The ineptitude of doctors never ceases to amaze me. One particularly idiotic fellow proudly announced to me and the entire office that he'd discovered I have diabetes. Even if that has been true, the manner in which he announced his pleasure at the epiphany made me want to punch him in the balls. hard. After a confused and sad ride home it only took a short talk with my extremely unqualified wife to convince me that he is mentally challenged and had no idea what he was talking about. Of course she was right.
In a fun twist, a month later I contacted a different Dr's office in the same plaza to get a new doctor. I wanted to verify it wasn't the same location, so I specifically asked if he worked there. The attendant said "No, but why do you ask?" I told her the story and she said that he had applied to be a part of their practice and, after my call, ther was an extremely slim chance of that happening. Made my day.
> The ineptitude of doctors never ceases to amaze me
Yeah there are stupid people in all professions but doctors in general are overworked and there's only so much specialized knowledge that generalists can hold in their heads.
Not a direct response to what you said, but since this is a common discussion on HN, I just want to get some facts straight pre-emptively:
1) The AMA has nothing to do with limiting the supply of doctors in the US
2) The AAMC (not the AMA) formerly limited the number of medical students per-year in the US, but they stopped this practice sometime around 2004 with the stated goal of increasing the number of medical school graduates.
3) Even if we doubled the number of medical school graduates overnight, we still would not have more practicing physicians in the US, because the bottleneck occurs during residency (after medical school) - there are a very limited number of residency slots.
4) Residency programs in the US are funded by the federal government through Medicare, so increasing the number of practicing physicians would require increasing funding to hospitals that offer residency programs by increasing spending on Medicare. This is both politically complicated and incredibly expensive (training a resident is very cost-intensive when you look at the big picture).
So yes, there is definitely an issue with the number of practicing physicians in the US, but fixing it requires Congressional authorization to increase spending (and not just by a little), so it's unlikely to change anytime soon.
So how about a residency system that doesn't depend on medicare government funding? Or accepting foreign residency programs? I wouldn't think canadian, scandianvian, british, german, australlian, etc residencies and doctors should be considered invalid for example. From what I know, even being a Sweden trained doctor makes it hard to transfer into the USA and get a licence.
Residents from what I know are not well paid, what makes it a profit cost center for them that they require government funding for it?
The reason why foreign residency programs aren't considered valid in the US is quality control, from both competency and medico-legal standpoints. If you were CEO of a private practice or hospital in New York City, who would you hire? A grad straight out of a US residency or one out of Swedish residency? The safer bet is the one straight out of US residency for numerous reasons: you can more easily trust and call his references, he has already likely taken the US medical licensing exams, you don't have to give him an English comprehension test, familiar with the mess that is US medical system, etc...
As a CEO of a hospital that wants to make money I would hire the Swedish grad for less and give him a 4 month US legal medical mess class for a lot less in cost that wouldn't involve a doctor. Since I'm known as a hospital that accepts non-us residency people, I can save a lot of money until the market resolves this inefficiency.
Also there are the other 5 anglo countries, which will have no problems with english. Many of these UK, german, etc grads could also be people from the US originally, so there wont be english competency problems there. Many europeans also have excellent english on average, like germans and scandianvians. It would be miles ahead of the average non-west euro immigrant software engineer that is very common in the USA.
QC and skills wise, I don't have much worries from these top tier countries medical practices. Do you freak out if you have to go to a hospital in Sweden because the doctors may be bad!?
I've heard of residents being paid as little as $25-30k/yr.
The issue is largely that you have an attending physician making a great deal of money (compared to the median US, not necessarily for a doctor) who spends the majority of his or her time teaching, watching, and fixing what the resident does.
You can easily have a hospital/government (not sure what the funding split is) spending $500k/yr for $100k/yr in productivity.
Is there some reason that hospitals can't fund the programs themselves? Or do they just choose not to?
More usefully, what could be done to get hospitals to fund the programs? Some hospital systems have billions of net income, they can clearly afford to fund at least a few residencies.
Couldn't it be same incentive why we like interns in tech? In tech, we love internships and most top companies go out of their way to have attractive internship programmes. This allows you to (1) filter future hires much better than hour long interview (2) lot of less complicated stuff can be offloaded to them (3) well, yeah, cheap labor (4) much better cultural training (5) young energetic employees with passion to improve things.
If consumers of IT products were given the right to potentially sue for every bug that resulted in adverse situations arising for them, the whole industry would collapse in less than a year.
