I remember when I was a kid, doctors were so interactive and really took time to get to know you and talk to you, learn about what you’re going through and explain things. Now as an adult, it’s been nearly impossible to find a doctor who is willing to take any amount of time to sit down, explain things, show any sort of compassion or empathy at all.
I suffer from acid reflux, and in order to diagnose that, they basically put a tube down your throat, it’s called an endoscopy. You have to be fully sedated with anesthesia and take nearly an entire day off of work because the way the anesthesia affects you, you can’t drive and someone has to drive you. Well for many years now we’ve had this other procedure which is a tube, but they put it through your nose instead. There’s been lots of research papers about the use of it, it’s used in other countries as a procedure regularly. So I asked several gastroenterologists if they offer the procedure and every single one of them said no, and would not provide any additional information or insight as to why you have to be completely sedated and pay thousands upon thousands of dollars for expensive anesthesia. I am simply blown away. It makes no sense. A research tested method that has been written about for about a decade now in actual research studies by board certified medical physicians, and no one offers it. Literally no one, and they won’t even consider it.
I’ve also been through at least several primary care physicians because the ones I have seen are so short and don’t really take time to get to know you at all. They just pop in, ask you a handful of questions and leave, if your test results come back with anything abnormal, they say it’s nothing to worry about, they don’t want to take any extra time to help look into anything or diagnose you… like wtf?
It just seems like doctors these days are out to get you to spend as much money as possible and do the absolute bare minimum for you in return. And now we have direct primary care options where you can circumvent insurance entirely, pay your doctor thousands upon thousands of dollars a year for the same level of care that we had in the '90s. But now you have to pay out of pocket for that in addition to your insurance. Wtfffff
Our Healthcare system is fucked. You really need to be your own advocate and do your own double-checking. Think about how many people are bad at their jobs, and realize that plenty of those people are doctors.
I’m lucky to have “inherited” my parents’ doctor. She is extremely compassionate and gets deeply involved in you and your concerns on every visit. So much so that she is infamous for being behind schedule, to the point where we fully expect to wait for an hour to see her after the scheduled appointment time. She makes up for it by talking with you for as long as you want.
She also hasn’t accepted new patients for like 4 years… so yeah, I guess all the good ones are taken.
Judging from my own doctors experience, they are way overbooked. Can’t get a personal experience when they gotta see a couple dozen more people the same day.
The US healthcare system is built around money and profit. A cheaper procedure which does not require general anaesthetic costs less, and reduces profit. That can be beneficial to the providers but bloat is incentivised in the US healthcare system as providers battle with insurance companies for money. Crudely healthcare providers don’t care about saving you money; they want to take as much money as they can get.
Meanwhile, countries with tax funded health care opt for the most cost effective procedures, investigations and treatments. The incentive is to reduce costs and offer the most effective things to the most people possible. That can also sometimes have negative side effects if not carefully regulated but in such systems generally Doctors advocate for the best procedure and best medical practice, as they themselves do not directly benefit financially from which procedure is pushed. The downside is you do get the opposite side of things where patients are dissuaded from things as they’re not deemed cost effective by those who control the spending.
I’ve only tangentially heard about this, but another issue is that doctors in the US don’t have to, and aren’t encouraged to keep up with recent research.
Combine that with a medical education system that hasn’t changed drastically in 70 years to keep up with that new research and most US doctors are just out of date.
Our ICD -10 is about a decade behind WHO, iirc.
There is some variation by state but in the US almost all licensed medical professionals are required to participate in continuing education to keep their license.
Which is hit or miss. I’ve been in those CE courses and seminars, and they range from informative and exciting to literal time-wasting. An example: What doctor needs to care about log-rolling patients and backboarding them? That’s something a firefighter or EMT does.
Well yes, the onus is on the healthcare provider to pick CME that’s relevant to them.
- Too many patients, not enough doctors.
- Private insurance and intrusive controlling software: the doctor is limited in what they are allowed to prescribe, they have to check all sorts of boxes, and they have complex computer forms to fill out. They are too busy with the laptop to have much attention left for patients.
- Non-compliant patients who “do their own research” on the internet.
Most doctors I know don’t even want to go to a doctor. They know all the providers are shit talking their patients and just doing the best they can in a very broken system.
Late stage capitalism and medical misinformation have made the doctor-patient relationship almost adversarial.
Non-compliance is often because it’s unaffordable, even diet.
Yes, I would not dispute that. Medication and PT is too expensive for many. And many people live in “food deserts”. Whatever the causes, it’s highly frustrating for doctors.
You know enough doctors well enough to know that most of them don’t want to go to a doctor?
Read what I said. Most doctors I know. I know several. I worked for a hospital system, and I currently have a healthcare adjacent job. We talk about these things, yes. I don’t claim to speak for all doctors.
