Sophia Thomas7 said:Let's look at it this way. This guy gets hit with ten dislikes per post. You really think people aren't going to read what he writes? If you set the filter to only show positive posts, things would get incredibly messy. You’d end up skipping over certain replies entirely, losing the context of how a conversation evolved, and you might miss some key info needed for the debate itself.
Some news sites use that kind of sorting, and it’s useless. Take CNN, for example; their comment section works like that, and it's a nightmare. You read the top post, realize it's an answer to something else, and then you have to dig through layers of junk just to find the context. In the end, if you actually want to follow a discussion, sticking to chronological order is the only way to go.
I just had a hunch it might be an upper tooth. They can cause these weird, nonsensical pains that you wouldn't even associate with a tooth at first glance. If there’s some kind of inflammation near the root, that could definitely be it—especially since you mentioned it's a pulsing sensation.
Go see a dentist. At the very least, have them take an X-ray to see if there's something going on inside the tooth.
vividsailor7, take a deep breath and actually try reading what people are saying to you for once.
First off, you’re talking trash about your own colleagues. 👎 Second, you’re asking the AMA to turn against their own superiors. Look, Medicare is the one calling the shots for them, so they have to follow those guidelines. Since you’re so hell-bent on having them defy their bosses, tell me—are you going to go against your department head? Or the hospital director? See, going against a director or a boss is hard enough, but trying to fight the entire Institute? That’s just suicide.
I know plenty of cases where specialists acted like cowards and refused to push back against their bosses, even when they disagreed and we were dealing with serious illnesses. I won’t get into specifics because I’m not exposing people close to me online, and since it’s specific, anyone would know who I’m talking about, but there it is. A few of them didn't agree with the boss's decision, so they’d pull a patient aside and informally mention they didn't agree, but at the end of the day, the boss made the call and they had to roll with it. Then these same people come crawling in here, acting like primary care doctors aren't fighting windmills, as if they aren't up against an entire government agency and the whole system. 🤣 Give me a break.
Honestly, they aren't just paper-pushers, no matter how much they get belittled. They have to manage the Institute on one side, furious patients on the other, and doctors who do whatever they want and couldn't care less about anything else. It isn't easy.
I don't want to drag this debate out on that other thread since it's already blowing up here, so I'm moving the quote over.
vividsailor7 said:I don't have any interest in following some arbitrary set of rules, and frankly, I don't want to. The only guidelines I care about—the only ones that actually matter—are the official standards set by my profession. Period. Period. Full stop. I am being crystal clear when I tell my patients: you need to listen. Does someone actually have a right to demand prescription medication? Look, if the insurance company denies the claim and blocks a patient from getting their medication again, I’m going to call them out directly. I'll make it crystal clear: I couldn't care less about Medicare's little guidelines or their threats of penalties. I don't care if they want to fine me. Period. I treat my patients based on the standards set by the American Medical Association, not some bureaucratic checklist. If I recommend a specific medication, then that is what gets prescribed. It’s that simple. You and Medicare are following the exact same playbook used all over the world, and because of that, a patient could literally die. It's reckless. I don't give a damn about Medicare's protocols; you are the ones denying the patient their medicine. Why even bother sending the claim in the first place if you're just going to block life-saving treatment? And there they go again, blathering on about those guidelines like they actually know what they're talking about. They act so incredibly condescending, too—half the time they just slam the phone down in your face before you can even get a word in edgewise. Typical. I only ever caved once, and that was only because she told me she couldn't care less if I decided to step up. $333 Monthly medication coverage for patients? Give me a break. They act like I’m living in some twisted Wonderland instead of reality. It's absolutely absurd. I’ll tell them they should just go ahead and change their insurance provider or, better yet, file a lawsuit or report the whole thing! Since we’re on the subject of cardiac medications, I have to bring up my own situation involving my father. It’s been a nightmare. He’s dealing with uncontrolled arterial hypertension and diabetes, plus he’s a post-MI patient with unstable VT and COPD. His current regimen includes Januvia, Clopidogrel, Preductal, Losartan, Foster, Sorits, Ramed, Nexium, and Nebilet. To make matters worse, the doctor actually refused to prescribe the first five of those! I had to step in and intervene myself just to get him what he needs. Honestly, it is an absolute disgrace.
