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.
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.
To start off, I’m sorry to hear that you’re not receiving the healthcare you need. I recognize that these words on a screen aren’t going to solve any concrete problems, but in the interest of a fuller comprehension of the USA healthcare system, I will try to offer an answer/opinion to your question that goes into further depth than simply “capitalism” or “money and profit” or “greed”.
What are my qualifications? Absolutely none, whatsoever. Although I did previously write a well-received answer in this community about the USA health insurance system, which may provide some background for what follows.
In short, the USA healthcare system is a hodge-podge of disparate insurers and government entities (collectively “payers”), and doctors, hospitals, clinics, ambulances, and more government entities (collectively “providers”), overseen by separate authorities in each of the 50 US States, territories, tribes, and certain federal departments (collectively “regulators”). There is virtually no national-scale vertical integration in any sense, meaning that no single or large entity has the viewpoint necessary to thoroughly review the systemic issues in this “system”, nor is there the visionary leadership from within the system to even begin addressing its problems.
It is my opinion that by bolting-on short-term solutions without a solid long-term basis, the nation was slowly led to the present dysfunction, akin to boiling a frog. And this need not be through malice or incompetence, since it can be shown that even the most well-intentioned entities in this sordid and intricate pantomime cannot overcome the pressures which this system creates. Even when there are apparent winners like filthy-rich plastic surgeons or research hospitals brimming with talented expert doctors of their specialty, know that the toll they paid was heavy and worse than it had to be.
That’s not to say you should have pity on all such players in this machine. Rather, I wish to point to what I’ll call “procedural ossification”, as my field of computer science has a term known as “protocol ossification” that originally borrowed the term from orthopedia, or the study of bone deformities. How very fitting for this discussion.
I define procedural ossification as the loss of flexibility in some existing process, such that rather than performing the process in pursuit of a larger goal, the process itself becomes the goal, a mindless, rote machine where the crank is turned and the results come out, even though this wasn’t what was idealized. To some, this will harken to bureaucracy in government, where pushing papers and forms may seem more important that actually solving real, pressing issues.
I posit to you that the USA healthcare system suffers from procedural ossification, as many/most of the players have no choice but to participate as cogs in the machine, and that we’ve now entirely missed the intended goal of providing for the health of people. To be an altruistic player is to be penalized by the crushing weight of practicalities.
What do I base this on? If we look at a simple doctor’s office, maybe somewhere in middle America, we might find the staff composed of a lead doctor – it’s her private practice, after all – some Registered Nurses, administrative staff, a technician, and an office manager. Each of these people have particular tasks to make just this single doctor’s office work. Whether it’s supervising the medical operations (the doctor) or operating/maintaining the X-ray machine (technician) or cutting the checks to pay the building rent (office manager), you do need all these roles to make a functioning, small doctor’s office.
How is this organization funded? In my prior comment about USA health insurance, there was a slide which showed the convoluted money flows from payers to providers, which I’ve included below. What’s missing from this picture is how even with huge injections of money, bad process will lead to bad outcomes.
In an ideal doctor’s office, every patient that walks in would be treated so that their health issues are managed properly, whether that’s fully curing the condition or controlling it to not get any worse. Payment would be conditioned upon the treatment being successful and within standard variances for the cost of such treatment, such as covering all tests to rule out contributing factors, repeat visits to reassess the patient’s condition, and outside collaboration with other doctors to devise a thorough plan.
That’s the ideal, and what we have in the USA is an ossified version of that, horribly contorted and in need of help. Everything done in a doctor’s office is tracked with a “CPT/HCPCS code”, which identifies the type of service rendered. That, in and of itself, could be compatible with the ideal doctor’s office, but the reality is that the codes control payment as hard rules, not considering “reasonable variances” that may have arisen. When you have whole professions dedicated to properly “coding” procedures so an insurer or Medicare will pay reimbursement, that’s when we’ve entirely lost the point and grossly departed from the ideal. The payment tail wags the doctor dog.
To be clear, the coding system is well intentioned. It’s just that its use has been institutionalized into only ever paying out if and only if a specific service was rendered, with zero consideration for whether this actually advanced the patient’s treatment. The coding system provides a wealth of directly-comparable statistical data, if we wanted to use that data to help reform the system. But that hasn’t substantially happened, and when you have fee-for-service (FFS) as the base assumption, of course patient care drops down the priority list. Truly, the acronym is very fitting.
Even if the lead doctor at this hypothetical office wanted to place patient health at the absolute forefront of her practice, she will be without the necessary tools to properly diagnose and treat the patient, if she cannot immediately or later obtain reimbursement for the necessary services rendered. She and her practice would have to absorb costs that a “conforming” doctor’s office would have, and that puts her at a further disadvantage. She may even run out of money and have to close.
