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

[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?

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.

PP again -- which they also entirely dismissed as a possibility, btw, because they hadn't yet heard of any such effect. It was only a few months into the vaccines. There were many things they hadn't yet noted about it and I think doctors should have been paying attention in case there were trends developing.

[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.

I don't get what this means. I've seen doctors regularly throughout my life. This wasn't a matter of it getting higher as I've aged. PE within the previous year was still what my BP always was. This was 35 higher. We re-took it in the office that day in case it was up from climbing the stairs to the office. Same result. It remained the same the day of my procedure ( a procedure I've had multiple times and never had any raised BP around it, so no, not anxious about it). Few months later at regular PE again, it was back down to normal -- same normal as 30 years ago.

The concern was the lack of "trending up." It was a sudden anomaly that should at least raise an eyebrow.

[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?

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.

So the doctor “dismissed” your concerns because you actually didn’t have a problem with hypertension? And you’re mad about this? What would you have rather him said? You wanted him to wonder why??

This is just more proof that doctors will never do right by people like PP.

[Anonymous]

No, not if the only "high for you" values were taken on the same day, or just on two different days but with a subsequent return to normal. That's not what is in line with evidence-based medicine, PP.

There are a thousand questions we never would get an answer to -- why you have a mole exactly here, or why your eyes suddenly crossed briefly then. You have to work with what is within normal overall, and what is within the group of things that need to be investigated.

You can do detailed analyses on yourself if you want, but that's not guideline based. And it's fine to do that, but you're in the realm of not being covered by insurance, as well as needing to pay someone for, well, personalized care that is more about curiosity than safety. A regular doc can't justify chasing that with you when there are other items on the list (for you, and for the rest of the people on the doc's panel) that do need to be chased.

I'm glad you're okay right now. I hope the procedure went well.

[Anonymous]

Anonymous wrote:

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.

I have yet for anyone to lay out exactly what other steps there were to take, at least as far as the AMA and overall practice of medicine.

You may say that you don't know, and that's my job -- but what you don't know is that those steps don't exist. And those that criticize are not in a position to see that, but they feel free to lob criticism.

I agree it's probably useless to discuss further here. That's a shame.

[Anonymous]

Anonymous wrote:No, not if the only "high for you" values were taken on the same day, or just on two different days but with a subsequent return to normal. That's not what is in line with evidence-based medicine, PP.

There are a thousand questions we never would get an answer to -- why you have a mole exactly here, or why your eyes suddenly crossed briefly then. You have to work with what is within normal overall, and what is within the group of things that need to be investigated.

You can do detailed analyses on yourself if you want, but that's not guideline based. And it's fine to do that, but you're in the realm of not being covered by insurance, as well as needing to pay someone for, well, personalized care that is more about curiosity than safety. A regular doc can't justify chasing that with you when there are other items on the list (for you, and for the rest of the people on the doc's panel) that do need to be chased.

I'm glad you're okay right now. I hope the procedure went well.

I am thoroughly enjoying this voice of reason. Thank you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

I have yet for anyone to lay out exactly what other steps there were to take, at least as far as the AMA and overall practice of medicine.

You may say that you don't know, and that's my job -- but what you don't know is that those steps don't exist. And those that criticize are not in a position to see that, but they feel free to lob criticism.

I agree it's probably useless to discuss further here. That's a shame.

Nihilism will get us everywhere! If you and I cannot come up with the solutions in this chat, it must mean they do not exist. QED.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

I have yet for anyone to lay out exactly what other steps there were to take, at least as far as the AMA and overall practice of medicine.

You may say that you don't know, and that's my job -- but what you don't know is that those steps don't exist. And those that criticize are not in a position to see that, but they feel free to lob criticism.

I agree it's probably useless to discuss further here. That's a shame.

Nihilism will get us everywhere! If you and I cannot come up with the solutions in this chat, it must mean they do not exist. QED.

I can't find them. If you can't find them, and nobody seems to be able to find them -- are you assuming some tenable action must exist because, why again? Because we want it to?

We're not children.

