Doctor rant...can I please please????

[tcartwri]

Alcohol can cause peripheral neuropathy so maybe you should lay off the beer.

uh oh.... lol.

 

[powerpace]

These scenarios will continue until the "profit motive" is taken out of the picture. Doctors are trained on borrowed money. Lots of borrowed money.
Some Doctors do enter the profession for noble purposes. To cure and help people. Most do it for the potential for earning money and prestige. I have known both types.

The Doctor "shortage" is not a shortage at all. It's just mismanagement of resources. Many physicians are not treating as General Practitioners but enter the high paying limited access "specialty" fields. High profit "very few poor people are referred to specialists" and low patient contact "lots of money coming from insured patients".

 

[powerpace]

Funny. If you take a vehicle to the shop for an engine miss, and they tell you it is the plugs, and you authorize them to change the plugs, but the miss is still there, so they also want to now change the wires, they do not refund the money for changing the plugs. Mechanic and shop charge for services rendered too, not overall outcome.

The medical field does not make $8000 off of me. The day may come, but I don't spend 1/10 of that a year now.

Most of a persons medical costs incur at the end of life. That is what insurance is for. Other people paying before hand for your treatment when needed and you paying for theirs. One person could never pay for all the medical treatment needed in a catastrophic event or chronic medical condition.
fpic

 

[Ramses]

These scenarios will continue until the "profit motive" is taken out of the picture. Doctors are trained on borrowed money. Lots of borrowed money.
Some Doctors do enter the profession for noble purposes. To cure and help people. Most do it for the potential for earning money and prestige. I have known both types.

The Doctor "shortage" is not a shortage at all. It's just mismanagement of resources. Many physicians are not treating as General Practitioners but enter the high paying limited access "specialty" fields. High profit "very few poor people are referred to specialists" and low patient contact "lots of money coming from insured patients".

If you take the "profit motive" out of any profession, the quality of people attracted to that profession tends to go down. I would not argue with you that the "profit motive" attracts many potential physicians but it also assures that some of the best people are attracted. The profit and prestige of being a physician isn't what it used to be anyway.

I find your second paragraph interesting. Who would you propose to manage physicians and allocation of specialists vs. primary care? If you take away the right of medical students to choose their specialty, you will end up adversely affecting the quality of the applicants. Would you choose to go to medical school knowing that someone will "assign" you to your final specialty? Specialties in medicine are very diverse and each one tends to attract a different type of person and personality. Most medical students find their "fit" while doing rotations in medical school. "Profit motive" may play a role here but I don't think this is necessarily a bad thing. Please refer to your own "Rules to live by" at the bottom of your post.

 

[MotorSeven]

Alcohol can cause peripheral neuropathy so maybe you should lay off the beer.

"Vitamin deficiencies and alcoholism can cause widespread damage to nerve tissue. Vitamins E, B1, B6, B12, and niacin are essential to healthy nerve function. Thiamine deficiency, in particular, is common among people with alcoholism because they often also have poor dietary habits. Thiamine deficiency can cause a painful neuropathy of the extremities. Some researchers believe that excessive alcohol consumption may, in itself, contribute directly to nerve damage, a condition referred to as alcoholic neuropathy."

My consumption of alcohol has never been excessive. The causes of Peripheral neuropathy are many, but I tend to lean towards some type of physical trama since I "qualify for most of these on the list:
Physical injury (trauma) is the most common cause of injury to a nerve. Injury or sudden trauma, such as from automobile accidents, falls, and sports-related activities, can cause nerves to be partially or completely severed, crushed, compressed, or stretched, sometimes so forcefully that they are partially or completely detached from the spinal cord. Less dramatic traumas also can cause serious nerve damage. Broken or dislocated bones can exert damaging pressure on neighboring nerves, and slipped disks between vertebrae can compress nerve fibers where they emerge from the spinal cord.

Of course without extensive testing ref the mild numbness in the feet it's all just speculation. So for now I will do nothing about that and just monitor it and see if it starts to spread. I have been reading up on this since the nerve test & this is a pretty good link:
http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm

 

[MotorSeven]

As a physician and a specialist (Head and Neck surgeon) I often see people who have symptoms of illnesses that fall outside my specialty such as diabetes. I will often suggest that the patient follow up with their family doctor for further work-up and diagnosis for several reasons:

1. I am not aware of all of their medical history like the family doctor is. The patient may have already been tested and found to be negative. (You would think that most patients would know this information, but many do not).

