Earlier quoted context omitted.
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…
Who is the top rheumatologist? Who would you recommend? My mother is in constant pain and has gone to a dozen different specialists. We are near Chicago, but I am happy to take her anywhere in the country.
Physicians’ attitudes about caring for people with disabilities
141–148 of 148 posts
Re: Physicians’ attitudes about caring for people with disabilities
#142Earlier quoted context omitted.
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?
It's not always a guaranteed correct answer - I know for a fact of some people at absolutely top ranked institutions, with top pedigrees, who clearly got there by academic skills and are absolute shit as clinicians - but for the most part, it'll get you where you need to go. Generally the only way you'll end up with one of those shiny pieces of shit is if referred to them strictly by reputation; no one that's worked with them would make that referral.
It's also an answer likely to overlook excellent clinicians - many (many!, maybe most) very good clinicians aren't academics, and this won't route you to them. But you're okay with overlooking excellent docs, as long as you end up at a top doc.
Finding excellent doctors without shiny pedigrees is not something a layman can do. It's just something that local docs eventually come to know about other docs in their social-professional network, and by no means is it an unbiased assessment.
If all you have available is people's online CVs, look strongly at people with mediocre or shitty medical schools and highly prestigious residencies and fellowships. Those are people who had networking and social signaling working actively against them, and managed to positively impress everyone they worked with. E.g., a buddy of mine got into a shit medical school, and got one of the country's most prestigious subspecialties in a prestigious institution. He had to impress every single person he worked with, had to do surpass everyone on his standardized exams, and otherwise be top-of-the-top in every way. He's a ridiculously top-notch doc.
Re: Physicians’ attitudes about caring for people with disabilities
#143Earlier quoted context omitted.
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…
Many people do not realize how cheap it can be to do direct-consultations; and it can't hurt to ask. Even a doctor pulling down $1m a year is only about $500 an hour, and that could be entirely worth it to get their time and dedicated.
The office manager may not be able to accommodate you, but if it can be done, they're the ones with the authority and autonomy to make it happen.
Re: Physicians’ attitudes about caring for people with disabilities
#144Earlier 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...
Re: Physicians’ attitudes about caring for people with disabilities
#145N=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 intere…
Re: Physicians’ attitudes about caring for people with disabilities
#146Earlier quoted context omitted.
That's false, but why let the truth get in the way? The limitation on doctors in the U.S. is based on the available funding for residents. The government supplies the money because private institutions largely are unwilling to do so.
Is it true that unsubsidized residencies would not be profitable? If so, I would not expect private institutions to opt to lose money. https://www.reddit.com/r/medicine/comments/a0pufi/comment/ea...
Re: Physicians’ attitudes about caring for people with disabilities
#147Earlier quoted context omitted.
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 intere…
This issue is at least somewhat perceptual. If you have to charge everyone the same, but some patients cost more, then you raise the prices to account for the fluctuation and the other patients subsidize the more costly one. If, instead, the extra cost were covered by a tax rebate or something, then the cost is still subsidized to the other patients. Effectively, it isn't any different, it's just a matter of accounti…
Re: Physicians’ attitudes about caring for people with disabilities
#148Earlier quoted context omitted.
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.
It is not a requirement of medical care that it be effectively free. You can choose to pay for it! Direct primary is generally quite affordable and worth it, particularly if the regular system is not working for you. The services I have subscribed to over the last fifteen years have generally been in the neighborhood of $60/mo for an adult, and they tend to pay for themselves quite quickly -- once or twice a year, I have some sort of debilitating problem, and a doctor who knows me and cares about me resolves the issue in a matter of hours. Compared to waiting weeks for a non-solution, that's a bargain! Some people make up the fee just in the money they save on prescriptions. Seriously look into it.