View Full Version : BMI, not a useful indicator of health
I'm glad that it's finally being viewed that the BMI has serious limitations:
BMI Not a Good Measure of Healthy Body Weight, Researchers Argue
When it comes to defining what body weight is considered healthy, one type of measurement does not fit all, some scientists say.
Body mass index is the standard metric for determining who is normal-weight, overweight and obese, but BMI is not an accurate measure of fat, and doesn't explain the causes of poor health, scientists argue in an editorial today (Aug. 22) in the journal Science.
Obesity can be a major risk for diabetes, heart disease and death, yet paradoxically, some studies suggest being overweight can improve survival of chronic diseases.
"Most studies depend on BMI, and we know it's not a very accurate measure," said Dr. Rexford Ahima, a medical professor at the University of Pennsylvania, in Philadelphia, and co-author of the editorial.
A person's BMI is calculated as her weight in kilograms divided by her height in meters, squared. A BMI of 18.5 to 24.9 is considered "normal," a BMI of 25 to 29.9 is "overweight," and a BMI greater than 30 is "obese."
People with BMIs higher than 30 are at an increased risk of dying from heart disease, diabetes, cancer and other diseases, many studies have shown. But several recent studies suggest that in some cases, a high BMI could actually protect a person from dying of heart failure, kidney failure and other chronic diseases.
When someone has a chronic illness, having more fat could possibly provide additional energy reserves. And in some cases, a low BMI may be a result of a person having an illness.
The health risks and benefits of obesity have generated "a lot of sniping back and forth between different groups of researchers," Ahima told LiveScience.
The problem stems from the fact that BMI is an inaccurate measure of health, Ahima said.
For one thing, BMI doesn't take into account fat, and it doesn't indicate where fat is distributed on the body. Belly fat (fat around the abdominal organs) increases the risk of diabetes, heart disease and death, whereas peripheral fat (fat beneath the skin elsewhere in the body) may be more innocuous, studies suggest. BMI also fails to account for differences in race, gender and age.
Cont:
http://www.livescience.com/39097-bmi-not-accurate-health-measure.html
As a Clinical Exercise Physiologist and Retired medical profession. It is absolutely a viable tool for assessing and risk stratify non physically active people. There are the acception of "short stocky" people who have low fat mass and have a high lean mass for ex. But for the sake of strictly BMI, HT, wt and age are factors. It does however become totally useless and sometimes detrimental when it is used as an evaluation tool for employment or medical insurance purposes. In these cases, use of many ACSM certified grads can have a job and BMI can be done away with as a primary evaluation and risk stratification tool. Another example of when BMI is very useful at a glance is in a new patient admission assessment. When a physician does a non urgent morning round he will most likely look for the BMI on the first page of the assessment immediately, "not a lot of acceptions to the rule admitted to hospitals." BMI will always have its place unless BIA or skin folds become standard as a universal evaluation tool for Ex. Which it needs to be for the insurance or employment purposes at a minimum.... Risk stratification places individuals into populations based on age, sex, gender and race will not be popular with minorities!
The article the OP cited is basically common knowledge in the ExPhys community but in order for the studies to be used and any of the evaluation tools to become standard, it will have to be recognized by the health assessment stands organizations. These would be The American College of Sports Medicine and The American Heart Associan and a few other standard organizations at a minimum.
Nevertheless the article was very helpful and in formative to people who otherwise lack the basic knowledge on the subject. But MRI's and DEXA scan's are a pipe dream as a preventative health maintanece tools. Thanks for the post, I am still waiting on the "loan" I mean BCA I bought from PSA :)
As a Clinical Exercise Physiologist and Retired medical profession. It is absolutely a viable tool for assessing and risk stratify non physically active people. There are the acception of "short stocky" people who have low fat mass and have a high lean mass for ex. But for the sake of strictly BMI, HT, wt and age are factors. It does however become totally useless and sometimes detrimental when it is used as an evaluation tool for employment or medical insurance purposes. In these cases, use of many ACSM certified grads can have a job and BMI can be done away with as a primary evaluation and risk stratification tool. Another example of when BMI is very useful at a glance is in a new patient admission assessment. When a physician does a non urgent morning round he will most likely look for the BMI on the first page of the assessment immediately, "not a lot of acceptions to the rule admitted to hospitals." BMI will always have its place unless BIA or skin folds become standard as a universal evaluation tool for Ex. Which it needs to be for the insurance or employment purposes at a minimum.... Risk stratification places individuals into populations based on age, sex, gender and race will not be popular with minorities!
