S/o What the f do you all want from doctors?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Everyone is mad at doctors. We should be mad at insurance companies and health systems. We should be mad at the broken free market system and republicans in general.

EMRs, while good in theory and intention, were a disaster to roll out. I’m curious how much time and money is spent implementing, maintaining and using these systems instead of focusing on the patient - a recurring complaint on this thread.

Medicine has become like everything else. Ruined by private equity and other bored, rich AHs who are looking for a new “tech disruption”

EMRs were a disaster to roll out because doctors and practices first did a horrible job picking systems, and then did a horrible job training their staff to use them. They made a self-fulfilling prophecy: they decided EMRs were going to be horrible, so they bought the cheapest EMRs they could find, which were obviously going to be horrible.

You really, really don't want to go back to paper charts.

What I hate is having different doctors on different electronic records portals. I've started picking doctors and specialists who use the same portal so they can all see my medical history and I'm not repeating tests or carrying records between practices. Nationalized health systems tend to do this automatically.

There again I saw someone in her complaining that she didn't want doctors seeing her past ER records.

That's not a red flag at all...

The ableism of this post suggests you've never had a whitecoat misdiagnose you in your <10 minute visit. ER docs are not exactly known for their deep compassion. And if you were in the ER for a mental health crisis, the odds of you getting misdiagnosed in a way that might permanently alter how you're seen by future clinicians is significant.

Universal recordkeeping with patient review and ability to redact and/or dispute input is the solution. Doctors shouldn't be allowed to pass notes about their patients w/o patient consent, and patients should be able to flag and comment on their own charts to dispute accuracy.

I've had several doctors write that they did things they didn't ("counseled re: nutrition" is the usual culprit) and a few leave out things they did say and probably shouldn't have.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Hit reply too fast. Do you see how this makes zero sense? You want them to know better than you but you don’t want to do what they tell you to do.

Also if they take all those phone calls they’ll never have time to actually see patients in person and also they won’t get paid. Sucks but true. Your quick phone call, multiplied by 15, plus the documentation required for it, would take up hours.

There's A LOT of real estate between
"makes $50k a year" and "makes $600k a year". Doctors could stop over-scheduling, spend more time with patients, take phone calls, work on bedside manner and still make what any American would consider a lavish sum. Nobody is asking them to impoverish themselves, just maybe make a couple thou less a day.

If a doctor actually can control his own patient schedule- and let’s say he sees 3 patients per hour at 20min per patient and then has an hour at the end of the day to answer calls. And a lunch 30min. That’s 21 patients a day. Billed at primary care sick visit rates to insurance. Now he has to pay his receptionist and his two medical assistants. He has to pay his billing lady and his office manager (unless he manages his own office in which case give him an additional patient free hour per day to do administrative work , so, that’s down to 18 patients a day). Now he doesn’t double book patients either. So imagine 3 patients a day no show. You’re down to 15 a day. Now he also has to pay rent , and malpractice insurance. Can you guess how much he’d take home at the end of the day? I’ll clue you in. Not enough to stay in business.

All my doctors are driving much nicer cars than I do—apparently there's some fat to cut in the system. Sorry, not sympathetic.

Of course you’re not sympathetic. You’re an idiot.

Just imagine the types of doctors you’d have if you offered people 50k salaries! the best of the best!

Is $50k the only alternative to $225k that you can think of?

How about, like with any other job, a part of a doctor's pay be tied to customer satisfaction? The contempt most MDs show for their patients would go away in a hurry!

How much do you propose doctors make? NP and PA already make six figures. If doctors made the same why would anyone put themselves through the process of exams and residency? Tell me who would be dumb enough to do that? And then who would do all the free labor that residents provide hospitals? Someone help me understand.

250-300k would be a good level. But many doctors in procedurally-driven specialties make several times that amount.

You won’t be able to get component surgeons if you pay this. They’ll go into tech right out of college for this.

I’ll do it.

DP. What's stopping you right now?

They are incapable of doing the work.

It’s always the people whose time is worth the least who are the loudest when it comes to this topic. That same group of unsophisticated obnoxious losers gripe about everything else in life. They also tend to skew towards the insane, showing up to their GP appointment with a big stack of their own research, demanding they have some special medical condition that warrants 10x the care of everybody else. The trend is easy to spot.

Meanwhile, those whose time is actually worth something either 1) deal with the system as it is or 2) pay for a higher level of service. That same group is aware life is hard and tend to be aware of the need to wear a helmet sometimes.

This attitude right here is why people hate whitecoats.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

DP. Now she calls back daily and is rude to the front desk staff person, who is already stressed, but without frankly cursing or threatening. You can expect your front desk staff to complain to you and possibly switch jobs if you don't support them.

