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The parasites in this situation are the health insurance companies, and to a lesser degree, the actual providers.
I was recently sick, and it took four different doctor visits before somebody just gave me the antibiotics which fixed whatever problem I was having. The first one, an "urgent care" told me to just rest and hydrate. The second, my PCP, gave me a covid test, said that it was negative, shrugged, and said R&H, the third (telehealth) gave me a useless antibiotic and did no testing. The fourth, another UC, gave me a strep test, a mono test, and then some steroids and antibiotics.
This is retarded. A family member, when I was first complaining about being sick, offered to just write me a prescription for the cocktail of drugs he takes when he starts feeling sick, but me being a good little boy said I wanted to go see a doctor.
This should have been a 2 minute long discussion with a pharmacist at most where I tell them what drugs I want, then half an hour at my local lab where they do a few tests for me, and that's it.
As it is, with the retarded "health" cartel, there was probably thousands of dollars of useless waste spent on useless doctors and useless nurses performing useless tests (covid? Really? Flu?). Their goal is to gatekeep as many things as possible behind absurdly expensive gates, then when costs go to infinity, they demand the government subsidize them.
The couple you talk about in the beginning of this post suck, but so does the industry they're sucking.
As usual this is all made a lot worse when the government subsidises all of it.
As usual I'm probably pissing into the wind here but this is so much more complicated than your over simplification. You aren't paying healthcare workers to answer simple questions, you are paying them to do things like know when something isn't actually simple - ex: your shoulder pain isn't your shoulder it's your gallbladder and you need surgery not pain killers for your arm.
Patients will always ask for antibiotics even if we know in advance the issue is viral and antibiotics won't do anything, and that's not counting the goal of abx stewardship, or just minimizing side effect burden. No medications are safe, if you give everyone in the country a full course of antibiotics people are going to lose their kidneys, have joins explode, or just flat out die.
All lab testing has sensitivity and specificity and someone needs to know when it should be ignored.
And so on and so forth.
And if you went to an urgent care you probably saw an NP/PA who doesn't know what they are doing but was put in place as a misguided cost saving and simplification mechanism.
I was making a general point about the inefficiency of the healthcare system, but to address these point specifically:
I didn't ask for antibiotics. I was trying to do things exactly the way you are advocating here. I didn't just get antibiotics, I did go to the doctor four times, and the first 3 of them did essentially nothing. The first one had this interaction:
The second one was this interaction
The third one was a telehealth visit, literally not even a video just a text message with a doctor (maybe?)
The fourth was:
etc.
Yeah probably a viral thing -> weakened immune system -> bacterial infection/secondary viral infection, and anti-biotics were a coincidence. My general point is that this entire escapade is only made worse by gatekeeping healthcare. Offhand I can think of 6 different doctors with different specialities in my very close family circle (either my siblings, or godparents of my kids), and all of them would easily just let me call them and give me recommendations on what do to while I'm sick. The point I'm making here is that I didn't do that, because I was just trying to use the healthcare system as prescribed, and that i was an inefficient joke.
I don't know your specific situation the abx thing is meant to be an example of more general problems, often brought up around here, including elsewhere in this thread.
Also, I want you to look up the professional credentials of the people who saw you and check if they are actual doctors. Bad doctors exist (although I don't know if you got bad care here) but several times a week I see questionable decisions and the patient says "my doctor blah blah" and I check and it's not actually a doctor.
The thing is you didn't do what you were supposed to do. I don't blame you, this happens for all kinds of reasons - an expansion of options making it unclear what is supposed to happen, advertising dollars, certain locations not having resources, a desire for convenience, poor planning. All kinds of stuff.
The system is designed such that you have a PCP, you see your PCP, they know you. Urgent care is almost always bad, and the range of things you should be using it for is minimal. It shouldn't exist but it exists because people refuse to have PCPs. Sometimes this is because of a shortage and insurance issues but usually its because of people not actually sitting down and finding a PCP, their are almost always university systems taking new patients for instance (and likewise Telehealth companies if they have physicians at all are shit quality care farms and not providing anything resembling acceptable standards of care).
But this means you need to establish with a PCP and do things like go to a well visit yearly when you don't have any complaints.
Then if you have issues you call your PCP, they have spots on their schedule for sick patients and you come in, or they tell you to go an ER because that's what you need to do (or they need to say to protect their license from lawsuits).
This does involve at times waiting with discomfort, which people do not want to do, but 100% on demand healthcare is expensive or low quality.
