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Comment by gaius | Hacker News Reader

Also, the doctor is aware of your health history

Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you’re even back in the waiting room after spending 5 minutes talking to you while she’s really thinking about the new Audi. That’s as far as the awareness goes.

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Thanks for speaking for the entire medical profession. That is in fact what a terrible physician does, and not what myself or other newly trained physicians aspire to do.

You may not aspire to it, but you likely will have to do it if you want to remain employed in many areas.

I have multiple friends who made it all the way through residency and have since stopped practicing within years of "graduating. The OP describes the profession much better than you do, as a whole.

Double booking patients, requiring certain revenue targets, massive amounts of useless paperwork, etc. Considering the varying ranges of where they took up residency I'd say this is endemic industry-wide. Also jives with my personal experiences with the medical field.

They should start their own practice and set their own rules. Good practices/doctors in my area are so in demand most aren't accepting new patients.

Is it even possible to set up an individual practice these days? Most individual practices were established decades ago. Most new physicians will work with an established group practice on contract.

It would be for those physicians without crippling debt loads. So, no, for those whose medical degrees were issued in the last couple of decades, it isn't possible.

Its not because billing is so complicated that it takes up to 50% of the doctors tie to manage his own practice.

Big companies have more people doing billing alone than doctors themselves. Pretty clear cut case that regulation is the enemy of efficient markets.

Wouldn't this be a perfect opportunity for a startup to handle billing for small doctor's offices?

There are several but its not as easy as it sounds. Its a very labor-intensive task. Its kind of like saying that a startup should be going to peoples homes and cook for them according to their liking.

The issue is that doctors work for insurance companies and that means you need to do things a certain way they like while matching the way they practice and document their medical decisions.

I could explain more since I am part of one of these startups :)

If you live in a location that has poor selection of GPs then it should be your choice to opt out without denying yourself access necessary medication.

If you don't go to a doctor, how do you know it's necessary?

If you’ve been taking the same medication for 10 years, then on day 1 of year 11 you need a refill, pretty good chance you know it is necessary. I wouldn’t claim you never need to see a doctor, but it is equally absurd to suggest you always need to see a doctor. My experience has been that I ask for refills, and my doctor unquestioningly gives them. It would save the whole system money and time if I could just refill them myself.

That is not at all the experience I have with my doctor, where the intake NP does a whole litany of the past several years worth of doctor visits before I’m seen.

I’m ok and I think glad that pharmacists don’t even have access to that information.

On your first visit or every visit thereafter? I think the issue is the overhead of unecessary repeat visits.

Every visit thereafter.

Not sure how your anecdata is any more or less valid than mine...

I never said it was! My point was just that a pharmacist probably couldn't replicate the routine experience that the large health provider chain my doctor works in provides for patients.

I sit with my primary care doctor at least a half hour each visit, but then I'm lucky. I live very close to a first class VA medical center. I don't believe the west palm beach center can be beat.

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