Fuck this doctor pity party. I've been to the doctors for four things in the last twenty years. Twice I was misdiagnosed. If the doctor had looked at the tests they had made me pay for they would have realized this immediately. The first time it happened I was out of work for three months as a consequence. I had been super sick but after four days of the wrong medicine I looked like I was on death door, doctor turned white as a sheet when he saw me and then took on a ghostly pallor again when I looked at my test results. The second time I called the day they said the results would be in and asked for my results. They said the results were in and they just had to get someone to look at them, they would call me back. I knew that things weren't going well so after a four hour wait I called them back again. Still no one available to look at my results...Wait two more hours and they call and say, "uh our diagnosis was wrong you have something else." I wait for them to say more...like thirty seconds of silence... "So should I stop taking my medicine?" "Uh yea, you really shouldn't be taking that." Fucking awesome job doc. Another time I was correctly diagnosed, they wanted to put me in the hospital but there is no way I'm going into a hospital to get myself a secondary infection if I don't have to and I really don't have the money for a hospital stay. So we work out treatment from my house but I don't get better. Go in to see him again and he asks me if I have been doing certain things and avoid certain other things, all things that he never mentioned the first time around. I go home and start doing and not doing the things he said and I'm mended up in a few days. The one other time the doctor said go home, rest and you'll be better in a few days, she was right. It's all argument by anecdote but I'm pretty sure that if you aren't looking out for yourself doctors will kill you.
As a healthcare provider - but one not too far out from being a layman - I really do understand where you're coming from. However, a few things to keep in mind: -Despite how strong of a scientific basis we like to pretend medicine has, the diagnostic process is a game of probability. There are very, very few diagnoses that we ever know for certain are going on. Things like colds, GI bugs, etc. are treated empirically, meaning without specific confirmation of the diagnosis (despite evidence supporting it) and based on the most likely possibility. This process works very well for common things, but it obviously results in missed diagnoses. A competent physician will correct an incorrect diagnosis and change your treatment plan accordingly. -While it's no excuse, most primary care physicians are sorely overworked and understaffed to manage the patient loads they do. This is largely due to the poor reimbursement they receive. Where, for example, a dermatologist might be able to bill anywhere from $100-1500 for a 15 minute appointment depending upon what's done, your standard 15-minute primary care appointment will not be billed for more than $200. The Medicare reimbursement rate is abysmal - less than $100. That sounds like a lot of money, but keep in mind that your average primary care office has substantial overhead associated with operating it. Throw in the fact that 15-minute appointments simply aren't long enough to effectively treat complex patients (in my opinion at least), appointments tend to run long, the physician has to deal with random patient calls, calls from insurance companies, having to write letters to various insurance payers (be they Medicare/Medicaid or private insurance) justifying why your patient needs x medication, and it perhaps might be more understandable why a physician doesn't remember you or everything going on with respect to your health. -Physicians as a whole are not the most personable people. I completely relate to your anecdote about the physician not being more, shall we say, compassionate and understanding when you called about the test results. Many physicians seem to have forgotten how anxiety-inducing things like a missed diagnosis, not calling to notify patients of test results when you said you would, and many other things that are routine for the physician but very out of the ordinary for patients can be. I think you're right in demanding better from your physician, and in no way do I excuse things like that. I make it a point to comfort patients as much as I can, and I'm a stickler with respect to things like calling about test results and providing good advice to patients because I remember what it was like to be the one sitting on the examining table. All that said, again, I submit to you that this phenomenon is NOT because the physician is uninterested in your health. Instead, I think it's a combination of two things: 1) differential experiences (i.e., what I mentioned above with respect to routine vs. non-routine things and the hugely different perspectives of patients and physicians) and 2) a primary care physician being pulled in 3 different directions at any one time during the work day. You're right that we should demand better of our physicians. At the end of the day, these things are small things that are easily correctable if you have the willpower. I also agree that at the end of the day, people need to look out for their own health. Yes, that's what physicians are supposed to do, and 90% of them do it well. But at the end of the day, you are your best advocate. Does something seem not right to you or do you have questions about something? ASK. If your doctor seems uninterested in spending the time that you feel is necessary to address your concerns, then you should find another physician if possible. Managing your health is very much a team sport, and you're likely to get the best results if you're teamed up with someone with whom you like and can work well. So, in closing, while I agree that there are some shortcomings in the way healthcare is delivered and doctor-patient relationships, I disagree with the notion that "if you aren't looking out for yourself doctors will kill you." -Your friendly neighborhood doc PS: Could I have said "at the end of the day" any more? :P
I do think that ordering and charging me for test that will never get looked at seem unethical. Because my experience with doctors has been pretty bad I tend to avoid them. I don't have a doctor, so when I get sick I end up relying on a doctor I don't know usually at the first place I can get into or the emergency room. I bet it's a shitty way to choose a doctor and ends up enhancing my fear of them. I don't care if a doctor has a nice bedside manner, just like a I don't care if my mechanic is friendly. The only thing I need is competent care. I'd certainly be dead today without modern medicine but I don't really think my Doctor can claim much of the credit for me being alive today, that would be like me taking credit for fermentation when I get someone drunk (bartender). Being really busy isn't a sufficient excuse for not doing ones job well. I understand that people will be misdiagnosed and that even the best doctor in the world will do so but it doesn't excuse not looking at the test results and realizing that you have put a patient in dire peril, out of work for a few months, or killed them.