3 ms·

> But if the problem doesn't fit those known processes, isn't mechanical, and you are relying on doctor for real troubleshooting of problems, that is where it f

> But if the problem doesn't fit those known processes, isn't mechanical, and you are relying on doctor for real troubleshooting of problems, that is where it falls short. I mean, you're not wrong, but... No one pays docs to do this. The overpriced insurance that's squeezing you dry pays the doc peanuts for his time on your case. Most docs get allotted something like 15 minutes, all-in, per patient: see you, talk to you, examine you, write up their notes, send out their scripts and billing. If you're a really well paid specialist and don't mind not maximizing your income, call it 30 minutes. This has gotten worse with the rise of EMRs, because they're slow as hell. They have a UI designed by an insurance company billing agent. It's terrible. And being the guy that spends more time is just a matter of pride/ego. I know an amazing doc who spent 40 hours going through boxes of old records on a patient. Figured out what years of previous docs hadn't, and solved - solved! - the lady's problem. He got paid 350$. Less than my niece makes per-hour selling iphone cases at the mall. You can't keep a practice open that way, not even a famous, "people fly in from wherever to see you" kind of practice (unless you're a surgeon - solve someone's problem with a 90 minute operation and people will cough up 30k$; solve their problem with 90 minutes of careful thinking and they're like, you didn't actually do anything, and now you want multiple hundreds of dollars?) But if someone wants to go ahead and pay me to spend 10 hours on a patient rather than 10 minutes, so I can analyze your symptoms and history and prior reports to hell and back, do some research, iterate a few hypotheses, wrangle phone battles with laboratories to get weird-ass custom tests done, etc. well, yes. I would be happy to do that. That's most docs' dream job. Seriously, and I kid you not even a little bit. Pay me per-unit time the same peanuts that the insurance company pays out, for the amount of time it takes to be your custom biochemical sleuth, and I'll happily do that over seeing a million patients a day. But as long as you and I are operating inside of the system where I'm squeezed on every side to get you in and out of the exam room in <10 minutes, you're not going to get medical services that take >10 minutes.

rscho 7y ago
Spoken from true experience! I, as most MDs will, totally agree.
jcims 7y ago
How do I pay a doc for their time? I just sent emails to 35 different PIs this morning trying to find the most suitable clinical trial for my wife. I’ve learned a bit in the process but I’m still funtionally illiterate. Both of the oncologists we are working with just look for trials out of their location. When i ask what else is out there they point me to clinicaltrials.gov and say Godspeed.
- rscho 7y ago
  First, let me say that I'm sorry that harm seems to have come your way. Second, unless you are extremely rich and can privately employ a doctor like a saudi prince would do, I do not know of any (non-forbidden) way to directly pay your doc for his time. Hopefully I'll stand corrected. Third, and that's the most important, primarily allocate your money to proven treatment. Clinical trials are not designed to help participants. Be weary of what people try to sell you. But if you've been dealing with the healthcare system for long enough, you probably know all about it already. I realize that's not very original, but godspeed nevertheless!
  - geofft 7y ago
    Aren't there a growing number of doctors who don't take insurance (under names like "cash-only" or "direct primary care")? Would you be able to buy a day of one of those doctors' time? It sounds like it won't run afoul of insurance but also sounds cheaper than having a personal physician.
  - darawk 7y ago
    There are a lot of doctors now that don't take insurance, and that you pay on retainer. The phrase you want to google here is "concierge medicine". It's definitely expensive, but not Saudi prince expensive.
    - arkades 7y ago
      Most concierge practices retain the same business model. They ditch insurance, and the billing staff they hired to wrangle the insurance, and reclaim the time they personally spent wrangling insurance. They then keep roughly the same business model, charging more or less what insurance would have paid them. They spend more time with patients because (a) not on the phone fighting, (b) though the patient pool goes down, they’re replaced by not having to pay for billing staff. Very very few “concierge” practices aim for any more deviation from the standard business mode than that. If you want someone to spend 40 minutes with you rather than 15, that’s your guy. If you want someone to spend a week analyzing all your old records and sleuthing it out, that model still doesn’t support it.

rscho 7y ago

Spoken from true experience! I, as most MDs will, totally agree.

jcims 7y ago

How do I pay a doc for their time? I just sent emails to 35 different PIs this morning trying to find the most suitable clinical trial for my wife. I’ve learned a bit in the process but I’m still funtionally illiterate. Both of the oncologists we are working with just look for trials out of their location. When i ask what else is out there they point me to clinicaltrials.gov and say Godspeed.

rscho 7y ago
First, let me say that I'm sorry that harm seems to have come your way. Second, unless you are extremely rich and can privately employ a doctor like a saudi prince would do, I do not know of any (non-forbidden) way to directly pay your doc for his time. Hopefully I'll stand corrected. Third, and that's the most important, primarily allocate your money to proven treatment. Clinical trials are not designed to help participants. Be weary of what people try to sell you. But if you've been dealing with the healthcare system for long enough, you probably know all about it already. I realize that's not very original, but godspeed nevertheless!
- geofft 7y ago
  Aren't there a growing number of doctors who don't take insurance (under names like "cash-only" or "direct primary care")? Would you be able to buy a day of one of those doctors' time? It sounds like it won't run afoul of insurance but also sounds cheaper than having a personal physician.
- darawk 7y ago
  There are a lot of doctors now that don't take insurance, and that you pay on retainer. The phrase you want to google here is "concierge medicine". It's definitely expensive, but not Saudi prince expensive.
  - arkades 7y ago
    Most concierge practices retain the same business model. They ditch insurance, and the billing staff they hired to wrangle the insurance, and reclaim the time they personally spent wrangling insurance. They then keep roughly the same business model, charging more or less what insurance would have paid them. They spend more time with patients because (a) not on the phone fighting, (b) though the patient pool goes down, they’re replaced by not having to pay for billing staff. Very very few “concierge” practices aim for any more deviation from the standard business mode than that. If you want someone to spend 40 minutes with you rather than 15, that’s your guy. If you want someone to spend a week analyzing all your old records and sleuthing it out, that model still doesn’t support it.