Whether or not you decide there is a therapeutic breakdown and decline to continue the person from your practice, she -- being angry and outraged, can leave as many negative reviews trashing your reputation, but you cannot respond with any refuting details or context because of HIPAA. That's annoying and will also put more stress on your staff, who may now be trying to answer questions about those comments.

But who cares, right? But if that patient then makes a complaint about you to the medical board, it follows you onward in many contexts even if there was no judgment against you. You have to report complaints on applications.

So ... you could set aside 30 minutes (because it will not be a 5 minute conversation) and try to deal with it head on, answer her questions, absorb the anger, and move on. And she will then tell people that "I gave him a piece of my mind, because I don't take 'no' for an answer," and so other people start to think this is how to get what they want.

None of this would have happened in 1984, by the way. Medicine is very different than it used to be, and the process continues to accelerate.

Good grief. Businesses deal with grumpy people all the time. It's not like you're dealing here with the outbreak of WW III or the collapse of the financial system.

If I'm grumpy, my first thought isn't "I'm reporting this person to the medical board". That's a lot of work and overkill. It's also counterproductive for a patient to be labeled difficult. The only person I ever considered reporting was an elderly doctor showing signs of Alzheimer's, and then I didn't. I did tell the referring doctor though.

My PCP dealt with complainers by having the meanest receptionist ever. I thought there was a special training school for mean school and medical receptionists because there are a lot of them.

Fabulous. But out of some 3000 patients, there are surprisingly many that are not like you.

Perhaps your experience has something to do with you and the quality of service you're providing, and not just your patients wanting to waste their time filing fraudulent reports? Maybe?

[Anonymous]

Anonymous wrote:

So seriously what do you want from doctors? Should they even exist anymore?

The AI isn't quite smart enough, yet, to run differential diagnosis protocols. But once it is? Any PCP who isn't capable of adding human compassion and value to that formula needs to GTFO. Most of the doctors I see are medgoogling my symptoms anyway. Once the algorithm can do that, we'll only need experienced doctors for review (we're already using this model, just with PAs and NPs instead of AI).

So I want doctors to act like their humanity is the value add, because that's going to be the only way they keep their jobs unless they're specialists.

[Anonymous]

My doctor takes at least 30 minutes with me and loves to chat. He is a one-of-a-kind physician. That said, I think he came out of medical school without a lot of debt, which allowed him to avoid having to see 20 million patients a day just to make a buck. Maybe we should offer free or discounted medical school to internal medical doctors/primary care physicians.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Hit reply too fast. Do you see how this makes zero sense? You want them to know better than you but you don’t want to do what they tell you to do.

Also if they take all those phone calls they’ll never have time to actually see patients in person and also they won’t get paid. Sucks but true. Your quick phone call, multiplied by 15, plus the documentation required for it, would take up hours.

There's A LOT of real estate between
"makes $50k a year" and "makes $600k a year". Doctors could stop over-scheduling, spend more time with patients, take phone calls, work on bedside manner and still make what any American would consider a lavish sum. Nobody is asking them to impoverish themselves, just maybe make a couple thou less a day.

If a doctor actually can control his own patient schedule- and let’s say he sees 3 patients per hour at 20min per patient and then has an hour at the end of the day to answer calls. And a lunch 30min. That’s 21 patients a day. Billed at primary care sick visit rates to insurance. Now he has to pay his receptionist and his two medical assistants. He has to pay his billing lady and his office manager (unless he manages his own office in which case give him an additional patient free hour per day to do administrative work , so, that’s down to 18 patients a day). Now he doesn’t double book patients either. So imagine 3 patients a day no show. You’re down to 15 a day. Now he also has to pay rent , and malpractice insurance. Can you guess how much he’d take home at the end of the day? I’ll clue you in. Not enough to stay in business.

All my doctors are driving much nicer cars than I do—apparently there's some fat to cut in the system. Sorry, not sympathetic.

Of course you’re not sympathetic. You’re an idiot.

Just imagine the types of doctors you’d have if you offered people 50k salaries! the best of the best!

Is $50k the only alternative to $225k that you can think of?

How about, like with any other job, a part of a doctor's pay be tied to customer satisfaction? The contempt most MDs show for their patients would go away in a hurry!

How much do you propose doctors make? NP and PA already make six figures. If doctors made the same why would anyone put themselves through the process of exams and residency? Tell me who would be dumb enough to do that? And then who would do all the free labor that residents provide hospitals? Someone help me understand.

250-300k would be a good level. But many doctors in procedurally-driven specialties make several times that amount.

You won’t be able to get component surgeons if you pay this. They’ll go into tech right out of college for this.

I’ll do it.

DP. What's stopping you right now?

They are incapable of doing the work.

