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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.
If you want us to redesign the system you need to sacrifice something else, most likely increased paternalism - is that what you want?
There are no penalties for misusing the system now, inducing penalties for bad behavior is the primary way we correct things and make systems function.
Or do you want Urgent Care to be staffed by ED and FM? That would certainly address the issue but would dramatically increase expense.
Look, all I want is to be able to buy health insurance that covers only catastrophic injuries and the attendant recovery. I want to be able to pay my doctor in cash for any other services, and be able to have medical care for any minor but debilitating injuries readily available on demand. Why is that practically impossible under the current system?
As it stands, with health insurance tied to employment, I can lose access to a doctor if I switch jobs or the my employer switches insurance plans, and I can't actually be sure how much anything costs because there's no price transparency.
So I'm 'forced' into getting health insurance that covers every little thing, which most studies show doesn't actually improve outcomes for people.
I would hesitate to use a study from that far back because the American health landscape is so different now (in terms of population health, costs, and availability of interventions). Diabetes alone could fuck up the results (and almost certainly does).
I mean what you are asking for is available. Catastrophic plans are available on the marketplace and plenty of family practice doctors offer a practice sort of what you are suggesting. It is expensive but that's primarily because this model is a thing of independent practice which is dying outside of high tax brackets. Doctors aren't in charge when they are employed so they have to do what the employer says. Although my PCP is boring and they can do that (minus cash pay).
Ultimately nearly everything most people hate about healthcare is stuff that doctors don't have any control over and also hate, but we get blamed and people want to make our lives more miserable. It is very frustrating.
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