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WTF?

2014/02/28

illnesses like cancer are not considered urgent, unless you are in the final stages.”

Because you know, then the State can exhibit “humane” behavior. The idiocy of this kind of thinking is beyond me. There are cases where the early stages should be treated as urgent. You know why? Because it is an investment and it works this way: You treat their condition and they get to work and pay you taxes. Wait until they get to the final stage and you’re billed for whatever treatment you offer them without any actual fiscal or moral return.

Then again, such thinking should not surprise me: A system does what a system does, despite its stated purpose. We know from Systemantics that the stated purpose is never served.

Update: This is not a post about cancer. This is about how a health system chooses to treat chronic situations. I thought it was obvious. Chronic situations are a real productivity killer, but hey what do I know, right?

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6 Responses to “WTF?”

  1. j95 Says:

    “Urgent” in the medical sense is something that _must_ be treated within hours or days or it will rapidly and with great certainty escalate. Cancer in early and middle stages simply does not work like that.

    Even in the earliest stages, even with the most aggressive forms, treatment is almost always scheduled in terms of weeks or months. That’s why you get e.g. a Pap-test or a full body scan for melanomas every 1-2 years and not every week.

    And it is never guaranteed to work. Almost every type of tumor removal means at least 5 years of follow-up exams (again: every six or twelve months). Which usually do reveal metastatic/secondary tumors, again to be treated in months, again to be followed up for years.

    It is NEVER a matter of removing a single tumor in the next couple of hours and be done with the whole matter.

    Basically cancer (until the final stages) is always chronic, and chronic is the exact opposite of urgent.

  2. adamo Says:

    The problem is that if you allow for a condition to become urgent in order to treat it, then it is actually game over.

    And given my experience with the same health system on chronic conditions, I guarantee you that the emergent behavior of the system is exactly this:

    We will not invest in the possibility of making your chronic condition manageable so that you too can be a contributor to the society. We will undertake a minimal cost only when it becomes a medical emergency.

  3. j95 Says:

    Again: Cancer does not work like you presume it does. There is no cheap or quick or easy way to treat it.

    Here is how it works:

    http://xkcd.com/931/

    Even your cost-comparison premise is wrong. Giving morphine and maybe some life support to a dying patient for a couple of weeks is orders of magnitude cheaper to a typical 5 year treatment with chemos and the suchlike.

    Finite resources. ER. Treat someone with a bacterial pneumonia or someone with lung cancer at early stages? That’s the real dillema. And the answer is the lung cancer ES patient has no business in the ER.

  4. adamo Says:

    Please consider the word “cancer” as an instance of a variable in the above phrase.

    Please also consider that I actually eat the dogfood that this policy already serves.


  5. The problem is that we are losing the point here, trying to be rational or whatever. Fuck growth, fuck prosperity, fuck everything apart from health. Shouldn’t survival be the highest, by miiiles, priority of any community, group, state, government, call it as you want?

    What on earth are we doing here discussing “urgency and…systems”?

  6. adamo Says:

    It becomes tricky when you bring survival of the group into the picture. Consider an amputation performed because otherwise infection will spread and the community of cells will vanish. By cutting your limb, the survival of the rest of the community is achieved at the expense of both the infected and not infected cells that are removed from the main body.

    So in the same manner, since health spending is vital to the survival of a community, one can easily come to the conclusion that you should not even treat the hopeless serious conditions since they are unmanageable anyway.

    I won’t continue down on this path, for Godwin’s Law is three replies forward.

    Urgency is a label that prompts a system to take a certain action.


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