I got to see this side of American medicine while in high school. My great aunt unofficially overdosed on a cocktail of drugs prescribed by a group of loosely coordinating doctors.
When she passed, her cocktail included 12 prescriptions. One of her doctors had prescribed her medication to lower her blood pressure while another had her on medication to raise it.
Ouch. People are really bad at handling their own medical care. I’m legitimately on 8 different medications and 3 supplements (not including vitamins), per doctor’s instructions.
There is no way I’m going to any appointment (including my dentist) without a printed list of everything, including the dosages, instructions, and reason for being on it.
Edit: I apologize for the poor phrasing. It comes off being flippant. The reality is the American system is often broken, and it’s up to the patient to manage their own care. And for many reasons, people don’t or can’t.
What I was trying to say is, I have to do this and be diligent about it because no one else will. :(
> People are really bad at handling their own medical care.
Of course they are, that's why they seek professional help from people who have spent years studying medicine and who can presumably be trusted to understand the intricacies of the issues involved.
People are bad at handling their own auto repairs, that's why we have mechanics. They're bad at handling their own legal issues, that's why we have lawyers. Etc etc etc
It seems pretty harsh to react so flippantly to someone facing negative consequences to the advice given to them professionals. It's nothing other than victim blaming in my view.
>People are bad at handling their own auto repairs, that's why we have mechanics.
And much like doctors, mechanics have a massive conflict of interest. If you're not careful, the mechanic will propose a bunch of unnecessary work on your car just to earn more money.
People really are bad at DIY medical care... if only we could found a profession dedicated to doing it for them...
I propose we call them, "Doctors," from the Latin word for "teacher," by reference to their role in instructing patients on the things they need to know about their health.
As an aside, what's with all the chiropractors starting cults and self-help websites and running for office calling themselves "doctors" these days? It's like every time I hear about some dirtbag doctor selling a fake covid cure, turns out to be a chiropractor. Chiropractic was a quack gig to begin with, but whatever online university decided to call it a doctoral degree deserves a special place in hell. Still, doesn't fully explain their disproportionate presence in the snake oil business in the past decade.
If they're "doctor" it's because they completed a doctorate program, typically a D.C.
All people who complete a doctorate program are entitled to be addressed as "doctor". This includes everything from a Ph.D. (the original "doctor"), to M.D.s and D.O.s (medical doctors), and yes, D.C.
The chiropractors aren't having folks call them doctor because they have the right to (as someone with a PhD would do). They are doing it to make folks think they are medical professionals in the same manner as an M.D.
In other words, posing as a medical doctor.
And this kills folks when you consider the sort of scam practices that a lot of chiropractors tend to practice. Honestly, I think it is too bad that we've decided to use the same word for all of these and I'd be happy to change things legally to protect folks from this sort of sham.
Joking aside, if I’m seeing more than one of these hypothetical professions, someone needs to coordinate my care. For myself, I trust me to keep everyone informed. Anyone else wouldn’t have the same incentive to do a good job. After all, I’m the one that suffers the consequences if there’s a mistake. :)
Well, going by our nomenclature for other things, the hypothetical leader of the other practitioners, by analogy to a leader in the army, could be called a "general practitioner."
All it takes is one accident or affliction to change this ability. Unresponsive due to a car accident, for example, or simply not having your list of information when you got rushed to the hospital. Confusion due to a high fever. A stroke due to an undiagnosed and hidden condition. Heck, simply age or winding up with a complicated health situation can do it.
In short: You really only can trust yourself if you have enough luck.
> Ouch. People are really bad at handling their own medical care. I’m legitimately on 8 different medications and 3 supplements (not including vitamins), per doctor’s instructions.
Hold on. We have computers and networks. In most other countries I've been in, records are computerized and there's no need to write a piece of paper that you hand to new doctors and 'get good at handling your own health care.' Even here I see some exchange across providers on a "Mychart" like app. That's a start.
But what you're seeing is inefficiency - a computerized world where you're telling people they should bring printouts of everything to all appointments seems really unnecessary a burden.
Here in the Basque Country we have a public health system, named Osakidetza. Such system implemented, like five years ago, a centralized electronic prescription system. Now doctors in the public system have to use that to make prescriptions which solved all problems caused by bad doctors handwriting, and also solved problems like you mentioned, because the system detects and warns against conflicting medications.
That's awesome! TIL that the Basque country has a separate medical system, i would have thought that would be one of the things alongside foreign affairs and military that wouldn't be devolved to autonomous regions.
In France there's a similar system being rolled out currently, Dossier médical partagé, which is opt-in, and contains all of your diagnosis, tests, prescriptions, so that doctors can quickly see your medical history and present.
It is worth noting that the Basque Country and Navarre have a special regime inside Spain, which roots back to the medieval _fueros_, going as far as having their own independent tax agencies. The rest of the autonomous communities have a lot of competencies devolved from the state (education, health, etc.) but are much more controlled by the central government.
Yes, I have seen something similar happen too - a temporary illnes that most likely didn't need any drugs, prescription for drugs that caused side effects, but then another drug for those side effects and the situation repeated 5 times in total, passing 3 different doctors. The real solution that worked was to stop taking everything.
Unfortunately listening to average doctor is a recipe for illness. Doctors belong to a medieval-style guild that managed to make it illegal to heal other people if you aren't its member, and extremely hard to buy needed drugs for yourself because of prescription (fortunately it's possible now because of internet pharmacies) - the latter of which is borderline slavery.
