3 ms·

I’m not sure transactional is the right word. The problem you are identifying is physician bandwidth, or more fundamentally, insufficient physician supply to me

I’m not sure transactional is the right word. The problem you are identifying is physician bandwidth, or more fundamentally, insufficient physician supply to meet medical demand, which leads to lower quality care.

ska 3y ago
That doesn't sound quite right to me. There is a lack of physicians, especially family/general, which makes everything harder. But that doesn't nearly account for everything. It is also true that the system is set up very transactionally, and that this makes it difficult to address many chronic issues as well as they could be. If you are lucky, you have an involved general practitioner who has a long history with you, good notes, and time to get into difficult analysis. For many people currently this is a pipe dream. Hell, many people are reliant on ER for basic care - a system that is fundamentally incompatible with this sort of baseline and evaluation.
notabee 3y ago
There are problems beyond just supply and demand. The reason in my experience that someone might use the term transactional is that at any given appointment, most doctors will only choose to focus on one or two topics or concerns. And generally, to get any sort of treatment option for those they'll need some sort of code for insurance to reimburse for the visit. This is especially true for specialists, whom if you visit enough doctors you'll realize push procedures or specialized tests very heavily because that's what makes money. In the current system every single aspect of medical care must have a price tag attached, must be composed of transactions and codes, or the doctors won't get paid. When the concept of "what is the diagnosis" implicitly morphs into "what is the billing code", medical care becomes a fractured and transactional experience rather than a holistic assessment. (And for any doctors reading this, I know that "holistic" is one of those quack trigger words, but those quacks are responding to an unmet need even if their treatments and diagnoses are pure bunkum.)
jnovek 3y ago
I think you’re absolutely right that that physician bandwidth is the cause, I think you could characterize the transactional medical experience as a side effect of that problem. When I say transactional, I mean that each interaction has a cause (“what brings you in today?”) and an action (“try this medication”, “see this specialist”); each visit is like a full story arc from start to finish. Compare that to psychotherapy where each visit is more like a continuation of the previous session — a narrative. IMO, people who suffer from chronic conditions would benefit from a model that draws on the narrative aspect of therapy.

ska 3y ago

That doesn't sound quite right to me. There is a lack of physicians, especially family/general, which makes everything harder. But that doesn't nearly account for everything. It is also true that the system is set up very transactionally, and that this makes it difficult to address many chronic issues as well as they could be. If you are lucky, you have an involved general practitioner who has a long history with you, good notes, and time to get into difficult analysis. For many people currently this is a pipe dream. Hell, many people are reliant on ER for basic care - a system that is fundamentally incompatible with this sort of baseline and evaluation.

notabee 3y ago

There are problems beyond just supply and demand. The reason in my experience that someone might use the term transactional is that at any given appointment, most doctors will only choose to focus on one or two topics or concerns. And generally, to get any sort of treatment option for those they'll need some sort of code for insurance to reimburse for the visit. This is especially true for specialists, whom if you visit enough doctors you'll realize push procedures or specialized tests very heavily because that's what makes money. In the current system every single aspect of medical care must have a price tag attached, must be composed of transactions and codes, or the doctors won't get paid. When the concept of "what is the diagnosis" implicitly morphs into "what is the billing code", medical care becomes a fractured and transactional experience rather than a holistic assessment. (And for any doctors reading this, I know that "holistic" is one of those quack trigger words, but those quacks are responding to an unmet need even if their treatments and diagnoses are pure bunkum.)

jnovek 3y ago

I think you’re absolutely right that that physician bandwidth is the cause, I think you could characterize the transactional medical experience as a side effect of that problem. When I say transactional, I mean that each interaction has a cause (“what brings you in today?”) and an action (“try this medication”, “see this specialist”); each visit is like a full story arc from start to finish. Compare that to psychotherapy where each visit is more like a continuation of the previous session — a narrative. IMO, people who suffer from chronic conditions would benefit from a model that draws on the narrative aspect of therapy.