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PaperclipPerfector  8d ago (text post)   24350 thread views

Culture War Roundup for the week of October 20, 2025

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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.

So; just more ridiculous inefficiency in the inefficient healthcare system.

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!

"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?"

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.

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.

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.

This is totally an impossible thing to fix? Like I agree there'd be friction issues where major issues aren't caught (though that's hardly exclusively a mid-level thing) but massive savings on decluttering the existing medical infrastructure whilst it urges people from a healthy, robust 83 to a diminished, venerable 84 at enormous cost.

I'm not sure what you mean, but an excess in consults is driving people out of practice, raising costs, lowering quality and all kinds of other shit. It's a mess.

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