# Bad doctors



## QtrBel (May 31, 2012)

If this wasn't the only issue he was stuck on I'd have switched but he is blind where this med is concerned. He's mentioned he credits it for saving his life so there's that as well as thinking kick backs. I have a great primary who will back me up and change a medicine if testing or excessive side effects show it's necessary. It can't just be willy-nilly I don't like this. With the drop from Oct to Jan 50 points just on diet, exercise and fiber she'll also support me staying off and seeing if it rises. May get me "fired" from the endo but at this point my primary could take over med management. That's the way my cardiologist rolls. He doesn't want you in his office once he makes an initial diagnosis and initial monitoring of any meds to ensure they are working as he intends. Then he'll tell you unless you're having a crisis or in the ER he has other patients that need his time and a yearly visit to a primary will take care of refills. He'll see you once every 5 years otherwise.


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## Aprilswissmiss (May 12, 2019)

I will say, over-prescribing (especially antibiotics) is more a result of liability and (sometimes assumed) patient demands than anything else. For example, if someone brings their child in with an upper respiratory infection, chances are it's a virus and antibiotics aren't going to touch it. But when the doctor tells them that, most parents will insist on medication anyway either because they don't understand, or because they want to do everything they can for their child and it makes them feel like they're doing a better job by medicating. The doctor isn't in a great position to say no because he'll upset the parent by overriding their decision that they feel they should have rightful choice over, and on the off chance that it is bacterial and the patient gets worse in a few days or weeks, the parent could claim that the doctor was negligent and create a whole world of legal and financial hurt. So, the doctor just says yes, or might even prescribe it without trying to discuss it because they don't have the time or they don't want to start an argument. It sucks, and it breeds antibiotic resistance, but it's a result of how the medical and legal systems are designed.

Often times, people won't advocate for themselves in the moment (this goes both ways - patients requesting treatment when they don't need it, and patients denying treatment when they do need it). The effects are twofold - the doctor feels like they have to offer medication or else the patient won't know how to advocate for themselves in case they really need it, and the patient doesn't say no because they don't know how to advocate for themselves if they don't want it.

There's a fine balance. Coming from the vet med side of things (where all of the above qualities present just as often) rather than human, there are definitely owners whose treatment-denying is detrimental to the animal. There are also owners who insist upon treatments that aren't ideal or that aren't even available (you'd be amazed at the treatments people create in their heads that don't actually exist). Same applies in human med.

I think there_ needs_ to be mutual trust, respect, and open discussion between doctors and patients in order for a healthy client-patient relationship, and it's sometimes severely lacking. Sometimes doctors could be more open to the patient's wishes and beliefs rather than copy-pasted treatments. Sometimes patients _do _need to listen better to medical advice or be persuaded into medication use (think type 1 diabetes) even if it's not what they want. I don't necessarily think doctors should be defined as "good" or "bad" based on their willingness to prescribe medication, but moreso their ability to communicate, which means both respecting the patient's wishes _and _convincing when it's necessary. A lot of doctors aren't "bad," but just might suit some people's wishes better than others.


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## QtrBel (May 31, 2012)

Aprilswissmiss said:


> I think there_ needs_ to be mutual trust, respect, and open discussion between doctors and patients in order for a healthy client-patient relationship, and it's sometimes severely lacking. Sometimes doctors could be more open to the patient's wishes and beliefs rather than copy-pasted treatments. Sometimes patients _do _need to listen better to medical advice or be persuaded into medication use (think type 1 diabetes) even if it's not what they want. I don't necessarily think doctors should be defined as "good" or "bad" based on their willingness to prescribe medication, but moreso their ability to communicate, which means both respecting the patient's wishes _and _convincing when it's necessary. A lot of doctors aren't "bad," but just might suit some people's wishes better than others.


Time seems to be the limiting factor. Most doctors don't have or take or insist on arranging their schedule to have time to talk to their patient. Some don't want that time. The above though is why I haven't found a new endo. He takes the time to talk and schedules patients so he has the time to spend. He and I have had several long conversations. This drug (lipitor) is his only sticking point. At $4 because my insurance is really good for most meds I can fill it and use or not. As I'm still having issues after the break he suggested I'll call and tell him that and see what he says. If he still insists I may break a couple in half and try 5mg to see what happens. I'm more inclined at this point to go without for 3 months using the I want the s/e gone before I try to see if my numbers stay in the range he wants. If they go up I already have the rx and can do what I originally thought by breaking in half and restarting at 5mg. Since I've found studies to support the 5mg every other day I may go with that. Makes you wonder why no 2.5 mg dose or even smaller as I bet they'll find that works for many without the s/e.

