Physicians paid a salary by an HMO or a government agency are required to be efficient and productive. A productive physician is one who "sees" many patients per day. An efficient physician is one who orders very few expensive tests.

Physicians have a saying, "When you hear hoof beats, think horses not zebras." Nearly all physicians interpret this to mean that rare diseases do not exist.

Nearly all physicians think that they have a magic ability to tell what diseases a patient has without using any tests to confirm their hypothesis. They call this "Clinical Judgment." They do not really have this ability.

Very few physicians listen to their patients. There are two reasons for this.

1. Listening to patients takes too much time to be profitable for the physician or the physician's employer.

2. Listening to patients is completely unnecessary because physicians already know EVERYTHING.

Nearly all physicians define themselves as perfect, infallible, godlike beings. Since they are perfect (by definition) their tests must also be perfect. Therefore, if an illness does not show up on their perfect tests, it MUST be a mental illness.

Once they diagnose a person (correctly or incorrectly) with a "mental" illness, most physicians then attribute ALL their symptoms to being caused by their "mental" illness.

Physicians practice what they call "evidence-based medicine." What this means, in practice, is that if the physician does not want to believe in something, the physician says, "I need more/better evidence for this." The physician will always do this. It does not matter how much evidence there is or how good the evidence is. On the other hand, if physicians want to believe in something, they require no evidence.

This is the most important reason that physicians do a bad job. This is an excerpt of an interview shown on CNN:

http://transcripts.cnn.com/TRANSCRIPTS/ ... sg.01.html

* CNN's Dr. Sanjay Gupta interviews Dr. Denis Cortese, former CEO of the Mayo Clinic.

"Over the past several years, payment has really been linked very much to whatever is done. We ended up with a model that is now called "fee for service," where we are paid for doing things to people.

The ultimate of that, if carried to the extreme, would be the sicker you are, the more money we make as physicians. The more times you come into our office, the more money we make. The more procedures we do, the more money we make."

(This is the end of the excerpt.)

You might think that physicians at HMOs have incentives to cure patients and keep them well. I do not think they do. When physicians keep people chronically ill, it increases the demand for medical services. When the demand for something goes up, the price goes up. When physicians keep people chronically ill, the salaries and earning of nearly all physicians go up.

HMOs will only have an incentive to cure chronically ill people if patients cannot switch to a different medical provider. HMOs can cut their costs by doing as little as possible for chronically ill patients until the patient leaves the HMO.

Because of the way we pay physicians, and the way we have organized our medical system, doing a bad job of providing medicine is vastly easier and enormously more profitable. We might be able to change our medical system so that physicians will do a better job. I strongly suspect that no matter how we change the system, physicians will figure out ways to cheat the system and make more money than they deserve. This will almost certainly result in patients getting bad "care."

My guess is....socialized medicine does away with this...dragonfly

I have developed a theory myself.

When you go to the doc's office they put you in an exam room to wait, with your chart in a holder on the outside of the door.

Many doctors come to your room, pick up the chart, glance at it, decide whats wrong with you, decide how to treat that, then come in and tell you what will be done. These are mostly not good doctors.

The issue is the time they have with you. In terms of them listening to you it usually less than 15 minutes per visit. Socialized medicine doesn't help (I've lived in Canada) because they also make more money by seeing more patients (socialized medicine just means the government provides the insurance, otherwise not much difference).

Luckily, in the modern age of the internet, you can get a good idea what you need before you go. It is really up to you to manage the doctors, not the other way around.

I know a lot of people who are in a lot of pain for varioius conditions, but when they go to the doctor they don't really express themselves well. Once I teach them to really explain what they need, they get better results. I knew a woman who couldn't even care for her kids due to back pain, but never told the doctor that. Once she did, the severity of the issue was taken seriously and she soon got a surgery (removed bone spur that was poking a disc) and was completely cured -- this after years of muscle relaxants, pain killers, physiotherapy, etc.

Doctors aren't psychic. So they really don't know how bad you feel. It is up to you to ensure their reaction matches the seriousness of what you're experiencing.

