问题不只是贵，是医生没经验，死教条，被保险公司掣肘。 我家医保是只付10刀copay，再没别的费了。max out of pocket 1500。这算很好的plan了吧？急诊100，urgent care 50。 结果呢？去医院看急诊，只有一个人在窗口那里。等就等了俩小时。 进去之后没有望闻问切，没有经验判断，除了身高体重心跳就是疼不疼。疼就布洛芬，再疼打吗啡。然后躺那里等俩小时医生才来。 后面我说想住院观察，医生说不用也不能住院。回家后果然复发了。再去急诊。 又是同一套：门口等俩小时；不看病历不问过往，身高体重血压心跳，布洛芬，等俩小时。医生说just bad of luck 就解释过去了。 WTF julie2020 发表于 2022-02-15 12:33
问题不只是贵，是医生没经验，死教条，被保险公司掣肘。 我家医保是只付10刀copay，再没别的费了。max out of pocket 1500。这算很好的plan了吧？急诊100，urgent care 50。 结果呢？去医院看急诊，只有一个人在窗口那里。等就等了俩小时。 进去之后没有望闻问切，没有经验判断，除了身高体重心跳就是疼不疼。疼就布洛芬，再疼打吗啡。然后躺那里等俩小时医生才来。 后面我说想住院观察，医生说不用也不能住院。回家后果然复发了。再去急诊。 又是同一套：门口等俩小时；不看病历不问过往，身高体重血压心跳，布洛芬，等俩小时。医生说just bad of luck 就解释过去了。 WTF julie2020 发表于 2022-02-15 12:33
西雅图儿童医院经典作业就是把孩子搞残， 然后一辈子拿钱。 你普通看病200， 这种搞残的一次outpatient 四五千美元。 一年几十万没有问题。 搞你一辈子。。 比如很简单的用新生儿筛查可以做出诊断的， 它们却故意谋杀。 这是我们把新生儿报告给西雅图儿童医院后， 这个垃圾医生的狡辩。 美国医院有多危险， 我可以告诉你远远比战场危险。 战场至少你还有一边， 有同志。 医院出了事故， 或是你发现罪恶后周围都是要搞死你的人， 除了医生护士， 还有社工和警察， 可以当场击毙你，而且保证媒体会说你打伤医护。 下面就看看这个医生如何狡辩的， Date: 4/23/2014 Yong Xie and liying Chen 21743 105th PI NE Redmond, WA 98053 To Jianhua''''''''s parents: I am writing this letter today in response to your email to our biochemical genetics nurse, Sarah Allen, RN, on Friday, 4/18/2014. In that email, you forwarded information on Jianhua''''''''s Washington state newborn screen results with comparison to reference ranges from plasma acylcarnitines done in the Mayo Clinic Biochemical Genetics Laboratory. In there, you note concentrations of Jianhua''''''''s newborn screening test results of C18:1, C16, and C18 acylcarnitines comparing these to the plasma reference ranges from the Mayo Clinic lab. In the letter you mention that the newborn screening values are 3 or 4 times the normal maximum range of the plasma reference ranges at Mayo Clinic. Then you question that if together with the labs done here at Seattle Children''''''''s Hospital in 2013 and his chronic liver problems -- are they convincing enough to say that Jianhua has a fatty acid oxidation disorder? In reviewing these results of Jianhua''''''''s newborn screening information, as we previously discussed, it is important to interpret the concentrations of the acylcarnitines on his newborn screening appropriately in the appropriate medical context and with the correct reference ranges. In this circumstance, we have to consider the Washington State newborn screen is done with a specific protocol and acylcarnitines are extracted from the dried blood spot collected on filter paper from when Jianhua was born. In this particular case, the concentrations of these C18:1, C16, and C18 acylcarnitines that you reference are from his first newborn screen that was done at 1 day and 2 hours of age, which is also documented on the newborn screening test document that you also forwarded attached to your email. The reference ranges from the Mayo Clinic Biochemical Genetics Laboratories are from a plasma acylcarnitine sample, as also is noted in the information you forwarded from their website from Test 10: ACRN. These reference ranges have been established based on the measurement of acylcarnitines in the plasma sample - collected from any individual who had had their plasma sample sent in an EDT A tube to the Biochemical Genetics Laboratory of the Mayo Clinic. They have established their own reference ranges based on their testing methodology using tandem mass spectrometry. These reference ranges actually will change over different ages, which they also note in their information. We also know from experience that the reference ranges will differ between commercial laboratories, as they would between any laboratory given that every laboratory has its own specific testing methodology, and has to establish their own population normal reference ranges according to their normal official laboratory certification protocols. In this particular case, as you note in your email.referencerangesfortheplasmaacylcarnitinesC18:1islessthanO.25micromolar.C16 is less than 0.036 micromolar, and C18 is less than 0.1 micromolar for children ages 8 days to 7 years of age, which would have been Jianhua''''''''s age in April 2013. We cannot use the reference ranges for plasma acylcarnitines from the Mayo Clinic Biochemical Genetics Laboratories for plasma samples from children collected between 8 days and 7 years of life when interpreting newborn screening result from a dried blood spot performed from blood collected from filter paper on a Washington State newborn screening report. This is because the Washington State newborn screening protocol is using a different extraction technique for extracting the blood from the filter paper compared to the plasma sample at the Mayo Clinic. This involves a different technical process. While they both may use tandem mass spectrometry, the reference ranges are completely different, which is a known fact seen between different sample types (plasma vs. dried blood spot), between screening laboratories, and between confirmatory diagnostic labs. We know actually reference ranges for newborn screening samples from filter samples are often much different. The Washington State Newborn Screening Laboratory does not release newborn screening information, nor do they release information on normal population references or their cutoffs used for newborn screening. I know from my experience as a biochemical geneticist that in newborn screening the normal range up to the 99th percentile may reach as high as 2.5 micromolars for the normal population range for C18:1 acylcarnitines. For C16 acylcarnitines, it may reach as high as 5-6 and for C18 