Diversity in healthcare delivery
Years ago, we had an MD/PhD student in our program who had Eilers-Danlos syndrome, a connective tissue disorder that causes joint laxity and frequent painful joint dislocations. After over a decade of being misdiagnosed, her correct diagnosis was made by a physical therapist, not a physician.
I noted in a previous post that I’ve been seen by nurses and physician’s assistants in clinics and gotten good care. I’ve had robotically assisted surgery that worked out fine. Now that AI can read radiological images with greater accuracy than most radiologists, we can expect machines and paraprofessionals increasingly to take over jobs that used to be done by physicians. American healthcare is evolving. Diversity in healthcare delivery is a good thing and should help control costs.
A PhD colleague who worked in a clinical department referred to physicians as “MDeities.” He was referring to their attitudes about their own status, but far too many patients treat their doctors as deities, too. Ideally, physicians and patients should be collaborators in treatment. Ask questions . . . but don’t forget to listen for answers.
I noted in a previous post that I’ve been seen by nurses and physician’s assistants in clinics and gotten good care. I’ve had robotically assisted surgery that worked out fine. Now that AI can read radiological images with greater accuracy than most radiologists, we can expect machines and paraprofessionals increasingly to take over jobs that used to be done by physicians. American healthcare is evolving. Diversity in healthcare delivery is a good thing and should help control costs.
A PhD colleague who worked in a clinical department referred to physicians as “MDeities.” He was referring to their attitudes about their own status, but far too many patients treat their doctors as deities, too. Ideally, physicians and patients should be collaborators in treatment. Ask questions . . . but don’t forget to listen for answers.
Joel:
Too many people take them for their position and word failing to ask the questions that separate the doctor from you. When you are older, they treat you differently and you are subjected to being treated as unknowing in terms of your health. It is no longer a patient – doctor relationship. It becomes more of a parent – doctor relationship where you are being told. Some get a little upset about the questions you ask.
If I did not have the operation, I had years ago, I might accept what I am being told. I have a pinched nerve in my spinal which radiates down my right leg. Something I had before 10 years ago. I was walking miles with my Elkhound “Tyler” who loved the sniffs and pointed pheasant on the way (much to the consternation of the pheasants who would take flight). Today, Minnie our German Shepherd walks with me for a couple of miles.
How does a weak spine relate to a pinched nerve which is cause by fat in the cord squeezing it. The live with it is not going to work in a few years when the pain increases and the need for wheel chair conveyance becomes more likely. Neither is an operation then as compared to now.
Why would I take them 100%?
@Bill,
Have you asked your doc about gabapentin? I didn’t use it for sciatica (which is caused by pinched sciatic nerves), but it can be prescribed for that indication.
Joel:
No, I have not.
1. I have an aversion to pain relieving drugs. There is also the potential of taking them and having to explain why to authorities. They are totally unbelieving.
2. They could have offered it. They did not. If I ask than I am subject to being asked why? I am not a junkie and never have been.
I really need to know why they deny me an operation which can remove a bit of fat from around my spinal cord which will alleviate the pain for the years to come till I am dead and do not give a damn then.
Right now in rehab, I am concentrating on building my strength with an emphasis on my back muscles. It is not impossible for me to add the muscle again. I just need the direction in how to do so to accommodate the issue.
My thoughts are about going back to my old doctors for another opinion as they know my background better.
@Bill,
A second opinion is always a good thing.
My experience has been that the MDs do a pretty good job. Now and then I need to find an appropriate specialist, but often that is what another MD would recommend. Of course, I’m white, male and well educated, so my symptoms are rarely discounted. Still, I’ve had excellent care from PAs and various xNs as well as MDs.
The medical industry has been changing over the last 20 years. The last big change was in the 1960s when health insurance became a common benefit and Medicare and Medicaid brought big money to the field. Before then, you either specialized in diseases of the rich or settled for a good but not astounding income. Then, it made sense for MDs to build out their businesses which could be quite profitable.