And this isn't being "okay" toward your colleagues. 🤷 Sorry, but Medicare is king here. It's not like we have some other independent agency to turn to, so we're stuck with them, and apparently, you think you can just pick favorites. If they are the authority and they say a drug can't be covered without paying out of pocket, and you intentionally write prescriptions for drugs you know aren't on the basic free list—and then you go as far as telling patients to sue the medical board—then you're just being disrespectful to your peers. Honestly, it doesn't surprise me that they hang up on you or act rude.🤷
We all know how drugs get added to the Medicare list. You should all get together and pressure them to include what the experts actually recommend instead of screwing over the patients. As if being sick isn't enough, we don't need doctors fighting amongst themselves and pitting people against each other.
Look, Hrvoje, I get that you write what you think is best, but damn it, we don't live in a utopia. You can't just take the "not my problem" approach. How are you supposed to collaborate with other specialists when things get serious and require a team effort if you're busy bickering over fucking medications?😢
Kyle Lee7 said:That is clearly possible too. In a way, it makes sense if the doctor believes it's necessary, since sometimes you really do need to rule out physical factors.
I originally went to psychotherapy convinced that my symptoms (vision issues) were just caused by work stress, rather than what was eventually suspected—Multiple Sclerosis. I actually refused neurological testing because I was terrified they might find out I have the same condition my mother has. After a few months, my psychiatrist managed to nudge me into getting the tests done, and it turned out I really do have MS, and those symptoms were indeed somatic in nature. By then, we had already heavily invested in therapy, so I continued with it; it’s definitely helping me cope with the MS diagnosis. And I've been going to the Mayo Clinic from day one, and I'm very happy with the care there.
What I wrote earlier was prompted by reading a thread on a psychology forum where most people described the opposite: having a new symptom every single day and begging doctors for referrals, even though they already have a diagnosed anxiety disorder. Also, I remember once when my therapist's phone rang; he picked up, and I sat there listening to him spend ten minutes explaining to someone that his daughter didn't need a full-body MRI or "some kind of infusion." The guy was trying to pull strings with the hospital director, and everyone was yelling and applying pressure. It was all because no one in the family wanted to accept that her problems were actually psychological, even after every single test came back negative.
We could fix this easily. If patients insist on specific tests, fine. Let them. Once the results come back perfectly normal, hand them the bill. When people realize they're dropping a couple hundred bucks on useless tests despite being told they're unnecessary, you'll see those demands drop significantly.
There's a massive difference between a doctor ordering tests to rule out a potential cause for symptoms, and someone showing up with a pre-written checklist of tests they want performed.
So they actually lowered the number. Way to go, guys—at least there's one bit of good news. 🙂
I’ve been under the weather lately, so I haven't had supplemental insurance for about a year. But honestly? Once you start needing actual tests and scans, not having it is a total rip-off. For every kid, you're looking at $20, $30, $13, just adding up fast. Then again, I know plenty of people around here who are perfectly healthy and don't bother with extra coverage. They don't need it. 🤷
I'm just unlucky like that. When I don't have coverage, everything hits me at once. When I do have it, I don't seem to need it. 😁
Nicholas Myers said:Under the new Medicare model, based on how they’ve presented it to us, specialists are no longer permitted to list the date for your next follow-up directly on the outpatient chart.
The scheduling and timing of these inspections should be left entirely to the ABA.
No, specialists still have the authority to recommend both diagnostic testing and therapeutic adjustments.