Now, put yourself in the shoes of a company/NGO that arose to fill in the abandoned niche afterwards. Would you be willing to take in a junior employee and let it do unsupervised work? Would the affordability, cultural fitness or "passion" of said junior employee make a big factor in your decision?
We obviously don't give wheels to interns and all go on vacation. Initially interns gets work that is fairly low risk to your business. You observe their quality and evolution and gradually give them work that has higher stacks. Same for residents, I would think they would get work that is at Nurse+ level initially, then may be they start as helping hand in operating rooms and so on. As you see they are reliable and consistent, you increase your risk tolerance. Although tech industry don't get as many law suits I think they face much higher financial consequences for screwing up. Imagine Facebook intern bringing down a service because of an error. That would be equivalent of many lawsuits in terms of loss of revenue.
> Although tech industry don't get as many law suits I think they face much higher financial consequences for screwing up.
Agreed on that, though there is an upper limit on that, you cannot lose more revenue than you make over the time it takes to resolve the incident.
On the other hand, doctors can be assigned punitive charges (is the term correct?) well beyond the "objective" loss of the patient. That kind of stuff can bankrupt health care practitioners... that's why they have insurance AND legal departments.
Maybe it is just the perception of risk, but I think that explains why there's much more caution around it.
Another data point. Medical schools in US accept only people that has successfully completed an undergraduate degree with transferable skills. In many countries, you can enter medical school after highschool (though the degree takes more years of study than your standard 4 year bachelors).
What are the expenses involved in a med student's residency? From the outside it looks like they do a full doctor's work, but are only paid 40k a year.
Hey, look at the bright side, at least yours didn't turn out to be stage IIIc cancer, after three months and two doctors assuring me "You're young! It's probably nothing." Even with a family history and scans showing an enlarged lymph node.
This is the most common story you'll hear from a cancer patient.
The most upsetting part is how critical early diagnosis is: the difference between stage II and IIIc can be the difference between 80% vs 20% five-year survival.
Good doctors are few and far between, and good diagnosticians... I dunno, me and my family have been in and out of the medical system for a while now, and I'm yet to meet one.
When you go in, do your own research, get a copy of your results, and tell them exactly what to do.
> Good doctors are few and far between, and good diagnosticians...
This has been my experience, repeatedly. The GPs I have had aren't motivated to get to the bottom of any problem that can't be solved in one 15 minute visit, and refers anything out to specialists. The specialists have all diagnosed me with whatever issues fit their specialty. No one in the US medical field seems interested in actually finding out the real problems, just what's easy for them to diagnose or fix.
After writing this I realize how cynical it reads, but it's the truth! I'm sure there are good doctors out there -- maybe in a teaching hospital?
I know doctors will hate that, but you do have to do your own research.
My mother was on phen fen for weeks even after telling the doctor she had chest pains. Only after she read a newspaper did she find out how horrible it was. The doctor was clueless and careless.
I have strong upper chest pains (constant pressure), regardless of position. Went to first doctor, was told "it's just bruised ribs", even though I don't play any sports or do any serious workouts.
Went to a second doctor recently after a few months as it started getting worse. "It's just heartburn", even though I told him I already take a PPI, H2 blocker and calcium. I've had heartburn for 12 years and know this was a very different feeling, but he basically ignored me and proceeded to ask me about how often I went to church and about my sex life. I wish I was joking. So he wrote me a prescription for ranitidine (a weaker H2 blocker, sold as Zantac OTC.)
But thankfully the second time I was given a blood test and found that my vitamin D level was <9ng/ml, even though I was already taking vitamin supplements. So he wrote me a prescription for 150,000 IU of D2 weekly. That seemed to make it worse.
So I looked into this and found that D2 has poor bioavailability and depletes magnesium. So I obtained D3 and magnesium supplements, am taking a saner supplement level (10,000 IU daily), and have been feeling quite a bit better. Not perfect, but supposedly it can take three months to fully recover.
I was very surprised to learn that a lot of people develop random musculoskeletal pains in response to very low vitamin D levels. Neither doctor even considered that possibility.
I was very worried that this might have been something more serious, and it was basically impossible to convince either of two doctors to actually do some real tests just to be safe. When I read stories like this, I can't help but wonder, what if it was the start of cancer (which killed my father)? And by the time the symptoms got bad enough to not write me off right away, it'd be too late to treat it?