It’s always the people whose time is worth the least who are the loudest when it comes to this topic. That same group of unsophisticated obnoxious losers gripe about everything else in life. They also tend to skew towards the insane, showing up to their GP appointment with a big stack of their own research, demanding they have some special medical condition that warrants 10x the care of everybody else. The trend is easy to spot.

Meanwhile, those whose time is actually worth something either 1) deal with the system as it is or 2) pay for a higher level of service. That same group is aware life is hard and tend to be aware of the need to wear a helmet sometimes.

This attitude right here is why people hate whitecoats.

I’m the person you quoted. I’m not a doctor. But I am just telling it like it is.

People want to be more special than they are. And they think the world owes them a ton of free labor. The way they got to that place of entitlement is because they feel slighted everywhere else in their life. This is just another one of a trail of expectations to remain unfulfilled.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Everyone is mad at doctors. We should be mad at insurance companies and health systems. We should be mad at the broken free market system and republicans in general.

EMRs, while good in theory and intention, were a disaster to roll out. I’m curious how much time and money is spent implementing, maintaining and using these systems instead of focusing on the patient - a recurring complaint on this thread.

Medicine has become like everything else. Ruined by private equity and other bored, rich AHs who are looking for a new “tech disruption”

EMRs were a disaster to roll out because doctors and practices first did a horrible job picking systems, and then did a horrible job training their staff to use them. They made a self-fulfilling prophecy: they decided EMRs were going to be horrible, so they bought the cheapest EMRs they could find, which were obviously going to be horrible.

You really, really don't want to go back to paper charts.

What I hate is having different doctors on different electronic records portals. I've started picking doctors and specialists who use the same portal so they can all see my medical history and I'm not repeating tests or carrying records between practices. Nationalized health systems tend to do this automatically.

There again I saw someone in her complaining that she didn't want doctors seeing her past ER records.

That's not a red flag at all...

The ableism of this post suggests you've never had a whitecoat misdiagnose you in your <10 minute visit. ER docs are not exactly known for their deep compassion. And if you were in the ER for a mental health crisis, the odds of you getting misdiagnosed in a way that might permanently alter how you're seen by future clinicians is significant.

Universal recordkeeping with patient review and ability to redact and/or dispute input is the solution. Doctors shouldn't be allowed to pass notes about their patients w/o patient consent, and patients should be able to flag and comment on their own charts to dispute accuracy.

I've had several doctors write that they did things they didn't ("counseled re: nutrition" is the usual culprit) and a few leave out things they did say and probably shouldn't have.

Well ER attendings get to deal with all kinds of things. Like people dying on them from a heart attack and triaging some guy with half his brain coming out after a motorcycle wreck.

Anyhow, WTF are you going to the ER for a mental health crisis? You can’t write this stuff if you tried.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

So seriously what do you want from doctors? Should they even exist anymore?

The AI isn't quite smart enough, yet, to run differential diagnosis protocols. But once it is? Any PCP who isn't capable of adding human compassion and value to that formula needs to GTFO. Most of the doctors I see are medgoogling my symptoms anyway. Once the algorithm can do that, we'll only need experienced doctors for review (we're already using this model, just with PAs and NPs instead of AI).

So I want doctors to act like their humanity is the value add, because that's going to be the only way they keep their jobs unless they're specialists.

By the time that happens, all the people who are part of the complaining group but can’t afford to pay for concierge because their skills and time are not valuable enough will be unemployed anyways. So I guess it will all work out in the end.

[Anonymous]

We should be mad at our government for not fixing the mess that is the US Healthcare system

[Anonymous]

It's almost as if when you give a clear answer, some people will willfully not understand it for their own purposes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Everyone is mad at doctors. We should be mad at insurance companies and health systems. We should be mad at the broken free market system and republicans in general.

EMRs, while good in theory and intention, were a disaster to roll out. I’m curious how much time and money is spent implementing, maintaining and using these systems instead of focusing on the patient - a recurring complaint on this thread.

Medicine has become like everything else. Ruined by private equity and other bored, rich AHs who are looking for a new “tech disruption”

EMRs were a disaster to roll out because doctors and practices first did a horrible job picking systems, and then did a horrible job training their staff to use them. They made a self-fulfilling prophecy: they decided EMRs were going to be horrible, so they bought the cheapest EMRs they could find, which were obviously going to be horrible.

You really, really don't want to go back to paper charts.

What I hate is having different doctors on different electronic records portals. I've started picking doctors and specialists who use the same portal so they can all see my medical history and I'm not repeating tests or carrying records between practices. Nationalized health systems tend to do this automatically.

There again I saw someone in her complaining that she didn't want doctors seeing her past ER records.

That's not a red flag at all...

The ableism of this post suggests you've never had a whitecoat misdiagnose you in your <10 minute visit. ER docs are not exactly known for their deep compassion. And if you were in the ER for a mental health crisis, the odds of you getting misdiagnosed in a way that might permanently alter how you're seen by future clinicians is significant.