Non-compliant patients who “do their own research” on the internet.
In the US they advertise drugs directly to us, we’re expected to do our own marketing-guided research to speed along the transaction.
You’re right, it’s a complex issue that my bullet point just kind of touched on (and lacks nuance). In many ways, patients are required to navigate their own health care and be their own champion and advocate It gets messy when we encounter misinformation that tells us what we want to hear, but isn’t based on solid science.
They are too busy with the laptop to have much attention left for patients.
I’m a nurse practitioner, and can confirm this: I spend at least half of my time tapping away at the computer, checking boxes, and completing often-redundant forms for insurance and regulatory compliance and whatnot. It’s really frustrating, and there’s a lot of room for improvement.
It’s astonishing (and insane) how private health insurance has taken over the entirety of health care at every operational level.
This is a type of insurance that started out decades ago as an unusual perk for executives. They called “major medical”. Nobody thought that much about it. In those days most working people simply could go see a doctor and just pay with cash or check.
Now, their tendrils have wrapped around everything from the lowest-paid pharmacy tech to most expensive surgeon…and everything and everyone in-between.
The board rooms of private health insurance companies have a gigantic dragon by the tail, and they have no damned clue what to do with it.
I’ll also add that I very much appreciate nurse practitioners. I have to go in every 6 months for routine “old man maintenance” checkups, and there’s really no need for me to see a doctor for these types of visits. You’re filling a much-needed role. (And I’m sure you do a lot more than just “old man maintenance” consults, LOL).
Also a very litigious society. Even if they mean well, going off the page and trying to figure out a “Haus” solution is just putting themselves at risk.
They have to check all the boxes for your insurance. They have to check all the boxes for their own malpractice insurance. Even if they followed procedure, they might get dragged through the legal system to defend themselves if a client feels wronged.
That turns you, the client, into a number in a dispassionated machine.
And I don’t have a solution to it.
Edit - that was a bit too bleak. There are a lot of doctors trying their best to retain humanity in a system aimed at destroying it. The whole med school journey is aimed at weeding the people out who are just in it for the money. It’s designed to gatekeep the industry to require a massive amount of passion to get your foot in the door. But the realities of the industry do their best to squash that.
Thank you, you bring up some important points. Malpractice lawsuits and insurance are significant problems, too.
In my limited anecdotal experience as a patient of (and support staff for) doctors I have met some very compassionate and capable doctors and nurses. I don’t see health care providers as being the problem with our system. It’s primarily the private health insurance companies and PBMs. They are the main reasons why we can’t have nice things.
I’m not in the USA but this trend is also happening in other countries. I guess USA feels it more because of the already punitive health system.
I’ve been thinking in recent times about pharmacies. 20 odd years ago, pharmacies used to deal with things too severe to put off, maybe not severe enough to see a doctor for. Now pharmacies are about “wellness” which is marketing crap to make more money. Middle aged woman feeling unwell? Cut your hair short and dye it 3 different colours. You’ll look young and feel young! But they’re still unwell and still have sore joints etc. Pretty depressing to think about.
U. S. medicine is corporatized. You are visiting a corporate store front, not a doctor’s office.
If you want personalized medicine from doctors who give a shit, you’ll either need to find a small clinic that gives a shit or you’ll need to get your procedures done for cash while on vacation in Europe.
Medical tourism can sometimes be the same price (including travel) as staying in the U.S and dealing with insurance.
I find a young doctor in a suburb almost 10 years ago. He’s been great and he listens to me, has no problem taking my suggestions into consideration, and he often admits when he doesn’t know something and will literally Google it right there in the room. It took as while to find someone I like, but it was worth looking.
Afaik it has to do with licensing regulations and litigations…
A doctor is licensed to practice by the state, and must carry insurance on a state-by-state basis to acquire a license to practice.
The problem is that if you get sued 3 times you get blackballed by the insurance industry in your state and the insurance companies won’t insure you.
You see a lot of doctors moving states often, its often because they became un-licensable in their former areas.
I have limited industry experience and have talked to quite a few doctors who were indeed a bit distant and hands-off in their practice for this reason alone.
Just fyi, the sedation is usually not medically necessary. I have had it (as well as a colonoscopy) done without, just got a spray to numb the throat for a short while. It’s not pleasant, but I found it bearable and it’s much nicer to just walk out and drive home on your own. If necessary I could still have told/signaled that I want sedation after all during the procedure. Propofol works within less than a minute. In that case they would have called someone to pick me up.
That said, I do live in Germany, so money does not play as big a role as in the US when it comes to healthcare. And the doctors and their staff were exceedingly nice and caring.
Maybe, if you believe you can bear it, and if acid reflux does not make it painful, ask to do it without sedation next time.
