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
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.
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.
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”.
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.
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.
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.
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.
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?
- 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-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.
You know enough doctors well enough to know that most of them don’t want to go to a doctor?
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.
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).”
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.
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.
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…
