4 ms·

Are you a US doctor? I urge you to explain why you charge so much and have the poorest performance out of all 1st world countries? It may change your perspectiv

Are you a US doctor? I urge you to explain why you charge so much and have the poorest performance out of all 1st world countries? It may change your perspective on treating patients like idiots when really the US doctor is the epitome of fraudulent incompetence. Over testing is a problem. The way to lessen over testing is to not be an incompetent doctor so that patients don't take things into their own hands. Barring that you have no choice but to let the patient test himself. It's the moral thing to do. I guess here's an interim solution. Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. The reason is the patient is more intimately familiar with his own symptoms and your just pattern matching based off of a high level probability. If you've never seen a patient with a certain condition you often bias towards the conditions you've seen. Yes patients can be biased but so can you. And there's no denying that patients can do more detailed research and they have a perspective with a resolution you will never achieve. The good doctor needs to listen to them.

rscho 3y ago
I have worked in both the US and Europe. I am back in Europe now, as I vastly prefer it over the US. > Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. Precisely not. That's exactly how you get unusable results with super expensive healthcare, because the follow up that a positive test dictates is often worse than the initial problem, and can impact the population at large (e.g. antibiotics use). All that in a context where the post test probability is very low. There are situations where this does not apply, because we have good exploratory AND confirmatory tests, but that's far from being the norm. Regarding your other points, sure we should always listen to what the patient has to say. There even is a saying about it: "90% of diagnoses are made on personal history". That's because diagnostic tests often are far less useful than you'd expect. Again, I encourage you to learn about how medical testing works. You say you root for AI to replace docs, but apart from not being human anymore, I doubt you'll find your robot doc to be so different regarding your particular situation. All that aside, I'm not rich. I chose to stay in Europe where I earn less because both US doctors and patients are so toxic. You are a prime example of this. In Europe, we test much less and overall both docs and patients are far less aggressive. Yet healthcare here is cheaper, universal and IMO better overall. Everybody profits from more relaxed doc-patient relationships. US Healthcare is first and foremost a cultural issue, and US patients are part of the problem as much as docs are.
- corethree 3y ago
  Also, the other part of this that's fishy is why can't the test results be reported to the patient? Your reasoning makes sense for over testing. But does it make sense to censor a doctor prescribed test from the patient? No it doesn't. The law is made to make the doctor central to treatment. The patient must schedule another appointment and must go through the doctor in order to treat himself. There's too much business incentive here. You label me as toxic but there's a reason why patients in the US have such a vicious attitude toward docs.
  - rscho 3y ago
    Many people feel the way you do, and it's understandable. Those laws vary from country to country, but variations of the same are found throughout western countries. It's in part a remain of the paternalistic medicine of olden times, where docs were supposed to decide for patients. But the main goal today is to avoid patients learning about life-changing news (AIDS, cancer, etc.) without being supported emotionally and informed about what results imply, to avoid rash or violent reactions (suicide) due to misunderstandings. I personally experienced grave misunderstandings over news that seemed trivial to me, but that the patient took as extremely aggravating. Of course this rule is very profitable as well for private care providers (which I am not, BTW). At this point, whether or not the rule is justified becomes a political issue, and I don't think there's a solution that would satisfy everybody.
    - corethree 3y ago
      Well how about letting the patient choose how its reported. And even letting the patient be aware that the results might be life threatening. This will satisfy everybody. Most tests aren't for things like testing for HIV. So your reasoning makes zero sense as this law is applied to every test. And the whole suicide thing is obviously a miniscule issue. You're just making that crap up to sow controversy. Yeah I'm sure you encountered dozens of patients ready to kill themselves over test results but only your kind words were able to completely assuage them and stop them... Yeah sounds like a load of bullshit to me. There's no controversy here. It's a business incentive through and through. Patient choice would satisfy all patients. Only doctors wouldn't be satisfied. And that's the problem. Patients are dealing with there lives here. And Even you as a third party are painting the situation as "controversy" because you've been so desensitized by the patients you're supposed to take care of. Even though you're not in private care you are part of the problem because you're blind to the problem. I know multiple patients who had surgery in America only to go to another country for a check up for the doctor in the other country to say the surgery was completely pointless. You know how serious that is? I don't think you get it. Painting a crime as "controversial" or "political" issue is extremely aggravating for the person who's life is at stake. The only reason you characterize it this way is because you're not the one who's life is at stake. Patients aren't toxic. Patients are desperate. And most doctors including you just don't give enough of a shit. I'm sorry but that's the truth.