Theoretically, the AMA has the authority to deny someone a referral for a follow-up exam. However, they need to be mindful that doing so shifts the liability onto them if the patient’s condition worsens because the AMA failed to provide proper care.
How exactly is my doctor supposed to gauge my asthma status if there isn't a spirometer available? A spirometry test is the baseline for monitoring this condition. Based on his track record with listening to my lungs via stethoscope, I’m skeptical—he spent enough time prescribing four different antibiotics in a row when what I actually had was asthma, not some random bacterial infection.
That’s an excellent question.
You can't get a real picture of what's actually going on without a spirometer. It’s just guesswork otherwise.
I find it hard to believe that Medicare would turn down a referral for a follow-up exam in a situation like this.
Not quite. He can issue a referral for something like a spirometry test, for instance. If those results look good compared to the last round and the patient’s clinical picture remains stable, he can choose to withhold the referral for a specialist follow-up—effectively taking full responsibility for that call.
Does he actually have the authority to override my pulmonologist's treatment plan? For instance, can he refuse to prescribe the Alvesco that my specialist recommended just to swap it out for a cheaper corticosteroid? I know they belong to different classes, and from what I understand, there isn't a generic version for Alvesco yet.
Based on how Medicare structures its sentences, it’s theoretically possible for the medical board to reject a therapy recommended by a specialist.
The setup goes like this:
The final call on proposed therapies, referrals for further testing, and determining an individual's fitness for work all fall under the authority of the primary care physician.
If... When a primary care physician decides to prescribe a treatment based on a specialist's recommendation, there's a better way to handle it: suggest switching to the most cost-effective generic version with the exact same active ingredients.
My takeaway? Theoretically, it’s possible—but you’re still the one holding the bag.
That’s how I saw it.
I wonder if my colleague will arrive at a similar interpretation.
Unless they start slapping on more restrictions—like strict mandates or tracking exactly how many times a doctor checks in on a patient—I highly doubt the primary care office is going to shoulder that much liability just to go against what a specialist recommends. 🤷
I don't see any reason why anyone would bother doing that unless Medicare is breathing down their neck and throwing penalties left and right—but hey, we'll see how that plays out.
Morgan Morgan5 Asks: It honestly makes me sad when people who don't have a clue about the profession start posting their opinions without doing any actual research first. Whether they’re doing it on purpose or just being lazy, they end up spreading nothing but misinformation. You see it all the time with journalists today—the hacks at the local news stations and those big cable networks. As far as medications go? Nothing. Absolutely nothing important is actually changing. For the patients.I'm talking primarily about prescription drugs—not the stuff they just hand out to you in a hospital ward. If prices actually drop, the pharmaceutical companies are going to take the hit first. And that’ll ripple right down to the doctors, too, since those big pharma outfits are the ones footing the bill for their "educational" seminars (or, let's be honest, just paying for their trips).
Look, we patients all read the same sensationalist garbage in the papers. The way they write things makes everything sound so murky just because they need clicks. I’m not exactly an expert—I'm definitely a layman—but I know enough about how things work to realize I totally misread the text. What do you think it’s like for someone who hasn't a clue how any of this works, especially when their only source of info is some tabloid churning out the same nonsense?
We’ll just have to wait and see how much this new policy ends up crushing the patient. All this back-and-forth between specialists and the insurance providers—it’s the patient who ultimately pays the price. It’ll be interesting to watch once the insurance companies get the final word on everything. Truth is, plenty of things are already being swept under the rug. Terrible stuff that people mostly stay quiet about. You know how it goes: there are limits on certain tests and caps on specific medications. You end up waiting two or three months for a basic lab test because they ran out of reagents or blew through their monthly budget. Or you have oncology patients sitting around waiting weeks for their treatment because the monthly quota was hit and the funding for those drugs just ran dry. It happens. You aren't going to convince me that we won't feel the fallout of this. Every single time they roll out some new reform or set of regulations, it’s the patients who end up paying the price.
