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Comment by mrangle | Hacker News Reader

A half-lifetime of experiencing and observing modern medicine, in good faith, has taught me that participating in the medical system while not in need of emergency care is risking one's health and life.

Assuming that one doesn't engage in risky behavior, the smartest path is to avoid the medical system altogether. That doesn't mean "seek alternative medicine". It's just what I said.

The Medical system doesn't highlight its failures. It obscures them, and only speaks in bullshit PR terms. Its failures (premature suffering and death) are almost always attributed to causes other than the malpractice that caused them. Even families are hoodwinked.

Laugh at anyone quoting "evidence" without citing it for critique. The medical profession hasn't had broadly-intact scientific integrity for decades.

Much of medicine is charlatanism for billing. Doctors know this though most won't admit it. The consequences range from annoyance, to minor malfunction, to catastrophic.

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Having kids has shown me how much of medicine is about incentive alignment, rather than doing no harm. Every time one of my kids gets an ear infection, pinkeye, or a sore throat, my daycare requires a doctor’s note and antibiotics to be given before they are allowed back in daycare. The urgent care doctors always prescribe antibiotics, even though the most likely cause is viral and most bacterial infections resolve within 3-5 days with or without antibiotics. I had one case where the strep test was negative, and the doctor still prescribed antibiotics because it could be a false negative. And my kids are allowed back in daycare after 0-24 hours depending on the diagnosis, even though the medicine takes 3-5 days to work.

I was shocked to go through this the first time, after reading so much about the over-prescription of antibiotics. But doctors would rather write a prescription than explain the evidence to stressed parents and daycare providers. And daycares all copy each others’ policies, because nobody wants to admit that kids are just contagious snot-monsters and medicine can’t really help.

It’s pure theatre, at the expense of kids’ health (antibiotics do a number on the digestive system) and leads to antibiotic-resistant strains. But at least nobody ever had to stop and have a difficult conversation.

That's crazy. I have small kids and the doctors never give antibiotics. They just say it's something viral and to give Tylenol / Ibuprofen to treat discomfort. The daycare doesn't have any rule like that either they just check for fevers and they have to stay out until no fever for 24 hours. When one was really sick with croup they gave him some steroids but that's it. We have even switched doctors 3x and always been the case.

Wow, I’m shocked (and heartened) to hear that your experience has been so different. Maybe it’s just the area I’m in or my healthcare provider. I always expect to be told “it’s a common cold, get the kid some rest and leave urgent care to the real illnesses” but I’ve literally never had that happen.

Definitely varies by country. In Czechia, they give antibiotics only after three days of fever or symptoms that strongly hint at bacterial infection. And they usually do at least a CRP test, often a cultivation.

The daycare rules here vary place by place, though. Some of them just check for fever, some don't like running noses.

I am on the west coast in the US, and my kids’ pediatric group almost never gives antibiotics. They typically tell me over the phone not to bother coming unless it has been a very high fever or multiple days of worsening symptoms.

Only antibiotics we have had were after they looked in ear and said the redness and pus indicated bacterial as well as the color and consistency of conjunctivitis discharge.

And around here, daycares do not require any doctors’ note. They just tell you not to bring your kid in if they have fever or vomiting or diarrhea within the last 24 hours.

Same for my family here in a midwestern state. I'm curious where OP is living...

I go to Palo Alto Medical Foundation in the Bay Area, literally down the street from Stanford. If there were any region I would expect to follow evidence-based practices I would expect it to be them.

I'm guessing they are more into doing the feel good thing to avoid angry parents.

My experience with doctors and daycare is similar to Hattmall. Keep them home for 24hrs if fever. No doctors note. I’m in Minnesota.

Yeah, my kids have had what feels like every illness under the sun, and I can count on one hand (maybe one finger?) the number of times we’ve been given antibiotics. They’re in public school, which may have something to do with it, but the rule has always been 24 hours sans fever with no antipyretics and you’re good to return. Sorry to hear that the parent poster has encountered such bizarre rules, that’s pretty lame.

This varies country by country. In Switzerland you need to beg for antibiotics if you think you need them.

Same in Sweden

I got antibiotics in Sweden when I had mononucleosis (a viral infection). It definitely varies.

