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Comment by drewr | Hacker News Reader

I'm sure this isn't the case for every doctor, but what I've observed is that scale seems to be killing everything. When you have 10 minutes with a patient, have no long-term relationship, ship them off to a specialist that has even less context of their overall health, and ultimately just prescribe them meds to treat a symptom, that person does not get healthier. Over thousands of patients that starts to challenge any sense of moral obligation you originally had when entering the field. Then you become disillusioned and burn out.

The irony is the part about everyone becoming less healthy. That creates more demand for medical services. Rinse, repeat. We truly have the worst system imaginable in the US. It evolved over time. It's nobody's fault. It's everybody's fault. It needs to be burned down and rebuilt. It seemed like we had a chance with the ACA but it was pretty clear early on that it wouldn't fix the root causes and it hasn't.

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There’s a few doctors in my city who charge a $50 a month fee for a 30-39 year old and you can call and see them whenever. Insurance doesn’t cover it at all. I’d also imagine if you tried to really abuse the relationship and show up constantly for no reason the doctor might fire you. I feel like it’d encourage a relationship of respect both ways.

I interviewed a couple of them and one talked to me for an hour about health and diet and exercise, just a friendly chat to see if I wanted to use him. He said he was getting ready to retire from medicine after years of ER work when his doctor friend encouraged him to try direct primary care. It was so different than the regular medical system, cutting out all the middle men.

My parents have a concierge medicine relationship with their physician. It's fantastic. He is a complete professional who cares deeply about all of his patients (he works nights and weekends, does research outside of business hours, works around insurance and exploits every legal loophole possible to help them) but holy crap is it expensive. They are paying for their normal insurance plus this service ($3000 annually). This is what it's come to in the US---to be able to have a semblance of a relationship with your physician you need to pay a premium on top of the gouging that your "insurance" already charges you.

Note: My parents are not* rich, they scrape by on social security and my dads part time work fixing sprinkler systems.

"I’d also imagine if you tried to really abuse the relationship and show up constantly for no reason the doctor might fire you." My worry with something like this would be the doctor firing me as a patient as soon as I became unprofitable for any reason. Sure if the doctor is good you'll be fine, but how can you really know until you need to know?

Is this in the US? I would think that US malpractice laws, and the corresponding malpractice insurance costs, make this impractical.

I have a friend here in U.S. who runs their practice like this. They don't make any money at all at this kind of price. They should be charing each patient more like USD 200 per month.

> When you have 10 minutes with a patient, have no long-term relationship, ship them off to a specialist that has even less context of their overall health[...]

If you see the same primary care physician and the same specialists (or is it just a random specialist in the US?), wouldn't that establish a long-term relationship with each? Plus your medical file should give any of them more context on your preconditions, history and general health.

(That's the case here in Israel and -- after googling -- the US too, but feel free to correct me)

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