Starting to distrust doctors and find most to be smug

[Anonymous]

Anonymous wrote:

Anonymous wrote:My main issue with doctors is not the arrogance, though that does exist. My issue is that many of them are quick to prescribe drugs, despite that many health issues could be combated with dietary changes. I would like for doctors to focus more on diet and less on drugs.

A question for the medical types on this board - I have heard that medical school includes a laughably small amount of instruction on diet. Is this true?

Yes, it’s true. American medicine is big business, and just like any other business the #1 priority has to be profits. No one here can dispute that. So why would they prioritize healthy lifestyle changes?

I love how you guys who have no idea how medicine works or how doctors actually make a living (spoiler: it’s not from prescriptions) are so confident in your wrong ideas.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm an RN and prefer NPs for my PCP. Dh and DS also see NPs. I really do think part of the MD burnout is because of how PCP is set up. Med school is long and expensive and in the grand scheme of the MD world, they don't make much. The system is set up to see as many patients as they can a day in order to make money. And dealing with the general public burns you out as it is.

Nps who go into a PCP do it because they want to. And while the schooling is hard, its not as expensive and time consuming as MD

Yeah and just wait until they miss something important or you get really sick or they screw up your medications. I’m an MD and spend about 1/3 of my time correcting and undoing the mistakes of NPs and PAs who practice without supervision. It’s crazy that this is even allowed. I’ve worked with absolutely wonderful NPs and RNs as part of a team, inpatient. But allowing them to practice independently unsupervised on the theory that 85% of medicine is “routine” is insane. 15% of the time it’s not. And even in that 85%, only the best ones know when they don’t know and are wise enough to say so. So much invested in proving that medical school and residency are somehow superfluous to the practice of being a doctor.

When “MDs” stop prescribing based on incentives they receive then maybe we can start trusting doctors a little more. The way I see it, these doctors don’t have the time for much other than straightforward routine cases. When a case is more complex, some doctors try pushing meds and some doctors seem to assume that people are hypochondriacs. I’m guessing very few people are hypochondriacs. Most people would just like to feel better.

The vast majority of MDs are now hospital employees on a salary, like everyone else. There are no “incentives” that you speak of. The days of private practice and these lucrative incentives are way long gone. Unless maybe you are in plastics

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:NP or PA is fine if you have an uncomplicated, easily diagnosable problem like strep throat that requires amoxicillin. Anything even slightly out of routine and they just aren't intelligent enough to deal with it. I've been misdiagnosed or received improper treatment from PAs/NPs many times, as have my family members.

Most of the time they will just throw a z-pack at a likely virus even after testing negative for strep just bc they get thrills from the feeling of doing something…I mean if they actually told you you have a virus they’d have to suffer the same haters as responsible physicians do.

I am an NP. I was a bedside nurse for a long time before I was an NP. I know what I don’t know. I have worked in Primary Care and specialities. In my experience, MDs give antibiotics much quicker than I do, esp in primary care. The time it takes to talk to a patient for symptom management for an upper respiratory infection and explain why he/she doesn’t need an antibiotic takes much longer than getting a Z-pack- which is what patients are used to. Some of that, I think, is just time saving for busy MDs.

Most of my NP colleagues are the same.

I don’t think intelligence has anything to do with it. Lots of super smart nurses out there. Education and training are different.

Interesting. It is not typical for NPs and PAs in general.

We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs.

Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/

This was national data over decades from sites across the country, sampling 1.3 million visits out of about 1.13 billion.

All ambulatory visits from 1998 to 2011 in the United States were divided into 2 groups: visits that involved a NP or PA, and visits that involved physicians only. Both the frequency of NP/PA visit involvement and trends in antibiotic prescribing for all conditions over this time period were assessed to determine whether significant differences exist in the proportion of visits that result in an antibiotic prescription. ...
Between 1998 and 2011, there were an average of 1.13 billion (95% confidence interval [CI], 1.04–1.21 billion) ambulatory visits per year in the United States based on estimates from 1,301,474 sampled visits in the NAMCS/NHAMCS.

