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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.
We are arguing the exact same thing now. The people who are talking to those people should NOT be the person I am talking to for a fever and a sore throat. Thats the absurd inefficiency.
I basically need to talk to a pharmacist, not a doctor.
No.... I think you are taking away the opposite from what I'm trying to impart?
Pharmacists are not the appropriate choice they have limited training in clinical medicine and diagnosis. Their job is to explain medication, mechanisms, and interactions not know when to prescribe or not to prescribe.
If only there was some sort of low-tier medical professional that doesn't require the full education of a Doctor but is better (or atleast a coat of paint on top of) a quick google search and 'make sure you hydrate and rest'.
Without even getting into the absurdity of the amount of investment, effort and expertise that goes into the 8 medication, 15 critical condition palliative care of the proverbial aunt.
Midlevels are ass and have no organized educational standards. They also appear to objectively hastening the demise of US healthcare through over utilization of referrals and unnecessary testing.
They also literally do not have the same practice and malpractice standards, which is just so so absurd.
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