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Comment by lotsofpulp | Hacker News Reader

The primary care doctor role is in the process of being supplanted by nurse practitioners and physician assistants.

I got an appointment at a pharmacy "instant clinic" when I was traveling because I had a persistent cough I couldn't see to throw. COVID test was negative but that doesn't necessarily mean much these days.

Got an appointment in less than a day. The nurse practitioner probably gave me a more thorough look over (absent labs) than my primary care would have. Gave me an inhaler prescription probably as much to do something other than tell me to just continue the OTC medication I was already taking.

Sure, in an ideal world, we'd probably have a next-day MD appointment for everyone. But there's a ton of stuff when an ER or physician isn't really called for.

Anecdotes are mixed. Here's one from me: See multiple PA's at E endocrinology office, test results indicate hyperthyroidism, they all say no that's just barely above normal (it was actually significantly higher), wait months between appointments, after nearly a year force an appointment with the actual doctor, "yep you have hyperthyroidism, let's get the drugs you need to live, I don't know how they missed that". Mind you the PAs worked under that same doctor. So had it not been for patient effort to read and interpret test results, things would still be getting worse. Some PAs are great, some are not. Same as doctors, same as patients self testing and diagnosing.

And a nurse practitioner who has years of varied hospital experience including ER is different from one who doesn't.

And France places an ER doctor in emergency response ambulances - apparently that has value (and they sometimes park themselves while the doctor works to stabilize the patient rather than try to bounce around to the ER.)

Same for France and urgent care. If the phone screen goes in the right direction, a doctor driving around from patient to patient will get to you quickly (~ 20 minutes last time for me.) Even if you don't have local insurance, and for a surprisingly low price.

None of this is impossible - as the US med professions want you to believe.

Not sure what your point is. It sounds like the instant clinic was functionally no different than doing nothing at all.

You don't see any benefit to having a trained/licensed professional taking vitals and making a diagnosis--even if that diagnosis is basically "you'll get better"? And the inhaler was actually helpful. And if the other option was to spend the day in a NYC ER I'd probably have passed.

I'm not a hypochondriac and maybe in a pre-COVID world I'd just have assumed I was "fine" but having a second opinion seemed warranted given the option.

I've also been in an ER when the diagnosis from an infectious disease specialist (after some really bad lab work and high fever) was basically go home, rest, and drink plenty of fluids when his assessment (of a fairly serious tropical disease) took a month to be confirmed from a lab in Paris.

So we just basically self-diagnose and assume it will all just get better?

A wrong diagnosis may be more harmful than you realize - if they are wrong (and they often are) it can lead to death/permanent disability.

I'm not sure what point you're making.

In one case, it would have been pretty ridiculous for me to have gone to the ER given that I didn't otherwise have COVID or other serious symptoms.

In the other case, in spite of a pretty high fever, I'm quite confident that had I gone into the local rural ER at the time they would have had zero idea about the tropical disease I had and, even after I got home with a fairly persistent mild fever, my very experienced primary care MD just knew that my blood work looked bad and it took an on-call infectious disease specialist to know what was going on.

You're not always going to have an expert specialist available.

Not that it mattered in either case because there wasn't really anything they could do other than let my body do its thing.

Ah yes, the perpetual margin chasing enshitification of healthcare.

And while we're at it, companies should probably only hire PhDs from elite schools as developers because you never know when that sort of (supposed) expertise might be needed.

Hiring doctors is exactly what the local hospital needs, and can no longer do after being bought out by a megacorp.

NP: "if it gets worse go to the ER" Thanks...I guess.

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