7 ms·

Not a diabetic and I live in one of the richest countries with a social medical system, but the medical industry is an abject failure. My experience with most D

Not a diabetic and I live in one of the richest countries with a social medical system, but the medical industry is an abject failure. My experience with most Doctors who are not surgeons has mostly been that are overpaid for doing essentially nothing and think all their patients are hypochondriacs.

alex_duf 2y ago
I also lived in two of the richest countries with a social medical system My experience is that GPs are over-worked, under paid (given their responsibilities), and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. That's explained by a slow but relentless dismantling of any operational margin that existed in the system, whether it's financial, time etc. I'm talking about the situation in France and the UK, not sure where you are, my point is that I agree about the system failing us, there's a lot to be said about what could be done but that's outside my area of expertise. I'm just being a little nicer to the doctors, as there's only so much they can do given the means they're given.
- jajko 2y ago
  My wife is a doctor (GP, before internal medicine in biggest hospitals), experience with France and Switzerland. What you say is true - they all start as naive optimists who get treated brutally by whole healthcare system first 7-10 years after school, everybody knows it, often illegal from hospitals but good luck suing your employer. Burned out, 60-70 hour work weeks with weekends is the standard, night shifts, a lot of responsibility with little help/oversight. Always 1 oversight away from harming/killing somebody. Many in Switzerland that are Swiss dropped out, foreigners don't have it so easy. Then afterwards they are put into position where they have 30 minutes for patients (in France its ridiculous 15 mins, saving money = worse diagnosis/treatment, no way around it). Don't expect miracles if they see 20 folks like you daily, ideally with very vague problems like chest pain which can be anything from sprained muscle due to bad sleeping position last night to heart attack, while having 10 other comorbidities and taking various medication. Doctors behave as whole system forces them to behave.
  - alex_duf 2y ago
    Doctors burning-out is probably the worse red-flag you could have for a health system. It's frightening to think the person diagnosing my parents and children might not be in full possession of their capacity or make rash decisions. I'm seeing the same pattern for many crucial functions having been pushed over the line during the last two decades or so. Whether it's a doctor, a teacher, a nurse, a childminder, the police, etc. All the jobs that are essential for a developed society have crumbled down to the point I'd discourage any young person to pursue a career in that sector.
    - jajko 2y ago
      If that worries you (and it should), never ever go to hospital during night (unless serious emergency of course) or very early morning, or generally just before the end of shifts. You will get potentially worse treatment by definition, depends on many things but probability is against you. Also, the bigger the hospital usually the better experts they have on critical stuff (and more chance you won't wait long for ie CT or MRI), smaller hospitals and clinics just forward serious patients to big ones. At the end healthcare is just another branch of market and all woes that apply to rest of us apply to them, no magical immunity due to more noble profession.
- flanked-evergl 2y ago
  > My experience is that GPs are over-worked, under paid (given their responsibilities Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. > and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medical industry is too incompetent to figure out what it is and that there are people who have worse problems, even though he has no idea what is actually wrong.
  - capnrefsmmat 2y ago
    The best sources I can find indicate that doctors work ~25% more hours than other workers, on average, though this has declined since the 70s. https://www.ajpmonline.org/article/S0749-3797(23)00166-6/fulltext https://www.ajpmonline.org/article/S0749-3797(23)00166-6/ful... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915438/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915438/
    - flanked-evergl 2y ago
      I don't live in the US so the stat is not really relevant.
  - gbuk2013 2y ago
    > Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. YMMV but as a software developer I am certainly not going to start throwing stones in a glass house. :) Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession.
    - flanked-evergl 2y ago
      > Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession. I'm not sure why the educational requirements are so extreme for all doctors. Certainly for some, like surgeons, I get it, but for my GP I think it's a total farce. I don't make the rules though, I just can see a broken system when it's right in front of me.
vjk800 2y ago
To be fair, most people probably are hypochondriacs. Somehow we have come to expect that all our nagging ailments should be fully treatable by either a pill or a surgery. In reality, human body is pretty good at self-repairing and self-regulating and modern medicine can help it only in certain clear cut cases. Medicine is just not that good and the doctors know it.
- flanked-evergl 2y ago
  I'm certain in the sample of patients most GPs see, hypochondriacs are overrepresented, but that really does not in any way eliminate the problems I experience, so from my point of view it's still a real concern.
- admissionsguy 2y ago
  Health anxiety high enough to prompt doctor visits is itself a serious issue that the medical system fails to help with.
aantix 2y ago
Agree - most of the advice is WebMD level. Anything outside the check list leaves them scratching their head. They’re terrible debuggers. I had early high blood pressure since high school. Four blood pressure medications, one being a diuretic. Signs of edema. It’s not like my condition required any complicated diagnostics. I met the checklist. 5 cardiologists 2 nephrologists in my lifetime. Nothing but more pills for treatment. Over two decades. I had to be the one to research and then ask to see an endocrinologist because I thought it might be hyperaldosteronism. They were dismissive when I asked but reluctantly made the referral. Yes, it was unilateral hyperaldosteronism. Had my left adrenal gland removed because of it. And now my BP is much more stable. I still take a couple of BP drugs, but in smaller doses. And my BP is much more normal and stable. No more wild, 3am ER visits where my BP was 200/120. And I lost about 15 lbs of water weight. If have long lived resistant hypertension, please ask to see an endocrinologist to get screened for hyperaldosteronism.
- flanked-evergl 2y ago
  In reality, there are few things a GP can do better than a nurse or some technician with an LLM, and the sooner that shift happens, the better for society.
  - greenavocado 2y ago
    It will be interesting when LLMs can do more to advance general public health more than the entire medical system in recent history.
    - nradov 2y ago
      What do you think that LLMs can do exactly? Sometimes naive technologists think of AI as some sort of magic solution. But if you look at overall healthcare system costs, very little is being spent in areas that could be easily automated with an LLM. And for T1D specifically it would be very dangerous to put an LLM in control of something like an insulin pump considering that we don't have any way to do quality assurance to the level required. Simple, deterministic algorithms are preferred for safety critical systems because they're less likely to fail in bizarre or unpredictable ways.
kvgr 2y ago
Something similar, u just switched to private clinic where i pay 500euros/year for general doctor(even when they work for insurance) and I pay like 100E for specialist. Never happier, fast and good communication.
carimura 2y ago
In the US, my experience has largely been that it's not healthcare, it's sickcare. Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick. I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fortunate enough to have the resources to push through, you can get all sorts of stuff done -- broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc. But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick. A friend of mine in the middle east says you can do all that for almost nothing by walking into any hospital, but it's subsidized by government (oil) dollars. [edit] Reading more of the comments this seems par for the course in many "wealthy" countries.
- Swizec 2y ago
  > But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick. Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it? Well it turns out you only have a 3% (my math is likely imperfect) chance of actually having the thing you tested for unless you also have other symptoms. Now what do you do about it? Unnecessary medical interventions kill people all the time. Prostate cancer is a great example here. If you’re over 30 and male, you very likely have a little bit of detectable prostate cancer. But you’re fine just leaving it alone for another 30 years and there’s a huge likelihood it’s never going to become a problem at all. Getting it fixed would be way worse for you than leaving it alone. (1 in 8 men eventually gets diagnosed with this meaning way more actually have it)
  - Palomides 2y ago
    the test isn't the problem, it's that doctors and patients aren't used to making decisions based on probability (patients demand something must be done, while doctors run on vibes and cover your ass) (context: spent some time working in a prostate cancer research lab and have doctors in the family)
sadcherry 2y ago
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alex_duf 2y ago