Starts a whole new line of thinking about how we may be being overdosed to ensure effectiveness. I know for me many of the meds I've taken were very effective at much lower doses. But there seems to be the mentality that more is always better (NOT).


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## QtrBel (May 31, 2012)

ACinATX said:


> This doctor I had didn't take insurance, and I have since switched to another provider who also doesn't take insurance. IME, if you can afford something like this, you'll get a much better standard of care.


I actually haven't found that to be true except in the case of gyn/ob care where midwives were not allowed to practice in our state and not covered under insurance. That is changing all over the U.S. Now that many states are offering certification programs and insurance companies are covering costs a very viable line of care is opening up to many women. With or without insurance they are an affordable option for many that qualify to be under their care.

Any provider is an individual and only as good as the effort they put out and time they put in in my opinion.


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## JCnGrace (Apr 28, 2013)

I fired the last nurse practitioner I had because of her insistence that I come in every 3 months. Ummmm....NO! Once a year is more than plenty. Just for clarity I'm not on any narcotics and the only prescription I really need is for Ventolin (albuterol inhaler for asthma), the rest of the stuff I take can be gotten OTC although it's cheaper to have a prescription and go through insurance. Plus she was always wanting to take the Ventolin away and put me on other asthma meds. Again NO!, it's worked for years without causing any side effects so if it aint broke it don't need fixin'! The last one she did talk me into trying resulted in breaking out into hives and a golf ball sized lump on the side of my face. My body doesn't tolerate very many meds either.


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## horselovinguy (Oct 1, 2013)

_DISCLAIMER: This is *not* aimed at any individual here, just my overall feelings gathered during a lifetime of experiences..._

I strongly dislike when blanket statements are made, cause that is a disservice to all. No different than anything else, you must find what works for you and then live with your decisions ongoing in your health and commitment to being healthy in this case.
Some people are just healthier, some not so lucky and as you age that health might just change no matter what you do...
Be prepared for a possible rocky future and a game-plan change needed to maintain that level of health for longer, but also recognize you just might be sitting in a medical office more often. Then the need to find and keep a doctor you trust with your life will be your challenge and you will face a gamut of questions, a barrage of tests to find and uncover what makes you tick so you continue to tick healthy...

I think its not that doctors won't take the time, many times the patient isn't interested...they know all coming through the door.😐
With the increased use of the internet and self-diagnosis commonly done...can't tell you how many times I've been in a doctors office and heard the patient tell, demand of the doctor certain medicines cause they know what is wrong based on their own diagnosis which is slanted, in reality may not be all the truth or basis a doctor makes judgement calls for medication prescribed.

I for one have had good doctors my entire life..
They took the time to listen to me, examine me and sought to find the best path to treat what was wrong with me.
Many a time I went to the doctor being ill, examined, checked over and sent home with "no-drugs" because they won't work on a virus, but to hear other patients screaming at the doctor cause they want to take a pill to make it better...
If my ailment was bacterial, then yes I had a prescription to take and instructions to take it all till finished and why to do such.
I've_* never *_arrived at a office and with armchair diagnosis of me demanding this or that... I trust my physicians to be the best, know their facts and combine that with my health, and steer me in the correct direction to regain or keep my health.

Today insurance companies negotiate the contracts of fees paid for seeing patients and it is disgusting what a doctor is paid for his/her years of education versus what is charged.. Few people can honestly afford the "cash" price of seeing a specialist when to walk through a door is many $$ hundreds, now add some of those in-office tests and your bill just went to $$$$$ thousands..
If a patient can get samples of a medication free from a pharmaceutical rep leaving them in a doctors office, allowing a person to take the medication to keep them healthy, why not!
It does not mean you will be steered to a particular drug, but maybe it is the one wanted for you and a chance to make a fixed income go a bit further...well, to me that is not such a bad thing either.
I have seen the "drug sample room" in a doctors office and it is mind-boggling how much is given away freely and how much assistance from the manufacturer is available if you need....it isn't just one manufacturer either but all of them do the "samples" thing..

I also choose to receive medical help both emergent and scheduled such as lab tests, xray, cat-scan, MRI, blood-flow, breathing, bone density, mammograms and a host of others as we age you face...and not pay the full costs of those tests.

