5 ms·

Is this a new thing? When I was a kid, we still had what was called a "family doctor." I'm not sure these really exist anymore. He never hesitated to tell my mo

Is this a new thing? When I was a kid, we still had what was called a "family doctor." I'm not sure these really exist anymore. He never hesitated to tell my mom she needed to lose weight or my dad he needed to stop smoking. Maybe the fact that he wasn't a specialist allowed him to be more practical with his advice.

grzm 9y ago
From what I've seen, family doctors have been replaced by primary care physicians. There's still a place for generalists in the medical profession.
- nradov 9y ago
  You've mixed up two separate concepts. Primary care physician is a role, not a specialty. Most PCPs specialize in family medicine, internal medicine, or pediatrics. The PCP acts as the patient's primary point of contact, leads the patient's care team, and makes referrals to specialists when necessary.
  - aviv 9y ago
    Effectively a PCP is a load balancer for the pharmaceutical industry, directing consumers to the appropriate pill pusher.
    - grzm 9y ago
      At this point you are trolling. Would you please stop?
      - aviv 9y ago
        Which part of my statement is inaccurate?
  - grzm 9y ago
    Could you clarify the distinction in the context of my parent's question? I think the same thing could be said of family doctor, but I'm not sure I understand what you're getting at. For what it's worth, my dictionary refers me to "general practitioner" when looking up "family doctor".
aviv 9y ago
You know how in technology we like to say "no one got fired for buying Cisco?". Well, for them it's no one got fired for selling Lipitor.
- darkerside 9y ago
  Exactly, and it's not an irrational decision either. There's a gap in the medical system. It's really really difficult to get people to change their behavior. It requires a completely different skill set from curing, preventing, or ameliorating clinical disease. Trying to get doctors do it is quite frankly a waste of everyone's time.
  - messick 9y ago
    This dude posted up thread that Crohn’s can be cured by a 2 week water fast, so I don’t think he’s on the same page as you.
    - darkerside 9y ago
      His views sound a little more extreme (and seem to ascribe malicious intent to what I would label as systemic biases), but I think there's a lot of truth in the principles behind what he says. It's accepted today to dismiss anything that hasn't been scientifically proven, which ironically does a disservice to science. I think if you asked most true experts in the field doing cutting edge research, they'd be the first to admit that they don't know if fasting could cure some cases of Crohn's.
      - aviv 9y ago
        You are being naive. Who do you expect to do the "cutting edge" research to confirm fasting can cure Crohn's? Do you honestly not realize this is career suicide? There is zero benefit to researchers funded by the government or pharma to find out not eating for 10-30 days is the cure to something they are selling $200K/year treatment for. This is not a conspiracy theory - this is modern life facts 101. http://www.crohnscolitisfoundation.org/about/sponsors/ http://www.crohnscolitisfoundation.org/about/sponsors/ Yeah - sure, every corporate sponsor on this list just wishes for the day that it is finally known that Crohn's is not actually a lifelong incurable disease - and not only there is a cure - it literally costs nothing. In fact, you SAVE money by not eating too! LOL. It's astonishing how otherwise very smart people (especially on HN) cannot see beyond what's in front of them. I actually think the more conventionally-educated someone is, the harder it is for them to admit solutions are far simpler than they "should" be.
darkerside 9y ago
And it stops there after a short suggestion. Maybe it's time for "behavioral medicine" a la behavioral finance. We already know people aren't going to listen (they statistically don't) so how else can we tell them in ways that they will listen.
- aviv 9y ago
  Make it like life or car insurance. I don't pay as high of a premium as a person with DUI history. Why is my health insurance premium the same as a person with an unhealthy lifestyle that frequents the doctor far more than I do for ailments resulting from their poor dietary choices?
  - nradov 9y ago
    For many people the premium isn't the same. Under US law, medical insurance companies are allowed to offer premium discounts for members who meet certain wellness goals such as maintaining a normal weight or blood glucose level.
nradov 9y ago
Family doctors (and specialists) still give their patients practical advice lose weight, drink less, eat better, exercise more, and stop smoking every day. Most patients ignore the advice. What more do you expect the doctors to do? If we want people to make better lifestyle choices it's going to take a new system of incentives separate from doctors.
- aviv 9y ago
  I agree though, by the time a patient makes it to a traditional physician for advice it's pretty much too late in the game. What do you expect from doctors that accumulated a total ~20 hours of nutritional education in their many years in school?

