Worst things about being a physician...

[AJMD429]

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The second-worst is of course the 'system' - our healthcare shouldn't even have a 'system', at least not a bureaucratized, government-mismanaged one, where big pharma and big insurance and other corporate influencers misuse government to distort the competitive free market, which always maximizes quality and minimizes cost, vs the opposite when third parties are involved, particularly 'government'...

The 'system' made me ashamed to be a physician, even though I have opted out of the 'third party payer' part of it.

The worst part, however, makes me SAD to be a physician. It is losing all the patients I know could have been saved. CoVid was a big deal, as we saw patients forced into treatment protocols that we knew were ineffective, and knew were dangerous. We also saw them prohibited from protocols we knew were safe and we knew were effective.

But that was 'only' for a couple years, and seems to be mostly over with. What is worse, as it has been going on since I started practice 35 years ago, and continues, is the failure of so many really nice people to address preventative care.

Some are just so disillusioned with the present 'system' that they don't trust it, or have been told so many conflicting things over the years, they don't know what to believe.

Sadly for a 'levergunner', many are the sort 'we' are - what might be called 'rugged individualists' - the "if it ain't broke, don't fix it" crowd. They distrust organized medicine, and get tired of 'pill-pusher' docs who are on quotas and spend 5 minutes or less with the patient, and refuse to do anything outside of 'protocol', referring anything 'complex' to specialists who often only seem interested in 'procedures'.

I get it. I'm a patient too, sometimes.

But just this year so far I've lost:

1. A guy who wouldn't get his prostate checked because it might mean a finger in a rude place for 2 seconds, whose PSA didn't turn positive until too late because a relative told him testosterone replacement was 'bad' (but didn't tell him that untreated low testosterone causes false negative PSA tests). He avoided the 'gay' exam, but passed away within six months of seeing mets on an ultrasound done when he went to urgent care for 'acid reflux'.

2. A woman who has vaginal cancer not stoppable, because her gynecologist told her that after her hysterectomy she no longer had a cervix so didn't need paps. She saw me for a cyst down there from an ingrown hair, when her gyn was out on vacation, and since I 'had the hood up, so I may as well check the oil', I did a cuff pap, only to find a cancer that was already metastatic and unstoppable. If she'd have come in for annual physicals I'd have been doing annual paps so likely found it 6-7 years ago when easily stopped.

3. A woman whose cardiologist said she was in tip-top shape because her calcium score was zero and her fasting sugar 92 and her LDL 42 (but her fasting insulin was 44 and her homocysteine was 16, her Lp(a) 88, and her LDL particles 2,120. She ate a very healthful diet and worked out regularly, but those genetic things did her in (all things we test at an annual physical). Myocardial infarct led to a-fib then stroke, then another lethal MI.

4. A guy who relied on seeing urology and cardiology so felt he didn't need to spend the time or money to see a family physician since his heart and pp were treated and ok, but neither pushed him at age 45 to get a screening colonoscopy. He was only 48. It would likely have been EASILY stoppable (just snipped off and cauterized during the colonoscopy) at age 45.

5. A woman who was only in her 30's and just came in when her sinuses would act up. Felt like since she saw a gynecologist for her 'annual' that was enough. Gyn was on vacation so she wound up seeing me for 'hemorrhoids' that weren't getting better despite the Rx gynecology had her on for nearly a year. When I examined her, she had a perianal melanoma, not hemorrhoids, and if she survives, she will likely have bags for liquid as well as solid, and no female parts left on the outside.

6. Another breast cancer in a woman who got mammograms every year, and was told they were 'normal' despite 'heterogenously dense breast tissue', a classic sign of either low progesterone (often caused by taking synthetic progestogen (in her case she had been on a hormonal IUD), or low iodine (cause vs correlation not clear). Had been getting 'annuals' at her gyn but hadn't really been shown proper self-examination and just relied on mammograms plus the MD or NP exam yearly since young and no family history. Big believer in doing all possible 'naturally' and had heard the 'estrogen-bad' dogma but somehow thought the IUD was ok. That, plus not knowing how to even check herself, spelled diaster. She saw an endocrinologist for thyroid issues and there was lactation they blamed on thyroid (can happen) but the endo didn't do s gowned exam, relying on the gyn. So she finally comes to see me after weight gain despite seeing endo for thyroid, and since I do a bit more lab tests for thyroid than most endos, I had her do labs then schedule a physical. Other than her gyn 'annual' she hadn't had an actual complete exam for 5 years or more. Although I think the lactation was not anything to do with the (found to be cancerous) masses I felt in the neck nodes and one breast, it's a moot point now, as the cancer is in lungs and brain too. That might explain now that despite suboptimal thyroid Rx, she's no longer gaining weight. Mets (and now chemo) will do that.

