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Why are doctors so hands off and unhelpful in the USA?

I remember when I was a kid, doctors were so interactive and really took time to get to know you and talk to you, learn about what you’re going through and explain things. Now as an adult, it’s been nearly impossible to find a doctor who is willing to take any amount of time to sit down, explain things, show any sort of compassion or empathy at all.

I suffer from acid reflux, and in order to diagnose that, they basically put a tube down your throat, it’s called an endoscopy. You have to be fully sedated with anesthesia and take nearly an entire day off of work because the way the anesthesia affects you, you can’t drive and someone has to drive you. Well for many years now we’ve had this other procedure which is a tube, but they put it through your nose instead. There’s been lots of research papers about the use of it, it’s used in other countries as a procedure regularly. So I asked several gastroenterologists if they offer the procedure and every single one of them said no, and would not provide any additional information or insight as to why you have to be completely sedated and pay thousands upon thousands of dollars for expensive anesthesia. I am simply blown away. It makes no sense. A research tested method that has been written about for about a decade now in actual research studies by board certified medical physicians, and no one offers it. Literally no one, and they won’t even consider it.

I’ve also been through at least several primary care physicians because the ones I have seen are so short and don’t really take time to get to know you at all. They just pop in, ask you a handful of questions and leave, if your test results come back with anything abnormal, they say it’s nothing to worry about, they don’t want to take any extra time to help look into anything or diagnose you… like wtf?

It just seems like doctors these days are out to get you to spend as much money as possible and do the absolute bare minimum for you in return. And now we have direct primary care options where you can circumvent insurance entirely, pay your doctor thousands upon thousands of dollars a year for the same level of care that we had in the '90s. But now you have to pay out of pocket for that in addition to your insurance. Wtfffff

IamAnonymous ,

This is just over generalization of your experience.

A primary care doctor should ask questions like if you are stressed out as it affects your life but they are not going to have a long non-medical related conversation because you are no longer a kid and also they won’t remember you until you go back the next time so why waste time when they can see other patients, unless it’s a psychiatrist. The questionnaire they have has all the required medical questions.

Doctors aren’t out to get your money. You don’t even pay them directly. Blame the health insurance companies for that. If they did want to take your money wouldn’t they make you do more tests and take more of your money? There are a lot of ways to get your money apart from anesthesia.

Maybe there is a different medical reason but it is certainly not to just to make your pay for anesthesia. I’m not in a medical field so I can’t into those details. However, I had some oral surgery and I refused anesthesia as I could handle the pain and didn’t want to pay more money. The surgeon didn’t force it on me. I’m not sure where you live but I hadn’t heard that we are forced to take anesthesia when it might not be required as it is has its own risk. Why would the hospital risk that? Just to make more money when they can just order other non-risky expensive tests?

originalucifer ,
@originalucifer@moist.catsweat.com avatar

the united states is addicted to litigation. something that goes wrong is always someone elses responsibility and they will pay.

if a kid breaks their arm at school way too many humans decide 'that school was negligent, no matter what the circumstances' and they sue instead of collectively realizing kids do stupid things, and get hurt sometimes. this leaves school districts banning things like 'tag'. banning being children

its the same nonsense with doctors. theyve been sued into seclusion of anything they arent explicitly required to do.

the insurance industry has a hand in managing doctors time also... theyre basically given zero time to work with patients or they cant make enough money to stay in business.

health insurance companies only profit when human beings suffer

pearsaltchocolatebar ,

Nah, it’s about cramming as many patients as possible into each day. If it was about litigation, being more personable and attentive would decrease the risk.

originalucifer ,
@originalucifer@moist.catsweat.com avatar

Cramming is due to insurance reimbursement t

reddit_sux ,

it’s about cramming as many patients as possible into each day.

Using general anaesthsia and controlling everything reduces risk as compared to doing it with local anaesthesia which might cause discomfort, vomiting. These can get you sued. You never know who will be the person who will screw you just because you tried to save a few bucks.

General anaesthsia might save a few minutes during the procedure but along with the time for giving anaesthsia, recovery from anaesthsia, after care. It is both more time consuming and costly.

being more personable and attentive would decrease the risk.

You would think so but in real world the more you speak more material you would give if you get sued. Hence the doctrine be professional and cover your ass.

RememberTheApollo_ ,

They’re paid by the job, not by the hour.

IOW they get paid a fee for the visit, a fee for any tests, etc.

Thank modern insurance for that.

They do not get paid any extra to have a conversation with you or to spend actual time with you to discuss whatever issues you are facing. I think the caveat is more that the GP/PCP is more likely to speed by you as they’ve got 20 more patients to see that day and a specialist will probably spend more time with you because they’re only trying to work on one issue rather than deal with weird pains, blood tests, talk to you about your weight, etc…

InternetCitizen2 ,

Doesn’t help that the insurance is the real employer and superior physician as they ultimately decides the treatment too

harsh3466 ,

Capitalism.