I _do_ understand how expensive it is to run a medical office of any kind. Beside the seen rent, utilities, salaries, new equipment needing continual upgrade, upgrade and maintenance of a building there are the hidden massive costs of insurance for several kinds of coverage from malpractice, health for employees, maintaining of those testing machines, the fees for having professional services of cleaning the facility to the accepted levels of the medical associations, let us not forget to renew licenses to practice and where they are affiliated.....and so much more.
If you think a volume of patients is not needed and that doctor can afford all those expenditures allowing each patient 1/2 hour or more of their time....the secret is to have a doctor who will give you that time when it _is_ needed, as needed and when all is going well a quicker visit to take place. 
It surely_ doesn't_ mean they don't care... Often my sisters & I would go in after-hours to meet with doctors when my mom was dealing with cancer and we _were_ permitted to know what was happening, did not understand or a game-change was needed hoping to steal more time here alive with her... The doctor was sitting their in the office with several patients charts surrounding them, reviewing, making notes and formulating a game plan of how to proceed for many patients....was that ever seen, _not by the patient _who thinks the office opens 9 - 5 and then all is done and home the doctor went...reality is often far different. That was my experience with my doctors and why they _were_ my doctors was the level of care both seen and unseen I had from them.

I read here threads on animal and human care and listen to disgruntled in so many places... It is not what I personally have been included to or exposed to in my care or that of my animals, the opposite often is true of most grumps and complaints.
Please include to this farriers who often apprentice train with a gifted farrier learning the trade. You become only as good as your education/training was...good or poor quality is often from where or who you learned, you work and what is allowed is what you become.
I also make it my business to know the training, the education of and where my doctors placed in their schooling to become a physician, veterinarian or farrier....you know doctors whether placed #1 in the class or #279 of 280, they all get the same degree to hang on a wall and shingle with their name on it. You can bet my "care-givers" are not the last in the class, but near the top or very close...and I do want to hear when scheduling a appointment, sorry no appointments that day the doctor/farrier is away at a seminar on new ...................... To continue to refine your trade, your calling in life where sometimes in your hands life does hang in the balance is so very important.

Not every person wants to take medications but to do a lifestyle change... For some it does work, but not all.
I'm just glad that when lifestyle change no longer meet the need, the needs my body has can be helped by swallowing a pill and if then you need a different pill to combat side-effects it is available...
It stinks sometimes to get older.....who ever said growing older is easy is wrong!
Growing older is not for sissies. Grasp the golden ring early in life cause often for many it seems to tarnish and leave a residue as we age...
You can age gracefully or fighting it every step of the way...
The option of grow old or die is not a option I wish to tread to close to for a very long time yet.... 
🐴... _jmo..._


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## ksbowman (Oct 30, 2018)

First I want to say that even though my wife and I have had some pretty serious illness's we have been bleesed as we both get around very good and have our problems under control. Since we are over 70 and can look around and see others our age that many that are not so fortunate. We have had good to excellent doctors most of the time and feel that is because we "shop around" when deciding which doctors are both qualified and have excellent track records. One should always keep in mind " Only half of the doctors graduate in the top half of their class" we keep this in mind with any professionals we deal with.


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## bsms (Dec 31, 2010)

ACinATX said:


> often without taking the time to actually think


In the military, we saw flight surgeons. Each squadron was assigned one. The good news was you could be seen easily and always had the same person. The bad news was some were very good...and some were barely competent. After retiring, I've been on Tricare. I've seen a doctor for a physical twice in the last 14 years. I've had physicals about every 2-3 years until COVID and haven't seen ANYONE since then except for A) Trip to the emergency room for a kidney stone, and B) twice a year visits to a dermatologist (a real doctor) for skin cancer examination & removal. Everything else is handled by phone.

The dermatologist is a really good guy but he admits he normally sees patients for 10 minutes tops unless something major is found. I don't blame him. Tricare pays him about $150 a visit, and there is a nurse plus the expenses of having a building, receptionist, etc.

I think doctors genuinely & honestly try, but much of medical practice seems driven by a need to keep government approved organizations (and thus insurers) happy while the vast amount of information means no one can absorb it all:

"_Last year, I received this email from a colleague. The medical group she belonged to was actively reviewing her prescribing habits *to make sure that each and every one of her diabetic patients was on a statin*...This illustrates a major problem in medicine today: Eminence based medicine where expert opinion is relied upon despite often being no more than perpetuation of long-standing myths and falsehoods. Basically those in authority at venerable institutions exert an undue degree of influence over general opinion. Eminence based medicine, it should be said, is the direct enemy of evidence based medicine which is based on critical appraisal of the best available science...._"- Dr. Paul Mason - 'Why your doctor thinks cholesterol is bad"






BTW - there is absolute risk and relative risk, and many doctors focus on relative risk because that is what the drug companies focus on. For example, suppose you have a 99.6% chance of NOT having a heart attack. A drug will improve your chances of not having a heart attack up to 99.8%. That is a 0.2% decrease in absolute risk, but a 50% improvement in relative risk. But just how many side effects would one risk to go from 99.6% to 99.8% chance of no heart attack? This plays out in statin prescriptions.

