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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

#131

Post by ad404b8a372f2b9 »

bombcar wrote: post #104
ad404b8a372f2b9 wrote: post #25

Earlier quoted context omitted.

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?

Can't fly if you're bed-ridden.

Re: Physicians’ attitudes about caring for people with disabilities

#132

Post by intelVISA »

throwing_away wrote: post #123
tux3 wrote: post #96

Earlier quoted context omitted.

>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 psychiat…

> both xanax (as needed) and adderall (daily) concurrently.

I'm not a doc but something about that combo activates my fear response... how would that even work?

Re: Physicians’ attitudes about caring for people with disabilities

#133

Post by pkaye »

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…

The tests can be ordered though a few online services. You pick the lab test, a doctor rubberstamps it and then go to Quest or LabCorp to get the blood draw. A few days later they send you the results. I don't think you can bill the insurer but the costs are not always that expensive for some of the common tests.

Re: Physicians’ attitudes about caring for people with disabilities

#135

Post by throwing_away »

intelVISA wrote: post #132
throwing_away wrote: post #123

Earlier quoted context omitted.

> 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 psychiat…

> both xanax (as needed) and adderall (daily) concurrently. I'm not a doc but something about that combo activates my fear response... how would that even work?

I take adderall most weekdays because I need to be reliable and on a schedule for work, but I usually take weekends off.

I take xanax when I have to go do something that causes me a lot of anxiety but is required (family function, some doctor appointments, etc) and to mitigate panic attacks when I feel them starting (which thankfully hasn't happened in a long time). But I'm not usually on adderall for those events, so there's not much overlap for interaction.

I spent way too many years pretending everything was fine when my head was spinning with anxiety or when I couldn't get motivated for work. Eventually I just sorted out what drugs modulated me successfully, realized that I don't have an addiction problem, and now I've got a system for managing my life better.

Re: Physicians’ attitudes about caring for people with disabilities

#136

Post by gizmo686 »

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…

Do you have a regular doctor?

I'm in a simmilar situation and need a dose of Lorazepam about once or twice a year. However, I've never had the problem you describe. The first time I spoke to my primary care physician about this, we had a discussion about my options and I left the consultation with a prescription for a rather large dose of Lorazepam [0].

Since then, I've just called her office whenever I needed another dose, and told the receptionist that I was previously prescribed Lorazepam for X, and I need another dose because I will be doing X again. A couple of times, I also asked the receptionist to ask the doctor to lower the dose. I've never had any problem with this. I don't think my doctor has even asked to talk to me at all before putting in the prescription. (Although we have spoken about unrelated medical issues).

I assume that she just looked at my file; confirmed that she previously prescribed it and that I wasn't asking for it too frequently, then rubber stamped a new prescription.

On one occasion, I was speaking to a specialist (again, for an unrelated medical concern), and asked her for a prescription, because I happened to know I would be needing one soon. She glanced through my file and wrote the prescription without complaint.

I don't know what is going on behind the scenes, but I think what is happening is that I have a regular doctors office through which I coordinate all of my care. This means that whenever I speak with a doctor, they have a file on me that says "patient prescribed Lorazepam for X", so doctors seem willing to repeated what they have documentation about having worked before.

[0] Enough that she suggested I use a wheel-chair after taking it.

Re: Physicians’ attitudes about caring for people with disabilities

#138

Post by trh0awayman »

ravenstine wrote: post #130
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.

Of course the whole system of becoming a doctor is screwed up (especially the match), but the chances that it will get fixed seem slim. I don't think we need tech to solve the problem in general - I think we need tech to solve the problem today.

Re: Physicians’ attitudes about caring for people with disabilities

#139

Post by LorenPechtel »

johannbok wrote: post #77
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.

This is partly true. In no small part because they tend to control the bulk (or all) of our patient supply. In part because people have gotten the idea that insurance equals care, and vice versa - so people tend not to think about high-impact moments where it pays to go cash. For instance, I specialize in neuromodulation for highly-treatment-resistance psychiatry. I'm very good at what I do; my mentor is (IMO) better…

How do you find these top people?

Re: Physicians’ attitudes about caring for people with disabilities

#140

Post by intelVISA »

throwing_away wrote: post #135
intelVISA wrote: post #132

Earlier quoted context omitted.

> both xanax (as needed) and adderall (daily) concurrently. I'm not a doc but something about that combo activates my fear response... how would that even work?

I take adderall most weekdays because I need to be reliable and on a schedule for work, but I usually take weekends off. I take xanax when I have to go do something that causes me a lot of anxiety but is required (family function, some doctor appointments, etc) and to mitigate panic attacks when I feel them starting (which thankfully hasn't happened in a long time). But I'm not usually on adderall for those events, s…

Ah okay, that makes a lot more sense than when I read concurrent as 'together'. Glad you figured yourself out and I can imagine that must be a drag to keep organized at the doc... reform is definitely needed there.
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