There is damn good reason for that. Wife is a doctor, although not a pediatrician. There are some long term stats that if kid receives antibiotics before age of 1, the risk of getting diabetes later in life jumps by at least 30%.

We have tons of doctors as friends, most work in biggest hospital in Switzerland (HUG in Geneve), and all with small kids adhere to this and try to steer away from atbs as much as possible. Its not some quack unproven theory.

Thats just 1 specific situation, you can deduct that atbs do quite a mess in those little bodies and it doesnt stop with age of 1.

If you meant even adult people dont get atbs automatically, thats also is great approach especially longterm. Most infections dont need them, they do more harm than good in the body. But uneducated folks that suffer seek literally anything that can help them, some basic medical facts be damned, so doctors sometimes give up and give atbs to obnoxious patients. Then there are of course those bacterial infections where they help, but they are rather small % and usually not the most severe ones.

Meanwhile here in Vietnam (and I guess for most of the developing world) I can walk into a pharmacy and ask for any medication they have available, including antibiotics, and they'll hand it over, no prescription needed.

I've heard this is slowly changing in the big cities but I'm not holding my breath.

> bacterial infections resolve within 3-5 days with or without antibiotics.

Citation needed

I do worry about overuse of antibiotics but I know a lot of times it just doesn't "go away without", or the viral infection ends up evolving to a bacterial one

Though what the doctors should do is give the prescription but say just to take it if the situation doesn't improve. This way you save a return to the doctor if it doesn't get better.

I don’t have any citation, but if you google bacterial ear infection or strep throat you’ll see that it’s true. And my pediatrician agrees with me, even if the urgent care docs don’t mention it.

The risks of Strep Throat include Rheumatic Fever, Kidney disease https://www.cdc.gov/groupastrep/diseases-public/strep-throat...

and https://www.cdc.gov/groupastrep/surveillance.html

and in some cases even death https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474463/

Thanks, I'd rather not risk it (though I will wait a couple of days to see if it gets better)

Yes, but even your link says that complications are uncommon. I’m not advocating waiting until you’re on death’s door, but isolating and waiting 2-3 days to see if you’re getting better is fine.

Must be specific your region. Not my experience around Atlanta.

Around here common illness kids can come back after 24 hours of symptom free (daycares dont ask how they became symptom free). Super contagious like pinkeye requires doctors note that it's not pink eye, or put on a treatment plan.

> The urgent care doctors always prescribe antibiotics, even though the most likely cause is viral

This is irresponsible, tackling AMR is a WHO priority and local guidance (e.g. NICE, I don't know about the states - is it ICER? the CDC?) should reflect this and steer away from "just in case" antibiotic prescriptions.

Individual organisations / groups' practices vary dramatically.

From a friend who was involved in health care analytics decades ago, they'd frequently find that specific norms of healthcare practice depended highly on senior medical personal (e.g., a head physician within a department), and that you'd find major differences in standards both at different-but-comparable groups and at the same group following a major personnel change (retirement, moving elsewhere).

Another friend doing roving-doctor work at a number of smaller clinics and facilities described wildly different standards amongst physicians specifically regarding antibiotic prescriptions (my friend resisted prescribing them without specific indication, other doctors offered them as a default).

As with many other aspects of the world, what we observe directly is very much through a drinking straw (if you can find one of those any more): it's a very narrow view. This doesn't mean your experience is invalid or even infrequent. It does mean that it's likely not especially generalisable.

That said, what seems to change overall behaviours most is standards and norms being applied through policy, whether institutional (think Kaiser in California) or at the governmental level (government-offered services, etc.). Thought comes to mind that much of the US is now experiencing the negative aspects of that last, as with many tools, it can cut both ways.

This is so skewed towards the US. Eg here in Europe people go to their GP much more often because those visits are free, and hard data says we live longer than in the the US. So the problem isn't "doctors" or "medicine", the problem is the US medical system.

Please. I've been through medical systems in several European countries, and the GP system is frustratingly bad. GPs will at best prescribe you some medication, but will otherwise act as entitled gatekeepers to the rest of the system. Unless you're bleeding on their table, they'll do their best to avoid sending you to a specialist. They'll engage in the same charlatanism that GP is talking about.

