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Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

nytimes.com

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Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#2
> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve.

No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read: hospitals) have no intention of going into the red.

Do note the key to this diagnosis wasn’t finding a brilliant or deeply experienced path: it was about putting it into the hands of a curious trainee, who had the time to chase that curiosity.

I’ve said it before and I’ll say it many times in the future: when it comes to complex patients, there’s enormous value in chucking insurance out the window and just paying the doc for their time. A moderately clever doc afforded more than 7 minutes to work on a case can solve a lot of problems.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#3
post #2

> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…

> there’s enormous value in chucking insurance out the window and just paying the doc for their time

I'm sure there's enormous value in chucking economic realities out the window for everyone's job, but that doesn't make those realities go away.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#4
post #2

> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…

Is there a way to actually request a specific doctor have some time dedicated to figuring your case out at your expense? i.e. "Please do more troubleshooting for me above what insurance pays."

I like your idea - but I fear the industry might have already ruled it out.

-edit- Granted, I've done this in my own life by going to specialists at their own offices/outside of a hospital or medical group.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#5
post #2

> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…

Why doctor? It's the most expensive part of your healthcare. But it can be trainee/researcher/AI. Which could be absolutely out of expensive healthcare system. Service which you could buy for additional cost from company which has good guess/prediction ratio based on input parameters from doctor. Service which could be in any part of the world.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#7
post #4
post #2

> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…

Is there a way to actually request a specific doctor have some time dedicated to figuring your case out at your expense? i.e. "Please do more troubleshooting for me above what insurance pays." I like your idea - but I fear the industry might have already ruled it out. -edit- Granted, I've done this in my own life by going to specialists at their own offices/outside of a hospital or medical group.

Unfortunately, no. Your doctor is contractually bound to the insurer’s fee structure; they can’t take an extra penny off of you. You’d have to go to someone that doesn’t take your insurance at all (or just don’t tell them you have that insurance).

The side effect of all this, honestly, is that doctors stop learning how to turn off 7-minute-mode. When it comes to very serious problems, it pays to go to a practice that doesn’t accept insurance at all, because they never got into the bad habit to begin with.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#8
post #5
post #2

> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…

Why doctor? It's the most expensive part of your healthcare. But it can be trainee/researcher/AI. Which could be absolutely out of expensive healthcare system. Service which you could buy for additional cost from company which has good guess/prediction ratio based on input parameters from doctor. Service which could be in any part of the world.

What? The doctor’s visit is the cheapest part of healthcare. Procedures cost far more, and pharm far more again. Perhaps you’re outside of the US, though I can’t think of a country where this isn’t true.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#9
post #3
post #2

> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…

> there’s enormous value in chucking insurance out the window and just paying the doc for their time I'm sure there's enormous value in chucking economic realities out the window for everyone's job, but that doesn't make those realities go away.

You perhaps misread what I wrote. I don’t know how to reply, since I don’t know what it is you think I said. I don’t believe it “throws economic realities out the window” to say that sometimes you need an extended interaction with an expert, and that if you want more than 7 minutes of an expert’s time, you should engage with a reimbursement model that pays for more than 7 minutes. That doesn’t ignore the economic realities of healthcare at large; it’s saying sometimes you need a premium good, and those have premium prices.
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