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People have stopped going to the doctor and most seem fine

nytimes.com

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Re: People have stopped going to the doctor and most seem fine

#41

Post by alistairSH »

retortio wrote: post #15
eyerony wrote: post #7

If I could get antibiotics for strep or sinus infections without going to them, I'd pretty much never go. Those visits are really dumb because I already know what's wrong, and just need them to say "yep, it's the thing you already knew it was, here's a prescription and a bill for doing nothing useful" ... actually on reflection already knowing what's wrong and just needing a doctor to say it so treatment can proceed…

GP's really should go away. We need specialists and technicians to perform tests when necessary. Medical training for everyone but surgeons should not take more than 5 total years including undergrad. Arbitrary number, but it should be significantly less time than it takes now. Technicians who can be trained on specific technologies (x-ray, ultrasound, etc) should be able to handle most cases. Medical treatment in th…

This is the role that physician's assistants (PAs) and nurse practitioners (NPs) fill at most large family practices in the US. I haven't seen an actual MD for a physical or sore throat in many years. And my communication with the practice is with a PA. Same for my wife, who has an in-house clinic at her employer (not in the medical field, just a perk).

Re: People have stopped going to the doctor and most seem fine

#42

Post by dannyw »

pjc50 wrote: post #34
wincy wrote: post #30

Earlier quoted context omitted.

I recently started paying for Direct Primary Care. We signed up as seeing a doctor during COVID became even more difficult than usual. It’s definitely a luxury but I pay $100 a month and my wife and I can bug our respective doctors (she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients) whenever we want. Obviously we try not to bug them all the time and be…

Effectively you're paying $100 a month to be treated for hypochondria?

Along with potential overprescription of antibiotics, which is a bad thing for the individual and a bad thing for community health. Mayo Clinic says "Acute sinusitis usually doesn't require any treatment beyond symptomatic relief".

Re: People have stopped going to the doctor and most seem fine

#43

Post by burkaman »

votepaunchy wrote: post #36
burkaman wrote: post #9

> In a recent survey, only one in 10 respondents said their or a family member’s health had worsened as a result of delayed care during the pandemic. That's 30 million people. And in a fantasy world where going to the doctor in America was cheap and easy, I imagine most people would be happy to go regularly if they knew there was a 10% chance it would make them healthier. Also, how are people answering this survey? O…

If the average family size is three, then to account for the "or a family member's health" would mean something on the order of 10 million Americans adversely affected.

That's true. But again, how could people know? My parents are not going to mention some minor health problem on the phone with me, especially if they can't go to the doctor to confirm there's something wrong.

Re: People have stopped going to the doctor and most seem fine

#44

Post by h2odragon »

Last time I went to a doctor, I was concerned about intestinal blockage; they gave me a prescription for a drug that slows intestinal motility. And told me I couldn't afford any tests to confirm my notions of what my actual health issues might be.

I've never been one of those who delegates the responsibility for my health to a doctor; but at least they used to be valuable consultants. Today I cannot imagine a circumstance that would make me want to be a customer of a health care provider. I can only hope to find a alternate source for any treatments they keep exclusive to themselves if i ever need one.

Re: People have stopped going to the doctor and most seem fine

#45

Post by alistairSH »

throwaway_jobs wrote: post #27
alistairSH wrote: post #16

Earlier quoted context omitted.

In my mind, the missed cancers could be a problem. But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5%…

> Those appointments should only occur if there's an issue that requires new dosing or a change of medication. But isn’t that a little bit of Monday morning quarter backing? In other words how does a doctor know if a therapy/Rx needs to be modified for a chronic condition without a doctor visit and in many cases blood work? In fact a 6 month therapy for a chronic condition would suggest The doctor has extreme confide…

Things like asthma inhalers don't normally require bloodwork. Just a quick Q&A, which could be done less expensively over the phone, if it's even really necessary. Or, annually instead of bi-annually.

Re: People have stopped going to the doctor and most seem fine

#46

Post by smnrchrds »

wincy wrote: post #30
alistairSH wrote: post #16

Earlier quoted context omitted.

In my mind, the missed cancers could be a problem. But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5%…

I recently started paying for Direct Primary Care. We signed up as seeing a doctor during COVID became even more difficult than usual. It’s definitely a luxury but I pay $100 a month and my wife and I can bug our respective doctors (she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients) whenever we want. Obviously we try not to bug them all the time and be…

> she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients

Is that legal?

Re: People have stopped going to the doctor and most seem fine

#48

Post by JTbane »

wincy wrote: post #30
alistairSH wrote: post #16

Earlier quoted context omitted.

In my mind, the missed cancers could be a problem. But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5%…

I recently started paying for Direct Primary Care. We signed up as seeing a doctor during COVID became even more difficult than usual. It’s definitely a luxury but I pay $100 a month and my wife and I can bug our respective doctors (she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients) whenever we want. Obviously we try not to bug them all the time and be…

You really shouldn't take antibiotics unless they are really needed... microbes get more resistant to them

Re: People have stopped going to the doctor and most seem fine

#49

Post by eyerony »

Wowfunhappy wrote: post #40
eyerony wrote: post #7

If I could get antibiotics for strep or sinus infections without going to them, I'd pretty much never go. Those visits are really dumb because I already know what's wrong, and just need them to say "yep, it's the thing you already knew it was, here's a prescription and a bill for doing nothing useful" ... actually on reflection already knowing what's wrong and just needing a doctor to say it so treatment can proceed…

The fact that you used antibiotics as the example makes me very uneasy on this. Antibiotics are almost certainly over-prescribed, and humanity is ultimately going to lose them as a result. It's good to make absolutely sure that you need them.

By the time I get them for those things I'm usually sitting at about 4 hours of sleep over the last 48-72(!) hours and unable to eat or (sometimes) even keep water down, so yeah, I need 'em. I wait that long so my body has a change to fight it off without resorting to antibiotics, which sometimes does work. Though also to avoid spending two and a half hours being sick and miserable in the car, at the doctor's office, in the car again, at the pharmacy, then in the car again, rather than at home resting, until I just cannot avoid it.

Re: People have stopped going to the doctor and most seem fine

#50

Post by dcolkitt »

This isn't that surprising. Healthcare economists have known for a very long time that medical spending, on the margin, has precious little impact on actual health outcomes.[1]

Basically there's a "core" set of medicine that constitutes basic care and is essential to health. But even during deep budget cuts or quarantine, very few people are avoiding vaccines, not setting broken legs, and letting appendices explode.

In contrast an enormous amount of healthcare is very expensive and of dubious effectiveness at best. For example it's not uncommon for courses of certain chemotherapy to cost $400,000 and have no statistical effectiveness.[2] Overall nearly half of medical procedures are unsupported by evidence[3]. Even procedures we take for granted, like routine mammograms[4], have no actual impact at reducing mortality at the population level.

This is what economists call "on the margin". These are the treatments that get cut first during rationing.

[1] https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-med... [2] https://freakonomics.com/2013/10/22/the-unsustainable-econom... [3] https://www.vox.com/the-big-idea/2017/12/28/16823266/medical... [4] https://theconversation.com/routine-mammograms-do-not-save-l...

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