Newly lost faith in health care

[MThuntrrr]

Only adding that as another fellow MD, I am not paid by any pharmaceutical company and don’t know any other doctor that is while practicing medicine over 15 years. This is complete BS that gets spread through the masses.

 

[mitchellmountain]

I'm not saying the system is perfect or awful but working within an imperfect system you have to act as a selective consumer and work to find healthcare at the level you want. Find a new doctor.

This is great advice.
I'm a chiropractor, have been for 20 years, but also have lots of friends in traditional healthcare ranging from neurosurgeons to LPN's. 80 percent of our patients ( mine and theirs) want to just deal with the current complaint and go on living their life the way they always have. 15 percent have a real interest in improving their health habits but they lack the ability to follow through with those changes on a long term basis. 5 percent ( and I might be a little liberal with that number) want to actively pursue long term health and functionality AND can commit long term to those goals.
I consider myself blessed that I have yet to be burned out by the 95% of clients that come through the door. I still am interested in helping them get healthier but only point those horses toward water that want to drink. I can totally empathize with MD's that mainly write scripts to address health issues. You can spend a lot of time and emotional energy trying to get people to take responsibility for their health and most will not get to thst point.
You need to shop for the right doctor thst fits your needs. It's that simple.
By the way, this is not a rant about the typical patient I see, it is recognition for the situation as it presents itself. I love my clients, enjoy the heck out of my job. I provide the type of care they are seeking( within reason) not providing the care I personally think they should have.

My 2 cents

MM

 

[Pharmseller]

Regarding drug reps:

Just like anything else, there’s good ones and bad ones.

The good ones can be an important resource if you let them.

The bad ones you simply ask not to return.

But deliberately refusing the potential (potential, because some drug reps are bad) benefit of an information resource makes no sense to me.

Plus, many reps carry samples of their medications, which can be another benefit when prescribing.

Speaking for myself, I wouldn’t see a doc who didn’t allow reps.





P

 

[P Carter]

Just wanted to drop a quick thanks to the participants in the thread, particularly the doctors - really helpful.

I’m a healthy 40-year-old that hasn’t seen a doctor since…sheesh, 2011? Apart from one visit for a particular nerve issue.

I need to “get a doctor,” but frankly concerned about the approach identified by many in the thread: I’ll want to optimize health, very little interest in a 15-minute non-substantive drive by where the doc says “good enough.” Doesn’t help that there is basically no information online that would help one choose a doctor, and it seems like 2/3 of the docs around here aren’t taking new patients anyway.

Thoughts? (No need to derail the thread…)

 

[waspocrew]

That’s good on you but most general practice guys just throw antihypertensives or statins at ya and send you on your way.

I mean if a guy has a BP of 140/88 but is 30 lbs overweight and his idea of exercise is walking from the house to the truck in the morning antihypertensives aren’t the answer.

People have more information at their fingertips than ever before and have become frustrated with a healthcare industry that increasingly pushes drugs, vaccines, and other profit makers instead of promoting actual health.

I’m actually a Mohs surgeon/Dermatologist. I was commenting on the nonsense that a computer tells me what to prescribe and if I don’t, I’ll have issues with my license or not be paid.

You’re absolutely right - information is everywhere, but there’s also a lot of false information to sift through as well.

 

[P Carter]

To somewhat contribute: my dad is in healthcare, and I remember him pronouncing “the country is doomed” when, in the 1990s, they had to add a new scale that went up to 300 lbs. And that was just the start.

A few years later that scale became the “ordinary” scale (before it was used only occasionally) and they had to get another scale that went up to *400* lbs. (this was in a clinic that treats exclusively women.)

Then they had to put in one double-wide chair in the waiting room. A few years later, the double-wide chair became the standard chair, so they only had a few single-wide chairs left.

Just walking through the airport is…so sad. There is simply no way we can continue to pay for the obvious wide scale poor health in this country, coupled with the low expectations and lack of personal responsibility.

 

[Split toe]

As a family doctor in a rural area (meaning very few specialists available to my patients without a lot of extra effort), I have so many thoughts upon reading this thread.

First, to the OP, I have to say I’m sorry you had such a poor experience. I agree with others, find a better doctor. At a minimum you should have heard your options for treating high cholesterol and had some agency in the decision on how to proceed. Like the quote above, the decision to start medicine should be based on good evidence. Early on I used this same calculator (ASCVD risk calculator for those wondering) for every patient I saw with high cholesterol. Now, a few years into practice, I always reference that calculator in my discussion and offer to go through it with the patient if they'd like to see it or if I’m unsure what the results will be. Otherwise, if I feel confident enough in what the answer will be based on their numbers/risk factors, then I will just tell them my recommendation and why.

Being a primary care doctor in the U.S. is becoming a very tall order. I still love my job and care a great deal for my patients, but the systems that I work within make that harder to maintain every day. Many of the medical decisions I make are determined by what treatments will or won’t be covered by insurance. As others have said, very few patients will follow my advice no matter how much extra training I’ve sought out to become more effective in educating people on healthy lifestyle choices. There is constant pressure to see more patients for shorter visit times. The amount of paperwork and administrative tasks I do amount to 1-2 hours every day after I finish clinic, the majority of which are completed to ensure my patients will get the things they need paid for by insurance. If I choose not to do that paperwork in a timely manner, the patient pays the price.

