It wouldn't be so bad, except so many MDs, PAs, and NPs are just bad.
This is coming from someone who has been traveling with a sick family member for a few years. There are great (read: skilled, thoughful, patient, investigative, this.patient data driven) professionals out there, but they are badly outnumbered and booked for months near a year into the future. A huge bunch display the interest, skill, or attention of someone working a a declining fast food franchise. Worst of all, most of the good medical practitioners don't even have their own practices, they can't afford the combo of liquidity and red tape, at least that's what a couple have told me.
I've had two experiences in the last 10 years or so involving two "significant" conditions — not necessarily in the standard sense of threat to life, but in the sense of nonroutine and potentially becoming something more problematic, involving multiple significant testing procedures and several different teams of providers. The two things were totally unrelated issues.
Both of them just reinforced my sense that the degree pretty much doesn't matter anymore. In one case I saw several physicians of different specialties, and none of them had any idea what was going on. My own initial hunch ended up being correct, and I kind of ended up fixing it myself (complicated to explain, nothing illegal or inappropriate; ironically the first physican I saw was also correct, the only one who got it right, but he dismissed it and convinced himself it was wrong). In the other case, the best care we got was from a PA. The physicians were all specialists who were financially motivated to give care that was totally useless but very expensive (we figured this out by looking in the primary scientific literature and realizing that all the procedures they were heavily pushing were no better than waitlist controls). The PA was the only one recommending things that were actually useful.
I've seen useful MDs as well, especially with pediatricians and radiologists. I'm not saying MDs are bad or useless. But I'm increasingly convinced that different educational and training paths do not necessarily mean inferior or superior care; that a lot of services could be provided through different providers or mechanisms; and a lot of what people see providers for could be obtained without any provider as a middleman.
This was my experience going through a half dozen doctors. I found a great one finally, but they didn't even bother taking insurance, and it was very expensive.
Excluding emergency situations, the biggest issue IMO is diagnosis. So many tests, scans, listening, observation, etc. is all about understanding what the problem actually is. Once you accurately identify the problem, treatment can be effectively given (if one exists) via the current system.
For mysterious problems that elude a simple diagnosis you can really be stuck. Most doctors don’t have the time for complex cases. It’s worth becoming your own health researcher if no one else can identify the issue.
> It’s worth becoming your own health researcher if no one else can identify the issue.
This is something I have been a big advocate of. I would never claim to know more than a professional nor would I ever give medical advice to another individual.
However, it has helped me plenty of times. I feel like I have been able to ask more important and impactful questions to doctors, and I have been able to push back on some choices that doctors would have made that I think might have been incorrect.
For example, I was almost prescribed a medication. That particular medication might have treated its indicated condition well, but it is known to exacerbate my immune-mediated disease as a side-effect (to clarify, the medication was not for the immune-mediated disease).
When I mentioned it to the NP I was under the care of, she said, "I have never heard that side-effect." Well, she looked into it, and it turns out I was right. Had I not done my research prior to our visit, then I might have been subjugated to changes to a disease that could have been entirely been avoided.
I still think she is a wonderful NP, and no one can know everything.
I even have another account.
I asked an MD about a newer medication for my immune-mediated disease. He said, "I have never heard of that before." After discussing it with him, he did not seem to be interested in trying it. I swapped doctors, mentioned it to the new doctor, and she prescribed it. It's actually the single most effective treatment I have tried since I acquired the disease 7 years ago.
As Schoolhouse Rock once said, "It's great to learn 'cause knowledge is power!"
The first doctor I had wanted to send me to get my thyroid nuked because it was inflamed after a viral infection.
After 2 years and 6 doctors I found I basically had long covid years before it was recognized. Probably from a low grade garden variety viral infection. My gut developed food sensitivities and I started to develop autoimmune problems from that.
After finding the right doctor who could handle researching chronic conditions, things improved within months and a few years later I completely recovered.
Typical doctors have 5-10 minutes to listen to you and click on drop-down boxes on the computer. They won't care about chronic or complex issues. They are good for low hanging fruit and steering you towards pharmacological intervention but unusable for anything more involved.