Universal recordkeeping with patient review and ability to redact and/or dispute input is the solution. Doctors shouldn't be allowed to pass notes about their patients w/o patient consent, and patients should be able to flag and comment on their own charts to dispute accuracy.

I've had several doctors write that they did things they didn't ("counseled re: nutrition" is the usual culprit) and a few leave out things they did say and probably shouldn't have.

Well ER attendings get to deal with all kinds of things. Like people dying on them from a heart attack and triaging some guy with half his brain coming out after a motorcycle wreck.

Anyhow, WTF are you going to the ER for a mental health crisis? You can’t write this stuff if you tried.

Since you’re obviously experienced, I am sure we’d all benefit from your obviously well-informed recommendations about how to correctly be a person, or caregiver of a person, with suicidality in a completely broken health care system.

Do tell.

[Anonymous]

DP. What is the ED going to do, if the person refuses care and does not fit the extremely limited and specific indications of the Baker Act?

Almost every time a person in mental health crisis comes in, all that happens is that they are checked to be medically stable, wait a very long time, and end up leaving AMA or with the person and those with them feeling like there was no help at all. Involuntary admissions happen, but not as common as this other situation. And then the people are mad more wasn't done.

Because it's not legal to do more. You may not be able to do anything for the suicidal person, but neither can the ED, in most cases. Just because you can't fix it doesn't mean that anyone else can. That's not great. It's not ideal. But it is the law.

[Anonymous]

^^There aren't legions of skilled and patient mental health workers available at 2am. There just aren't. And the fact that you took someone into the ED doesn't magically make more psychiatrists or counselors available, or open more slots up. A lot of the time the people who already have appointments need them just as much as the person you brought to the ED.

Even if not, the providers already seeing patients have a therapeutic responsibility to their own patients, first and foremost, and not to take on more if it compromises the care the give to the people they are already promised to. That's how licenses and professional responsibility works.

If you think there should be more providers, then please, apply for training. (Any reasons you have for not doing so are exactly the same reasons for thousands and thousands of others. If you think they should be forced to anyway, then please, volunteer yourself first.)

[Anonymous]

What I would like from doctors isn’t something they can provide. I would like unrushed, affordable, personalized care. But I fully understand that in the existing healthcare system I’m only going to get 2/3 at best. I don’t blame the doctors, I blame capitalism.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Everyone is mad at doctors. We should be mad at insurance companies and health systems. We should be mad at the broken free market system and republicans in general.

EMRs, while good in theory and intention, were a disaster to roll out. I’m curious how much time and money is spent implementing, maintaining and using these systems instead of focusing on the patient - a recurring complaint on this thread.

Medicine has become like everything else. Ruined by private equity and other bored, rich AHs who are looking for a new “tech disruption”

EMRs were a disaster to roll out because doctors and practices first did a horrible job picking systems, and then did a horrible job training their staff to use them. They made a self-fulfilling prophecy: they decided EMRs were going to be horrible, so they bought the cheapest EMRs they could find, which were obviously going to be horrible.

You really, really don't want to go back to paper charts.

What I hate is having different doctors on different electronic records portals. I've started picking doctors and specialists who use the same portal so they can all see my medical history and I'm not repeating tests or carrying records between practices. Nationalized health systems tend to do this automatically.

There again I saw someone in her complaining that she didn't want doctors seeing her past ER records.

That's not a red flag at all...

The ableism of this post suggests you've never had a whitecoat misdiagnose you in your <10 minute visit. ER docs are not exactly known for their deep compassion. And if you were in the ER for a mental health crisis, the odds of you getting misdiagnosed in a way that might permanently alter how you're seen by future clinicians is significant.

Universal recordkeeping with patient review and ability to redact and/or dispute input is the solution. Doctors shouldn't be allowed to pass notes about their patients w/o patient consent, and patients should be able to flag and comment on their own charts to dispute accuracy.

I've had several doctors write that they did things they didn't ("counseled re: nutrition" is the usual culprit) and a few leave out things they did say and probably shouldn't have.

Well ER attendings get to deal with all kinds of things. Like people dying on them from a heart attack and triaging some guy with half his brain coming out after a motorcycle wreck.

Anyhow, WTF are you going to the ER for a mental health crisis? You can’t write this stuff if you tried.

Since you’re obviously experienced, I am sure we’d all benefit from your obviously well-informed recommendations about how to correctly be a person, or caregiver of a person, with suicidality in a completely broken health care system.

Do tell.

Not clog up the ER. That’s what. This thread really delivers on the ridiculous expectations. Now we’ve moved on to burdening the ER with mental health crisis. That makes a ton of sense.