I realize much of what I wrote above sounds like a complaint and to a degree, it is. However my complaints rarely revolve around the patients I see or the organization I work for. The most challenging part of working in primary care is all the systems that don’t allow us to practice medicine in a way that we or our patients enjoy. For perspective, this year (2025), over 800 training spots in family medicine went unfilled, which is the largest number in history (though this is possibly skewed as we also have increased training spots for FM over time). I think this really speaks to how little incentive there is to go into primary care right now.

To be honest, I agree with many who say that healthcare needs a reset. It feels as though we’re at a tipping point where health insurance has developed a monopoly on the entire US healthcare system and they get to call all the shots. Due to the insanely high costs, very few can afford to go outside the insurance system for major medical needs, procedures or surgeries, though that can be a nice option for primary care. Despite that, some insurances (looking at you United Healthcare) have denial rates that approach 90%, meaning less than 10% of requests are actually paid for by insurance. I have cared for many patients with this experience and their choices are to pay the bill or take it to court and likely spend even more in legal fees.

I want to again say that I love my job and it feels like a blessing every day that I get to do this work. Yet despite that passion, the system has become so challenging to work within, even I have days where I consider another career just to get out of it.

There are lots of great doctors out there and if you look hard enough, I’m sure you’ll find one. That said, I fear the current system is going to gradually make that a rarer occurrence with each passing year until we see some major reform.

One final thought for those advocating lifestyle changes vs medications - I 100% agree with you but the vast majority of my patients don’t see it that way. I legitimately had a visit last week where a patient was mad his insurance wouldn’t cover ozempic for weight loss and he asked me if I could help him understand what foods to eat so he could “temporarily develop diabetes” in order to get the ozempic covered. He actually got angry with me when I suggested he focus on a healthy lifestyle and be grateful he doesn’t have diabetes and therefore doesn’t need mediation like ozempic to treat it. I have not seen him back since then and I doubt that I will.

You can't blame some of the med school graduates that avoid primary care anymore these days when hospital systems view us as replaceable and midlevels as equivocal until it is one of their family members that need to be seen.

Really glad that the folks that I treat with acute life threatening illness are more grateful than the hyperlipidemia crowd…

EM guy here and it is threads like these that make me thankful as well that I don't have to deal with some of this nonsense in this thread and that circulates in society daily.

 

[Split toe]

For everybody that has not made their mind up about functional/integrative medicine...let me give you some insight, it is just another avenue to separate you from your hard earned money with very little benefit if any. Some of the stuff I see in the ER that these quacks are doing outpatient leaves me speechless and shaking my head sometimes.

 

[average]

A healthy 33yo going to the doctor for yearly checkups? I think your first step is to stop doing that. Get a checkup at 30,40,50, etc. Check your own BP regularly at home, stay fit and active. Go in between 10 yr checkups if you break something or have a reason.

Seeing a general practitioner once a year is a waste of time and you’ll absolutely get offered meds to micromanage things. You certainly won’t get lifestyle advice meds are easier.

I don't know if everyone who's employed by the medical system should thank you for keeping them employed by pushing this attitude or lecture you on how the "don't need a doctor until something is obviously broke" attitude is a big factor in the short comings of the US medical system.

 

[S.Clancy]

I always love these threads. Not only do 99% of people not have a rudimentary idea of human biology, the same or less don't understand statistics or how too read a research paper. But they'll give advice all day long....

As a final thought, it's pretty obvious our standards for appropriate weight/body fat are hugely skewed. If you are 20% body fat you are fat, as a man. Everyone hates BMI, but it's a pretty good indicator of healthy weight for a lean person. It's pretty hard to get above BMI of 25-26 with 12-14% BF.

 

[Split toe]

A healthy 33yo going to the doctor for yearly checkups? I think your first step is to stop doing that. Get a checkup at 30,40,50, etc. Check your own BP regularly at home, stay fit and active. Go in between 10 yr checkups if you break something or have a reason.

Seeing a general practitioner once a year is a waste of time and you’ll absolutely get offered meds to micromanage things. You certainly won’t get lifestyle advice meds are easier.

To some extent this is misguided. One reason for our poor outcomes in our country is lack of access/preventative care. It is like saying don't look for a small problem until it's a big problem. As for the lifestyle advice, you'd be surprised at what percentage (it's high) of people don't want that and just want the easy button, aka medication.

That’s good on you but most general practice guys just throw antihypertensives or statins at ya and send you on your way.

I mean if a guy has a BP of 140/88 but is 30 lbs overweight and his idea of exercise is walking from the house to the truck in the morning antihypertensives aren’t the answer.

People have more information at their fingertips than ever before and have become frustrated with a healthcare industry that increasingly pushes drugs, vaccines, and other profit makers instead of promoting actual health.