acylcarnitines may reach as high as 1.5-2. These would clearly place Jianhua''''''''s newborn screening test results for C18:1, C16 and C18 acylcarnitines well within the normal range for a newborn screening specimen from a child collected during the first week of life. I very much appreciate your sincere efforts to completely examine all of the possibilities that Jianhua may have a fatty acid oxidation disorder. His newborn screening results as you provided here from his first and second newborn screens are well within normal population ranges. Additionally, from the information that you have shared with me and from what I have been able to determine from his medical records, he had no symptoms that I am aware of, or that you have shared with me, that would be consistent with a fatty acid oxidation disorder prior to his presentation in the hospital in April 2013. Additionally, his initial presentation in the hospital in April 2013 with acute liver failure would be a very atypical presentation for a fatty oxidation disorder without other simultaneous presenting symptoms such as hypoglycemia at presentation. His hypoglycemia occurred later during his hospitalization and this could be explained by his acute liver failure itself and not due to a fatty acid oxidation disorder causing the hypoglycemia. The plasma acylcarnitines were not elevated to the levels we would expect if a fatty acid oxidation disorder was causing the hypoglycemia. The findings on his urine organic acids were inconsistent with a fatty acid oxidation disorder when interpreted in clinical context with his plasma acylcarnitines and his health state in the hospital at that time. The interpretation of all of his biochemical testing would not support a fatty acid oxidation disorder as causing his acute liver failure nor the hypoglycemia at that time. If we then were to further theoretically assume he still had a chance of having a fatty oxidation disorder based on his acylcarnitine measurements, then the next step would be then do DNA sequencing. Jianhua has had whole exome sequencing and a microarray looking for deletions and duplications in mitochondria-related genes including the fatty acid oxidation disorder genes. He was only found to have one sequence variant for ACAD9 and no other variants for any other type of fatty acid oxidation disorder. Fatty acid oxidation disorders are autosomal recessive conditions so in order to have a fatty acid oxidation disorder a person would have to have two DNA sequence changes believed to cause disease, one in each of the two gene alleles for that particular gene. Jianhua has been only been found to have one DNA sequence variant in ACAD9, and nothing else. There is no DNA sequence evidence to support a possibility of a fatty acid oxidation disorder in Jianhua at this time. Overall, we have demonstrated clear evidence, both biochemical and molecular, reassuring us that he does not have a fatty acid oxidation disorder. I would not recommend any additional testing for fatty acid oxidation disorders based on this evidence. His clinical improvements over that past year have truly been wonderful, but I do not believe that this is due to his dietary treatment for a fatty acid oxidation disorder that you have started at your own initiative. Dietary evaluation should continue to reassure us that he does not have nutritional deficiencies. Since we have not demonstrated that he has an inborn error of metabolism that would require a fat-restricted and MCT supplemented diet, I would support you if you chose to transition him to a more normal diet. As we have discussed previously, he may benefit from further evaluation for common variable immune deficiency and I would recommend further conSUltation for this. I appreciate your sending me this information. I would be happy to discuss this further in the future at a clinic visit if you so wish to do so. Sincerely, Electronically Authenticated by J Lawrence Merritt, II, MD 04/29/201410:44 A J Lawrence Merritt, II, MD , Attending Physician, Genetics
下面这个华人医生举报我们家， 要把孩子带走， 在医院， 医生想着法子往死里整。。 这是医院举报的信息： Today, I received a call from Evelyn Hsu, MD, Gastroenterology Transplant attending. She and her team have been concerned that Jianhua initially presented about 7 months ago with acute liver failure. On biopsy, he had micronodular cirrhosis. Extensive testing was done at that time for a cause, and none determined; however, subsequently the clinical evidence of his liver disease has improved. He was last seen last spring, with the plan that he would follow up this fall. During the course of his evaluations, his father developed concerns that he had a fatty acid oxidation defect. Extensive metabolic testing has been negative so far, yet dad has been unwilling to drop this diagnostic concern. Due to conflicts with the Gastroenterology Service, he also has indicated that he is seeking care elsewhere, including at Pittsburgh and Portland, Oregon. The Gastroenterology Service is concerned that it would be important to document that, whatever the cause of the liver failure was, it is no longer active. I discussed with Dr. Hsu that, since Jianhua has a very serious medical problem, that failure of his father to seek appropriate follow-up care would constitute medical neglect. I recommended that Gastroenterology connect with dad and set a date this fall by which he must provide documentation that Jianhua is receiving appropriate care elsewhere. Short of that documentation, a Protective Services referral for medical neglect should be made.
