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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

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.

Boozilla ,
@Boozilla@lemmy.world avatar
  • Too many patients, not enough doctors.
  • Private insurance and intrusive controlling software: the doctor is limited in what they are allowed to prescribe, they have to check all sorts of boxes, and they have complex computer forms to fill out. They are too busy with the laptop to have much attention left for patients.
  • Non-compliant patients who “do their own research” on the internet.

Most doctors I know don’t even want to go to a doctor. They know all the providers are shit talking their patients and just doing the best they can in a very broken system.

Late stage capitalism and medical misinformation have made the doctor-patient relationship almost adversarial.

Nougat ,

You know enough doctors well enough to know that most of them don't want to go to a doctor?

Boozilla ,
@Boozilla@lemmy.world avatar

Read what I said. Most doctors I know. I know several. I worked for a hospital system, and I currently have a healthcare adjacent job. We talk about these things, yes. I don’t claim to speak for all doctors.

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.

pearsaltchocolatebar ,

I’m not sure why you’re talking about anesthesia.

reddit_sux ,

OP’s post was about anaesthesia.

paddirn , (edited )

Not a doctor and just talking out my ass, but I’m assuming part of it has to do with patient workloads and dealing with insurance companies, they’re just not incentivized to really take any time with patients, just get 'em through the visit, check whatever boxes they need to, and move on.

But yeah, I very much have had the same experience for the past 10 years or so with my same doctor, it just feels absolutely useless going to them for anything. It takes alot for me to go to the doctor for anything or to bring anything up even with the doctor if it’s not life-threatening. I’m not a hypochondriac by any stretch, I just try to keep an eye out on my health and if I notice my body doing something out of the ordinary, I just ask about it to see if it means anything.

Before my regular check-up though I’ll kind of bank up whatever questions or oddities that I’ve noticed, things that I figure I can bring up and see if maybe it’s a sign of one thing or another. Most of the time when I mention anything though, it just feels like the doctor is blowing me off, or he’ll just give a guess, maybe google it and show some pictures. At best he might tell me something like, “Hmmm, well it’s probably not cancer.” and then just sort of shrug and move on. I’m a guy, so I’m used to no one caring about my health or well-being at all, but I think I had a different image in my head when I was a kid about what it was doctors actually did.

The one regular benefit I see from going to the doctor is getting my blood drawn and being able to track health numbers from that, my job does the same thing too, so I get two sets of numbers from my blood work every year and I track it to see overall condition of my health, which I kind of wish was something my doctor did. He’ll mostly just comment the most obvious thing possible when the test results come in, but there’s never a look at health numbers over time, which is why I started just tracking it on my own.

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

litchralee , (edited )

To start off, I’m sorry to hear that you’re not receiving the healthcare you need. I recognize that these words on a screen aren’t going to solve any concrete problems, but in the interest of a fuller comprehension of the USA healthcare system, I will try to offer an answer/opinion to your question that goes into further depth than simply “capitalism” or “money and profit” or “greed”.

What are my qualifications? Absolutely none, whatsoever. Although I did previously write a well-received answer in this community about the USA health , which may provide some background for what follows.

In short, the USA healthcare system is a hodge-podge of disparate insurers and government entities (collectively “payers”), and doctors, hospitals, clinics, ambulances, and more government entities (collectively “providers”), overseen by separate authorities in each of the 50 US States, territories, tribes, and certain federal departments (collectively “regulators”). There is virtually no national-scale vertical integration in any sense, meaning that no single or large entity has the viewpoint necessary to thoroughly review the systemic issues in this “system”, nor is there the visionary leadership from within the system to even begin addressing its problems.

It is my opinion that by bolting-on short-term solutions without a solid long-term basis, the nation was slowly led to the present dysfunction, akin to boiling a frog. And this need not be through malice or incompetence, since it can be shown that even the most well-intentioned entities in this sordid and intricate pantomime cannot overcome the pressures which this system creates. Even when there are apparent winners like filthy-rich plastic surgeons or research hospitals brimming with talented expert doctors of their specialty, know that the toll they paid was heavy and worse than it had to be.

