[watermelon59]

That listening is no longer valued in today’s medicine. The patient’s “history” was once the centerpiece of his medical record, his story written in narrative form. With current electronic templates, information is fragmented into chunks designed to meet so-called quality metrics and maximize revenue from insurers. The patient’s story has been reduced to telegraphed key words that trigger prefigured algorithms, which generate pop-ups on the computer screen for further testing or generic therapies.

This finally explains why I find medical care in the US so different than what I had in my birth country (Brazil).

My US experience so far (multiple times): go to the doctor and have 15-20 minutes tops to talk to them (and most of that time is taken by a nurse and then waiting), describe symptoms and general observations I've made about them (I listen a lot to my body). With almost no discussion or explanation, I'm quickly diagnosed with something that almost always sounds bogus to me and I'm prescribed some medicine with no explanation of what it does.

Back in Brazil: go to the doctor and have 30-45 minutes booked. No nurse. Explain symptoms. Doctor asks further questions. I answer and offer general observations. Doctor writes down everything. Doctor appears to think about it. Doctor offers a few possible explanations as to what is going on and what is the course of action from then on. Asks what I think about it. If I'm prescribed something, I receive a full explanation of what the medicine does, and if I'm OK with taking it.

Another major difference I've observed is that doctors in the US tend to attempt to treat things starting from the least concerning ailment. I guess that's why there are so many stories of cancer patients going to doctor after doctor who treat them for minor things, only for a cancer diagnostic to be made when the disease has progressed a lot further. Back in Brazil, the doctors I went to would usually go a completely different route: "it's probably <insert minor/treatable problem here>", but let's rule out the sinister stuff first [like cancer]."

I love 99% of my life in America when compared to Brazil, and have no plans to go back. But going to the doctor here is definitely a subpar experience compared to what I had there.

[nugget]

For an annual fee somewhere between $500 and $1500 you can sign up for concierge primary care via a network like MDVip.com. I signed up my mother last year when she encountered some health issues and didn't feel like her primary care doctor had time to work with her and formulate an appropriate treatment plan. No fault of his - I found out later that he has a panel of almost 3,000 patients. Her new MD has less than 500 patients and will spend an hour per visit with her, is reachable via cell phone nearly 24/7, and will often check in pro-actively to see how she is doing. The difference is night and day, much more comparable to the experience you describe in Brazil. And for less than $1000/year I consider it an absolute bargain.

[noshbrinken]

I've had the exact same experience with American doctors. What is that? These people are supposed to be scientific thinkers. They've had years of biology. But I've never met a doctor who applies the scientific method, or cares to. They are a fundamentally uncurious bunch.

[abrookewood]

I suspect it's economic. The faster they can reach a diagnosis, the more patients they can see, the more money they make. It certainly pays to shop around in order to find a doctor that you are comfortable with and then stick with them for life.

[shados]

Doctors are human though, and different practices have different processes. Some are absolutely the way you describe. Maybe most, I don't know (my experience is limited there).

Personally when I moved to the US, I had one experience like what you describe, at MGH (best hospital in the world! blah blah blah).

I said screw that, went to a local practice (though still a big one, not an independent) instead. My experience over 3 different doctors (my main one and some specialists) closely match your second one. Been happy since then.

The one exception has been GI doctors. Since everyone in the US has digestion related issues because of the crap they eat, GIs are overloaded and ends up following a near assembly line process with patients. That sucks.

[kurthr]

Weird... I don't know anyone with digestion disorders. Well, I know a couple of people who came from India with treatable H.pylori, but that's about it for the last 20 years including friends, family, and co-workers. Maybe it's a different part of the country.

I've definitely had bad doctors and you have to treat them like any professional (Lawyer, Architect, Engineer) who may have very limited time, but certainly they aren't all bad.

[thaeli]

Wow, that's the complete opposite of my own experiences with American healthcare. Doctors here always seem to want to do the "yeah it's probably just a headache but let's get an MRI just in case it's cancer" thing. Maybe it's because my insurance covers it, and I tell them that up front so they won't try to save me money by limiting the tests they order?