Lastly, the vast majority of run of the mill illness has a treatment of "supportive care" aka we can't do shit so just wait and rest. Even if that is not your illness the best resource stewardship generally involves waiting for awhile before doing anything because it costs everybody less money and involves "do no harm" by not doing extra, unnecessary stuff that causes avoidable illness.
People don't want to sit and wait and be sick but it is often the correct thing to do.
My insurance changed last month, my PCP is no longer “in network” and the wait to get into a new one is long, which is why I was at UC. I did go to me “PCP” (a concierge group). That was the second doctor, which I paid cash for. As the symptoms worsened I could have gone back to them again, I guess. However when I was there, they seemed almost offended that I was because my insurance wasn’t usable to them. One reason the doctor said she didn’t want to do any tests (and tried to just get me to go to CVS for the Covid test instead of doing it there) was that my insurance wouldnt cover any of them.
So; just more ridiculous inefficiency in the inefficient healthcare system.
Kind of a meta point here, but I think you’re demonstrating maybe my exact frustration. You assume I’m stupid and don’t know how the system is supposed to work, or that I’m trying to abuse it in some way. I’m assuring you: I do know how it is supposed to work and I’m trying to use it correctly. It’s just that the system does suck
While that's something of an edge case, again watchful waiting is the treatment for most human illness by the numbers. That's appropriate, but annoying. Most doctors are used to doing something because patients demand it but that doesn't mean it's a good idea, just that they don't want complaints/bad reviews/lawsuits/etc.
What about this was inefficient?
You want doctors to order expense interventions that are not risk free just because you demand them?
You want to do what most countries do instead which is provide significant care rationing and shortages?
You got to rapidly see several providers, in most countries you'd just be waiting for days to weeks or even months and then they would tell you they weren't going to do anything most of the time.
Maybe you want to be able to decide your own care. A few countries allow that but they are never countries remotely like the U.S. - usually some combination of much poorer (so few people can afford to dictate their own care), much healthier (and critically with less comorbidity so stupid decisions are less risky) and perhaps most critically: anti-intervention. I've heard from Indian doctors that their patients refuse to take medication most of the time. Americans overuse. It just wouldn't work here for a million reasons.
Lastly, who would they sue when things went wrong? Can the government sue you for fucking things up? Can we order your death because you chose to do something stupid and destroyed your kidneys for no reason?
Fundamentally most people can't be trusted to manage anything technical - if you poll people on a plane that's being delayed for deicing a good chunk would want it to take off and get themselves killed. Even most doctors can't be trusted to sensibly manage their own care because they are too close to it. People off the street? Jesus.
Recently experiencing mild inconvenience is not a good reason to advocate for disastrously stupid policy.
Again, I am not a doctor. The response I am giving here is essentially me echoing the response I've gotten from telling this story to my doctor friends/family. Basically: "You had a fever for a week, you tested negative for the few viral things they tested for, and they didn't want to explore it further at all or put you on an antibiotic as a precaution?"
Maybe that's wrong. I don't know! What I do know is that "the only people who should be able to tell you anything about this have to make $250k/yr at a minimum, and have to have a seemingly endless number of administrators around them" seems outrageously inefficient to me. Maybe it's not!
As presented (which it may not be! One of the things we get paid for is to know what information is important) um, to put it gently they need to reconsider what they are doing or if they are specialists they should refresh on general medicine. Antibiotics target a specific organism, random antibiotics is effectively never a good idea in an outpatient setting. Empirical supportive care is fine for a variety of things. Things like an extended viral panel would be low value but critical for having an informed opinion. Knowing your Centor score (which a Telehealth doc can't do either) would be important.
To be charitable maybe they haven't been following practice guidelines. Or maybe I haven't been following practice guideline updates since I'm not in primary care, but viral illness is the primary cause of sore throat and with rare exceptions we don't have any way to treat viral illness.
Any kind of fever of unknown origin work up is a bonk straight to idiot jail with your timeline.
In any case, as I've mentioned before, we don't get paid to manage stuff like this - usually go home and relax is the treatment. We get paid to manage your aunt who is on 8 medications for chronic conditions including hypertension, diabetes, heart failure and s/p hysterectomy for 3a cancer who we see every 4-6 weeks instead of once a year.
Most of the job is not the kind of thing that relatively young and healthy people are seeing us for.