Family of Chinese mom who died after birth complications gets $5.2 million Ling Nie died in an Orange County hospital afterr her doctor allegedly abandoned her amid complications after her C-section. (Family photo)
Asian Americans Facing High COVID-19 Case Fatality Brandon W. Yan Fiona Ng Janet Chu Janice Tsoh Tung Nguyen JULY 13, 2020 10.1377/forefront.20200708.894552
ADD TO FAVORITES SHARE In San Francisco, a steady trend in coronavirus (COVID-19) deaths has gone largely unnoticed until recently: Asian Americans consistently account for nearly half of COVID-19 deaths. For a city that is one-third Asian American, the disproportionate number of deaths appears striking, yet this highlights an even more worrisome statistic—Asian Americans experience a four times higher case fatality rate (CFR) than that of the overall population (5.2 percent versus 1.3 percent).
Asian Americans in San Francisco are dying at alarming rates from COVID-19: Racism is to blame COVID-19 is killing Asian Americans in the Bay Area. In this six-part series, USA TODAY investigates how systemic racism is driving high death rates. Marco della Cava, USA TODAY Published 6:03 PM PDT Oct. 18, 2020 Updated 6:12 PM PDT Oct. 21, 2020 SAN FRANCISCO – Mandy Rong was terrified her 12-year-old daughter had COVID-19. It was 2 a.m. and the young girl was hours into a fierce fever and a racking cough. She was weak and didn’t want to eat. What few medications were on hand had expired. She sipped warm water instead.
问题不只是贵，是医生没经验，死教条，被保险公司掣肘。 我家医保是只付10刀copay，再没别的费了。max out of pocket 1500。这算很好的plan了吧？急诊100，urgent care 50。 结果呢？去医院看急诊，只有一个人在窗口那里。等就等了俩小时。 进去之后没有望闻问切，没有经验判断，除了身高体重心跳就是疼不疼。疼就布洛芬，再疼打吗啡。然后躺那里等俩小时医生才来。 后面我说想住院观察，医生说不用也不能住院。回家后果然复发了。再去急诊。 又是同一套：门口等俩小时；不看病历不问过往，身高体重血压心跳，布洛芬，等俩小时。医生说just bad of luck 就解释过去了。 WTF julie2020 发表于 2022-02-15 12:33
问题不只是贵，是医生没经验，死教条，被保险公司掣肘。 我家医保是只付10刀copay，再没别的费了。max out of pocket 1500。这算很好的plan了吧？急诊100，urgent care 50。 结果呢？去医院看急诊，只有一个人在窗口那里。等就等了俩小时。 进去之后没有望闻问切，没有经验判断，除了身高体重心跳就是疼不疼。疼就布洛芬，再疼打吗啡。然后躺那里等俩小时医生才来。 后面我说想住院观察，医生说不用也不能住院。回家后果然复发了。再去急诊。 又是同一套：门口等俩小时；不看病历不问过往，身高体重血压心跳，布洛芬，等俩小时。医生说just bad of luck 就解释过去了。 WTF julie2020 发表于 2022-02-15 12:33
The U.S. is the only industrialized nation in the world where maternal mortality is rising. And, the U.S. has nearly the highest maternal mortality rate among high-income countries. Each year, approximately 700 American women die during pregnancy, childbirth or subsequent complications. And with respect to infant mortality, the U.S. ranks 33 out of 36 Organization of Economic Cooperation and Development (OECD) nations. In 2018, while infant mortality reached an all-time low in the U.S., at 5.9 infant deaths per 1,000 live births, still more than 21,000 infants died. Compared to countries with a similar GDP, the U.S. infant mortality rate is much higher. France and the U.K., for example, have 3.8 deaths per 1,000 live births. 垃圾国家。。 垫底
About one-quarter of U.S. adults report having a mental health diagnosis such as anxiety or depression or experiencing emotional distress. This is one of the highest rates among 11 high-income countries. The United States has some of the worst mental health–related outcomes, including the highest suicide rate and second-highest drug-related death rate.
美国人就是猪 The US obesity prevalence was 42.4% in 2017 – 2018. From 1999 –2000 through 2017 –2018, US obesity prevalence increased from 30.5% to 42.4%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer. These are among the leading causes of preventable, premature death. The estimated annual medical cost of obesity external icon in the United States was $147 billion in 2008. Medical costs for people who had obesity was $1,429 higher than medical costs for people with healthy weight. 中国瘦多了 Obesity in China is a major health concern according to the WHO, with overall rates of obesity between 5% and 6% for the country, but greater than 20% in some cities where fast food is popular.
