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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Posters:

Why are doctors running late

Posters:

My doctors doesn’t spend enough time with me.

Which do you want? If doctors take the time to listen, they will be behind. There are booked for 15 mins which includes the vitals.

If your whole model is based on you not having the time to do the work, at some point you’re not really doing the work, are you?

That’s what the f we all want from doctors: for them to get loud enough about it to CHANGE IT.

How? You seem to think there is a way to do it, or that doctors can. You seem to be a citizen in a country going down in flames, politically -- so why haven't you CHANGED IT? why haven't you FIXED AMERICA?

Maybe because you can't, even you are a part of it. But yeah, nobody outside the country can fix America, either. Not so far.

Doctors’ professional organizations have stood shoulder to shoulder against most innovations that would improve the system for patients. (The AMA even opposed Medicare!) Maybe start by getting your own orgs, which you do control, acting for the greater good and not just for docs.

It is for sure what I am doing in the parallel circumstances in my own life to which you point.

How? I was a member of the AMA, but stopped giving them membership money because my voting didn't matter. I'm still a member of the AAP, which was formed in opposition to the AMA opposing Medicare and still supports universal health care for our patients.

But you don't care about that, do you?

AAP champions universal health coverage for all children in all settings
https://publications.aap.org/aapnews/news/6554/AAP-champions-universal-health-coverage-for-all

https://www.aap.org/en/advocacy/health-care-access-coverage/
AAP Advocacy: Health Care Access & Coverage

So are you, what, running for political office? Are you actually changing anything, or are you just trumpeting around on the internet what you think other people should be doing? Why aren't you fixing America? A heckuva lot of your reps aren't doing what they should. Fix it.

Your description of your AMA membership trajectory really tells the story. The AMA is bigger and more powerful than the AAP. You quit to join an org that represented your opinions better, at a time when you thought you had the option to ignore what the larger and more powerful orgs were doing.

What you’re describing is a strategic mistake at every level of governance—organizations, political parties, the works. The answer is never to divest; it is to lean in on winning.

These folks you want me to fix are your reps as well, so I hope you’re calling them; they take docs a lot more seriously than they take patients.

And as a patient, I’d be a lot more willing to tolerate all your dithering with the EMR if I knew you were doing that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Posters:

Why are doctors running late

Posters:

My doctors doesn’t spend enough time with me.

Which do you want? If doctors take the time to listen, they will be behind. There are booked for 15 mins which includes the vitals.

If your whole model is based on you not having the time to do the work, at some point you’re not really doing the work, are you?

That’s what the f we all want from doctors: for them to get loud enough about it to CHANGE IT.

How? You seem to think there is a way to do it, or that doctors can. You seem to be a citizen in a country going down in flames, politically -- so why haven't you CHANGED IT? why haven't you FIXED AMERICA?

Maybe because you can't, even you are a part of it. But yeah, nobody outside the country can fix America, either. Not so far.

Doctors’ professional organizations have stood shoulder to shoulder against most innovations that would improve the system for patients. (The AMA even opposed Medicare!) Maybe start by getting your own orgs, which you do control, acting for the greater good and not just for docs.

It is for sure what I am doing in the parallel circumstances in my own life to which you point.

How? I was a member of the AMA, but stopped giving them membership money because my voting didn't matter. I'm still a member of the AAP, which was formed in opposition to the AMA opposing Medicare and still supports universal health care for our patients.

But you don't care about that, do you?

AAP champions universal health coverage for all children in all settings
https://publications.aap.org/aapnews/news/6554/AAP-champions-universal-health-coverage-for-all

https://www.aap.org/en/advocacy/health-care-access-coverage/
AAP Advocacy: Health Care Access & Coverage

So are you, what, running for political office? Are you actually changing anything, or are you just trumpeting around on the internet what you think other people should be doing? Why aren't you fixing America? A heckuva lot of your reps aren't doing what they should. Fix it.

