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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

#121

Post by octokatt »

Dove wrote: post #118
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…

Dude, you need direct primary care. When you pay the bills and no one else is involved, the doctor works for YOU. It's a profound difference, and one that it sounds like you need more than most. https://www.dpcare.org/ is a good place to start, but I guarantee there's direct primary in your city - just google for it.

This sounds good, but I have health insurance to cover for catastrophic health failure, which is very probable for me.

I'd need to pay for both direct primary care and health insurance, and primary care payments wouldn't count towards my deductible.

This is a situation without fast solutions.

Re: Physicians’ attitudes about caring for people with disabilities

#122

Post by fzeroracer »

Test0129 wrote: post #12
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…

The ADA is a definitely a case of great idea, terrible execution. Unfortunately, doctors (and really businesses in general) are forced into a no-win situation where as you stated you either comply in the fullest legally, or face a potential customer looking for a reason to sink your business. Where I live, the ADA is also responsible for some of the large increase in home prices over the last 20 years. I wish it diff…

> Where I live, the ADA is also responsible for some of the large increase in home prices over the last 20 years.

Where exactly are you getting this from?

Re: Physicians’ attitudes about caring for people with disabilities

#123

Post by throwing_away »

tux3 wrote: post #96
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.

>and asking for large numbers of pills is treated (not unreasonably) as a sign of drug seeking. Something that keeps tripping me up with the label of drug seeking, is that in this situation the person is correctly drug seeking in a situation they've previously had a specific problem diagnosed and have had positive experiences with a therapeutic. They simply need to subject themselves to the ritual, follow doctor's or…

> the person is correctly drug seeking in a situation they've previously had a specific problem diagnosed and have had positive experiences with a therapeutic

I've been in this situation a few times as I've moved around the US for both xanax (as needed) and adderall (daily) concurrently.

The short of it is this: you just have to find the right clinician.

Because of how the system works, you're not limited to psychiatrists. Pretty much anyone with a prescription pad can dispense these in month-sized quantities (primary care, psychiatrists, prescribing nurses, even dentists).

Call providers and tell them explicitly what prescription you need and that you're having trouble finding a doctor to work with you and it's frustrating. A lot of them will say "oh, this practice isn't what you're looking for" and eventually you'll find one that says yes.

Try to think of it as "patient advocacy" instead of "drug seeking behavior" while you're having conversations with professionals.

Re: Physicians’ attitudes about caring for people with disabilities

#124

Post by mianos »

sen wrote: post #101
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?

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 practi…

Keep in mind, if you follow economics, there is not enough money produced by working people to fund the growth of Medicare and NDIS. Not tax, even if they taxed everyone much much more, there will still not be enough money by 2027.

Re: Physicians’ attitudes about caring for people with disabilities

#125

Post by throwing_away »

somehnguy wrote: post #103
Calavar wrote: post #95

Earlier quoted context omitted.

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.

This is also common for dentists and other outpatient procedures.

Re: Physicians’ attitudes about caring for people with disabilities

#126

Post by sterlind »

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.

Are you on team "collectively bear the costs" or team "remove accomodations?" Because one of the two parties always looks to cut government spending, and most voters don't care about the disabled. I'd vote for government rebates for accessible construction and services, but if you got rid of the mandate there'd be no accountability left, and the rebate program would get axed the next time Republicans want to pass a tax cut.

There is so much apathy towards the disabled. I had to take a lift to exit a parking garage in my wheelchair, which needed an attendant key. I called the number listed and the lady just told me "oh, it's broken, find another garage." But it wasn't broken. She just didn't want to come over and unlock the elevator for me. Her coworker finally helped me though, after much pleading.

Re: Physicians’ attitudes about caring for people with disabilities

#127

Post by bradleyjg »

sterlind wrote: post #126
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.

Are you on team "collectively bear the costs" or team "remove accomodations?" Because one of the two parties always looks to cut government spending, and most voters don't care about the disabled. I'd vote for government rebates for accessible construction and services, but if you got rid of the mandate there'd be no accountability left, and the rebate program would get axed the next time Republicans want to pass a t…

I’ll be honest and say it depends. But for many things I am on team bear the costs collectively. I do want people in wheelchairs to be able to participate fully in the life of the nation.

I think the apathy you see is, in part, because companies are being forced to bear the cost. If every time you used a garage, the company got a check I think you’d see a different attitude.

Re: Physicians’ attitudes about caring for people with disabilities

#128

Post by [deleted] »

zen_1 wrote: post #53
knaekhoved wrote: post #37

Earlier quoted context omitted.

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...

[deleted]

Re: Physicians’ attitudes about caring for people with disabilities

#129

Post by Gibbon1 »

Buttons840 wrote: post #120
parkerhiggins wrote: post #18

Earlier 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.

I worked at a company that did background checks on doctors. Part of that involved involved checking doctors licenses in all 50 states, which all do things a little differently. I was paid 6 figures a year to help automate this, and this company had a few hundred other employees who would make calls and do other things to support that. It was all very expensive and could have gone away if only there were some standar…

> Sadly, making healthcare cheaper will involve pushing a lot of these people out of the industry

As someone 20 years into a chronic condition who has to deal with this mess constantly. We'd be ahead if we paid those people to stay home and drink themselves to death. Because it's not just the money it's also the interference in care. That sounds harsh but above and beyond the stress they are actually killing people.

Re: Physicians’ attitudes about caring for people with disabilities

#130

Post by ravenstine »

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…

How about maybe we decide we don't need people to slave away in medical school for a decade and go through residency in order for them to diagnose and treat patients? Is anyone stopping to think that the way we become doctors might be very stupid? We don't necessarily need tech to solve this problem.
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