The article the OP cited is basically common knowledge in the ExPhys community but in order for the studies to be used and any of the evaluation tools to become standard, it will have to be recognized by the health assessment stands organizations. These would be The American College of Sports Medicine and The American Heart Associan and a few other standard organizations at a minimum.
Nevertheless the article was very helpful and in formative to people who otherwise lack the basic knowledge on the subject. But MRI's and DEXA scan's are a pipe dream as a preventative health maintanece tools. Thanks for the post, I am still waiting on the "loan" I mean BCA I bought from PSA :)
Personally, I don't consider BMI "useless" in all settings as some do, but few in the medical arena seem to understand or appreciate its considerable limitations. I, and others, are "obese" by BMI standards, which exposes one of its glaring limitations: it actually penalizes athletic/muscular types and is not a good indicator of actual health status when used alone.
To easily and quickly evaluate large numbers of people in the general population, it's a tool in the tool box if those using it also understand its limitations, and I thought the article posted did a good job of exposing those limitations.
BMI is a crude tool, but its absolutely useful at the extremes and as a blunt screening tool for large populations. True, the current Mr. Universe has a BMI of 44, but especially in the USA, that subset of the population is so small that it doesn't invalidate the use of BMI as a statistically valid means of assessing the general obesity of the population. When I have a patient with a BMI of 44 sitting in my office, it doesn't take any clinical acumen to decide whether they're obese or muscular. I do agree that one has to be a little more careful in the 25-35 BMI range, and body composition might be a valid consideration for those patients when considering their obesity relative to comorbidities.
BMI is a crude tool, but its absolutely useful at the extremes and as a blunt screening tool for large populations. True, the current Mr. Universe has a BMI of 44, but especially in the USA, that subset of the population is so small that it doesn't invalidate the use of BMI as a statistically valid means of assessing the general obesity of the population. When I have a patient with a BMI of 44 sitting in my office, it doesn't take any clinical acumen to decide whether they're obese or muscular. I do agree that one has to be a little more careful in the 25-35 BMI range, and body composition might be a valid consideration for those patients when considering their obesity relative to comorbidities.
Well, of course you're totally correct in the above but perhaps overestimating the "clinical acumen to decide whether they're obese or muscular" of many out there. It's astounding to me the number of athletic/muscular people I know (myself included) who have been told they were "obese" due to their BMI when one look at the person was very obvious it was not fat but muscle. No doubt, such people are a statistically rare (sadly...) but can be put through a lot of BS over it due to the lack of apparent understanding of the limitations of the BMI.
People have lost jobs over it, insurance issues, etc over the lack of understanding of that limitation where muscular/athletic types are concerned.
To be sure "BMI is a crude tool, but its absolutely useful at the extremes and as a blunt screening tool for large populations" but in my experience, the clinical acumen to decide whether they're obese or muscular surprisingly few and far between.
For obvious reasons, that's one of the limitations of the BMI that tends to stick with me, and perhaps improved understanding of it's benefits and drawbacks (per articles like that) can be a net +.
Yes it is unfortunate that most people that do moderate to intense static and aerobic exercise get lumped into the obese category and hit with all the cardiopulmonary and metabolic risks associated.
But this is an old dead horse and many healthcare professional all the way down to the personal trainer and body building enthusiast have grumble about for many years.
The fact is BMI as it is used for primary clinical and nonclinical health evaluation will not change. But, it can be used in conjunction with other health and fitness evaluation and risk stratification techniques according to the ACSM, CDC and AHA recommendations. Believe me there are many 4 year and master degree that would love it too.
Being big and strong with a dedicated workout and a strict diet is no doubt a much higher bar than most stagnant people hold. What you eat is very important just as a safe aerobic and static exercise regimen is. Following ACSM recommendations have the strongest evidence of lowering mortality rate by reducing risk for: cardiopulmonary and metabolic disease among others.
