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There's a huge number of people who vastly overestimate their medical knowledge, google some symptoms (I'm sure you know the pitfalls of that but many don't), do self-diagnosis as a hobby with friends over coffee, come to absurd conclusions and then bother their doctors about it.
It's not ideal but somewhat understandable that under time pressure experts want to to know the object level (symptoms, history) and don't want to waste time listening to the speculation of non-experts, even if that speculation is sometimes right, and even if some (the doctor can't tell who) of those non-experts actually make good points.
It's understandable from the standpoint of irritation, if the doctor is presented with the same crack pot theories all the time then it's understandable how he would ignore such theories.
It's not understandable from a moral standpoint. If the doctor isn't delivering to the patient what equates to the thousands of dollars the patient forked over to him, then the doctor needs to be paid the amount he deserves.
When a drunk driver kills someone on accident he is honor bound by morality to be responsible for the death. Being drunk is not excuse. Same with a doctor. If he claims he's an expert and he's paid thousands of dollars for a check up he is responsible for being right and if being right means listening to every single theory from the patient because that's what he's morally obligated to do. Not wanting to "waste time" because of "pressure" is not an excuse. Ever. Lives are at stake.
https://www.cnn.com/2023/01/31/health/us-health-care-spendin...
It's disgusting.
Oh and check this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139931/#:~:tex....
It's not just incompetence. Trustworthiness is also an issue.
There's a cost to tests of rare diseases.
This is a cartel based law. Basically patients can't order tests or even look at results from tests by law.
The "made up" reasoning for why this law exists is because the law makers acquiesced into agreeing with doctors that all patients are fucking idiots. That's the bullshit reason.
But really it's business reasons. Same reason why the doctor supply is made artificially low, all these things are legislated by the AmA to lower the supply of doctors and give them more control.
>Sounds like you have a problem with either your insurance provider or your wallet.
If you're a doctor. My problem is you. How does a doctor even have the gall to say this? It's flat out wrong. So if you're a doctor there's only two logical possibilities for why you said what you said. 1. You're a liar and are therefore untrustworthy. 2. You don't know what you're talking about and are therefore incompetent. Which is it?
Over testing is a problem. The way to lessen over testing is to not be an incompetent doctor so that patients don't take things into their own hands. Barring that you have no choice but to let the patient test himself. It's the moral thing to do.
I guess here's an interim solution. Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. The reason is the patient is more intimately familiar with his own symptoms and your just pattern matching based off of a high level probability. If you've never seen a patient with a certain condition you often bias towards the conditions you've seen.
Yes patients can be biased but so can you. And there's no denying that patients can do more detailed research and they have a perspective with a resolution you will never achieve. The good doctor needs to listen to them.
> Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it.
Precisely not. That's exactly how you get unusable results with super expensive healthcare, because the follow up that a positive test dictates is often worse than the initial problem, and can impact the population at large (e.g. antibiotics use). All that in a context where the post test probability is very low. There are situations where this does not apply, because we have good exploratory AND confirmatory tests, but that's far from being the norm.
Regarding your other points, sure we should always listen to what the patient has to say. There even is a saying about it: "90% of diagnoses are made on personal history". That's because diagnostic tests often are far less useful than you'd expect. Again, I encourage you to learn about how medical testing works. You say you root for AI to replace docs, but apart from not being human anymore, I doubt you'll find your robot doc to be so different regarding your particular situation.
All that aside, I'm not rich. I chose to stay in Europe where I earn less because both US doctors and patients are so toxic. You are a prime example of this. In Europe, we test much less and overall both docs and patients are far less aggressive. Yet healthcare here is cheaper, universal and IMO better overall. Everybody profits from more relaxed doc-patient relationships. US Healthcare is first and foremost a cultural issue, and US patients are part of the problem as much as docs are.
I'm not gonna deny this. A lot of people in the US hate doctors. Part of it is the ineffectiveness of the health care and the other part is the price. We aren't getting what we pay for and we also don't trust the doctors. So there's both a lack of trust and a lack of respect. I enter any doctors office the same way I enter into a hardcore business deal which is I anticipate that the doctor is not in it to care for me, he's in it to get the most money out of me possible without breaking the law.
There's too much business incentive here. You label me as toxic but there's a reason why patients in the US have such a vicious attitude toward docs.
Most tests aren't for things like testing for HIV. So your reasoning makes zero sense as this law is applied to every test. And the whole suicide thing is obviously a miniscule issue. You're just making that crap up to sow controversy. Yeah I'm sure you encountered dozens of patients ready to kill themselves over test results but only your kind words were able to completely assuage them and stop them... Yeah sounds like a load of bullshit to me.
There's no controversy here. It's a business incentive through and through.
Patient choice would satisfy all patients. Only doctors wouldn't be satisfied. And that's the problem.
Patients are dealing with there lives here. And Even you as a third party are painting the situation as "controversy" because you've been so desensitized by the patients you're supposed to take care of.
Even though you're not in private care you are part of the problem because you're blind to the problem. I know multiple patients who had surgery in America only to go to another country for a check up for the doctor in the other country to say the surgery was completely pointless.
You know how serious that is? I don't think you get it. Painting a crime as "controversial" or "political" issue is extremely aggravating for the person who's life is at stake. The only reason you characterize it this way is because you're not the one who's life is at stake.
Patients aren't toxic. Patients are desperate. And most doctors including you just don't give enough of a shit. I'm sorry but that's the truth.
I can't respect a doctor who doesn't understand that and thinks it's just toxic. You're lucky to be practicing Europe.
Insurance is one of the major problems in the US, and they're a parasite on all of the US society, so this line of thinking is completely backwards.
However, the idea that physicians should make less is reasonable, in order to get people who are more interested in the real medicine, rather than money seeking people that is often found now. Getting rid of insurance and the structures that involve it essentially solves this issue.
Unfortunately, it's unlikely to occur, so sidestepping everything using capitalism is the only way forward I can see. One good example is making diagnostic tools at the house more common place. It's pretty typical to be able to purchase an entire machine for the price you will be charged at a physician's office.
For instance, a good 12 lead ECG may cost about $1300 to get for your house, but it will also cost that much to get one test done at the physicians office. So it's clear that buying one for the house is the way to go, as you can do it everyday for years for the price of one time through 'the system'. It could also be much cheaper if targeting every household through economies of scale.
This is true for essentially all diagnostic tools. So it's about time people just expand their first aid kits to involve some of these simple diagnostic tools, like urinalysis kits, etc.
The interpretation is of course valuable, as it takes a little while to understand the output of different tools, but much of this is very capable to be automated and sold with the tool or plugged into a foss solution.
Perhaps it's not ideal to some, but it's the easiest to occur in capitalistic settings and where insurance keeps costs at institutions so high.
Of course the reason why there's a low supply of doctors is a deliberate business maneuver made by the AmA to lower the amount of doctors by lowering the amount of medical schools. In short Doctors are the reason why there's a low supply of doctors.
The problem isn't purely capitalistic. It's sort of a hybrid of capitalism and government thats what causes this problem. When doctors aka the AmA are able to influence law to give them an unfair advantage that's what is responsible for the current state of things.
In fact hybrids are responsible for most of corruption. You have to keep a clear separation between business and government for a healthy free market economy as in business cannot influence government but government can influence business. The incentives are misaligned for both parties. One is profit the other is honor, thus they cannot mix.