I also lived in two of the richest countries with a social medical system My experience is that GPs are over-worked, under paid (given their responsibilities), and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. That's explained by a slow but relentless dismantling of any operational margin that existed in the system, whether it's financial, time etc. I'm talking about the situation in France and the UK, not sure where you are, my point is that I agree about the system failing us, there's a lot to be said about what could be done but that's outside my area of expertise. I'm just being a little nicer to the doctors, as there's only so much they can do given the means they're given.

jajko 2y ago
My wife is a doctor (GP, before internal medicine in biggest hospitals), experience with France and Switzerland. What you say is true - they all start as naive optimists who get treated brutally by whole healthcare system first 7-10 years after school, everybody knows it, often illegal from hospitals but good luck suing your employer. Burned out, 60-70 hour work weeks with weekends is the standard, night shifts, a lot of responsibility with little help/oversight. Always 1 oversight away from harming/killing somebody. Many in Switzerland that are Swiss dropped out, foreigners don't have it so easy. Then afterwards they are put into position where they have 30 minutes for patients (in France its ridiculous 15 mins, saving money = worse diagnosis/treatment, no way around it). Don't expect miracles if they see 20 folks like you daily, ideally with very vague problems like chest pain which can be anything from sprained muscle due to bad sleeping position last night to heart attack, while having 10 other comorbidities and taking various medication. Doctors behave as whole system forces them to behave.
- alex_duf 2y ago
  Doctors burning-out is probably the worse red-flag you could have for a health system. It's frightening to think the person diagnosing my parents and children might not be in full possession of their capacity or make rash decisions. I'm seeing the same pattern for many crucial functions having been pushed over the line during the last two decades or so. Whether it's a doctor, a teacher, a nurse, a childminder, the police, etc. All the jobs that are essential for a developed society have crumbled down to the point I'd discourage any young person to pursue a career in that sector.
  - jajko 2y ago
    If that worries you (and it should), never ever go to hospital during night (unless serious emergency of course) or very early morning, or generally just before the end of shifts. You will get potentially worse treatment by definition, depends on many things but probability is against you. Also, the bigger the hospital usually the better experts they have on critical stuff (and more chance you won't wait long for ie CT or MRI), smaller hospitals and clinics just forward serious patients to big ones. At the end healthcare is just another branch of market and all woes that apply to rest of us apply to them, no magical immunity due to more noble profession.
flanked-evergl 2y ago
> My experience is that GPs are over-worked, under paid (given their responsibilities Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. > and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medical industry is too incompetent to figure out what it is and that there are people who have worse problems, even though he has no idea what is actually wrong.
- capnrefsmmat 2y ago
  The best sources I can find indicate that doctors work ~25% more hours than other workers, on average, though this has declined since the 70s. https://www.ajpmonline.org/article/S0749-3797(23)00166-6/fulltext https://www.ajpmonline.org/article/S0749-3797(23)00166-6/ful... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915438/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915438/
  - flanked-evergl 2y ago
    I don't live in the US so the stat is not really relevant.
- gbuk2013 2y ago
  > Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. YMMV but as a software developer I am certainly not going to start throwing stones in a glass house. :) Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession.
  - flanked-evergl 2y ago
    > Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession. I'm not sure why the educational requirements are so extreme for all doctors. Certainly for some, like surgeons, I get it, but for my GP I think it's a total farce. I don't make the rules though, I just can see a broken system when it's right in front of me.

