[Thomas the Rhymer]

I reckon it's about time I started my own medical practice, running my own ship. I've always worked for someone else, generally in places where I could grow in my skillz and have easy access to mentorship, but now I am confident enough in my medical skillz that it's time set sail on my own.

But I don't want to follow the grain. It's clear that both doctors and patients are unhappy with the way the system works. I want to do my own thing, and I've got a couple of ideas of what to do. But I was hoping to tap into the collective mind of the Rooshvforum to get some more brainstorming ideas. I'm not looking for you guys to plan out my life, but I want to get more ideas to play with.

All I ask is that you answer this question: What do you want out of a doctor; specifically a primary care physician/general practitioner?

Maybe you want more time to spend with a doctor. Maybe you want a doctor with an app that diagnosis you even before you arrive at the office. Maybe you want a doctor who'll go to the gym with you to check your squat form and teach you how to make protein bars. I want all your ideas, crazy or not.

Also, what pisses you off about doctors? What makes you hate them? Is there anything about medicine that ticks you off? Whether you think all doctors are in some sort of secret conspiracy with big pharma, or whether you don't like doctors that don't take your insurance, I also want to know these things.

In short: what would you think represent the ideal doctor visit?

Gazillions of thanks in advance for the guys who reply!

[Tex Cruise]

Sorry, has to be said...

[Fortis]

Someone who lives that lifestyle.

I hate when a fat-fuck doctor tells me not to eat certain foods, or a non-lifter doctor tells me how to lift.

On the other hand, I respect the fuck out of doctors like Brett Osborne who know their shit and practice what they preach. I know that's WAYYYYY easier said than done, but it goes a long way to earning my trust (and my money). I had an older doctor who was squatting, benching and deading three days a week and it showed. I respect the hell out of that man.

[kinjutsu]

The best anyone can hope for is that the patients that eventually come to find you are the ones you and you alone can help the most.

[Ringo]

The best doctor I've ever had initially specialized in orthopedics but came to be a mix of GP, psychologist and homeopathist. Say what you want about homeopathy, I'm convinced this guy did a great job and cured my terrible skin allergies and rashes.

He charges a pretty penny for his consultations and only takes a fixed number of clients, but he's usually booked (he does take a couple of days/hours off every week). I've been seeing him for about 18 years.

#1
What makes him great is that he really pays attention to what you are saying and doing - he's not just going through the motions and looking for a diagnosis. There's nothing worse than going to a doctor who barely listens to your complaint, prescribes you something and gets you out in 10min like you are disturbing them. He's looking for the right solution, not the fast one, and that can take some time.

#2
His clinic has a pretty relaxed vibe. When I was kid, he'd put me in a room with a bunch of toys and play with me while he'd ask questions. I don't play with toys anymore when I go see him but he still asks me many apparently unrelated questions to try to understand where I'm at and how that can relate to whatever condition I'm going to see him for. The typical consultation is 60min long - 40min of me talking, 10min of him examining me, 5-10min of him talking.

#3
As a doctor, people are paying you to 1) fix them and 2) make them feel like they are safe and are going to get better.

This doc understands that the body is a complex machine and if something hurts in my foot, maybe it's not because I have something on the foot but it may be a problem on the hip or spine; or if I have a skin rash on my scalp, it may be a digestive issue, not a topical one, for example.

Because of that, another important characteristic I love in a doctor is a holistic view of the body. Be confident when you show a solution, but always be open minded to the reason the problem exists and communicate clearly with the patient when you're not sure and want to explore other possibilities. Don't limit yourself to medications or traditional practices. Maybe get the patient to write a food diary; or do yoga; or change his sleep schedule. Look for the solution, wherever it may lay.

#4
Besides the examination, my doc always asks me for blood and hormone panels, even if there's nothing wrong with me - he just wants to keep tabs on markers and be on the lookout for relevant changes.

[Yeti]

I'd like my doctor to be healthy and youthful himself - he knows his stuff, but he gets enough exercise and sleep, and eats right. There are good doctors who are fat with puffy faces, but I feel more comfortable with a doctor who takes care of himself and follows his own advice.