其实人一般生大病是在60岁后。假设人的寿命90岁。假设每年生大病，够倒霉吧。那么只要存30万在HSA就够了。因为deductible 后面是全包的，难道我理解错了吗。 再说护理，护理可以买long term care。其实单单long term care insurance 不是很贵。一般人需要长期护理是3年。3年再加个10万。 那么总体是40万。 假设你在hsa存钱，每5年翻倍，基本上25年的时间就可以存到40万了。假设你60岁需要用医疗，那么你在35岁开始存hsa都不晚。
其实人一般生大病是在60岁后。假设人的寿命90岁。假设每年生大病，够倒霉吧。那么只要存30万在HSA就够了。因为deductible 后面是全包的，难道我理解错了吗。 再说护理，护理可以买long term care。其实单单long term care insurance 不是很贵。一般人需要长期护理是3年。3年再加个10万。 那么总体是40万。 假设你在hsa存钱，每5年翻倍，基本上25年的时间就可以存到40万了。假设你60岁需要用医疗，那么你在35岁开始存hsa都不晚。
急诊和urgent care 有什么区别？前者接待有生命危险的？后者处理急性但不危及生命的病痛？ mouton 发表于 2022-02-16 01:13
ER 1.治有生命危险的或者急病. 2.排队时间长,除非你很紧急. 3.不论你的保险,全收. 4.开24小时7天. urgent care 1.没有生命危险的病. 2.排队时间比ER短. 3.看保险,需要co-pay或者不在网内收很贵. 4.不是24小时服务. btw,有些你觉得不太严重的病其实也是需要去ER的,比如任何的突然失去某些功能,就突然看不见东西loss of vision,或者突然头剧烈的痛,又或者突然走路不平衡,走不了路了.是应该去ER的.还有烧伤严重的.
如果有绿卡，可以买保险，走正常美国人治疗渠道，可在家庭医生那备个档。我们经过的医生护士都非常负责，所有的治疗方案包括器械，用药，都会提前得到保险公司审批，所有没有保险公司拒保一说，医院还专门为父亲配了一个医疗陪护，帮助治疗上随时沟通，保险公司也安排了一个客户咨询，定期和父亲聊天，疏通心理压力。目前整个过程下来非常舒心，我们经历了母亲在国内患癌-治疗-去世的过程。只想说，一个是天堂，一个是地狱。没有绿卡，准备好现金，联系大医院的国际部，比如Anderson, JHU,都会有中国业务代表，负责所有的安排。
国内是这样，如果欠款，所有机器立刻停止。
美国是灯塔当然应该率先研发新药新科技。不仅医疗为全世界买单，科技也是。苹果，微软，哪一个不是美国股民为全世界买单呢？但是这不就代表着美国的好吗？你率先享受，率先使用，就比其他人进步嘛。
医疗研发为全世界买单理所当然，如果不愿意买单，完全可以去中等国家享受现成的，但最新成果就与您无缘了。
蠢不蠢？难道不知道urgent care 的存在？不危机生命的情况去急诊当然是等。
就医程序明显在美国要花的精力比国内多太多了
在国内都是一站式服务，你看了医生，开了单子就可以在医院里做各项检查了，快的所有的当天就能做完，很多你当天检查完出结果马上就能拿去给医生看给你开药了，即使当天检查不上，一周肯定全部能检查完出结果
美国你看完医生，然后要打各种电话，约各个地方，可能分好几次，几周做检查，
就是同样的事情，国内一周办完，美国一个月办完是常态，这期间你都拖着病痛的身体， 国内看病即使家人陪着去，去个2次就全解决了，这边就让家人带着东奔西跑N次吧
两边花的时间，精力完全不是一个数量级的，你说哪个对病人的心理和康复好？
非常感谢MM的信息！准备把你说的这些转告给我认识的那个朋友。
当然还要具体看保险和医院，希望帮助到你朋友。
嗯嗯，我明白，具体医院不同应该还是有些差别，但大的方面肯定都是大同小异的。
再次谢谢你的信息了！
那你是因为啥去的急诊？去年我自己因为胸闷喘不上气去急诊，前台接诊后3分钟不到就进去做一系列监测了，别的不说美国医院住院不用陪护这点真的对我们这种一代移民太便利了，不然找人都找不着
国内一站看完的都不是大病。。小病确实国内方便
大病，住院这种应该是美国比较好，不过没有怎么体验过就生娃住过院。小病，你压根进不了医院啊，小诊所看看，然后要拿着单子去lab，往往还不在一起。
国内一站式还能说的这么好听呢，看一次病经常楼上楼下到处跑来跑去排好多个队，挂号，缴费，问诊，检查，每次去国内医院大厅都是乱哄哄的，每个人看着都愁眉苦脸，一到那个环境就焦虑，就那种环境和焦虑感，国内医患纠纷不多才怪呢。
在美国看到医生之前就是打电话，约好了就进一个屋子里等着医生过来，看完就走，收费什么都是后续解决。waiting room里面，病人都很轻松的坐着，有时候还跟前台开心的聊聊天，有一次是在cancer center等人，也一点也没有沉重感。
我在美国习惯了看医生都是自己，然后去国内也自己一个人去医院，结果每次都来回跑的要崩溃，有一次国内小手术住院我也自己一个人去，发现整一走廊就我一个人没带家属，其他人都是一病就要折腾一大家子。
美国医院有多危险， 我可以告诉你远远比战场危险。 战场至少你还有一边， 有同志。 医院出了事故， 或是你发现罪恶后周围都是要搞死你的人， 除了医生护士， 还有社工和警察， 可以当场击毙你，而且保证媒体会说你打伤医护。
下面就看看这个医生如何狡辩的，
Date: 4/23/2014 Yong Xie and liying Chen 21743 105th PI NE Redmond, WA 98053
To Jianhua''''''''s parents:
I am writing this letter today in response to your email to our biochemical genetics nurse, Sarah Allen, RN, on Friday, 4/18/2014. In that email, you forwarded information on Jianhua''''''''s Washington state newborn screen results with comparison to reference ranges from plasma acylcarnitines done in the Mayo Clinic Biochemical Genetics Laboratory. In there, you note concentrations of Jianhua''''''''s newborn screening test results of C18:1, C16, and C18 acylcarnitines comparing these to the plasma reference ranges from the Mayo Clinic lab. In the letter you mention that the newborn screening values are 3 or 4 times the normal maximum range of the plasma reference ranges at Mayo Clinic. Then you question that if together with the labs done here at Seattle Children''''''''s Hospital in 2013 and his chronic liver problems -- are they convincing enough to say that Jianhua has a fatty acid oxidation disorder? In reviewing these results of Jianhua''''''''s newborn screening information, as we previously discussed, it is important to interpret the concentrations of the acylcarnitines on his newborn screening appropriately in the appropriate medical context and with the correct reference ranges. In this circumstance, we have to consider the Washington State newborn screen is done with a specific protocol and acylcarnitines are extracted from the dried blood spot collected on filter paper from when Jianhua was born. In this particular case, the concentrations of these C18:1, C16, and C18 acylcarnitines that you reference are from his first newborn screen that was done at 1 day and 2 hours of age, which is also documented on the newborn screening test document that you also forwarded attached to your email. The reference ranges from the Mayo Clinic Biochemical Genetics Laboratories are from a plasma acylcarnitine sample, as also is noted in the information you forwarded from their website from Test 10: ACRN. These reference ranges have been established based on the measurement of acylcarnitines in the plasma sample - collected from any individual who had had their plasma sample sent in an EDT A tube to the Biochemical Genetics Laboratory of the Mayo Clinic. They have established their own reference ranges based on their testing methodology using tandem mass spectrometry. These reference