Control
Golden Baronet of the Realm
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Health Problems
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Kithani
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How many landmark/practice changing papers do you think are released in a year?
Control
Golden Baronet of the Realm
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Just a guess, but more than the average pcp reads? And then what about papers that probably should be practice changing, but aren't?
But really, what's the alternative? Just very generally describe your problem and then blindly trust that the doctor is fully informed on your situation and also that he is able and willing to fully inform you based on his expertise in the maybe 5 minutes that you see him every few months? Even assuming complete competence, how can you even properly articulate your issues without doing some of your own legwork first?
I mean, seeing drug ads on tv and then asking your doctor for them seems to be a pretty accepted way to practice medicine these days. Almost anything is an upgrade to this.
Kithani
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I’ve said it before on these boards but the answer to basically all of your guys’ complaints is to sign up for a direct primary care office where the doc will spend more time with you than your insurance will pay for.
Personally I would wager the answer to both of our questions is prob a single digit number but I am somewhat far removed from being a PCP. It’s more common to keep up with stuff by podcast, internet, literature databases and CME conferences than it is to sit down and read dry papers. I would wager big money your PCP reads *something* *somewhere* on a pretty daily basis
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Sheriff Cad
scientia potentia est
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It's okay, it's his choice to leave his future health up to the guys with the lowest possible board scores that didn't match into anything good.
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Sheriff Cad
scientia potentia est
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Hey man, kindly fuck off, I'm giving advice to people here to help own their own health outcomes and you are not contributing or being helpful.LOL at a lawyer talking down about PCPs
Hey at least you and your buddies can swoop in to save the day if something bad happens help them win that jackpot
If you have other advice to give, give it. Recall you are in the grown up forum.
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Control
Golden Baronet of the Realm
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Even in the most charitable view of pcp preparedness, didn't the 10 million pages of the covid thread teach us that the range of available treatment options is largely set by admins and/or heuristic? And (again, charitably) assuming competence and best intentions, that probably works for most problems/people. Should you blindly bet your health that your problem conforms to most? Sorry, I'm not trying to bitch at you, but that just really seems like a confusing position. I mentioned it somewhere a few weeks ago, but when I complained about terrible/declining energy and mood and asked for a hormone panel, the reply was literally "well, I guess we can do that, but have you considered an ssri? prozac worked wonders for me!"
I mean, I'm obviously nobody's health role model, but I try to at least be minimally prepared for the relevant conversations.
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Kithani
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I've given the best advice I can, multiple times in this thread, and that is direct primary care. I'm not giving out actual medical advice on the internet but 90% of this forum probably should drop the pizza rolls and get on the exercise bike and you don't need an MD for that.
I get that this thread is largely the blind leading the blind with occasional input from an RN but implying that PCPs are somehow borderline incompetent because they didn't go into a competitive specialty is completely ridiculous, borderline Dunning-Kruger from someone in a completely different professional field, and also not helpful at all to anybody. I would generally steer well clear of midlevels although that one guy's PA seems pretty hard working and PAs are certainly better than NPs, but to imply a residency trained MD/DO PCP is just one of "the guys with the lowest board scores possible" and that somehow makes them less competent to diagnose and treat medical problems than all you random ass IT workers and a lawyer in this thread is just ignorant at best. I mean that sincerely, going and trying to read papers and diagnose yourself is only going to cause confusion/anxiety and I see it at least monthly if not multiple times a week.
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Many experienced doctors just go by checklists/procedures; not much critical thinking. Especially the ones that do routine procedures for a living.
I went to see a GI doc, and mentioned I had food poisoning a while back that had mostly resolved, and that I had rectal bleeding due to hemmorhoids/fissure (diagnosed by a proctologist).
His first response? Oh let's do a colonoscopy + endoscopy! Despite the fact that the chances of me having colon cancer at my age is .009%, and and an endoscopy wouldn't yield anything more than telling me if there was an ulcer or not.
I asked him about a stool test and he said those are only for people 45+ (same as colonoscopy which you are recommending for some reason eh..) and GI map to see if I had any bacterial overgrowth in the gut, and apparently he doesn't do that, that's a different GI doctor.
His reasoning? "Oh we don't take chances when it comes to colon cancer, it's on the rise..". Yea.. you're recommending a highly invasive procedure that could potentially puncture the colon and harm the patient because there's a .009% chance he has colon cancer. I imagine they don't even teach statistics in med school. Same reason so many idiots recommended and took the covid jab. Not only that but the incidence of colon cancer in men age 0-49 is 10,500 cases per year out of 110 million men. That's a .009% chance, and pretty much every doctor I talked to doesn't realize that even if the incidence of colon cancer DOUBLES, that's still only a .019% incidence. So whoopdy doo, instead of there being a 99.99% chance I don't have it, there's a 99.98% chance..