Unbelievable. Apparently, this new regulation kicks in on September 1st, so let's just sit back and see what "wonderful" surprises they have in store for us. And look, I'm with you on one thing: I honestly don't care what a drug is called as long as it works and doesn't wreck my body. I couldn't care less if it's the brand name or a generic, unless that cheap version actually performs worse.
edit: And get this—over on the other thread, people are saying exactly what I've been hammering on about here. They're claiming Misar hits harder than Xanax or Helex. Yeah, I get it, it's the exact same medication under a different name, but clearly, for some reason, certain people respond better to one brand over another in the same class. How? Why? Is it a placebo effect, or are they lying to their doctors? 😁 I don't know, but it's not the first time I've heard someone swear that a version from a different manufacturer works significantly better.
Yeah, Jamie Clark74 just reminded me—you should probably try taking some omega 3-6-9 since that’s also great for joint health. Just make sure you grab a higher-quality brand. You get what you pay for, really; if you pick up some cheap omega supplement at a CVS for $10, you can't exactly expect top-tier quality.
That isn't quite how it works. 1. I can't just "call in" a patient for a check-up; that decision rests entirely with the Primary Care Physician (PCP). 2. But if they send a patient over with an 'A' code, the PCP is the one issuing the red slip for the required tests. If they send them with a 'C' code (and those are limited), I am under no obligation to issue internal referrals. I haven't issued any of those so far, nor do I plan to, much like most of my colleagues at the Social Security Administration. 3. I also treat patients with other internal medicine issues—diabetes, hypertension, hyperlipidemia alongside GI diagnoses like gastritis—because I'm not strictly tied to just gastrointestinal issues (most people accept this), but rather the whole "internal medicine package." For patients with things like IBD, I usually request follow-ups every 2–3 months; 6 months is the absolute maximum gap I'll allow. Even though I can't order follow-ups directly anymore, I can still refer them to my colleagues, whether they are specialists or not. And if there is a genuine need, or if I manage to pull some strings with the PCP, we can hospitalize them and then "call them in" three times a year.
The PCP has nothing to do with whether it's IV or oral; Medicare has already decided who covers that. And the PCP can't even prescribe them if they wanted to, because there are strict limits on diagnosis codes and clinical guidelines.
Honestly, reading this from a doctor is just depressing. You guys know perfectly well that in medicine, two plus two doesn't always equal four. There's so much we still don't know, and half the time, treating rare conditions is basically just trial and error.
And since when did "official medicine" become some unchangeable holy scripture? Why cling so blindly to every single word in a textbook? 🤷
Dana Roberts4 said:Look, I’m just some average person in my thirties, so I’m definitely not out here constantly searching for symptoms... let alone popping pills. Plus, I like to think I’ve got enough discipline to just take whatever cash I’d be blowing on supplemental insurance over, say, three years, and stash it away—boom—$1000 ready if an emergency actually hits. Is there any actual reason to pay for extra coverage besides avoiding that "$1000" situation? 🤔 Honestly, I've been wrestling with this for ages and still can't make a call that feels right...
Listen, if you're healthy, if you're disciplined, and you can actually squirrel away enough cash to cover a potential hospital stay, then yeah, you don't need the extra insurance.
The problem is when an emergency hits and you don't have the coverage, and you don't have the cash either. That's why most people just pay for it.
And since when did young people stop getting sick or getting into accidents? 🤷 Actually, more and more young people around me are getting sick—and I mean seriously ill—so age really doesn't mean a thing.
Maybe it’s because those $333 are set up on a 12-month payment plan. But when you actually get stuck in a hospital bed? From what I know, you're expected to cough up the cash right then and there—unless they decide to be nice and offer some kind of financing. And don't even get me started on the extra costs; you're constantly paying out of pocket for every single test and prescription. It adds up fast.
If you have the luxury of dropping $1000 all at once, good for you. For most people, that's just not an option. 🤷
To strengthen the tendons around your joints? Absolutely.