I've had similarly terrible experiences with fatigue during the day due to my job's oncall responsibilities. That doctor told me it was depression (I am absolutely not depressed), and tried to get me to start taking Zoloft, which I refused.
These GP doctors just don't listen to their patients nor take their concerns seriously. I'm sure everyone always assumes the worst when something bad starts to happen, and likely it does turn out to be nothing. But one in three people do develop cancer in their lifetimes. How the hell are we supposed to get it diagnosed early when doctors just casually dismiss us out of hand?
I can relate to this. A few years ago I was a 30 year old guy who felt like a feeble 70 year old. I was tired, depressed, and just didn't feel well at all. I had a blood test and the doc was flabbergasted at how low my Vitamin D levels were. Technically I had rickets! But then I started taking 10-15k of D3 a day and in a couple of weeks I felt great. Now I take 5k in the summer and 10k in the winter and haven't a had a problem since.
So, moral of the story: get your Vitamin D levels checked. And take D3, not D2.
Same here, add poor circulation to the list of symptoms. I no longer have perpetually cold feet. I had to have my GP refer me to an endocrinologist though. The endocrinologist spotted it right away. Super cheap to treat. Been taking it for about ~6 mos.
>So, moral of the story: get your Vitamin D levels checked. And take D3, not D2.
Especially if you work indoors or otherwise avoid sunlight. (I don't take special pains to avoid the sun. I like the sun, but I do avoid outdoors when it is too hot, which is most of the time in my area.)
Exactly how I felt! I'm 31 now myself. I'm really hoping my experience is like yours, because I'm still not 100% myself again. Currently 2.5 weeks in.
I can't even imagine what my levels were prior to taking the 500% RDV supplement I was on before having my blood checked. But at <9ng/ml, I most likely have osteomalacia.
All doctors will only prescribe D2 (ergocalciferol); so you really need to go and get D3 (cholecalciferol). Your body naturally produces D3, and the latter is much more bioavailable. Because of this, you will also want to scale down your dose and not take as much. It's possible to go too far and end up with hypervitaminosis, which ironically can also cause random bone pains, and calcification of your arteries.
It's important to test your 25(OH)-D levels every few months when taking extreme supplements.
Also, be sure you are getting enough calcium and magnesium. These are the chemicals needed to maintain healthy bones. Doctors do not prescribe the magnesium, and large vitamin D supplements will deplete this, also leading to calcification and other problems.
Finally, for anyone living north of South Carolina, you will not receive enough UVB radiation from the sun to produce sufficient levels of vitamin D during the winter months, and milk really has very little vitamin D. So you might want to test and possibly supplement if you are experiencing random musculoskeletal pains. Low levels are fairly common, and usually not a huge deal. But at my level, it was fairly severe.
Out of curiosity, why do doctors only prescribe D2? It sounds from your description like there's essentially no reason they shouldn't be prescribing D3, and yet apparently none do.
A doctor did advise me to take D3, though she's an unusual one, far more helpful than my official insurance-provided doctor. I don't know what the official one would've prescribed, because none of them even considered testing for it.
My GP is a Certified Nurse Practitioner and I'm ok with that because she actually talks to me about my life and what is going on to try and get the whole picture.
Doctors are people like you and I. They are imperfect and make mistakes. There are plenty of brilliant doctors out there and not-so-good doctors out there. It takes responsibility on the patients' part to advocate for themselves, do some research, and find the right fit for them.
To add to this, I used to be very critical of doctors but having had various metabolic challenges and going off and learning all that stuff, medicine is a difficult confusing mess.
If you disagree, read this (about 2/3 of which is relevant to me):
There are thousands of diseases and not that many different symptoms. Most serious diseases have numbers of mild conditions that look very similar.
This is not to say there are not major issues with the way medicine is researched and practised. And that being a doctor does tend to encourage people to be arrogant and overconfident. And that the medical basically selects people who are good at memorizing stuff.
A friend of mine was told by a doctor that he had AIDS as it fit his symptoms and he had been an inter vinous drug user long in the past (what drug counselor hasn't?). Didn't wait for test results. He was a bit peeved and relieved to find a negative test 2 weeks later. He had the flu.
In a fun twist, a month later I contacted a different Dr's office in the same plaza to get a new doctor. I wanted to verify it wasn't the same location, so I specifically asked if he worked there. The attendant said "No, but why do you ask?" I told her the story and she said that he had applied to be a part of their practice and, after my call, ther was an extremely slim chance of that happening. Made my day.