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.

Maybe examine the roots of your own paranoia. The fact is that the vast majority of doctors are not incentivized in any way by pharma, and there are rules in place especially at academic centers to prevent this. Over the last 20 years these rules have become more strict not less. Pharma will try anything to influence prescribing patterns but the reality is doctors do not rely on pharma sales for their income, their income comes from clinical practice and insurance billing. They don’t get a cut from prescribing or referring. That is literally illegal.

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.

Anonymous wrote:

Anonymous wrote:I never cease to be amazed by the doctor hatred on this board. You’d rather entrust your health to someone who never went to medical school or trained in a residency. Just astonishing.

Based on many patient experiences, that training obviously doesn't help them to develop patient interaction and listening skills. Most patients just want someone to listen to them and take them seriously. Doctors seem to be trained in finding the quickest solution possible to get the patient out of the office.

It's either you have unlimited time to listen and then get behind and piss off the remaining appointments of the day, or you have to be short and stay on time. I can't count the number of threads on doctors who run late on DCUM.
It's not an easy environment to work in.

Anonymous wrote:

Anonymous wrote:I never cease to be amazed by the doctor hatred on this board. You’d rather entrust your health to someone who never went to medical school or trained in a residency. Just astonishing.

Based on many patient experiences, that training obviously doesn't help them to develop patient interaction and listening skills. Most patients just want someone to listen to them and take them seriously. Doctors seem to be trained in finding the quickest solution possible to get the patient out of the office.

Well be sure to call a paralegal next time you need a lawyer. I’ve heard they are great listeners.

Anonymous wrote:

Anonymous wrote:I never cease to be amazed by the doctor hatred on this board. You’d rather entrust your health to someone who never went to medical school or trained in a residency. Just astonishing.

Based on many patient experiences, that training obviously doesn't help them to develop patient interaction and listening skills. Most patients just want someone to listen to them and take them seriously. Doctors seem to be trained in finding the quickest solution possible to get the patient out of the office.

Yes, this.
I don't have any health problems and avoid doctors, but when I've gone with my father I can't believe what I see. His lab results were TERRIBLE, his weight was up, and his doctor had nothing to say except "I'm going to increase your dose of X and add a daily Y pill" while looking at the computer. He couldn't have a ten minute conversation explaining "You're on your way to kidney failure and here are the changes you need to make." So then my father thinks everything's fine since his doctor didn't say anything negative.
Another one I prodded to discuss diet and they recommend "small frequent healthy snacks". For someone who already grazes all day on nuts and dried fruit and his A1C keeps going up. They just want to check off the box "discussed diet" and get out of there.

I've had this problem with specialists and surgeons, not PCPs. I'm 54 and female.

Has anyone had a better experience going to a concierge practice like One Medical? I really need a new PCP and the one I like is with OM, but I’m hesitant to join a concierge practice - but will if it means more attention and less of a rat race.

Anonymous wrote:

Anonymous wrote:I never used to have this problem. But lately I am beginning to be distrusting of most primary care providers. I’ve never had an issue with any specialists I’ve seen.

My primary care providers have either abruptly left, not paid attention during my visits, talked over me, been demeaning, and overall just smug and rude.

Do you see MDs for primary care? I stopped seeing doctors and now see NPs and PAs and stopped having this problem. However I feel like primary care especially is a profit-optimization machine rather than focused on patient experience, so I have low expectations.

In addition to profit-optimization, primary care is also focused on symptom management through pharmaceuticals, instead of root cause diagnostics and true health management through lifestyle choices, diet, etc.

Anonymous wrote:I never cease to be amazed by the doctor hatred on this board. You’d rather entrust your health to someone who never went to medical school or trained in a residency. Just astonishing.

Based on many patient experiences, that training obviously doesn't help them to develop patient interaction and listening skills. Most patients just want someone to listen to them and take them seriously. Doctors seem to be trained in finding the quickest solution possible to get the patient out of the office.

Anonymous wrote:Yup.

I'm guessing you are a woman just now entering middle age? Welcome.

Truth right here.

I switched from Dr to a PA at my OB/GYN and primary care office. I'm healthy, age 52, weigh 142, and take no meds. I'm just there for my screenings and bloodwork. Most doctors are just guessing at solutions and incentivized by big Pharma - "practice" is an apt description.

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.

PAs listen and follow up more than any doctor we’ve had.

Anonymous wrote:Yup.

I'm guessing you are a woman just now entering middle age? Welcome.

LOL New poster, who is 50. This made me giggle. I have found good doctors, but have gone through major duds.I find the ones in their late 60s can be the most smug and some can teeter on the brink of malpractice because they have gone so long without major consequences. I was surprised by one doctor's very serious medical diagnosis of my daughter and so I decided to get a second opinion from the top person in the country. He didn't use electronic records (red flag) and he simply turned my records over to me, said "how dare you question me" and promptly fired me. He had indeed made a false diagnosis. Even I reading all the labs and pathology report as a layperson could see it, but it helped to get input from the leading doctor on this and to get guidance on where to go next. Because he was useful with other medical issues with our medically complex daughter I am letting it go, but in parent support groups for kids with medical issues I have shared our experience and apparently I am not alone.

A year later after a doctor of mine retired I went to a new one, a smug female in her late 60s, who insisted on all these tests. One thing came up slightly abnormal. I read it was no big deal, but she insisted we explore it and she kept scheduling me to come back to see her for each new test. I asked her what disorder she even thought I might have. I then read up on the disorder. It was extremely rare, not life threatening and limited to people who are of a totally different ethnic background. When I gently questioned her she got highly defensive. The next doctor I saw said she was totally out of line and it's not the first time. On her reviews, the people who are positive something is wrong with them, but nobody takes them seriously so she was willing to run all the tests. It didn't sound like she found anything real with them either, which is insane. I also wonder if we didn't have such well paying insurance if she would have given up earlier and left me alone. Keep in mind I had NO symptoms.

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.

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.

The problem is the way health care is set up in this country. I like my primary care physician; she's young. But I hate going to the office - it's like a factory. And I hate going to specialists because they're so siloed. Holistic health care is non-existent in the US. And while I've never seen an NP or a PA, I have a new-ish friend who is a PA, and I honestly can't imagine being under her care.