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Comment by austenallred | Hacker News Reader

You’re right, but respectfully, in the long term, “I want this specific provider at any cost” is somewhat of an edge case. A lot of (most?) people just want good healthcare and a low cost. That’s a complex but solveable problem.

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No, its not an edge case. If you have a rapport with a doctor/care provider, you would want to stay with them. I have a genetic disease and an endocrinologist who helps me manage it. I wouldn't want to leave that doctor, who has seen me multiple times, has my charts, understands what Im working with, and so much more.

But isn't that OP's point? By nature of your specific disease/condition you are a bit of an outlier no?

Obviously the ideal would be you have a system that accommodates "my kid has a fever/fell out of a tree and broke their arm" majority of medical issues who could be helped by basically anyone trained in basic medicine while also accommodating people who need a rapport with a highly trained/expensive specialist.

That's how I took the comment...apologies in advance if this comes off as insensitive to your condition, definitely not my intention.

People want to believe that their medical condition(s) are a special, one-in-a-billion mix requiring years or decades of rapport-building and conversations. That's not the case for the vast majority of people, even with very complicated medical histories and diagnoses.

"Has seen me in the past" and "has my charts" are not indicative of medical efficacy. There are doctors I have rapport with, absolutely. I still have lunch occasionally with the physician who was my family doctor as a child and still sees my parents. But that doesn't mean his medical treatment is going to be any better than a doctor seeing me for the second or third time.

there is clinically proven evidence that seeing the same provider in the same setting improves outcomes:

https://www.newyorker.com/magazine/2017/01/23/the-heroism-of...

Given the tiny slices of time doctors seem to have for each patient, it would seem that having time and history to have actually spent time with patients and their medical background would seem to be a common sense advantage. It's good to see that borne out in evidence.

There's also clinical evidence in favor of placebo usage, that doesn't mean that placebos increase medical efficacy, it means sometimes people just need to feel good about what's happening. And people - myself included - would probably prefer seeing the same physician long term.

Wait...except the decrease in care when transferring a patient to a new doctor is the EXACT reason health care professionals say we can't put a cap on working hours and introduce more doctors to help with the work-load.

They always says it hurts the patient's care. I think there is some truth to both sides, but we'll probably never know. Too many people are making out like bandits in the current health care system.

I'm sorry but that does sound like the definition of an edge case to me. You have a rare situation that requires a unique solution.

I bet that health outcomes are improved with longer term patient-physician relationships - Imagine having a new family doctor every year vs. a doctor who has known you for the last 15 years.

edit: This (quite extensive and longitudinal) study would suggest that it's true. Check out the sources on the paper for other studies with similar findings:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226774/

I'd like to see some evidence on that because I can imagine staying with one doctor might result in some conditions not being diagnosed.

Indeed - I am familiar with people who were misdiagnosed by a GP (in England) for over a decade before a visit to a different doctor yielded the correct diagnosis and treatment.

Updated my post - The introduction provides a decent overview of other studies (and and their limitations) suggesting the same results.

Each rare disease is rare, but it is not very rare to have a rare disease. There are just thousands of rare diseases. For example, it is estimated that 6-8% of the EU population has a rare disease: https://en.wikipedia.org/wiki/Rare_disease#Prevalence

Wanting to continue to see a provider that you know and trust is an "edge case" now?

We truly live in the darkest timeline.

I've had great luck with just using whatever specialist is in network by default, and just calling or emailing my old doctor for a second opinion if something weird happens. I assume not all doctors are so communicative, but I think many are happy to help as long as it doesn't take much time.

> “I want this specific provider at any cost” is somewhat of an edge case

Not really. I want someone I can trust. For my primary care needs, I have established trust with someone and know their capabilities, their business practices, and their character. I don't want to roll the dice with someone new when I can still go to them.

Example 1: My primary care provider(been seeing him for 10 years.

Example 2: My dentist (been seeing him or his predecessor for 30 years)

The OP reports the insurer misrepresenting their in-network coverage. I've had this experience with BCBS -- the list of in-network doctors on the website was wrong. Hard to prove incompetence vs. malice, but there seems to be zero accountability for this sort of thing.

Agreed. Care continuity is certainly important, but it's not $30k-out-of-pocket important...

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