Now, the big corporations have taken over. Small practitioners have been squeezed out and most MDs are employees not small businessmen. Some of this was MDs being too pro-business and thinking that there weren’t any bigger fish around. Some of it was big businesses learning the ropes and finally seizing the opportunity. The increased number of women MDs is obviously tied into this, but I’ll leave that to the women’s studies department.
I expect we’ll see more and more MD failure stories as the propaganda push against the people who actually know medicine continues. They have to be fully discredited and pushed out of power. Introducing AI will be part of it. If you think human MDs have a horse versus zebra problem, try arguing with a stiff bureaucracy run by overpaid executives about an AI driven decision.
Kaleburg:
The large part of this is trust. Trust, they can help you, trust in their diagnosis, and trust in what they do is correct. My first serious venture down here was to get my back fixed. Silly me, I thought the same procedure would work. I was told I have a weak back. And there in the issue lies.
I have a pinched nerve coming out of my spine and the pain radiates into my right leg causing numbness there. Ten years ago about two miles away from home and walking with my Elkhound on dirt roads in Michigan, I went to seat on a large rock and almost fell over. It was diagnosed as stenosis.
L2-L5 and I was fixed.
I think the big issue here is age. At 75 I am a risk to them. Let’s say I live beyond 85. Do I want to be pushed in a wheelchair when I could still walk? And what is a weak back? You do not know me and I understand such.
I am a tall thin type of unimposing guy. I was the kid with the acne who grew up working with men on scaffolds stories up and went into the Corps in 68. I married the prettiest woman around and still am married. I went as far as an MA out of Loyola and am considered a supply chain expert with multiple certificates.
In Madison, I decided I wanted to do something different. I started lifting as taught by a woman. The skinny guy not so broad in the shoulders got as far as 254 lbs in the bench press and 300 lbs on squats using the machine.
Weak back, my ass. I can not do that anymore, but I am still mobile and can pick up 75 or more pounds.
Kaleberg:
To add to this, my first excursion after waiting 6 weeks to get to see a surgeon resulted in them wanting to install meatal rods and screws in my back. They recommended epidurals to start with to see if it helped. I waited six weeks to see that doctor.
No problem with the epidurals; but then, he wanted to do a comprehensive blood test. I explained I had one two months ago and had already given it to him. Then he want to do cholesterol treatment. My cholesterol level is at 129 without fasting. Then it was weight. Yeah, I can stand to lose 10 pounds but I can do that myself. He was upcoding me which angers me. Because I know what it is.
I am asking for a copy of my records from the VA to see what hey have diagnosed and why beyond the weak back BS. Now I have to kick myself out of here for being vulgar and going beyond Joel’s commentary.
I have more stores about my ventures with new doctors. I am afraid I will not find a good one.
@Bill,
One of the three major causes of sciatica is spinal stenosis. Yes, it’s usually age-related.
While I mostly recovered from my bout with severe sciatica after 16 visits with a PT, I still had occasional flare-ups. I finally figured out that it was my wallet in my back right pocket. I was sitting a lot, and the wallet had enough of an effect on my spinal posture that it was irritating my sciatic nerves on the right side. Bought three pairs of cargo pants and I keep my wallet in a pocket down on my thigh. No more issues!
Joel:
Too much paper money in the wallet I suspect. I and AB readers and other writers could have helped you there. That is a good suggestion though. I was diagnosed with stenosis 10 years ago. It was fixed and I was great again. I can use the exercise to build some strength back into my body. I can feel it. I am not in favor of rods and screws. Add to that upcoding. And the guy was serious. The VA agreed with me on nixing the additional comprehensive blood test.
If I have to do so, I will go back to Michigan to see my old doctors. AZ is crowded with too many oldsters and we are seen as a profit center.
I am not a patient. I am the customer and they are the vendor.
Dave:
You get to select the service they offer. They tell you what they can offer and you nod yes or shake your head no. It is a profit center.