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On 25 Sep 2005 15:08:10 -0500, "Howard McCollister" wrote:
>>>This patient will still need to be admitted, his care supervised by
>>>an attending physician. It won't be free, or even cheaper. Certainly
>>>not in the sense that you can get a cheap haircut at a barber college.
...to which SJ Doc responded:
>> Where the hell have you been for the past dozen years and more?
>> An uncomplicated inguinal herniorrhaphy is performed on an out-
>> patient basis rather more often than not nowadays. The cutters
>> practically slap the patient awake in the recovery room and make
>> him jog down the corridor to get dressed.
...whereupon "Howard McCollister" wrote:
>Where have YOU been? Patients don't just walk into the surgery area, take a
>number, and wait to have their hernia fixed. But by all means, I'd be very
>interested to have you explain to me all the ins and outs of how surgery is
>performed for inguinal hernia - or anything else where you believe your
>experience exceeds mine.
I haven't had all that much trouble getting patients referred to
general surgeons who will evaluate an uncomplicated individual
in the office or the clinic, "buff" him preoperatively, and get him
scheduled for an outpatient inguinal herniorrhapy. What's so
damned complicated about the process? And what's *your*
experience in the medical and/or surgical management of such
patients? Do you prefer the Halstead technique or the Bassini?
And what's your opinion of endoscopic extraperitoneal hernia
repair (see http://www.sma.org.sg/smj/4506/4506a1.pdf)
procedures?
>> You're right that having the surgery performed while on a teaching
>> service won't be free, but what makes you think that it will be less
>> expensive if it's performed by a surgeon in private practice in the
>> same city or surroundings?
>I didn't say that. Did I?
And what has that to do with the price of pearls in Perth Amboy?
What you had said was: "This patient will still need to be admitted,
his care supervised by an attending physician. It won't be free, or
even cheaper." That was the comment to which I responded.
As a rule, a patient seeking care through the outpatient clinic of a
surgical training program tends to pay less for his/her care than one
who consults a surgeon in private practice in the same health care
market. Your particular bucketful of bilge about how "It won't be
free, or even cheaper" was sloshed all over that fact.
Do you believe that valuable goods and services should be devoted
to the benefit of a patient with no expectation of payment whatso-
ever? Or that a patient is not free to determine for him/herself
whether or not he/she will seek care of possibly lesser quality (on
a teaching service) in exchange for a lesser price?
Hm. What *do* you say? Thus far, not much worth listening to.
----------------------
...[E]very individual necessarily labours to render the annual
revenue of the society as great as he can. He generally, indeed,
neither intends to promote the public interest, nor knows how
much he is promoting it. By preferring the support of domestic
to that of foreign industry, he intends only his own security; and
by directing that industry in such a manner as its produce may be
of the greatest value, he intends only his own gain, and he is in
this, as in many other cases, led by an invisible hand to promote
an end which was no part of his intention. Nor is it always the
worse for the society that it was no part of it. By pursuing his
own interest he frequently promotes that of the society more
effectually than when he really intends to promote it. I have
never known much good done by those who affected to trade
for the public good.
-- Adam Smith, *The Wealth of Nations* (1776)
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