im sort of nervous for the day that i have some serious medical issue. every time ive helped family members in hospital, i have been pretty let down by the average level of competence in the room.
i wonder if you have similar feelings.
Discussion
What competence concerns did you have? Perceived, or did you experience a true fck up?
I get to meet many folks who complain about the ācompetenceā of the people before me, but when I dig into it itās because somebody didnāt bring them a turkey sandwich fast enough, or something else didnāt get done fast enough (usually because their neighbor was more critically ill and needed more attention).
That being said, all staff/institutions arenāt created equal so thereās definitely times where Iāve walked into a room and thought ātf did they do that for?ā
Ways you can safeguard yourself and put your mind at ease:
Step 1. Donāt get old
Step 2. If you fail step 1 (you will) find a PCP/internist that you trust. Not just for the medical treatment/advice, but also on where/who to go to for unusual/significant diagnoses, testing, treatment, etc. This separates the good PCPs from the great PCPs.
full disclosureā¦I feel that the system is slowly teetering/breaking/collapsing
MD/DOs are getting squeezed on all sides but especially the primary care side of things. The docs arenāt being given adequate time to see patients in the office and Iām seeing more and more midlevels without adequate training serving as āprimary care providers.ā Unfortunately many of them donāt have a clue what theyāre doing (not all, but many)ā¦but hey, theyāre cheaper to hire than physicians so the VC groups, insurance companies, and health systems like that.
so yesā¦im right there with you and get nervous about the future as well sometimes and I work in the biz
you aināt alone š«
Yes I agree the system is fucked. The individuals are generally ok, although sometimes could use some humble pie.
Primary care is so bad. 20 minute appointments that the doctor basically sneaks out of when the timer is up. How can that honestly be the deal? And like you say, many are not even very competent.
I want more smart people with the latitude to make decisions rather than some "system" that gets put onto everyone.
I am considering a "concierge" pcp. You pay like $2k per year to be one of the 300 patients the doctor has, rather than 3,000 patients like in a "system". Crazy this has to be an additional charge on top of the already outrageous health care costs, but health is everything.
I appreciate the response! Maybe I should have kept it to myself though, because it feels like a lot to properly relay here now.
I am not talking about delayed turkey sandwiches (although the food in hospital is another confusing thing), but I am also not talking about outright mistakes resulting in bad outcomes. Luckily I haven't really experienced that.
Some examples of the things I have experienced. I have had to insist on a family member's hospital discharge because after days of testing, the doctors were off on a tangent based on results of one of the tests, and by that point the hospital stay was doing more harm than good for the elderly patient, and certainly not solving the problem that put the patient in hospital. They looked at me like I was doing the wrong thing. No doubt I did the right thing, even with hindsight. Another example, I was helping this family member with an arthritic autoimmune disorder. This involved steroids when necessary. The patient was adamant about using steroids as sparingly as possible. The first rheumatologist wanted some mg of prednisone daily, and would not allow us to play around with that. I went to the next rheumatologist, which turned out to be one of the best doctors I've ever worked with. He gave us the tools we needed to handle this without having to come in every 6 months etc unless something was wrong. I loved that. I understand a lot of people may not be capable, but being treated like you dont know what is best for you is not why I go to a doctor. I consider it a "medical consultation", which means I am paying for expert advice, not required to take that advice. I think a lot of doctors out there could benefit from being reminded of that. These weren't great examples of "incompetence", but at least this gives some idea of the things I have experienced. I think the individuals are mostly good, but the system is fucked.
Your advice is spot on. It's all about finding the people you trust. Luckily I have a friend that is an internist, so I can get advice and recommendations. I can't imagine dealing with things without this sort of resource.
Isn't medical malpractice the 3rd leading cause of death though?
No pal. That is a fiat narrative and fueled by shit statistics. Itās like saying being alive is the leading cause of death.
Medical errors occur, but instead of asking WHY this narrative gets shat about as fact.
Since so many medical errors occur we definitely need to have more government involvement/oversight, hire a bunch of useless bureaucrats/administrators to dictate care, and while weāre at it we should probably just implement treatment algorithms/pathways so that every single person gets the same exact care because all people are exactly the same. This is how that line of thinking ends up going.
Medical errors do happen, but the why is important.
Yeah I guess what I'm saying is I don't trust modern western medicine, but I do trust passionate doctors who are always learning and improving. They're just hard to find. The state has been known to create a crisis to push a solution, and they've been moving toward centralized control over medicine for decades. Now they wanna replace doctors with AI. I believe that medical malpractice is dangerous because the majority of doctors are so quick to follow the officially approved path, just pushers for big pharma. They will be replaced with AI and most patients won't tell a difference.
a lot of what primary care doctors do anymore is just pill management.
The good ones do more than that and thereās a lot out there, but sometimes harder to find.
That being said, itās hard to do much of anything when youāre allotted to a grand total of 5-15 minutes per encounter. Doubly so for complex patients.
In some countries, such as Sweden, primary care physicians are seen as the most vital physicians in the healthcare system. They are the gatekeepers and are the ones involved in preventative care. They are generalists and jacks of all trades. They donāt just study one part of the body. They also have to understand how to interact with all kinds of people, and most importantly when to treat someone and what to investigate. The shitty ones order everything and ship their patients off to specialists. The good ones will tell you what you donāt need and come with a plan to prevent you from getting worst, and when they see something that worries them, then theyāll ship you off.
Fuck AI, thereās no replacing a primary care physician.
And they are šÆ not just pill pushers (Iām not in the states so I canāt relate to them there)
This is what I trained in. Itās awesome being a skilled all trades dude, but aināt easy to get there and requires lifelong learning. The compensation isnāt as great relative to specialists, because doing things to people is more billable (ie procedures, surgeries, etc.), but both are definitely needed.
I donāt get where that whole pill pusher thing comes from. Thatās nonsense from my experience.
I always felt profoundly accomplished when I could get people off unnecessary medications. Hellā¦I met one dude and I think he was on 14-18 first encounter. When I graduated from training had bro down to 2-3 š.
Exactly, and in Sweden GPs are paid more than specialists because it is much more difficult to decide when/or when not to perform a procedure. Also, convincing a patient to change their lifestyles/and or take medications so that they donāt get sicker and cost the system more money down the road is vital. In my mind, all physicians are important, but gps are the linchpin. Here in Canada they arenāt paid the most, but do well comparatively, especially if they work rurally and are involved in complex care.