Approved standards of care seem to be "_Did you prescribe everything possible to reduce risk?_" That is very different from, "_Did you examine the patient closely and consider all the factors involved?_"

And genetics. My sister got her genes from my Dad's side of the family. They all tended to be leaner and lived into their 90s. I got my Mom's genes. Her family was all VERY fat, very high blood pressure...bad news. Except...they all lived to be 85+ with sky high cholesterol, blood pressure and very obese. Keto and Intermittent Fasting and jogging have left me in far better shape than my Mom's brothers and sisters. But I honestly cannot remember ever being asked about my relatives during a physical. Certainly not by the guy who wanted to put me on statins and told me Keto was dangerous to my health....


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## ChieTheRider (May 3, 2017)

One of the big differences between veterinary medicine and human medicine is that veterinary medicine, at least where I live and in general practice, is still somewhat holistic. The vets look (or SHOULD) at the entire animal before prescribing something, not just handing out pills because the textbook says. You may completely go against what the textbook suggests for a particular animal and try alternative therapy. Some older vets will throw some steroids and penicillin at literally anything, but that is changing for the better. I'm actually writing one of my last projects before I graduate the vet tech program about antibiotic resistance because the AVMA came out with an article discussing it.

Humans in this fast-paced world want a quick pill to fix the problem. We don't want to change our diet/lifestyle/other supplements/way of thinking in order to stay healthy. It's become discriminatory to talk about weight. I've never once had a conversation with a doctor about nutrition the few times I've actually gone in...especially now, my trust for our hospitals, doctors, and the people running them has plummeted into the deepest depths of the earth. Nobody talks about actually supporting your body's natural ability to heal itself. What about less expensive and healthier ways to boost you immune system without destroying the natural ecosystem in your guts? Why do we just throw pain meds at something? Recently I've been studying some of Europe's homeopathic medications and how those patients are treated instead of just popping pills. It's crazy how western medicine has taken a huge turn for the quick and easy rather than considering the long term effects.

To clarify, I'm not necessarily anti-antibiotic, but lord they are SO overused. There's no reason to throw an antibiotic at someone who has the flu as a prophylactic treatment for a possible secondary upper respiratory infection. Give them some zinc, vitamin C, D, A...all the immune boosters, along with some quercetin to help them absorb effectively! If we didn't live in the world of junk food, pesticide ridden produce, tainted water, and genetically modified alien grains, then we'd probably be healthier anyway. Obviously if you come in with septic peritonitis then SLAM them bad boys but you don't generally need to be destroying your body's natural flora as a "just in case" for a shallow cut or the common cold. The only time I think I've had antibiotics was with my wisdom teeth, and I could have probably been fine without them, but possible infection + very close to your brain = no thanks I choose life. I've had my hand ripped up by a dog (no, their saliva doesn't heal you, they lick their butts, nuff said), sliced by a ceramic jar (still have nerve damage from that one and it was 2 years ago), stepped on rusty things, licked a salt block, drank from the water tank...I probably have the farm to credit for my immune system.

There's nobody better to blame than the drug companies. The price of insulin is a prime example. It costs pennies to make and when a Type-1 diabetic needs it to literally survive they have to spend thousands a month, end up rationing their insulin, and die. Have you ever seen a diabetic seizure or how much discomfort a patient is in when in DKA? Nobody better to blame then the companies playing on people's incurable illnesses to hike up prices.

And, an interesting thing about ivermectin: Ivermectin, a potential anticancer drug derived from an antiparasitic drug It's actually been used in some cancer research because of its ability to target drug-resistant cells.

This is an abstract, but the reasoning doctors have used it for the _other sickness_ is similar. It allows the real virus killing medicines (zinc, etc) to better penetrate those cells. It's a pathway for the real immune-boosters to work, not really a treatment in and of itself. The same is the experimenting with HCQ. I'm just going over the science and not taking sides so this doesn't need to be debated, as the mods said, we're not gonna fuss about the 'rona here. It's just interesting to see what happens when doctors, trying to save lives, think for themselves instead of following the drug companies' and AMA's protocols and are attacked from all angles for it. The whole issue on free thinking/free speech is also a problem but not for this thread.

Doctors are taught from textbooks and taught protocols written by the drug companies. So who's really to blame, the docs who are mostly doing what they're taught, or the big wigs making ungodly amounts of money off of people's terminal illnesses?

My trust in the medical system is currently "Give me some lidocaine and I'll stitch myself up."