Your description of your AMA membership trajectory really tells the story. The AMA is bigger and more powerful than the AAP. You quit to join an org that represented your opinions better, at a time when you thought you had the option to ignore what the larger and more powerful orgs were doing.

What you’re describing is a strategic mistake at every level of governance—organizations, political parties, the works. The answer is never to divest; it is to lean in on winning.

These folks you want me to fix are your reps as well, so I hope you’re calling them; they take docs a lot more seriously than they take patients.

And as a patient, I’d be a lot more willing to tolerate all your dithering with the EMR if I knew you were doing that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Posters:

Why are doctors running late

Posters:

My doctors doesn’t spend enough time with me.

Which do you want? If doctors take the time to listen, they will be behind. There are booked for 15 mins which includes the vitals.

If your whole model is based on you not having the time to do the work, at some point you’re not really doing the work, are you?

That’s what the f we all want from doctors: for them to get loud enough about it to CHANGE IT.

How? You seem to think there is a way to do it, or that doctors can. You seem to be a citizen in a country going down in flames, politically -- so why haven't you CHANGED IT? why haven't you FIXED AMERICA?

Maybe because you can't, even you are a part of it. But yeah, nobody outside the country can fix America, either. Not so far.

Doctors’ professional organizations have stood shoulder to shoulder against most innovations that would improve the system for patients. (The AMA even opposed Medicare!) Maybe start by getting your own orgs, which you do control, acting for the greater good and not just for docs.

It is for sure what I am doing in the parallel circumstances in my own life to which you point.

How? I was a member of the AMA, but stopped giving them membership money because my voting didn't matter. I'm still a member of the AAP, which was formed in opposition to the AMA opposing Medicare and still supports universal health care for our patients.

But you don't care about that, do you?

AAP champions universal health coverage for all children in all settings
https://publications.aap.org/aapnews/news/6554/AAP-champions-universal-health-coverage-for-all

https://www.aap.org/en/advocacy/health-care-access-coverage/
AAP Advocacy: Health Care Access & Coverage

So are you, what, running for political office? Are you actually changing anything, or are you just trumpeting around on the internet what you think other people should be doing? Why aren't you fixing America? A heckuva lot of your reps aren't doing what they should. Fix it.

Your description of your AMA membership trajectory really tells the story. The AMA is bigger and more powerful than the AAP. You quit to join an org that represented your opinions better, at a time when you thought you had the option to ignore what the larger and more powerful orgs were doing.

What you’re describing is a strategic mistake at every level of governance—organizations, political parties, the works. The answer is never to divest; it is to lean in on winning.

These folks you want me to fix are your reps as well, so I hope you’re calling them; they take docs a lot more seriously than they take patients.

And as a patient, I’d be a lot more willing to tolerate all your dithering with the EMR if I knew you were doing that.

Sure it is. So tell me what exactly I was supposed to do (while seeing patients) in the AMA that I didn't -- what more than voting, serving on committees, and advocacy?

And what exactly are you "doing" to fix our country politically? Why is it even more of a dumpster fire now than it has ever been?

This looks a LOT like someone who likes to give advice and criticism but produces jack squat. Am I wrong?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Posters:

Why are doctors running late

Posters:

My doctors doesn’t spend enough time with me.

Which do you want? If doctors take the time to listen, they will be behind. There are booked for 15 mins which includes the vitals.

If your whole model is based on you not having the time to do the work, at some point you’re not really doing the work, are you?

That’s what the f we all want from doctors: for them to get loud enough about it to CHANGE IT.

How? You seem to think there is a way to do it, or that doctors can. You seem to be a citizen in a country going down in flames, politically -- so why haven't you CHANGED IT? why haven't you FIXED AMERICA?

Maybe because you can't, even you are a part of it. But yeah, nobody outside the country can fix America, either. Not so far.

Doctors’ professional organizations have stood shoulder to shoulder against most innovations that would improve the system for patients. (The AMA even opposed Medicare!) Maybe start by getting your own orgs, which you do control, acting for the greater good and not just for docs.

It is for sure what I am doing in the parallel circumstances in my own life to which you point.

