Medical Doctors / General Practitioners

[Richard Masters]

Shouldn't there be some way to avoid paying a "doctor tax" every time you need a medication?

I'm not saying GPs are useless (OK, maybe a little bit), but if you have no medical insurance, private or otherwise, and you are experienced enough with your symptoms and/or educated enough with pharmacology, shouldn't you be allowed to walk up to a pharmacy and get the medication you need?

Note: I am not talking about antibiotics.

(1) The cost of medications and doctor visits would drop.
(2) Insurance costs would drop.
(3) Doctors would value you as customer, instead of seeing you as a recurring and replaceable source of income irrespective of service.
(4) Patients would value their doctors proportionally in respect to their services, and not merely as an economic obstacle to health.

 

[gtc]

There are quite a few medicines that you can purchase without prescription.

There ought to be solid evidence to justify restricting access to each medicine but doctors have enormous monopoly powers so I don't expect things to change in the near future.

 

[The Atheist]

Note: I am not talking about antibiotics.

I can't think of a single time anyone in my family has been to a doctor when at least antibiotics was needed.

Seems to me you're talking about the huge number of "comfort visits" people make, because the only thing which might fot your scenario is strong painkillers, and I think there's a good case to keep them prescription-only anway.

 

[WildCat]

Shouldn't there be some way to avoid paying a "doctor tax" every time you need a medication?

There is.

It's called "Mexico".

 

[Miss_Kitt]

@ The Atheist -- I think there's a typo in your post somehow. The sentence didn't make sense. (though you'll probably have fixed it as soon as I post this)

To the OP: Almost all medications are able to have negative, sometimes even dangerous, side-effects. Some only have that risk when they are taken in large doses or over a long period of time; some are only risky if you have certain medical conditions; some are only a concern if you are taking certain other medications. Some are only a concern if you are pregnant or breast-feeding, or are trying to become pregnant. Sometimes a medication will prove inadvisable because the condition it is requested for is not what it appears to be.

To use many medications safely, it's necessary to have someone trained to look into all those issues; listen to the patient, ask them questions, and sometimes run periodic tests (to monitor, say, blood chemistry to see if a kidney problem is developing due to the medication being used). The person would also have to be able to access the patient's healthcare records, have a listing of what other meds they might be taking, and be able to screen for any other signs or symptoms that might lead to a different diagnosis.

We call these people "doctors", though for some conditions a "nurse practicioner" is sufficient.

Medicines that are considered difficult--not impossible, but difficult--to harm or kill yourself with, are sold without a prescription. These include analgesics; antihistamines; cough suppressants; anti-pyretics; vitamins; mineral supplements; topical ointments to treat mild fungal, yeast or bacterial infections...the list goes on.

The other issue, which is becoming more recognized as MRSA moves out into the community, is that some drugs can impact other people by improper use. Even with doctors acting as controls, antibiotics are overused to some extent (less now I believe than in the 60's, when the cure for everything seemed to be penicillin); if the general public got to decide when they were needed, it would be even worse.

In fact, I suspect the current trend towards "antibacterial" soaps, wipes, sprays, embedded plastics, etc. is creating more superbugs to haunt us in the future. Bacteria, yeast and fungi are natural to the world, and natural to animals (including humans); if you kill off the weak, you will make a niche available for those that resist being easily killed.

This bit of reasoning presented by: Miss Kitt, matron of medical interests

 

[fls]

My first thought is that it is a good idea, but I am brought up short when I try to think of any relevant examples. Can you help me out?

Linda

 

[shecky]

There seem to be few times that folks go to a doctor with problems that don't require justifiably restricted medicines. Certainly, some prescription meds are not terribly dangerous even if abused. But folks go to the doctor often because they need some stronger (and correspondingly more risky) medications than are available over the counter.

That being said, there are significant regulatory bars to affordable health care in much of the US, where government allows doctors to operate somewhat like cartels. Nurse practitioners or equivalent can administer quite a bit of health care that would simply be overkill for a physician. Minute clinics and such are increasingly popping up to address this demand, shifting the gatekeeper effect to lower rungs on the ladder.

There is.

It's called "Mexico".

Not as much as you might think. I found generic antibiotics over the counter, but opiates required a prescription. Yes, I tried.

 

[Miss_Kitt]

Was just reminded that my GP actually does this for me on a few, limited issues. I have had a number of UTIs, and she will sometimes call in an Rx to my pharmacy based upon a phone conversation. Similarly, I get about 15 tablets a year for use when migraine strikes--because when the big M comes a-callin', you can't wait for a doctor to see you. But for most issues, we meet and do some talking, and she does some checking things, because it's too easy for a layman to not know what else might be causing symptoms.

Just my thoughts, MK

 

[fls]

I also have to ask what you would make of the estimated 100,000 deaths per year in the US due to adverse drug events.

Linda

 

[Richard Masters]

My first thought is that it is a good idea, but I am brought up short when I try to think of any relevant examples. Can you help me out?

Linda

For example, you know what is ailing you and you cannot afford a visit to the doctor, but you can afford a medication that has been prescribed to you in the past for this ailment.

Another example: The only places that are open are pharmacies and "emergency care" clinics.

Another: You know that your doctor is going to pick an arbitrary medication and see if it works for you (SSRIs, SNRIs, for example), but you can easily do the same and avoid paying for the doctor visit.

 

[Richard Masters]

..

 

[Richard Masters]

There are quite a few medicines that you can purchase without prescription.

There ought to be solid evidence to justify restricting access to each medicine but doctors have enormous monopoly powers so I don't expect things to change in the near future.

I agree.

 

[Richard Masters]

There is.

It's called "Mexico".

That works if you live near the border, I guess; though in my experience, most border cities are not very pleasant. Plus, you'll be treated like a terrorist on your way back.

