Why Did My Patient Leave Me? • Hacker News Board

Re: Why Did My Patient Leave Me?

#111

Post by 77pt77 » Sat, Apr 15, 2017, 2:50 PM UTC

ziikutv wrote: post #97

It ain't perfect in Canada either. I remember losing my hairs and getting patches of super smooth bald spots. Super embarrassing for a kid in a bad neighbourhood and bad school. Went to the doctor she looked at my charts and said I was super low on iron so low that I might even die if it continues to lower. I was given iron pills. Two months after I went to the doctor again and said my hair patches are not fixed. She…

> Then upon investigation it was noted that the staff gave her wrong chart; of a pregnant woman who had a similar "feminized" version of my name.

This has happened many times to me. It's quite scary once you realize it. Thankfully no one ever told me I was pregnant.

> We filed a complaint but she then resorted to personal attacks in her report

Care to go into more detail? I'm really interested in knowing how these details.

> Said symptoms always keep coming back and I keep getting more of the same prescriptions.

This is just called making sure your business is recurrent.

Re: Why Did My Patient Leave Me?

#112

Post by nicky0 » Sat, Apr 15, 2017, 2:51 PM UTC

ThomPete wrote: post #67

ajnin wrote: post #41

Earlier quoted context omitted.

You're right that the budget is tighter, however the healthcare budget is separate from the main state budget, and you can't have a situation where for example you'd allocate less to health to pay for schools or army or something like that. The money still comes from taxes though and there is enormous pressure currently due to the economic situation in Europe, especially from businesses, to lower those taxes. It can…

It's not separate from the reality that they have to decide what kind of ex. treatment they are going to support for how many etc.

That seems more a theoretical or ideological objection. Yes there may be some outlying cases where people can't their treatment paid for and have to resort to going private, but the vast majority of citizens in countries with state healthcare enjoy free and effective healthcare for their entire lives.

Re: Why Did My Patient Leave Me?

#113

Post by cortic » Sat, Apr 15, 2017, 2:51 PM UTC

ThomPete wrote: post #71

cortic wrote: post #46

Earlier quoted context omitted.

I do question the morality of the US system, and the sustainability of inflated prices it creates. Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly. This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc. Not saying th…

I am unconvinced any of the systems are sustainable. The US system isn't better it's different. The inflated prices aren't due to it being more privately driven but because of lobbying which can be dealt with.

EU systems get much better outcomes for a fraction of the cost, and you think that's 'unsustainable'? 'lobbying' can be dealt with a either side of the pond, the only thing you are arguing for is making profit from the poor and sick.

Re: Why Did My Patient Leave Me?

#114

Post by CydeWeys » Sat, Apr 15, 2017, 2:51 PM UTC

I abandoned an orthopedist last year because I felt that he was using hard-sell tactics on me to get me to agree to surgery for my broken ankle. Basically, he had a surgery slot open in a few days and it seemed like he wanted to book it, with increasing discounts (including exploding offers!) on the surgery as I kept demurring. He was a referral from the urgent care clinic that I went to immediately following the accident, and I think they recommended him solely because he was in the same doctor/hospital network (although he did not take my insurance!).

So I spent several hours doing research on orthopedic surgeons and went to visit one of the best ones at the best hospital in the city (who also happened to be in-network). He looked at my X-rays and recommended against surgery, saying that the break wasn't that bad and that it would heal fine with just the cast I was already in! He was not as personable and a bit more robotic than the other guy who was giving off the salesman vibes, but I trusted him because of my research rather than the first doc who was essentially just some random referral through happenstance.

A year has gone by now and I'm glad that I didn't get the surgery, because my ankle healed perfectly without it (the second doc was right). I would've been walking faster with the surgery, it's true, but I also would've had permanently implanted metal hardware (which can cause lifelong irritation issues), and which could have necessitated a second surgery for later removal. In hindsight I regret nothing, and of course not having the surgery was also much, much cheaper.

So if that first doctor were to ask me why I'd leave him, I'd just say that it seemed like he was placing profits above the best interests of the patient, or, more charitably, that since he's a surgeon he thinks of surgery as the solution to every problem, even when it's not necessary.

Re: Why Did My Patient Leave Me?

#115

Post by sxg » Sat, Apr 15, 2017, 2:53 PM UTC

jacquesm wrote: post #4

I've done this, without feedback. The reason was that doctors seem to come in several varieties when it comes to bringing their ego to work and my doctor had a serious case of that. I was dehydrated after an operation and when he asked if he could do something for me I asked for some water, the doctor then ordered someone else not in the room to come and get me a glass of water. He couldn't be bothered to walk to the…

I'm not totally convinced your story with the cup of water was an ego related issue. The workflow of doctors in the hospital is complicated, and different doctors and nurses have different privileges for different patients, which can make things appear to be ego related. In your scenario, you're a post-operative patient. Your primary doctor is likely the surgeon that performed surgery on you. I'm thinking the doctor that saw you and wouldn't get a cup of water was a consulting-team doctor that was asked by your primary doctor (the surgeon) to see you. Consulting doctors don't "own" their patients (although this differs in different hospitals). This means they can't put in orders (i.e. prescribe meds, give you food, water) for you. They can evaluate you and provide recommendations to the primary doctor, and it's up to the primary doctor to make the final call on the recommendations. If a patient asks a consulting doctor for water, the safest thing for the doctor to do is to defer to the primary doctor or nurse who does "own" the patient. The nurse will know from the orders put in for the patient what kind of diet the patient is on and whether the patient is allowed to have water.

