6 ms·

My significant other is going through this situation, and in my experience it seems as though most doctors just simply don’t care to actually find a diagnosis (

My significant other is going through this situation, and in my experience it seems as though most doctors just simply don’t care to actually find a diagnosis (or at least, don’t have the time or motivation to care), combined with a hefty dose of “that’s not my job”. My SO has been to specialist after specialist who spends a grand total of 2 minutes listening to the symptoms, followed by “well let’s do some blood tests and see what they say” (ignoring that the last 5 doctors already did blood tests). And then when the blood tests come back with nothing obvious, the doctor just throws up their hands and says “well I don’t know what to do, you should go see <other specialist>”. The reason the “family member or friend who knows someone who can recommend a doctor” seems to work well, in my experience, is because that doctor then has some motivation to actually care, as the patient is connected to someone they already know and care about. Our medical system financially incentivizes doctors to see as many patients as possible, but doesn’t financially incentivize actually making them better. For that, the system just hopes that doctors will care, without giving them the room to do so.

Henchman21 1y ago
What our "system" seems to actually incentivize is keeping people chronically ill so that they're forced to continually pay for their non-treatment. It's hard not to be incredibly cynical in the face of things like this. Way more than once have I thought "this is a cruel and unusual punishment" -- wait aren't those prohibited?? Oh right we get around that by making cruelty usual.
- liquidise 1y ago
  I feel this is more a societal failing than a medical one. Most people don’t want to take better care of themselves: eating better, portion control, more regular exercise, etc. Too hard. People want a pill to solve the ailments they have.
  - kjkjadksj 1y ago
    Exactly why weight loss pills are a multibillion dollar industry today.
    - nradov 1y ago
      Technically those are mostly weight loss injections now. The pills don't work nearly as well.
- tekla 1y ago
  People want medication to solve their problems, not actually try and solve things without paying money for it
  - const_cast 1y ago
    You can't solve your health issues without paying money. If you have high cholesterol and you decide to make lifestyle changes, you still have to go to the cardiologist. Because you have absolutely no idea if you actually lowered your cholesterol. A big fallacy is people thinking they know if they are healthy or they know about their bodies. You don't. Even if you live a very healthy lifestyle, you still have to go to the doctor. You still need screening.
- margalabargala 1y ago
  I see this view sometimes and it really annoys me. The number of doctors and nurses that attempt to keep people chronically ill rather than curing them if possible, is essentially zero. People get into that field frequently because they actually care, and people that actually care are the most likely to not follow a vague profit incentive that actively hurts people. Similarly, most medical researchers would love to cure diseases, and actively seek out jobs where they do so and will object if asked to suppress curative research. To the extent that what you describe exists, it is limited to MBA people at insurance companies and big pharma determining what gets funded for research. While exceptions always exist, the incidence of that attitude among the people actually doing the work is very close to nil.
  - Henchman21 1y ago
    I think we agree on this point almost entirely. But let’s not pretend the doctors, nurses, and researchers are running the show. This attitude of mine persists because of the way the insurance companies run the system: profits first, patients last. Sorry to annoy you.
    - margalabargala 1y ago
