6 ms·

I went down a Reddit rabbit hole, a sub called /r/noctor. Basically people, mostly doctors, complaining about the prevalence of nurse practitioners, PAs practic

I went down a Reddit rabbit hole, a sub called /r/noctor. Basically people, mostly doctors, complaining about the prevalence of nurse practitioners, PAs practicing independently/outside of their scope, etc. The general consensus I see there is that the only people benefiting from this are private equity firms trying to squeeze more profit since they bill the same based on whether you see a doctor or an NP. This in turn has an affect where it doesn’t make sense financially to go through so much school and take on so much debt.

renewiltord 7mo ago
The primary utility of most medical professionals is to act as a gatekeeper to distinguish me from a drug-seeker. They are glorified security guards around medication. Fortunately, I always get what I want.
- stalfie 7mo ago
  As an internist (not in the US), I would like to put in my two cents to say this is just wrong. The primary utility of most medical professionals is to diagnose and treat a condition correctly. In the ER and elsewhere, the correct diagnosis is indeed often "drug seeking behaviour". And this is also a major aspect of medicine that many relatively healthy people interface with and remember. They are in pain for whatever reason, they desire to be relieved of said pain, and that desire puts them into contact with the skepticism and hesitancy around opiods that physicians have built up out of unfortunate necessity. It's often a hurtful and protracted experience, and so they remember it and form opinions like yours. But this area of contact with medicine is a tiny, very visible tip of a much larger iceberg. Your description of "security guard around medication" is not strictly wrong for my field, seeing as internal medicine is largely about administering the right drug at the right time, but the 99% of the drugs we guard are not desirable at all for any drug-seeker. They are potent, full of side effects, are sometimes potentially deadly. But they do work. And you do not see any of this until you get properly sick, which to most people does not happen very often often (at least until they approach 70). And when it does happen, most people tend to focus on the one little side of the ice berg they come into contact with. But it is there, and it is about much more than distinguishing you from a drug seeker.
  - renewiltord 7mo ago
    No professional has ever taken kindly to being told their primary function. The notion of greater grandeur infects everyone from janitor to president. I'm not foolish enough to tell doctors these things. If I did, I doubt I'd get what I want. There are limits, naturally. I don't really expect to fit the percutaneous pins into my hand myself, even if I had third hand capable of equal dexterity. But if I have to sing a song you can be sure the song is sung. It's no different from selling B2B SaaS. You just need to make the sale.
    - stalfie 7mo ago
      I'm sure that's at least somewhat correct, but if I'd offer a similar reply, I could say that amateurs rarely takes kindly to being told that they do not understand what they are talking about. Dunning Kruger is endemic, and especially prevalent in populations making reductive comments about a group of professionals they maintain an adverserial relationship with. My point was not about the emotional experience of being presented with a certain viewpoint of the function of physicians. My point was simply that if you look at the details of what physicians actually do, the stated viewpoint is wrong. Of course, "primary function" is a somewhat subjective concept that you could define however you'd like, so it is more or less unfalsifiable as a standpoint.
      - renewiltord 7mo ago
        Haha that is just as true. I suppose I should say “the primary function to me of doctors who are not family members is”. They are a vending machine with a code and fortunately I know the code. Others need to be told to “advocate for themselves”. I simply get what I want and it always works.
  - Eisenstein 7mo ago
    What exactly is the problem with giving drugs to someone who might be a drug seeker? Is it worth letting someone sit in pain on the chance you might allow an addict to get high?

renewiltord 7mo ago

The primary utility of most medical professionals is to act as a gatekeeper to distinguish me from a drug-seeker. They are glorified security guards around medication. Fortunately, I always get what I want.

stalfie 7mo ago
As an internist (not in the US), I would like to put in my two cents to say this is just wrong. The primary utility of most medical professionals is to diagnose and treat a condition correctly. In the ER and elsewhere, the correct diagnosis is indeed often "drug seeking behaviour". And this is also a major aspect of medicine that many relatively healthy people interface with and remember. They are in pain for whatever reason, they desire to be relieved of said pain, and that desire puts them into contact with the skepticism and hesitancy around opiods that physicians have built up out of unfortunate necessity. It's often a hurtful and protracted experience, and so they remember it and form opinions like yours. But this area of contact with medicine is a tiny, very visible tip of a much larger iceberg. Your description of "security guard around medication" is not strictly wrong for my field, seeing as internal medicine is largely about administering the right drug at the right time, but the 99% of the drugs we guard are not desirable at all for any drug-seeker. They are potent, full of side effects, are sometimes potentially deadly. But they do work. And you do not see any of this until you get properly sick, which to most people does not happen very often often (at least until they approach 70). And when it does happen, most people tend to focus on the one little side of the ice berg they come into contact with. But it is there, and it is about much more than distinguishing you from a drug seeker.
- renewiltord 7mo ago
  No professional has ever taken kindly to being told their primary function. The notion of greater grandeur infects everyone from janitor to president. I'm not foolish enough to tell doctors these things. If I did, I doubt I'd get what I want. There are limits, naturally. I don't really expect to fit the percutaneous pins into my hand myself, even if I had third hand capable of equal dexterity. But if I have to sing a song you can be sure the song is sung. It's no different from selling B2B SaaS. You just need to make the sale.
  - stalfie 7mo ago
    I'm sure that's at least somewhat correct, but if I'd offer a similar reply, I could say that amateurs rarely takes kindly to being told that they do not understand what they are talking about. Dunning Kruger is endemic, and especially prevalent in populations making reductive comments about a group of professionals they maintain an adverserial relationship with. My point was not about the emotional experience of being presented with a certain viewpoint of the function of physicians. My point was simply that if you look at the details of what physicians actually do, the stated viewpoint is wrong. Of course, "primary function" is a somewhat subjective concept that you could define however you'd like, so it is more or less unfalsifiable as a standpoint.
    - renewiltord 7mo ago
      Haha that is just as true. I suppose I should say “the primary function to me of doctors who are not family members is”. They are a vending machine with a code and fortunately I know the code. Others need to be told to “advocate for themselves”. I simply get what I want and it always works.
- Eisenstein 7mo ago
  What exactly is the problem with giving drugs to someone who might be a drug seeker? Is it worth letting someone sit in pain on the chance you might allow an addict to get high?