People have stopped going to the doctor and most seem fine • Hacker News Board

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

#51

Post by ryandrake » Mon, Jun 22, 2020, 3:08 PM UTC

robbiep wrote: post #14

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…

Whilst I can’t speak for your particular circumstances and will assume you know exactly what is wrong with you and what you need, this assumption cannot be applied more broadly. In many respects the family practitioner’s role as gatekeeper to further medical care is anachronistic; perhaps we will be able to solve this with better technology. Until then, it provides a important centre for coordination of care and the…

As someone who rarely goes to the doctor (unless it's very serious) and when he does, does extensive "internet research" of his symptoms beforehand to come in knowledgable, I agree that for me, GPs gatekeeping medicine is unnecessary.

BUUUUT, I have a family friend who is basically a hypochondriac. She goes to the doctor ridiculously frequently, and is always trying to convince them (and everyone else who will listen) that she has all these undiagnosed medical conditions that she needs constant treatment for. Usually she's just sent home, where she does more and more "internet research" to find even more things that must be wrong with her. And it's not substance addiction: She's not going in there seeking abusable medication. She just wants validation that she has all these terrible conditions that she's dreamt up, and someone to finally tell her she's right. So, I guess at the end of the day we do need the gatekeepers, as anachronistic as they seem.

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

#52

Post by Cthulhu_ » Mon, Jun 22, 2020, 3:09 PM UTC

alistairSH wrote: post #16

Icathian wrote: post #3

This article seems to suggest that because no spike in short-term ailments due to lower frequency of care has been observed in a 5-month span, there is no damage to the quality of our society's physical health overall. That seems incredibly myopic to me. The real question is whether there there will be statistically detectable increases in severity or prevalence of chronic or emergent ailments in the long run. How ma…

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%…

But you cannot trust patients, and as a doctor you have to do the due diligence; if the patient's health changes (e.g. weight, blood pressure, adjustment to the medication) they may need to adjust the dosage. That 5% can save lives. Prescription medication should not be fucked with.

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

#53

Post by dcolkitt » Mon, Jun 22, 2020, 3:09 PM UTC

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.

Actually, the medical system has probably on net contributed to antibiotic abuse. Yes, if antibiotics were OTC, people would use them more.

However for decades, doctors have universally instructed patients that they must finish the prescribed course. Even if the symptoms abate, patients are instructed to keep taking the dosage until done.

However this maxim was never supported by evidence[1]. Careful studies show that this approach leads to worse outcomes, because the patient's more likely to develop resistance on subsequent infections. And on average it leads to people taking two to three times more antibiotics than if they followed the intuitive approach of stopping when they feel better.

[1] https://www.nhs.uk/news/medication/questions-over-advice-to-...

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

#54

Post by Cthulhu_ » Mon, Jun 22, 2020, 3:11 PM UTC

ryandrake wrote: post #51

robbiep wrote: post #14

Earlier quoted context omitted.

Whilst I can’t speak for your particular circumstances and will assume you know exactly what is wrong with you and what you need, this assumption cannot be applied more broadly. In many respects the family practitioner’s role as gatekeeper to further medical care is anachronistic; perhaps we will be able to solve this with better technology. Until then, it provides a important centre for coordination of care and the…

As someone who rarely goes to the doctor (unless it's very serious) and when he does, does extensive "internet research" of his symptoms beforehand to come in knowledgable, I agree that for me, GPs gatekeeping medicine is unnecessary. BUUUUT, I have a family friend who is basically a hypochondriac. She goes to the doctor ridiculously frequently, and is always trying to convince them (and everyone else who will listen…

Counterpoint: What if she's not faking it? There's conditions like endometriosis that are horribly underdiagnosed and often dismissed as IBS; the average diagnosis takes seven years. Recently a 40-some year old died after being dismissed for years; her abdomen was riddled with endo tissue and adhesions, likely killing her in the end.

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

#55

Post by Cthulhu_ » Mon, Jun 22, 2020, 3:12 PM UTC

pjc50 wrote: post #37

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…

If people could get antibiotics on demand, the antibiotics would stop working a lot sooner... Mind you, penicillin is cheap and widespread enough that we could probably hand that out.

We could, but we shouldn't because there's already too much superbacteria that are resistant to penicillin. Antibiotics should NEVER be handed out.

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

#56

Post by hckr_news » Mon, Jun 22, 2020, 3:13 PM UTC

smnrchrds wrote: post #46

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…

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

Perhaps due to religion or culture, the doctor is allowed especially in primary care?

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

#57

Post by sixothree » Mon, Jun 22, 2020, 3:14 PM UTC

JoeAltmaier wrote: post #8

The postponed dentist visits will have their fallout (!) eventually. Delayed annual visits to check for skin cancer, colon cancer etc will statistically hurt us. Mammograms put off, should have a definite downside in terms of early detection. Heck, even delaying car maintenance will cost folks hard cash later. The bill will definitely come due, for the slowdown.

I am scared of having any sort of dental issues. The few times in the past I've had any issues, they felt... urgent.

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

#58

Post by Delk » Mon, Jun 22, 2020, 3:15 PM UTC

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…

Genuine and slightly off-topic question out of curiousity: how often do you have strep, a sinus infection (that doesn't go away on its own), or some other condition that requires treatment with antibiotics?

I think I've needed a course of antibiotics perhaps twice in the past ten or fifteen years (can't remember exactly; not often anyway), and one of them was in an exceptional situation.

That leads me to somewhat doubt most (generally healthy) people would manage to get infections requiring antibiotics so often that it would lead to the large (now temporarily reduced) total number of doctor's visits that the article brings up. Or if they do, then people are getting infections that require medical treatment way more often than I imagine. (That's also possible, since I live in a northern climate that doesn't really promote infections most of the time.)

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

#59

Post by tetromino_ » Mon, Jun 22, 2020, 3:23 PM UTC

jjk166 wrote: post #33

tetromino_ wrote: post #25

Earlier quoted context omitted.

Counterexample from recent personal experience: I developed pain in my hand which made it difficult to type. Some googling revealed that my set of symptoms could be caused by 3 rather different underlying causes requiring very different treatments. Failing to treat the correct underlying cause could permanently damage my ability to use my hand, and thus my ability to earn a living. I _needed_ to go to a physician for…

And what are the odds you will encounter that situation again in the next 10 years? In the same time period, what are the odds you'll need a prescription for antibiotics for a common disease? No one is saying you should stop seeing doctors entirely, but several things that currently require a doctor's appointment probably shouldn't.

Based on past experience, I expect to encounter a situation requiring expert medical attention every 5 years, and a situation requiring only a common antibiotic prescription every 1-2 years.

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

#60

Post by majewsky » Mon, Jun 22, 2020, 3:23 PM UTC

alistairSH wrote: post #16

Icathian wrote: post #3

This article seems to suggest that because no spike in short-term ailments due to lower frequency of care has been observed in a 5-month span, there is no damage to the quality of our society's physical health overall. That seems incredibly myopic to me. The real question is whether there there will be statistically detectable increases in severity or prevalence of chronic or emergent ailments in the long run. How ma…

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'm an asthma patient in Germany. I visit my lung doctor twice a year for checkups, but the checkups are performed by a nurse. My doctor then briefly looks at the data collected by the nurse and decides whether she wants to talk to me in her office, which happens about once every two years. If that's not the case, I just get my usual roundup of refills and everything is said and done in about 30 minutes.