That’s not to say you should have pity on all such players in this machine. Rather, I wish to point to what I’ll call “procedural ossification”, as my field of computer science has a term known as “protocol ossification” that originally borrowed the term from orthopedia, or the study of bone deformities. How very fitting for this discussion.

I define procedural ossification as the loss of flexibility in some existing process, such that rather than performing the process in pursuit of a larger goal, the process itself becomes the goal, a mindless, rote machine where the crank is turned and the results come out, even though this wasn’t what was idealized. To some, this will harken to bureaucracy in government, where pushing papers and forms may seem more important that actually solving real, pressing issues.

I posit to you that the USA healthcare system suffers from procedural ossification, as many/most of the players have no choice but to participate as cogs in the machine, and that we’ve now entirely missed the intended goal of providing for the health of people. To be an altruistic player is to be penalized by the crushing weight of practicalities.

What do I base this on? If we look at a simple doctor’s office, maybe somewhere in middle America, we might find the staff composed of a lead doctor – it’s her private practice, after all – some Registered Nurses, administrative staff, a technician, and an office manager. Each of these people have particular tasks to make just this single doctor’s office work. Whether it’s supervising the medical operations (the doctor) or operating/maintaining the X-ray machine (technician) or cutting the checks to pay the building rent (office manager), you do need all these roles to make a functioning, small doctor’s office.

How is this organization funded? In my prior comment about USA health insurance, there was a slide which showed the convoluted money flows from payers to providers, which I’ve included below. What’s missing from this picture is how even with huge injections of money, bad process will lead to bad outcomes.

financial flow in the US healthcare systemSource

In an ideal doctor’s office, every patient that walks in would be treated so that their health issues are managed properly, whether that’s fully curing the condition or controlling it to not get any worse. Payment would be conditioned upon the treatment being successful and within standard variances for the cost of such treatment, such as covering all tests to rule out contributing factors, repeat visits to reassess the patient’s condition, and outside collaboration with other doctors to devise a thorough plan.

That’s the ideal, and what we have in the USA is an ossified version of that, horribly contorted and in need of help. Everything done in a doctor’s office is tracked with a “CPT/HCPCS code”, which identifies the type of service rendered. That, in and of itself, could be compatible with the ideal doctor’s office, but the reality is that the codes control payment as hard rules, not considering “reasonable variances” that may have arisen. When you have whole professions dedicated to properly “coding” procedures so an insurer or Medicare will pay reimbursement, that’s when we’ve entirely lost the point and grossly departed from the ideal. The payment tail wags the doctor dog.

To be clear, the coding system is well intentioned. It’s just that its use has been institutionalized into only ever paying out if and only if a specific service was rendered, with zero consideration for whether this actually advanced the patient’s treatment. The coding system provides a wealth of directly-comparable statistical data, if we wanted to use that data to help reform the system. But that hasn’t substantially happened, and when you have fee-for-service (FFS) as the base assumption, of course patient care drops down the priority list. Truly, the acronym is very fitting.

Even if the lead doctor at this hypothetical office wanted to place patient health at the absolute forefront of her practice, she will be without the necessary tools to properly diagnose and treat the patient, if she cannot immediately or later obtain reimbursement for the necessary services rendered. She and her practice would have to absorb costs that a “conforming” doctor’s office would have, and that puts her at a further disadvantage. She may even run out of money and have to close.

The only major profession that I’m immediately aware of which undertakes unknown costs with regularity, in the hopes of a later full-and-worthwhile reimbursement, is the legal profession. There, it is the norm for personal injury lawyers to take cases on contingency, meaning that the lawyer will eat all the costs if the lawsuit does not ultimately prevail. But if the lawyer succeeds, then they earn a fixed percentage of the settlement or court judgement, typically 15-22%, to compensate for the risk of taking the case on contingency.