Remember the heart has to pump blood all the same whether its fat or lean mass. Too much of either can have a negative impact on your cardiovascular system. Nearly a mute point but there is sufficient clinical data on the subject. (EDIT: The heart does adapt with the proper exercise but stroke volume has to increase to compensate. Cardiovascular gains through aerobic activity are what gives the heart the ability to compensate. But there is a tradeoff at a point. Hypotrophy of the heart "cardiomegaly" is a big one. My wife "a former Olympian" suffers from this. But she is comfortable with a HR of 50bpm and has suffered from this since 15 years of age. It will cause her problems one day if she becomes stagnant.) IMHO, this day in age, meeting the minimum criteria for aerobic activity as recommended by the CDC and ACSM is impressive.
Before I hack this up too much I have been a Clinical ExPhys since 2003 working in Phase I and Phase II Cardiac Rehabilitation, Physical Therapy aid PRN, and a CCRN on a Acute Cardiac Care Unit for 4 years. I have seen life long smokers that lived on fat back and soda pop live to 90 with there independence. I have also seen avid joggers with strict diets have massive MI's. Becoming a Nurse nearly broke me on Exercise Physiology as genetics seemed to now obviously play too much into CPD, metabolic disease. This and the my opinion that people were a product of there lifestyle. Live hard and burn the candle at both ends, smoke, drink and dip, overeat and walk around with uncontrolled diabetes, poor personal hygiene all stood out as repeat offenders.
All the studies are there and everything is in place to rid the BMI from places and people it need not apply. Until there is incentive "real incentive" for people to adhere to these minimum guidelines, nothing will really change. Its not healthcare its sickcare. "Fix me I'm suffering from being a product of my lifestyle." ;)
brickboy240
08-26-13, 14:39
I have Googled various BMI charts and mostly to see where I sit on these charts.
For my height and age....many of these charts have me at a weight that is WAY below any weight I have been at since maybe my early teen years.
Even in my early 20s, when I was a serious mt biker and what most people would consider pretty thin...I did not weigh what these BMI charts say I should currently weigh!
Even today, at age 47, I could use to lose maybe 10 pounds or so (I like to eat...sue me LOL) but geez...to be anywhere near what these BMI charts say....I would have to go on some sort of serious crash diet.
Many of my friends have looked at these BMI charts as well and not one of them is anywhere near close to the suggested weight for their height on the charts.
Its as if this is the "supermodel" BMI chart or something! LOL Seriously...who developed this thing?
-brickboy240
I have Googled various BMI charts and mostly to see where I sit on these charts.
For my height and age....many of these charts have me at a weight that is WAY below any weight I have been at since maybe my early teen years.
Even in my early 20s, when I was a serious mt biker and what most people would consider pretty thin...I did not weigh what these BMI charts say I should currently weigh!
Even today, at age 47, I could use to lose maybe 10 pounds or so (I like to eat...sue me LOL) but geez...to be anywhere near what these BMI charts say....I would have to go on some sort of serious crash diet.
Many of my friends have looked at these BMI charts as well and not one of them is anywhere near close to the suggested weight for their height on the charts.
Its as if this is the "supermodel" BMI chart or something! LOL Seriously...who developed this thing?
-brickboy240
That's the problem, most of America IS obese. So these charts actually work, when you plug in height/weight to, say, 1950s America (or most third worlds). Go back and watch Goonies some day; remember how fat Chunk is? Now see how many kids are his size .... and that's just a 30 year time frame. These charts are based on ideal body weight, not population average. And FWIW, my BMI is 27-28, placing me overweight. I like to eat too.
My personal "favorite" fat person excuse is "I'm big boned." I'd love to pull up all the CT scans that I've seen where th hips and ribs are just like everyone else, with a 5 inch ring of fat encircling the bone structure.
Off topic, but some charts are population specific. For example, child growth charts are supposed to be country or region specific. A 50% percentile 1 year old in the US is likely bigger than a 50% percentile kid in, say, Zimbabwe.
thopkins22
08-26-13, 15:09
Body fat percentage always struck me as far more valuable. But I guess people don't like their fat being grabbed with calibers. I'd be interested in what you pros think.
