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
the united states is addicted to litigation. something that goes wrong is always someone elses responsibility and they will pay.
if a kid breaks their arm at school way too many humans decide ‘that school was negligent, no matter what the circumstances’ and they sue instead of collectively realizing kids do stupid things, and get hurt sometimes. this leaves school districts banning things like ‘tag’. banning being children
its the same nonsense with doctors. theyve been sued into seclusion of anything they arent explicitly required to do.
the insurance industry has a hand in managing doctors time also… theyre basically given zero time to work with patients or they cant make enough money to stay in business.
health insurance companies only profit when human beings suffer
Nah, it’s about cramming as many patients as possible into each day. If it was about litigation, being more personable and attentive would decrease the risk.
Cramming is due to insurance reimbursement t
it’s about cramming as many patients as possible into each day.
Using general anaesthsia and controlling everything reduces risk as compared to doing it with local anaesthesia which might cause discomfort, vomiting. These can get you sued. You never know who will be the person who will screw you just because you tried to save a few bucks.
General anaesthsia might save a few minutes during the procedure but along with the time for giving anaesthsia, recovery from anaesthsia, after care. It is both more time consuming and costly.
being more personable and attentive would decrease the risk.
You would think so but in real world the more you speak more material you would give if you get sued. Hence the doctrine be professional and cover your ass.
I’m not sure why you’re talking about anesthesia.
OP’s post was about anaesthesia.
No, they used anesthesia as an example. Their post was about doctors not spending time and communicating with patients.
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
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.
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.
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 medical industry and the insurance industry are locked in a battle for money, and you don’t have a lot of say in it. I used to run an ambulance service. Let’s discuss.
If I took you to the hospital, and you were on medicare, there was a fixed rate to pick you up and a per mile rate. I got paid part by the government and part by the patient, who I was legally required to bill. If I failed to adequately bill the patient (10% or so), if I lied on the parts and mileage, silver bracelets and court time. We loved billing care/caid, because it was a fixed price, and we knew the payer of 90% paid regularly.
If you have private ambulance transport, you have no idea what you’ll get. The patient can have a $13,000 deductible, a 50% copay, and. $20,000 per-event cap. There’s no rule what a reasonable bill can be. The insurance company is trying to rig the game so the patient pays most of the bill while paying that sweet monthly premium at the same time. The ambulance is trying to be reimbursed for the time and materials. The red states opened the door for the patients to again be uninsured and pay you $0 for everything. So bills have to be high, to ensure some money comes in from insurance, to insure things can keep running. I would have loved to have a country of all care/caid and it be illegal to live there otherwise. They’d be the best cared for poor and old people in the world, getting quality care backed by the “only if you’re poor or old” US single-payer system.
But we have what we have, and it’s been well sold to enough clueless people that it’s here to stay.
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.
Doctors are not individual practitioners and cannot normally decide to go off on their own doing a procedure that they were not specifically trained to do (doctors are trained in procedures during their residency and in CTE). Unless they are offered a course in this new method, the hospital would not authorize them to perform that new procedure. The best way to get this care would be to travel or to lobby the hospital to train staff on this new methodology.
Ten years in medical school and still can’t think for themselves!
Most people never become auto-didacts. Most auto-didacts still benefit from formal training because above average gross performance can mask subtle mistakes until the mistake becomes root cause for a significant error.
Under significant pressure (like a well-written dramatic fiction, but almost never IRL), most doctors will be willing to perform a procedure without formal training, but under normal conditions, they know it is not worth the additional risk.
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?
Because we’re not people to them. They’re incentivized to treat us like cars. Repair as fast and as many as you can to get the most money.
Insurance companies have control over what the doctors can do and over their schedules. They are only allowed to spend certain amounts of time with patients or they get in trouble. All the doctors I’ve talked to hate this. Blame insurance companies and the hospitals for prioritizing profit, not the doctors.
They can spend as much time as they want with the patient. The insurance simply caps how much is billable.
Yes, but to clarify: the time constraints are imposed by for-profit healthcare businesses trying to optimize billable time because insurance will only reimburse for so much time, rather than being imposed by the insurance companies directly. (It’s generally not quite as silly in the non-profit sector.) I work in healthcare in the US: we all hate how it works. The system sucks and it interferes with the quality of care that can be provided, leaving patients worse off just so that greedy can be fed. It’s just asinine that anyone who has no medical knowledge/training is making decisions about how patient care can be implemented, especially where there’s a profit motive involved. We really need to pivot to single-payer or national healthcare system, and abolish for-profit ownership of hospitals.