Healthcare in Europe is not free. You're taxed for it quite highly.

Calling this system "healthcare" is too generous. It only exists to keep people from complaining, and healthy enough so they can be productive enough to be taxed. There is no care.

You are often also charged fees at the doctors office or even emergency care. And places like Sweden have private health insurance so you domt have to stay in the “free” broken system with years of waiting before getting to a specialist. I always cringe when nordics make fun of the US healthcare system. Ours is just as expensive and horribly broken. You may not get a 20k dollar bill for immediate care. You are instead set on a 5-14 year (not a typo ) waiting list.

Sweden is a capitalist country with socialist taxes.

There are waitlists but not for urgent care, this data suggest the US actually has the highest waitlists:

https://worldpopulationreview.com/country-rankings/health-ca...

But maybe if you are rich you can buy a place faster. Not sure if that should be celebrated.

What we have in much of Europe is mostly a dream compared to clusterfuck that US healthcare is. US has by far the highest costs globally, unavoidable even if insured. People here never think 'should I go to doctor, can I afford treatment'. Thats 3rd world country stuff.

Yes we pay for it, much less than US, but its not part of our net salary so nobody actually cares, this topic is simply not discussed by commin folks, and you can easily see how much stress it causes even to wealthy US folks.

We treat people in same way regardless of their origin, wealth, status, even homeless get top notch care if they dont run away from it.

Something in your words tell me you are not a standard patient.

> GPs will at best prescribe you some medication, but will otherwise act as entitled gatekeepers to the rest of the system

I feel that's more on the UK/Irish medical system

On the continent specialists will happily take you without a referral, though usually private only (which to be honest, the "GP as gatekeeper" method is stupid - thanks I know which doctor to go for a skin disease, I'm not from the sticks)

> I feel that's more on the UK/Irish medical system

I've had no issues getting a referral in the UK system, though I appreciate some people do struggle. Hell, I've had to actively turn down the offer of a referral when I felt like the problem would be better dealt with in primary care.

That's not my (UK) experience.

I can get a telephone consultation with a GP within 24 hours; if I need to see my own designated GP, I can get a face appointment within a week, usually. If consultants are appropriate, I'm referred to a consultant.

There are some specialisms where it's hard to get a referral; podiatry is an example. As far as I can tell, NHS podiatry is mainly reserved for people with diabetes. I had to hire a private podiatrist, £50 per session, 6 sessions. I gather there are long queues for mental treatment (although GPs enthusiatically diagnose depression, and hand out antidepressants like jellybeans).

I don't like taking antibiotics; I don't want to nuke my gut biome, if I can avoid it. I can't remember the last time I was prescribed antibiotics prophylactically.

When was the last time you tried that? In the past month there have been a number of newspaper headlines about difficulties in accessing GP services.

Eg: https://inews.co.uk/news/health/gp-receptionists-care-naviga...

> When was the last time you tried that?

Last summer.

There's been a wave of strikes in the NHS since Christmas; I've only used the surgery recently to renew prescriptions over the phone, and I was able to get through with a 5-minute wait. I haven't had a proper appointment for 2 years.

What? I have never seen these alleged "entitled gatekeepers". I have been passed to specialists with no issue. The public sector healthcare is excellent and the same medical standard as is received in the private sector.

Let's talk about that price. So how does healthcare work out for you in the US system if you cannot pay for insurance? In a public sector system you still get healthcare just the same if your income is zero. The total tax cost for middle (or even higher) earners in European countries is often less than equivalent private insurance premiums paid in the US. In private sector systems you still ending up paying out of pocket even when you are "covered" with those deductibles. So your overall cost is even higher. Don't forget in the US you still pay taxes for healthcare for schemes like Medicare so don't forget to add that on when doing comparisons. What does the typical private insurance policy say about pre-existing conditions and congenital disorders? You're fully covered in public sector healthcare. What if you suffer from an expensive illness? You may find your insurance premiums increase. Your taxes don't increase in public sector healthcare regardless of what illness you have.