[Anonymous]

^^PS: Just to be clear, this side conversation was about why I should have continued to send hundreds of dollars in dues to the AMA, even after 20 odd years of membership and voting and advocacy from within wasn't going anywhere. Compared to what was -- I suppose -- the worse decision to focus my money, time, and energy into my specialty medical association and work hard in concert with people who agreed with me, instead of those that didn't have any interest in what I was saying.

That's what this was about. You can trace the claims back through the pages if you want.

I couldn't find a way to change the AMA, other than to oppose it. There's someone (or someone-s) who apparently have some kind of irrefutable proof that there is a way to fix the AMA from within. I don't know, but I think 20 years of trying from was enough to demonstrate that my time and energy was better spent elsewhere, but we can agree to disagree.

That doesn't seem like nihilism to me.

[Anonymous]

Anonymous wrote:^^PS: Just to be clear, this side conversation was about why I should have continued to send hundreds of dollars in dues to the AMA, even after 20 odd years of membership and voting and advocacy from within wasn't going anywhere. Compared to what was -- I suppose -- the worse decision to focus my money, time, and energy into my specialty medical association and work hard in concert with people who agreed with me, instead of those that didn't have any interest in what I was saying.

That's what this was about. You can trace the claims back through the pages if you want.

I couldn't find a way to change the AMA, other than to oppose it. There's someone (or someone-s) who apparently have some kind of irrefutable proof that there is a way to fix the AMA from within. I don't know, but I think 20 years of trying from was enough to demonstrate that my time and energy was better spent elsewhere, but we can agree to disagree.

That doesn't seem like nihilism to me.

Making this all about your personal actions and your personal feelings and what you did and what your cred is…well, it’s consistent with what patients are complaining about here.

I am sorry that you expected a profession where you would principally be treated like a demi-god and instead are now treated as an employee, but again: the power relationship here goes the other way.

You complain sideways or up to someone else who expected to be a demi-god about this, not down to a person who needs the services the health care system—in which you occupy a relatively privileged position—cannot provide.

[Anonymous]

That response is illustrative of how this conversation has gone, and I doubt it actually calls for any answer.

Let's let it sit there.

[Anonymous]

Anonymous wrote:

Anonymous wrote:^^

You know what changing it looks like? Concierge medicine. That works like gangbusters.

No no no. These people DESERVE all the benefits of concierge medicine without paying for it!

Are you really saying that punctuality is a benefit of concierge medicine, not something that should be expected from, and by, everyone?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Doctors have reasons they are late, and so do patients. You should not assume yours are valid and the patient’s are not.

At least have your office call people in advance when you know you are running way late. And for God’s sake apologize to those who came on time and have been waiting for a half hour or more . And if you are going to charge those who are delayed, you need to pay your waiting patients when you are delayed. You are really not the only busy, important person in this equation, whose time has value.

Do you want an apology, or do you want an explanation?

Doctor's reasons for being late are usually other patients, not their own reason. Are the other patients not as valid as you?

You could factor such delays into your schedule, especially since you claim they are common and to be expected. Instead you book us back to back, because you don’t want to lose a dime of time. So we lose time (and often money).

Do you know any places where you can get in to see your primary doctor without an inordinately long wait? Just curious. Please share the name, if so.

Sure. One Medical.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:^^

You know what changing it looks like? Concierge medicine. That works like gangbusters.

No no no. These people DESERVE all the benefits of concierge medicine without paying for it!

Are you really saying that punctuality is a benefit of concierge medicine, not something that should be expected from, and by, everyone?

And being treated with kindness and respect. I’d like to think we all deserve that, not just the people who can afford concierge medicine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:^^

You know what changing it looks like? Concierge medicine. That works like gangbusters.

No no no. These people DESERVE all the benefits of concierge medicine without paying for it!

Are you really saying that punctuality is a benefit of concierge medicine, not something that should be expected from, and by, everyone?

Correct. That is what I am saying. This is the way the system is built. The doctors LITERALLY cannot control that UNLESS they want to attempt to pay back 300K+ in student loans on a 75k salary. I paid back 150K on a 100k salary and it took me 10+ years (not a physician). That was hellish.


So absolutely yes. If you want punctuality you pay for it with a concierge practice. That’s just the way it is.