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A fourth of U.S. health visits now delivered by non-physicians

hms.harvard.edu

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Re: A fourth of U.S. health visits now delivered by non-physicians

#121

Post by vrc »

OldGuyInTheClub wrote: post #55
outlace wrote: post #28

MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…

The current choices are 1) Uniterested, slapdash care from an MD with 12+ years of training and no ability to listen or empathize but eager to make the money s/he went into medicine to make 2) The same from an assistant of some kind who uses ever-degrading search engines to look up not-your-problem and give you potentially dangerous suggestions The future will undoubtedly be worse. As someone mentioned below, we'll p…

1) isn’t being entirely fair. MDs or any other practitioner are generally restricted by what they can bill insurance since only a minority of patients opt for concierge care. So if insurance allows for “X minutes for Y service”, that’s what they generally do in most “eat what you kill” practices (which is most). Some will go above and beyond, but that’s to their detriment. Insurance billing generally makes care “billability”-centric.

Re: A fourth of U.S. health visits now delivered by non-physicians

#122

Post by sneak »

outlace wrote: post #28

MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…

Fact: babies not born in hospitals are 2x more likely to die during childbirth.

Brings the rest of the equation into focus, at least for me.

Re: A fourth of U.S. health visits now delivered by non-physicians

#123

Post by smcin »

foolish79 wrote: post #10
fnfjfkdngh wrote: post #5

Because PA time is cheaper to the provider than MD time. Give it a few years and a trip to the doctor's office will mean using a touch screen a-la-mcdonalds to describe your symptoms and then the first-line medication pops out of a drawer. I'm pretty jaded with our (US) healthcare system. As long as you stay on the happy path it's fine, but if you stray from that, good luck. Over the last few years I was given antibi…

[flagged]

To keep it constructive, please explain why systemic fungal infections is not likely to be the cause, and what coule be the cause.

Re: A fourth of U.S. health visits now delivered by non-physicians

#124

Post by lukevp »

pen2l wrote: post #71
FireBeyond wrote: post #60

Earlier quoted context omitted.

Having worked in healthcare IT, and as a prehospital provider who has seen and interacted with many EHR systems, including Epic, Meditech, and ESO (moreso for prehospital)... the sooner Epic dies in a fire the better. Keyword-driven differentials should be, if anything, the baseline, bottom rung, pattern matching to inspire and drive critical thinking, focused assessment, and diagnostic skills. Not to "easy mode" the…

Epic very much is poised to take over and every week it appears a new large healthcare center makes the switch to it. I think the hard lesson everyone must learn eventually is that they have to take control of/become deeply involved with their healthcare as much as possible, because dragons are everywhere. For the average person acute care is not needed when they're thinking of reaching out to the doctor, and they sh…

Can you really just download epic? Like it’s free? I thought it was super specialized and you had to have some kind of business relationship to get access to it. I tried to find it online but didn’t see anything.

Re: A fourth of U.S. health visits now delivered by non-physicians

#125

Post by Danjoe4 »

ngngngng wrote: post #64
outlace wrote: post #28

MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…

> On the other hand, a lot of what I do doesn't require 12 years of training What, besides surgery, really requires 12 years of training? I've found I have a greater success rate with self diagnosis and treatment than I have with seeing my physician, and I've found a very good internist. An hour spent with ChatGPT and Google and I always find a couple options that fit what I'm experiencing as well as detailed descrip…

What, is that you likely have an IQ ~2 standard deviations above average. Most doctors are similarly intelligent. While he/she possesses more medical domain knowledge, you are able to problem solve with similar accuracy with a little research. Most people do not possess the domain knowledge nor the problem-solving ability.

Re: A fourth of U.S. health visits now delivered by non-physicians

#126

Post by jjtheblunt »

outlace wrote: post #28

MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…

I wonder if MDs realize that engineering and math can easily be longer schooling, without being paid like an MD that last four.

Re: A fourth of U.S. health visits now delivered by non-physicians

#127

Post by HDThoreaun »

ejb999 wrote: post #84
hx8 wrote: post #44

Earlier quoted context omitted.

