shopping for doctors

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Vacation! Day one. Today is the first day of my first ever 2 week-long vacation. I even get paid extra for taking 2 weeks off in a row. I have been a little slow on the writing for 2 reasons. 1) I have spent the last several weeks delegated to cardiac surgery, who have made sure that I was busy in the OR, mostly involved in venous harvesting all day, and 2) I have really been making an effort to reduce my exposure to the EMS world so I don’t actually have much to write about.

One of the things that is a cause of ongoing grief for me is antibiotic therapy. Rather the lack of antibiotic therapy among physicians who not only seem to have latched on to a fatally flawed theory of antibiotic resistance, but more importantly, because it seems to me most physicians simply do not understand the difference between acute infection, chronic infection, and an acute exacerbation of a chronic infection.

All 3 of these conditions have different findings and history, despite this, it seems most physicians only use the guidelines for acute infection and subsequently misdiagnose and do not treat the other two. While it is simply another example of the failure of McMedicine in action, it is one that stresses me.

When staring at a patient’s blood counts, in chronic infection and acute exacerbation of chronic infection, forget about seeing an elevated neutrophil count. You won’t. Sometimes you can see a middle or upper end of normal range neutrophil count, but mainly you see mid-range of normal to slightly elevated lymphocytes. Anyone who actually understands the immune system should not be surprised by this.

Another matter of misdiagnosing chronic infection is the absence of fever. Generalized fever is actually part of the initial inflammatory response. Why would anyone expect to find a generalized fever in a chronic infection? I don’t know. But I really wish more doctors (I expect less from other providers) would take some time to actually understand immune response and correlate it with patient findings when choosing therapies.

Just because a patient has WNL lab values does not mean they have a viral infection. Why is that so hard to figure out?

Moving right along to another topic that “emergency” workers seem to really not have caught onto is that “true emergencies” are actually pretty rare. The ability to effectively intervene in these “true emergencies “ is rarer still. But for some reason there is this complete denial of reality of emergency physicians and those working in emergency.

It really pains me when I hear emergency docs give people grief on how they should not have come to the emergency room because they don’t have an emergency. But it totally ignores the reasons many people go to the emergency room.

You see, no matter what country you go to, primary care operates on a totally outdated concept. That you will take time off of work or make an appointment to see a doctor some weeks in advance. This is completely unrealistic in the year 2014. First, the main purpose of medicine has always been to maintain individual and sociological productivity. In order to be productive, people need the doctor after normal business hours. Primary care providers see this as a burden that interferes with their life style. In doing so, they have basically made themselves irrelevant as physicians. They claim there is the alternative of “urgent care” but it has accessibility problems and suffers from the same inadequacies of emergency care, namely the lack of long term history and care. Also let’s face it, when you have a UTI, a sinus infection, an STD, or even pneumonia, waiting 2+ weeks for an appointment with a GP is just not realistic.

So people naturally gravitate where and when they can for care. That is the emergency system. Emergency workers might as well get used to it because it is not going to change. More than getting used to it, maybe they should make an effort to actually be good at it?

What a crazy concept, doctors who actually help people with their problems instead of endlessly referring them through unnavigable systems at a later date when they are sick now. You see that’s what GPs do.

Both of these topics together lead people to “doctor shop”, basically search for a doctor who will actually help with their problem. In the healthcare industry this is viewed in a very negative way. Most often it is labled as “drug seeking” behavior, even when it is for medications other than pain meds. It is in fact drug seeking, but I would say more accurately believing that drugs are the help sought.

It is all really a situation where nobody can win. Providers don’t get to do what they want. Patients don’t get help. Money trades hands and nobody is better off.

I would hope one day it will change. But reality is that it will not. This mentality is absolutely engrained in every medical system I have ever seen. I am opened to reasonable solutions. Even unreasonable ones. I have yet to figure out why despite the world being completely different in 2014 than it was even 10 years ago, medical providers still insist on working and acting like it is the 1800s. I am not even convinced people have the mental capability to change it.

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