It's just americabrain. You can hardly blame them as this is the only system they know and were socialized in. I've talked to otherwise intelligent and well adjusted people who came up with the most spectacular mental gymnastics defending the US health system and coming up with the weirdest reason why public health care in the developed world isn't actually better (you have to pay taxes!!:(), it's absolutely mindboggling and I just laugh at them now. It really sucks for the families who have their lived destroyed due to unnecessary and massive medical bills.

The irony of the comment you’re responding to is that Americans also pay a lot for healthcare in taxes and we don’t even get decent healthcare in return.

> What? I have never seen these alleged "entitled gatekeepers". I have been passed to specialists with no issue. The public sector healthcare is excellent and the same medical standard as is received in the private sector.

I saw it and "suffered" it in the UK. GP visits are terrible there: You only had 15 minutes and GPs seem to always be in a hurry. I've always had IBS and had to go through several GP appointments until they refereed me to a gastroenterologist. Once I was referred, it was pure joy and incredibly good, and I din't pay A DIME.

I also experienced it in Germany. Although it was a bit better than in the UK. My GP in Germany referred me to a specialist Gastro pretty quickly.

I am talking coming from Mexico and the Mexican system. Here we are very used to two systems: A nefarious public one which is just terrible. And a private one which is quite good and at great price. Also, for private care, you can go directly to specialists.

> GP visits are terrible there: You only had 15 minutes and GPs seem to always be in a hurry.

This is how standard care in the US is, even with good insurance. I've always assumed a doctor's time is so valuable it makes sense to carve it into ever smaller pieces.

They are gatekeepers. That is literally their job. Doctors are a scarce resource that you're not paying for. You think all the taxes you pay in a lifetime is enough to cover even a week in a ICU?

Your anecdotes aren’t data.

And the data is pretty clear.

Also, GPs should act as gatekeepers to the far more expensive, and far more risky, specialists. That’s what will keep costs down and reduce risks.

> Healthcare in Europe is not free. You're taxed for it quite highly.

Healthcare isn't free, but the visits to your GP are free, which is what I said.

The real hack is having friends and family in the medical field. You can skip the chicanery of medical “intake” and diagnosis outside highly specialized conditions, get advice without extortionate bills or misaligned incentivizes, and they can help you get appointments with specialists/tell you who’s the best to see, even write you rx’s directly.

I recently had an infection that, due to being geographically isolated from my typical medical network of friends and family, resulted in $1k of bills after insurance for something that was essentially routine and which I would have been able to treat myself if I had the ability to get medicine without an rx.

The general public who don’t have the scientific/medical literacy to self-serve and lack the network to get treatment without going through the formal process are getting fleeced.

Friends and family need to be off the clock too, be respectful if anyone chooses to do this.

The flip side is that they sometimes genuinely want to help. As you say, be respectful.

My elderly neighbour (who I saw maybe twice in a decade) had her daughter visiting, and the daughter came by and suggested I might like to change the dressings on her mother’s ulcers because I’m “used to looking at gross stuff.”

I’m a radiographer. I’m pretty much useless in every situation unless someone has a a high field magnets and wants pictures.

Right, I am speaking more about close relationships where they’d offer help without you even having to ask, not some long-lost friend that you only ever bother when you need their medical opinion.

Is “rx” an abbreviation of “prescription”?

Yup.

> Rx (sometimes written ℞) is a common abbreviation for medical prescriptions derived from the Latin word for recipe, recipere.

https://en.wikipedia.org/wiki/Rx

The medical field will soon be over-ran by software and AI specialists applying and graduating from medical school in order to build the modern individualized medicine augmentation systems of the future. Think about the specialization required to build a reliable, trusted and tested GPT-for-medicine, and then give it to all citizens for free, because, hey, it's going to be a huge boon for our country.

> A half-lifetime of experiencing and observing modern medicine, in good faith, has taught me that participating in the medical system while not in need of emergency care is risking one's health and life.

This is rather hyperbolic. And furthermore, your clearly don't have chronic but non-emergency conditions which require regular care if you care to have a reasonable life (3 going on 4 for me).

So you advocate avoiding doctors and prescriptions unless you break a leg? Good luck when you get one of the many things modern medicine does treat pretty well.

Your criticism of it may have some truth to it, possibly particularly when applied to the US, but the conclusions you draw from them are foolish.

