I agree with what everyone above is saying. However, it is wrong when we think the "old days" were better. The doctors might have seemed to care more and had more time, but they also had their share of mis-diagnoses, weird biases, outmoded methods, mistakes, etc. There are lots of horror stories from the old days too.

I actually think the computerized diagnostic is the best idea -- it makes sure that all doctors have access to all the information and you're not at the mercy of your own particular doctor's limited knowledge, etc.

A computerized diagnostic might still start with the "horses", but would also have all the "zebras" in it, and as they go along they should consistently zero in on those rarer problems.

I do think that doctors in the future will only be most useful for physical issues (setting a bone, surgery) and for authorizing prescriptions, but for diagnosis they are becoming obsolete. I think that's fine, because I have the feeling that it would be better generally than either the current doctors or the old-timers in terms of consistently finding the root cause.

Slammr (imported) wrote: Thu May 12, 2011 5:18 pm The last time I went to the doctor he punched my symptoms into the computer, and it gave him the information on how to treat it.

Of course, they're going to restrict our access to those databases; otherwise, we no longer need doctors, unless we need surgery or hands-on treatment.

Let the Indians do it! Some bright bulb will come along and outsource it.

http://www.youtube.com/watch?v=z5Nz9uetlUU

Surely next after medical diagnosis will be company management. It will be really interesting to see the social consequences of outsourcing medical diagnosis and company management. Maybe the Republican party will move to India where the real corporate powers are. I predict future Indian legislation like making the Henry rifle the official state firearm and outsourcing the labor of filling out long form birth certificates to Pakistan.

Sure the doc's in the cottage industry days could not get a scan of everything as today. The consumer decided who was "good" and who was not.

I am not a data base. I am a person who's skin never, ever heals with any sort of suture unless a vertical mattress suture technique is used. That closes and hardly leaves a scar.

Nope! I am definitely not a database, and that phenomena is not in the database.

Besides better clinical diagnosis, the docs of the old days may have had to employ a little more ESP without realizing it.

If doc's were returned to cottage industry arrangements, the market would sort out the good ones.

Currently in my rich neighborhood, if you see one Hindu doc, you get referred to two more. Minimum total of three Hindu specialist per single referral. And there is no substantial Hindu population here. I call it rape and pillage medicine. Oh and don't bother calling for care before your next appointment. Go to the ER.

Sometimes the consumer market is too naive to see it coming. I preach, one Hindu doctor okay, but if you get referred to a second - be weary.

Moi

We do have it a bit better in Canada than you folks in the USA. Not much, but somewhat.

I live in the country, near a small town that as a great hospital, and I get better doctors and surgery scheduling than anybody in Winnipeg. There are four doctors at my towns hospital, and whenever I've had a diagnosis from one he SUGGESTS I talk to one of the others if I wish. They all use the internet database for checking symptoms, as well as experience.

I have read from several sources that the USA spends far more per capita than any other first world country on health care, yet has the worst mortality. From what I can tell, it's all because of the insurance industry. They suck up all your health care money, through wages for themselves and the horrendous way they 'manage' doctors and the choices they are ALLOWED to make re. their patients.

It's horrific. Sure, if you have money, you can get a good doctor who is free to do what is needed, but who can afford that?

For-profit insurance running medical systems and making "health" (read "profit") decisions can only ruin the health of the people. In Canada, yes, we have government-run health care, but it's not for profit; this makes a HUGE, MASSIVE difference.

But, when you have semi-retarted Tea Partiers, many over middle-age and obviously not wealthy, holding up signs at rallies that read "No Socialist Health Care!", one wonders if change can ever happen. Your own people who most need "socialist" (non-profit) health care are scuttelling their own health care needs. Wow. Just, wow.

My God, I pity USA'ers who get sick. Emergency care involving obviously "broken" body parts (fractured legs, cut-off hands, stab-wounds) are about the only thing doctors are allowed to treat properly. God help you if you get a disease, though. Then, you better hope it's covered by your HMO; chances are, it won't be.

You poor folks.

moi621 (imported) wrote: Fri May 13, 2011 6:25 pm The consumer decided who was "good" and who was not.

The problem is that you don't really have that much ability (even in the old days) to pick and choose your doctors.

First of all, it is really difficult to even find a doctor nowadays that is taking new patients -- you only have a couple in any given area. For example, I'm new to Silicon Valley and I can't find ANY psychiatrists taking new adult patients (lots of child psychiatrists though -- must be more lucrative). And small towns have always had really limited doctor choice (often only one!).

Secondly, it is a real pain to switch doctors. You have to transfer your records, have several sessions to give them all your history, reveal embarassing information (I've tried to castrate myself), etc. Plus you have to make co-payments for every visit and those $20 payments can add up.

Third, you never really know if your doctor is good until it is important and usually too late. I mean you can happily go to a doctor for years who successfully treats you for rashes and simple stuff, then suddenly you get some serious condition and only then do you find out (often after the fact) that they were bad.