ranges actually will change over different ages, which they also note in their information. We also know from experience that the reference ranges will differ between commercial laboratories, as they would between any laboratory given that every laboratory has its own specific testing methodology, and has to establish their own population normal reference ranges according to their normal official laboratory certification protocols. In this particular case, as you note in your email.referencerangesfortheplasmaacylcarnitinesC18:1islessthanO.25micromolar.C16 is less than 0.036 micromolar, and C18 is less than 0.1 micromolar for children ages 8 days to 7 years of age, which would have been Jianhua''''''''s age in April 2013. We cannot use the reference ranges for plasma acylcarnitines from the Mayo Clinic Biochemical Genetics Laboratories for plasma samples from children collected between 8 days and 7 years of life when interpreting newborn screening result from a dried blood spot performed from blood collected from filter paper on a Washington State newborn screening report. This is because the Washington State newborn screening protocol is using a different extraction technique for extracting the blood from the filter paper compared to the plasma sample at the Mayo Clinic. This involves a different technical process. While they both may use tandem mass spectrometry, the reference ranges are completely different, which is a known fact seen between different sample types (plasma vs. dried blood spot), between screening laboratories, and between confirmatory diagnostic labs. We know actually reference ranges for newborn screening samples from filter samples are often much different. The Washington State Newborn Screening Laboratory does not release newborn screening information, nor do they release information on normal population references or their cutoffs used for newborn screening. I know from my experience as a biochemical geneticist that in newborn screening the normal range up to the 99th percentile may reach as high as 2.5 micromolars for the normal population range for C18:1 acylcarnitines. For C16 acylcarnitines, it may reach as high as 5-6 and for C18 acylcarnitines may reach as high as 1.5-2. These would clearly place Jianhua''''''''s newborn screening test results for C18:1, C16 and C18 acylcarnitines well within the normal range for a newborn screening specimen from a child collected during the first week of life. I very much appreciate your sincere efforts to completely examine all of the possibilities that Jianhua may have a fatty acid oxidation disorder. His newborn screening results as you provided here from his first and second newborn screens are well within normal population ranges. Additionally, from the information that you have shared with me and from what I have been able to determine from his medical records, he had no symptoms that I am aware of, or that you have shared with me, that would be consistent with a fatty acid oxidation disorder prior to his presentation in the hospital in April 2013. Additionally, his initial presentation in the hospital in April 2013 with acute liver failure would be a very atypical presentation for a fatty oxidation disorder without other simultaneous presenting symptoms such as hypoglycemia at presentation. His hypoglycemia occurred later during his hospitalization and this could be explained by his acute liver failure itself and not due to a fatty acid oxidation disorder causing the hypoglycemia. The plasma acylcarnitines were not elevated to the levels we would expect if a fatty acid oxidation disorder was causing the hypoglycemia. The findings on his urine organic acids were inconsistent with a fatty acid oxidation disorder when interpreted in clinical context with his plasma acylcarnitines and his health state in the hospital at that time. The interpretation of all of his biochemical testing would not support a fatty acid oxidation disorder as causing his acute liver failure nor the hypoglycemia at that time. If we then were to further theoretically assume he still had a chance of having a fatty oxidation disorder based on his acylcarnitine measurements, then the next step would be then do DNA sequencing. Jianhua has had whole exome sequencing and a microarray looking for deletions and duplications in mitochondria-related genes including the fatty acid oxidation disorder genes. He was only found to have one sequence variant for ACAD9 and no other variants for any other type of fatty acid oxidation disorder. Fatty acid oxidation disorders are autosomal recessive conditions so in order to have a fatty acid oxidation disorder a person would have to have