How? I was a member of the AMA, but stopped giving them membership money because my voting didn't matter. I'm still a member of the AAP, which was formed in opposition to the AMA opposing Medicare and still supports universal health care for our patients.

But you don't care about that, do you?

AAP champions universal health coverage for all children in all settings
https://publications.aap.org/aapnews/news/6554/AAP-champions-universal-health-coverage-for-all

https://www.aap.org/en/advocacy/health-care-access-coverage/
AAP Advocacy: Health Care Access & Coverage

So are you, what, running for political office? Are you actually changing anything, or are you just trumpeting around on the internet what you think other people should be doing? Why aren't you fixing America? A heckuva lot of your reps aren't doing what they should. Fix it.

Your description of your AMA membership trajectory really tells the story. The AMA is bigger and more powerful than the AAP. You quit to join an org that represented your opinions better, at a time when you thought you had the option to ignore what the larger and more powerful orgs were doing.

What you’re describing is a strategic mistake at every level of governance—organizations, political parties, the works. The answer is never to divest; it is to lean in on winning.

These folks you want me to fix are your reps as well, so I hope you’re calling them; they take docs a lot more seriously than they take patients.

And as a patient, I’d be a lot more willing to tolerate all your dithering with the EMR if I knew you were doing that.

I think it's hilarious that you think they will listen more to one doc than to a national voice of more than 65,000 members. You like to talk, don't you? Focus on being accurate instead.

[Anonymous]

Anonymous wrote:Doctors need to get the AMA to stop lobbying for very limited residency seats. Many of these problems could be solved if we stop artificially restricting the number of doctors.

+2

[Anonymous]

It might be a starting point, but it's meaningless on its own. If you increase medical student admissions, where are you going to find the clinical slots for training?

Concierge medicine doctors are usually not training students. Private equity sees it as a drain on efficiency and a loss on profit.

The Crisis of Clinical Education for Physicians in Training
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797035/

The number of allopathic medical students enrolled in the first year class has increased by 29% since the year 2002–2003, with over half of the growth occurring due to increases in class size of existing schools. This produces a cohort of over 21,000 allopathic medical students who require clinical education yearly. In 2016 over half of the MD schools surveyed mentioned the clinical training of students from other health care professional schools as a source of decreased availability of clerkship training spots for medical students, as compared to approximately 25% of schools reporting this in 2009.

...Combined osteopathic and allopathic first-year medical student enrollment has increased by 50% since 2002–2003, with almost 28,000 students per year entering medical school.

Although the number of osteopathic and allopathic medical students requiring clerkship spots has increased, there has not been a commensurate increase in the number of clerkship spots nor has there been an increase in clinical preceptors. There are several additional factors which compound this challenge. Many community-based hospitals have closed, or been acquired by larger organizations, decreasing the available hospital based rotations for students. Preceptors who have historically provided clinical education are retiring, and many preceptors are joining practices that limit medical students, or don’t permit students at all.

[Anonymous]

Anonymous wrote:I want them to listen to what I'm telling them and not dismiss my concerns without any consideration. Example: never ever ever had high blood pressure outside of pre-eclampsia during pregnancy. In my 50's, after COVID (which I had not had but had the vaccine), blood pressure significantly higher than typical for me at GI doctor office visit. Dr's first response: it's not that high. (It is for me!) Second response: some people have white coat high blood pressure due to anxiety at doctor appointments (in my 50+ years of life, this has never ever been the case for me!) Third response: you can get a monitor at CVS and check it at home if you're concerned.

I want them to try to figure out what the cause of something is instead of going "hmm" and moving on with the exam never to return.

I want them to take the information from other doctors and specialists as a whole and consider relationships between medical findings. The rare doctors we've had that actually did this were old, experienced, and since retired.

Young doctors coming out just don't do these things and apparently aren't trained to. Our most current PCP even told my spouse that they would take the practice's PA over all of the new MDs there.

This is the logical first step. If someone’s BP is higher than usual you monitor for a few weeks. You don’t jump into extensive testing or refer after one elevated reading.