 

[Richard Masters]

@ The Atheist -- I think there's a typo in your post somehow. The sentence didn't make sense. (though you'll probably have fixed it as soon as I post this)

To the OP: Almost all medications are able to have negative, sometimes even dangerous, side-effects. Some only have that risk when they are taken in large doses or over a long period of time; some are only risky if you have certain medical conditions; some are only a concern if you are taking certain other medications. Some are only a concern if you are pregnant or breast-feeding, or are trying to become pregnant. Sometimes a medication will prove inadvisable because the condition it is requested for is not what it appears to be.

To use many medications safely, it's necessary to have someone trained to look into all those issues; listen to the patient, ask them questions, and sometimes run periodic tests (to monitor, say, blood chemistry to see if a kidney problem is developing due to the medication being used). The person would also have to be able to access the patient's healthcare records, have a listing of what other meds they might be taking, and be able to screen for any other signs or symptoms that might lead to a different diagnosis.

We call these people "doctors", though for some conditions a "nurse practicioner" is sufficient.

Medicines that are considered difficult--not impossible, but difficult--to harm or kill yourself with, are sold without a prescription. These include analgesics; antihistamines; cough suppressants; anti-pyretics; vitamins; mineral supplements; topical ointments to treat mild fungal, yeast or bacterial infections...the list goes on.

The other issue, which is becoming more recognized as MRSA moves out into the community, is that some drugs can impact other people by improper use. Even with doctors acting as controls, antibiotics are overused to some extent (less now I believe than in the 60's, when the cure for everything seemed to be penicillin); if the general public got to decide when they were needed, it would be even worse.

That's why I made a special note about antibiotics. But it is ironic that it's OK to hurt yourself with aspirin or alcohol or even herbal supplements, but you are not allowed to make an informed decision on other safer medications.

In fact, I suspect the current trend towards "antibacterial" soaps, wipes, sprays, embedded plastics, etc. is creating more superbugs to haunt us in the future. Bacteria, yeast and fungi are natural to the world, and natural to animals (including humans); if you kill off the weak, you will make a niche available for those that resist being easily killed.

This bit of reasoning presented by: Miss Kitt, matron of medical interests

I generally agree, but more often than not, in my experience, visiting a doctor is a waste of time and money, as I can predict what they will prescribe and why.

I certainly wouldn't try or want to avoid the doctor if the problem is outside the scope of my knowledge. But I guess we can't all be held responsible for our actions.

 

[Neally]

Shouldn't there be some way to avoid paying a "doctor tax" every time you need a medication?

Yes there should, but the AMA have a monopoly. This is one reason medical care is so damn expensive, and why all the talk about socialized insurance only solves one piece of the puzzle.

To use many medications safely, it's necessary to have someone trained to look into all those issues

And many, even prescriptions, can and should be available to people without the added expense of a doctor visit. Just as contraindications and risks can be evaluated by a doctor, individuals should be able to make those same decisions with proper labeling and disclosures.

 

[Richard Masters]

Was just reminded that my GP actually does this for me on a few, limited issues. I have had a number of UTIs, and she will sometimes call in an Rx to my pharmacy based upon a phone conversation. Similarly, I get about 15 tablets a year for use when migraine strikes--because when the big M comes a-callin', you can't wait for a doctor to see you. But for most issues, we meet and do some talking, and she does some checking things, because it's too easy for a layman to not know what else might be causing symptoms.

Just my thoughts, MK

I've had doctors provide me with "courtesy" and preemptive prescriptions, but why should I consider this a privilege?

My last experience involved a prescription for which there is no generic; the medication helps; I can't afford it, but my doctor won't talk to me because there is a small balance due on my account.

I could easily find a medication with the same interaction profile, and a similar mechanism of action and use that instead.

One might say I should just pay the balance off on my account, but as a contractor, I can't really afford anything if I can't work; and I can't get any meaningful work done without the medication.

In other words, the only meaningful obstacle to my health is my doctor and the law.

 

[The Atheist]

@ The Atheist -- I think there's a typo in your post somehow. The sentence didn't make sense. (though you'll probably have fixed it as soon as I post this)

Thanks, but unfortunately it's too late to edit.

You were dead right - it's missing a "NOT".

Proofreading skills 0/10

 

[fls]

For example, you know what is ailing you and you cannot afford a visit to the doctor, but you can afford a medication that has been prescribed to you in the past for this ailment.

I got that. I was looking for a specific example that didn't involve antibiotics. I keep coming up against the need for diagnostic tests or that the devil is in the details.

Another: You know that your doctor is going to pick an arbitrary medication and see if it works for you (SSRIs, SNRIs, for example), but you can easily do the same and avoid paying for the doctor visit.

Okay - recurrence of depression as a specific example.

Linda

 

[fls]

There are quite a few medicines that you can purchase without prescription.

There ought to be solid evidence to justify restricting access to each medicine but doctors have enormous monopoly powers so I don't expect things to change in the near future.

I should point out that this has nothing to do with doctors. Decisions as to whether a particular drug is OTC are made through the FDA.

Linda

 

[fls]

Yes there should, but the AMA have a monopoly.

I should point out that the AMA does not control who can practise medicine, nor who can prescribe medication or other medical therapies.

And many, even prescriptions, can and should be available to people without the added expense of a doctor visit. Just as contraindications and risks can be evaluated by a doctor, individuals should be able to make those same decisions with proper labeling and disclosures.

The part that holds me up is figuring out what conditions can be diagnosed on the basis of symptoms alone, are not self-limiting anyway, and do not involve antibiotics. Can you give me some examples? We've had the example of anti-depressants and I think you could make the case that they are underutilized anyway. The other thing I thought of was migraine headaches.

And this isn't an ailment, but a case could be made for oral contraceptives.

Linda