4 ms·

> The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. Th

> The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. This remark seems somewhat lacking in rigor. I know bagging on capitalism is a common reflex, particularly in medicine, but something more is almost certainly going on. The default thought process for a retailer is to move units. A lawyer wants to rack up billable hours. A subscription service wants more subscriptions. So why would a specialist look for fewer cases? There is almost certainly a perverse incentive involved, because a competitive market would usually prompt a service provider to accept business and grow with demand.

leksak 4y ago
Specialists are hard to get a face-to-face with even with socialized medicine (personal anecdote from Sweden). I assume that one thing that transcends national borders is that unless your symptoms suggest anything life-threatening care will be administered in accordance with heuristics. The most probable diagnosis is set, and it is assumed that a patient will return if things does not improve. However, failing to communicate to a patient that a diagnosis is provisional might serve to undermine their faith in the healthcare system leading to periods of fatigue wherein one doesn't have the self-efficacy to continue seeking care if things haven't improved even if quality of life is severely impacted. From my limited understanding of the US healthcare system I'd imagine you don't want an excess of cases because each case 1. Is a responsibility, and thus a liability, and 2. every patient your staff needs to accommodate is draining (risk of overwork). If that would apply to a country with socialized medicine I imagine that Item 1. receives significantly less consideration but that Item 2. is still very much considered. If a unit isn't a first-line care-provider they can in theory be a bit more guarded about who they receive, while first-line just has to bear whatever comes through the doors. I feel as if I'm shifting to a different point of discussion but I still struggle not to mention the fact that a specialist may not be readily at hand depending on what city you are in.
throwawayboise 4y ago
Specialists are called that for a reason. They are not general practitioners and their time is extremely valuable. Access to them needs to be managed so that they do not waste their time on people who do not need their specialty. The way it's supposed to work is that the general practitioner rules out a bunch of stuff, and then starts referring to specialists who can diagnose/treat the rare things. In practice it's not quite perfect, but it's hard for me to think of a better way to deal with it.
- treeman79 4y ago
  I probably cost insurance company 300-500,000 while figuring out what was wrong with me. A full round of blood tests by a few specialist would’ve saved everyone involved a lot of money. Wasn’t even a super rare thing. Just 2 somewhat common conditions. One of which is known for being dismissed as anxiety.
  - FollowingTheDao 4y ago
    For the life of me I do not understand why they just do not throw a bunch of tests at people with chronic conditions. They all say they do not know what is wrong with us bu they never do any testing, and the outcome is the same every time; patients suffer and costs are higher.
    - throwawayboise 4y ago
      Many tests are not 100% accurate, nor do they necessarily pinpoint the problem (often they just rule something out). There's no magic doctor who would be a flawless diagnostician if he just had more time to spend with the patient and less interference by the insurance companies. And if he did spend hours and hours on your case, and run all the tests, that would be hours he's not spending helping other people and delays in other people's labwork. Medicine is imperfect, and diagnosis is based in large part on probabilities. Doctors do what their education and experience tells the is most likely to help. Sometimes they are wrong, because people are different, and some doctors aren't as good as others. Sorry your chronic condition was misdiagnosed. It sucks. There's no magic answer.
      - treeman79 4y ago
        I had one that was abnormal. They kept telling me to ignore. I had to push really hard for the follow up test. That one was abnormal. I was still told to ignore it. More pushing. The next obvious test to run was negative. Did a bunch of research and found out there was another related condition. I had every symptom. Pushed really hard. Tons of positive tests for that one. They still told me ignore results. A hard fight later I started treatment. Dramatic and immediate health improvement. Some of my doctors still refuse to believe I have condition. Process Took 3 years. The average time for diagnosis is 7 years. Had about 30 doctors during this time frame. Not even a rare condition.
WalterBright 4y ago
> I am on a six month wait to see a rheumatologist. Why? Capitalism. Consider that the AMA is a monopoly enshrined by the government, and their purpose is to limit the supply of doctors, which they do by limiting the seats in medical schools. It's not capitalism. See Competition & Monopoly in Medical Care by Frech. https://www.amazon.com/Competition-Monopoly-Medical-Care-Frech/dp/0844738840/ https://www.amazon.com/Competition-Monopoly-Medical-Care-Fre...
- Tostino 4y ago
  It's regulatory capture, which i'd argue could be part of any economic system, but is deeply embedded in our current "capitalist" system. The AMA has put in place rules to protect itself at the expense of society as a whole.