A doctor who practices a more holistic approach; going over with patients the root causes of their problems. Not just prescribing a few pills. That means seeing fewer patients and perhaps not making as much money. Going over the proper diet (depends on the patient), what foods to eat and to avoid, daily routines, managing stress. A doctor who is open to new ideas about how different people can do different things to reach good health. Someone who is up to date on the latest research but also the latest bro science, haha.

[Vienna]

I'm coming at this from the angle of a physiotherapist who mainly see patients with musculoskeletal complaints, hence it's a bit nitpicky.

I get the impression that many doctors don't understand the effects of nocebo, and because of this explain a patient's injury or sickness in a way that ultimately makes them even worse. Ie. telling a patient with a herniated disc that they should "move carefully" and not bend their backs, or someone with shoulder impingement to "take it easy".

Many patients' first line of treatment is to get rid of their fear of movement induced by doctors.

So a good visit at the doctor's does not induce nocebo. Particularly, where relevant and applicable, explain a patient's pathology in a manner that does not create fear of movement.

Best of luck in your endeavours Thomas the Rhymer! I hope you'll update here when you've started.

[SunW]

• I like virtual affordable virtual doctors. You get to live anywhere you want, and I get more affordable healthcare. Win-win.
• A doctor who helps me do more self-diagnosis on minor things, like fever, oxygen levels, etc. What basic tools do I need so I don't have to run into a doctor every now and then?
• What are some more natural ways of assisting with a problem before I jump into meds? If I can avoid meds, I will.
• If you don't jump into prescribe anti-ds, I'm already liking you. I once had a doctor prescribe these when I said I had the fever. WTF?
• You're red pill. I prefer to do business with RP men so that we keep each other in business and help the community as a whole build wealth.
• You have flexible hours for those of us with inflexible schedules.
• You accept bitcoin.
  

[Thomas the Rhymer]

(11-26-2016 10:00 AM)SunW Wrote:  

• I like virtual affordable virtual doctors. You get to live anywhere you want, and I get more affordable healthcare. Win-win.
  

This is a challenge, because my particular style of medicine is heavily reliant on my hands. Even after taking a thorough history, I still sometimes won't have any idea what's going on until I touch the patient. Having examined thousands upon thousands of patients, my hands have become accustomed to the feel of fever, of cancer, of arthritis, etc. I'm not saying they are 100% accurate but I get an incredible amount of information through the physical examination that simply does not come out of an interview. What my hands don't pick up, my stethoscope (i.e. my ears) or my nose (certain diseases have certain smells) will often pick up. I've done telephonic and video consults before, but I feel helplessly inadequate when doing them if they are for complex problems.

Also, a lot of my work is skills based - I do a lot of anaesthetic injections for common muscle and joint pains. For example, a spastic muscle can sometimes be instantly cured just by injection a small amount of lidocaine into it (the patients tend to be rather psychological stunned when I do this and it works - they walk in in severe pain, they walk out cured. One of my patients told me that the community I work in has nicknamed me 'Dr Alright' - because you walk in sick and you walk out alright.) So a lot of my skillz that patients seek cannot actually be given through a virtual consults.

So the challenge with virtual consults is that major aspects of my medical practice style are taken out of the equation. I just can't deliver an the same level of excellent care that I aspire too.

What I do think is feasible is health consultancy work. We can do a virtual consultation regarding your lifestyle, current medication, current diet, last blood results, etc; and I could give a report back on what lifestyle changes need to be made, what your blood results mean, etc. Legal requirements are such that it would not be possible to consider this a medical consult, so no prescription would be possible, but this could be a relatively cheap way of getting a second opinion on something.

Would you consider that worthwhile?

Or would you prefer a full on virtual consult with prescription? This would offer a huge amount of legal hurdles, but it might be possible. In essence, I could prescribe and dispense your treatment in my country and then ship a small amount of treatment to your country to try out. If it works well you can then get a prescription from your local doc if it is chronic medication. I know the USA does allow small imports of chronic meds, but not more than 3 months worth or so I have been told. So you could get 3 months of cheap treatment to try out before commiting yourself to it long term. I would have to really work out the logistics of it, but it's possible. But again, I'd be prescribing stuff without the full benefit of a physical examination, which might not be appropriate in all cases.