Many of them recommended these procedures guilt free because there really is an infinitesimally small chance their patient has something serious, and they make bank off the procedure.
Lesson I learned is to avoid young doctors. This dude was probably 10 years out of med school.
This is my next step, I need a GI doctor that understands my risk profile and won't jump straight into a fucking colonoscopy due to hemmorhoids/fissures I've had for probably 18 years.
I went to see a GI doc, and mentioned I had food poisoning a while back that had mostly resolved, and that I had rectal bleeding due to hemmorhoids/fissure (diagnosed by a proctologist).
His first response? Oh let's do a colonoscopy + endoscopy! Despite the fact that the chances of me having colon cancer at my age is .009%, and and an endoscopy wouldn't yield anything more than telling me if there was an ulcer or not.
I asked him about a stool test and he said those are only for people 45+ (same as colonoscopy which you are recommending for some reason eh..) and GI map to see if I had any bacterial overgrowth in the gut, and apparently he doesn't do that, that's a different GI doctor.
His reasoning? "Oh we don't take chances when it comes to colon cancer, it's on the rise..". Yea.. you're recommending a highly invasive procedure that could potentially puncture the colon and harm the patient because there's a .009% chance he has colon cancer. I imagine they don't even teach statistics in med school. Same reason so many idiots recommended and took the covid jab. Not only that but the incidence of colon cancer in men age 0-49 is 10,500 cases per year out of 110 million men. That's a .009% chance, and pretty much every doctor I talked to doesn't realize that even if the incidence of colon cancer DOUBLES, that's still only a .019% incidence. So whoopdy doo, instead of there being a 99.99% chance I don't have it, there's a 99.98% chance..
Many of them recommended these procedures guilt free because there really is an infinitesimally small chance their patient has something serious, and they make bank off the procedure.
Lesson I learned is to avoid young doctors. This dude was probably 10 years out of med school.
This is my next step, I need a GI doctor that understands my risk profile and won't jump straight into a fucking colonoscopy due to hemmorhoids/fissures I've had for probably 18 years.
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moonarchia
The Scientific Shitlord
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Uhh, dude, if you've had that for 18 years you should probably get the colonoscopy. They have made them very safe these days, and knock you completely out for the procedure. The 3 days leading up to it will suck, but if they can find a way to help you not have hemorrhoids anymore that is money well spent.
It's been an issue on and off because I've neglected fiber/water intake. It's flared up recently because I haven't been taking my diet seriously.
It's something that I've fixed within literal days... I raised my water intake to about .75-1.0 gallons daily, added some fibrous veggies to my diet, and now my bowel movements are perfect, all issues gone. The problem with things like fissures/hemmorhoids is that people aren't consistent enough in their regimen and all it takes is one round of constipation to set back to square one. Constipation = tearing of lining. So if you have normal bowel movements long enough, it allows the wounds to heal.
Colonoscopy for that serves no real purpose as there are other means to deal with rectal issues like flexible sigmoidoscopy, proctoscopy, etc..
My proctologist might have recommended surgery for it if it continued to be a problem, but he wouldn't have suggested a colonoscopy just for that issue.
Gavinmad
Mr. Poopybutthole
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The diligence of my primary most likely saved me from needing a lobectomy and I easily could have ended up losing the entire lung or dying if the lung infection had gone even a couple more days without being diagnosed. Instead of a wildly invasive chest surgery I got a simple debridement and a picc line. The suggestion that she's only in family medicine because she wasn't fit for anything else makes me want to slap the person who suggested it.
Although how dare you suggest that typing a couple symptoms into a bing search isn't enough to confidently self-diagnose with 47 different kinds of cancer?
Izo
Tranny Chaser
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Haus
I am Big Balls!
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I will say this. I do agree with
Cad
in that everybody needs to be engaged and involved enough to be an active participant. if you have an IQ north of 120-ish you shouldn't have any problem understanding medical terminology and situations. Hell, when
Mrs. Haus
had her kidney and other medical situations around a decade ago I ended up going deep enough to learn how to properly read and go through imaging with the medical imaging software and understand what was what so I could ask better questions and understand more (which one kidney Dr was amused/impressed by, and another was borderline indignantly insulted that I would ask things....)
With that said when she had her situation start coming up, because of previous situations and complications we opted to do something along the line of what
Kithani
said and we dropped the coin for 3 years of a concierge medical practice PCP, which was a whole different world. It was like going from a normal Dr to borderline Dr House level diagnostic experience. But in the end it ended up being a budget line item we found wasn't delivering the benefits once she was past her crazy medical hoot-n-nanny (Yes
Izo
that's an American technical term) phase.
