fired my doctor

[brianl703]

Originally Posted By: Gary Allan

A doctor these days is a very expensive service adviser ..and the hospital is nothing more than a rent-a-bay with extended shop services (lab,xray, etc.). They also have a quick lube dept ..that's anything but quick.


Yes, and the shop manual is the Physician's Desk Reference.

 

[BrianWC]

The PDR is for prescribing. UpToDate is the reference of choice for primary care, now. you can access it online or download it to PDA.

But once again, I'd point out...physicians usually aren't as stumped as we'd like to imagine they are...

 

[BearZDefect]

BrianWC, I appreciate your helpful input. Like Gary Allan wrote above, we the patients are guilty too. Ex, lawsuits (which relates to the cost of malpractice insurance) and running to the doctor for every little discomfort.

In the children cases, I realize they are "stewpots" of common illnesses, but when a problem doesn't respond cookbook style to the cookbook solution isn't it likely not a "common illness" per se? In other words, isn't it time to think about it a bit harder?

It seems the typical "primary care" physician visit buys about 3 minutes of the physician's braintime. Perhaps they are overwhelmed with too many patients? (Too many $$$?) Anyway, their 3 minutes of highly educated and intelligent braintime is no doubt worth a lot more than ten times as much of my braintime on the subject, but how far can they think the matter through in that short time?

Disclaimer: I am not a physician, so I don't know the realities behind the scenes. I could be way off base.

 

[BrianWC]

I'm not a physician, either. I just share a bed with one.

From personal experience, on most days my wife sees 30 or so patients a day. That averages out to less than 4 an hour. In the summer, less... On an absolutely slammed winter day, it can get up to 50 or so a day max. That's just under 10 mins a patient. This is at the biggest clinic in town so most others are seeing a tad less.

 

[XS650]

About 15 minutes fits what I see what at my current doctor at a major non-profit. I switched from a for-profit health care provider with a good reputation and it seemed like they provided 10 minutes or less per patient.

Might have something to do with a non-profit not having to support parasitic health care insurance companies and show a fat profit every quarter.

Edit: I had a complicated office visit a few months ago, the Dr had no problem spending over 30 minutes with me. That's why I don't mind if he's late.

 

[Gary Allan]

Originally Posted By: BrianWC
The PDR is for prescribing. UpToDate is the reference of choice for primary care, now. you can access it online or download it to PDA.

But once again, I'd point out...physicians usually aren't as stumped as we'd like to imagine they are...


Don't get the impression that my objections to contemporary medicine was in any way in terms of "incompetence" or lacking in anything. It's the "routine" that has turned direct interaction into a mechanical process. It's flow charted and can probably be graphed. It's a "practice model" ..much like a business model and reduces medicine to "expensively generic". You're the same cattle you are for any other number of enterprises out there.


I've hardy ever had any antibiotics prescribed over my lifetime. Many warnings have been given about the over use of antibiotics ..yet even my Vietnamese EXCELLENT eclectic doctor (pulmonary specialist) will whip you one out at the drop of a hat.

His successor (he got too busy doing his specialty) ..she's a pencil whipping tramp. She says, "You're non compliant". I say, "You like to prescribe too many high dollar drugs that I cannot endure in my household ..even with prescription insurance and mail order".

This doesn't stop her from trying to give me expensive drugs ..even though I'm quite willing to abandon "future health" by not using them. She's not interested in treating me, as physicians did for eons, ..on an "as needed" basis. She wants to embrace me in "perpetual health care".

All of this costs my insurance carrier a bundle ..and us too ...and I have no desire to feed the machinery.

 

[Cutehumor]

yeah, my dad got mad at his doctor for prescribing him all these expensive drugs when the $4 generics are cheaper. So he demanded another prescription, the doctor was mad about it. Well, when the pharmaceutical company is giving doctors all these free lunches and nudging them to prescribe their new on the market drugs aka expensive. It's business to them.

 

[BrianWC]

Originally Posted By: XS650
About 15 minutes fits what I see what at my current doctor at a major non-profit. I switched from a for-profit health care provider with a good reputation and it seemed like they provided 10 minutes or less per patient.

Might have something to do with a non-profit not having to support parasitic health care insurance companies and show a fat profit every quarter.

Edit: I had a complicated office visit a few months ago, the Dr had no problem spending over 30 minutes with me. That's why I don't mind if he's late.


Weird thing is, it seems to be hit or miss depending on where you are. For instance, the local big for profit hospital was noted on the ABC World News last night was noted as the hospital with the lowest incidence of death from heart attack in the nation.

 

[XS650]

When I switched health care providers to a non-profit I sent my new doctor my prescriptions by email. He sent them to their in house pharmacy who contacted me to advise me that couple of them were expensive and one had no generic replacement. At my first appointment with my new doctor, I asked him if he could re-arrange my medication to get me on all generics, which he cheerfully did by juggling things around. 3 out of the 5 cost less than my $22 co-pay for a 100 day supply, so I pay the lower actual cost.

When you take the profit motive out of the system, you not only don't spend money supporting the parasite health insurance companies, the Drs have little to no incentive to push higher priced drugs.

Yet, the same place is much more liberal with tests and treatment when it's justified. Where I was getting an annual x-ray and some lab tests as follow on to kidney cancer at the for-profit provider, my new place gave me a CT scan and more tests. Found some problems the other place had missed.

