[eyerony]

If I could get antibiotics for strep or sinus infections without going to them, I'd pretty much never go. Those visits are really dumb because I already know what's wrong, and just need them to say "yep, it's the thing you already knew it was, here's a prescription and a bill for doing nothing useful"

... actually on reflection already knowing what's wrong and just needing a doctor to say it so treatment can proceed is the norm for interaction with doctors generally among friends and family. Including having to gently walk the doctor to the correct diagnosis so they don't waste a bunch of time and get you in for more visits and tests than you need.

[Wowfunhappy]

The fact that you used antibiotics as the example makes me very uneasy on this.

Antibiotics are almost certainly over-prescribed, and humanity is ultimately going to lose them as a result. It's good to make absolutely sure that you need them.

[eyerony]

By the time I get them for those things I'm usually sitting at about 4 hours of sleep over the last 48-72(!) hours and unable to eat or (sometimes) even keep water down, so yeah, I need 'em. I wait that long so my body has a change to fight it off without resorting to antibiotics, which sometimes does work. Though also to avoid spending two and a half hours being sick and miserable in the car, at the doctor's office, in the car again, at the pharmacy, then in the car again, rather than at home resting, until I just cannot avoid it.

[dcolkitt]

Actually, the medical system has probably on net contributed to antibiotic abuse. Yes, if antibiotics were OTC, people would use them more.

However for decades, doctors have universally instructed patients that they must finish the prescribed course. Even if the symptoms abate, patients are instructed to keep taking the dosage until done.

However this maxim was never supported by evidence[1]. Careful studies show that this approach leads to worse outcomes, because the patient's more likely to develop resistance on subsequent infections. And on average it leads to people taking two to three times more antibiotics than if they followed the intuitive approach of stopping when they feel better.

[1] https://www.nhs.uk/news/medication/questions-over-advice-to-...

[Delk]

Genuine and slightly off-topic question out of curiousity: how often do you have strep, a sinus infection (that doesn't go away on its own), or some other condition that requires treatment with antibiotics?

I think I've needed a course of antibiotics perhaps twice in the past ten or fifteen years (can't remember exactly; not often anyway), and one of them was in an exceptional situation.

That leads me to somewhat doubt most (generally healthy) people would manage to get infections requiring antibiotics so often that it would lead to the large (now temporarily reduced) total number of doctor's visits that the article brings up. Or if they do, then people are getting infections that require medical treatment way more often than I imagine. (That's also possible, since I live in a northern climate that doesn't really promote infections most of the time.)

[eyerony]

Ages 0-22: zero times, basically never sick, never had strep or a sinus infection even once. Maybe, maybe had very mild cases of the flu once or twice when very young but then never got it again in that age range, despite never bothering with the vaccine or taking any precautions whatsoever. I'd get my "annual sniffles" when I felt slightly off and had a slightly runny nose for about 36 hours. That's as sick as I got.

After that, once a year in a good year, twice in a bad one, and I get the flu every other year or so, even with the vaccine. If I get the flu it also gives me a sinus infection more often than not. Nose slightly stuffy 100% of the time, now. Almost all my strep and sinus infections trend toward landing me in the ER, on saline, if I don't get antibiotics—rarely do they just go away. Haven't made it quite that far yet but I've been damn close.

All I can figure is HGH is a hell of a drug. I was also super-fit (looking, plus solidly healthy-range BP) until about the end of that age range, despite eating ~2x my on-paper "maintenance" calories of pure garbage food every day. Go figure. I eat much less and much better now, am fatter, and get sick sometimes rather than never getting sick. Getting old sucks.

[Delk]

I see. I'm sorry you've seen such a drastic change.

I'm 37 now and went for years in my 20's without needing to visit a doctor more than a couple of times in total. I can see some of the changes that come with age but for me they're mostly related to slower physical recovery after exercise and some general wear on knees etc. Common colds might also make me feel somewhat worse than they would have 10 or 15 years ago, but I almost never develop any complications that would require anything else than time, and the change has been gradual enough to make it difficult to judge.

[robbiep]

Whilst I can’t speak for your particular circumstances and will assume you know exactly what is wrong with you and what you need, this assumption cannot be applied more broadly. In many respects the family practitioner’s role as gatekeeper to further medical care is anachronistic; perhaps we will be able to solve this with better technology. Until then, it provides a important centre for coordination of care and the prevention of unnecessary care (however imperfect this is at present)

[ryandrake]

As someone who rarely goes to the doctor (unless it's very serious) and when he does, does extensive "internet research" of his symptoms beforehand to come in knowledgable, I agree that for me, GPs gatekeeping medicine is unnecessary.

