Physicians’ attitudes about caring for people with disabilities • Hacker News Board

Re: Physicians’ attitudes about caring for people with disabilities

#51

Post by marcinzm » Sun, Oct 30, 2022, 3:30 PM UTC

My partner has a number of chronic medical conditions. In general dealing with doctors is a pain for various already cited reasons. One advantage of the American system is that, with the right insurance, you can book almost any specialist with no gate keeping. We've eventually found a few very helpful doctors who spend a lot of time with their patients. The general things that tie them together:

- Older (40+) so already made money and paid off their medical school loans.

- Their own small practice rather than part of a larger medical system or having partners.

- Negative reviews about long waiting times. If a patient needs more time then they spend it but that does make other patients have to wait.

Covid has been very helpful as more routine visits can now be done over the phone rather than having to go somewhere.

Re: Physicians’ attitudes about caring for people with disabilities

#52

Post by ad404b8a372f2b9 » Sun, Oct 30, 2022, 3:31 PM UTC

lotsofpulp wrote: post #29

Test0129 wrote: post #20

Earlier quoted context omitted.

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 f…

This is entirely ineffective, in fact that's what the government does in many countries including the U.S.

You cannot address the second-order effects of the lack of accessibility by throwing pennies at disabled people, unless you want to write them million dollar cheques. The problem can only be solved by giving them equal access to healthcare, education, employment and society in general, when you do this you allow them to become productive members of society who are self-sufficient. Giving someone a 1000$ in welfare every month is not going to help when they were prevented from going to school, finding a job, and getting out of their house at all.

Re: Physicians’ attitudes about caring for people with disabilities

#53

Post by zen_1 » Sun, Oct 30, 2022, 3:32 PM UTC

knaekhoved wrote: post #37

thepasswordis wrote: post #30

I 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 re…

You can order xanax on the darkweb, FYI. I mostly agree with you - the problem is that doctors are trained to deal with the lowest common denominator of patient: an addictive idiot who would kill themselves with benzos or opiates, given the chance. 90% of doctors are absolutely not equipped to deal with high-agency, high-intelligence patients. I've had a few doctors that were smart enough to work with me on experimen…

You can also order fentanyl labeled as xanax on the darkweb...

Re: Physicians’ attitudes about caring for people with disabilities

#54

Post by Broken_Hippo » Sun, Oct 30, 2022, 3:32 PM UTC

wholinator2 wrote: post #36

thepasswordis wrote: post #30

I 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 re…

You can just keep the pills. If you're really that strong about avoiding addiction why do you feel the need to throw them away?

I'm not sure where they said they got rid of them to avoid addiction: It is more that they have to convince medical staff that they aren't simply looking to get high but want health instead.

But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect. Plus, a lot of folks don't like to keep stuff they aren't using around the house - it is always a bit of upkeep or storage.

And that doesn't even get into it being safer around children. It is easier to prevent children from getting into such things if they aren't in the house.

FYI: Check with your pharmacy about bringing unused medicine to them to dispose of properly instead of putting it in the trash.

Re: Physicians’ attitudes about caring for people with disabilities

#55

Post by orbital223 » Sun, Oct 30, 2022, 3:34 PM UTC

wholinator2 wrote: post #36

thepasswordis wrote: post #30

I 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 re…

You can just keep the pills. If you're really that strong about avoiding addiction why do you feel the need to throw them away?

Most medicine has expiration dates. If he needs it only every 3-5 years, it's unlikely the pills will still be usable.

Re: Physicians’ attitudes about caring for people with disabilities

#56

Post by zo1 » Sun, Oct 30, 2022, 3:35 PM UTC

kelseyfrog wrote: post #34

lotsofpulp wrote: post #29

Earlier quoted context omitted.

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 f…

How does a disabled person purchase a ramp or handrail for the building they are trying to enter?

They hire someone to carry them? They fund an insurance pool that allows them to dial a handy caretaker within distance when they need it? Maybe it's enough to fund stair-capable wheel chair robots. Who knows. Maybe they just call ahead, check, and then ask a friend or family member to go with them.

Re: Physicians’ attitudes about caring for people with disabilities

#57

Post by [deleted] » Sun, Oct 30, 2022, 3:37 PM UTC

fhsm wrote: post #49

ChrisMarshallNY wrote: post #5

Earlier quoted context omitted.

I believe that you are correct. The doctor's office, as a business, already needs to abide by the ADA. It could be a convenience store, and still have the same requirements.

This is true but really doesn’t capture much of the truth. As a first approximation you can split spaces into licensed and unlicensed spaces. The former are the conventional purview of “private practice”. The latter are the typical purview of “hospitals”. These are in quotes because this is merely a correlation and neither concept has a strict definition. Critically without domain knowledge it’s unlikely you’d be abl…

[deleted]

Re: Physicians’ attitudes about caring for people with disabilities

#58

Post by berberous » Sun, Oct 30, 2022, 3:38 PM UTC

Broken_Hippo wrote: post #54

wholinator2 wrote: post #36

Earlier quoted context omitted.

You can just keep the pills. If you're really that strong about avoiding addiction why do you feel the need to throw them away?

I'm not sure where they said they got rid of them to avoid addiction: It is more that they have to convince medical staff that they aren't simply looking to get high but want health instead. But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect. Plus, a lot of folks don't like to keep stuff they aren't usi…

I am not a doctor or chemist so I do not want to speak definitively, but I highly doubt most common drugs (Xanax, Advil, etc) really lose much efficacy past their expiration date (at least within some reasonable time, like 10-15 years). Happy to be shown evidence otherwise. I wouldn’t rely on this for say, antibiotics to treat an infection, but I wouldn’t hesitate to take a 5 year old Xanax.

Re: Physicians’ attitudes about caring for people with disabilities

#59

Post by csdvrx » Sun, Oct 30, 2022, 3:39 PM UTC

Broken_Hippo wrote: post #54

wholinator2 wrote: post #36

Earlier quoted context omitted.

You can just keep the pills. If you're really that strong about avoiding addiction why do you feel the need to throw them away?

I'm not sure where they said they got rid of them to avoid addiction: It is more that they have to convince medical staff that they aren't simply looking to get high but want health instead. But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect. Plus, a lot of folks don't like to keep stuff they aren't usi…

> But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect.

Evidence required.

Expiration dates are put on many things as a CYA, but I don't expect dry chemicals destined for human (or animal!) use kept in an airtight container protected from the sunlight to degrade within 10 years.

Should they degrade, the question is into what, and how much: 5% degradation into what the human body breaks the chemical into should have no consequence.

> FYI: Check with your pharmacy about bringing unused medicine to them to dispose of properly instead of putting it in the trash.

Or just keep it and use it as needed, solving both of your problems at once!

Re: Physicians’ attitudes about caring for people with disabilities

#60

Post by chromatin » Sun, Oct 30, 2022, 3:40 PM UTC

octokatt wrote: post #11

N=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…

As a sibling commenter notes, it's great that you recognize the real root of this is often not a lack of empathy by physicians, but instead constraints of the system and especially the payors, who are not patients but insurers (or the federal government). Frankly, I'm surprised a small community-based primary care physician practice is even financially tractable in 2022.

This bit from the article was also very interesting to me:

Participants described both financial and time-related challenges of accommodating communication needs. One non-rural-practicing primary care physician stated: “I took it upon myself to actually hire an outside service to do [sign language interpretation]. They billed the office. …Their bill was higher than what we were making, so it was a losing venture. …It cost me $30 per visit for that patient, out of pocket.”