Healthcare and insurance are for profit industries and the corporations running the healthcare and insurance business don’t give a fuck about the health of the patients. They want all the monies and want to move patients through as quickly and cheaply as possible to maximize their profits.

placatedmayhem ,

It’s exactly this. The policies put in place by “healthcare administrators” (MBAs and such with healthcare flavoring, not people that actually know how to care for people’s health like doctors and nurses) are designed to process the most patience in the least amount of face time possible, so that each doctor and nurse can see more patients per day, meaning more office visit fees, meaning higher profit. My dad calls it the “cattle shoot” and I feel that’s a pretty apt analogy. It’s the same general reason that fast food restaurants and pharmacies and department stores are perpetually understaffed: fewer staff members means lower “overhead” costs.

EleventhHour ,
@EleventhHour@lemmy.world avatar

This combined with liability. If the patient gets anything even resembling an unsatisfactory result, they’re likely to sue the doctor.

Buttflapper OP ,

Honestly, I think this is not true, in my experience at least. I think suing doctors was a feature of the '90s and early 2000s, but now people are so poor they can’t afford lawyers to sue a doctor for them, and medical malpractice runs so rampant that doctors don’t even seem to care at all. Everyone has had a bad running with a doctor, yet you’re very unlikely to hear of someone who has sued a doctor and gotten away with it.

bluGill ,

What the US has isn't free market capitalism. It is capitalism but with government imposed rules that are harmful to the common person. Your insurance depends your employer and you don't get a reasonable choice - they put in $1000/month that if you go elsewhere you lose that. Of course what your employer wants and what you want are different. Your employer wants the lowest costs for something expensive, and they want you to not quit until they are ready to get rid of you. You want some service with that insurance, but you are not a player with power so you don't get that.

harsh3466 ,

It’s not pure capitalism, but it’s definitely crony capitalism. Us plebs get fucked either way.

bluGill ,

I feel compelled to point that out though as government provided health care is not the only possible solution, and I'm in the group that would oppose that. However I have provided a better alternative: eliminate the deductions for employer provided insurance. (I think the above about other benefits jobs provide - I should be comparing paycheck not "fringe benefits".

harsh3466 ,

The profit motive needs to be removed from healthcare, or patients will continue to get fucked.

Healthcare needs to be separated from employment, and the profit motive needs to be removed from healthcare.

Should the government run it? Maybe not, but what’s the alternative? It’s like every election. Choosing one of two bad choices and hoping you choose the less bad.

And in the case of healthcare, I’ll take government run, profit free, tax funded healthcare over what we have now.

Edit: autocorrect error.

harsh3466 ,

Also, I don’t see how eliminating the deductions helps. And I don’t mean that in a snarky way. I’m genuinely asking how that would make the situation better.

bluGill ,

When companies pay me more if I don't take their insurance I have an option to choose something better. Right now I have no optioniso nobody cares to serve me.

LibertyLizard ,

This might be better for wealthy people but it’s hard to see how this would benefit the very poorest who are in most need of health care. What does this solution do for them?

bluGill ,

Only a tiny minority who mostly don't have jobs and thus no insurance and so we already need to do something different. For the middle class this is better.

Random123 ,

Thats BS theres plenty of lower class who have jobs and get shit insurance. I shouldnt have to say this…

But sure the middle class is more important

bluGill ,

The middle class is much larger. Not ignoring the plight of them, but don't force something subpar on me just for a small percetage. With several hundred americans there are a lot of poor but still a tiny percentage

Grunt4019 ,

What about contracting a terminal illness like cancer where you might not be able to work. You need a job to keep your healthcare but if an illness or disability that you have or get at some point stops you from working and you need to pay for that healthcare, what do you do?

bluGill ,

I think insurance should cover you for all current conditions for life even if you otherwise switch insurance for new issues

Random123 ,

The policies out in place by healthcare and hospitals arent forced by government.. these policies are by the companies so its not even about “but da gubnent is ebil!”

bluGill ,

They are the naturatual concequense of the policies put into place. They are not required but they are still the result that should be expected.

TimewornTraveler ,

this is such a cliché, short-sighted oversimplification that doesn’t address the root of how individual physicians end up caught in these systems of apathy.

like yes capitalism is part of the problem but that’s about as useful as saying, why is there climate change? capitalism! like sure, yes, but isn’t there so much more to the story that can inform us on why the systems are the way they are, so that maybe we can address it? or i guess lemmy.ml users already have that answer, just start a global revolution and hope the winners care enough to fix it before all the survivors die of heat stroke dysentery and starvation, easy. capitalism. upvotes to the left.

corsicanguppy ,

why you have to be completely sedated and pay thousands upon thousands of dollars for expensive anesthesia

I’ve got this one, my dude. It’s because American healthcare is mercenary and broken. When I had, um, a similar ‘retroscopic’ test from the other end, I was under a general, needed a buddy at the end, out for a few hours, etc; seems to be about the same.