BUUUUT, I have a family friend who is basically a hypochondriac. She goes to the doctor ridiculously frequently, and is always trying to convince them (and everyone else who will listen) that she has all these undiagnosed medical conditions that she needs constant treatment for. Usually she's just sent home, where she does more and more "internet research" to find even more things that must be wrong with her. And it's not substance addiction: She's not going in there seeking abusable medication. She just wants validation that she has all these terrible conditions that she's dreamt up, and someone to finally tell her she's right. So, I guess at the end of the day we do need the gatekeepers, as anachronistic as they seem.

[Cthulhu_]

Counterpoint: What if she's not faking it? There's conditions like endometriosis that are horribly underdiagnosed and often dismissed as IBS; the average diagnosis takes seven years. Recently a 40-some year old died after being dismissed for years; her abdomen was riddled with endo tissue and adhesions, likely killing her in the end.

[robbiep]

There is no easy way to solve the problem of mis- or un-diagnosis, except better training, better awareness and hopefully better diagnostic techniques

[tetromino_]

Counterexample from recent personal experience: I developed pain in my hand which made it difficult to type. Some googling revealed that my set of symptoms could be caused by 3 rather different underlying causes requiring very different treatments. Failing to treat the correct underlying cause could permanently damage my ability to use my hand, and thus my ability to earn a living.

I _needed_ to go to a physician for a preliminary assessment and then needed to get an X-ray, and have the X-ray interpreted by a professional, to know how to proceed.

Unless you somehow have built a medical lab in your basement with instruments and reagents to do bloodwork, take X-rays, etc., doctor visits are occasionally absolutely needed.

[jjk166]

And what are the odds you will encounter that situation again in the next 10 years? In the same time period, what are the odds you'll need a prescription for antibiotics for a common disease?

No one is saying you should stop seeing doctors entirely, but several things that currently require a doctor's appointment probably shouldn't.

[jeltz]

Anecdotally I have required antibiotics once the last 30 or 35 years so I doubt I would need it any time soon and if I need it I do not think I would be able to self diagnose reliably. Maybe I am an extreme outlier but I do not think taking antibiotics is common among my friends and family either, other than a friend who has chronic ear issues.

Personally I think antibiotics is one of the cases where having a gatekeeper is the most important since we must fight antibiotics resistance.

[tetromino_]

Based on past experience, I expect to encounter a situation requiring expert medical attention every 5 years, and a situation requiring only a common antibiotic prescription every 1-2 years.

[JoeAltmaier]

The doctor can check for problems with similar symptoms. The simple act of looking up your nose and into your throat tells a lot.

Simply thinking "I hurt, like I hurt the last time I got strep" isn't a diagnosis. Its witchcraft essentially.

[Cactus2018]

>sinus infections

I previously had sinus infections all the time. I also took allergy pills every day. Now I don't.

I discovered 'sinus rinsing', you get a sinus rinse bottle (such as name brand NeilMed), a cup of distilled water, an appropriate amount of sea-salt, and microwave for x seconds (30-40).

This solves mold induced migraines, stuffy sinus from tree and grass allergy, and headaches from breathing pollution.

If you rolled around in grass and had itchy skin - you would shower and wash. Contrasted with breathing tree pollen all day - then taking a pharmaceutical anti-histamine.

[pjc50]

If people could get antibiotics on demand, the antibiotics would stop working a lot sooner...

Mind you, penicillin is cheap and widespread enough that we could probably hand that out.

[Cthulhu_]

We could, but we shouldn't because there's already too much superbacteria that are resistant to penicillin. Antibiotics should NEVER be handed out.

[retortio]

GP's really should go away. We need specialists and technicians to perform tests when necessary.

Medical training for everyone but surgeons should not take more than 5 total years including undergrad. Arbitrary number, but it should be significantly less time than it takes now.

Technicians who can be trained on specific technologies (x-ray, ultrasound, etc) should be able to handle most cases.

Medical treatment in the US today is a horribly inefficient hybrid of old and new.

[alistairSH]

This is the role that physician's assistants (PAs) and nurse practitioners (NPs) fill at most large family practices in the US. I haven't seen an actual MD for a physical or sore throat in many years. And my communication with the practice is with a PA. Same for my wife, who has an in-house clinic at her employer (not in the medical field, just a perk).