I don't do Pilates myself because I honestly couldn't pull off half the moves—holding certain positions puts way too much strain on my specific joints. 🙂 I actually watched this documentary once about a woman living with rheumatoid arthritis. She was basically facing total disability; she ended up needing a wheelchair just to get around. But, working closely with her rheumatologist, she started a specialized version of Pilates. It worked so well she’s actually out skiing now. She even runs her own Pilates classes specifically for people with RA, and her doctor literally refers patients to her because the results are so solid. Pilates builds up the muscles and tendons surrounding those joints, which increases flexibility and takes the pressure off the actual joint itself since the tendons start carrying more of the load.
You've got nothing to lose. Give it a shot; you might be surprised. 😉
Alright, look, it’s obvious the Secretary and his little inner circle have completely lost the plot. Honestly, if I were a GP, I’d be raising hell right now because they’re about to dump all this liability on our shoulders. We’ll be the ones making the final calls, which just means we’ll be the ones getting sued constantly. And let's not forget that primary care offices employ doctors who haven't even finished their specializations yet—you can't just shove this kind of responsibility onto people like that. It's reckless.
melloworca6 kaže: The referral system is getting a complete overhaul. They’re rolling out a new encryption method for all incoming referrals, and it’s going to be categorized based on where the patient is actually headed: whether they're being sent for a multidisciplinary consultation at the hospital (A), direct inpatient care (B), specialized outpatient services (C), or standard ambulatory treatment (D). Under this new directive, the specialist's role covers the initial consultation and all those necessary diagnostic tests. They’re also cleared to suggest follow-up screenings, specific medications, or specialized therapies—though, let's be clear, the family doctor still holds the final say on any of that. But here is where I get frustrated: the specialist's hands are tied when it comes to actual follow-through. They can't refer a patient for further hospital treatment, they can't schedule follow-up appointments, and they certainly can't issue any official opinions regarding a patient's ability to work. It’s a massive gap in the process!
vividsailor7, I’m genuinely terrified that I might be misinterpreting this, so please, read these specific excerpts I’ve pulled from the text. Honestly, I am praying to God that I’ve just gotten everything wrong. Look, I have a wonderful primary care physician—really, she's great—but I refuse to let her play judge and jury on whether my immunologist prescribed the right treatment or which additional tests I need to undergo. She couldn't even fully explain my own lab results to me! How on earth is she qualified to dictate my medical regimen when she can't even provide a detailed breakdown of my findings? I don't expect my GP to be an encyclopedia or to interpret every single nuance of my data, but that is exactly why we have specialists who have actually completed their advanced fellowships and subspecialties.
Look, I couldn't disagree with you more if we’re pretending it doesn't matter which medication we take just because the active ingredients are technically the same. Let’s talk about antibiotics—and don't even get me started on things like chemotherapy, where you absolutely *do* care about the specific brand and wouldn't dream of settling for the cheapest option available. Take penicillin, for instance. There are tons of different brands prescribed under various names. Suppose I wake up with a nasty sore throat, head to my doctor, and she prescribes me Silapen simply because it’s the cheapest one on the list. Honestly, I have no clue why they always push Silapen on us whenever they prescribe a penicillin-based antibiotic, but that's usually what I end up with. Now, here's the problem: what if my friend and I both have terrible side effects from Silapen? We're talking debilitating diarrhea and insane stomach cramps—the kind of reaction I personally get from Erythromycin. It is infuriating that we’re forced to choke down medications that clearly don't agree with our bodies just because they happen to be the budget option. If you want the more expensive version from the same class of drugs, fine—pay the extra money yourself. But don't act like it's all the same.
