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I had severe and persistent shoulder pain a few years back, it would radiate down my arm to the point it it became actually debilitating. Went to urgent care, they did X-rays, a doc came in and felt around, asked me some questions, and looked at the X-ray results.
Said I likely had bursitis and gave me a scrip for muscle relaxers and painkillers, that BARELY got me through the next couple weeks until the pain went away.
Last year, the pain came back. This time I spoke to one of my Physical Therapist friends who I KNEW saw tons of patients a year. She agreed to do an exam for cash, then give me her thoughts and possible options.
Took her about 10-15 minutes of prodding around to diagnose elevated first rib and a muscle imbalance causing possible shoulder impingement.
She gave me some stretches to ease the discomfort, then some exercises to remedy the imbalance once the pain subsided. Took <1 week for the pain to alleviate, and after easing into the exercises everything started working even better than before. No drugs needed.
Sort of broke my last remaining faith in Doctors as the gatekeepers of health.
I know this is an immensely frustrating experience as a patient but it is important to understand that this is not what urgent care is for.
If you saw a physiatrist (which is the specialty that handles this kind of problem) and they get it wrong....that person's license should maybe go away. A good PCP should get this right but these days we don't do nearly as much MSK work and hospital demands mean we aren't as good at this kind of thing as we used to, you may have PT be the replacement for managing it since it isn't really a medication issue.
But it's effectively out of scope of practice for Urgent Care and ED.
Patients go to UC and ED because it's more convenient than getting a PCP, but ED physicians don't handle these kinds of issues, their job is to triage and manage emergencies, which would likely involving turfing this back to a PCP or PM&R doctor for outpatient management.
There's all kinds of reasons why patients use UC and I get it, but ultimately it results in a lot of disastifiaction because it's generally not the right doctor for the problem.
The fact that I was able to get an issue solved by a Physical Therapist with an investment of about $50 and 30 minutes of time seems to suggest that the medical industry is overcharging for certain services.
Not sure what you'd suggest I do when I'm experiencing ongoing immense pain but no immediate danger and it'd take weeks or possibly more to get in with a specialist.
If the urgent care folks had said "oh, we aren't really geared for this, go see a physiatrist" then I'd give them credit.
That ain't what happened.
I mean a physical therapist is the appropriate medical professional for the issue you had. You went to the "am I dying" doctor and they said "shit I don't know, you aren't dying," if you were dying they would be able to help you. They have limited training in diagnosing MSK issues because that's not what they are for.
Routine issues and urgent care level emergencies are supposed to be managed through your primary care doctor who would say "this seems like an MSK problem, here's as prescription to go see a PT for that, as they are the experts in this area and can spend an hour with you twice a week and I can't do that without it being cost prohibitive."
We see this all the time, people go to the ED for non-emergent issues and get frustrated when they get what seems like poor quality care and it takes forever.
Furthermore patients don't like hearing this so you get some half-assed attempts at managing these issues in those settings instead of the correct response which is "no go see your PCP."
Ultimately if you say, go to your lawyer and ask for accounting help, they may charge you for it and try and help but they aren't an accountant.
Well conveniently I explained what happened with my primary care physician elsewhere in this thread.
i.e., he's been 99% useless to me compared to the time and money cost, so urgent care is simply the better option.
Ackshully, as a practicing lawyer, I can say that that may very well be malpractice, and its for this exact reason I keep a number of trusted accountant and financial advisors in my rolodex to send clients to rather than even risk that issue.
PCPs have sick visits, you establish with a PCP and they'll schedule you urgently if something needs to be managed urgently, if you have an established relationship with a PCP they'll know how reliably you are and will do somethings over the phone. This is how it is supposed to work, Urgent Cares exist because people these days refuse to use the system how its designed (and it's because of incentives, I get it and have committed this crime also) but they aren't really designed for the care people ask of them.
Additionally, physician pay has decreased year after year for longer than the majority of the people in this forum have been alive. This has a number of important effects one of which is: most of the shit that annoys you most about doctors is not their fault, they are required to do it because they aren't in charge anymore (most people in most specialties are employed now and not in independent private practice).
-Can't do something simple over the phone has to be an appointment? It's because that doctor's employer requires it so they can bill.
-Appointment short and unrewarding? It's because that is how the employer wants appointments scheduled.
-Doctor pays mostly attention to the computer? It's because there is no admin time and if he wants to go home before 8pm he's gotta start charting in the room.
-Doctor asks you annoying repetitive questions? Someone has mandated they ask them in order to bill or satisfy regulatory requirements or some other annoying thing. Or some incompetent front desk staff person said you were a smoker or a drinker or are missing your appendix and it requires forms in triplicate to remove from your chart.
Doctors no longer work for themselves and are now required by law and by their employer to do things that annoy the hell out of patients and we hate it but its not our fault please dont blame us thank you.
Sounds like a design problem.
Sounds like a design problem.
Sounds like a design problem. I'm not blaming them, definitely not individual doctors.
But doctors are theoretically in the best position to raise the issue and demand or impart adjustments. Seems like there's a large... incentive problem, who profits from keeping things as they are, and why don't they suffer consequences for failure?
Another Eliezer Yudkowsky tweet that lives rent free in my head on top of the other one is his almost certainly correct argument that completely removing all regulations currently effecting the healthcare industry would create immediate improvements compared to the status quo.
So, hope that Trump takes a chainsaw to the healthcare regs?
He also has interesting ideas on addressing the status quo.
It's designed well, people just refuse to use it correctly and we can't force them. No amount of civil engineering is going to make up for disaffected young males who insist on driving around at 40 miles over the speed limit.
Society has mostly decided we can't force patients to use the systems correctly or take care of themselves. And I'm okay with that. Although this was a big part of what the ACA was about - health insurance only really works if everyone has it so you needed to force people to get.
I'm not saying all the regulations are good, many are emphatically not - physician salaries have been dropping for forever, so what's causing increased costs? Well a bunch of it is admin and other horseshit like that.
Think about how complex some of this system is, a huge percentage of costs, maybe even worth as much of 50% of doctors salaries, is healthcare workers and systems protecting themselves from getting sued. You want to drop healthcare costs and make access easier? Great make it so we can't get sued. I promise you that you will mostly get better quality care faster and for cheaper. But no, people don't want that, they want to be able to sue.
So healthcare is more expensive.
So much of what goes on is like that.
"People refuse to use it correctly" sure looks like bad design from the outside.
Ever heard of "Desire paths?". You can have a beautifully engineered and designed walkway, and people will still walk through the dirt if that makes more sense to them.
Similarly, you can try to get people to use their PCP as the doorway... but if that's too complex or annoying of a process they'll skip that and use urgent care.
Maybe just maybe there's a way that accommodates people's preferences.
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