Anyway, that's just the way it is. Doctors now are just someone certified to authorize prescriptions and tests. If you're lucky their experience will help, but generally you just have to direct them with your own information.

Yes some physicians are psychic. And proper testing confirms what they know. The psychic ones are also caring and "the system" beats them down.

The solution is to put physicians back into their own offices. Not group offices or partnered offices or HMO factories. Physicians working as a cottage industry offer the best quality and most personable medicine.

Kaiser in San Jose, California killed my best friend since 1966, a few years ago. They let him sit three months with a tumor in his lung before removing it. The surgeon even went on leave three times over that period. My friend lived after removal but the cancer had spread.

His wife died about a year later of breast cancer. She was a Kaiser patient for some four decades receiving regularly schedules care yet, when they "discovered" her breast cancer - it was advanced beyond the nodes. I was best man at their wedding in 1969.

I find the state of good medical care as Kaiser statistics support a horror story. When Kaiser is rated as good, think of how bad the rest is.

Moi

I live in Canada, and I have to argue that there are both good and bad doctors here, the same as everywhere.

When I was a boy, I came down with an illness, that the doctor took over 2 months to identify. Because he was thinking "horses, not zebras".

It turns out I had an illness called Kawasaki's Disease. It usually strikes children under five, and almost exclusively in Asia, Japan actually. I was twelve years old, and Caucasian. So a "zebra" illness wasn't considered.

The result of my illness, was my reproductive organs were damaged, puberty delayed, etcetera. Only after my two month fever finally broke, did he come up with the diagnosis.

Had he been a good doctor, he would have then told my parents what to look for. He would have warned, that my cardiovascular system might have been damaged. He might have warned to be aware of changes to my moods, or inability to maintain an erection. They might have gotten me on hormones to supplement my reduced testosterone levels. He could have at least told my parents what damage a two month fever could have caused.

That asshole kept his damn mouth shut, and I went 24 years not knowing what was wrong with me.

It was at a walk in clinic that a doctor recognized I had a problem. He asked the right questions, took the right blood-work, etcetera, to finally tell me what was wrong. I was there for a touch of bronchitis.

My whole developmental years were ruined by a doctor who just didn't give a damn. 24 years later, a doctor who does give a crap has me on the path to finally set my life on track again.

A lot of the blame for what happened to me, lies on my own shoulders. I haven't maintained a regular doctor since I was a lad. After I started getting fat after my illness (a symptom of low testosterone) any doctor I saw, only saw the fat, and that was my problem. It was because I didn't exercise enough, or ate too much. I was humiliated having doctors tell me I was too fat, no matter why I was there. Once I was old enough. I simply stopped going to doctors.

If I had kept going, I might have been diagnosed a lot sooner. After I was 12 years old, I only went to the doctor if I had a problem, like a broken bone, or the flu. I stopped going out of my own humiliation. I should have kept at it. It makes me mad, not one of those ass-hats took the time to diagnose me properly. But I have to recognize I had a hand in not wanting to be naked in front of anyone. If I had, they might have seen my small genitalia, or the thinness of my body hair.

Not stripping off in front of doctors was my problem. Doctors only seeing what they wanted to see was theirs.

Good doctors who care, are rare. They do seem to be outweighed by the bad ones though. Socialized medicine will never get rid of the core problem. Doctors will only see what they expect to see.

Yes, in this day of medical insurance and HMO's you do have to manage your doctors. I learned the hard way.

I remember when a doctor would examine you, ask probing questions about your symptoms, run tests, and then call you into his office at the end of the visit to discuss what he/she had found, what test results were pending, and what the plan was to go on from here. This was what I was used to in a doctor's visit until about the mid 1970's. The family doctor I had until this time sold his practice and retired when most of his patients became covered by medical insurance and HMOs. He said that while he was old enough and comfortable enough to retire the real reason that he decided to was that he did not feel right about being forced into practicing "eight minute medicine" by the insurance companies.