rscho 3y ago

I have worked in both the US and Europe. I am back in Europe now, as I vastly prefer it over the US. > Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. Precisely not. That's exactly how you get unusable results with super expensive healthcare, because the follow up that a positive test dictates is often worse than the initial problem, and can impact the population at large (e.g. antibiotics use). All that in a context where the post test probability is very low. There are situations where this does not apply, because we have good exploratory AND confirmatory tests, but that's far from being the norm. Regarding your other points, sure we should always listen to what the patient has to say. There even is a saying about it: "90% of diagnoses are made on personal history". That's because diagnostic tests often are far less useful than you'd expect. Again, I encourage you to learn about how medical testing works. You say you root for AI to replace docs, but apart from not being human anymore, I doubt you'll find your robot doc to be so different regarding your particular situation. All that aside, I'm not rich. I chose to stay in Europe where I earn less because both US doctors and patients are so toxic. You are a prime example of this. In Europe, we test much less and overall both docs and patients are far less aggressive. Yet healthcare here is cheaper, universal and IMO better overall. Everybody profits from more relaxed doc-patient relationships. US Healthcare is first and foremost a cultural issue, and US patients are part of the problem as much as docs are.

corethree 3y ago
Also, the other part of this that's fishy is why can't the test results be reported to the patient? Your reasoning makes sense for over testing. But does it make sense to censor a doctor prescribed test from the patient? No it doesn't. The law is made to make the doctor central to treatment. The patient must schedule another appointment and must go through the doctor in order to treat himself. There's too much business incentive here. You label me as toxic but there's a reason why patients in the US have such a vicious attitude toward docs.
- rscho 3y ago
  Many people feel the way you do, and it's understandable. Those laws vary from country to country, but variations of the same are found throughout western countries. It's in part a remain of the paternalistic medicine of olden times, where docs were supposed to decide for patients. But the main goal today is to avoid patients learning about life-changing news (AIDS, cancer, etc.) without being supported emotionally and informed about what results imply, to avoid rash or violent reactions (suicide) due to misunderstandings. I personally experienced grave misunderstandings over news that seemed trivial to me, but that the patient took as extremely aggravating. Of course this rule is very profitable as well for private care providers (which I am not, BTW). At this point, whether or not the rule is justified becomes a political issue, and I don't think there's a solution that would satisfy everybody.
  - corethree 3y ago
    Well how about letting the patient choose how its reported. And even letting the patient be aware that the results might be life threatening. This will satisfy everybody. Most tests aren't for things like testing for HIV. So your reasoning makes zero sense as this law is applied to every test. And the whole suicide thing is obviously a miniscule issue. You're just making that crap up to sow controversy. Yeah I'm sure you encountered dozens of patients ready to kill themselves over test results but only your kind words were able to completely assuage them and stop them... Yeah sounds like a load of bullshit to me. There's no controversy here. It's a business incentive through and through. Patient choice would satisfy all patients. Only doctors wouldn't be satisfied. And that's the problem. Patients are dealing with there lives here. And Even you as a third party are painting the situation as "controversy" because you've been so desensitized by the patients you're supposed to take care of. Even though you're not in private care you are part of the problem because you're blind to the problem. I know multiple patients who had surgery in America only to go to another country for a check up for the doctor in the other country to say the surgery was completely pointless. You know how serious that is? I don't think you get it. Painting a crime as "controversial" or "political" issue is extremely aggravating for the person who's life is at stake. The only reason you characterize it this way is because you're not the one who's life is at stake. Patients aren't toxic. Patients are desperate. And most doctors including you just don't give enough of a shit. I'm sorry but that's the truth.