Back to my point above, you are obviously an outlier and in the minority being motivated and making lifestyle changes to avoid medication and prolong your life, vast majority of people don't want to do anything other than take medication and take the easy route.

 

[ODB]

To somewhat contribute: my dad is in healthcare, and I remember him pronouncing “the country is doomed” when, in the 1990s, they had to add a new scale that went up to 300 lbs. And that was just the start.

A few years later that scale became the “ordinary” scale (before it was used only occasionally) and they had to get another scale that went up to *400* lbs. (this was in a clinic that treats exclusively women.)

Then they had to put in one double-wide chair in the waiting room. A few years later, the double-wide chair became the standard chair, so they only had a few single-wide chairs left.

Just walking through the airport is…so sad. There is simply no way we can continue to pay for the obvious wide scale poor health in this country, coupled with the low expectations and lack of personal responsibility.

Fall protection harnesses used to cap user weight at 310lb…now it’s generally 420lb.

 

[Idaboy]

What were your numbers?

LDL does not really mean squat, get an apoB test for about $15 if insurance will not cover it. Volume of LDL is totally meaningless other than a loose correlation to count especially if you eat healthy fats.

High trigs is a big red flag though for metabolic function, I would cut out sugar and reduce carbs to reduce those. Spend $80 to wear a CGM for a month if you think your diet already matches this and see how you are actually reacting to food.

If apob does show high in addition to exercise crank fiber way up, its the easiest way to impact that number. Adding an avocado and some collards to eggs in the morning is an easy low carb way to do it, fiber supplements can help too. The "dont eat red meat" advice is generally bad though reducing saturated fat is not the worst idea, grass fed beef and cutting out saturated fat from desert items is a good step though.

This is all IF you buy the LDL/apob causation of heart disease, I think the science on that is loose.

No matter what deal with those trigs though, if nothing else its a sign of diabetes looming.

Good points. Not sure we have clear evidence that lowering ApoB then leads to good outcomes In primary prevention/people as described in OP. Hopefully more studies on ApoB in upcoming years, as it has some good data on risks

 

[Bighorse]

LOL....I didn't read this entire thread but it cracks me up that one post on Rokslide gets more quality info and access to providers than a scheduled visit. I've been working in Healthcare for 23 years. I'm an imaging technologist, so no pill pushin or whatnots. I just provide high quality evidence based care.

 

[fwafwow]

I went the concierge route almost 5 years ago. Now my doctor talks to me. He was very helpful after my TBI. During my annual “physical” we just talked about what was on my mind. My blood test results, including my “red” numbers (241 total cholesterol, 166 LDL and 186 non-HDL and 7.6 PSA) never even came up. Certainly no statin recommendation, as we covered that 4 years ago.

Yeah, I pay monthly out of pocket for what I *should* be getting as part of my health insurance. Given the ridiculous amount of money I spend on stuff due to RS, paying extra is probably the best splurge of mine.

 

[Speaks]

I went the concierge route almost 5 years ago. Now my doctor talks to me. He was very helpful after my TBI. During my annual “physical” we just talked about what was on my mind. My blood test results, including my “red” numbers (241 total cholesterol, 166 LDL and 186 non-HDL and 7.6 PSA) never even came up. Certainly no statin recommendation, as we covered that 4 years ago.

Yeah, I pay monthly out of pocket for what I *should* be getting as part of my health insurance. Given the ridiculous amount of money I spend on stuff due to RS, paying extra is probably the best splurge of mine.

Ball park what does a concierge doc run you? Have toyed with looking into one.

 

[Theringworm]

Ball park what does a concierge doc run you? Have toyed with looking into one.

All depends on where you live. Local to me, it's anywhere between $2k and $10k annually. The majority are in the $2-3k range.

 

[fwafwow]

All depends on where you live. Local to me, it's anywhere between $2k and $10k annually. The majority are in the $2-3k range.

I’m in the lower range. My guy charges monthly and it varies by age.

 

[yfarm]

Fall protection harnesses used to cap user weight at 310lb…now it’s generally 420lb.

CT scanners originally had weight limits of 300 lbs as did xray tables. The CTs table drive gears would jump and stop. Companies gradually increased table limits. Next issue was bore diameter, if the patient makes contact with the inside of the bore, machine stops. There are eventually design limits on machines you cant overcome. When you do the scanogram at the start, you see a tiny skeleton in a body 3 or 4 times larger. No surprise why joints wear out.

 

[Forestryguy]

I’ve worked in health care for quite a while.

The system is broken. People want an instant fix, so that’s why doctors say “here, take this.” Most people don’t want or care to change their lifestyle. And doctors aren’t going to waste their time trying to change someone who isn’t going to change.

You have the right to refuse. So do it. Tell your doctor you don’t want a pill, that you want a second opinion or other options besides medicine.

It’s well documented that the US is probably the worst advanced nation in the world at treating long term medical issues.

Not to mention a large percentage of patients won’t even follow through with taking meds or if there is a care plan in place. Just show up to the ED when symptoms are bad to get fixed.