What was the end result? Did they find a reason for your hypertension?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I want them to listen to what I'm telling them and not dismiss my concerns without any consideration. Example: never ever ever had high blood pressure outside of pre-eclampsia during pregnancy. In my 50's, after COVID (which I had not had but had the vaccine), blood pressure significantly higher than typical for me at GI doctor office visit. Dr's first response: it's not that high. (It is for me!) Second response: some people have white coat high blood pressure due to anxiety at doctor appointments (in my 50+ years of life, this has never ever been the case for me!) Third response: you can get a monitor at CVS and check it at home if you're concerned.

I want them to try to figure out what the cause of something is instead of going "hmm" and moving on with the exam never to return.

I want them to take the information from other doctors and specialists as a whole and consider relationships between medical findings. The rare doctors we've had that actually did this were old, experienced, and since retired.

Young doctors coming out just don't do these things and apparently aren't trained to. Our most current PCP even told my spouse that they would take the practice's PA over all of the new MDs there.

This is the logical first step. If someone’s BP is higher than usual you monitor for a few weeks. You don’t jump into extensive testing or refer after one elevated reading.

What was the end result? Did they find a reason for your hypertension?

This correct. You don't make a diagnosis of hypertension on one value, but on multiple values taken on different days. Blood pressure is too labile. It also trends up as you get older, so although it may have been "high for you" at a younger age, it's not unexpected to be higher now.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want them to listen to what I'm telling them and not dismiss my concerns without any consideration. Example: never ever ever had high blood pressure outside of pre-eclampsia during pregnancy. In my 50's, after COVID (which I had not had but had the vaccine), blood pressure significantly higher than typical for me at GI doctor office visit. Dr's first response: it's not that high. (It is for me!) Second response: some people have white coat high blood pressure due to anxiety at doctor appointments (in my 50+ years of life, this has never ever been the case for me!) Third response: you can get a monitor at CVS and check it at home if you're concerned.

I want them to try to figure out what the cause of something is instead of going "hmm" and moving on with the exam never to return.

I want them to take the information from other doctors and specialists as a whole and consider relationships between medical findings. The rare doctors we've had that actually did this were old, experienced, and since retired.

Young doctors coming out just don't do these things and apparently aren't trained to. Our most current PCP even told my spouse that they would take the practice's PA over all of the new MDs there.

This is the logical first step. If someone’s BP is higher than usual you monitor for a few weeks. You don’t jump into extensive testing or refer after one elevated reading.

What was the end result? Did they find a reason for your hypertension?

This correct. You don't make a diagnosis of hypertension on one value, but on multiple values taken on different days. Blood pressure is too labile. It also trends up as you get older, so although it may have been "high for you" at a younger age, it's not unexpected to be higher now.

And this here is the problem. People want to be treated in the way they have descided was best (which is not the appropriate way to proceed), and if they’re not, then the doctor sucks. I mean how do you deal with that?

[Anonymous]

You can try to explain it to them in person or online, and often get accused of being defensive or spending too much time doing that. But it does take time.

Sometimes people are open to looking at the actual protocols and recommendations. However, no amount of time is going to replace a thorough grounding in statistics, critical analysis, and how to do an accurate lit review. People who don't want to understand can always just say, or write, "word salad" or say you don't make sense. And from their point of view they may be justified, but the truth is that the time spent with someone with that perspective is entirely wasted. Entirely.

Some people have a provider they trust, and they don't need details. You can move through that appointment both accurately and on time. Some people don't trust for very understandable or valid reasons, or they may have a good sense that they are outliers in dome way (rightly or wrongly).

All of them deserve good care. Only some of them can get it in the current system. The system needs to change.

One way of doing it is for physicians to take more control of their professional workspace, decide who they can work with (even if it takes more time), set aside the needed time, and charge what they need to make up for loss in economies of space, shared overhead, etc. But they can make sure they do it right.

