Look, these days people don't want advice from actual experts, because it might be laden with ambiguity and qualification, or require them to do actual work. What they want is a strong, unambiguous promise of a cure, preferably from someone young, beautiful, and slightly anti-establishment. They want the advice doctors won't tell you!
As a "these-days person" I would generally like doctors with better bed side manners more than anything else.
In Germany, the healthcare system is readily accessible for people who are insured by one of the providers of national health insurance [1]. However, doctors need to process a large amount of patient per day to make ends meet.
Note, I chose the word "process" with intent, because that's what it feels like with 9 out of 10 doctors in Germany's cities nowadays. Go in, have a less than 1min chat about your health, get screened with a medical move set that rivals street food artists in Bangkok, then get a run-of-the-mill answer with little effort to personalize treatment according to your medical history.
The younger the doctors, the more intense is this issue. This isn't because younger doctors are less empathetic or something. The system simply demands this or else. People are more cattle than anything...
Oh and fitting right in with the Instagram fame, young medical professionals are all moving to the fun cities in Germany. Smaller towns and villages are hemorrhaging doctors. They are just not attractive in any way, especially with Germanys catastrophically bad Internet and mobile infrastructure.
As much as Europeans love to crap on USA health care I have a polar opposite accedcdote.
Last time I was at my general doctor, I was in the room for an hour with Doc and nurse. Talking about how I’m eating, how I feel after running long distance, if this blemish has changed shape, how I’ve been sleeping, etc etc.
It took 10 days to make an appointment which is annoying, but I have never once felt rushed or that staff was rushed.
Usually specialists are more like this, but not general practitioners. Also if you are privately insured you get premium service because the physician earns multiple times as much as from national health insurance. He now has time for you without jeopardizing his ability to pay off his office location.
Not too long ago, I still had my general physician who could sit down and talk it all through. He retired... and another one in another city did as well. Younger ones seem under much higher economic stress. Maybe also stress from peers?
It seems more of an emergent problem to be honest.
Yeah, I'm first to crap on US health care, but there are days I sort of understand why things in the States are the way they are. Almost everyone I know here (in Poland) tries to go for private care whenever they have spare cash, because public health care is pretty unpleasant and makes you waste a lot of time (+ you usually get scheduled for a visit many months in the future). This can actually be more expensive than private care if you count opportunity costs.
Recently my wife & I were forced to use the public service, and after 3 days of traveling back & forth, day after day, to another city, being told to visit another ward next day, and come back the day later, I was begging for someone to throw money at to make our problem go away. And I'm not really blaming the staff; they're all severely overworked, underequipped and underpaid. There's a huge problem with public health care here, kind of an opposite to the US problems. Poor or rich, you will get medical attention, just possibly months after when it's needed.
I was born in Poland. Yes the system sucks but US is on another level.
Imagine visiting a hospital for an emergency, and receiving 10 bills from different doctors totaling to few thousand dollars then fighting with insurance to pay for it.
Universal healthcare brings OVERALL cost down. It makes private treatment cheaper. A crown and root canal costs about $2k in the US. Plus, it is nearly impossible to find cost of a procedure prior to it. It is fking weird.
Uh ok. Thanks for the perspective. I guess we are better off, because private healthcare here is straightforward and not that expensive for the basics. For a root canal here I paid maybe 200 USD in total.
I'm also from Germany, and going through some treatments right now (Surgery/Orthopedics) and I think this comment is too harsh.
It overemphasises that some doctors may seem arrogant, or staff may have a negative attitude.
For instance Internet connectivity is not "catastrophically" bad, (could indeed be better, though).
An overlooked trend that has has changed communication patterns with patients for the worse is a trend towards larger joint practices with doctors as employees often not working fulltime. Joint practices tend to have larger, fuller waiting rooms, and which necessarily results in (in my experience) a more stressful doctor-visiting atmosphere.
Moreover, paperwork has become more complex also for patients, e.g. when agreements and waivers (for operations) have to be signed, nobody has the time to explain these. Nobody can explain finer points of medicine prescriptions, and usage of technical helping equipments (e.g. hearing aids). The staff at the front desk can't explain this, and the doctors do not have the time to either.
These are all general problems, not Germany-specific.
I tend to agree with you, even about my comment being a bit harsh. It's not like I want to attribute malice to physicians. The system just cannot operate smoothly under its current load and structure.
However, I heavily disagree about Internet connectivity. In cities like BER, HAM or MUC it is "meh". On the country-side and in smaller towns it is catastrophically bad for the 4th largest economy on the planet.