I know the sedation is not medically necessary, lots of places outside the USA don’t do it at all. Japan, Europe, etc. There’s research studies that even show non sedated procedures are being used and have been favorably received. Every single doctor I’ve asked about them, they outright refuse to do it without sedation or anesthesia. Guess how much that costs? Thousands of dollars, with insurance. So I have to pay about $5,000 at least out of pocket a year for insurance, then I have to pay $3,500 for this procedure, and the last two that I’ve gotten, they haven’t shown anything. So naturally I’m like okay, can we do a less invasive one without sedation, like they do in other countries? Absolutely not. We won’t do that, and we don’t know anyone else who will ever do it. Like what the hell is this?
This is not medical advice, just some general comments regarding your post.
An upper endoscopy is rarely needed for evaluation for uncomplicated acid reflux. It alone is not even an appropriate indication for an upper endoscopy, except for a specific patient population and that’s to screen for a disorder related to acid reflux.
Unsedated endoscopies are uncomfortable for the patient and the physician. They suck. Many gastroenterologists will do it, but there’s at least some reason for why others won’t. Doctors in countries that do a lot of unsedated upper endoscopies do so because these patients have them much more often (screening for a much higher risk of gastric cancer in, say, Japan). But the way, whether you get anesthesia from an anesthesiologist or no anesthesia doesn’t affect how much insurance pays the endoscopist.
The tube you’re referring to sounds like pH monitoring with an impedance catheter. It stays in your nose for 24 hours, and generally isn’t more convenient than an upper endoscopy. It’s not required for diagnosis of simple acid reflux, and serves a completely different purpose than an endoscopy. It’s used mainly when the diagnosis is in question. Most gastroenterologists aren’t sufficiently trained to read these studies anyway. These patients are usually referred to high volume centers.
Sedation for upper endoscopy isn’t even necessarily the norm throughout different countries. It is in the US, but I had my first upper endoscopy in Japan, and they just numbed my throat.
They’re paid by the job, not by the hour.
IOW they get paid a fee for the visit, a fee for any tests, etc.
Thank modern insurance for that.
They do not get paid any extra to have a conversation with you or to spend actual time with you to discuss whatever issues you are facing. I think the caveat is more that the GP/PCP is more likely to speed by you as they’ve got 20 more patients to see that day and a specialist will probably spend more time with you because they’re only trying to work on one issue rather than deal with weird pains, blood tests, talk to you about your weight, etc…
Doesn’t help that the insurance is the real employer and superior physician as they ultimately decides the treatment too
Because medical care in the US places profit over people
In the US, unlike most other countries, medical doctors are most at risk for suicide.
Source?
I’m not the person you asked but I just did a quick search. I don’t know if it’s more prevalent in the US or not, but here is a scientific journal on the subject:
“The medical profession faces a critical challenge with the mental health of its practitioners, leading to an alarming increase in suicide rates among healthcare workers (HCW).”
The CDC reports rates pretty well below the general average, at least for 2021.
why you have to be completely sedated and pay thousands upon thousands of dollars for expensive anesthesia
I’ve got this one, my dude. It’s because American healthcare is mercenary and broken. When I had, um, a similar ‘retroscopic’ test from the other end, I was under a general, needed a buddy at the end, out for a few hours, etc; seems to be about the same.
Cost: $0
Premiums/subscription: $0
Material costs: $0 also
Like, I pay my income tax and the healthcare is just what’s there – we run it on income tax only, and before covid it was apparently funded adequately. Yeah, we’re short on doctors right now as many of them left the field because of aggressive ‘mah raghts’ hillbillies whipped into a frenzy by the conservatives, but they run the triage and they keep their appointments. It’s so different from when I lived in 07974.
Capitalism.
Healthcare and insurance are for profit industries and the corporations running the healthcare and insurance business don’t give a fuck about the health of the patients. They want all the monies and want to move patients through as quickly and cheaply as possible to maximize their profits.
It’s exactly this. The policies put in place by “healthcare administrators” (MBAs and such with healthcare flavoring, not people that actually know how to care for people’s health like doctors and nurses) are designed to process the most patience in the least amount of face time possible, so that each doctor and nurse can see more patients per day, meaning more office visit fees, meaning higher profit. My dad calls it the “cattle shoot” and I feel that’s a pretty apt analogy. It’s the same general reason that fast food restaurants and pharmacies and department stores are perpetually understaffed: fewer staff members means lower “overhead” costs.
This combined with liability. If the patient gets anything even resembling an unsatisfactory result, they’re likely to sue the doctor.