[Thomas the Rhymer]

(11-26-2016 07:14 AM)Ringo Wrote:  

The best doctor I've ever had initially specialized in orthopedics but came to be a mix of GP, psychologist and homeopathist. Say what you want about homeopathy, I'm convinced this guy did a great job and cured my terrible skin allergies and rashes.

He charges a pretty penny for his consultations and only takes a fixed number of clients, but he's usually booked (he does take a couple of days/hours off every week). I've been seeing him for about 18 years.

#1
What makes him great is that he really pays attention to what you are saying and doing - he's not just going through the motions and looking for a diagnosis. There's nothing worse than going to a doctor who barely listens to your complaint, prescribes you something and gets you out in 10min like you are disturbing them. He's looking for the right solution, not the fast one, and that can take some time.

#2
His clinic has a pretty relaxed vibe. When I was kid, he'd put me in a room with a bunch of toys and play with me while he'd ask questions. I don't play with toys anymore when I go see him but he still asks me many apparently unrelated questions to try to understand where I'm at and how that can relate to whatever condition I'm going to see him for. The typical consultation is 60min long - 40min of me talking, 10min of him examining me, 5-10min of him talking.

#3
As a doctor, people are paying you to 1) fix them and 2) make them feel like they are safe and are going to get better.

This doc understands that the body is a complex machine and if something hurts in my foot, maybe it's not because I have something on the foot but it may be a problem on the hip or spine; or if I have a skin rash on my scalp, it may be a digestive issue, not a topical one, for example.

Because of that, another important characteristic I love in a doctor is a holistic view of the body. Be confident when you show a solution, but always be open minded to the reason the problem exists and communicate clearly with the patient when you're not sure and want to explore other possibilities. Don't limit yourself to medications or traditional practices. Maybe get the patient to write a food diary; or do yoga; or change his sleep schedule. Look for the solution, wherever it may lay.

#4
Besides the examination, my doc always asks me for blood and hormone panels, even if there's nothing wrong with me - he just wants to keep tabs on markers and be on the lookout for relevant changes.

What you have described is the kind of practice I'd like to run. There is a lot of pressure in the health industry to run factory practice - to provide sub-optimal treatment to as many patients as possible as fast as possible. I'd rather run a slow, boutique type of practice for people with challenging problems. Rather than treat diseases, I want to be the doc people go to for a yearly thorough service.

I've cured some patients of diseases through lifestyle changes - especially hypertension, which in many cases is caused by excess consumption of sodas (cut out the sodas, and that ends the hypertension). The problem is that I really can't run a factory practice like this. The key to running a factory practice is that you keep your patients as sick as possible as long as possible - in other words, sick enough to keep coming to you, but not so sick that they die or have to quit working (which then ends the income stream). In essence, there is a lot of perverse incentives at work in medicine and a lot of push towards rent-seeking behaviour. I've worked locum tenens in practice where it was clear that the docs were pushing addictive pills and psych meds not because people needed them, but because it messes them up enough that they become permanent patients, needing to come in every few months for repeat scripts (which don't come free).

Maybe there is something wrong with me, but I don't want to be that kind of doctor. Which means I can't run a traditional factory practice, focused on treating diseases. I need to run a practice that is focused on creating and maintaining health.

So I was already thinking of starting a practice with 45 - 60 minute consultations (I'm thinking of throwing in a free 20 minute follow up session - I don't want patients feeling like they are left in the lurch when treatment fails). So I'm really glad you posted in this thread, because to know that there is someone else out there making a living practicing real medicine (as opposed to factory medicine) is inspiring. Thanks a lot for posting your experience, I'm giving you a rep!

[redbeard]

Cheers, Thomas! I'm happy to hear you are taking the next step.

I have many thoughts on this, here's a few.

1. Absolutely use prescription drugs as a last resort. Yes, big pharma is evil, jamming pills down our throat, but it's my understanding that they're so often prescribed because the drugs work. If a man comes in for erectile dysfunction, yes, there are millions of ways to fight ED, but guess what works 100% of the time? Cialis. Why would a doctor take a risk with beet juice when he makes money off each Cialis prescription?