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## Jolly101 (Jul 2, 2018)

Very interesting discussion! I am definitely coming back later to read the other comments here and learn more about the U.S. system.

Definitely lots of issues with the medical system that were especially highlighted over the pandemic. I'm in Canada, so I realize we have quite the different issues here, but it is by no means better, maybe in terms of payment, but we get subpar medication (since the government only wants to pay for the cheapest) and long long waits. A large portion of the population can't even get doctors here and I remember an old professor of mine (born Canadian) saying she was quoted up to 8 years to get a doctor on the waiting list, when moving provinces. Pros and Cons to each the US system and Canada.

I definitely understand not wanting to be pushed medications, as I am much the same myself. I could see that being very irritating. I think when it comes down to it, medical schools teach very little about alternative routes of medication, in fact, I believe they even may frown upon it, leading to many graduates emphasizing medication first. You especially have to consider the historic relationships between doctors and big pharma, and actually, I know for a fact that the medical council here is very strict on any doctor who may "appear" to support anything other than medication, whether the allegations are true or not. There is a negative connotation that goes along with holistic medicine in the medical community and most doctors are not willing to take on those risks both for the patient and their appearance. All of this just perpetuates a culture where medications are to be pushed first for patients.


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## ChieTheRider (May 3, 2017)

Jolly101 said:


> I know for a fact that the medical council here is very strict on any doctor who may "appear" to support anything other than medication, whether the allegations are true or not. There is a negative connotation that goes along with holistic medicine in the medical community and most doctors are not willing to take on those risks both for the patient and their appearance


This is one of the things that frustrates me the most, because the main reason behind this is that drug companies aren't getting their money. If a doctor with years of experience says "hey, let's see if aloe helps with this patient's ulcers" or "hey, maybe Arnica as a homeopathic medication can help with swelling for a patient who is allergic to NSAIDS" or "hey, this patient is anxious, can't hurt to see if aromatherapy might make them at least feel better in addition to their pharmaceuticals". These things are significantly safer than pharmaceuticals especially when used under a doctor's care. Again, there are conditions which can benefit from pharmaceuticals, but like I said before, people want a pill to pop instead of a long term solution.

It's the drug companies, it's the medical associations, it's the people making crap-tons of money off sick people. Let's circle back to the insulin again as a perfect example of the corruption. It's disgusting. And the issue with totally government controlled healthcare is that you aren't getting the best care possible, you're getting whatever's the cheapest. You aren't getting what's best for you, you're getting whatever makes them money. They care absolutely nothing about your health, they care about money and being able to control your healthcare. Hate to think what happens when terminal patients get too expensive to keep alive. It's trying to be that way here in the US as government control creeps into every aspect of our existence but isn't as bad just yet.

It's more than just irritating, it's vile that there are people who would completely ignore patient wellbeing in order to pad their pocketbooks.


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## beau159 (Oct 4, 2010)

ACinATX said:


> The thread about Ivermectin got closed, and I don't want to re-open it, but if it is acceptable I would like to comment about bad doctors. I couldn't believe @QtrBel 's story about her doctor pushing Lipitor, even after it caused reactions. I mean, I could, of course. It's just ... sad. If that had been someone's vet, I'm sure they would have gotten fired. Honestly if that had been my doctor I would have found a new doctor. I am also a medical minimalist. It's actually one of the things I really looked for in a doctor, that they would be also. I found one that I had for a while that I really liked. He was a physician but more into natural medicine and very much into not taking medicine unless it was really needed. But when I had pneumonia he prescribed antibiotics. We talked it over and he explained his thinking, and it convinced me. Plus I felt better about taking his recommendation because I knew that in general he didn't prescribe antibiotics for anything.
> 
> I really hate it when doctors push the meds without giving it a second thought. Makes you wonder what sort of incentives they are getting from the drug companies. The whole thing is just a symptom of our modern medical system, IMO, which just prioritizes getting as many patients through the door and billed as possible, often without taking the time to actually think about what is best for a particular person.
> 
> ...


I didn't see the Lipitor thread so I missed that.

I'm an optometrist and a good portion of my job is MEDICAL. So I get to see "the other side" of it. I do agree that many doctors are quick to put a patient on a medication. However, most of society is lazy. And I'm dead honest when I say that. They aren't interested in simply taking care of their body and they just want a pill to do it for them. It's a sad, sad, truth. At least half of my day every single day is seeing DIABETIC patients, as one example. Which is 100% preventable, if people would just take care of themselves in the first place. No one knows their blood sugar readings. No one knows what they should eat and what they should avoid. Etc. Very basic things.