The referenced article is from 2016 with data from up to 2011. 10+ year old data. I am not saying that there are not NPs that are not following evidence based medicine. There are. There are also MDs doing the same, despite the longer education and training.

[Anonymous]

I feel like some run a mill. Come in, take test X, be sure to hydrate, rest, eat well, goodbye that's it. Others it's an ideological thing. No matter what you have, hydrate, rest, eat well see ya. Try a doctor trained overseas from a different culture. Experience might be different.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My main issue with doctors is not the arrogance, though that does exist. My issue is that many of them are quick to prescribe drugs, despite that many health issues could be combated with dietary changes. I would like for doctors to focus more on diet and less on drugs.

A question for the medical types on this board - I have heard that medical school includes a laughably small amount of instruction on diet. Is this true?

Not really we had a mini course on nutrition. And we do learn about nutrition aspects relevant to our specialty during residency. However, practically speaking, medical school does not spend time educating people in professions that are staffed by non-doctors and hospitals routinely employ registered dieticians who have degrees in nutrition, so we incorporate them into a multifaceted team. Other things doctors don’t learn: dentistry, podiatry, physical therapy, respiratory therapy, speech therapy. Bc those are all degree programs and we work collaboratively with the appropriate licensed professional who does that.

Understood but it just seems weird that a healthcare professional would learn so little about one of the most important tools to manage your health. And I’m not sure how it works in hospitals, but my PCP works in a private practice and does not appear to be working as part of a multifaceted team. Pretty sure they do not have a dietician or nutritionist on staff, and my sense is that many practices are like that. I suppose they could always refer me out but still the whole thing seems odd.

[Anonymous]

Well most people go to the doctor when they are already feeling bad and therefore most work apart from pediatrics is not prevention it’s addressing already existing problems. Everyone knows by now that you should not smoke or drink, you should exercise, maintain a normal BMI, cut out transfats, and eat a diet rich in fruits, vegetables, whole grain and lean protein and sparing in refined sugar. And yet, most people do not do all those things so primary care doctors spend most of their time treating the consequences: hypertension, diabetes, high cholesterol, and consequences of smoking. I’m not sure why you think doctors, especially primary care doctors, have no interest in prevention. It’s literally their greatest hope that people would listen to them and take better care of their health. Instead doctors wind up working very downstream when problems have already developed and then people complain that things are so entrenched they have to take drugs—that they often can’t afford or don’t take.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm an RN and prefer NPs for my PCP. Dh and DS also see NPs. I really do think part of the MD burnout is because of how PCP is set up. Med school is long and expensive and in the grand scheme of the MD world, they don't make much. The system is set up to see as many patients as they can a day in order to make money. And dealing with the general public burns you out as it is.

Nps who go into a PCP do it because they want to. And while the schooling is hard, its not as expensive and time consuming as MD

Yeah and just wait until they miss something important or you get really sick or they screw up your medications. I’m an MD and spend about 1/3 of my time correcting and undoing the mistakes of NPs and PAs who practice without supervision. It’s crazy that this is even allowed. I’ve worked with absolutely wonderful NPs and RNs as part of a team, inpatient. But allowing them to practice independently unsupervised on the theory that 85% of medicine is “routine” is insane. 15% of the time it’s not. And even in that 85%, only the best ones know when they don’t know and are wise enough to say so. So much invested in proving that medical school and residency are somehow superfluous to the practice of being a doctor.

The reverse is true, too. My wife is a PA in an inpatient setting and a large amount of her time is spent cleaning up the messes made by hospitalists and ED providers, most of whom are MDs. Or managing the supervising physicians in her own group, who are more focused on procedures than diagnosing and managing the patients on the floor.

[Anonymous]

Anonymous wrote:Well most people go to the doctor when they are already feeling bad and therefore most work apart from pediatrics is not prevention it’s addressing already existing problems. Everyone knows by now that you should not smoke or drink, you should exercise, maintain a normal BMI, cut out transfats, and eat a diet rich in fruits, vegetables, whole grain and lean protein and sparing in refined sugar. And yet, most people do not do all those things so primary care doctors spend most of their time treating the consequences: hypertension, diabetes, high cholesterol, and consequences of smoking. I’m not sure why you think doctors, especially primary care doctors, have no interest in prevention. It’s literally their greatest hope that people would listen to them and take better care of their health. Instead doctors wind up working very downstream when problems have already developed and then people complain that things are so entrenched they have to take drugs—that they often can’t afford or don’t take.