Cost: $0

Premiums/subscription: $0

Material costs: $0 also

Like, I pay my income tax and the healthcare is just what’s there – we run it on income tax only, and before covid it was apparently funded adequately. Yeah, we’re short on doctors right now as many of them left the field because of aggressive ‘mah raghts’ hillbillies whipped into a frenzy by the conservatives, but they run the triage and they keep their appointments. It’s so different from when I lived in 07974.

fine_sandy_bottom ,

Australia checking in … I feel similarly about the attitude of doctors and the type of care I receive. I don’t have any amazing advice that you’re not already following, but I’ll regale you with my thoughts regardless…

About 18 months ago I developed a chronic health condition that I will need to manage for the rest of my life (hopefully several decades). In that time I’ve seen a myriad of medical professionals.

My first tip would simply be that if you’re not satisfied with a doctor or specialist, your only recourse it to arrange to see another instead. Sometimes the advice / treatment prescribed will vary significantly, sometimes they just have a less punchable face.

As regards GPs, I’ve come to categorise them thusly: those that just prescribe meds without any conversation, those that try to manipulate you into wanting the meds they want to prescribe, and those that will have a conversation with you about what meds you ought to take. Obviously this last category is the one you want.

Finally, I’ve gotten a lot of mileage out of simply staying on top of all the data about me. I have all my test results available on my phone, as well as medications, dates of treatments, contact details for specialists, et cetera. Also just understanding the available treatments.

circledsquare ,
@circledsquare@fedia.io avatar

I'm not in the USA but this trend is also happening in other countries. I guess USA feels it more because of the already punitive health system.

I've been thinking in recent times about pharmacies. 20 odd years ago, pharmacies used to deal with things too severe to put off, maybe not severe enough to see a doctor for. Now pharmacies are about "wellness" which is marketing crap to make more money. Middle aged woman feeling unwell? Cut your hair short and dye it 3 different colours. You'll look young and feel young! But they're still unwell and still have sore joints etc. Pretty depressing to think about.

GaMEChld ,

Our Healthcare system is fucked. You really need to be your own advocate and do your own double-checking. Think about how many people are bad at their jobs, and realize that plenty of those people are doctors.

magiccupcake ,

I’ve only tangentially heard about this, but another issue is that doctors in the US don’t have to, and aren’t encouraged to keep up with recent research.

Combine that with a medical education system that hasn’t changed drastically in 70 years to keep up with that new research and most US doctors are just out of date.

Lemmeenym ,

There is some variation by state but in the US almost all licensed medical professionals are required to participate in continuing education to keep their license.

Drusas ,

I'm sorry you've gone through this, but I am also an American suffering from the same issues as you, and I have found no shortage of ENTs willing to shove the camera down my nose. That seems to be what they always recommend straight from the get-go.

Buttflapper OP ,

Seems to be especially bad in Georgia where there’s very poor access to healthcare. More progressive places like NY may have different results I’m not sure. It’s just shocking, no one will even consider helping me

Drusas ,

That is difficult. I assume you've tried Atlanta? I would think you would be able to find decent care there. If not, it might be worth traveling a few hours to wherever you can just to get a diagnosis at least.

And make sure the doctor or clinic knows in advance what you are seeking.

lemmylommy ,

Just fyi, the sedation is usually not medically necessary. I have had it (as well as a colonoscopy) done without, just got a spray to numb the throat for a short while. It’s not pleasant, but I found it bearable and it’s much nicer to just walk out and drive home on your own. If necessary I could still have told/signaled that I want sedation after all during the procedure. Propofol works within less than a minute. In that case they would have called someone to pick me up.

That said, I do live in Germany, so money does not play as big a role as in the US when it comes to healthcare. And the doctors and their staff were exceedingly nice and caring.

Maybe, if you believe you can bear it, and if acid reflux does not make it painful, ask to do it without sedation next time.

Buttflapper OP ,

I know the sedation is not medically necessary, lots of places outside the USA don’t do it at all. Japan, Europe, etc. There’s research studies that even show non sedated procedures are being used and have been favorably received. Every single doctor I’ve asked about them, they outright refuse to do it without sedation or anesthesia. Guess how much that costs? Thousands of dollars, with insurance. So I have to pay about $5,000 at least out of pocket a year for insurance, then I have to pay $3,500 for this procedure, and the last two that I’ve gotten, they haven’t shown anything. So naturally I’m like okay, can we do a less invasive one without sedation, like they do in other countries? Absolutely not. We won’t do that, and we don’t know anyone else who will ever do it. Like what the hell is this?

crusty_baboon , (edited )

This is not medical advice, just some general comments regarding your post.