 

[BrianWC]

Gary/Cutehumor,

If there's a generic equivalent, yes, your doctor should point you to it. However, every now and then there just aren't generic equivs or there's some past experience the doctor may have with the generic not seeming to be as effective.... At the very least, your doctor does have a responsibility to explain why they are not going with the generic.

 

[XS650]

Brian, my former for-profit also had an excellent record once you got into serious care. I had kidney cancer surgury there and they were terrific. Problem was I was the one that took care of getting it diagnosed outside their system and had to convince my primary care Dr that there was problem.

It was the day to day care that might keep you out of trouble that wasn't as good.

I don't think that a for-profit is necessarily worse than a non-profit, but their set of motivations are different and you have to deal with insurance companies unless you are very rich, poor or have no sense.

 

[BearZDefect]

Tell me more about this non-profit health care. I don't expect physicians to work without good pay, so is it the institution that is non-profit? Say, unlike the typical hospital megaprofit centers.

 

[XS650]

Quite a few hospitals are non-profit. Their staff me be as well paid as staff in for-profit hospitals, but they aren't paying a bunch of money to stockholders or other owners and so they can take a longer term view of the world.

 

[BearZDefect]

Thanks, XS650.

I imagine VA hospitals are non-profit, but many of us are not veterans. I suppose a hospital would disclose whether it is for profit or not.

Would there be non-profit "primary health care" clinics too?

 

[BrianWC]

Many university teaching hospitals are non-profit and often have clinical primary care clinics to keep people out of the ER. The non-profit university hospital docs don't prescribe you something there unless you absolutely need it. At the same time, they have great docs and the best trauma center in the state (and maybe only level 1 trauma center after Katrina). But the for-profit hospitals usually have better specialists b/c they can be better compensated.

But it's not all a bad thing be more liberal with tests and procedures. When she went into private practice, my wife was suprised at the frequency that her partners ordered bloodwork. This was something that was almost never done in her residency hospital. But, after a while, she realized just what a good tool this was for confirming or denying that "gut feeling" diagnosis. You can tell if something is a virus or bacterial infection and even help rule out somethingmore sinister like cancer.

I know doctors are supposed to be an altruistic bunch, but at the same time, they spend a lot of their life in school and in low-paying residencies....So I do understand profit motive to a degree.

Charity isn't buying my kids school supplies...or, more importantly, adding quarts to my oil stash.

 

[Gary Allan]

Agreed. Most of the drugs they push are under patent and have no generic alternative. The thing is, there are alternative drugs that they don't prescribe simply due to the promotional considerations that they get from drug companies.

They're weighing in on the benefits vs. the product liability on a high profit margin product ..and they're being compelled to side with the high profit product.

The Pharmaceutical cartel will continue to dispense leading edge expensive drugs that are weighed in that balance ..and do it in concert with the current, properly conditioned and cooperating, medical practitioners.

Have you read the precautionary disclaimers with most of the popular drugs?

What this produces is a "choke point" where lower cost drugs could be used ..even if less effective, but will never be prescribed. This creates the exact situation I will not participate in. She won't prescribe cheaper meds regardless of my wishes. I'm then left with forced purchasing of expensive meds ..or no meds at all.



Now apply that across a whole population that has to come through the cattle chute ..and what do you have

 

[BrianWC]

Don't get me wrong guys, I agree with a lot of what y'all are saying. Just playing devil's advocate b/c I have seen a bit of the other side. I have to agree a bit on pharmaceuticals. Every person I went to college with who was a spectacular [censored] artist yet possessed no other obvious talents sells either cars or pharmaceuticals. I know they have a job to do, though, just like everyone else. Many good drugs that have helped a lot of people might not be prescribed so regularly if there wasn't some drug rep out there catering lunch to the practice and handing out samples.

As for the precautionary disclaimers on drugs, they come courtesy of everyones' other favorite boogeymen, the lawyers. If taking Bayer Aspirin produced a 1 in 889,945,247,323 chance of being hit by a meteor from the far side of Neptune, you can bet someone would sue if that probability weren't published somehwhere.

 

[XS650]

Originally Posted By: BrianWC


But it's not all a bad thing be more liberal with tests and procedures. When she went into private practice, my wife was suprised at the frequency that her partners ordered bloodwork. This was something that was almost never done in her residency hospital. But, after a while, she realized just what a good tool this was for confirming or denying that "gut feeling" diagnosis.


Bloodwork is like used oil analysis. Having good baseline and tracking trends can be useful indicators of developing internal conditions.

My doctor can just pop up my history with trendlines showing on his computer. So can I from home. I can also get my lab test results at home as soon as the doctor can.

 

[moribundman]

Originally Posted By: Cutehumor
yeah, my dad got mad at his doctor for prescribing him all these expensive drugs when the $4 generics are cheaper. So he demanded another prescription, the doctor was mad about it. Well, when the pharmaceutical company is giving doctors all these free lunches and nudging them to prescribe their new on the market drugs aka expensive. It's business to them.


The quality of generics is frequently nowhere near that of brand names.

 

[The_Jeff]

Originally Posted By: moribundman

The quality of generics is frequently nowhere near that of brand names.


Says who?