I have heard that person care providers that incentivize them to keep the medical costs per patient low, especially for HMOs. If there are doctors who are reluctant to have patients with disabilities, could metrics KPIs be in play here?
Physicians’ attitudes about caring for people with disabilities
21–30 of 148 posts
Re: Physicians’ attitudes about caring for people with disabilities
#22N=1, but I can confirm the experience of being disabled and getting medical care is mutually frustrating. Taylorism and one-size-fits-all fails hard. Appointment times are standardized, despite patients not being standard. I know I'm going to take extra time. I have multiple chronic conditions, getting treatment is a mess. But I can't arbitrarily ask for more time during booking; it's all automated now. Worse, I need…
> Worse, I need to confirm the doctor kept in mind _all_ of this in my treatment plan, because I've had awful reactions when they haven't. I'm not disabled but do have some chronic stuff. A couple decades ago I started carrying my medical record (well...the synopsis) to the doctors office for this reason. Especially when you end up in a clinic rather than a real private practice you're often not guaranteed to even se…
That’s not what the doc gets paid. That’s the pretend amount that the insurer and doc have agreed upon, before their agreed upon discount.
Source: doctor.
Re: Physicians’ attitudes about caring for people with disabilities
#23From the synopsis: > Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. In the U.S., primary care is becoming more and more industrialized, with patients limited to very short visits. Patients hate this because they…
It's not even remotely efficient industrialization though. Doctors spend a lot of time doing things that could easily be done by someone with much less training. Doctors would have more time to spend with patients that actually need their expertise if we had a better system for delegating tasks and triaging patients.
It kind of reminds me of how the medical industry in the US is more privatized than most places, yet pricing actually works in such an anti-capitalist way (even for elective/non-urgent procedures). They really manage to capture the worst of both worlds.
Re: Physicians’ attitudes about caring for people with disabilities
#24Could the ADA itself be the cause of at least some of this hesitation by some doctors to want to deal with disabled patients? With a disabled patient, there's a larger chance that something about your medical practice (the parking lot, the hallway, the stairs and ramps, the chairs in the waiting room, the equipment in your office, etc) aren't going to satisfy somebody and you're faced with a dumb legal headache even…
I just assumed that ADA requirements made their way into commercial building codes a while ago. And because of that, physicians would rarely bump into that issue, whether leasing office space or building new space. Am I mistaken?
Unfortunately, it's not that simple.
ADA requirements are incredibly complex, at times very specific and at times very unclear and open to interpretation. The truth is that almost every building could be found to be in violation, no matter how hard the builders tried to make it ADA compliant.
In practice, this rarely matters. 99% of people with disabilities are just trying to get around, not looking for an opportunity to sue. But, the risk is still there, all it takes is one litigious individual to make your life a lot worse.
Re: Physicians’ attitudes about caring for people with disabilities
#25A lot of modern medicine is factory work, there is no time or interest for the patient. It's the same reason people with symptoms that aren't immediately obvious get diagnosed with anxiety. It can be life-destroying when it's systemic, a lot of disabled people find that when they age out of pediatric care no one will touch them, not doctors, not physiotherapists, nobody.
Does this apply globally or just in the US? Do folks in other countries with disabilities have better experiences?
Same thing globally from the people I've talked to, I only have personal experience with American and European healthcare though.
A problem we have in Europe is that the regulation of medical professions prevents anyone from paying for better care. There were times in my life I would have paid any amount of money to see a professional but was unable to find anyone who could take my money. That means we all receive equal care but it's equally poor and the government doesn't put the necessary resources in place to improve it.
Re: Physicians’ attitudes about caring for people with disabilities
#26A lot of modern medicine is factory work, there is no time or interest for the patient. It's the same reason people with symptoms that aren't immediately obvious get diagnosed with anxiety. It can be life-destroying when it's systemic, a lot of disabled people find that when they age out of pediatric care no one will touch them, not doctors, not physiotherapists, nobody.
Does this apply globally or just in the US? Do folks in other countries with disabilities have better experiences?