Lastly, you have to be careful about switching doctors because you could burn some bridges or otherwise be flagged as doing too much shopping around (this is often flagged by insurance companies because they're worried about prescription abuse).

In other words it is not really a free market because there are "switching costs". So you need other mechanisms to ensure a minimum level of care. There is of course the medical schooling, the medical licensing, and I think also the use of computers and medical databases, as all important factors in filtering out the really bad doctors.

I agree that the "consumer" is not the best judge of the medical quality they are receiving as no one believes they are seeing the second best doctor.

Most important is that both patient and healer feel comfortable with each other. And I have known some who felt uncomfortable with doctors I believed offered quality. Beware of smooth ones as sell personality.

Then satisfaction with the healers attentiveness and partnership with the patient to the road of recovery. Remember, sometimes the ethnic healer may be a bigot against all not his own. Watch for the within the ethnic referrals.

Finding a good primary care physician is paramount and go from there. Sometimes a specialist may be asked to be a primary care physician and they will agree. A neighbor on multi multi meds happened to find one at the walk in clinic. Just asked.

Moi

True, personality counts, but should not override quality.

As a child (about 10), I had one doctor who was terribly brusk; he'd burst into the examination room, rush about, talk fast and was generally un-friendly. However, he was the one that caught a problem I was having, and did a superb job on me. Also, much to my surprise, his bedside manner the day of the operation was AWESOME; I went from being scared of him, to liking him a lot that day. But, he went back to being a jerk after, so mom and dad switched doctors for me.

Next doctor was a total sweetheart; I really loved him (still do; he only recently retired). Very kind, very nice, but not somebody I'd trust for anything really important.

Then, at 11 years old, I saw a urologist because of scarring in my urethra, about 3 inches inside. This guy came HIGHLY reccommended. Yet, he accused me over and over of "shoving things up my pee pee"; this was completely untrue, and I hated his use of that term at that age. He committed surgery on me, doing a skin graft on the scar. As a "bonus", he widened my urethra opening, telling my parents I needed it done because the opening was 'too small' and restricting my urine flow.

From that day on, I've never pissed straight. It squirts out any which way, frequently in more than one stream.

So, personality can be important, but unfortunately, one never really knows 'quality' until after surgery.

My family doctor / surgeon I have now (he both takes patients as a family doctor in the clinic and did my hernia surgery himself) is awesome... blunt, bit of a jerk, but did great work on me. I feel pretty lucky.

Often times the "jerk" is really just someone who doesn't sugar coat things or someone who is highly technical ... to me that's a plus not a drawback. I don't go to a doctor for friends, that's what ... well ... friends are for. I go to a doctor for their knowledge. The least popular doctor at the clinic I go to (who is sadly retired now) was not only the nicest but also knew what she was doing, which was almost shocking to me. The reason she was less popular was because she didn't make brash and rushed decisions, which was a trait I really liked. The surgeon who removed my gallbladder was blunt and forward, though he did try to adopt a "friendly" bedside manner he realised I wanted facts not personality and actually warmed up to me, as opposed to having patients needing to be warmed up to them.

The real reason doctors in the US do an extremely poor job is actually too many to count, one being that a large number of them have figured out that the citizens here will continually see them even if they are wrong. Another reason is the extremely high amount of hypochondria now rampant in the US. We all think we're sick even when we aren't. This leads to the doctors not listening to most of the symptoms and often missing important ones because they are tired of hearing the rapid fire long list of most likely imaginary symptoms brought on by self and media driven diagnosis.

Again, there are many more reasons for the decline, you can't just narrow it down to one, however hospitals and clinics are taking advantage of this. One doctor explained that the only reason many tests are never done is because the administration won't allow the nurses to administer them unless it's covered by insurance, even if the patient has cash in their pocket.

butterflyjack (imported) wrote: Wed May 11, 2011 1:47 pm My guess is....socialized medicine does away with this...dragonfly

Socialized medicine would do little to solve the problems we have with physicians in the US. I think the real solution is to replace the physicians with robots. The process should be gradual. People should have the choice of going to a human physician or to a robotic physician. At first, very few people would go to a robotic physician.

After people learn that their family members, friends, coworkers etc. are getting MUCH better results from a robotic physician at a much lower cost, more and more of them would choose a robotic physician. Any businessperson who has not been convicted of fraud should be able to buy or lease a robotic physician and set up a medical service business.

The robotic physician should be designed to be extremely difficult to tamper with. Legal penalties for tampering with the programming of a robotic physician to increase profits by making or keeping patients ill should be very severe. The minimum penalty should be a million dollar fine and 20 years in prison.

artisticlicense (imported) wrote: Thu May 12, 2011 2:49 pm The days of 'trusting' your physician are over. People are more like 'clientèle' than 'patients'.

You can trust physicians to do these things:

1. Put their financial interest 100,000,000,000,000 light years ahead of your health interest.

2. Work very hard to make and keep you chronically ill because they make more money that way.

3. Lie to you every time it is to their advantage.