grzm 9y ago

From what I've seen, family doctors have been replaced by primary care physicians. There's still a place for generalists in the medical profession.

nradov 9y ago
You've mixed up two separate concepts. Primary care physician is a role, not a specialty. Most PCPs specialize in family medicine, internal medicine, or pediatrics. The PCP acts as the patient's primary point of contact, leads the patient's care team, and makes referrals to specialists when necessary.
- aviv 9y ago
  Effectively a PCP is a load balancer for the pharmaceutical industry, directing consumers to the appropriate pill pusher.
  - grzm 9y ago
    At this point you are trolling. Would you please stop?
    - aviv 9y ago
      Which part of my statement is inaccurate?
- grzm 9y ago
  Could you clarify the distinction in the context of my parent's question? I think the same thing could be said of family doctor, but I'm not sure I understand what you're getting at. For what it's worth, my dictionary refers me to "general practitioner" when looking up "family doctor".

aviv 9y ago

You know how in technology we like to say "no one got fired for buying Cisco?". Well, for them it's no one got fired for selling Lipitor.

darkerside 9y ago
Exactly, and it's not an irrational decision either. There's a gap in the medical system. It's really really difficult to get people to change their behavior. It requires a completely different skill set from curing, preventing, or ameliorating clinical disease. Trying to get doctors do it is quite frankly a waste of everyone's time.
- messick 9y ago
  This dude posted up thread that Crohn’s can be cured by a 2 week water fast, so I don’t think he’s on the same page as you.
  - darkerside 9y ago
    His views sound a little more extreme (and seem to ascribe malicious intent to what I would label as systemic biases), but I think there's a lot of truth in the principles behind what he says. It's accepted today to dismiss anything that hasn't been scientifically proven, which ironically does a disservice to science. I think if you asked most true experts in the field doing cutting edge research, they'd be the first to admit that they don't know if fasting could cure some cases of Crohn's.
    - aviv 9y ago
      You are being naive. Who do you expect to do the "cutting edge" research to confirm fasting can cure Crohn's? Do you honestly not realize this is career suicide? There is zero benefit to researchers funded by the government or pharma to find out not eating for 10-30 days is the cure to something they are selling $200K/year treatment for. This is not a conspiracy theory - this is modern life facts 101. http://www.crohnscolitisfoundation.org/about/sponsors/ http://www.crohnscolitisfoundation.org/about/sponsors/ Yeah - sure, every corporate sponsor on this list just wishes for the day that it is finally known that Crohn's is not actually a lifelong incurable disease - and not only there is a cure - it literally costs nothing. In fact, you SAVE money by not eating too! LOL. It's astonishing how otherwise very smart people (especially on HN) cannot see beyond what's in front of them. I actually think the more conventionally-educated someone is, the harder it is for them to admit solutions are far simpler than they "should" be.

darkerside 9y ago

And it stops there after a short suggestion. Maybe it's time for "behavioral medicine" a la behavioral finance. We already know people aren't going to listen (they statistically don't) so how else can we tell them in ways that they will listen.

aviv 9y ago
Make it like life or car insurance. I don't pay as high of a premium as a person with DUI history. Why is my health insurance premium the same as a person with an unhealthy lifestyle that frequents the doctor far more than I do for ailments resulting from their poor dietary choices?
- nradov 9y ago
  For many people the premium isn't the same. Under US law, medical insurance companies are allowed to offer premium discounts for members who meet certain wellness goals such as maintaining a normal weight or blood glucose level.

nradov 9y ago

Family doctors (and specialists) still give their patients practical advice lose weight, drink less, eat better, exercise more, and stop smoking every day. Most patients ignore the advice. What more do you expect the doctors to do? If we want people to make better lifestyle choices it's going to take a new system of incentives separate from doctors.

aviv 9y ago
I agree though, by the time a patient makes it to a traditional physician for advice it's pretty much too late in the game. What do you expect from doctors that accumulated a total ~20 hours of nutritional education in their many years in school?