two DNA sequence changes believed to cause disease, one in each of the two gene alleles for that particular gene. Jianhua has been only been found to have one DNA sequence variant in ACAD9, and nothing else. There is no DNA sequence evidence to support a possibility of a fatty acid oxidation disorder in Jianhua at this time. Overall, we have demonstrated clear evidence, both biochemical and molecular, reassuring us that he does not have a fatty acid oxidation disorder. I would not recommend any additional testing for fatty acid oxidation disorders based on this evidence. His clinical improvements over that past year have truly been wonderful, but I do not believe that this is due to his dietary treatment for a fatty acid oxidation disorder that you have started at your own initiative. Dietary evaluation should continue to reassure us that he does not have nutritional deficiencies. Since we have not demonstrated that he has an inborn error of metabolism that would require a fat-restricted and MCT supplemented diet, I would support you if you chose to transition him to a more normal diet. As we have discussed previously, he may benefit from further evaluation for common variable immune deficiency and I would recommend further conSUltation for this. I appreciate your sending me this information. I would be happy to discuss this further in the future at a clinic visit if you so wish to do so. Sincerely, Electronically Authenticated by J Lawrence Merritt, II, MD 04/29/201410:44 A J Lawrence Merritt, II, MD , Attending Physician, Genetics
这个医生和PICU director故意杀害病人。。 后来接手的不比前面的手软。。 当然最牛逼的是picu director， 不留下一点点痕迹， 杀人杀熟练了。。 西雅图儿童医院这么杀人， 在这类病已知如何诊断治疗的情况下， 至少应该从七十年代就开始了。到现在五十年罪恶累累了。 我跟华盛顿州举报了， 根本不查。。。 州还派人到家里威胁我们要把孩子抢走。。
没有比美国更邪恶的国家了。
这是医院举报的信息：
Today, I received a call from Evelyn Hsu, MD, Gastroenterology Transplant attending. She and her team have been concerned that Jianhua initially presented about 7 months ago with acute liver failure. On biopsy, he had micronodular cirrhosis. Extensive testing was done at that time for a cause, and none determined; however, subsequently the clinical evidence of his liver disease has improved. He was last seen last spring, with the plan that he would follow up this fall.
During the course of his evaluations, his father developed concerns that he had a fatty acid oxidation defect. Extensive metabolic testing has been negative so far, yet dad has been unwilling to drop this diagnostic concern. Due to conflicts with the Gastroenterology Service, he also has indicated that he is seeking care elsewhere, including at Pittsburgh and Portland, Oregon.
The Gastroenterology Service is concerned that it would be important to document that, whatever the cause of the liver failure was, it is no longer active. I discussed with Dr. Hsu that, since Jianhua has a very serious medical problem, that failure of his father to seek appropriate follow-up care would constitute medical neglect. I recommended that Gastroenterology connect with dad and set a date this fall by which he must provide documentation that Jianhua is receiving appropriate care elsewhere. Short of that documentation, a Protective Services referral for medical neglect should be made.
是啊。新病人最难约。很多医生每天限制给新病人的appointment时间。
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Urgent care 也有下班时间的。动不动说人蠢，也是够mean
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我遇到过这样的。国内的时候，邻居车祸腿骨折送医院，几次打电话来家里催缴费做手术（很多年以前那还是公用电话）
到了美国读书的时候，同学踢球腿骨折了要等几天才骨折（好像说医生还是医院没空）。当时才来美国没多久，简直难以相信骨折还不能当天手术的
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你这是对苹果有多大的误解。。。 苹果的医保并不好
一个发达国家，医疗占GDP的20%+，远超其他欧美国家，收费那么贵而不透明，结果医疗水平沦落到和中国比？
请问我哪句话是比了医疗水平了？医疗水平这么复杂的事情，外行还真不敢说。也就是就从病人的角度感受一下觉得在美国看病人舒服一点而已，个人因此会选择在美国看病。
如果没有中美两边同等情况就医体验的，或者看重的对比指标不一样的（比如只看账面价格），空谈半天，其实对别人也没啥借鉴价值。
美国这么多黑心医生，不愁，等你遇上了就知道了，舒心得很。
在美国这么多年了，不知道64岁有medicare吗？觉得cover不够，可以叠加保险。
什么乱七八糟的
这种其实就和美国差不多了，就是贵。而且中小城市未必有
我一般都是找2-3个医生谈，然后定下来主治医生。至少我找的医生愿意在我身上花时间，专科医生30分钟每次吧，问题都问清楚了才走的。
中国我家里是医疗系统的，认识医生，体验也不错。我一个亲戚在北京肿瘤医院开刀，打招呼，安排在第一个手术，结果完美，不过可想而知最后一个手术的人如何 （一天7台），好可怕，然而医生说你想多了，能在他们医院做手术的都是有后门的，外地人基本没戏，就是后门大小而已。
我家人在美国做了个手术，4-5个小时，美国主刀医生说他一天只开一次刀。这样才合理吧，保障他充分休息和计划。而这个医生是top 医院一把刀，只要想看都约得上的，他有不少世界各国的患者来美国手术找他开刀。
ADD TO FAVORITES SHARE In San Francisco, a steady trend in coronavirus (COVID-19) deaths has gone largely unnoticed until recently: Asian Americans consistently account for nearly half of COVID-19 deaths. For a city that is one-third Asian American, the disproportionate number of deaths appears striking, yet this highlights an even more worrisome statistic—Asian Americans experience a four times higher case fatality rate (CFR) than that of the overall population (5.2 percent versus 1.3 percent).
