - it's a thing". The record is fine by itself, I want them to know I took XY successfully (or had a bad reaction to it), I just don't want them thinking I'm still taking something I was given once, 10 years ago, for reasons that should be obvious. Let me pick two.

      Let's assume they it had on my list I was taking an opioid for pain, when that prescription was for two weeks two years ago. That will mess up anything they want to give me. If I'm unconscious in the ER, having been hit by a car while walking, I just may want those. Worse, they may assume I'm an addict trying to get more of those opioids and I get into trouble.

      The other reason is what if they think I'm taking X and that would interfere with what I need now? They can't give me something that would greatly help me because when the two compounds meet, my liver leaps out of my body and runs away screaming. Except that I'm not taking X.

      They should be two separate lists.

      Besides that, I like to think my readers are different from the average person. Personally, I know exactly what I'm taking, exactly why, exactly what dosage, what schedule and all those other things you mention. It's not hard and I don't think one needs a 3 sigma IQ to do it.

      You're going by the logical fallacy that because a subset of the people that come into your ER are lying scumbags and idiots that everyone is a lying scumbag and idiot not capable of understanding these things. Even if it's the majority of what you see, it's not fair to assume it's the majority of the population. That requires your patient population to be a valid sample of the general population and I doubt that's true.

      It's a great example of why the medical providers don't want patients near their records. To recap what you said in 25 words or less, providers don't trust patients near their records because they think patients are idiots, drug addicts and con artists looking for a way to get more drugs or a new con job to run.

      Listen, I don't even particularly want to be responsible for my medical records. I'd like my word listened to when I try to correct the "are you still taking?" questionnaire, but even that seems difficult to achieve.

    2. from Aesop:
      My comments weren't solely directed at your objections, SiG.

      1) What's needed is electronic perspective.
      If we see you were taking an antibiotic, we know you're taking it for a course, not life.
      Pain, OTOH, can be chronic or acute.
      What the record should reflect is current and ongoing vs. a one-time thing. Like I said about the system's designers doing their thing in a provider-free vacuum, from total ignorance of what the program needs to do, there's a reason it doesn't differentiate that bit of data: they're not bright enough to write it so it does, because programmer, not end-user nor consumer.

      2) While your sense of your commentariat is probably true, some comments belie that assumption. The fact that you know and have a record of your own meds puts you into a sub-group of the population approaching single digit percentages, based purely upon direct observation of tens of thousands of a representative sample. I've probably only triaged and taken histories from 50K-100K patients over the years, so maybe my sample is too small to be statistically significant, but my statistics class would suggest otherwise, even being anecdotally based on only 20 years' experience at 15 different ERs, including two of the busiest on the entire planet.

      And no, it certainly doesn't take a 2 sigma IQ to accomplish; most nights, I'd settle for an IQ in the very low triple digits. But for every 110, there has to be a corresponding 90, and for every 130, there's a 70, somewhere. If you look at the sub-heading on my ER blog, you'll see who the overwhelming end of the gene pool are in my world.
      TL;DR: If you're home in bed after 11PM, you odds of being in the ER between the age of 25 and 65 are almost nil, unless you're either
      a) having a baby, or
      b) a fucking idiot
      I figured that one out in the first three hours as a young student clerk recording visit demographics in the log of an ER back when the president was once again prematurely orange.

      Take a SWAG how many times, when I ask "What pills do you take?" the answer received is "I take one big white one, a little blue one, and a half of the red one." delivered deadpan and straight-faced...

      And I've literally had fights break out when I try to elicit that minimal information from people, who are convinced from total ignorance of reality when i ask that question that I'm wasting their precious time, because "It's all in your computer..."
      Straight-up fucktards, I tell you.
      Bastard-coated bastards, with bastard filling, exactly as John McGinley's character observed.


      Who lie to your face, and then tell a different lie to the doctors two minutes later, and think he and I never talk.

      3) This is no logical fallacy, nor a lowest common denominator.
      At which bank does the establishment allow the customer to edit their balance online?
      I'll wait.