Do you have physician's assistants (PA) in Germany? Sort of between a nurse and an MD. I've found for general care, they strike a reasonable balance. And it really doesn't take an MD to tell me I have a sinus infection and hand me a pack of anti-biotics (or anything similar).
I know, my gf in the US used to be a PA. We do not have this exact position but others are filling it in a way. It's generally a slightly different structure.
I generally agree. But experts could also stand to improve their ability to give meaningful actionable advice, separated from all the various information that may be useful as part of the broader discussion/treatment.
I asked a handyman community the other day if my furnace running 22 hours a day during the winter is normal and how furnaces work.
I got about a dozen "it depends..." answers that enumerated all the factors involving a house heating and cooling until someone basically said, "no it doesn't really depend. That's very much not normal regardless of any factors. You'd have to be in a really unusual situation for this to be normal and not warrant further investigation."
If the fear of being publicly proven wrong or held liable causes people to hedge/water down their advice, maybe this creates a space that allows frauds, charlatans, and confident fools to thrive.
> That's very much not normal regardless of any factors.
See, this is the problem with you not being an expert in the field.
For example, if your house had terrible insulation and it was -10 out. Yea, that thing is going to run all day. If you had a new house, but left all your windows open, yea it will run all day too. So, yea, "it depends' is a perfectly cromulent answer without you giving lots of information.
People that don't have much experience are the ones that will say "yep, it's broke" right off the bat. When I was younger and you asked "Can you make my software stack faster", I'd have answered yes. These days "It depends", probably followed by "How much money do you want to spend".
TL:DR; The complexity of reality doesn't give a damn how simple you want your problem to be.
But both of those situations are not normal. He did not ask if it was possible for an AC to run for 22 hours a day. He asked it was normal. If someone asked if it was normal for a page to take 10 mins to load I would say no. However, I would then list circumstances where that would make sense.
Right. I'm not discarding the value of the details. But right now I just want to know, "does it seem like I might have a problem?"
As a non expert I wouldn't have been surprised if someone said, "yeah it's pretty common for furnaces to run non stop in cold winters. That's their design."
And if you were asking about air conditioning in the summer, that would be the answer. Moderately "oversizing" a furnace vs. the heat loss calcs doesn't cause major problems; for air conditioning it does, with an oversized unit you don't get adequate humidity control. But for furnaces, to get noticeable negative effects you have to MASSIVELY oversize. The upshot of this (and other factors such as needing to upsize the furnace to get enough air handler capacity for the cooling load in summer) is that no, if your furnace is firing almost constantly all winter, something is probably wrong. That "wrong" is likely to be "the furnace itself is working fine, but you don't have enough insulation and your windows are super drafty", but for purposes of the basic "is this normal".. no. It's not, given common North American residential HVAC practice. Certainly worth further investigation.
Importantly in this case, the outside temperature at which your heat or AC runs constantly is the maximum where your house will maintain temperature. So, because of the different tradeoffs of oversizing heat vs AC, normal practice is to put in enough AC for a typical summer (and just let the house get a little warmer during a heat wave) so that dehumidification remains optimal, and to put in enough heating for a worst-case cold snap because, well, it doesn't hurt much and people REALLY complain when their house gets cold in the winter.
>As a non expert I wouldn't have been surprised if someone said, "yeah it's pretty common for furnaces to run non stop in cold winters. That's their design."
This was not uncommon in rich (big houses) older (built up before WW2) towns in MA because the houses are big and old and state law regarding who can perform plumbing/electrical/hvac work greatly drive up costs and are a massive incentive to always minimum amount of work possible so tons of people would have poorly insulated houses with smaller than ideal heating systems. For the coldest days in the winter many people's furnaces would run all day to keep the house warm (whereas poor people just turn down the heat).
This has changed recently because the state is pumping a ton of money into incentives for people to make their homes energy efficient now basically every old house has had insulation blown in everywhere because with state subsidies the cost to do so is now justifiable in the overwhelming majority of use cases.
"The further you are from mainstream medicine, the greater the confidence signaling. Doctors tend to express the least confidence, and crackpots the most. This is why alternative medicine thrives."
I just want to expand on the "unambiguous promise of a cure". It is a huge problem especially for incurable diseases.
I have a relative that was diagnosed with EDS, it is a very serious disease with no cure. This relative has spent $20k+ on prolotherapy. There is 0 scientific evidence that prolo works, and 0 evidence that it works on this specific disease. Those doctors just make up claims and for sources link to their site. But what they sell is hope, which is really saddening considering that person will be unable to afford housing/food soon. Just thinking about it makes me angry that people like that exist.
People simply have a hard time accepting their fate. REAL doctor will tell you what you don't want to hear, a doctor that sells snake oil will promise BENEFICIAL treatments based on bs.
