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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

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.

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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.

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.

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.

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.

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.

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.

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