Another way is to use the economies of scale and shared overhead costs to the advantage of patients, but this requires larger group buy-in and the removal of financial investment and shareholder interests from the provision of medical care, which shouldn't be driven by making as much money as you can squeeze. That's more systemic, and it's much more difficult. It comes with other costs, too.

But if someone is convinced that they are right and unable to consider in any significant ways that they have no idea what they don't know, then this system does not permit good care for them without going concierge, or -- possibly -- getting very very lucky, in a specific context which cannot be held over time, or for many people.

[Anonymous]

^^"outliers in some way"

[Anonymous]

Reading this thread has been very informative about the lack of bedside manner. While there have been some extremes, generally speaking, the most common complaints have been physicians being very late for appointments and not listening to the patients. Most providers, rather than acknowledge that these are valid complaints and offer empathy, instead tell patients to either 'deal with it' or 'get a concierge doc.'

It would have been more effective to have noted that it's often out of the doc's hands, but agree that these are valid complaints. Too many egos though seemed to get in the way for a reasonable approach.

Of course, the worst have been the spouses of docs. I'm not sure why they believe they have special insight because of who they sleep with.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Posters:

Why are doctors running late

Posters:

My doctors doesn’t spend enough time with me.

Which do you want? If doctors take the time to listen, they will be behind. There are booked for 15 mins which includes the vitals.

If your whole model is based on you not having the time to do the work, at some point you’re not really doing the work, are you?

That’s what the f we all want from doctors: for them to get loud enough about it to CHANGE IT.

How? You seem to think there is a way to do it, or that doctors can. You seem to be a citizen in a country going down in flames, politically -- so why haven't you CHANGED IT? why haven't you FIXED AMERICA?

Maybe because you can't, even you are a part of it. But yeah, nobody outside the country can fix America, either. Not so far.

Doctors’ professional organizations have stood shoulder to shoulder against most innovations that would improve the system for patients. (The AMA even opposed Medicare!) Maybe start by getting your own orgs, which you do control, acting for the greater good and not just for docs.

It is for sure what I am doing in the parallel circumstances in my own life to which you point.

How? I was a member of the AMA, but stopped giving them membership money because my voting didn't matter. I'm still a member of the AAP, which was formed in opposition to the AMA opposing Medicare and still supports universal health care for our patients.

But you don't care about that, do you?

AAP champions universal health coverage for all children in all settings
https://publications.aap.org/aapnews/news/6554/AAP-champions-universal-health-coverage-for-all

https://www.aap.org/en/advocacy/health-care-access-coverage/
AAP Advocacy: Health Care Access & Coverage

So are you, what, running for political office? Are you actually changing anything, or are you just trumpeting around on the internet what you think other people should be doing? Why aren't you fixing America? A heckuva lot of your reps aren't doing what they should. Fix it.

Your description of your AMA membership trajectory really tells the story. The AMA is bigger and more powerful than the AAP. You quit to join an org that represented your opinions better, at a time when you thought you had the option to ignore what the larger and more powerful orgs were doing.

What you’re describing is a strategic mistake at every level of governance—organizations, political parties, the works. The answer is never to divest; it is to lean in on winning.

These folks you want me to fix are your reps as well, so I hope you’re calling them; they take docs a lot more seriously than they take patients.

And as a patient, I’d be a lot more willing to tolerate all your dithering with the EMR if I knew you were doing that.

Sure it is. So tell me what exactly I was supposed to do (while seeing patients) in the AMA that I didn't -- what more than voting, serving on committees, and advocacy?

And what exactly are you "doing" to fix our country politically? Why is it even more of a dumpster fire now than it has ever been?

This looks a LOT like someone who likes to give advice and criticism but produces jack squat. Am I wrong?

You sound so angry—imagine how angry a patient is. Imagine you had multiple people in your immediate household attempting to navigate this garbage, broken system with disabling illnesses—and the healthiest one of them was you.

Doctors and patients are not equally situated in this debacle. The badness that prevails in your work and the badness that prevails in patients’ lives are not the same experiences.

