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    (Original post by Isometrix)
    Why don't we adopt the same system as I think healthcare in Singapore. Over there doesn't everyone get like a certain amount of credits for healthcare, which is free, but it puts the responsibility on them on how they use it?
    So there is a (free) limited number of credits to use? And do you 'top up' via paying privately? Hmm doesn't seem very fair for chronic sufferers or those who get illnesses when young - such as leukaemia. I like our system, we're quite lucky we have access to so much so easily.

    (Original post by Captain Crash)
    Sure, I agree - sure the private medical companies for their liabilities (indeed, I believe Lansley said as much), but that shouldn't mean that the NHS shouldn't treat the breast implants in the first place
    Stupid question I'm sure - but what exactly is wrong with the implants - is it the implants themselves, the procedure? (A bit out of loop with medical news). Because if it's down to a procedural/defective implants - then don't believe the NHS is responsible at all or the patients. Its the private sector that should fork out to clean it's own mess. Like say I did a cataracts op privately - but the lens I used was defective or I did the procedure wrong, then why should I expect public healthcare (which is rationed already) to also have to deal with this.
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    (Original post by Supermassive_muse_fan)
    So there is a (free) limited number of credits to use? And do you 'top up' via paying privately? Hmm doesn't seem very fair for chronic sufferers or those who get illnesses when young - such as leukaemia. I like our system, we're quite lucky we have access to so much so easily.
    Well their government forces every citizen to put aside a certain % of their monthly income into healthcare savings. This can be pooled together within families too. They use this to co-pay part of their medical expenses, which cost more for a higher level of service. Also to keep basic healthcare affordable they subsidise everyone through means testing, those who earn less get a higher subsidy. I guess it reduces overutilisation and prevents the healthcare system from being exploited?
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    (Original post by Isometrix)
    Well their government forces every citizen to put aside a certain % of their monthly income into healthcare savings. This can be pooled together within families too. They use this to co-pay part of their medical expenses, which cost more for a higher level of service. Also to keep basic healthcare affordable they subsidise everyone through means testing, those who earn less get a higher subsidy. I guess it reduces overutilisation and prevents the healthcare system from being exploited?
    Probably, but it adds a barrier to consultation. Imagine all those people who are already reluctant visitors to their GP, but with another layer of excuse to avoid going.
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    (Original post by Kinkerz)
    Probably, but it adds a barrier to consultation. Imagine all those people who are already reluctant visitors to their GP, but with another layer of excuse to avoid going.
    On the other hand, no A&E flooded with drunks, no granny dumping, and we wouldn't have wards chock full of dementia, unwanted by family, refer social ?plan.

    Somehow combine this with the french reimbursement system, and it would be perfect.
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    (Original post by Kinkerz)
    Probably, but it adds a barrier to consultation. Imagine all those people who are already reluctant visitors to their GP, but with another layer of excuse to avoid going.
    Well you could also look at the flip side to that argument. Imagine all the people who keep coming to their GP for self-limiting/trivial things that take up time and resources.

    Also they'd be paying less for low levels of service, which would probably account for most gp consultations anyway. And those on lower incomes would get a higher subsidy on top of that too, so relatively speaking the cost wouldn't really act as a deterrent.
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    (Original post by Isometrix)
    Well you could also look at the flip side to that argument. Imagine all the people who keep coming to their GP for self-limiting/trivial things that take up time and resources.

    Also they'd be paying less for low levels of service, which would probably account for most gp consultations anyway. And those on lower incomes would get a higher subsidy on top of that too, so relatively speaking the cost really wouldn't really act as a deterrent.
    (Original post by Wangers)
    On the other hand, no A&E flooded with drunks, no granny dumping, and we wouldn't have wards chock full of dementia, unwanted by family, refer social ?plan.
    Not saying I disagreed with it. Just adding a different perspective.
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    Oh, my back. Buggeration. I'm a very old 20.
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    (Original post by Wangers)
    AFAIK Crash course:

    Bilirubin comes in 2 forms - when initially produced from haem breakdown, it is unconjugated and floats around in blood - therefore high unconjugated bilirubin is one possible indicator of acute haemolysis.

    There are 2 main ways out of the body, urine and excreta. UC Bilirubin is insoluble - therefore it dosn't go in urine. This is a problem because it floats around in blood and starts affecting acid base. the gut is a major conjugation factory as is the liver, conjugated bilirubin can go out in the urine. This is also why hepatic failure gives clinical jaundice - because the UC bilirubin sticks around and is clinically detectable at around 35 whatever the units are.

    Acute haemolysis would give unconjugated bilirubin which is insoluble. The source is a deficiency in GPD, which means the RBC can't run ?NADPH, which means it can't keep ions in the right places, osmotic effects therefore destroy it.