Earlier this year when I had my own kidney misadventure it armed me to be able to read all my own imaging, thoroughly understand what was needing to be done, and in one case make a decision which I think mildly annoyed yet another kidney Dr but in the end has turned out rather well for me (opting for a cryoablation rather than a traditional robotically assisted partial nephrectomy).
Personally, the feeling I get from the
Cad
commentary on this is one of a legitimately good intentioned advice, but that came across a little odd. If I was going to go full tilt boogie and dive into all things medical enough to be able to self diagnose or fully guide my care regardless of my Dr or her PAs opinion I believe it would introduce a higher chance of medical misstep. The same way I would trust her to make medical advisement, I would expect if she had cybersecurity questions or concerns she would trust my advice on, and if I had legal situations I would want a lawyer I could trust more than my personal opinion (no matter how well informed/trained by the internet) Whereas I don't believe in over specialization, I do also understand the benefit of finding good reliable experts and trusting them in their respective fields of expertise. To paraphrase Steve Jobs (IIRC) "You don't hire smart people to tell them what to do, you hire smart people to have them tell you what to do".
Cad
in that everybody needs to be engaged and involved enough to be an active participant. if you have an IQ north of 120-ish you shouldn't have any problem understanding medical terminology and situations. Hell, when
Mrs. Haus
had her kidney and other medical situations around a decade ago I ended up going deep enough to learn how to properly read and go through imaging with the medical imaging software and understand what was what so I could ask better questions and understand more (which one kidney Dr was amused/impressed by, and another was borderline indignantly insulted that I would ask things....)With that said when she had her situation start coming up, because of previous situations and complications we opted to do something along the line of what
Kithani
said and we dropped the coin for 3 years of a concierge medical practice PCP, which was a whole different world. It was like going from a normal Dr to borderline Dr House level diagnostic experience. But in the end it ended up being a budget line item we found wasn't delivering the benefits once she was past her crazy medical hoot-n-nanny (Yes
Izo
that's an American technical term) phase.Earlier this year when I had my own kidney misadventure it armed me to be able to read all my own imaging, thoroughly understand what was needing to be done, and in one case make a decision which I think mildly annoyed yet another kidney Dr but in the end has turned out rather well for me (opting for a cryoablation rather than a traditional robotically assisted partial nephrectomy).
Personally, the feeling I get from the
Cad
commentary on this is one of a legitimately good intentioned advice, but that came across a little odd. If I was going to go full tilt boogie and dive into all things medical enough to be able to self diagnose or fully guide my care regardless of my Dr or her PAs opinion I believe it would introduce a higher chance of medical misstep. The same way I would trust her to make medical advisement, I would expect if she had cybersecurity questions or concerns she would trust my advice on, and if I had legal situations I would want a lawyer I could trust more than my personal opinion (no matter how well informed/trained by the internet) Whereas I don't believe in over specialization, I do also understand the benefit of finding good reliable experts and trusting them in their respective fields of expertise. To paraphrase Steve Jobs (IIRC) "You don't hire smart people to tell them what to do, you hire smart people to have them tell you what to do".- 2
Izo
Tranny Chaser
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It took SJ +9 months from pNET diagnosis to accepting treatment. Inbetween he tried all sorts of diets before accepting, at the time, the best treatment option, surgery. Should've gone with his own advice, mebbe?
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Can you provide some guidance on how to do this? Seems like what you're saying is that you went for some kind of private more personalized doctor? Does insurance cover that?
Haus
I am Big Balls!
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Insurance DOESN'T cover it. If you're in the US, google up "Concierge Doctor" in your area. The idea is you pay a yearly "membership" to the practice essentially. What this allows is that instead of being like a normal PCP where the Dr needs to have thousands of patients to make the practice sustainable due to how insurance pays out they make enough money on the memberships to do with a TON fewer patients. What this does is it let's them given honest and dedicated attention to the patients they have. They still bill what they can to your insurance, but the yearly fee for them won't be covered.
If you've ever become hyper-frustrated with how is feels like you struggle to get a Dr appointment, have to schedule one way far out, can never get one when you have something come up suddenly, and then when you get to the Dr you wait a long time, get put into a room talk to a nurse for a while, then get MAYBE 5-10 minutes with the actual Dr, then feel like they hand you a "one size fits most" diagnosis (usually with a script for whatever the latest pharma rep coming through was pimping) and you have some cash to spare, then you're the target audience for Concierge Doctors.
When she was seeing one my wife never had to wait more than 2 days to see the Dr. When she went in there were nurses there, but most of the time was with the actual Dr. The Doctor would explain anything she had a question about. The Doctor would answer emails, their patient portal, and even texts. She had the Doctors actual cell phone number if she needed to call it. The doctor would coordinate to make sure the various specialists and diagnostics were all on the same page.
OTOH, it added a few benjis a month onto the budget.
But with what she was going through I consider it worth every penny we spent at the time.
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