So I guess just trying to present the other side of the conversation. Doesn't mean it's right to just stick someone on a medication without considering other avenues, but it "gets old" when the patient doesn't even care about themselves. 

As with anything, you need to select a doctor that you can be a team with and have open discussion and have your concerns met and have an agreed-upon game plan. That's the truth.

But it is also CRAZY how much INSURANCE is getting their little fingers into EVERYTHING. Absolutely insane. And yes, it is influencing the care of patients. 

I am happy with one very recent change to CMS's way of coding office visits that was actually for the better. It was less about "checking boxes" and more about the actual problem the patient presented with. But......... did you know if the doctor prescribed a medication, that automatically gives a higher level of coding and higher payment? You know, that could very well push some doctors to prescribe a med, when they wouldn't have normally. Especially if they are in a hospital based system that pushes for numbers. Not to stereotype anyone, but it does happen. 

I too like to go to private independent offices when it can for medical care, but those seem to come and go around here because they sometimes don't make it on their own.


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## QtrBel (May 31, 2012)

https://www.horseforum.com/threads/tennessee-passes-otc-ivermectin-bill-for-human-consumption.830013/post-1971015587



It was here @beau159


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## ACinATX (Sep 12, 2018)

beau159 said:


> At least half of my day every single day is seeing DIABETIC patients, as one example. Which is 100% preventable, if people would just take care of themselves in the first place.


And this may be part of what happened to my dad. As an endocrinologist in a small town in Texas, after a while he got tired of telling people "stop drinking a six pack of Dr Pepper a day" and being ignored, and then they keep complaining about how bad they feel, they end up in the hospital, they have to have feet amputated, etc. I guess after decades and decades, that just wears you down.

I hadn't thought about people being lazy and honestly just wanting a pill. I guess, to be fair, if I could be super fit and healthy without doing any work and just by taking one pill a day _that didn't have side effects_, then I might be interested. But everything has side effects, even a lot of "natural" products, if they are taken in high enough doses to be effective. And there just isn't a pill that can replicate all of the positive benefits of getting outside and being active.

The side effects thing is one that really kills me. I don't watch a lot of TV, but sometimes I peak in on my family watching TV, and there are so many drug commercials. And just listening to the side effects, I feel like, unless I was almost certainly going to die without this pill, or if I were in actual constant terrible pain, I can't imagine wanting to take any of that. Because then you have to add more pills for the side effects of the first pills, then so on and so on...


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## bsms (Dec 31, 2010)

A friend has Type 2 Diabetes. She's a retired nurse with nearly 40 years of experience. Her health plan paid for a couple of expensive medicines. She is now on Medicare...which won't pay for both medications. So NOW she's considering diet and exercise! She's a nice and caring person but I honestly doubt she'll quit eating rich desserts...and muffins, and "_just a bite of_"....And she _knows_ better! 

I love running and riding. They give me all the incentive I need to try to stay in shape - the motivation as well as the means. I often forget how weird that makes me in modern American society!


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## QtrBel (May 31, 2012)

See. That is the bad thing about the statins. They are being pushed as excercise in a bottle. A friend's Dr went so far as to tell her she wouldn't need to excercise once she was on it as it was just like her running marathons.


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## ACinATX (Sep 12, 2018)

QtrBel said:


> See. That is the bad thing about the statins. They are being pushed as excercise in a bottle. A friend's Dr went so far as to tell her she wouldn't need to excercise once she was on it as it was just like her running marathons.


Well, sounds like I need statins LOL. A marathon in a bottle. Heck, I could start giving them to Pony, and I'll never have to worry about him being fat again! It'll be like he's an endurance horse!


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## bsms (Dec 31, 2010)

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults (Nature)

"_Reduction of total cholesterol (TC) has been an integral part of public health campaigns, such as Healthy People 2020 in the US and Under 5 in Norway as well as cardiovascular disease (CVD) risk prediction models. This goal has primarily been supported by the success of statin trials showing that statin therapy reduced mortality from ischemic heart disease (IHD). “The lower, the better” cholesterol hypothesis has been accepted by many health professionals. *However, the statin trials were mainly performed in persons at a high risk of heart disease, especially in men with manifest CVD, in whom heart disease mortality constituted approximately 50% of all deaths.*

Although disease-specific morbidity and mortality, such as IHD mortality, have their analytical merits, *all-cause mortality is arguably the most important endpoint for patients* or the general population when assessing risk factors and the effectiveness of a treatment or a public health intervention for life-threatening diseases. The target TC levels for public health interventions in the general population should be determined after careful consideration of the levels associated with the lowest mortality in the general population....A U-shaped relationship between TC and mortality was observed in each age-sex group. *TC levels associated with the lowest mortality were 210–249 mg/dL in both sexes in all age groups, except for the youngest groups of men*.._."