leksak 4y ago

Specialists are hard to get a face-to-face with even with socialized medicine (personal anecdote from Sweden). I assume that one thing that transcends national borders is that unless your symptoms suggest anything life-threatening care will be administered in accordance with heuristics. The most probable diagnosis is set, and it is assumed that a patient will return if things does not improve. However, failing to communicate to a patient that a diagnosis is provisional might serve to undermine their faith in the healthcare system leading to periods of fatigue wherein one doesn't have the self-efficacy to continue seeking care if things haven't improved even if quality of life is severely impacted. From my limited understanding of the US healthcare system I'd imagine you don't want an excess of cases because each case 1. Is a responsibility, and thus a liability, and 2. every patient your staff needs to accommodate is draining (risk of overwork). If that would apply to a country with socialized medicine I imagine that Item 1. receives significantly less consideration but that Item 2. is still very much considered. If a unit isn't a first-line care-provider they can in theory be a bit more guarded about who they receive, while first-line just has to bear whatever comes through the doors. I feel as if I'm shifting to a different point of discussion but I still struggle not to mention the fact that a specialist may not be readily at hand depending on what city you are in.

throwawayboise 4y ago

Specialists are called that for a reason. They are not general practitioners and their time is extremely valuable. Access to them needs to be managed so that they do not waste their time on people who do not need their specialty. The way it's supposed to work is that the general practitioner rules out a bunch of stuff, and then starts referring to specialists who can diagnose/treat the rare things. In practice it's not quite perfect, but it's hard for me to think of a better way to deal with it.

treeman79 4y ago
I probably cost insurance company 300-500,000 while figuring out what was wrong with me. A full round of blood tests by a few specialist would’ve saved everyone involved a lot of money. Wasn’t even a super rare thing. Just 2 somewhat common conditions. One of which is known for being dismissed as anxiety.
- FollowingTheDao 4y ago
  For the life of me I do not understand why they just do not throw a bunch of tests at people with chronic conditions. They all say they do not know what is wrong with us bu they never do any testing, and the outcome is the same every time; patients suffer and costs are higher.
  - throwawayboise 4y ago
    Many tests are not 100% accurate, nor do they necessarily pinpoint the problem (often they just rule something out). There's no magic doctor who would be a flawless diagnostician if he just had more time to spend with the patient and less interference by the insurance companies. And if he did spend hours and hours on your case, and run all the tests, that would be hours he's not spending helping other people and delays in other people's labwork. Medicine is imperfect, and diagnosis is based in large part on probabilities. Doctors do what their education and experience tells the is most likely to help. Sometimes they are wrong, because people are different, and some doctors aren't as good as others. Sorry your chronic condition was misdiagnosed. It sucks. There's no magic answer.
    - treeman79 4y ago
      I had one that was abnormal. They kept telling me to ignore. I had to push really hard for the follow up test. That one was abnormal. I was still told to ignore it. More pushing. The next obvious test to run was negative. Did a bunch of research and found out there was another related condition. I had every symptom. Pushed really hard. Tons of positive tests for that one. They still told me ignore results. A hard fight later I started treatment. Dramatic and immediate health improvement. Some of my doctors still refuse to believe I have condition. Process Took 3 years. The average time for diagnosis is 7 years. Had about 30 doctors during this time frame. Not even a rare condition.

WalterBright 4y ago

> I am on a six month wait to see a rheumatologist. Why? Capitalism. Consider that the AMA is a monopoly enshrined by the government, and their purpose is to limit the supply of doctors, which they do by limiting the seats in medical schools. It's not capitalism. See Competition & Monopoly in Medical Care by Frech. https://www.amazon.com/Competition-Monopoly-Medical-Care-Frech/dp/0844738840/ https://www.amazon.com/Competition-Monopoly-Medical-Care-Fre...

Tostino 4y ago
It's regulatory capture, which i'd argue could be part of any economic system, but is deeply embedded in our current "capitalist" system. The AMA has put in place rules to protect itself at the expense of society as a whole.