这个是按预防报批吧，要是真有问题应该约的蛮快的。不过几个月也长了点，我的肠镜约了一个多月以后的。
哦，所以做同样的几项检查，在同一个地方楼上楼下跑一下就累了，焦虑了；而要分别打电话预约，要分几天，分别跑不同的地方，每个地方弄不好都要10 miles, 20 miles, 弄不好还要请很多次假，这样的叫享受？
舔呢，也要有点脑子，讲点科学
这种用夸张的想象来怼别人实际经历对比的，打电话预约觉得比到处排队受冷眼呵斥要难的（语言不通？），其实也是幸运，没有切身对比的机会，所以会觉得国内看病那种被对待的态度也没啥问题。有个朋友以前还真是这种一样的腔调，然后在美国发现了早期癌症，一天院都没住最后治疗好了，有了切身感受，就懂了。
其实真心想了解也不需要生病，有机会好好观察一下中国和美国的医院里面，不同的人的表情，医护，病人，家属们，很大区别的。
我们全民公费的呢，慢是慢的，但是也是有选择的。比如说我女儿得肺炎，老公得阑尾炎，胆结石，我妈得急性胃炎，这种比较紧急的事情，没有等的，都是送去就住院，立刻治疗/抢救/手术。让你等的，都不是急茬。小感冒什么的，主要是觉得吃药也没用，所以我们一般就不去看了，但是如果去看的话，也没有什么等的，就约一下家医，一般当天或者次日看呗。
另外有人说，全民公费的，医院的人工作没有积极性，我看到的不是这样。公费，是国家花钱，并不是医院不挣钱。医生护士照样按照市场价格获得收入。而且想要当专家，不在医院混没戏。我们小国职位少，高水平的医生统统都在公立医院有职位。你有商业保险，跟没有，看同样的专家。有保险的不用排队而已，但是如果病急，没保险的也不用排队。我看医院的医生护士都挺好的。水平一般的，一般是家医。但是其实家医也有很不错的，他们只是没有得到那个宝贵的医院职位而已。我家某人长期看一个韩裔医生，非常好。
中国是什么情况，别逗了，怎么能跟美国比，我看就医体验连泰国都不能比。世界上还有哪个国家是住院的病人需要好几个家人放弃工作24小时陪护，不陪护就立刻出幺蛾子的？楼上非说病人楼上楼下跑并不累，我看此人脑子抽了。我爸前几年回国看病，因为有人告诉他北京哪里哪里有这方面的高水平医生。他的确是去看了这个名医，名医本人也没问题。但是七十多岁老头子没有子女陪伴，去过一次医院回家跟我说，我再也不看了，我回新西兰看！这里的医院拿病人不当人！我也是含糊了，没有叮嘱我弟弟陪着去，我爸呢，他在新西兰生活十几年，习惯了这些地方都自己一个人去，惯性让他回国非常不适应。还不用说费用呢，不交钱不治病，哪怕你就要挂了，医院也不收治。病房紧张的时候，除非权贵，否则你马上要咽气了，医院也不收你。我18年底回去，赶上我舅舅病了就是这个遭遇，他还是很有身份的人呢。跟西方国家比，中国的医疗就是一个笑话。医生是有技术好的，但比例也极低。整个系统烂透了。
如果你们提供zip code, 我可以志愿帮你们看看有无比较合适的保险，不过不能保证成功。
弱智 任何一家医院也不会没有人看你对你多好
参见河山硕。。
纽约老人院多少没有人管。。都逃了
I care a lot..
不是吧！你是道听途说吗？
你别认真了。他们这些都是不了解美国医保的来抬杠的。就拿加州来说吧，40岁的人买医保如果high deductible的话是250一个月。没有deductible是300多。2022最新价格如下： https://www.valuepenguin.com/best-cheap-health-insurance-california
8万年薪就算拿500出来买保险也不算多。何况公司还能帮你付点。如果是自雇的话那是他个人的选择。加州找个八万的工作不是那么困难，非要自雇那是因为兴趣爱好或者其他方面的原因，与其说给不起医保不如说是自己选择的一种生活方式。
这个好像不是的。google有可能
很对。日本，台湾的医疗系统是很好的。美国，欧洲的医疗系统也是各有利弊，医疗条件也是好的。中国的所谓医疗服务，就是个笑话，虽然最近十几年来，医保这一块是在进步，但是，医疗服务一塌糊涂，老人没有年轻人陪同去看病，医生护士会直接说沟通不了，医院误诊，会直接说家属不负责任，没有及时准确的观察到症状等等，简直不停挑战三观。
保险这么好。
你这应该去urgent care或者walk-in clinic。我们这边walk-in clinic当天能约到。结束后会让你跟你自己的primary care医生follow up。
我大体同意你，不过，与人为善吧，也许他们是有困难找到合适保险。我们都是这个地方的第一代移民，在新的国家相互帮助，有时就是举手之劳。
正解。自己首先要钻研医疗系统，不要一有问题就怪别方。
对，其实我们也是有娃后才必须要弄慬美国这一套系统。
国内住院费50人民币一天。 这个得自己出。 大概美国住院费不用自己出。 最重要的是， 国内认识人。。 那个直接进病房的就是我们农村亲戚孩子到那里工作去了。 你想想中国你认识多少人， 能跟多少人说上话。 美国你算个屁啊。。
至于照顾。 一半不需要， 或者需要可以便宜雇护工， 整体医疗价格降下来， 对全社会都好。
层主哪年国内看病？现如今都手机预约挂号，也可以排队，大医院到处是自动挂号结账机，排队早已不像以往
很多人还做梦hsa存钱。。 麻痹那个钱是医院保险公司要你命的。
医院抓住我闺女不放出来， 我说辞职没有保险你们何必做这缺德事情。。 医院社工根本懒得否认， 告诉我你别担心， 我们有政府项目， 可以拿到钱。。。 美国他妈的赤裸裸绑架病人。。
这个垃圾国家存在就是人类的耻辱。
年轻人怎么预约都无所谓，小孩子的病都是急性的，美国大多数地方都有固定时间walk-in，国内要找关系，所以国内生完一个孩子的，大多数不愿再生了，太麻烦。
你内部认识人还说啥。我认识口腔医院的人，看牙不用挂号，去各课检查之前电话有人先打过去，手术一分钱不用花。外面挂号的人排队天不亮就开始。
不要得了便宜还卖乖。