In high school I had a a BMI of 31-33 but my body fat percentage was around 15. Working out for hours everyday along with my build meant that to not be obese by BMI standards I would have had to lose a lot of muscle to the point of being weak. Literally forty pounds needed to be lost to get to the high end of normal with body fat around 15%...I'm not buying it.
Now...now I am fat. Fortunately I still have powerful legs and lose it quickly when I move more and stop drinking soda.
I have Googled various BMI charts and mostly to see where I sit on these charts.
For my height and age....many of these charts have me at a weight that is WAY below any weight I have been at since maybe my early teen years.
Even in my early 20s, when I was a serious mt biker and what most people would consider pretty thin...I did not weigh what these BMI charts say I should currently weigh!
Even today, at age 47, I could use to lose maybe 10 pounds or so (I like to eat...sue me LOL) but geez...to be anywhere near what these BMI charts say....I would have to go on some sort of serious crash diet.
Many of my friends have looked at these BMI charts as well and not one of them is anywhere near close to the suggested weight for their height on the charts.
Its as if this is the "supermodel" BMI chart or something! LOL Seriously...who developed this thing?
-brickboy240
Heh. Doctors hear that exact speech on a daily basis. :rolleyes:
Anyway, most doctors don't use BMI alone to label a patient as "overweight", or "obese" or "morbidly obese". In many patients, especially those with BMIs in the 25-35 range, that diagnosis might come only in conjunction with other factors such as body composition, skin fold thickness, and especially associated co-morbidities. Note that that label might be applied by insurance agencies, based on the height/weight data, but they draw their own conclusions based on their own data for their own purposes. They don't get the diagnosis from your doctor.
No, BMI is not an exact tool. One can complain that their BMI is 34 because they're "big-boned" or "mostly muscle", but if your blood pressure is high, or your cholesterol is elevated, or your fasting blood sugar is up, or you have obstructive sleep apnea...most doctor's ain't gonna buy it and they're going to recommend weight loss.
brickboy240
08-26-13, 15:18
The chart is deceiving because none of us that the chart deems "overweight" are what you would call heavy people.
I mean....if you met me on the street....I seriously doubt you'd say I was heavy or needed to lose weight at all. However, the BMI chart has me in the "overweight" category.
Actually, at my absolute lightest I have ever weighed....back when I was seriously biking and running....I STILL would have been right against the "overweight" bracket on the BMI chart. Back then, I was pretty thin and had a 32in waist.
I don't know about that chart...it seems to have the norm way too much on the thin side. I'd have to almost kill myself with dieting and working out to reach what the BMI chart says I should be.
-brickboy240
The chart is deceiving because none of us that the chart deems "overweight" are what you would call heavy people.
I mean....if you met me on the street....I seriously doubt you'd say I was heavy or needed to lose weight at all. However, the BMI chart has me in the "overweight" category.
Actually, at my absolute lightest I have ever weighed....back when I was seriously biking and running....I STILL would have been right against the "overweight" bracket on the BMI chart. Back then, I was pretty thin and had a 32in waist.
I don't know about that chart...it seems to have the norm way too much on the thin side. I'd have to almost kill myself with dieting and working out to reach what the BMI chart says I should be.
-brickboy240
Your BMI might be a problem for your insurance company but most doctors aren't going to care about your BMI if your body composition is normal and you don't have high blood pressure, elevated fasting blood sugar, elevated cholesterol, or any other weight-related co-morbidities.
The way this works is that if all of those things are OK, then there's no problem no matter what your weight. If you do have any of those issues, losing weight is going to be on the list of recommendations from your doctor because it's likely playing a role. Where weight loss by itself IS recommended regardless of co-morbidities is at BMI's over 40. In that category it is statistically very likely that if those patients don't have any comorbidities, they soon will.
They're just numbers, and pretty arbitrary ones at that. They don't tell the whole story by themselves and it's not useful for you or your doctor to obsess over them if you are otherwise healthy.
brickboy240
08-26-13, 16:16
No I have no blood pressure or cholesterol issues. In fact...my cholesterol is extremely low.
I also would NEVER say something silly like "I am big -boned" I always thought that was an odd statement! LOL
I think that if I was ever to achieve the "ideal weight" suggested on the BMI chart....I'd look very emaciated.