    Once Bilirubin is conjugated it can go one of two ways

    conjugated bilirubin -> Urobiliogen -> in urine
    conjugated Bilirubin -> Steabililogen in the excreta

    My guess would be that in the acute case, the liver is overwhelmed, and so you get a backlog of all 3 with some urobilinogen in the urine which would colour it.

    Side point -

    If the conjugated bilirubin can't get out, then you get high levels with no uribilinogen in the urine - This happens in complete obstructive jaundice, which is why you get dark urine, pale stools - because it can't go through the gut.

    This is also why in ?Gilbert's you can do a urine dip (should show positive urobilinogen).


    Thanks! thats cleared things up
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    Regarding the PIP implants - why exactly are we removing/replacing them? As far as I understand it, there's a marginally increased risk of rupture (I understand they're made of substandard silicone, but on a practical basis rupture is the issue), and with rupture comes increased scar tissue and possibly pain & mishapen boobs. But it's not life threatening or catastrophic, whereas to offer to remove/replace is introducing all the (potentially life threatening) risks of surgery. (I'm ignoring the reports of cancer in France cos my understanding is that it's not necessarily causation but correlation).

    There are similar issues (increased risk of problems compared to expected risk) in lots of medical implants - De Puy's ASR system is one that comes to mind, and yet the advice by and large was not to replace unless there were symptoms of failure, so why is the immediate response to PIP to offer to remove them? Why can we not leave them in, knowing that we're talking about a small group of patients, with a small risk of rupture, and therefore bypass this entire argument? Is there a way of assessing whether a breast implant is about to rupture, and therefore offer MRI or other 'safe' imaging to assess this rather than taking the possibly overactive approach of immediately removing every implant?
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    (Original post by Isometrix)
    Well their government forces every citizen to put aside a certain % of their monthly income into healthcare savings. This can be pooled together within families too. They use this to co-pay part of their medical expenses, which cost more for a higher level of service. Also to keep basic healthcare affordable they subsidise everyone through means testing, those who earn less get a higher subsidy. I guess it reduces overutilisation and prevents the healthcare system from being exploited?
    I think the Singapore health system is excellent. In fact, I remember reading about how it was the most cost effective health system with excellent outcomes.

    NHS = way too bloated and drowning in the bureaucracy that a healthcare monopoly provides. I am all for a mixed payment system such as the Singapore model.
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    Just to clarify, the test for the 8th (Vestibulococlear) cranial nerves uses a 512Hz Tuning fork right? And its the same fork for both Rinnes and Webers tests?
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    (Original post by planetconwy1)
    Just to clarify, the test for the 8th (Vestibulococlear) cranial nerves uses a 512Hz Tuning fork right? And its the same fork for both Rinnes and Webers tests?
    Its the big one 256Hz for the webers test in the middle and the little one 512Hz for Rinnes test. Could test both the vestibular and cochlear parts of the nerve if you like. Shut your eyes, feet together and do you fall over? But make sure your actually standing there to catch them. Rombergs test i think its called, to differentiate between sensory (propreoception) and cerebellar ataxia.

    On a different note - i already have exam/revision munchies and i may need a crane to get me to my finals exams.
    Gym time.
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    (Original post by digitalis)
    I think the Singapore health system is excellent. In fact, I remember reading about how it was the most cost effective health system with excellent outcomes.

    NHS = way too bloated and drowning in the bureaucracy that a healthcare monopoly provides. I am all for a mixed payment system such as the Singapore model.
    Well it just directly places responsibility to one's own health, when considering the number of self-inflicted cases that are admitted to the GP/hospital, could save a lot of money and improve social well-being in general.
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    (Original post by fairy spangles)
    Its the big one 256Hz for the webers test in the middle and the little one 512Hz for Rinnes test. Could test both the vestibular and cochlear parts of the nerve if you like. Shut your eyes, feet together and do you fall over? But make sure your actually standing there to catch them. Rombergs test i think its called, to differentiate between sensory (propreoception) and cerebellar ataxia.

    On a different note - i already have exam/revision munchies and i may need a crane to get me to my finals exams.
    Gym time.
    I was taught a simple screening procedure

    Get a pt to close their eyes, feet together, then hold out their hands. Then, slowly get them to stand up on tiptoe. If they can do this, theres almost certainlly nothing wrong with the NS.
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    Back from a months ban. Come at me, mods.
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    (Original post by Wangers)
    (1)As I am now saying for the 3rd time - yes you can. You name them as negligent companies who refuse to look after their patients. These companies are like any other company - they trade on reputation - they will then bend over backwards to repair the damage. This will work. And even if it dosn't - what I would then do is go directly to threatening the surgeons involved - with name and shame stories - they will act. I would then go after the companies after all the work has been done. I would also go after the surgeon's GMC registrations - if this was NHS work this would have been done already, the CEO of the hospital would have resigned. You have to play hardball, these companies will cave. It is absolutely practical. I would be calling up these surgeons directly, 'either you put the work right for free and pay damages - and you might even get some good publicity for it, or I will wreck your career within the next hour.' Then wait til they've done the work and bring cases to the GMC anyway.