vjk800 2y ago

To be fair, most people probably are hypochondriacs. Somehow we have come to expect that all our nagging ailments should be fully treatable by either a pill or a surgery. In reality, human body is pretty good at self-repairing and self-regulating and modern medicine can help it only in certain clear cut cases. Medicine is just not that good and the doctors know it.

flanked-evergl 2y ago
I'm certain in the sample of patients most GPs see, hypochondriacs are overrepresented, but that really does not in any way eliminate the problems I experience, so from my point of view it's still a real concern.
admissionsguy 2y ago
Health anxiety high enough to prompt doctor visits is itself a serious issue that the medical system fails to help with.

aantix 2y ago

Agree - most of the advice is WebMD level. Anything outside the check list leaves them scratching their head. They’re terrible debuggers. I had early high blood pressure since high school. Four blood pressure medications, one being a diuretic. Signs of edema. It’s not like my condition required any complicated diagnostics. I met the checklist. 5 cardiologists 2 nephrologists in my lifetime. Nothing but more pills for treatment. Over two decades. I had to be the one to research and then ask to see an endocrinologist because I thought it might be hyperaldosteronism. They were dismissive when I asked but reluctantly made the referral. Yes, it was unilateral hyperaldosteronism. Had my left adrenal gland removed because of it. And now my BP is much more stable. I still take a couple of BP drugs, but in smaller doses. And my BP is much more normal and stable. No more wild, 3am ER visits where my BP was 200/120. And I lost about 15 lbs of water weight. If have long lived resistant hypertension, please ask to see an endocrinologist to get screened for hyperaldosteronism.

flanked-evergl 2y ago
In reality, there are few things a GP can do better than a nurse or some technician with an LLM, and the sooner that shift happens, the better for society.
- greenavocado 2y ago
  It will be interesting when LLMs can do more to advance general public health more than the entire medical system in recent history.
  - nradov 2y ago
    What do you think that LLMs can do exactly? Sometimes naive technologists think of AI as some sort of magic solution. But if you look at overall healthcare system costs, very little is being spent in areas that could be easily automated with an LLM. And for T1D specifically it would be very dangerous to put an LLM in control of something like an insulin pump considering that we don't have any way to do quality assurance to the level required. Simple, deterministic algorithms are preferred for safety critical systems because they're less likely to fail in bizarre or unpredictable ways.

kvgr 2y ago

Something similar, u just switched to private clinic where i pay 500euros/year for general doctor(even when they work for insurance) and I pay like 100E for specialist. Never happier, fast and good communication.

carimura 2y ago

In the US, my experience has largely been that it's not healthcare, it's sickcare. Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick. I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fortunate enough to have the resources to push through, you can get all sorts of stuff done -- broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc. But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick. A friend of mine in the middle east says you can do all that for almost nothing by walking into any hospital, but it's subsidized by government (oil) dollars. [edit] Reading more of the comments this seems par for the course in many "wealthy" countries.

Swizec 2y ago
> But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick. Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it? Well it turns out you only have a 3% (my math is likely imperfect) chance of actually having the thing you tested for unless you also have other symptoms. Now what do you do about it? Unnecessary medical interventions kill people all the time. Prostate cancer is a great example here. If you’re over 30 and male, you very likely have a little bit of detectable prostate cancer. But you’re fine just leaving it alone for another 30 years and there’s a huge likelihood it’s never going to become a problem at all. Getting it fixed would be way worse for you than leaving it alone. (1 in 8 men eventually gets diagnosed with this meaning way more actually have it)
- Palomides 2y ago
  the test isn't the problem, it's that doctors and patients aren't used to making decisions based on probability (patients demand something must be done, while doctors run on vibes and cover your ass) (context: spent some time working in a prostate cancer research lab and have doctors in the family)

sadcherry 2y ago

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