[Shinkei]

Wow. I am a physician and this is perfect.

1. You just need to read about the Dunning-Kruger effect. Enough said. https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect

2. Each physician has their own motivations for this one... some liability, some internal moral code, but some just understand that science is about being objective. That being said, prevailing wisdom is that medicine is as much an art as it is a science.

3. Yes, but be careful. Try to establish a relationship with your provider before pulling out the graphs and spreadsheets.

[arpa]

If you read about the Dunning-Kruger effect, it is essential to also read its' criticism, very aptly summarized here: http://www.talyarkoni.org/blog/2010/07/07/what-the-dunning-k... (posted here numerous times; the truth is, well, we all suck at heuristic self-assessment, regardless of our skill, sorry). It's always easy to write off other people as "incompetent", blame Dunning-Kruger, and just ignore what they say and think they know. A lot of physicians tend to do that, and, frankly speaking, it just comes off as arrogance and does not help confidence at all.

[aangjie]

After a recent argument with my wife's doctor, I decided to write a rationality style guide for new doctors. Feedback from practicing Doctors is hard to find. Please comment. Here's the link http://lesswrong.com/lw/ntq/advice_to_new_doctors_starting_p... .

[Shinkei]

It looks great! I will read it over the next few days.

[icantdrive55]

Let's not forget good insurance, and large amounts of money.

I hate to be that guy, but I have been to too many unneeded office visits over my years, or have been told flat out Dr. Whatever charges $350/hr. Hour? It's always just a short visit. As, I've gotten older, I don't want to spend to much time with them. The shorter the office visit the better.

Yea, and I know, your physician lives are so terrible. You had to pay $400,000 for school. You had to get through that residency in which you where hazed, by other Doctors. You have to listen to people whine, and complain--in many cases because they are sick, and in pain. (Get ready for the "I don't treat pain" Doctor", and the FDA is on their side. I don't feel like debating this one either. Too tired.)

Yea, you guessed right, I'm no fan of the American Doctor. I don't like the system? Or, I just don't like American Doctors, with that ego. An ego that seems undeserved after getting into med school, in so, so many cases.

On another note, I'm shocked at how seemingly little advances medicine has made in the last 30 years. Advances that help the patients. Not theoretical advances that look nice on paper.

I smile, and kiss their ass, but there's no love, nor even much respect anymore.

Signed,

Alotofpatients

(I'm not comming back to this post. I will add this, I used to think older doctors were better. I think I was really wrong. In my life, I have met one doctor who appeared to get better with age. He had some unusual medical issues throughout his life that appeared to make him care?)

[cmdrfred]

I take home about 32k a year. I also have asthma. I will have it until I die. With the insurance my company offers my medicine is 150 dollars a month on top of the $175 a month fee. To get the prescription I need to pay another $75 dollars every 6 months to the doctor (At the end, They dident even bother with the pretense of busting out the stethoscope anymore I'd come in sit down and they would write the script) I buy the same medicine from India for $30 without a prescription online. It's a scam pure and simple. The choice for me was either drop the insurance and buy a house or rent and pay for insurance that covers little and costs a lot.

[no1youknowz]

I too have asthma.

When I was in the US, I needed a certain type of inhaler. It cost $150. I kid you not, I was furious! I had to pay knowing full well, the same inhaler cost £5 in the UK. Talk about a serious markup!

Now back in the UK. Before I go back. I will visit my doctor about 5 times and stock up on them. Bring as many as I can in the UK so that I never run out again!

[cmdrfred]

People claim that they "Spend so much on R and D that they need to be able to charge these prices". My drug albuterol was in use 100 years ago.

[squeaky-clean]

Similar situation here. My inhalers are $40 each after insurance and last me about 30 days. And then I still have to pay to visit the doctor, who refuses to give me more than 3 at a time.

Nowadays, I have a friend from Cuba who also has Asthma and can buy them for less than a dollar with no prescription. So I just buy him a case of beer and get a year's worth of Salbutamol inhalers.

I can't find somewhere as cheap to get my Advair, but I find I don't really need that one.

[davidjnelson]

Have you checked the prices at the Costco pharmacy? Usually 10-20x less.

[Maskawanian]

Out of curiosity, which vendor do you use?

[cmdrfred]

So they pop in and out of existence from time to time but they are all basically front business from what I can tell. support-rx.com is the 'support' site that you get sent to after you order (I've ordered from 5 or so 'front businesses' and always get sent there), but to actually order anything I go to canadapharmacy24h.com currently. Shipping is costly so I buy in bulk, it takes about 2 weeks to get to my door. When I was working as a cook these companies saved my life, this is what capitalism is all about.

[Shinkei]

Well, I'm sorry you aren't coming back to this post because I think you should read the reply.

The healthcare system has problems, but NOT because of most doctors. Yes, just like in every field, there are unscrupulous individuals... but most of the people I have known and worked with are not sociopaths in white coats. Just follow the money... Medicare Part D was the single biggest travesty visited on the American people in recent memory. It was literally a theft of our tax money and a gift to the drug companies. While Insurance companies, hospitals, drug companies, devices companies, etc. continue to increase gains and conspire to steal from the healthcare system (inversions, mergers, price-fixing, the list goes on...) physician pay actually represents a small percentage of healthcare costs. (Depending on who you get the numbers from, it is about 10% of the total). Believe me, when I have to get healthcare, I see the same problems you do. I've waited on hold, been over-billed, late appointments, all of it... even medical complications. The fact is, the bureaucracy is strangling any attempts at improvement.

I'll give you an example, I work in a bunch of different healthcare systems and each one of them is required to independently verify my credentials. Everything from my medical school diploma to my training and license. It requires primary source too! So every hospital--even different hospitals owned by the same system--has to do this incredibly redundant and wasteful process. Not to mention that it does nothing to ensure quality. So here's a whole army of people doing something that should be a simple database query that takes 1 minute. That's increased cost. There are these companies now that an insurer can hire to field imaging orders and determine which are appropriate and which are not. If they save the insurer even $1 over what they are being paid... then they win. Meanwhile, that's maybe $1-2 million that could've just been used to pay for care... instead it's going to a middleman simply to DENY care!

Believe me. Your frustrations are justified... but don't hang the physicians out to dry. My generation was not the architects of this disaster and we are suffering from it too. We are still individuals, wage-earners. We are not the corporations that would happily merge and invert our way off-shore. They are the real conspirators in this.

[kranner]

Why #3?

[Shinkei]

Because--for better or worse--this raises red flags I think. I could see a lot of people getting defensive.

[kranner]

I'm sorry but I don't understand. What red flags? If I come into the hospital with detailed data on what pills I took and how symptoms varied from day to day (without offering my own interpretation as to causes), compared to coming in with no history, how is the former a cause for suspicion?

As a haemophilia patient who carries a decade+ log of infusions (Factor VIII in my case) I have never been met with any kind of suspicion or defiance by doctors. In fact this has persuaded doctors in unfamiliar hospitals (when I have a bleeding episode while travelling) to give me only as much Factor VIII as I have needed historically, and not a much larger amount based on my body weight. (Large amounts of Factor VIII seem to be a trigger for inhibitor formation so I am interested in taking as little as needed.) Factor VIII assays on the other hand seem to present a different result every time I get them done (varying from <1% to 25%).

I can assure you that any data geek who bothers to note this stuff down is very, very concerned about keeping accurate logs.

[Shinkei]

Ah, I think I misunderstood your situation. Yes, your specific case I think warrants that kind of specific, careful monitoring.

I was speaking more generally about people who don't have significant past medical history who arrive with superfluous data.