    (2) - I foresee what will happen - they'll slime their way out of it.

    My method ensures that the women get treatment, costs are nil to the state, women get compensation and the surgeons involved are deciplined. Too long has the NHS been a soft target.
    Except, no you can't. Negligence is far from proven. The private medical companies inserted the implants in good faith. The liability lies with either the PIP company (which doesn't exist anymore) or with the medical standards body, which doesn't have the money to put this right. There is no straight forward legal imperative to make them pay and certainly the GMC wouldn't get involved.

    And that's not to mention there is a massive (and IMO wrong) precedent dating back to the NHS charter that the NHS looks after the complications of private patients. This week alone, my firm admitted two patients with post-op complications from the private hospital across the way.

    You can, of course, play hardball, but that's no guarantee it will work. Also, considering many of the surgeons are also NHS surgeons, ruining their careers perhaps isn't the best way to manage your workforce....
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    (Original post by Supermassive_muse_fan)
    Stupid question I'm sure - but what exactly is wrong with the implants - is it the implants themselves, the procedure? (A bit out of loop with medical news). Because if it's down to a procedural/defective implants - then don't believe the NHS is responsible at all or the patients. Its the private sector that should fork out to clean it's own mess. Like say I did a cataracts op privately - but the lens I used was defective or I did the procedure wrong, then why should I expect public healthcare (which is rationed already) to also have to deal with this.
    As I mentioned above, the liability lies either with the company that made the implants (which now doesn't exist) or the body that approved them as reaching medical standards (which doesn't have the money to pay out).
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    (Original post by Becca-Sarah)
    Regarding the PIP implants - why exactly are we removing/replacing them? As far as I understand it, there's a marginally increased risk of rupture (I understand they're made of substandard silicone, but on a practical basis rupture is the issue), and with rupture comes increased scar tissue and possibly pain & mishapen boobs. But it's not life threatening or catastrophic, whereas to offer to remove/replace is introducing all the (potentially life threatening) risks of surgery. (I'm ignoring the reports of cancer in France cos my understanding is that it's not necessarily causation but correlation).

    There are similar issues (increased risk of problems compared to expected risk) in lots of medical implants - De Puy's ASR system is one that comes to mind, and yet the advice by and large was not to replace unless there were symptoms of failure, so why is the immediate response to PIP to offer to remove them? Why can we not leave them in, knowing that we're talking about a small group of patients, with a small risk of rupture, and therefore bypass this entire argument? Is there a way of assessing whether a breast implant is about to rupture, and therefore offer MRI or other 'safe' imaging to assess this rather than taking the possibly overactive approach of immediately removing every implant?
    The problem is that once the implants burst, they cause pain and scarring and are nigh on impossible to completely remove. I'm not sure of the ability to predict bursting, but I imagine the move is one of cheaper prevention rather than have potentially thousands of new chronic pain cases. And that's before we even approach the psychological aspect...
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    (Original post by Wangers)
    I was taught a simple screening procedure

    Get a pt to close their eyes, feet together, then hold out their hands. Then, slowly get them to stand up on tiptoe. If they can do this, theres almost certainlly nothing wrong with the NS.

    However if they fall forwards instead of backwards and your standing the wrong side = lawsuit.
    But if your lucky and standing on the right side better hope the patient doesnt fall on top of you
    Think im sticking with the simple, least sueable way.
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    (Original post by digitalis)
    I think the Singapore health system is excellent. In fact, I remember reading about how it was the most cost effective health system with excellent outcomes.

    NHS = way too bloated and drowning in the bureaucracy that a healthcare monopoly provides. I am all for a mixed payment system such as the Singapore model.
    Singapore is, on the face of it, the most cost-effective healthcare system spending approximately half of what we spend as % of GDP.

    However:

    -They have proportionally half the >65 year population that we do. If we knocked off half our elderly population, we would see our healthcare costs plummet.
    -The government implements strict price controls on healthcare avoiding a lot of healthcare inflation.
    -Singapore is practically a single city. Providing healthcare there is always going to be cheaper than with a country like ours.
    -Singapore is full of migrant workers who contribute to GDP, but aren't eligable for healthcare and therefore distort the % of GDP stat.
    -Healthcare accounts haven't worked anywhere else it is tried, in particular the US.

    In short, the 'success' of Singapore has little to do with the healthcare accounts and more to do with the reasons stated above.
 
 
 
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