      There are a lot of doctors and researchers running research arms of large, well funded institutions. Sloan Kettering for example. I'll grant you that that is a low percentage of the total US medical research spend. But also, most of the world does not have the same profit motive; in most Western countries, a cure is categorically cheaper for everyone than a chronic illness, because healthcare is paid for by taxpayers. And countries besides the US do plenty of medical research. If the hypothesis were true that there exist cures to many diseases that simply haven't been explored due to profit motive, then I would expect countries without that profit motive to have a higher proportion of cures among their medical.discoveries than the US. I don't believe that is true though. Basically my point is that the effect you mention likely has little actual impact on the larger medical field.
    - BobaFloutist 1y ago
      There's pretty universally much more demand for doctors than supply. And insurance companies, the other major power that's, to an upsetting degree, "running the show" would love for everyone to be perfectly healthy so they can collect premiums and never pay out.
- nradov 1y ago
  Nonsense. The clinicians working in the healthcare system have zero incentive to keep patients chronically ill. This isn't a matter of keeping patients coming back: most doctors already have more workload than they can even handle. Most chronic diseases are primarily caused by lifestyle choices. This is largely outside the scope of medical practice. A doctor can prescribe metformin to treat type-2 diabetes and a statin to reduce cholesterol but they can't force you to clean up your diet and get some exercise. https://peterattiamd.com/outlive/ https://peterattiamd.com/outlive/
epistasis 1y ago
Another way to look at it instead of "they don't care" is "they have nothing they can offer." We have progressed fantastically on the common medical conditions, but once you get into more rare stuff it gets a lot harder. Doctors have huge breadth of knowledge, but the sum of human medical knowledge could never fit into a human brain, even within a specialty, and even then there's so much we are not even close to understanding or knowing. And for rarer stuff that is just getting discovered and learned about, there will only be a few specialists who are the ones figuring it out. That's why you go to lots of doctors that offer nothing, then a hint directs you to the doctors that are in the cutting edge of expanding knowledge. Even if we financially incentivized each and every doctor to spend hours or days trying to find out what's going on with a patient that the doctor can't help with their current knowledge, it's quite likely that doctor could never help on the basis of a single patient. Medicine advances through discovery in groups of people and transferring knowledge from the results of one patient to others, incrementally. A single patient is far less likely to lead to advancement than a doctor having a group of people with similar symptoms. The financial incentive for this discovery comes from research hospitals that collect these difficult cases, and obtain federal research grants from the National Institute of Health that allows them to do research and publish papers and share the knowledge. The proposed budget for the US drastically slashes this, greatly reducing our ability to advance medicine. And in advance of the budget cuts, the NIH is in violation of current contracts stopping payment, resulting in massive waste as research dies on the vine. So what I'm trying to say is that the logistics of advancing medicine require grouping patients, and the place where that happens is at research hospitals, not at the local community doctor for everyday care. And our society is choosing, consciously or unconsciously, to drastically reduce access to that type of care.
- asdf6969 1y ago
  They genuinely don’t care. Don’t over think it
- dinkumthinkum 1y ago
  While I might be sympathetic to what you’re saying, endometriosis is not a very rare condition.
- 1y ago
dapper_bison17 1y ago
[flagged]
drewg123 1y ago
What kind of specialists? An ex of mine had severe endo, and it was finally treated by a reproductive endocrinologist (in Raleigh, NC) after going through many other doctors.
- toomuchtodo 1y ago
  University of Chicago Medicine has a great endo program, all of their specialists are highly rated. Edit: https://www.uchicagomedicine.org/forefront/news/2023/august/uchicago-medicine-us-news-rankings-2023 https://www.uchicagomedicine.org/forefront/news/2023/august/...
  - nradov 1y ago
    Rated how? Metrics like patient satisfaction scores are not correlated with actual clinical outcomes.