Look, I honestly don’t give a damn how they plan to reorganize the system or whether they start slapping fines on doctors just because they keep prescribing the most expensive drugs on the market. My priority is simple: I want to be able to get the medication that actually works for me—the one that doesn't make me feel like death or wreck my body with side effects. I don't care about the price tag, provided it’s on the approved list and covered by Medicare. Instead of actually doing their jobs and monitoring who is prescribing what—and maybe earning those ridiculous salaries instead of sitting around in offices doing absolutely nothing—they’ve chosen the easiest, laziest way out. They're basically saying, "Fine, pay the premium, we don't care." It’s a joke. If you have money, great, you get the top-tier meds. If you don't? Well, tough luck. When we politicians inevitably fall ill with some kind of tumor or need major surgery, we won't be stuck in this mess. We’ll be using Medicare to fly straight to Germany for surgeries or heading to the States for experimental treatments that cost an absolute fortune. Meanwhile, little Nora will be left begging for scraps on the news just to get some basic help. 🤮
Regarding the medical care in your neck of the woods—honestly, that sounds great. Why bother with actual treatment when we could just pass around a handful of pills and end up dead instead? It’s much more efficient, right? I can't speak for hospitals in other parts of the country since I don't know what they're dealing with elsewhere, but where I'm at? You're better off avoiding certain wards entirely. It’s just one "expert" after another, all pretending to know what they're doing. Absolute nonsense. Don't even get me started. Are you seriously telling me that in your hospital there isn't an entire ward where most of your colleagues—to put it mildly—don't have the slightest clue what they're doing? We’re talking about people who wouldn't know how to actually treat a patient if their lives depended on it, let alone someone working there without even holding a degree! It's absolutely infuriating. Look, in my experience, there are certain departments where it’s just better to head straight to a major medical hub like Washington, D.C. immediately—unless you actually want some amateur poking around inside you without having a clue what they're doing.
Let’s take this one step at a time. 1. We're talking about Code A versus Code C; we already settled that part. 2. This isn't anything new; they've been doing this forever. In some cases, we even had to call people on the phone just to have them hang up on us while rambling about "guidelines" and other absolute nonsense. 3. Good grief, you completely missed the point! You didn't even read my example regarding esomeprazole. Both Emaner and Nexium 40 mg are absolutely identical; they just come from different manufacturers. That is what I am talking about. It’s not even about different drug classes; it's about the originator versus the generic. Your example doesn't work because Silapen is a penicillin and doesn't have a generic equivalent, whereas Erythromycin is a macrolide (a completely different class from Abbott Laboratories). So, with all due respect, please don't lecture me about things you clearly don't understand with such intensity. I’m not attacking you personally, but rather speaking generally about the North American regiment. It is standard practice worldwide (take Abbott Laboratories as an example again) that if you want the brand-name version, say Sumamed, you pay extra, whereas insurance might cover something like Belupo Azithromycin. At the end of the day, it's all just azithromycin. 4. Let me clarify this once more. Say you have a urinary tract infection. You get a urine culture back, and it shows, for instance, *Pseudomonas aeruginosa* which is sensitive to ciprofloxacin. This means you will receive ciprofloxacin, but instead of the expensive Ciprinol, you might get Cipromed. Either way, you got the correct therapy, not some cheap Amoxicillin. Honestly, I don't see why patients should care which manufacturer produced their meds. If ciprofloxacin is indicated, it shouldn't matter who made it. 5. As for the pointed comment regarding this: Well, if that were the case, you'd be heading straight to Washington, D.C. too. We need to distinguish between primary, secondary, and tertiary healthcare. If it's a complex case, then there's no issue with traveling to a major city like D.C. The problem is when people with trivial issues—like allergic rhinitis, gallstones, or a million other minor things—flood the big city hospitals, instead of saving those resources for someone dealing with a brain tumor or a rare disease.