I am not going to lose sleep over it. I'll keep lifting and biking and worry only if my pants start feeling tight. That is probably the best indicator ever. LOL
-brickboy240
Averageman
08-26-13, 16:22
I just did a little experiment.
Went to the CDC website and I thought .gov agency; lets see what they have to say?
Okay there are two inputs.
1) Height
2 Weight
So if you might be my height 5'11" your optimum weight according to the CDC should be.
For your height, a normal weight range would be from 133 to 179 pounds.
Now if 133 lbs to 179 lbs would be healthy I wonder what I would look and feel like at 133?
Right now I'm eating 100% Paleo and working out 3 to 4 days a week (to include running and rowing as cardio) and have an "Outside" job that requires 3 + miles of walking and often picking up heavy stuff and carrying it. Right now I'm exactly 30 pounds over 179 at 209.
To be honest I dont think I could do that at 133.
I wonder what my weight will be after I'm dead 6 weeks, because I should by this chart be in remarkable health and well within the acceptable weight limits.
Meet with a licensed registered dietician and tell them to take the gloves off and give you an appropriate diet for optimum weight, caloric intake and nutritional value. You will think you are being starved. I actually had patients seriously tell me we were trying to kill them with just a 1800 cal diet ordered. Skinny is being use as a derogatory term to describe people at optimum healthy weight. Being "skinny" alone does not make you healthy though. All other criterial need to be met for greatest reduction of risk factors. It is extreme to me as we'll and I did this stuff for a living.
I just did a little experiment.
Went to the CDC website and I thought .gov agency; lets see what they have to say?
Okay there are two inputs.
1) Height
2 Weight
So if you might be my height 5'11" your optimum weight according to the CDC should be.
For your height, a normal weight range would be from 133 to 179 pounds.
Now if 133 lbs to 179 lbs would be healthy I wonder what I would look and feel like at 133?
Right now I'm eating 100% Paleo and working out 3 to 4 days a week (to include running and rowing as cardio) and have an "Outside" job that requires 3 + miles of walking and often picking up heavy stuff and carrying it. Right now I'm exactly 30 pounds over 179 at 209.
To be honest I dont think I could do that at 133.
I wonder what my weight will be after I'm dead 6 weeks, because I should by this chart be in remarkable health and well within the acceptable weight limits.
You obese SOB! :D:nono::D
The best BMI tool I've found is on WebMD's website.
http://www.webmd.com/diet/calc-bmi-plus
It includes waist size.
My healthy weight range according to the calculator, I'm 6'-3", is 148-199lbs. I'm 187 now.
I don't agree with their heart rate zones however. 130-148 BPM is a good range for easy pace training, but 148 to max doesn't equal anaerobic.
After doing many years of different methods of est body comp, I found most people, "especially" gym rats have 20%+ body fat and claim 15% ;)
After doing many years of different methods of est body comp, I found most people, "especially" gym rats have 20%+ body fat and claim 15% ;)
Underestimating bodyfat is far from unique to gym rats. Wishful thinking is a universal human condition in my experience. ;)
The best BMI tool I've found is on WebMD's website.
http://www.webmd.com/diet/calc-bmi-plus
It includes waist size.
My healthy weight range according to the calculator, I'm 6'-3", is 148-199lbs. I'm 187 now.
I don't agree with their heart rate zones however. 130-148 BPM is a good range for easy pace training, but 148 to max doesn't equal anaerobic. Intensity and Duration are the key. HRR is just a guide to get you up to the appropriate MET level. There is no hard line between the 3 energy systems. All are initiated with exercise. Get a V02 max test ;) that's the best way to get to your personal HRR.
Averageman
08-26-13, 18:47
I will continue with this lifestyle until I drop dead, but I'm a little better judge of what my body should weigh and how it reacts to stimuli such as food and exersize.
The CDC is brought to you by the same folks who would like you to use the Farm Industries food pyramid and eat nasty amounts of nonpaleo grains and such.
I believe the first uses of BMI were brought about by the insurance companies that were using your height/weight to predict your health risks to determine how much to charge you for your life insurance.
I will use my common sense, Paleo eating and Exersize and worry less about all of the folks who are lined up ready to make a buck off me becomming a skinny boy.