      4) I don't want you responsible for your medical record; I just want you to be responsible, period. You undoubtedly are; it's the other 299.999999M assholes I'm worried about.
      The solution to "Are you still taking" questionnaires is to simply update the entries as necessary. I'm conversant in about seven different EMRs, at last glance.
      In none of them can even *I* differentiate between current/active meds, and former meds. Unlike ink-and-paper charting, there's not even the option to denote that information, so I can't record what the EMR won't let me.

    3. from Aesop:

      *I* didn't write the gorram things, and I've certainly never been consulted in any way, shape or form about how they should work or appear. I don't know anyone who was asked or consulted either.

      You're far techier than I ever will be; see if you can figure out where the problem lies, knowing that.

      Though I dropped it out of sheer boredom, I majored in computer science, but never completed that degree, nor work in that field. I similarly don't expect computer scientists to know jack or squat about medicine or medical care delivery.
      I do have a quaint notion, however, that if they're going to attempt to write code for that field, some research beyond watching old 3 Stooges shorts would probably be a great idea, if only for the novelty of the approach in their field.

      But until the assatrds who write code in a vacuum are cudgeled into writing patient- and care-delivery-focused EMRs, you're going to get the finest model of care the Soviet-style health care system will ever manage to deliver, like a boot stomping on a human face, forever.

      And BTW, I'm a patient too, not to mention a pretty damned conscientious care deliverer, so if you think I'm a fan of how it is, you're sincerely mistaken.

      The problem is, the people in charge of fixing things are the ones who effed it up so royally in the first place.

      So, asking for a friend, how many times to you keep taking your car back to the mechanic who rigged your transmission such that it fell out of the car...?

    4. D'oh! I just knew I should have explained That requires your patient population to be a valid sample of the general population and I doubt that's true. One of those thoughts that evaporated due to insufficient coffee.

      What I'm thinking is along the lines of your rule of thumb: If you're home in bed after 11PM, you odds of being in the ER between the age of 25 and 65 are almost nil, unless you're either
      a) having a baby, or
      b) a fucking idiot

      What I was thinking is that I'm under the impression from talking heads that a lot of uninsured people use the ER as their walk-in clinic. That's 3 sigma - as in the normal population doesn't do that. Then add in the people "doing stupid things with stupid people at stupid hours of the night", and you know they're not close to the statistical normal, either. With the exception of someone having reason to believe they're having a heart attack or stroke or involved in an accident, (which can be some other idiot's accident and you happen to be in the wrong place at the wrong time) normal people go to the ER when a doctor sends them or someone brings them.

      So I think the population you deal with is different from the other 5 sigma of country, probably very significantly.

      I'm totally with you on the software abomination of not paying attention to the people doing the work. Seen that in my ex industry, too. Far too much "make the customer adapt to what we write" rather than "adapt what we write to the customer".

      We could have some conversations that I think could be productive; not just about this, but certainly partly this. The comments form isn't a good place, though.

    5. from Aesop:
      True, but factor this in:
      The people most likely to be taking multiple meds aren't the ones using the ER for primary care.
      The indigent idiots do indeed do that, but they seldom have multiple meds, because no regular doctor (which brings its own problem set).

      So the most pharmacy-illiterate folks are the ones with the best insurance, a raft of specialists they see regularly, and more meds than they can remember (which number is generally three or more).

      And while I get that I don't see the brightest patients, for the same reason cops never catch the brightest crooks, after this amount of time, data clusters appear, and certain trends become more apparent, even if we allow for culling the outliers.

      Agree about the comments as a forum.
      Normally after one or two extended-length replies, I've made a blog post, and post same.
      But I've beaten this topic near to death over the years, and it's just as relevant now as when I started, and I frankly was just happy to be thinking about something that wasn't related to the Kavanaugh three ring circus and insane clown posse.

  11. I've dealt with the problem by not going to doctors. When I get sick, I wait a while, and then I get over it.

    Other than trauma care, there isn't much that modern medicine can do that doesn't boil down to ``then you get over it.''

