Women Doctors more better

[xoxoxoBruce]

“If we had a treatment that lowered mortality by 0.4 percentage points or half a percentage point, that is a treatment we would use widely. We would think of that as a clinically important treatment we want to use for our patients,” said Ashish Jha, professor of health policy at the Harvard School of Public Health. The estimate that 32,000 patients’ lives could be saved in the Medicare population alone is on par with the number of deaths from vehicle crashes each year.

Link

[Pico and ME]

The things that I noticed (and liked) about women doctors (and NP's) is that they listen better and ask better questions. I feel more like a collaborator about my health with them than with most male doctors.

[xoxoxoBruce]

They seem to be more empathetic to how things other than any medical problem they might find are affecting your well being. They know shit happen in your life and it does affect your health. My female heart doctor is concerned with my mental condition at any moment. My Male heart doctor(electronics) couldn't give a shit, bow before Zod.

[orthodoc]

There's always another perspective ... I have to say, the neurologist I see for intractable migraine is a woman (younger, but then most docs are younger than I these days) and has zero empathy, dismisses everything I venture to contribute about my triggers and experience, and generally couldn't give a shit. It will take years, and maybe not then, before experience teaches her to listen. I've also encountered more than my share of angry, unempathetic women in medicine.

That's all anecdoctal of course, but N of 1 studies have some validity. In the '80s, the system selected against empathy and for acute intervention. Women in medicine were careful to be very macha and hard-nosed. As the system then moved in a different direction, other outcomes were valued and measured more.

That said, I'm glad that empathy and 'softer' outcomes are valued more, even if the reason they're measured is still $$$.

[xoxoxoBruce]

Maybe I'm bias because my female heart doctor has this whole Stevie Nicks thing going on.
To be fair, my male GP is great, listens, asks follow up questions to be clear on what I was saying, and a great sense of humor.

[Carruthers]

I much preferred the woman GP, who I'd had to consult, to the male Doc who is my named GP.
She has taken a job elsewhere so I reverted to the male Doc. He didn't seem to listen that intently or take much interest on the rare occasions I had to consult him in the past.
Also, I could never take him seriously as I always thought that he bore a striking resemblance to Stan Laurel.
In fairness, when I had to see him three weeks ago, things went much better than I had feared they might.
On the other hand, on the way in, the receptionist had given me a patient feedback form to complete.

Cynical? Me? Yep!

[xoxoxoBruce]

He was on his best behavior because the rabble were given a chance to rat on him?
Every time I have a Doctors appointment I get an email begging me to go to my health systems website and fill out a followup questionnaire. I checked one of them out and probably 85% of the questions were related to the personal interaction with everyone from the receptionist to the doctor.

I guess that makes sense because if they ask if the Doctor did the right thing, how the fuck do I know? But I do know how everyone treated me and I was satisfied or not about them taking what I had to say seriously.

It use to be going to the doctors was point at some body part and grunt hurt a couple times. But since the internet too many people arrive determined they know what's wrong and how they want it treated. Yeah Doc I've got a pain in my wrist and must get treatment in the Hadron Collider by Tuesday or I'll explode.

[orthodoc]

Exactly. The doc is evaluated on those surveys; keeping your job, your ability to pay the rent and send your kids to school, depends on making your patients happy. What if they want stuff that isn't helpful, or even harmful? They know they can get you fired if you don't fall in with their wishes.

The people who decide what medical decisions are made are not sitting in the exam room. They don't know, and don't give a damn, what the right thing is, medically. They are bean-counters who make the business go. Patients are fooled into thinking that by bullying their docs into doing what they want, they are empowered. But they're just feeding the business.

[BigV]

I don't want to bully my doctor. I want my problem solved, and that includes problems I don't know about like hypertension. I also want my questions answered, I like being an informed patient. For the record, I'm very happy with my current doctor, except I've moved farther away and seeing him is a bit of an ordeal now.

I definitely don't want to be insulted or ignored or disregarded. Those kinds of personal interactions are definitely ones I have a legitimate ability to assess.

I can't speak for those patients that come in to see the doctor having succumbed to the power of marketing on the part of big pharma. Those people get what they deserve. I say that then immediately feel chagrined. I deal with customers who hire me to give them professional help, and sometimes they insist on the solution too. It's a common problem, I bet mechanics and service pros of all stripes can tell such stories. It's important to make sure the patient/customer knows what they're getting--which might not be the rosy happy ending of the commercial they saw.