Underestimating bodyfat is far from unique to gym rats. Wishful thinking is a universal human condition in my experience. ;)
Yes and "gym rat" is not meant to be a derogatory term. I spent 2
Hours a day everyday Ina gym for 15 years. I did not consider myself as a body builder but became very strong, good size on me too. I still never got below 18% body fat. I was mostly at 20-23%. But I did a lot of damage before I learned how to train smart and pay for it now. I can think muscle mag workout articles for that. I go 5-6 days a week and if I am in there over 45 min I have wasted time somewhere.
[QUOTE=Averageman;1730807]I will continue with this lifestyle until I drop dead, but I'm a little better judge of what my body should weigh and how it reacts to stimuli such as food and exersize.
The CDC is brought to you by the same folks who would like you to use the Farm Industries food pyramid and eat nasty amounts of nonpaleo grains and such.
I believe the first uses of BMI were brought about by the insurance companies that were using your height/weight to predict your health risks to determine how much to charge you for your life insurance.
I will use my common sense, Paleo eating and Exersize and worry less about all of the folks who are lined up ready to make a buck off me becomming a skinny
BMI as it became to be known, was a good tool for scientists to study populations. It was never meant to use on such an individual bases. It's ease of use pushed it to the front of the line. It has a very valuable place but, unfortunately will become another tool to penalize and take away civil liberties. liberties that are taken away everyday by government health services put in place to help us. So yeah BMI as a primary evaluation tool to affect medicare/medicaid exemption, insurance coverage/medical intervention is a real possibility. The foundation is laid and mass electronic integration of your health records will soon damage more than help. Health information protection is just back door tattle agencies, will become that and more anyway.
But, my opinion is live life as healthy as you can. Enjoy life because I have seen it cut short far too many times.
Intensity and Duration are the key. HRR is just a guide to get you up to the appropriate MET level. There is no hard line between the 3 energy systems. All are initiated with exercise. Get a V02 max test ;) that's the best way to get to your personal HRR.
The most logical use of heart rate based training I've come across is the VDOT system and the training principles that go with it.
BMI as it became to be known, was a good tool for scientists to study populations. It was never meant to use on such an individual bases. It's ease of use pushed it to the front of the line. It has a very valuable place but, unfortunately will become another tool to penalize and take away civil liberties. liberties that are taken away everyday by government health services put in place to help us. So yeah BMI as a primary evaluation tool to affect medicare/medicaid exemption, insurance coverage/medical intervention is a real possibility. The foundation is laid and mass electronic integration of your health records will soon damage more than help. Health information protection is just back door tattle agencies, will become that and more anyway.
But, my opinion is live life as healthy as you can. Enjoy life because I have seen it cut short far too many times.
I think this is absolutely true. Health care is too much a part of people's lives and too big a part of the economy for the government not to be involved. Single-payer is too expensive and harder to drag out, so instead we have this slow march through the back door to the same end. Obamacare is a sort of Swiss Army knife of tools to help achieve that, along with the governent's insistence on electronic health records.
I think this is absolutely true. Health care is too much a part of people's lives and too big a part of the economy for the government not to be involved. Single-payer is too expensive and harder to drag out, so instead we have this slow march through the back door to the same end. Obamacare is a sort of Swiss Army knife of tools to help achieve that, along with the governent's insistence on electronic health records.
That's only because people run to health care for every little sniffle.
If half of America "man'd up" and just dealt with their crap like Dr. Mom did (ie, a cold can be dealt with at home. A bruise can too. So can bug bites. I kid you not, these are all things I see on a weekly basis), I'm sure that we wouldn't be running up the massive costs that we are.
brickboy240
08-27-13, 15:30
How about the fact that many people use hand sanitizer all the time and spend almost no time outdoors?
They probably never build up any immunities and get very sick at the drop of a hat.
The sickest people in my office are the ones that always use hand sanitizer and compulsively wash their hands.
-brickboy240
That's only because people run to health care for every little sniffle.
If half of America "man'd up" and just dealt with their crap like Dr. Mom did (ie, a cold can be dealt with at home. A bruise can too. So can bug bites. I kid you not, these are all things I see on a weekly basis), I'm sure that we wouldn't be running up the massive costs that we are.
