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People have stopped going to the doctor and most seem fine

nytimes.com

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Re: People have stopped going to the doctor and most seem fine

#21

Post by robbiep »

Icathian wrote: post #3

This article seems to suggest that because no spike in short-term ailments due to lower frequency of care has been observed in a 5-month span, there is no damage to the quality of our society's physical health overall. That seems incredibly myopic to me. The real question is whether there there will be statistically detectable increases in severity or prevalence of chronic or emergent ailments in the long run. How ma…

I agree the longer term studies are going to be fascinating.

Anecdotally, in Australia (where I work/practice and have many colleagues completing their specialist training currently) presentations for chest pain and total heart attack presentations are down significantly. No studies yet. Will be interesting to see if we will see deferred cases present later and with greater morbidity or just what the hell is going on, but my incoming assumption would have been that heart attacks would be something that someone is going to present with anyway.

As an example of how COVID has changed our approach in hospital, telehealth clinics are now replacing many outpatient visits (your other commenter below hits on the wastefulness of this). 10 years of IT change came to healthcare in about 2 weeks. It’s been wild.

It’s also caused us to get much more efficient with referrals. My colleague is a Plastics resident and had to trim his 500 patient referral list into must see and defer piles. He trimmed it to 100 by ensuring that, for instance, skin cancer referrals had tissue diagnoses before coming into clinic to be booked for surgery (something that the GPs should have done anyway) - so everyone is being forced to polish up their referral pathways and pull their weight along the healthcare chain, rather than what I often witness which is everyone just picking up slack wherever it lands.

Will be interesting to see how far this holds as life returns to normal here

Re: People have stopped going to the doctor and most seem fine

#24

Post by op03 »

Not leaving home much probably minimizes exposure to all the usual threats.

Reminds me of my grandaunt who rarely left the house after the death of her husband. But she was very active, and had family members around to help out. She was quite healthy till the end and outlived her siblings/peer group by a big margin.

Re: People have stopped going to the doctor and most seem fine

#25

Post by tetromino_ »

eyerony wrote: post #7

If I could get antibiotics for strep or sinus infections without going to them, I'd pretty much never go. Those visits are really dumb because I already know what's wrong, and just need them to say "yep, it's the thing you already knew it was, here's a prescription and a bill for doing nothing useful" ... actually on reflection already knowing what's wrong and just needing a doctor to say it so treatment can proceed…

Counterexample from recent personal experience: I developed pain in my hand which made it difficult to type. Some googling revealed that my set of symptoms could be caused by 3 rather different underlying causes requiring very different treatments. Failing to treat the correct underlying cause could permanently damage my ability to use my hand, and thus my ability to earn a living.

I _needed_ to go to a physician for a preliminary assessment and then needed to get an X-ray, and have the X-ray interpreted by a professional, to know how to proceed.

Unless you somehow have built a medical lab in your basement with instruments and reagents to do bloodwork, take X-rays, etc., doctor visits are occasionally absolutely needed.

Re: People have stopped going to the doctor and most seem fine

#26

Post by ianleeclark »

The more I think about the healthcare problem in the United States, the more it appears to be a Gordian knot.

The author doesn't explicitly call for any policy proposal, rather he wishes some medically informed patient into existence. This effectively turns the doctor-patient relationship on its head, but, unfortunately, it seems reasonable to do so, given the opioid epidemic. I don't want to have to know as much as my doctor, I just want them to tell me how to fix it, and I am willing to bet most people largely feel the same.

On the other hand, I can hardly imagine that decreased consumption of healthcare isn't going to cause corporations to recoup lost profits elsewhere, so I'm not sure if the long-run is particularly different from the author's suggestion.

In short: indecision.

Re: People have stopped going to the doctor and most seem fine

#27

Post by throwaway_jobs »

alistairSH wrote: post #16
Icathian wrote: post #3

This article seems to suggest that because no spike in short-term ailments due to lower frequency of care has been observed in a 5-month span, there is no damage to the quality of our society's physical health overall. That seems incredibly myopic to me. The real question is whether there there will be statistically detectable increases in severity or prevalence of chronic or emergent ailments in the long run. How ma…

In my mind, the missed cancers could be a problem. But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5%…

> Those appointments should only occur if there's an issue that requires new dosing or a change of medication.

But isn’t that a little bit of Monday morning quarter backing? In other words how does a doctor know if a therapy/Rx needs to be modified for a chronic condition without a doctor visit and in many cases blood work?

In fact a 6 month therapy for a chronic condition would suggest The doctor has extreme confidence in the patient to adhere to their therapies...statistically about 1M hospitalizations occur in the US per year (Coating billions) because of lack of medication adherence (and these are only those cases resulting in hospitalization), how many more simply result in a sicker patient without a hospitalization event?

Re: People have stopped going to the doctor and most seem fine

#28

Post by silveroriole »

“Only” 1 in 10 respondents said their health had worsened due to delayed treatment? That seems really high to me! There’s a very obvious ulterior motive we could ascribe to papers publishing anti-healthcare pieces.

e: and note this is only people whose health WORSENED. People like me who have a condition which has stayed the same, but have not been able to receive further tests and treatment, are not accounted for in that figure.

Re: People have stopped going to the doctor and most seem fine

#29

Post by bjarneh »

throwaway_USD wrote: post #10

This is like a cruel joke...its like saying if you are not diagnosed with a disease you don't have it. All anyone need to look at is the incidences of people getting a chronic condition as soon become medicare eligible. Its like magic people are healthy, then they receive Medicare and they get chronic conditions...no they had the chronic condition they just weren't diagnosed and treated until Medicare eligible. Medic…

> .its like saying if you are not diagnosed with a disease you don't have it.

But most "seem fine" :-)

Re: People have stopped going to the doctor and most seem fine

#30

Post by wincy »

alistairSH wrote: post #16
Icathian wrote: post #3

This article seems to suggest that because no spike in short-term ailments due to lower frequency of care has been observed in a 5-month span, there is no damage to the quality of our society's physical health overall. That seems incredibly myopic to me. The real question is whether there there will be statistically detectable increases in severity or prevalence of chronic or emergent ailments in the long run. How ma…

In my mind, the missed cancers could be a problem. But, there's a lot of "health care" that doesn't really need to happen. A few of my family members have chronic health issues that require medication. These are typically prescribed 6-months at a time, requiring in-person bi-annual follow-ups. That's a waste of both parties time - patient and doctor - as 95% of the time, the result is "here's another 6 months" and 5%…

I recently started paying for Direct Primary Care. We signed up as seeing a doctor during COVID became even more difficult than usual. It’s definitely a luxury but I pay $100 a month and my wife and I can bug our respective doctors (she has a woman doctor that will only accept women and children patients; my male doctor only accepts male patients) whenever we want. Obviously we try not to bug them all the time and be respectful, but I’m seeing weird spots at 7pm; text my doctor he says don’t worry about it. I’m kind of a hypochondriac — this saves me a trip to the ER. I say I’m pretty sure I have a sinus infection, and the symptoms are similar to one I had last year. He wrote me a prescription for antibiotics, tells me to let him know if it doesn’t clear up.

It feels how I’d expect modern medicine to feel, rather than everything being set up to gatekeep me from interacting with the doctor in any way except for fifteen minutes after paying $150 for the pleasure. The doctor has an incentive to keep us healthy because we’re not paying by the visit anymore.

I love love the direct primary care approach and wish I’d started paying for it sooner.

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