Untangling those two takes skill. I've been ... told/upbraided/counseled by bosses who heard negative reactions from my customers. That part sucks. And the customer pays the bills. But, they won't pay if they're not getting their problems solved.

[xoxoxoBruce]

I told my GP I'm just waiting for one of my meds to show up on the TV lawyer ads so I can be rich. He laughed so hard I thought he'd fall off his chair.

[orthodoc]

Forgive me, V, I didn't express my concern well. The pressures brought to bear when health care is conducted as big business more than as a professional relationship have both intended and unintended consequences. The relationship can end up much poorer than it might otherwise be. But personalities play a role too, no matter what the structure of the interaction.

As I mentioned earlier, I am glad for the change in emphasis and type of evaluation that has taken place over the past 30 years.

[BigV]

orthodoc, first of all, good to see you again.


Next, you don't owe me any apologies, we're just talkin here. I agree with everything you say in post #11 (except the apology part). Healthcare, when delivered as a fee for service leads to trouble. I'm not trying to get free healthcare. I want my healthcare providers to be rewarded for their work. But there are problems.

Like, ordering unnecessary tests. I'm sure we've all heard such stories. "couldn't hurt, let's just check t be sure out of an abundance of caution". And the obfuscation of not paying for it DIRECTLY confuses the issue, "um, sure, yeah, let's be safe". ka-ching!

But of course we pay later in higher premiums for more shit that wasn't really needed. I could run up the bills on lots of the customers that I do work for. But, I don't get paid for how much billable time I log. I just get my paycheck based on getting the work done.

There's much to be said of the organization, the name escapes me at the moment, where the care delivery outfit is paid a base rate and they keep/make more if the person doesn't come back. Make'em healthy, do the job right the first time, and send them home. But not like some places where the longer they keep you the more they can do to you and the more fees can be collected. That, combined with a fear of being sued for malpractice for not finding something that MIGHT be found with xyz test, and a doctor's desire to obey their oath to do no harm, and it doesn't cost THEM anything extra, and *maybe* they get extra something on the side, not a kickback, though that can happen, but reciprocal superfluous traffic from the tester... I can see how this would go wrong.

But being paid a flat rate, I want to do the job right the first time, expeditiously.

I don't know any doctors who ... nope, take that back. I do know a doctor who runs his own practice. I'd put my life in his hands. But most of the others all work for biiiig hospitals, umbilicaled to biiiiig insurance companies...

Unintended consequences? Ortho, my friend, you have a flair for understatement.

[xoxoxoBruce]

Like, ordering unnecessary tests. I'm sure we've all heard such stories. "couldn't hurt, let's just check t be sure out of an abundance of caution". And the obfuscation of not paying for it DIRECTLY confuses the issue, "um, sure, yeah, let's be safe". ka-ching!

They're trying to keep their malpractice insurance in check. If there are six tests they could have done, and they do five, then something that one test could revealed gets you, your lawyer buys another condo it Aspen.

[BigV]

so, there's no perfect security. not in healthcare, not in national defense, not in threads on a message board on the internet.

What I want is good enough. I want to be well. I appreciate your point that the fuckstick that sues on the basis of the missing sixth test becomes a powerful reason to do six goddamn tests for e.v.e.r.y.b.o.d.y. is a "real thing" (tm). Witness the galactic majority of us who are not bombers who've had to take off our goddamn shoes to pass security to board a plane.

It sucks.

Being in the position of having to defend against the lowest, most remote possibility, and in every case, regardless of the unlikelihood of a positive result SUCKS. and it's expensive. that sloooow burn is more insidious because you DO pay for it and you generally don't notice it. Unlike the test for a nonexistent circumstance that you DO notice, but DO NOT notice paying for. It's fucked up.

Y'know, a friend of mine sent me an article the other day. I read it and liked it, mostly because it had lots of cartoons in it. I'll post it here. It applies to our conversation. How much testing, defense, erring on the side of caution is the right amount. No one wants to die, so stipulated. But at what cost do we raise the possible defenses against the possible assaults? How high is high enough? How many tests are enough? How do you know? Why not do ALL of them. Every test. Because, you know, better safe than sorry.

Actually, actually sorry there. I'm trying to keep it in check, and sarcasm aside, my point is there's always some degree of mortality at a given point, and at another given point absolute mortality.

Fuck.

[BigV]

http://www.sassquach.com/journal/201...-hot-dogs.html