The point isn't that patients die - we all will do that. But every one of these folks was (or is, for the ones not passed yet) the 'rugged individual' type I identify with so much. They are the 'salt of the Earth's folks who don't like to be dependent, don't like taking medication, don't trust the 'system', and...are paying the price.

It just breaks my heart to see these, of all people, fail to get GOOD preventative care, which could easily have saved every one of these people, due to just not liking the 'system', not being willing to 'go out of network's to a doc who would treat THEM rather than their insurance, or for fear of "embarrassment' because a complete physical is 'complete', so does involve discussing personal symptoms or body functions or parts to be checked.

And our society NEEDS these 'independent' types now, more than ever. And the survivors will miss their spouses terribly.

Don't do that to your family and friends, or even your nation. TAKE CARE OF YOURSELVES...! The cost of going 'out of network' for DirectPay care is typically less than most people spend on pet food, but since the crappy care is "free" people just settle for that. It's free because it stinks...

[piller]

Pre exam Friday to see if I am a candidate for TERP procedure. No cancer. Sort of weird seeing parts on screen that you don't even look at on a deer you have killed. Last CT scan showed gallstones. Waiting and watching. No symptoms. All cancers so far have been on my face. 3 different Baylor trained Primary Care Physicians called them eczema. I argued that eczema didn't hurt, and didn't bleed when accidentally touched. Insurance finally let me do a self referral. One cancer, a squamous cell carcinoma was almost 30 grams. No, not eczema. It was almost to turn dangerous.
My takeaway? Get a Doctor who listens to your symptoms and looks into your condition. Quickly glossing over it by my Doctors and their not listening to my total symptoms could have killed me.
Andy, you are one of the rare ones who doesn't decide what he will find and then only goes looking for proof of his initial diagnosis. If I lived closer, you would be my first choice for PCP.

[Bridger]

I had the same thought Piller. He’d be my doctor if I lived closer as well. Wish I could find a local doc who is outside the system as Doc speaks of and doesn’t do 3rd party payer. Just old school cash and looks out for his patient. I’ve got insurance and would still prefer to see such a doctor when I need one.

[Pitchy]

Ya have a tough job and bet a lot of sleepless nights but i bet you have a lot of grateful patients too.

[stretch]

My doctor's office is a joke. Most are, it seems.
The ONE doctor who works there cannot see everyone, so staff is a mish-mash of nurse practitioners and
physician assistants with a fairly high turnover. Why no docs? When I worked for the State doing income tax IT, I would sometimes run
some queries out of curiosity. At that time, PAs and NPs were paid somewhat LESS than HALF what a GP made.
THAT'S why there are so many PAs and NPs.

The PAs and NPs are sincere people, but they don't have the training to do what needs to be done. They read
the numbers back to me from the standard tests, which I can look up myself. Nothing too difficult there.

One of the best doctors in the area is a chiropractor.
He has a genuine curiosity about ALL aspects of the human organism. Of course, he can't practice
"medicine", but he has more than once steered me in the right direction for something unrelated
to chiropracty. He has to be VERY careful not to overstep the bounds of his specialty.

-Stretch

[Paladin]

Sorry to hear you confirm what has been going on for years. I have been lucky on the Treatment side and I have three Docs. One, my first Special Forces medic on my 1st A-Team who became a Doctor and later GP, then a Flight surgeon for the Navy who has known my medical history and I was his office manager in Alaska for a while, A Tri-Care assigned Physician after I retired whos son is doing what I used to, and one more at the VA Hospital who I just started seeing after I went to their ER after I overloaded my capabilities and had a farming accident. Not all of them agree with the different treatments they recommend but I get to pick the one I trust the most and agree with. The Tric-Care and the Flight surgeon are the most trusted and the VA is the most convenient (only 50 miles).