Even if the doctor is working downstream when the issues have aLready developed, those issues can often still be reversed thru dietary changes. But doctors don’t prescribe that. They prescribe drugs instead.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:NP or PA is fine if you have an uncomplicated, easily diagnosable problem like strep throat that requires amoxicillin. Anything even slightly out of routine and they just aren't intelligent enough to deal with it. I've been misdiagnosed or received improper treatment from PAs/NPs many times, as have my family members.

Most of the time they will just throw a z-pack at a likely virus even after testing negative for strep just bc they get thrills from the feeling of doing something…I mean if they actually told you you have a virus they’d have to suffer the same haters as responsible physicians do.

I am an NP. I was a bedside nurse for a long time before I was an NP. I know what I don’t know. I have worked in Primary Care and specialities. In my experience, MDs give antibiotics much quicker than I do, esp in primary care. The time it takes to talk to a patient for symptom management for an upper respiratory infection and explain why he/she doesn’t need an antibiotic takes much longer than getting a Z-pack- which is what patients are used to. Some of that, I think, is just time saving for busy MDs.

Most of my NP colleagues are the same.

I don’t think intelligence has anything to do with it. Lots of super smart nurses out there. Education and training are different.

Interesting. It is not typical for NPs and PAs in general.

We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs.

Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/

This was national data over decades from sites across the country, sampling 1.3 million visits out of about 1.13 billion.

All ambulatory visits from 1998 to 2011 in the United States were divided into 2 groups: visits that involved a NP or PA, and visits that involved physicians only. Both the frequency of NP/PA visit involvement and trends in antibiotic prescribing for all conditions over this time period were assessed to determine whether significant differences exist in the proportion of visits that result in an antibiotic prescription. ...
Between 1998 and 2011, there were an average of 1.13 billion (95% confidence interval [CI], 1.04–1.21 billion) ambulatory visits per year in the United States based on estimates from 1,301,474 sampled visits in the NAMCS/NHAMCS.

The referenced article is from 2016 with data from up to 2011. 10+ year old data. I am not saying that there are not NPs that are not following evidence based medicine. There are. There are also MDs doing the same, despite the longer education and training.

The issue isn't the age of the data as much as the methodology. When patients suspect a bacterial infection, same-day or next-day appointments are more likely to be available with a mid-level. Or, at least, they're more likely to end up seeing someone other than their PCP than a typical follow-up appointment.

Even when restricting the set to respiratory infection visits, if you really think you have a bacterial infection, you're going to try harder to get in quickly. And about half the time I bring my kids in for a well-child visit I end up getting hit with a copay because of an incidental URI finding.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Well most people go to the doctor when they are already feeling bad and therefore most work apart from pediatrics is not prevention it’s addressing already existing problems. Everyone knows by now that you should not smoke or drink, you should exercise, maintain a normal BMI, cut out transfats, and eat a diet rich in fruits, vegetables, whole grain and lean protein and sparing in refined sugar. And yet, most people do not do all those things so primary care doctors spend most of their time treating the consequences: hypertension, diabetes, high cholesterol, and consequences of smoking. I’m not sure why you think doctors, especially primary care doctors, have no interest in prevention. It’s literally their greatest hope that people would listen to them and take better care of their health. Instead doctors wind up working very downstream when problems have already developed and then people complain that things are so entrenched they have to take drugs—that they often can’t afford or don’t take.

Even if the doctor is working downstream when the issues have aLready developed, those issues can often still be reversed thru dietary changes. But doctors don’t prescribe that. They prescribe drugs instead.

You clearly have an axe to grind here. It’s not either/or. They do both. Unfortunately most of the time people don’t listen or follow through. Doctors would be happier if they did.