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.
Not a doctor and just talking out my ass, but I’m assuming part of it has to do with patient workloads and dealing with insurance companies, they’re just not incentivized to really take any time with patients, just get 'em through the visit, check whatever boxes they need to, and move on.
But yeah, I very much have had the same experience for the past 10 years or so with my same doctor, it just feels absolutely useless going to them for anything. It takes alot for me to go to the doctor for anything or to bring anything up even with the doctor if it’s not life-threatening. I’m not a hypochondriac by any stretch, I just try to keep an eye out on my health and if I notice my body doing something out of the ordinary, I just ask about it to see if it means anything.
Before my regular check-up though I’ll kind of bank up whatever questions or oddities that I’ve noticed, things that I figure I can bring up and see if maybe it’s a sign of one thing or another. Most of the time when I mention anything though, it just feels like the doctor is blowing me off, or he’ll just give a guess, maybe google it and show some pictures. At best he might tell me something like, “Hmmm, well it’s probably not cancer.” and then just sort of shrug and move on. I’m a guy, so I’m used to no one caring about my health or well-being at all, but I think I had a different image in my head when I was a kid about what it was doctors actually did.
The one regular benefit I see from going to the doctor is getting my blood drawn and being able to track health numbers from that, my job does the same thing too, so I get two sets of numbers from my blood work every year and I track it to see overall condition of my health, which I kind of wish was something my doctor did. He’ll mostly just comment the most obvious thing possible when the test results come in, but there’s never a look at health numbers over time, which is why I started just tracking it on my own.
Finding a good physician is as difficult as finding a good romance or a good therapist. You need to shop around to find the right fit. After years of struggling with horrible Healthcare I finally found the perfect fit - a middle aged lesbian Nurse Practitioner working out of a health center that caters to lower income folks and the LGBTQ community. Every time I go in we chit chat for a few minutes, then she spends at least half an hour with me going through all of my concerns. She’s very thorough and has made a dramatically positive experience in my health. I can even shoot her an email any time and she gets back to me within a day.
I think it helps that the health center’s board of directors is entirely staffed by the physicians working there, overseen by an elderly doctor who spent his entire career helping the needy in his community.
Keep trying. It’s frustrating, but the right fit is out there.
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.
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.
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 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.
This is just over generalization of your experience.
A primary care doctor should ask questions like if you are stressed out as it affects your life but they are not going to have a long non-medical related conversation because you are no longer a kid and also they won’t remember you until you go back the next time so why waste time when they can see other patients, unless it’s a psychiatrist. The questionnaire they have has all the required medical questions.
Doctors aren’t out to get your money. You don’t even pay them directly. Blame the health insurance companies for that. If they did want to take your money wouldn’t they make you do more tests and take more of your money? There are a lot of ways to get your money apart from anesthesia.
Maybe there is a different medical reason but it is certainly not to just to make your pay for anesthesia. I’m not in a medical field so I can’t into those details. However, I had some oral surgery and I refused anesthesia as I could handle the pain and didn’t want to pay more money. The surgeon didn’t force it on me. I’m not sure where you live but I hadn’t heard that we are forced to take anesthesia when it might not be required as it is has its own risk. Why would the hospital risk that? Just to make more money when they can just order other non-risky expensive tests?
Yeah, I don’t feel this is on the doctors. They’re overrun with work and are just trying to get through it. I was unable to find a single GP in my town that takes both insurance and new patients. My wife can’t find a heart doctor, no one is taking new patients.
An anecdote that illustrates my point:
Went to CVS one Sunday with what I had thought was a mild, post-surgery infection. Turned out it wasn’t, I merely overworked my hand, and was in fact healing up great! This young doctor, having no other patients, sat and shot the shit with me for nearly an hour. I learned so much about my current and past problems. He spoke casually, fielded questions unrelated to my current issue, treated me like an old friend. “The hell made you think kayaking was OK 6-days out of surgery?! Damn, man…” All because he had time to kill. Imagine that. (LOL, he have me antibiotics anyway, knowing I was losing my insurance and would bank them against future need.)
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