> Not sure what line of work you are in, but are you willing to answer endless emails and or voice mails from customers, all for free? It's common practice to answer emails and take calls from customers and not charge them for it in many industries. If you have 3000 patients, and you spend 3 minutes/patient/year on these interactions, then you spend ~30 minutes a day answering emails or leaving voice mails which is p…

No way a typical question takes 3 minutes to answer; just by time you read the message, pull up the chart, read the chart, make the call, talk with the patient and then document the outcome of the call back into the chart, you are in it for 15 minutes at least … not to mention the context-switching time you need as you move from one task to the next. And I disagree that it is ‘common’ in other industries - ever try t…

Doctors do entire appointments in 10-15 minutes. I think they can rip through messages sub 3 minutes.

Re: A fourth of U.S. health visits now delivered by non-physicians

#128

Post by bitcurious »

SOLAR_FIELDS wrote: post #70
ngngngng wrote: post #64

Earlier quoted context omitted.

> On the other hand, a lot of what I do doesn't require 12 years of training What, besides surgery, really requires 12 years of training? I've found I have a greater success rate with self diagnosis and treatment than I have with seeing my physician, and I've found a very good internist. An hour spent with ChatGPT and Google and I always find a couple options that fit what I'm experiencing as well as detailed descrip…

A recent occurrence I will share related to this was having to convince my doctor that I had Lyme disease. I Googled the symptoms, saw the trademark bullseye, and of course concluded that I had Lyme disease. It was right where I got the tick bite, 8 weeks later. My doctor refused to believe me. He told me to see a dermatologist about it, thinking it was some skin rash, even though it was exactly where the tick had bi…

It’s intuitive that a patient who can spend an order of magnitude more time on his self care, and can self-articulate their symptoms, can occasionally self-diagnose better than a doctor. It’s not intuitive that a clinician with 4 years training and the same 30 minute window to diagnose you would do better than a physician with 12 years training.

Re: A fourth of U.S. health visits now delivered by non-physicians

#129

Post by OldGuyInTheClub »

vrc wrote: post #121
OldGuyInTheClub wrote: post #55

Earlier quoted context omitted.

The current choices are 1) Uniterested, slapdash care from an MD with 12+ years of training and no ability to listen or empathize but eager to make the money s/he went into medicine to make 2) The same from an assistant of some kind who uses ever-degrading search engines to look up not-your-problem and give you potentially dangerous suggestions The future will undoubtedly be worse. As someone mentioned below, we'll p…

1) isn’t being entirely fair. MDs or any other practitioner are generally restricted by what they can bill insurance since only a minority of patients opt for concierge care. So if insurance allows for “X minutes for Y service”, that’s what they generally do in most “eat what you kill” practices (which is most). Some will go above and beyond, but that’s to their detriment. Insurance billing generally makes care “bill…

Believe it or not, I tried concierge care. Pretty much the same thing only with a big "cover charge" and a lot of gorilla juice about personalized attention. Left after three months - initial comprehensive exam where the practice owner/doctor was distracted by multiple phone calls and a student he was teaching on my time. I was telling him about my bad Achilles tendon which he proceeded to whack when the reflex test on my knee didn't go the way he expected. The pain was excruciating and when I found my voice, I let him have it.

He was late to the followup, couldn't explain the results his machines had given him, and then rushed me out after the usual 10 minutes.

I think family practice/primary care is on the ropes. The big lie is that some doctor will "get to know you as an individual." Reality is that s/he's given a quota and time limits by some MBA and the Epic system will make damn sure that the doctor does not use any initiative in solving the patient's problem.

I am still at the point where I can prepare and advocate for myself. When that goes, it'll be curtains.

Re: A fourth of U.S. health visits now delivered by non-physicians

#130

Post by Pigalowda »

NonAnonCoward wrote: post #104

Perhaps I’m just getting crap doctors but I’ve had so many bad experiences even with specialists that it seems nearly impossible to get help with anything past super basic issues. Over a year ago I had a dive related injury to my ear and I can’t get any help past “everything looks great” from any ENT. For context I can barely stand to be in many social situations without earplugs in one ear because I’m hearing some f…

ENT aren’t a bunch of dummies.

What tests did you get? Only thing I can think of when you say “everything looks great” is an otoscope exam.

But if they did audiometry, CT temporal bones, MRI IAC and those are normal? Then those are tough breaks because they can’t fix a problem they can’t see.

Only thing I can think of is maybe a subtle/occult ossicular chain disruption. Is there a little incudomalleal diastases?

Anyways I give up that’ll be $500 see ya

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