2. I may not be aware of the best test to rule-in or rule-out a specific disorder outside of my specialty.

3. Since it is not in my specialty and was not the reason that they were referred to me, insurance companies may not cover the test, leaving the patient alone responsible for the cost. I spend a fair amount of my time on the phone with insurance companies justifying tests that I order for problems that fall within my specialty (CT scans, MRI's, etc.).

4. In your case, the test may have required a specific prep, such as fasting, making it more than a simple blood draw for diagnosis.

So as you can see, there are valid reasons for a specialist to refer you back to your family doctor for further testing. I try to do the best for my patients every day and just like a family doctor should not be performing a neck dissection or parotidectomy because they do not have the training, I should not be diagnosing and treating diabetes.

I understand and agree with you....but it really could have been explained better & I don't think 5 min of her time would have ruined her day. Looking at the list of possible causes I have to wonder why she only picked Diabetes to rule out. Trauma damage, toxins, hormones, kidney disorders, cancers, tumors, infections, stress, lyme disease...the list is long, yet she didn't say we should test for all of those things...why?

 

[ultrarunner]

Many Docs are not happy either... I know a lot that decided affordable health care was the last straw and folded the practice.

It's hard to find that old time doctor... they don't make them anymore.

Most of the new Docs are employees of medical or HMO groups... they are graded and expected to produce... I've seen Docs let go because they spend too much time with patients.

The best way to sum it up is not a single Doctor I know encourages their kids to go into medicine... in my area the vast majority of new Docs are foreign born... just the way it is.

On a personal note... Mom somehow moved wrong and was in severe pain and basically immobilized... her new family Doctor ordered a scan...

I was in the locker room at the end of the day and one of the specialists just happened to be there after finishing surgery... he asked how Mom was and I told her... he said she needs a scan and I said had one done this morning... he asked where, called his office and had a copy withing 10 minutes... calls me an hour later and says he can help her and if she wants... he will do her surgery at 6am the next morning... called Mom and she said yes...

Surgery went well... a little mix up at registration because there was nothing for her scheduled... not even a chart... but, you know no Hospital wants to piss off a Doctor with privileges

Anyway... Mom started feeling much better the following days.

Four days after her surgery... he family Doctor calls her and says he reviewed the scan and said he is referring her to a specialist... which happened to be the Doctor I saw in the Locker room that did her surgery.

Family Doctor simply couldn't understand how she could have been seen, let alone had surgery before he had even seen the report...

As with most things... it is often who you know or luck.

By the way... this Doc breeds horses and his stress reliever is seat time on his JohnDeere TLB working on the ranch... we normally talk about tractors... at least weekly.

His wife has gotten to the point of telling him... I think it's time you go to your tractor!!!

 

[powerpace]

If you take the "profit motive" out of any profession, the quality of people attracted to that profession tends to go down. I would not argue with you that the "profit motive" attracts many potential physicians but it also assures that some of the best people are attracted. The profit and prestige of being a physician isn't what it used to be anyway.

I find your second paragraph interesting. Who would you propose to manage physicians and allocation of specialists vs. primary care? If you take away the right of medical students to choose their specialty, you will end up adversely affecting the quality of the applicants. Would you choose to go to medical school knowing that someone will "assign" you to your final specialty? Specialties in medicine are very diverse and each one tends to attract a different type of person and personality. Most medical students find their "fit" while doing rotations in medical school. "Profit motive" may play a role here but I don't think this is necessarily a bad thing. Please refer to your own "Rules to live by" at the bottom of your post.

Any # in particular?

The high cost of a particular Physician associated with a specialty has no relation as to quality of care received. Not all Physicians graduate at the top of their class.
2011 - 2012 Physician Salary Survey - Profiles - ProfilesDatabase.com

The Ultimate Guide To Physician Salaries | ShortWhiteCoats.com

4 bad reasons why medical students choose a specialty

What is your motivation in becoming a doctor?