Regarding Code A. As far as I know, a consultation is when a group of doctors gathers to discuss a case. At our hospital, this usually happens between 8 and 9 AM before they head down to the wards and clinics. So, if I'm wrong about what that code refers to, fine, my mistake. My doctor referred me to a consultation, where a panel of doctors discusses my case, suggests therapy, tests, and medication, and then my GP decides how to proceed and what I'll be taking. If I understood this code correctly, the whole system is a total comedy. I honestly wonder how long it will take before we start reading in the news that people have started murdering their GPs—especially if they end up with incompetent doctors like the one I had.☕
For heaven's sake, I know Silapen and Erythromycin are different antibiotic classes. I wasn't comparing them against each other; I was comparing the side effects that both my friend and I experienced from those two drugs. Since you brought up Sumamed, let me explain my point better. Why do you think there are people for whom Sumamed works perfectly, but the Belupo version doesn't? And vice versa. I'm not going to sit here and study the chemical composition of every pill to see if they are identical, but the physical makeup of a tablet isn't always the same (and when I say "makeup," I mean the inactive ingredients, not the active drug). I have family members who are sensitive to certain fillers used in tablets and have huge issues swallowing any kind of pill. Those people won't have a choice; they'll have to pay out of pocket if the cheapest option makes them sick. These people pay for health insurance, they pay for supplemental insurance—they should have the right to get a medicine that doesn't make them ill or cause massive side effects. People with lactose intolerance know they can get diarrhea from meds containing lactose. I know people who had terrible digestive issues with Euthyrox, but were fine with Letrox, even though they contain the exact same active ingredient. The tablet composition just isn't identical, but go ahead and try explaining that to them. If Euthyrox is the cheaper option, then sorry, folks—either buy the Letrox or take the Euthyrox and deal with the cramps and diarrhea.
Should we talk about the heavy hitters? Things like corticosteroids, antimalarials, or cytostatics—medications where it actually matters which brand you’re taking. Should I mention that people have tried different manufacturers of steroids and found that the side effects weren't the same across the board? Same ingredients, same dosage, yet different results. How do you explain that? 🤷 Maybe it's time to realize the human body isn't some math equation you can just solve. Every organism is its own unique story, and life isn't always black and white; it's mostly gray.
vividsailor7, if we're restricted to only getting treatment in our own backyard, that won't just apply to allergies or minor stuff—it applies to everything. If I want to see the top immunologist in the entire US because my local doctors are basically stumbling around in the dark with no clue what's actually happening to me (I might be exaggerating, but I'm not far off), why should that be blocked? 🤷 And it's not just me. It's anyone else being bounced from ward to ward without a single concrete answer. Look, we have hospitals, we have specialists, but just because half of them don't have a clue doesn't mean we should just shrug and say, "Oh well, we're lucky we don't live somewhere else." Honestly, it's more likely that we're all just unlucky to live in a country where we can't even tell if our healthcare system is supposed to be social or private. This messed-up hybrid we've got here isn't even funny anymore; it's pathetic.
Diagnosis, patient treatment, and managing chronic conditions are shifting over to primary care physicians, who will no longer act as mere administrators for hospital doctors...
Hospital doctors can still suggest specific therapies or medications, but they won't handle sick leave; family doctors will be the ones calling the shots on next steps.>
Referrals are getting a new encryption system based on whether you’re being sent for a specialist consultation at a hospital (A), inpatient treatment (B), specialty outpatient care (C), or standard outpatient treatment (D). Under Referral A, you get a specialist consult and necessary diagnostics. The specialist might recommend further testing, drugs, or therapy, but the final decision rests with the family doctor. However, with this type of referral, the specialist won't be able to send you for further hospital processing, schedule follow-ups, or sign off on your ability to work.>
Hrvoje, I’m terrified I haven't understood this correctly—read these sections I pulled out. Honestly, I really hope I’ve got it all wrong. I have an amazing GP, but I don't want her deciding if my immunologist gave me the right treatment or which extra tests I need to run. She couldn't even fully explain my last lab results to me, so how is she qualified to dictate my therapy when she can't even interpret the details? Not that I expect my primary doctor to know everything or decode every single finding—that's why we have specialists who actually finished their residencies and sub-specialties.