We continued with the doctor who bought the practice and his practice evolved into a group. Then in the mid 1980's, I started having problems with impotence, weight gain and depression. Those of you who have seen my previous posts know I had an undetected prolactinoma. The prevalent medical opinion, at the time, was that these tumors were extremely rare and exclusively a woman's problem. The "When you hear hoof beats, look for horses not zebras" mindset kicked in and for 12 years I was misdiagnosed by my regular doctor and several others. After all, impotence, weight gain and depression in a man in his 40s was not that unexpected. Of course, by the time I was diagnosed my physicians had me auditioning shrinks.

By this time I had Internet access at home and did a little research on the subject. I did have to physically assault my doctor at the end of a visit for something else to get him to listen but that shocked him into the old physician mode and he came to the conclusion that he should at least check for one of these tumors. (He had successfully diagnosed one as an intern many years before.) When my MRI results came in positive he started checking his other patients with similar complaints and found thirteen more of them! Fortunately, these tumors are easily suppressed by medication.

As to the effect of the doctor's attitudes on their diagnostic skills, I pointed out to my doctor that the NIH had on it's web site diagnostic check lists for hundreds of common complaints. Prolactinomas are the 5th thing on a list of 22 possible causal diseases for men presenting with primary impotence. (The diagnostic lists are no longer locatable or accessible on the web unless you have a physician password.) His reply was. " Oh, nobody uses those things." I found the results of a study the rated the effectiveness of diagnosis with interns using the check lists versus experienced physicians. The published results were that the interns made a successful initial diagnosis 70 percent of the time while the experienced physicians made a successful initial diagnosis only 35 percent of the time.

You need to be aware of your body, precise in describing symptoms, review the effects and benefits of any medications prescribed, and above all insistent that the doctor tell you what he has found, his plan for your treatment and the expected result. And, if you find that the word "hypercondriac" has been written into your chart, find another doctor.

The days of 'trusting' your physician are over. People are more like 'clientèle' than 'patients'.

Money is a factor.

As I've said before. "Treatment" is the norm, "cure" is absurd.

Managed care demands that the member doctor treat what is in front of their face. Judgment calls based on averages.

Prospective patients need to learn all they can about what is affecting them before making an appointment, and still demand that the physician consider their input or thoughts.

I've had IBS for years. Did my doctor know about particular causes of IBS? Yes. All of them do. Is it 'treatable'? Sure. Do they tell their patients what typically causes it? No. They feel patients want as easy a 'treatment' as possible. And, they will be repeat customers.

I've said it before . . . mention the WORD 'cure' in front of your doctor, and watch their expression. (Mind-you, you had better have all your ducks in a row first.)

When I asked about gluten intolerance, my current physician hem-hawed around a sentence or two, but admitted it was a likely solution.

Guess what? It was. (BTW; for another post, forgive me, my tests came back positive for gluten anti-bodies, but negative on the dermatitis . . . the rash was just another symptom/side-effect.)

Had I been tested for the gluten insensitivity several years ago, Who knows how I might be doing today? (It has been around quite a while.) A fair proportion of patients with symptoms of IBS have underlying coeliac disease, and screening for coeliac disease is recommended for those with IBS symptoms; but you won't get it unless you beg (on managed care).

Treating the obvious symptoms is so much more profitable, and they can get away with it because patients don't want to go to any effort to 'cure' their own ills (an accustomed teaching to new physicians). They have succumbed to the notion that a pill is preferred over, say - a life-style change.

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. This was the first time a doctor did it while I watched. Later, when I asked if it were possible to increase the dose of my medication, he checked again on the computer to see if it were.

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.

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. This was the first time a doctor did it while I watched. Later, when I asked if it were possible to increase the dose of my medication, he checked again on the computer to see if it were.

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.

How sad.

People are not databases. Kaiser's database looks great but I know them to be well shielded perpetrators of minimally,,, negligent homicide.

If my friend takes even a pediatric dose of Sudefed/pseudoephedrine he is hyper for days. Normally it should be gone in hours. Nothing can beat the one on one. Would the patient rather have a cholesterol a little too high or be on an expensive, liver killing medicine? This is not the stuff of computers but, old fashion, cottage industry - one doctor, one office, medical care.

Moi