Physician Payment: Forget Carrots And Sticks, It’s Motivation – Health Affairs Blog

Physician Drug Use Not Uncommon « CBS Denver

Why physicians abuse prescription drugs - EmaxHealth

 

[IslandTractor]

I do get it, Dr's are hardened like Cops because they see and endless line of people every day with problems. They want the facts and not the drivel("Let me do my job and go"). And, they deal with a bunch of folks that are slowly killing themselves by their lifestyle, then come in for help, not to mention the hypochondriac's, the not too bright, bad breath, etc etc. So after a while compassion takes a back seat and it's human nature to clump all your patients into one big category. But(you knew there would be a "but" right?). We as patients are not all the same, and here is a recent experience that left me perturbed and a little pizzed off. I have been ignoring(when it let's me) my left elbow now going on 10+ years. It clicks, locks & pops, stops working when doing repetitive tasks(ummmm.. like building a house for two years by myself), numbness & tingling, range of motion loss @ 30%, then hurts like heck for a couple of days after using it before a rinse & repeat. Lately I am just losing my superhero power and about 50% is gone on that arm, so I decided to bite the bullet and go in and see if they can do something about all of the above. I have a $5K deductible so I went right to an orthopedic surgeon which I knew would order a MRI...she did and it is a whole page of "loose material in the joint, Mr. Arthur Itis, several torn tendons, bone spurs, Carpal tunnel likely, a kitchen sink and a bag of rusty nuts & bolts." Off to another surgeon that specializes in elbows, who then tells me, I'm special and will need two surgeons...him for the arthroscopic, and another to repair tendons and possibly move things off the damaged nerves. Dr # 3 looks at everything, then sends me off for a Nerve Test to determine how bad and what nerves are shorting out so he can avoid or attempt repairs. And, my friends we have now burrowed down into the issue, or let's say Dr #4...the Nerve Tester. First a tech comes in and hooks up some electrodes then proceeds to shock my finger & hand into doing a jumping bean dance while listening to some sounds similar to a needle dragged across a album(remember those?). Turns out, he is not measuring how big of a twitch my fingers/arm/wrist have, but it's more of a resistance test...kinda like an ohm meter. Then he leaves and #4 comes in to stick some very fine needles into my nerves while hooked up to the same machine. She was pretty good and only made it really unpleasant one time. Then she asks me about my neck...any problems there...yep, it's a long-er story, but back in the late 80's while attempting an arrest I lost the battle but won the war. Ended up with 26 stitches on the coconut, which messed my neck up for life...lot's of grinding and popping these days but I deal with it just fine. Bad guy ended up in the ER with two bullets in him...he lived. Anywhoo, #4 then asks if I have any numbness or tingling on the bottoms of my feet or my toes. Well, by golly we are getting somewhere now, she is right on the money...slight numbness on the ball and pad of the big toe..both feet. She then get's up, says "You have Carpal Tunnel" (which I already knew and expected) and some nerve damage(angin no shocker there), then say's, "Oh, that numbness on your feet, it could be DIABETES, so you need to have your family Doctor run some tests"....then starts to walk OUT! WHOA whoa whoa.......hold on there Doc, whuddaya mean "diabetes", no family history, no weight issues, and I get plenty of exercise? She says, "well, your damaged nerves could be because of that, so have it checked"....poof, out the door she goes. Need I point out that I am IN A HOSPITAL at that very moment, over an hour away from home. I am pretty sure there is someone there that could take the 3.5min to draw blood and send it off to the Lab that is on the next floor to rule in or rule out diabetes that very same day. Nope, I'm left to ponder my fate until I make an appointment closer to home to get a blood test done, and 6 days later it's confirmed...NO DIABETES. Anyway, I just wanted to rant a little and point out the overspecialization in the medical field fails to recognize common sense and the ensuing 6 day depression of a patient that might have to ponder giving up BEER....f...fffo....forever:laughing:. Thank you Doctor #4 for Mr Toads wild nondiabetic ride. I appreciate you ruling out all possibly related medical conditions to a particular ailment.....but it could have been done quicker and easier on the patient's part. :drink:

You are right to be pissed off. The nerve tester #4 should have checked your blood sugar at least. Of course she wouldn't have been paid extra for taking three minutes to order the test and, she didn't want to be stuck with the follow up because that doesn't bring in big bucks either. Welcome to pay per procedure medicine. Bottom line: You got crappy care.

 

[Looking4new]

I'm sure many of us have had, or are having, similar problems with the medical profession, and I can't help but wonder how much of them are due to:

1. fear of lawsuits, so they send you to one doctor after another and run many, many "tests", and

2. insurance requirements, private insurance as well as Medicare. I know that doctors usually only want to talk about, test for, and/or treat the one specific thing you came in for. For anything else, you need another appointment so they can get paid for another office visit. For example, I had (still have to some extent) shoulder problems with both shoulders, but the orthopedic doctor requires separate visits and appointments for the right shoulder and then for the left shoulder.

That is the way it is up here, too. Last year my Dr. forgot to sign off on my eye test for my DL medical. I had to make a separate appointment just for her to initial the paper.