And you'll drop them like they're nothing when you get a bacterial infection your body can't deal with, the likelihood of which will increase in the second half of your life. Or maybe you won't, and die much earlier than necessary. We just had this discussion on a societal level.

The worst experience for me has been dentists in the US. To me it’s a massive fraud industry.

Thank you for your comment. Now I don't need to write the same thing.

I think this is a reasonable response to the terrible atrocity that is medical care (in the US*). The way forward is likely going to be the medical form of 'self-hosted': home medical devices for self diagnosis.

There will be many that flock to this comment to make claims about home devices and how they're 'inaccurate' or other nonsense, but the truth is that it is very possible and in many situations already the case that home devices are FDA approved, and often better accuracy than what you may receive in the clinic. Obviously, this is for a subset of diagnostic tests, and certainly nothing dealing with radiation potential, but the opportunity for expansion is certainly there and I think will continue to expand and fill this enormous hole the US has.

You obviously have no clue how this stuff actually works. Most major medical insurers already have programs to distribute connected smart devices for monitoring vital signs to patients that have been diagnosed with chronic diseases such as heart failure or type-2 diabetes. But those devices are largely useless for diagnosis. You can't really get a home HbA1c blood test.

Demonstrably untrue. CVS sells a kit to do hba1c for $50

https://www.cvs.com/shop/cvs-health-at-home-a1c-test-kit-pro...

Other tests can also be done with a lab. You just have to ask.

Yeah, it's a whole cottage thing: https://www.everlywell.com/

Time in range is arguably a better metric to control anyway, and that’s really easy to track now with a CGM and one of the myriad diabetes apps.

Chronically ill person here, cannot help but agree. "The doctor committed neither malpractice nor acted abusive" is the best outcome you can get out of the average healthcare professional.

It's a profession where practitioners are treated like saints, while having zero incentive to actually do their job- there's no other field in which telling every client "it's all in your head" after running some meaninglessly basic and unlikely to be wrong diagnostics until they give up and go home keeps you employed and paid.

How many people have ever heard the term iatrogenic harm? Basically no one. "Iatrogenesis refers to harm experienced by patients resulting from medical care"

Studies put iatrogenic harm at about 30%.

It is also estimated that the 14th leading cause of death in the world is iatrogenic harm

30% of what? What studies?

Yup. I cannot believe how much insurance providers bend over for actual fake bullshit like chiropractors, dentists or "naturopathic doctors" who use homeopathic remedies, and related quakery, but then try to screw people over on stuff that's actually scientifically more sound.

Are dentist really fake bullshit tho? Dental insurance is bullshit but like dentistry is a legitimate profession.

Insurance however is selling to the customer and the government, it's easy to cover the fake bullshit.

I mean dentists who peddle homeopathic remedies. This literally happened to me where a dental surgeon had me purchase some homeopathic thing to use before a surgery and gave me scare tactics about how much I needed to use it. I ended up forgetting to use it, and was freaked out. When they told me not to worry, I had a hunch, and sure enough when I got home, I saw "homeopathic" on it.

I ceased all service with this dental surgeon and filed complaints with my states dental board. They told me to pound sand, as I have to show that this stuff would hurt people. You could hear my eyes roll as I listened to the states dental investigator explain this crap to me.

> They told me to pound sand, as I have to show that this stuff would hurt people.

What total nonsense. What the dentist did is actually _worse_ than just stealing the same amount of money from your wallet. I guess the only reasonable approach is to try to ruin the dentist’s reputation publicly. Or I guess to just move on since that dentist is just one in a million professional charlatans in modern American society.

CBC did a study went to 20 dentists each of them found a different number of fillings required

Out of curiosity, where are you from?

FWIW, I agree with you, although I experienced the medical system only as a patient / outsider. I live in a former communist country in Eastern Europe.

At this point I'd rather die in my house. So much of it is obviously crap and it's so inconvenient and expensive I'd rather avoid doctors altogether.

If you’re on hospice, you can die at home while still making use of the US medical system.

Nah I don't want them involved.

Hospice’s amount of involvement is largely up to you. Also hospice doesn’t only help you, but also your family. That said, it is of course your own choice. I would personally want as as little involvement as possible from people outside the family.

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