I am far from disabled but I have multiple chronic issues, one of them being 100% visible to the naked eye and I've been told by multiple doctors to "not stress about it".
And we're taking about a nail color change, a fingers temperature change during winter, and a constant feeling of headache that feels like worms are throwing a party under my hair (which they clearly don't).
Also, for what it's worth, I'm from Europe and I tried both the free and the private health sector in my country. My only other options are to fly abroad for "medical tourism", but that would require a lot of money.
Re: Physicians’ attitudes about caring for people with disabilities
#27N=1, but I can confirm the experience of being disabled and getting medical care is mutually frustrating. Taylorism and one-size-fits-all fails hard. Appointment times are standardized, despite patients not being standard. I know I'm going to take extra time. I have multiple chronic conditions, getting treatment is a mess. But I can't arbitrarily ask for more time during booking; it's all automated now. Worse, I need…
Spot on. It becomes more clear when you ask who pays medical professionals salaries? Insurance companies do. Insurance companies are medical professionals’ bosses. The customer receiving treatment has no influence on the standard of care.
Most customers could not afford the treatment at the standard of care they want anyway, hence the reason they purchase via insurance.
Re: Physicians’ attitudes about caring for people with disabilities
#28Earlier quoted context omitted.
Spot on. It becomes more clear when you ask who pays medical professionals salaries? Insurance companies do. Insurance companies are medical professionals’ bosses. The customer receiving treatment has no influence on the standard of care.
Most customers could not afford the treatment at the standard of care they want anyway, hence the reason they purchase via insurance.
A large portion of patients (customers seems like a dirty word in this context...) can't even afford insurance!
Re: Physicians’ attitudes about caring for people with disabilities
#29Earlier quoted context omitted.
What’s an example of an unnecessary thing?
I dunno, that's the point. Since it only technically requires "reasonable accommodation" it's up to interpretation. "Reasonable accommodation" has been used by ambulance chasers to sink businesses. I'm sure a set of absolutes could be codified. I'm getting downvoted to death for having an opinion again so I'm just gonna leave the topic.
The ADA should have been the government providing disabled people with sufficient cash to purchase the services or products they need to address their disability, or the government can provide it directly.
But by diffusing the responsibility across businesses, the government can say they helped people without spending any money or taking responsibility to help people.
For example, why would a doctor need to arrange for translation or sign language services? If the government wants to give a disabled person those benefits, the government should pay the disabled person to purchase the services of a sign language interpreter, or provide them one directly.
Re: Physicians’ attitudes about caring for people with disabilities
#30I really wish I could just (safely) order whatever medications, tests, and treatments I want online.
Let me consult a doctor if I need one, but also: don't gatekeep treatment from me because the doctor is having a bad day, doesn't like me, etc.
I have a severe, debilitating anxiety disorder. It's extremely frustrating, and sometimes I will have to leave classes I'm teaching, social functions, etc. for no apparent reason because my body starts an anxiety attack.
This flares up once every 3-5 years and has for most of my life. The solution to this, which has worked for most of my life, is: xanax. Take a small amount of xanax before an anxiety trigger, do the trigger, and break the trigger->anxiety association/cycle. It takes like 3 doses total, and the rest of the pills go in the trash (or in the medicine cabinet, and then eventually the trash).
Almost every time I have to go through some weird and insulting dance with a doctor essentially pleading with them for this medication, I get told I'm a drug addict, and finally after explaining that no actually I'm a 40 year old semi retired founder/software developer, not a homeless unemployed addict, which is what your leading questions about what I do for a living led you to think, I might get a prescription for the drug that I have been taking rarely, but to great effect, for 30 years.
I *HATE* the medical system. I hate it. People talk about how the rich get access to some other medical system that gives them what they want with concierge doctors or whatever. Well I'm rich and I don't get that. I'd pay almost anything to just get a license that says "this guy is responsible, successful, and a massive contributor to society. Let him do whatever the fuck he wants and order whatever the fuck medications he needs."