Yes, this is a lot of bureaucracy, but there is a reason for it. If your surgeon thought there was a good chance that you'd have to go back in for surgery soon, he'd likely want you to be NPO (no food or water intake) to minimize the risk of aspiration and choking during anesthesia and intubation if you were to undergo surgery again. He might want you NPO if you had just had some sort of GI surgery or were due for a barium swallow study. A lot of patients are NPO in the hospital, and for consulting doctors, it's much easier to defer to your nurse or your primary doctor for even basic needs like food and water.

Re: Why Did My Patient Leave Me?

#116

Post by giardini » Sat, Apr 15, 2017, 2:54 PM UTC

Waterluvian wrote: post #108

Does it spread well on toast?

The fungus or the steroid cream?

Re: Why Did My Patient Leave Me?

#117

Post by yourapostasy » Sat, Apr 15, 2017, 2:55 PM UTC

foldr wrote: post #93

muninn_ wrote: post #58

Earlier quoted context omitted.

I hear you. Previous office I went to I had to wait more than 30 minutes past my appointment time before being seen by the nurse (before being seen by the doctor) which didn't include "arrive 10 minutes before your appointment". Obviously this is annoying. The third time I showed up to the same office I was 10 minutes late to my appointment, and they told me I would have to reschedule or wait about 45 minutes to an h…

What you appear to want is contradictory. Tolerance for people arriving late is incompatible with having appointments start on time, as everything gets backed up.

Lots of medical professionals use an app/site to help manage patient appointments. I want one of those suppliers to come out with a smartphone app for the patients to run to give the medical office real-time projected arrival time on the day of the appointment.

Then the office can offer expedited check-in for patients that use the app, because they know the patient will arrive on time and don't have to pad the check-in time estimates. Bonus for watching traffic patterns and looking for accidents/road closures, then giving the patient a heads up to start making their way to the office earlier than anticipated; bonus for storing trending data on individual patients to adjust reminders (those more consistently tardy get earlier and more frequent reminders).

Re: Why Did My Patient Leave Me?

#118

Post by samirillian » Sat, Apr 15, 2017, 2:55 PM UTC

theoneone wrote: post #61

csydas wrote: post #35

Earlier quoted context omitted.

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...). This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer…

So 3000$ for a biopsy: ticket to Greece and back to USA : let's say 1000€. Biopsy procedure if it's ultrasound guided around 300€. Lab fee for examining the biopsy:around 200€ max, maybe less. Hotel room for 2-4 days in Thessaloniki 120€-150€ in a decent hotel. Total:1500€ or even less. All these can be done by highly and well educate medical doctors, treatment in private clinics is very good(since you are paying in…

Obviously, the problem with this strategy is uncertainty. Part of the point of healthcare is that other people worry about it so you don't have to. Better the Byzantine, inefficient healthcare system you know than a system you don't know at all.

That said, I consider myself lucky to have been in Japan when my lung collapsed. The surgery itself was $80!

Re: Why Did My Patient Leave Me?

#119

Post by QSIITurbo » Sat, Apr 15, 2017, 2:58 PM UTC

sxg wrote: post #98

QSIITurbo wrote: post #34

Earlier quoted context omitted.

Another alternative that I've run into. Visiting a doctor friend of mine. She needed to deliver some papers to another room and summoned the nurse for that. I joked that why you can't do that yourself (omg) and she replied that the nurses start to complain if you do stuff that's earmarked to them. It might be that it's because they're in a union or it's a company policy. Who knows, I never asked. But the point was th…

It's not necessarily an ego or union thing. It's more of a protocol thing. The nurse needs to know what papers have been signed and generally where the patients are in terms of paperwork. I'm a medical student, and I've been amazed at how efficiently the inefficient system in an outpatient clinic works. There's a very specific protocol that all the assistants, nurses, and doctors adhere to, and any deviation from the…

No it wasn't a situation like that. It was just that some papers needed to be delivered to someone (don't want to go into details). There were two relevant people: the doctor and the destination. There was no need for the nurse other than some agreement between either the company or the union.

Re: Why Did My Patient Leave Me?

#120

Post by cortic » Sat, Apr 15, 2017, 3:02 PM UTC

ThomPete wrote: post #92

alphonsegaston wrote: post #88

Earlier quoted context omitted.

There's no question about it morality - it's immoral. Creating a system where whether you live or die is premised on your income is immoral. Even more so when single-payer systems demonstrably achieve better health outcomes at lower prices. The reality is that that so many people in this country have bought into some kind of Capitalist Calvinism, where the suffering is not only pre-ordained by "market forces," but co…

It's not that simple. Single payer systems also decide who to treat and for what sicknesses, what machines to buy etc. The reason why the US system is so expensive is because of perverse incentives given to the industry. As long as you can afford it I would rather be treated in the US system than the French or Danish system.

" [] systems also decide who to treat and for what" - in privately owned companies, this decision is made to maximize profits, in publicly owned companies this decision is made to please constituents.

"The reason why the US system is so expensive" - Is because an individual with a health condition is in a poor position to negotiate the price of a treatment for themselves. To the extent a private company could give fair prices, they would have to be regulated heavily.

"As long as you can afford it I would rather be treated in the US" - You believe this because much of the massive profit margins goes into advertising.