Outpatient administrative burden is usually because of regulation and actually has value (at least in my experience). You won't catch many (if any) physicians supporting the existence of the assistant infection control nurse for the 15th-20th floor but I'm zeroing in on the implied attack on physicians bit.
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Completely agree with this. I use a website called telyrx (https://telyrx.com/), so that I can have some amoxicillin and tamiflu on hand, if paxlovid wasn’t so expensive it’s another one I would have ready to go.
I use daily 5mg Cialis from HIMS.
About 4-5 a week so 149$ for 4.5 months or so.
This place cheaper and reputable?
Actually just asking reputable since I can check price myself.
E: I guess I didn’t need to give you any of that information but I’ve been sharing deep insights about myself online since 1997 so I guess why ever stop ?
I haven’t had any issues and it does include an actual prescription. It’s obviously sketchy in as much as you never actually see a doctor, but I’m assuming that the majority of telehealth firms work that way.
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This doesn't work because 1) stupid people will ask for antibiotics when they don't have good reason to expect them to work, and 2) giving out unneeded antibiotics has bad externalities. And the pharmacist can't administer a stupidity test.
And even in your case, you say that one doctor gave you a useless antibiotic before the second doctor gave you a useful one. If you go to a pharmacist, how are either you or the pharmacist going to know which one is useful and which one isn't? How are either of you going to know that your condition needs antibiotics at all, aside from you getting lucky? ("It worked for my family member, so it should work for me", and that actually being true, is luck.)
Well first of all the family member is a doctor (just not a family doctor), and second: how does the doctor know? Are they given secret knowledge that is inaccessible to mere humans?
Doctors aren’t priests. The stuff that 90% of PCPs are doing could be replaced by a flow chart. As far as antibiotic stewardship, when China and India and Brazil and everybody else gets on board, maybe.
My read is that when antibiotic resistance becomes a big problem, we will have plenty of warning because it'll be STD's and hospital caused infections first(and neither of those are a huge problem for normal healthy people), and also that there's lots of antibiotics to cycle through before we start needing to invent new ones. I invite doctors on the motte to chime in, of course, but that kinda points to it being a problem we don't need to be quite so vigilant about.
There's an additional discussion that the most common forms of antibiotic resistance seem to be otherwise fitness reducing; when bacteria need to compete without antibiotic pressure, the non-antibiotic resistant variant usually wins. Seems like it's some sort of limiting factor outside of, again, STDs and hospital caused infections, which don't have as much of a reservoir.
It's a real problem with research done on it - check out abx resistant in STDs (and by this I mean the details) MRSA vs. MSSA is a huge issue also.
We are in the growing warning stage with tons of money being pumped into avoiding the problem but as always man on the street won't notice until something boils over.
We have plenty of back up agents but often it means a switch to something less convenient, has worse side effects, or in the case with MRSA may result in increased sepsis fatality rates because of complicated things like time to static blood concentration, interaction with comorbid end organ dysfunction and other blah blah boring but important stuff.
Having an illness that goes from no big deal to no big deal but 1.2 out of 10k have a joint explode is not something the average person is going to notice but is an avoidable problem if idiots would stop pretending like they know everything and their doctors thousands of hours of education was meaningless.
Likewise you have stuff like some drug addict, illegal immigrant, or even just a regular person with the wrong insurance getting housed in the hospitals for 6 weeks because IV antibiotics is the only thing that works now instead of oral.
All these small things grow and contribute to the collapse of American healthcare.
In other countries rampant with problems (India, China) they just let people die a lot more. I'd like to keep our system.
Also hospital specific antibiotiograms are a thing.
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I'm pretty sure that community-originated antibiotic resistance is a myth kept up mostly to have a gotcha for anyone who wants to end the prescription monopoly, or just generally legalize drugs. The vast majority of the dangerous antibiotic-resistant strains are hospital-originated.
One of the most obvious examples if STDs, which is a known (and serious and growing) issue that's been magnified by homosexual sex norms (especially now that we have HIV medication).
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I was under the impression that agricultural use (misuse?) was one of the biggest sources of antibiotic-resistant strains
A lot of antibiotic-resistant bacteria are resistant to antibiotics not used in agriculture.
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Nuking your microbiome for no reason with unnecessary antibiotics every time you have a sniffle is a bad thing for you personally even if the Chinese are doing it too.
Also, statistically, a bad thing for everyone else because it promotes antibiotic resistance.
The poster’s point was that China, India, Brazil don’t need American help to develop antibiotic resistant strains
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