Honestly, I think this is not true, in my experience at least. I think suing doctors was a feature of the '90s and early 2000s, but now people are so poor they can’t afford lawyers to sue a doctor for them, and medical malpractice runs so rampant that doctors don’t even seem to care at all. Everyone has had a bad running with a doctor, yet you’re very unlikely to hear of someone who has sued a doctor and gotten away with it.
What the US has isn’t free market capitalism. It is capitalism but with government imposed rules that are harmful to the common person. Your insurance depends your employer and you don’t get a reasonable choice - they put in $1000/month that if you go elsewhere you lose that. Of course what your employer wants and what you want are different. Your employer wants the lowest costs for something expensive, and they want you to not quit until they are ready to get rid of you. You want some service with that insurance, but you are not a player with power so you don’t get that.
The policies out in place by healthcare and hospitals arent forced by government… these policies are by the companies so its not even about “but da gubnent is ebil!”
They are the naturatual concequense of the policies put into place. They are not required but they are still the result that should be expected.
If its to be expected then something should be done about it even if we all have to make a contribution either by tax or by putting your due diligence and voting for the right person for everyone, not for yourself
It’s not pure capitalism, but it’s definitely crony capitalism. Us plebs get fucked either way.
I feel compelled to point that out though as government provided health care is not the only possible solution, and I’m in the group that would oppose that. However I have provided a better alternative: eliminate the deductions for employer provided insurance. (I think the above about other benefits jobs provide - I should be comparing paycheck not “fringe benefits”.
Also, I don’t see how eliminating the deductions helps. And I don’t mean that in a snarky way. I’m genuinely asking how that would make the situation better.
When companies pay me more if I don’t take their insurance I have an option to choose something better. Right now I have no optioniso nobody cares to serve me.
The profit motive needs to be removed from healthcare, or patients will continue to get fucked.
Healthcare needs to be separated from employment, and the profit motive needs to be removed from healthcare.
Should the government run it? Maybe not, but what’s the alternative? It’s like every election. Choosing one of two bad choices and hoping you choose the less bad.
And in the case of healthcare, I’ll take government run, profit free, tax funded healthcare over what we have now.
Edit: autocorrect error.
Non profit, non vertically integrated healthcare. Letting the insurance companies “partner” with the pharmacies and hospitals is monopolistic or at best duopolistic in some markets. And it lets them charge whatever or threaten to leave a community. Which has happened repeatedly in my area. Then the biggest hospital in the area buys up another small one and the costs go up again.
This might be better for wealthy people but it’s hard to see how this would benefit the very poorest who are in most need of health care. What does this solution do for them?
Only a tiny minority who mostly don’t have jobs and thus no insurance and so we already need to do something different. For the middle class this is better.
Thats BS theres plenty of lower class who have jobs and get shit insurance. I shouldnt have to say this…
But sure the middle class is more important
The middle class is much larger. Not ignoring the plight of them, but don’t force something subpar on me just for a small percetage. With several hundred americans there are a lot of poor but still a tiny percentage
What about contracting a terminal illness like cancer where you might not be able to work. You need a job to keep your healthcare but if an illness or disability that you have or get at some point stops you from working and you need to pay for that healthcare, what do you do?
I think insurance should cover you for all current conditions for life even if you otherwise switch insurance for new issues
this is such a cliché, short-sighted oversimplification that doesn’t address the root of how individual physicians end up caught in these systems of apathy.
like yes capitalism is part of the problem but that’s about as useful as saying, why is there climate change? capitalism! like sure, yes, but isn’t there so much more to the story that can inform us on why the systems are the way they are, so that maybe we can address it? or i guess .ml users already have that answer, just start a global revolution and hope the winners care enough to fix it before all the survivors die of heat stroke dysentery and starvation, easy. capitalism. upvotes to the left.
How do people not get so sick of this meme of an answer?
Its like how every opinion teenagers have is the antithesis of their parents ideology.
What if a communist doctor withholds execllent care to preserve resources for the motherland?
We do get sick of it, but only because it’s always true.
Im not convinced alturism seeps from our pores when currency is taken away. I would say its more human nature to claim and horde anything of value, and those who are generous will slowly give up their equity to those who arent generous.
If the system is changed to force people to be generous or outlaw hording then you would see people with power continuing to do it, as they do now.
Maybe captialism is just what fits because this is what we are.
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That doesnt address my perspective. I dont think you understood what i said.
Capitalism/the profit motive is how physicians get caught in these systems of apathy. My comment isn’t an over simplification, it is the root cause.
Is the entirety of the healthcare system incredibly complex? Absolutely, and within that complex system there are all sorts of problems that could be teased out to study and address. None of that will dramatically change the outcome of a system that is designed solely to extract as much profit as it can.
When profit is the primary goal of a healthcare company (and the legally mandated responsibility of that company if it is publicly traded) the end result is the system we have.