Henchman21 1y ago

What our "system" seems to actually incentivize is keeping people chronically ill so that they're forced to continually pay for their non-treatment. It's hard not to be incredibly cynical in the face of things like this. Way more than once have I thought "this is a cruel and unusual punishment" -- wait aren't those prohibited?? Oh right we get around that by making cruelty usual.

liquidise 1y ago
I feel this is more a societal failing than a medical one. Most people don’t want to take better care of themselves: eating better, portion control, more regular exercise, etc. Too hard. People want a pill to solve the ailments they have.
- kjkjadksj 1y ago
  Exactly why weight loss pills are a multibillion dollar industry today.
  - nradov 1y ago
    Technically those are mostly weight loss injections now. The pills don't work nearly as well.
tekla 1y ago
People want medication to solve their problems, not actually try and solve things without paying money for it
- const_cast 1y ago
  You can't solve your health issues without paying money. If you have high cholesterol and you decide to make lifestyle changes, you still have to go to the cardiologist. Because you have absolutely no idea if you actually lowered your cholesterol. A big fallacy is people thinking they know if they are healthy or they know about their bodies. You don't. Even if you live a very healthy lifestyle, you still have to go to the doctor. You still need screening.
margalabargala 1y ago
I see this view sometimes and it really annoys me. The number of doctors and nurses that attempt to keep people chronically ill rather than curing them if possible, is essentially zero. People get into that field frequently because they actually care, and people that actually care are the most likely to not follow a vague profit incentive that actively hurts people. Similarly, most medical researchers would love to cure diseases, and actively seek out jobs where they do so and will object if asked to suppress curative research. To the extent that what you describe exists, it is limited to MBA people at insurance companies and big pharma determining what gets funded for research. While exceptions always exist, the incidence of that attitude among the people actually doing the work is very close to nil.
- Henchman21 1y ago
  I think we agree on this point almost entirely. But let’s not pretend the doctors, nurses, and researchers are running the show. This attitude of mine persists because of the way the insurance companies run the system: profits first, patients last. Sorry to annoy you.
  - margalabargala 1y ago
    There are a lot of doctors and researchers running research arms of large, well funded institutions. Sloan Kettering for example. I'll grant you that that is a low percentage of the total US medical research spend. But also, most of the world does not have the same profit motive; in most Western countries, a cure is categorically cheaper for everyone than a chronic illness, because healthcare is paid for by taxpayers. And countries besides the US do plenty of medical research. If the hypothesis were true that there exist cures to many diseases that simply haven't been explored due to profit motive, then I would expect countries without that profit motive to have a higher proportion of cures among their medical.discoveries than the US. I don't believe that is true though. Basically my point is that the effect you mention likely has little actual impact on the larger medical field.
  - BobaFloutist 1y ago
    There's pretty universally much more demand for doctors than supply. And insurance companies, the other major power that's, to an upsetting degree, "running the show" would love for everyone to be perfectly healthy so they can collect premiums and never pay out.
nradov 1y ago
Nonsense. The clinicians working in the healthcare system have zero incentive to keep patients chronically ill. This isn't a matter of keeping patients coming back: most doctors already have more workload than they can even handle. Most chronic diseases are primarily caused by lifestyle choices. This is largely outside the scope of medical practice. A doctor can prescribe metformin to treat type-2 diabetes and a statin to reduce cholesterol but they can't force you to clean up your diet and get some exercise. https://peterattiamd.com/outlive/ https://peterattiamd.com/outlive/

epistasis 1y ago

Another way to look at it instead of "they don't care" is "they have nothing they can offer." We have progressed fantastically on the common medical conditions, but once you get into more rare stuff it gets a lot harder. Doctors have huge breadth of knowledge, but the sum of human medical knowledge could never fit into a human brain, even within a specialty, and even then there's so much we are not even close to understanding or knowing. And for rarer stuff that is just getting discovered and learned about, there will only be a few specialists who are the ones figuring it out. That's why you go to lots of doctors that offer nothing, then a hint directs you to the doctors that are in the cutting edge of expanding knowledge. Even if we financially incentivized each and every doctor to spend hours or days trying to find out what's going on with a patient that the doctor can't help with their current knowledge, it's quite likely that doctor could never help on the basis of a single patient. Medicine advances through discovery in groups of people and transferring knowledge from the results of one patient to others, incrementally. A single patient is far less likely to lead to advancement than a doctor having a group of people with similar symptoms. The financial incentive for this discovery comes from research hospitals that collect these difficult cases, and obtain federal research grants from the National Institute of Health that allows them to do research and publish papers and share the knowledge. The proposed budget for the US drastically slashes this, greatly reducing our ability to advance medicine. And in advance of the budget cuts, the NIH is in violation of current contracts stopping payment, resulting in massive waste as research dies on the vine. So what I'm trying to say is that the logistics of advancing medicine require grouping patients, and the place where that happens is at research hospitals, not at the local community doctor for everyday care. And our society is choosing, consciously or unconsciously, to drastically reduce access to that type of care.

asdf6969 1y ago
They genuinely don’t care. Don’t over think it
dinkumthinkum 1y ago
While I might be sympathetic to what you’re saying, endometriosis is not a very rare condition.
1y ago

dapper_bison17 1y ago

[flagged]

drewg123 1y ago

What kind of specialists? An ex of mine had severe endo, and it was finally treated by a reproductive endocrinologist (in Raleigh, NC) after going through many other doctors.

toomuchtodo 1y ago
University of Chicago Medicine has a great endo program, all of their specialists are highly rated. Edit: https://www.uchicagomedicine.org/forefront/news/2023/august/uchicago-medicine-us-news-rankings-2023 https://www.uchicagomedicine.org/forefront/news/2023/august/...
- nradov 1y ago
  Rated how? Metrics like patient satisfaction scores are not correlated with actual clinical outcomes.