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[andius]

I feel part of the problem is they don't have the time to really listen to the patient, or even the desire anymore with all the advancement in medicine and the regulations and legal issues concerned now.  They also have no incentive as they are being paid less and less and not on their experience or treatment of the patient, but on saving money.  Complex patients cost money. Medicine used to be an "art" that some docs practiced  well and others got by well enough with their education.  Now it is like a computer program that the doctor must follow and you are only allowed one problem due to little time available.

 The doctors have become "providers" and they just provide the route to the "diagnostic flow chart" for your symptom with the "likely" drug or treatment given at the bottom (end).  If they follow the "likely" path, it is considered acceptable. The art of medicine has become  like a computer program that even other allied heath professionals like nurses have been taught how to navigate. The problem is that those don't have the education or experience to handle anything very complicated or to integrate different health problems.

 Only the ear ache, sore throat or high blood pressure, ect. is considered at a time.  The whole person and their other issues are ignored for the most likely problem or the easy solution. If you don't fit that, then they aren't willing to work out the issues until the next visit, when it is time to start all over again with the "other" most likely problem. It seems to take forever to get a decent evaluation as they send you to  each "specialist" to have you follow down their respective flow charts.  If you don't fit or the treatment doesn't work, then you are off to the next specialist or considered a difficult patient or a "flake". Each specialist only handles their branch of medicine, so you must see another you have an ancillary issue outside their field.

It can be very frustrating. I can't imagine what it must be like to have major health issues in old age. Trying to navigate the medical system would be like having a job in retirement! Staying healthy is really important.

Andius

[devonhil]

Andius, LFS (and everyone else!)

you are so spot on about the irritating way GPs immediately start tapping into their computers the minute you mention a symptom. It feels like they are just using a program where symptom is typed in the top with the goal of a particular drug coming out the other end. Whether it's because we, as patients, expect to leave clutching a prescription or whether GPs feel that they should give us one I don't know. I think it is really interesting in Andius' post that doctors are called 'providers' with the emphasis on providing drugs rather than as 'carers' - which tends to be the description given to low-paid/low-status health care (mostly done by women!). Providers tend to be quick and drug-based, carers less hasty and working without drugs.

As Andius says there is a kind of flow chart system for each symptom which could potentially mean being prescribed a separate drug (and maybe even a separate appointment) for each symptom. Whilst I appreciate the NHS is cash-starved surely someone somewhere has worked out the maths:


(1 symptom x 1 drug) x lots of short appointments = lots of drugs + lots of time + frustrated patient + irritated GP

(multiple symptoms x 1 drug/regime - HRT) x 1 longer appointment = one drug/regime + medium time + happier patient + fulfilled GP

the first one is what usually happens and it surely costs much much more than the second? Especially if some of those single symptoms involve being sent to specialists (rheumatologist for joint paint for example). With the emphasis these days on 'customer satisfaction' I would also be prepared to bet that the second example, where the patient feels listened to, is much more likely to make everyone feel better!

I wonder how much money is wasted with hasty diagnosis designed precisely to save money 

hil

[Trey]

Head in the computer syndrome very prevalent in US as well.  Disgusting.

[honeybun]

I must be very lucky because my doctors surgery just don't do this at all. There are eight doctors and not one of them has made me feel as if I was not important. The don't sit behind a desk looking at a computer. They only refer to the computer when they are looking at my records.

If people are unsatisfied with the service they get then complain and change surgery if you can. There are good doctors out there, it's just a case of finding them.


Honeyb
X

[Taz2]

Mine are great too. They always have a good look at the notes on the screen before asking what's wrong and the doc I am seeing at the moment gives you as much time as you  need. It is an accepted fact that if you have an appointment to see her then you are usually at least 45 minutes late going in. I don't feel that I am being treated via a flow-chart at all. Is this how the American system works Andius?

I thought that doctors were called providers because they "provide" a service?

Taz x 

[Limpy]

The GPs at the surgery I attend are really good.
I tend not to see the same one each time, it depends on who's available, but they all really speak and listen to you.
I know what Taz means about going in late though, but it does mean they DO listen to you.

[Dana]

Just on the subject of bioidenticals in America - I blame Oprah, Suzanne Somers and Robin McGraw (Dr Phil's wife) for most of the misunderstanding.

I'm not in America, but I remember seeing one of Oprah's shows a few years back and it was all about "Oh my gosh" there is this wonderful "new" thing called bioidenticals, except you can only get it if you go to a very expensive compounding pharmacy. Suzanne Somers was there talking about her whacko ideas, and Robin McGraw was extolling the virtues of getting her hormones "specially designed" for her. Yeah well she's got the money to pay for them I guess.

There was absolutely no mention whatsoever that bioidentical hormones were already freely available and approved by their FDA, so of course all these poor women were sitting in the audience looking like this  .

I'm also on another health forum (different topic, but with largely American posters) and if you mention "bioidenticals" there, most women seem to automatically think of compounded hormones. Even here in Australia, where I live, a lot of women don't even know that bioidenticals are available from their normal doctor and pharmacist. I've had many discussions (and debates) on this other forum, and I think I am starting to make a difference because I've been able to give them plenty of legitimate information to back up what I'm saying. However, I still get a bit frustrated by women who buy these OTC and online progesterone creams thinking that's going to be some sort of “cure-all”, but who can blame them though. There are so many dodgy internet sites, that claim they have all the answers, so it becomes very easy to believe them.

I actually try to avoid using the word "bioidentical" now, because I know how much it is misunderstood in different countries. I prefer to use the word "natural", because it says what it is on the tin. Somehow there needs to be more information put out in the public domain in all countries that "natural" hormones are available and cheap, and you don't need a compounding pharmacist to get them.

[devonhil]

thanks for that Dana

I know I have been confused so it's good to have it explained.

I think there are still lots of synthetic HRT treatments in the US (some of which have had quite nasty side-effects and have put women off HRT) - maybe they are behind Europe (and Australia?) in using natural versions? I read somewhere that natural hormone HRT as been the standard treatment in France for decades.

It seems that most eostrogen parts of HRT are natural but there are still quite a lot of synthetic progesterone substitutes (progestins) being used. My GP didn't know much about natural progesterone and clearly hadn't prescribed it (though she was happy to when I asked and mentioned that it was often called micronised progesterone). As lots of women on this forum seem to struggle with progestins it would definitely be worth trying the natural version instead.

hil

[Rowan]

Hormones, natural, compounded, bioidentical, conjugated, made to measure, over the counter, bought off the internet what ever you want to call them, they all have the potential for side effects, plus making you feel great or not so great.

Its the dose, type that suits you, that is the right one for you, no woman should be made to feel she has made the wrong choice whatever HRT she chooses or if she chooses at all to take it.