Dr. Ghassibi ~ Feb. 2024
Greetings.
This month Valley Patriot publisher Tom Duggan asked me to talk about why doctors are leaving the profession and how to find a really good doctor as well as the signs and symptoms of serious ailments
The first issue is easier to talk about, but I will try to answer all three questions.
1) The insurance companies slowly but surely took over the medical world. These guys are investors and of course, the bottom line is their basic goal. They now control almost every step of our job. As doctors, we have to see more patients to make a living. We have to ask the insurance to approve a patient’s workup and medications. Cancer and autoimmune medications are expensive and approval often takes time. Patients have the doctor in front of them and take out their justified frustrations on us.
Some doctors were shot dead for delaying treatments. Between the regulations, the punitive atmosphere, the angry patients, life became too stressful to accept. Early retirement or change from clinical to administrative work became a way to deal with the stress and anxiety. A surgeon pays close to 200 thousand in malpractice insurance. Overhead is getting more than the income.
Meanwhile, many nurses were told that they can become nurse practitioners and do.
The job that doctors do. This was very attractive for them. So many excellent nurses joined the NP profession.
They do 500 hours of hands on training during their clinical studies.
I calculated that doctors do close to twenty thousand hands on during their training. These are cold facts. The nurse practitioners and physician assistants are very competent and highly educated professionals.
Yet, I think that they still need oversight by a physician. But the physicians are not there. Massachusetts has signed a decree that they do not need to work with a physician.
2) With the above in mind, you should be able to know how to find a good physician or nurse practitioner for your primary care. The specialties follow a different paradigm and they have less of this kind of problems than primary care. The reviews online are not reliable because people judge only the kindness and attention, which although important, does not always correspond to the medical competence.
Patients can advocate for themselves only to a certain degree, but it is very hard because they are not usually clinicians. It should not be our job to double check every doctor’s or NP’s decision.
3) As for the third question, different serious ailments present differently. My quick response is go with your gut feeling. I would add that often a feeling of severe anxiety comes with serious physical diseases, like heart attack, meningitis, a bleeding ulcer, a pulmonary clot, etc. Somehow the brain knows that something is not right. Fever, difficulty breathing, fear of moving or talking for unknown reasons, poor balance, lower vision, high or very low pulse, skin mottling, all could presage a serious dysfunction and require an emergency room urgent visit.
It is often better to call an ambulance rather than getting driven to the ER in case initiation of treatment needs to be started on the way.
P. Ghassibi, MD
ghassibi@hotmail.com