    1. Pretty much.

      Except that modern medicine is great at some surgical interventions. I've always heard that warfare advances medicine, and they get really good at trauma treatments. They're also really good at things like repairing that bad hip or removing that bad gall bladder or appendix. Bad, painful knees are harder - I know far fewer people with successful knee replacements compared to hips. And if you have painful, arthritic hands and fingers: tough luck. No fixes.

      They're really bad at chronic diseases like diabetes and heart disease. Which is what the civilized world is suffering from.

  12. from Aesop:
    Au contraire.
    Mom, God rest her, had both knees done, and was toddling around into nearly her late 80s just fine, despite emphysema, which was what finally did her in.

    And we do better with heart disease every year.
    Coronary arterial bypass grafts (which are so fifteen years ago) work, but not nearly as well nor as long as simple coiled spring-metal coronary stents do.
    The former was a marathon surgery, and months of difficult recovery; the latter can be done under a local anaesthetic while the patient watches it on TV, and they're home in days, not weeks.

    Neither of those are trauma-based.

    "And you get over it" doesn't work for appendicitis much.
    Or ectopic pregnancy.
    Or diabetic ketoacidosis.
    Or stroke.
    Or sepsis, which kills more people than trauma, and nearly as much as cancer or heart disease.

    You' been lucky, or simply just not that sick.
    The alternative spelling of "Suit yourself" is "suture self".

    And pain control is a legitimate emergency. I've had an abscessed tooth and kidney stones: ask me how I know. Oh, and neither of them is a guaranteed "then you get over it" thing either.

    Don't believe me, though.
    Call up Jim Henson.

    1. I said, I know far fewer people with successful knee replacements compared to hips.

      You said,Mom, God rest her, had both knees done, and was toddling around into nearly her late 80s just fine, despite emphysema, which was what finally did her in.

      I know five people who have had hips replaced, and some have had both replaced (my wife is one of those). All of them were successful. The people were mobile quickly and swear they'd do it again. One guy woke up from having the first side replaced and his first words to the surgeon were, "let's do the other side".

      I know three people who have had knee replacements. All three had more problems, recovery took much longer and two of three had permanent degradation.

      I'm not saying there are never good outcomes, I'm simply saying I know more people who had problems with knee replacements than hip replacements.

    2. from Aesop:

      And I'm sure that's true.

      As a rule, if someone suggests back surgery, run away!

      If they want to do a knee replacement, put it off for as long as you can (but know that cartilage never grows back).

      Hip replacement, OTOH, means you can get it, and walk, or not get it, and die of septic shock from bedsores in a few months, being completely immobile. So the benefits outweigh the risks handsomely.

  13. (cont.)
    from Aesop:
    It boggles the mind that folks here, now, have access to health care that's the envy of 6000 years of recorded human history, and would rightly have been regarded as magic even a century ago, and still find more to bitch about that a fair universe should allow.

    Stay home; I don't care. I've got job security forever, unless immortality breaks out somewhere.

    Most health care boils down to advances in sanitation and public health, which is why the population is now pushing 8B instead of 1B, with commensurate lengthening of life expectancies; and deaths related entirely preventable causes, being either the
    "Hold my beer, and watch this..." or
    "I weigh 350 pound, down a twelve pack, and smoke two packs a day, and I feel fine" type.
    Google the top ten causes of death.

    Grow a brain, wash your hands, push away from the table, and get off the couch, and I'll probably never see you until your funeral, if I outlive you.

    The 70-year-olds I meet are all on 5-10 prescriptions.
    They don't make it to 90.

    The 90+-year-olds I meet are usually just taking vitamins (because they didn't screw themselves up to need the other things in the first place.)

    But the mortality rate is still running right at 100%.
    The only choices you get to make are how long before you get to that point, and how torn up you want to be for the last 5-10 years of your life.

  14. Modern Western medicine....and the associated Gordian Knot called " Medical Records" is a horrible, costly, inefficient and terrible system to rely on for ones well being. But.....just as capitalism is a horrible economic system.....both are VASTLY Superior to ANYTHING else humanity has tried.