An upper endoscopy is rarely needed for evaluation for uncomplicated acid reflux. It alone is not even an appropriate indication for an upper endoscopy, except for a specific patient population and that’s to screen for a disorder related to acid reflux.

Unsedated endoscopies are uncomfortable for the patient and the physician. They suck. Many gastroenterologists will do it, but there’s at least some reason for why others won’t. Doctors in countries that do a lot of unsedated upper endoscopies do so because these patients have them much more often (screening for a much higher risk of gastric cancer in, say, Japan). But the way, whether you get anesthesia from an anesthesiologist or no anesthesia doesn’t affect how much insurance pays the endoscopist.

The tube you’re referring to sounds like pH monitoring with an impedance catheter. It stays in your nose for 24 hours, and generally isn’t more convenient than an upper endoscopy. It’s not required for diagnosis of simple acid reflux, and serves a completely different purpose than an endoscopy. It’s used mainly when the diagnosis is in question. Most gastroenterologists aren’t sufficiently trained to read these studies anyway. These patients are usually referred to high volume centers.

Drusas ,

Sedation for upper endoscopy isn't even necessarily the norm throughout different countries. It is in the US, but I had my first upper endoscopy in Japan, and they just numbed my throat.

FridgeReborn ,

I’m lucky to have “inherited” my parents’ doctor. She is extremely compassionate and gets deeply involved in you and your concerns on every visit. So much so that she is infamous for being behind schedule, to the point where we fully expect to wait for an hour to see her after the scheduled appointment time. She makes up for it by talking with you for as long as you want.

She also hasn’t accepted new patients for like 4 years… so yeah, I guess all the good ones are taken.

Bob_Robertson_IX ,

I find a young doctor in a suburb almost 10 years ago. He’s been great and he listens to me, has no problem taking my suggestions into consideration, and he often admits when he doesn’t know something and will literally Google it right there in the room. It took as while to find someone I like, but it was worth looking.

curbstickle , (edited )

My doctors have been incredible, at least those I’ve had for the past 4 years or so. Including my gastro.

They take the time to talk to me, they remember who I am, and my gastro is even a direct recommendation from my primary doctor (my gastro is his gastro).

I’ve been going to gastroenterologists for literally decades, the one I got a couple years ago is the first to finally find the issue, and I’ve been reflux free. I doubt he’d do a transnasal either - its more limited in scope (hah!), you’re only getting part of what an endoscopy can do. That’s why its not transnasal endoscopy, its transnasal esophagoscopy.

And that’s probably why. Why they wouldn’t just say that, I don’t know. There are lots of places that will do transnasal esophagoscopy throughout the US, so it isn’t a procedure that is just “not done here” or anything, its not as popular in general because its just not as thorough of a procedure.

I hope you find a doctor in the future that takes the time to explain things though.

Edit: Forgot to mention, the hospital system by me is a non profit. Only differentiator I am aware of, and its a great hospital system.

kungen ,

you’re only getting part of what an endoscopy can do.

But it’s much less intrusive, no? So should it not be considered to see if a good diagnosis can be made via it?

curbstickle ,

If it doesn’t cover the expected area of concern? No

If you dont know the cause of the issue? No

If you know the issue, and just need to check the state of the esophagus or something? Sure.

Its done for specific reasons, just like an endoscopy is done for specific reasons. When it comes down to it though, it only does a small part of what an endoscopy can do, and with a generic “acid reflux”, its not going to give enough information to diagnose. Its a way to assess symptoms, not a way to diagnose a gastrointestinal problem.

Buttflapper OP ,

And that’s probably why. Why they wouldn’t just say that, I don’t know. There are lots of places that will do transnasal esophagoscopy throughout the US, so it isn’t a procedure that is just “not done here” or anything, its not as popular in general because its just not as thorough of a procedure.

Here’s the exact wording I got from my Gastro in the USA in a major metro serving millions of people.

I have reached out to our gastroenterology department and have learned that we do not do this procedure. Additionally, we are not aware of anyone in the state of Georgia that offers it.

No one in the ENTIRE state of Georgia… does a Nasal Endoscopy or esophagoscopy, a common procedure all across the world. Truly asinine.

curbstickle ,

I can tell you its done in the tristate area.

Maybe its a Georgia thing.

Rolder ,

Judging from my own doctors experience, they are way overbooked. Can’t get a personal experience when they gotta see a couple dozen more people the same day.

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