The only major profession that I’m immediately aware of which undertakes unknown costs with regularity, in the hopes of a later full-and-worthwhile reimbursement, is the legal profession. There, it is the norm for personal injury lawyers to take cases on contingency, meaning that the lawyer will eat all the costs if the lawsuit does not ultimately prevail. But if the lawyer succeeds, then they earn a fixed percentage of the settlement or court judgement, typically 15-22%, to compensate for the risk of taking the case on contingency.
What’s particularly notable is that lawyers must have a good eye to only accept cases they can reasonably win, and to decline cases which are marginal or unlikely to cover costs. This heuristic takes time to hone, but a lawyer could start by being conservative with cases accepted. The reason I mention this is because a doctor-patient relationship is not at all as transactional as a lawyer-client relationship. A doctor should not drop a patient because their health issues won’t allow the doctor to recoup costs.
The notion that an altruistic doctor’s office can exist sustainably under the FFS model would require said doctor to discard the final shred of decency that we still have in this dysfunctional system. This is wrong in a laissez-faire viewpoint, is wrong in a moral viewpoint, and is wrong in a healthcare viewpoint. Everything about this is wrong.
But the most insidious problems are those that perpetuate themselves. And because of all those aforementioned payers, providers, and regulators are merely existing and cannot themselves take the initiative to unwind this mess, it’s going to take more than a nudge from outside to make actual changes.
As I concluded my prior answer on USA health insurance, I noted that Congressional or state-level legislation would be necessary to deal with spiraling costs for healthcare. I believe the same would be required to refocus the nation’s healthcare procedures to put patient care back as the primary objective. This could come in the form of a single-payer model. Or by eschewing insurance pools outright by extending a government obligation to the health of the citizenry, commonly in the form of a universal healthcare system. Costs of the system would become a budgetary line-item so that the health department can focus its energy on care.
To be clear, the costs still have to be borne, but rather than fighting for reimbursement, it could be made into a form of mandatory spending, meaning that they are already authorized to be paid from the Treasury on an ongoing basis. For reference, the federal Medicare health insurance system (for people over 65) is already a mandatory spending obligation. So upgrading Medicare to universal old-people healthcare is not that far of a stretch,
I’m not qualified to say if this is accurate but thanks for putting in the effort to write it!
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.
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.
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.
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.
Ask the doctors who moved out of their home states instead of risking being jailed for “performing an abortion” when they were doling out life-saving medicine.
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.
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
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.
I’m sorry you’ve gone through this, but I am also an American suffering from the same issues as you, and I have found no shortage of ENTs willing to shove the camera down my nose. That seems to be what they always recommend straight from the get-go.
Seems to be especially bad in Georgia where there’s very poor access to healthcare. More progressive places like NY may have different results I’m not sure. It’s just shocking, no one will even consider helping me
It’s pretty much the same. Most insurance companies follow CMS policy.
That is difficult. I assume you’ve tried Atlanta? I would think you would be able to find decent care there. If not, it might be worth traveling a few hours to wherever you can just to get a diagnosis at least.
And make sure the doctor or clinic knows in advance what you are seeking.
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.
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
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 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.
Australia checking in … I feel similarly about the attitude of doctors and the type of care I receive. I don’t have any amazing advice that you’re not already following, but I’ll regale you with my thoughts regardless…
About 18 months ago I developed a chronic health condition that I will need to manage for the rest of my life (hopefully several decades). In that time I’ve seen a myriad of medical professionals.
My first tip would simply be that if you’re not satisfied with a doctor or specialist, your only recourse it to arrange to see another instead. Sometimes the advice / treatment prescribed will vary significantly, sometimes they just have a less punchable face.
As regards GPs, I’ve come to categorise them thusly: those that just prescribe meds without any conversation, those that try to manipulate you into wanting the meds they want to prescribe, and those that will have a conversation with you about what meds you ought to take. Obviously this last category is the one you want.
Finally, I’ve gotten a lot of mileage out of simply staying on top of all the data about me. I have all my test results available on my phone, as well as medications, dates of treatments, contact details for specialists, et cetera. Also just understanding the available treatments.
When you go to a doctor in the USA, you’re really being treated by their lawyer and insurance company.
And the practice. In most cases are doctors are now essentially hair stylists working for some larger entity. A larger entity with shareholders. If you want somebody that cares you probably need to go see a family practice with only one or two doctors. The problem is places like that run out of spaces to see people quickly.
Chrissie Hynde…“I hate anything official”
Good guiding principle right thete.
Corporations, now. Can’t even really call it a practice. They are businesses that employ doctors. In law, most civilized places, you can’t own stake in a law firm unless you are a member of the bar. Makes for a more service focused industry.
Another thing I haven’t seen mentioned is the way people find doctors now has changed. People look online, and there are plenty of sites that are just aggregators for data about doctors. Anyone can scrape that info and then setup a webpage to rate doctors. So now doctors are finding that they aren’t getting patients if they aren’t getting good ratings, so now we have doctors just telling patients what they want to hear, prescribing what they want to be prescribed. Gotta keep up that 9.8/10 rating to keep patients coming in.
