16 Comments

The thing is, doctors will soon be a thing of the past anyway. The family GP/MD is likely to be replaced by an app very very soon indeed. And doctors have set themselves up for this by adhering to "best practice" which basically means standardisation. Since they no longer hold their own opinion, there is nothing they can do that an algorithm can't do better.

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This is an inevitable reality for many doctors.

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Thanks for pointing out the continuing education treadmill, which eats up the brains of health care professionals with pharma "approved" material. Maintaining various board certifications ties people down even more to the approved material, leaving them less time to explore alternatives and new thought. The high interest, student loans are further enslavement. Who can expect free thought and new ideas from a someone who's basically a slave?

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I came to say all of this, but you’ve already said it well yourself.

Doctors have been made into unwitting slaves.

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Thanks!

The sad burnout rates indicate that most of them now are aware they've been sucked in, but don't feel able to do what it takes to get out.

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I think most do not actually realize the significance of their situation beyond knowing they don't like it. Meaning, many do not realize that The Guidelines and algorithms are part of the enslavement and detrimental to the very patients they're trying to help.

They don't like the short visits. They don't like dropping reimbursement. They don't like the red tape of being hospital/system employed. They don't like the dissatisfaction of so many patients.

But they largely believe that The Guidelines are there to help, that the professional societies have their and patients' best interests in mind, and that the 3-letter agencies still know what they're talking about.

If only patients would be more compliant and follow The Guidelines and eat better (according to The Food Pyramid or My Plate) and exercise more, the doctors' workload would be reduced and life made easier.

They literally do not know of any alternative paradigm for doing what they do (helping people). Alternative medicine is hocus pocus, so they give it very little consideration unless they themselves find themselves struggling and then perhaps they'll venture into a functional med office.

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More of the newer prescribers fall into the compliant category that you described, and whichever imported docs who went through US medical schools, fall more into this group. You see differences in those who practiced medicine in other countries, and were trained to do an actual physical assessment, for example. But it’s true that a lot lean on the protocols and algorithms, and too many still trust pharma and CDC.

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a huge component of leaning on protocols and algorithims is the desire to avoid malpractice cases.

even if it's an inferior approach, there are players who weaponize divergence from the 'guidelines'

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Bingo.

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Dr. Remmant, si todos los médicos pensaran como usted, sería maravilloso. Otra es la realidad, en alguna ocasión hablaba con un medico amigo y me decía que tenía muy pocos colegas amigos por que las charlas con ellos giraban en torno a temas como, el último modelo del carro de lujo, las propiedades de recreo, las vacaciones en el exterior y lo que cada uno ganaba.

Es triste decirlo pero la medicina y su ejercicio en muchos casos , se han alejado de los ideales éticos y se enmarcan en el utilitarismo individual. Doctor Remmant, felicitaciones, seguramente muy pocos médicos piensan como usted.

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So far as I can tell, what’s really driving the focus on maximizing quantity over quality is the high - & ever increasing - proportion of MDs who now work for healthcare systems rather than themselves. I’ve been in academic med for almost 20 years & I’ve watched exactly the same process in 2 states: systems suck up as many community hospitals & private practices as they can, until they dominate the entire market & there are few (if any) opportunities for patients to find help outside these behemoths, who have strict triaging/referral policies and years long waiting lists for appts.

It’s not primarily about loans or unavoidable costs (eg. malpractice premiums), but about meeting the financial demands of bean counters & bureaucrats. Ironically, by giving up their autonomy & resigning their clinical autonomy to “standard of care” protocols, they are putting themselves out of business… & the “healthcare” employers who they work to please are rewarding them by replacing them with mid-levels who make (sometimes) a fraction of what they do.

And from the patient perspective… if all an MD is going to do is spend 10 mins figuring out which Rx they should add to their existing polypharmacy, why *would* they prefer an MD over a PA?

No wonder there’s both burn out and a growing chorus of disgruntled MDs complaining about midlevels being called “doctor” & the like.

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It does seem painfully obvious to balance work, home and really want to gain new insights into chosen profession as you move through it with more experience and years. But, greed. Apathy. Lack of creativity or imagination.

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Honestly, it’s appalling how often I know more about something than my doctor does. I had a doc tell me recently that my cholesterol was high and I should stop eating dairy and avoid shrimp. That’s 1990s information. No, I never went back.

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I once saw a poster in a stroke ward advising people to avoid saturated fat and salt. I told the nurse I disagreed with that information. She said "yes, we all do, but we have to say it until they tell us to say something else". So my question is, who is really treating the patient?

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Great article and so true! I went to nursing school for ONLY one year and saw enough in the medical field that made me want to leave immediately. I eventually found my path in nutrition and natural ways.....sooooo much better.

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Well done! I saw the best brains in healthcare fail to see the obvious and so I trained as an osteopath to try and fix the mess they left behind. Only too late I realised the alternative professions have been captured as well. So I dropped out of that and now I've written two books about all this. The first one should be out late summer, all going well. It's my antidote to both medicine and the supposed alternatives in modern natural medicine, since they can all suffer the same problems. If you're in an unregulated field there is still a chance. Fight to keep it that way!

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