We'll big brother is gonna make sure people go for annual checkups! So now the sue happy, uneducated, high risk population will be penalized for not getting annual checkups. We'll the last clinic I worked at after I quit bedside was full of nothing but poor noncompliant patients. They were there because they did not go to the MD after being diagnosed years ago. So how are they goin to be monetarily penalized for noncompliance with no job? Who will end up paying the bill?
On a different note, just for kicks I will go ahead and give everyone some "bizarre" advise. If you are over 50 yrs of age, male with a family Hx of CAD. Go ahead and fake chest pain and go to the ER. Your cardiac enzymes will be negative and your EKG will be "most o the time" unremarkable. But, demand a heart cath and ask to have your renal arteries and mesenterics as we'll. You might get some of those things checked despite the malpractice being performed "basically." What's comming in this socialist healthcare will require you to have much stricter criteria to get a PTCA and stent. It sounds crazy but I don't want to be stopped up and kidneys barely breathing before I can have my pipes opened. I logged alot of time in the cath lab and all I have heard from the top cardiologist was how this will go down.
In fact our top Cardiologist would be sure to give all indigent care patients food for thought as they were wheeled out of the cath lab he would say "he don't say much mind you," "I just saved both your kidneys, and your heart, now you won't have to be on dialysis the rest of your life. Remember free healthcare means no healthcare, have a good day." That was on a patient with very tight renal arts and some tight spots in the heart.
In my wife's country you have to negotiate a procedure before its done. You also have to pay each nurse cash too. This ensures the healthcare professions responsible for your life give a damn.
How about the fact that many people use hand sanitizer all the time and spend almost no time outdoors?
They probably never build up any immunities and get very sick at the drop of a hat.
The sickest people in my office are the ones that always use hand sanitizer and compulsively wash their hands.
-brickboy240
But did they have insurance? And, with say BCbS the MD is paid the bulk of the bill and now will be looking at no specialty pay and less pay. ICD 9 code juggling will be front and center way more than now. It is going to force a level of dishonesty into inpatient and outpatient care. No incentive for the best to come here to practice. That's troubling.
But yeah, hand sanitizer freaks are,,,, a problem. ;)
That's only because people run to health care for every little sniffle.
If half of America "man'd up" and just dealt with their crap like Dr. Mom did (ie, a cold can be dealt with at home. A bruise can too. So can bug bites. I kid you not, these are all things I see on a weekly basis), I'm sure that we wouldn't be running up the massive costs that we are.
Overutilization probably represents some part of the reason.
How about the fact that many people use hand sanitizer all the time and spend almost no time outdoors?
They probably never build up any immunities and get very sick at the drop of a hat.
The sickest people in my office are the ones that always use hand sanitizer and compulsively wash their hands.
-brickboy240
Nah.
On a different note, just for kicks I will go ahead and give everyone some "bizarre" advise. If you are over 50 yrs of age, male with a family Hx of CAD. Go ahead and fake chest pain and go to the ER. Your cardiac enzymes will be negative and your EKG will be "most o the time" unremarkable. But, demand a heart cath and ask to have your renal arteries and mesenterics as we'll. You might get some of those things checked despite the malpractice being performed "basically." What's comming in this socialist healthcare will require you to have much stricter criteria to get a PTCA and stent. It sounds crazy but I don't want to be stopped up and kidneys barely breathing before I can have my pipes opened. I logged alot of time in the cath lab and all I have heard from the top cardiologist was how this will go down.
Jesus, what kind of place were you working? You take a lot of normal people back to the cath lab?
Jesus, what kind of place were you working? You take a lot of normal people back to the cath lab?
I can't tell you how many PT's with neg enzymes and normal EKGs got cathed. But they had strong family history maybe a few other dx and chest pain unrelieved with mso4 and nitro for ex. Enough to get contrast and pictures shot as long as renal labs were ok. Many people ended up with interventions and I saw it as a good thing in nearly all cases. Some wouldn't get stents where as another cardiologist would. I guess that could be debated but not too long ago the surgeons got to split people open alot easier than now. So CABG went down and PTCA and stent went up. "Bad memories of fresh hearts" when I would get pulled to CSU. I have run nipride, hespan, LR and Dopamine on a fresh heart with a roll a dial, watching art pressure with only 1 other nurse trendelenburging as needed. I would also be adjusting a temp pacer and checking WEDG pressure too. I would be on my second double too :) never again and it will only get worse for the RN's that sacrifice their health, family time and sanity with the new healthcare system. I'm done. I wish newer gen of MD'S and RN's happiness and success.