[Anonymous]

Same troll posting over and over again. Just stop seeing doctors and call it a day.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My main issue with doctors is not the arrogance, though that does exist. My issue is that many of them are quick to prescribe drugs, despite that many health issues could be combated with dietary changes. I would like for doctors to focus more on diet and less on drugs.

A question for the medical types on this board - I have heard that medical school includes a laughably small amount of instruction on diet. Is this true?

Not really we had a mini course on nutrition. And we do learn about nutrition aspects relevant to our specialty during residency. However, practically speaking, medical school does not spend time educating people in professions that are staffed by non-doctors and hospitals routinely employ registered dieticians who have degrees in nutrition, so we incorporate them into a multifaceted team. Other things doctors don’t learn: dentistry, podiatry, physical therapy, respiratory therapy, speech therapy. Bc those are all degree programs and we work collaboratively with the appropriate licensed professional who does that.

Understood but it just seems weird that a healthcare professional would learn so little about one of the most important tools to manage your health. And I’m not sure how it works in hospitals, but my PCP works in a private practice and does not appear to be working as part of a multifaceted team. Pretty sure they do not have a dietician or nutritionist on staff, and my sense is that many practices are like that. I suppose they could always refer me out but still the whole thing seems odd.

I’m a dietitian and one problem is that insurance reimbursement for dietitians is pretty low, so it’s hard to incorporate them into a practice. Medicare will only pay dietitians for treating diabetes and kidney disease (and only for obesity if they’re working in addition to a MD). Private insurance will reimburse dietitians for other conditions but it can be a hassle to ensure the payment. Patients usually can’t or won’t pay out of pocket for nutrition.

[Anonymous]

My doctor is cool. But his nurse always freaks out I didn’t get vaccinated (she’s super liberal). I told her I believe it’s no big deal since the cdc has no comment on millions of unvaccinated crossing the border and congress exempted itself plus nobody is getting the boosters. She told me to shut up. I laughed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My main issue with doctors is not the arrogance, though that does exist. My issue is that many of them are quick to prescribe drugs, despite that many health issues could be combated with dietary changes. I would like for doctors to focus more on diet and less on drugs.

A question for the medical types on this board - I have heard that medical school includes a laughably small amount of instruction on diet. Is this true?

Yes, it’s true. American medicine is big business, and just like any other business the #1 priority has to be profits. No one here can dispute that. So why would they prioritize healthy lifestyle changes?

I love how you guys who have no idea how medicine works or how doctors actually make a living (spoiler: it’s not from prescriptions) are so confident in your wrong ideas.

What do you love about it? That your ego gets to feel “better, bigger and smarter” for knowing things you sense others don’t? Why not just share your knowledge then?

I always presumed it was largely procedure based. For example I heard a doctor/hospital gets paid out from insurance about $9000 more for a c section than a vaginal delivery. I’m not assuming the worst of doctors. I do believe they strive to provide best care but I also think as a whole the direction of our health care system is also driven by profit.

There are multiple reasons for why the US’s c section rate at 32%+ is the highest for any developed first world country. This is despite the fact that the WHO acknowledges that c section rates above 10% do not reflect an increase in maternal or fetal health. Our health care system is very very pro surgery/pro procedures. It is not proactive health or wellness based, and as other posters have commented, this is not what is taught in medical school. What is taught is symptom management focused. At that point the patients problems are just that - problematic.

This conversation is broader than just about doctors. Doctors absolutely help and save lives with their care and procedures, and as a country we do not emphasize enough the value of proactive integrative care that is largely outside the realm of a conventional doctors practice. As patients we also need to stop relying on doctors to be these God-like healers. There is more responsibility to be had on all fronts for the demise of our nations health.

[Anonymous]

Anonymous wrote:I feel like some run a mill. Come in, take test X, be sure to hydrate, rest, eat well, goodbye that's it. Others it's an ideological thing. No matter what you have, hydrate, rest, eat well see ya. Try a doctor trained overseas from a different culture. Experience might be different.

Exactly! take this medicine and come back in 3 months for a follow up you do and again come back in 3 months again it's a total farce, a racket to keep you coming back, if you feel well why do you have to come back so soon? $$$$? To keep the machine running?