So no, we won’t be having a showdown about how angry and helpless it makes you, a doc, feel that your industry is on fire, and what patients should do about that. Start a new thread if you’d like.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Posters:

Why are doctors running late

Posters:

My doctors doesn’t spend enough time with me.

Which do you want? If doctors take the time to listen, they will be behind. There are booked for 15 mins which includes the vitals.

If your whole model is based on you not having the time to do the work, at some point you’re not really doing the work, are you?

That’s what the f we all want from doctors: for them to get loud enough about it to CHANGE IT.

How? You seem to think there is a way to do it, or that doctors can. You seem to be a citizen in a country going down in flames, politically -- so why haven't you CHANGED IT? why haven't you FIXED AMERICA?

Maybe because you can't, even you are a part of it. But yeah, nobody outside the country can fix America, either. Not so far.

Doctors’ professional organizations have stood shoulder to shoulder against most innovations that would improve the system for patients. (The AMA even opposed Medicare!) Maybe start by getting your own orgs, which you do control, acting for the greater good and not just for docs.

It is for sure what I am doing in the parallel circumstances in my own life to which you point.

How? I was a member of the AMA, but stopped giving them membership money because my voting didn't matter. I'm still a member of the AAP, which was formed in opposition to the AMA opposing Medicare and still supports universal health care for our patients.

But you don't care about that, do you?

AAP champions universal health coverage for all children in all settings
https://publications.aap.org/aapnews/news/6554/AAP-champions-universal-health-coverage-for-all

https://www.aap.org/en/advocacy/health-care-access-coverage/
AAP Advocacy: Health Care Access & Coverage

So are you, what, running for political office? Are you actually changing anything, or are you just trumpeting around on the internet what you think other people should be doing? Why aren't you fixing America? A heckuva lot of your reps aren't doing what they should. Fix it.

Your description of your AMA membership trajectory really tells the story. The AMA is bigger and more powerful than the AAP. You quit to join an org that represented your opinions better, at a time when you thought you had the option to ignore what the larger and more powerful orgs were doing.

What you’re describing is a strategic mistake at every level of governance—organizations, political parties, the works. The answer is never to divest; it is to lean in on winning.

These folks you want me to fix are your reps as well, so I hope you’re calling them; they take docs a lot more seriously than they take patients.

And as a patient, I’d be a lot more willing to tolerate all your dithering with the EMR if I knew you were doing that.

I think it's hilarious that you think they will listen more to one doc than to a national voice of more than 65,000 members. You like to talk, don't you? Focus on being accurate instead.

Focus on returning the messages in your patient portal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I want them to listen to what I'm telling them and not dismiss my concerns without any consideration. Example: never ever ever had high blood pressure outside of pre-eclampsia during pregnancy. In my 50's, after COVID (which I had not had but had the vaccine), blood pressure significantly higher than typical for me at GI doctor office visit. Dr's first response: it's not that high. (It is for me!) Second response: some people have white coat high blood pressure due to anxiety at doctor appointments (in my 50+ years of life, this has never ever been the case for me!) Third response: you can get a monitor at CVS and check it at home if you're concerned.

I want them to try to figure out what the cause of something is instead of going "hmm" and moving on with the exam never to return.

I want them to take the information from other doctors and specialists as a whole and consider relationships between medical findings. The rare doctors we've had that actually did this were old, experienced, and since retired.

Young doctors coming out just don't do these things and apparently aren't trained to. Our most current PCP even told my spouse that they would take the practice's PA over all of the new MDs there.

This is the logical first step. If someone’s BP is higher than usual you monitor for a few weeks. You don’t jump into extensive testing or refer after one elevated reading.

What was the end result? Did they find a reason for your hypertension?

it was the dismissive attitude about it. When it is unusual for that person, the doctor should at least wonder why.
No, they didn't find a reason because they never looked into it. He was just the GI doc, anyway. By the time I got back to my PCP, it was nearer to my normal. I personally believe it was a short "long-term) temporary effect related to the COVID vaccine.