The cardiopulmonary system is what I do and excelled at. I don't think MD's should abuse the system but i only saw a handful of cases where I thought an intervention was too risky or absolutely not needed. The evolution of the heart catherization is truly remarkable and I participated in saving people's lives who didn't even wash their arse. Our great nation is about to fix an unbroken working healthcare system because of a uneducated, welfare dependent, work capable population segment cannot be addressed. And fill the hospitals and clinics with indigent patients that ride on your backs. That'a just scratching the surface.
Our great nation is about to fix an unbroken working healthcare system because of a uneducated, welfare dependent, work capable population segment cannot be addressed. And fill the hospitals and clinics with indigent patients that ride on your backs. That'a just scratching the surface.
I certainly don't disagree with that.
Jesus, what kind of place were you working? You take a lot of normal people back to the cath lab?
That was really a joke but it is not completely insane IMHO. The criteria for an intervention will most likely require blockage that would be addressed be left to ride because whatever tissue it's perfusing is not stressing "YET!"
The patient will have to come back when damage is just about guaranteed. Chest wall pain and anxiety like problems that landed pTS in the cath lab who got a well blocked but not contributing. Or say a PT that is adm for irregular rhythm is cardioverted but maybe reverts to afib etc. The decision is made to cath, some pipes are opened, care and future piece of mind achieved. You get a Cadillac treatment no matter you race, socio economic status etc. right now! Free "to the PT", top notch nursing care, the whole 9 yards.
The ExPhys in me screams education an prevention. That's what this new healthcare plan will emphasize. But it will fall on the same def ears it always has.
I need a heavy buffer and a RRA or DPMS A2 carry handle. :)
How about the fact that many people use hand sanitizer all the time and spend almost no time outdoors?
They probably never build up any immunities and get very sick at the drop of a hat.
The sickest people in my office are the ones that always use hand sanitizer and compulsively wash their hands.
-brickboy240
I worry less about them and more about the fact that you can barely find hand soap anymore that doesn't have clorhexidine or some other anti microbial in it.
As to the cath lab story above, well, docs get paid by procedures. So any little reason to pull a patient to the cath lab = pay check. There's a difference between a therapeutic and a diagnostic procedure.
Coding and procedure-based pay also has a LOT to do with health care costs. You realize pediatricians are the least paid of physicians? Sure, you seem them a million times if you have a new kid, but all those shots get reimbursed about $20 each, and the visit might be $50-100. Preventative medicine doesn't pay - they'd be better off fiscally if measles and pertussis ran rampant through the US.
But they don't do that, do they?
Obamacare/health care is 'trying' to push for preventative care, but ... it sure doesn't pay the providers. Hence, having to do procedures for the flimsiest of reasons to recoup losses.
I worry less about them and more about the fact that you can barely find hand soap anymore that doesn't have clorhexidine or some other anti microbial in it.
As to the cath lab story above, well, docs get paid by procedures. So any little reason to pull a patient to the cath lab = pay check. There's a difference between a therapeutic and a diagnostic procedure.
Coding and procedure-based pay also has a LOT to do with health care costs. You realize pediatricians are the least paid of physicians? Sure, you seem them a million times if you have a new kid, but all those shots get reimbursed about $20 each, and the visit might be $50-100. Preventative medicine doesn't pay - they'd be better off fiscally if measles and pertussis ran rampant through the US.
But they don't do that, do they?
Obamacare/health care is 'trying' to push for preventative care, but ... it sure doesn't pay the providers. Hence, having to do procedures for the flimsiest of reasons to recoup losses.
Things must work differently where you live. Even if I were so unethical that I'd operate on a patient without justification, there are barriers at every turn to prevent that. ... Hospital utilization review, insurance company pre-authorization requirements, post reviews by CMS, peer reporting....christ, we cant even get a CT scan without a preauthorization. If you're a doctor, you must work in a pretty scummy system if unnecessary procedures are as prevalent as you suggest.
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