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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

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.

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.

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.

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.

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.

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