问题是我们就是普通家庭认识熟人， 不是有权势的。
这是一般农村家庭就可以得到的治疗。 石家庄而已。
And with respect to infant mortality, the U.S. ranks 33 out of 36 Organization of Economic Cooperation and Development (OECD) nations. In 2018, while infant mortality reached an all-time low in the U.S., at 5.9 infant deaths per 1,000 live births, still more than 21,000 infants died. Compared to countries with a similar GDP, the U.S. infant mortality rate is much higher. France and the U.K., for example, have 3.8 deaths per 1,000 live births.
垃圾国家。。 垫底
The United States has some of the worst mental health–related outcomes, including the highest suicide rate and second-highest drug-related death rate.
你选一个大医院的pcp呢？也可以看医生做检查都在一个地方
The US obesity prevalence was 42.4% in 2017 – 2018. From 1999 –2000 through 2017 –2018, US obesity prevalence increased from 30.5% to 42.4%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer. These are among the leading causes of preventable, premature death. The estimated annual medical cost of obesity external icon
in the United States was $147 billion in 2008. Medical costs for people who had obesity was $1,429 higher than medical costs for people with healthy weight.
中国瘦多了 Obesity in China is a major health concern according to the WHO, with overall rates of obesity between 5% and 6% for the country, but greater than 20% in some cities where fast food is popular.
其实人一般生大病是在60岁后。假设人的寿命90岁。假设每年生大病，够倒霉吧。那么只要存30万在HSA就够了。因为deductible 后面是全包的，难道我理解错了吗。
再说护理，护理可以买long term care。其实单单long term care insurance 不是很贵。一般人需要长期护理是3年。3年再加个10万。
那么总体是40万。
假设你在hsa存钱，每5年翻倍，基本上25年的时间就可以存到40万了。假设你60岁需要用医疗，那么你在35岁开始存hsa都不晚。
你没考虑通胀。
Urgent Care 要看保险，先交co-pay ER什么都不看。国内去医院看的那些病肯定是去Urgent Care，人口密集的地方，挺多的。外伤一般是ER，或者不想掏钱的。不知道这个群里有那么多人喜欢ER，也许他们根本没来过美国。
就上礼拜6,亲戚在美国入院做割胸腔息肉,住了一晚上,因为年纪有点大了70+岁.一点英文都不会,我问他怎么跟医生沟通的?他说那个医院的护士医生人手一台手机,里面有翻译软件...一般的聊天没问题. 讲解手术过程 会连接到人工客服,手机连到大屏幕 ,你会看到翻译在镜头,医生说一段翻译员在线翻译. 然后给他照CT,不用去CT房,直接把一台机器推到你床边给你拍,入院后的全部检查都没离开过病房,都是机器推着来床边做的. 听完后我觉得我有点out了...
通货膨胀和deductible 没有关系吧。 我理解在美国生小病很贵。生大病不是很贵。
被赶回家 半个月后就死了
这是大家都熟知的 还是教授 著名民运人士
其他人的医疗会如何？！
而方励之死了也没有个诊断。。。 他器官功能全部下降 竟然被赶回家去
他七十多
同事国内大概都要八十五九十岁了
看看那个学部死这么早？！
ER 1.治有生命危险的或者急病. 2.排队时间长,除非你很紧急. 3.不论你的保险,全收. 4.开24小时7天.
urgent care 1.没有生命危险的病. 2.排队时间比ER短. 3.看保险,需要co-pay或者不在网内收很贵. 4.不是24小时服务.
btw,有些你觉得不太严重的病其实也是需要去ER的,比如任何的突然失去某些功能,就突然看不见东西loss of vision,或者突然头剧烈的痛,又或者突然走路不平衡,走不了路了.是应该去ER的.还有烧伤严重的.
详细说说？
从来不用家庭医生的飘过，直接约专科
估计就是个骗子 详细说个大病治疗不是那么容易的
？？？ fang or maga 没有一家是这样的。。
不是华人网都是家庭平均70万码农么， 怎么这个评论这么多赞。
生小孩条件是不错 电视还有 cable. ESPN TNT 看球赛