And I wouldn't agree with you that it doesn't matter which drug we take, provided the active ingredient is the same. Take antibiotics, for example (and I won't even start on things like chemotherapy where it *really* matters which drug you receive and whether it's the cheapest option). Let's say we use penicillin; there are plenty of versions under different names that get prescribed. So, I have a sore throat, go to my doctor, and she prescribes Silapen because it’s apparently the cheapest (I have no clue why, but they usually just shove Silapen at us whenever they prescribe penicillin-type antibiotics). Now, let's say my friend and I get terrible side effects from Silapen—diarrhea and insane stomach pains (that's what happens to me with Erythromycin). Now we'll be forced to take drugs that don't work for our bodies just because they're the budget option. If you want the more expensive one from the same class, pay up yourself. Sorry, I don't give a damn how they plan to organize themselves or if they'll start slapping fines on doctors for constantly prescribing the most expensive meds. I want to be able to get the medicine that doesn't make me sick and has fewer side effects for my body. I don't care about the cost, as long as it's on the list and covered by Medicare. Instead of actually monitoring who is prescribing what and how much (and making a decent salary instead of sitting in offices doing nothing), they decided on the easiest fix: let them pay for the expensive stuff and screw them. Whoever has the cash gets treated with better meds; whoever doesn't, well, sucks. When we politicians get hit with some kind of cancer and need surgery, we'll use Medicare to fly to Germany or the USA for experimental treatments that cost a fortune, while little Nora will have to beg in the media just to get some help. 🤮>
(Apologies for the language, but this kind of stuff really ticks me off)
As for getting treated where you belong—great, maybe we can just hand out bullets so we can kill ourselves instead of suffering through this. I don't know how hospitals in other cities operate, so I won't comment on that, but around here, it's better to avoid certain wards altogether because it's just one "expert" after another. Don't tell me your hospital doesn't have wards where most of your colleagues basically have no clue what they're doing, or could treat things just as well without a degree. In my area, there are some departments where it's better to just drive straight to Washington, D.C., unless you want someone poking and prodding at you without having any idea what they're doing.
Here’s the article: and I made sure to give them a piece of my mind yesterday, item by item.
Long story short: doctors are going to be prescribing the cheapest options available, and if you want the premium stuff, you’re paying out of pocket. From what I can gather, specialists won't be calling the shots on therapy or tests anymore either; they’ll just make recommendations while Medicare makes the final call on everything. There’s also talk that we won't be able to seek treatment anywhere except at their specific hospitals and such.
I am not a fan of this at all, and I’ll get into why in a bit. It’s infuriating. Between health insurance and supplemental coverage, even as someone who's unemployed, I’m going to have to pay for my own meds if I don't want the cheap junk they’re pushing—and let's be real, the cheapest version isn't always the best one with that same formula. Meanwhile, you've got politicians getting whatever procedures they need treated abroad on Medicare's dime.
Basically, if you're looking at joint issues, you might want to try Pilates. I've heard it’s great because it strengthens your tendons, which takes some of the pressure off the joints themselves. Honestly, I'm not sure how much this is bothering you or if it's just standard stiffness. I deal with stuff like this too—sometimes my fingers even lock up while I'm typing on my laptop—but since I have chronic joint problems, I guess it's nothing new to me. I'm used to it.
Just try what they recommended for now. If things haven't improved in a few months, go back and demand more thorough testing or ask for a referral to a specialist.
It’s actually a good sign that you aren't dealing with morning stiffness after sleeping—that's usually a telltale symptom of rheumatoid arthritis. Did your doctor order any tests yet? Maybe a basic blood panel? You should check your ESR or CRP levels. Those are just markers that show if there's inflammation happening in the body. They don't always spike even when your joints are acting up (mine stay totally normal despite having joint inflammation), but they're a solid starting point for getting answers.