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Comment by mindslight | Hacker News Reader

That's a typical experience of the US medical system, where you're lucky if you get ten minutes before they start looking around for a broom stick to shoo you out the door.

One should have some idea of what levers one expects a doctor to pull. If a doctor isn't really engaging with your problem, then push towards those. Obviously you can't directly ask for them but rather focus on the right symptoms to nudge them there. You have to tiptoe around their ego.

And if you're wondering why you've got to learn to be your own doctor instead of relying on specialization of labor, well, welcome to our post-capitalist overfinancialized hellhole.

Also for this particular topic, you can send a tick in to UMass for testing and they'll tell you if it has Lyme and many other diseases. There's a bit of a turnaround time so it doesn't work for primary triage, but it's sure nice to find out that you're definitely in the clear.

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"You have to tiptoe around their ego."

Only if you have a shit doctor. I've had to be an advocate for medical care of family members, and I've had a few doctors actually compliment me on being an engaged advocate for their treatment. You still want to be respectful and open minded, but some basic study of the condition/treatment/lingo can go a long way to them seeing you as an informed patient they are willing to work with.

I agree about self/family advocacy, and for sure some of the doctors one gets are engaged and good. I think doctors generally become less shit as the stakes go up (end of life, pediatrics, emergency triage, etc). The problem is getting them to talk about anything proactively before you get to that point.

My comment was more along the lines of if you know you need Doxycycline for a tick bite and they're holding off, you can't just come out and request it. They'll play the 'expert', defending their ego that they aren't working as a mere rubric-following pill-gatekeeper, and tell you how they know better, even though they hand prescriptions out like candy in other contexts. Rather you need to emphasize the symptoms you do have, equivocate rather than ruling things out (eg the tick could have been on me all day or even multiple days), and focus on the less probable bad outcomes that you're ultimately trying to avoid.

"eg the tick could have been on me all day"

Well, that's a problem. If it's only been one day, they aren't going to give it to you. It's only supposed to be past 72 hours. Of course they're not going to listen and they'll argue if you're pushing something beyond the guidelines. If you frame it differently, like you don't know if it's been on there for days, then they're more likely to work with you.

I've actually had a similar tick issue for a child. There was no way of knowing for sure how long it was attached until tested in the lab. The doctor was still willing to prescribe the doxycycline when we explained the situation. There's also a state lab that will test ticks and give a report on whether the tick tests positive for about a half dozen diseases and also tell you how long it was attached. The doctor's lab could only test the tick for Lyme. He was genuinely interested in learning about this other lab from me even though I was not a medical professional.

My griping was more about the medical system in general. My one experience of going to the doctor for a tick was actually pretty good (my primary care doctor, who suffers from the standard push you out the door after 10 minutes and can't you go to the ER instead, but has otherwise been pretty agreeable). I think I told them I knew it was on me for at least 4 hours, but could have been 12, and they prescribed Doxycycline. So either the 72h guideline isn't standard, or there is room for judgement that makes sense to push for. Because personally, I'm not looking to gamble with long tail Lyme and I generally find length of time guidelines for stochastic events pretty uncompelling.

It's standard. Although in this publication they are going by engorgement. Doctors aren't that concerned with the details. It's unlikely they will get sued for prescribing doxycycline to a patient who doesn't have a known allergy to it, so why not.

https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophy...

Is it really supposed to take 72 hours for a tick to begin feeding? The 72 hours in that link seems to be about whether it's within the window that prophylaxis would have an effect (although you seem to be acknowledging this?).

In my case the doc asked if the tick was engorged, to which I responded that I didn't know - I'm not a biologist that studies ticks and can't give such a judgement as a nice tidy answer. Which is getting back to my point about expectations - if the treatment was amputating my leg, then I'd want some professional judgement calls. But given that the output of the medical system was going to be either (doxycycline and blood draw for lab, or nothing), I'm going to push towards the former option given the lack of expected harm and overall lack of attention outside of these scarce 10 minute visits.

FWIW I think I got a full course of doxycycline, perhaps just to avoid breeding antibiotic resistant bacteria rather than for the tick bite itself.

The post exposure prophylactic treatment is actually only a single dose.

The 72 hours in the link is from time of removal. The 72 hours I reference is how long it typically takes for a tick to regurgitate into a host (it has to feed for some time before it regurgitates). The article referenced it as being engorged. The correct answer is in the middle. It takes 72 hours for the tick to regurgitate, but it could technically crawl off a dead host and on to you. But it's harder to identify if it's engorged. These facts led us to use the doxycycline while the lab confirmed if the tick was positive and how long it was feeding.

When you go to an urgent care it is a total crapshoot. I've seen some of the worst doctors ever there. One literally looked at my throat for 5 seconds, said I had strep, and went back to playing on his phone, they weren't busy I was the only person in there.

I've had other misread tests for my kids, saying they had strep when they had RSV. But some urgent care doctors have been really good. I think the ratio is changing in the wrong direction though.

These were in a variety of facility types and there wasn't any real pattern for me.

Wait till they are all replaced by midlevel NP and PAs like is currently happening in hospitals everywhere. The quality of care is going to be even more fractured by their lack of education to med school trained docs.

How do you get a non-shit doctor? They are all shit in my experience.

Any nowadays I can't see ANY doctor outside of an ER or urgent care visit.

Most of it's just by luck. Some can be by references or online reviews.

"They are all shit in my experience."

I don't know, maybe your area is bad, maybe you've had limited experiences, maybe you're a statistical anomaly. Or maybe the problem is on the other side of the relationship.

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