Also: U-shaped association between LDL-c levels and all cause mortality in the general population - PACE-CME



https://www.researchgate.net/publication/346526078_A_U-shaped_association_between_the_LDL-cholesterol_to_HDL-cholesterol_ratio_and_all-cause_mortality_in_elderly_hypertensive_patients_a_prospective_cohort_study


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## beau159 (Oct 4, 2010)

ACinATX said:


> I hadn't thought about people being lazy and honestly just wanting a pill.


Yup. I distinctly remember one patient (who's blood sugar is out of control) and I was trying to help educate her on what she should and shouldn't eat and she flat out told me: _"I've been eating white bread for 60 years and I'm not stopping!!! I guess I'll just die early." _ No joke. She might just get her wish. 

Most people (not everyone of course) don't want to change what they are doing and instead take a pill so they don't have to change. Then when that pill stops working, they get another one. And then when that pill gives you a side effect, they take another pill to combat the side effect. And the snowball grows.



ACinATX said:


> Because then you have to add more pills for the side effects of the first pills, then so on and so on...


My own MIL at one point was on Adderall during the day to stay awake and Ambian at night to sleep ......... and she is also a nurse.  Even the people that you think should know better and do better....


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## gottatrot (Jan 9, 2011)

I've known several people who started on statins and ended up with cognitive impairment very quickly. As my dad says, the brain contains 20% of our cholesterol. Are the drugs smart enough to lower it in our blood and not our brain?

Studies are conflicting. But a lot of money is at stake.





Some Statins Appear to Increase Dementia in Patients With Mild Cognitive Issues







www.uspharmacist.com





But the muscle weakness and joint swelling is even worse for some people, to the point of debilitating. I personally believe in quality of life versus quantity. Doctors can tell you to take any drug but there is no reason you should if your risk/benefit analysis says you shouldn't.

I've observed how the insurance reimbursements have made health systems try to standardize treatments. To the detriment of patients, who are all individuals. If a patient meets certain criteria, an order set opens, and if a doctor does not click on the recommended drugs, they have to explain why to the computer. 

I once had to delay giving an antibiotic to a very sick person in the ER because of arguing with a pharmacist about why doctor hadn't gone with the recommended dose of antibiotic. The person had kidney failure and needed a lower dose, but we were supposed to just stay in the box even if it was the wrong thing to do.


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## QtrBel (May 31, 2012)

gottatrot said:


> But the muscle weakness and joint swelling is even worse for some people, to the point of debilitating. I personally believe in quality of life versus quantity. Doctors can tell you to take any drug but there is no reason you should if your risk/benefit analysis says you shouldn't.


I whole heartedly agree with this. BUT Big Brother has invaded or privacy and right to choose. Drs can fire you for not filling the RX. They can't yet prove what you did once you filled it thankfully but that your medical care and insurance is now likely in jeopardy because someone wants their pocket lined is evil at its core. You are now spending money you shouldn't have to just to keep your care.


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## QtrBel (May 31, 2012)

gottatrot said:


> I've observed how the insurance reimbursements have made health systems try to standardize treatments. To the detriment of patients, who are all individuals. If a patient meets certain criteria, an order set opens, and if a doctor does not click on the recommended drugs, they have to explain why to the computer.


Yep. Noticed that as well. The if/then madness that can literally take 1/2 hrs or more of the tech (as here it isn't a nurse) that comes ask you all those questions that lead to questions. I'm waiting for flags to start appearing when you answer differently.


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## beau159 (Oct 4, 2010)

gottatrot said:


> I've observed how the insurance reimbursements have made health systems try to standardize treatments. To the detriment of patients, who are all individuals. If a patient meets certain criteria, an order set opens, and if a doctor does not click on the recommended drugs, they have to explain why to the computer.


Yup. It's called "prior authorizations". I have to deal with them frequently. It's a complete waste of time and resources and I think most of the insurance companies hope the doctor/staff gives up and just does what they say. My synopsis is:

_Insurance:_ Are you sure you wanted to prescribe medication X for your patient?
_Doctor:_ Yes, that's why I prescribed it.
_Insurance:_ Well what about medication Y instead?
_Doctor:_ No, medication Y isn't even the same thing and will not work. My patient needs medication X.
_Insurance: _Well, have you already tried medication A?
_Doctor: _Yes, we have tried medication A and that doesn't work. 
_Insurance:_ Are you going to use medication X with medication D?
_Doctor:_ No. (I obviously didn't send a prescription through for that one!)
_Insurance:_ Have you considered medication F?
_Doctor:_ The patient has an allergy to that and cannot use it. That's why we need medication X.