Against all 'expert' opinion, I'm pretty on average everyone would be better off trying to cure themselves using information from the internet - or at the very least everyone on hn.
My mother had hypothyroidism and got prescribed levothyroxine. She didn't like the idea of taking it forever, and after researching the internet found out selenium deficiency can cause it too. Directed blood test found a severe deficiency. After a month of taking selenium supplements thyroid hormones normalized. Internet self-diagnosis > average doctor.
> Against all 'expert' opinion, I'm pretty on average everyone would be better off trying to cure themselves using information from the internet - or at the very least everyone on hn.
Yes, why would it take more than an internet search or two to diagnose and fix one of the most complex systems known to man? Having people spend half a decade or more studying this is an obvious absurdity, tantamount to slavery!
Beyond the sarcasm, just like you wouldn't expect StackOverflow to help you fix your company's complex bugs, you can't realistically expect to be able to treat yourself if you don't spend a good year or two researching your specific health issues.
Sure, it's a good idea to read about it and not blindly trust your doctor - sometimes they do make mistakes, assume diagnoses without testing, or even actively seek to prevent you receiving the best care for various biases. Sometimes you have a simple issue and the solution is to simply take a targeted medicine or supplement.
But a lot of the time, the problems are complex, and they interact in complex ways with other issues. For a lot of diseases there are no treatments without serious side-effects, and drugs to address those side-effects can have other side-effects and so on. A lot of symptoms are common to many illnesses, so you need a wide array of information to arrive at a correct differential diagnosis (quickly). Sometimes the differences between symptoms are subtle, and you need experience telling them apart.
Not to mention, while classes of life saving medications are highly addictive, so patient's access to them must be carefully managed to avoid making their lives even worse. Benzodiazepines, as in TFA, are a good example.
>you can't realistically expect to be able to treat yourself if you don't spend a good year or two researching your specific health issues.
There's a big difference between trying to learn everything and about some specific issue. Every doctor would destroy anyone self-taught on general medical knowledge, of course, but in areas that are specifically relevant to that person - anyone of above average intelligence can definitely become more competent than an average doctor, just because the person with a problem is motivated to spend hours or even days finding relevant information. Then there's of course the whole area of surgery where self-treatment is borderline impossible - which is a major part of medical studies.
>For a lot of diseases there are no treatments without serious side-effects, and drugs to address those side-effects can have other side-effects and so on. A lot of symptoms are common to many illnesses, so you need a wide array of information to arrive at a correct differential diagnosis (quickly).
This describes an absolute best case and presents it as the average. Chances are if you go to a doctor with a viral infection you will get a prescription for antibiotics, an obvious absurdity. Why? Because a patient expects 'something', so doing that makes the uninformed patient happier - while in reality, at best it's minimally harmful.
This is so prevalent there are multiple studies about this, eg:
"More than half the GP respondents to the survey in Australia self-reported that they would prescribe antibiotics for an URTI to meet patient expectations. Our qualitative findings suggest that ‘patient expectations’ may be the main reason given for inappropriate prescribing, but it is an all-encompassing phrase that includes other reasons."
More than half! That's the actual quality of care that's being delivered, it's worse than doing nothing at all. Risk of side effects is completely ignored. Millions of people have allergy to amoxicillin, one of the most commonly prescribed one.
My opinion based on my experiences, experiences of others and studies like that - is that advice from an average doctor is completely worthless. Of course there are competent doctors - but there's a contradiction here: for any specific problem, the only way to determine competency is to become competent yourself, but the moment you do, you stop needing the advice. Therefore, as long as you're capable of doing research based on symptoms, and the situation isn't an emergency - going to a doctor is pointless. Yet the law system is doing everything it can to force me.
>Not to mention, while classes of life saving medications are highly addictive, so patient's access to them must be carefully managed to avoid making their lives even worse. Benzodiazepines, as in TFA, are a good example.
This is paternalism and it's abhorrent. In fact I have another related real life story: my grandma has extreme sleep problems and no OTC supplements helped. After some research I decided that etizolam is the safest and most likely to help drug - which turned out to be right, as it worked perfectly for over 2 years, along with a very strong increase in general mood (etizolam itself is mildly anxiolytic - but probably mostly due to more sleep) and mental capability. No side effects reported. Unfortunately it became a controlled substance here (even though in some countries it's a normal prescription drug - at least Japan and Italy) and she definitely didn't want to break any laws. As the daily dose was small (0.7mg before sleep - chosen experimentally as the minimum one that worked), there were no noticeable withdrawal symptoms. Went to a doctor, eventually got a prescription for zolpidem. Result: works for sleep, but also caused an enormous increase in depression symptoms and noticeable memory problems. Real life result from "managing access".
Especially for someone taking what was clearly a complex treatment, perhaps it was assumed that, say, the drug that increases BP was given for some other reason, and then the drug to decrease BP was given specifically to counteract the effect of the first drug.
Of course, it seems that in this case that assumption (if indeed that happened) was tragically wrong, and instead the cocktail was a product of doctors disinterested in communication. But such complex treatments can be intentionally prescribed.
When she passed, her cocktail included 12 prescriptions. One of her doctors had prescribed her medication to lower her blood pressure while another had her on medication to raise it.