What’s particularly notable is that lawyers must have a good eye to only accept cases they can reasonably win, and to decline cases which are marginal or unlikely to cover costs. This heuristic takes time to hone, but a lawyer could start by being conservative with cases accepted. The reason I mention this is because a doctor-patient relationship is not at all as transactional as a lawyer-client relationship. A doctor should not drop a patient because their health issues won’t allow the doctor to recoup costs.

The notion that an altruistic doctor’s office can exist sustainably under the FFS model would require said doctor to discard the final shred of decency that we still have in this dysfunctional system. This is wrong in a laissez-faire viewpoint, is wrong in a moral viewpoint, and is wrong in a healthcare viewpoint. Everything about this is wrong.

But the most insidious problems are those that perpetuate themselves. And because of all those aforementioned payers, providers, and regulators are merely existing and cannot themselves take the initiative to unwind this mess, it’s going to take more than a nudge from outside to make actual changes.

As I concluded my prior answer on USA health insurance, I noted that Congressional or state-level legislation would be necessary to deal with spiraling costs for healthcare. I believe the same would be required to refocus the nation’s healthcare procedures to put patient care back as the primary objective. This could come in the form of a single-payer model. Or by eschewing insurance pools outright by extending a government obligation to the health of the citizenry, commonly in the form of a universal healthcare system. Costs of the system would become a budgetary line-item so that the health department can focus its energy on care.

To be clear, the costs still have to be borne, but rather than fighting for reimbursement, it could be made into a form of mandatory spending, meaning that they are already authorized to be paid from the Treasury on an ongoing basis. For reference, the federal Medicare health insurance system (for people over 65) is already a mandatory spending obligation. So upgrading Medicare to universal old-people healthcare is not that far of a stretch,

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?

SnotFlickerman ,
@SnotFlickerman@lemmy.blahaj.zone avatar

Ask the doctors who moved out of their home states instead of risking being jailed for “performing an abortion” when they were doling out life-saving medicine.

BananaTrifleViolin ,

The US healthcare system is built around money and profit. A cheaper procedure which does not require general anaesthetic costs less, and reduces profit. That can be beneficial to the providers but bloat is incentivised in the US healthcare system as providers battle with insurance companies for money. Crudely healthcare providers don’t care about saving you money; they want to take as much money as they can get.

Meanwhile, countries with tax funded health care opt for the most cost effective procedures, investigations and treatments. The incentive is to reduce costs and offer the most effective things to the most people possible. That can also sometimes have negative side effects if not carefully regulated but in such systems generally Doctors advocate for the best procedure and best medical practice, as they themselves do not directly benefit financially from which procedure is pushed. The downside is you do get the opposite side of things where patients are dissuaded from things as they’re not deemed cost effective by those who control the spending.

bradorsomething ,

The medical industry and the insurance industry are locked in a battle for money, and you don’t have a lot of say in it. I used to run an ambulance service. Let’s discuss.

If I took you to the hospital, and you were on medicare, there was a fixed rate to pick you up and a per mile rate. I got paid part by the government and part by the patient, who I was legally required to bill. If I failed to adequately bill the patient (10% or so), if I lied on the parts and mileage, silver bracelets and court time. We loved billing care/caid, because it was a fixed price, and we knew the payer of 90% paid regularly.

If you have private ambulance transport, you have no idea what you’ll get. The patient can have a $13,000 deductible, a 50% copay, and. $20,000 per-event cap. There’s no rule what a reasonable bill can be. The insurance company is trying to rig the game so the patient pays most of the bill while paying that sweet monthly premium at the same time. The ambulance is trying to be reimbursed for the time and materials. The red states opened the door for the patients to again be uninsured and pay you $0 for everything. So bills have to be high, to ensure some money comes in from insurance, to insure things can keep running. I would have loved to have a country of all care/caid and it be illegal to live there otherwise. They’d be the best cared for poor and old people in the world, getting quality care backed by the “only if you’re poor or old” US single-payer system.

But we have what we have, and it’s been well sold to enough clueless people that it’s here to stay.

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.

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.

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.

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.

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