In my opinion this is how treatment should go -

Lifestyle changes ---> Homeopathic methods ---> Over the counter ---> Prescription

I have been prescribed antibiotics numerous times I should NOT have. I need a doctor with a pair of balls who would tell me to drink chicken noodle soup and sleep for a week before taking antibiotics and destroying my gut flora.

2. Knowing the patient's ENTIRE HEALTH HISTORY. Everything you can find, should be found. Doctors should not be able to prescribe without knowing the full medical history. Inpatient forms are insufficient. There should be a "new member" consultation where one of your nurses specifically sits down with the patient and goes through as much of their life that they can remember.

As you know, everything is connected, but doctors are often only experts in their specialty. This leads to missing big issues when the relationship is ignored.

3. Scaling of treatment. Sometimes an office visit is necessary for the doctor to listen to me breathe and feel the sickness. Sometimes a skype video chat is needed so the doctor can check if that growth on my dick is an STD. Sometimes, just a phone call is necessary. I would LOVE it if I could schedule quick 15-minute calls with my doctor. Scale the treatment cost to how much effort is required on your part.

15 minute phone call - $
15 minute skype call - $$
30 minute in person visit - $$$$

4. Most importantly, build a relationship. I would pay high dollar for a doctor that knows and cares about me, and provides preventative care like you describe. What about requiring a yearly checkup for everyone? Even if healthy, it'd be great to go into my doctor and talk about what's been going on.

[Phoenix]

1. I care about two things: does the doctor know what he's doing; does the doctor give a shit if I get better.

I'd say about 80% of the doctors I've seen in my life were dumb and incompetent, or didn't give a shit if I got better. They just kind of look at you with this begrudging look like "please stop talking and walk out so I can collect my check". They were all GP's. Frankly I dislike GP's a lot. I've self-diagnosed myself based on common sense better than a GP has on two occasions now. And he had to sheepishly walk back his cocky dismissal after the first time when his diagnosis was wrong and mine was right. Another doctor prescribed me a drug which I knew for a fact would wipe out my testosterone levels (just ignored the prescription). This is why I'm passionately against the prescription system. They don't deserve that power whatsoever.

The best doctor is genuinely interested in the medicine. Even if he treats you completely impersonally, like you're a puzzle, a machine to be fixed. That's fine. As long as he gives enough of a shit about it all to get the job done. For example, I introduced a new medicine I had found by research to one doctor, and he was like a kid in a candy shop -- spent 15minutes reading the documentation about it, and then wanted me to give a full report after I used it, like a guinea pig. That's fine. Contrast that with other doctors who just roll their eyes when a patient says "... on the internet".

2. More of a "how do I improve" mentality. Medicine seems to be about fixing very bad health (i.e. some magical threshold where you suddenly go from "healthy" to "sick"), not about improving mediocre health. There should be more investigative, health-optimization services. Instead of just constantly patching over problems with drugs, there should be more root-cause work.

[DrugAdvisor]

OP,

Thanks for starting this thread.

I run my own pharmacy chain and do lots of Over the counter diagnosis.

All the posts from members here are very valuable information for me as well. thanks for sharing guys.

The only thing I'd like to add for OP is that, the boutique clinic that you choose to run will most likely cater to a niche market (upscale clients), and I am sure they will be more than willing to pay for that kind of service. It's definitely doable. I have a few colleagues practicing in such places, run by specialists.

However, the start up costs (meaning the equipment and decor) will be much much higher than a GP's practice. So be prepared, funding wise.

Treat them from the heart, I am sure they will feel it, and come back.

[Khan]

Very good question OP. The first thing I care about is knowledge and experience. This is fairly obvious, medicine is one of the fields where you really don't want to run into someone who's incompetent.

The second is mentality. A lot of doctors have some kind of a God complex which stems from their job and the social status it provides. Those guys are usually arrogant and dismissive of others, and their patients are just numbers for them. I ran into a couple of doctors who were like this; I had a feeling they didn't take their job seriously so I went to be examined by another doctor afterwards, just in case.