.......and so on. I'm not even joking sometimes. It's just ridiculous. Some insurance companies are worse than others. Some will give you a quick determination. Some take several days to approve. 

It's like beating your head against the wall.

And just because the insurance "approved" the prior authorization, doesn't mean they will actually pay any money on it. So sometimes I go through all the work, and the patient doesn't get it anyway because they can't afford it. Then back to square one.


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## bsms (Dec 31, 2010)

My first encounter with insurance driving things was with blood pressure. My systolic blood pressure was 155 and I was prescribed Diovan. It worked great, lowering it to 130-135. When I retired, they switched me to a different drug. Wouldn't tell me why. It lowered my systolic pressure to...150. I spent a year taking daily blood pressure readings and giving the log to my "primary care" person. They wouldn't switch me back. After a year I went in and complained in person, loud enough and obnoxious enough that a doctor showed up. She said my primary care person wasn't authorized to make the switch but as a doctor SHE could. Went to the computer...and found Diovan was now available off-label. "Oh," she said, "_Your primary care person COULD have authorized it now that it is available generic_...."

It is now running 130 without drugs, but I can understand why medical folks don't want to tell people to lose weight - even assuming they have a clue on HOW to lose weight and keep it off. Many people just won't. I understand them too, since many have tried for years, failed, and see no reason to keep trying. And I've got friends who just won't give up their sweets. 

Still, prescribing a drug that made no difference because the one that worked cost more taught me my HEALTH wasn't the goal. I don't think it is the fault of the medical people. Our system of care has turned into a computer program giving standardized answers beneficial to the insurance companies. If "standard" doesn't fit you, tough!


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## Zimalia22 (Jun 15, 2021)

When my mother was alive, she loved her Dr. I hated him, with a passion. His cure for everything was his prescription pad. Got cancer, here's a script. got a hangnail, here's a script.

I don't trust Dr's as far as I can throw them. I even like the Dr I have now, but I only trust him so far. I trust my horse vet farther. 
I told my Dr don't get used to seeing me. If I have a broken leg, you'll see me. If I have a broken arm, you'll see me. If I have a belly ache that I can't get over myself, you might see me. Other than that, you won't see me. 
Last time I was in, he was all for me getting a certain injection (not going to mention what as it's not allowed). I said no. He went on for 10 minutes or so on all the reason why I should, then asked if we were going to do this today. Nope. I told him I have done a pretty good job of taking care of me these 60 some past years, and that was good enough. He called me rude. I was not. I sat quietly and attentively while he droned on. He just didn't like my conclusions.

Don't get me wrong, Dr's have a time and a place. If and when I need one, I'll go. 
For the moment, I am fine.


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## Aprilswissmiss (May 12, 2019)

bsms said:


> I don't think it is the fault of the medical people. Our system of care has turned into a computer program giving standardized answers beneficial to the insurance companies. If "standard" doesn't fit you, tough!


This is what I believe, too. From what I've gathered with conversations with human doctors (surprisingly easy to have online conversations with them when you're in vet med), they hate the system just as much as we do.

It reminds me of when I needed a physical exam to start grad school. I was living outside of my home state and never needed a doctor, so I had to find a new doctor just to do the physical exam before I moved to yet another state. When I showed up, the intake questionnaire was just "Who is your radiologist? Who is your dermatologist? Where you do go for x, who do you see for y..." I couldn't answer the questions because I had never been to any of those types of doctors. When I was done, I tried handing the paperwork to the receptionist with all those spots blank and she immediately went off on me about "You _need_ to fill out the form _completely_ or else your exam won't be valid/your insurance won't cover it/we can't release your medical record to you." I tried explaining to her that I couldn't provide answers I didn't have, and that I'd only ever be in this office for this exact physical because I'm moving, and she said "You _need_ to answer these questions in full before you leave. Why are you even here if you're never coming back?" Thankfully, that's when a nurse interrupted and brought me into an exam room.

The doctor was very charismatic and asked me all about where I'm moving, the courses I'd be taking, etc. I told him this would be the only time I'd ever see him and he was more than understanding about it all. I asked about the questionnaire and he said "Don't even worry about it, it's just the insurance companies that force us to have that information. I'll make something up for those fields so you can get your insurance coverage and I'll give you a copy of your exam record now so it won't be a problem later." When we were done, I practically bolted out the front door without a single glance at the receptionist. 

I think doctors see just as much of a problem with the system as we do. There are even some painfully hilarious satire videos on youtube posted by doctors about how corrupt the US medical system is:













Prior Authorizations







www.youtube.com


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