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Physicians’ attitudes about caring for people with disabilities

healthaffairs.org

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Re: Physicians’ attitudes about caring for people with disabilities

#101

Post by sen »

candiddevmike wrote: post #13
ad404b8a372f2b9 wrote: post #9

A 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’m physically disabled and have various mental issues (ASD, ADHD, Bipolar, and some other minor things, all diagnosed).

In Australia I find our medical system to be incredibly supportive of disabled people as long as you don’t go to the “bottom of the barrel” doctors (eg local big medical centres). Those places are purely set up to churn people through for sickie notes or basic scripts. Every town has “family practice” GPs and even with me having moved all over the country I’ve always found them to be very accomodating.

Almost any appointment can be done over the phone or Telehealth (government video conference system) if I don’t feel I can make it in that day. Scripts can also be done like that then SMSed to my phone, or emailed direct to my local pharmacy who drop the medications off same day for free (paid by government). If I do have to go in physically to an appointment, they always have my full medical record thanks to our MyGov system and have a tl;dr on the screen when I go in, so I’m not wasting time going over everything again and again (which is how it worked before MyGov).

Overall I love our medical system. It’s absolutely not perfect but I’ve lived overseas in a few places and despite loving the idea of living overseas again (and having various serious issues with other aspects of this country) I stay here purely for the medical support I get with my conditions.

Re: Physicians’ attitudes about caring for people with disabilities

#102

Post by bombcar »

chromatin wrote: post #62
logicalmonster wrote: post #2

Could 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…

Yes, since ADA mandates that accommodations must be provided at no cost to the patient (an unfunded mandate). Here is a tidbit from the article: 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 of…

This is the problem - people reduce "ADA mandates" to "lol you had to install a ramp or elevator" but it's much more than that.

As a society we need to provide for those who are disabled, but we need more than just "lol pay for it" as a method. From one point of view a sign-language interpreter for someone who is deaf and cannot read is entirely a "reasonable accommodation" and from another (losing money on the transaction) it is not.

While there's no guarantee that every customer is "profitable" we should work to make sure that the "disabled" aren't always in that group. For example, the ramp is a one time cost and amortized over all customers forever, and so it's not noticed much. But the interpreter was - because there is nothing that disconnects the cost from the service. If instead there was a city-wide pool of translators and interpreters that can be summoned/scheduled, and the pool was paid for by a tax/fee across all interactions, then it would barely be noticed, and those who have to use it wouldn't feel like they got cheated.

Re: Physicians’ attitudes about caring for people with disabilities

#103

Post by somehnguy »

Calavar wrote: post #95
amalcon wrote: post #87

Earlier quoted context omitted.

For medication like this, the doctor will usually prescribe a specific number of pills at a specific dosage. The number will rarely exceed what you ask for, and asking for large numbers of pills is treated (not unreasonably) as a sign of drug seeking.

This is true in general, but as a doctor, I've never written a prescription for only 3 Xanax pills. Usually more like 10 to 30 depending on the situation. The only time I write for a single digit number of pills is for antibiotics, where I know ahead of time exactly how many pills they will need.

Anecdotally I’ve received a script for exactly 3 Xanax pills. The eye surgeon prescribed them for my LASIK surgery.

Re: Physicians’ attitudes about caring for people with disabilities

#104

Post by bombcar »

ad404b8a372f2b9 wrote: post #25
candiddevmike wrote: post #13

Earlier quoted context omitted.

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 eq…

> 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.

Isn't that when you fly to the Mayo Clinic and throw money at the silly Americans?

Re: Physicians’ attitudes about caring for people with disabilities

#105

Post by colechristensen »

lotsofpulp wrote: post #83
johannbok wrote: post #82

Earlier quoted context omitted.

That's right, only there is no normal physician visit that bills $1300. The absolute highest reimbursement you're gonna get for an outpatient visit - a level 5 evaluation and management first-time patient visit plus double-coding an 'prolonged visit for high complexity care' (some handful of insurers allow triple-coding a G2212) - (a 99205 + G2212 x 2) is 244.99 + something like $30 (I don't recall the G2212 reimburs…

I did not intend to claim that the doctor got paid $1,300 for a consultation (that person wrote they received lab work too). I was clarifying what arkades claimed, which I interpreted as the EOB does not state the true remuneration for the healthcare provider.

Every EOB I’ve ever seen includes both the fantasy number (that no one ever pays or is charged) and the discount negotiated rate which is what the provider actually gets paid including your portion and the insurance paid portion.

Re: Physicians’ attitudes about caring for people with disabilities

#106

Post by bombcar »

caddemon wrote: post #23
jt2190 wrote: post #8

From 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…

When you work out "who is responsible for mistakes" you start to realize why doctors wouldn't even want to delegate tasks.

Re: Physicians’ attitudes about caring for people with disabilities

#107

Post by bombcar »

bradleyjg wrote: post #94

Our entire framework of accommodation is a mistake. If we wish for people—disabled, pregnant, whatever—to be subsidized we should collectively bear the costs. We shouldn’t insist that whoever they randomly come across be forced to eat those costs. That’s both unjust and a recipe for resentment, reluctant service, and hidden avoidance.

Some of the costs are "universal" (such as requiring all commercial buildings have wheelchair ramps) and so don't need to be "funded". Other costs are not universal and only appear when serving a customer/patient/person with the condition.

And we already handle the worst cases (where someone is disabled such that they need round-the-clock assistance, the state will hire said assistant; everyone expects Walmart to provide a handicap stall, nobody expects Walmart to change someone's diaper), so why not handle more?

Re: Physicians’ attitudes about caring for people with disabilities

#108

Post by bombcar »

trh0awayman wrote: post #85

One low-hanging fruit to help the medical system is to replace/supplement GPs. GPs just route to a specialist, with some treatment short-circuits along the way. Sometimes you are forced through this pipeline for insurance reasons. There's a shortage of these doctors, at least in the US. Create what WebMd should be: an actual working expert system. Take some modern medical textbooks and create a basic expert system. Y…

The idea behind a GP is supposed to be someone who knows you and your history, and can help recommend care, but they've been forced to become gatekeepers for the insurance system to reduce specialist use. The incentives are all sorts of misaligned.

Re: Physicians’ attitudes about caring for people with disabilities

#109

Post by bombcar »

marcinzm wrote: post #51

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 alre…

This applies for many things in general, if the only negative reviews are about wait times, you probably have a winner on your hands.

Re: Physicians’ attitudes about caring for people with disabilities

#110

Post by bombcar »

lotsofpulp wrote: post #69
hn_throwaway_99 wrote: post #35

Earlier quoted context omitted.

This was the thing that was so baffling to me about this study. I read the interview quotes, but then was baffled by the study's conclusion where they focused on things like "attitudes" and "structural barriers" (I kinda hate that term because it's easily interpreted in different ways). Meanwhile I'm screaming "Duh, it's money!". Meaning that: 1. The study, for some reason seems reluctant to come out and say "treatin…

>2. Thus, in a private care system where reimbursements aren't changed for treating people with disabilities, there are tons of embedded incentives to not want to deal with those with disabilities. >The only was to get rid of these unwanted incentives is to fundamentally change the for-profit nature of American health care. Good luck with that. As I understand, in the US, it is often the government itself that is not…

Yeah, there's a simple and probably not that expensive solution - anyone who is disabled (define it by SDI or whatever) automatically triggers an $X payment direct to the doctor/facility/hospital whenever they interact with them. Adjust X to be moderately above the costs.

Suddenly all the normies would be on the outside looking in as the doctors would be fighting over the disabled patients.

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