I don't think you understand quite how it works.
You don't simply write a diagnosis and treat for it.
You explore for a diagnosis based on history, physical, and adjuncts to a physical.
It is in the best interest of a patient and the medical system to be as accurate as possible.
A good example would be primary and secondary hypertension.
You could easily Dx hypertension and treat the patient for the rest of their life, however, discovering a reversible cause of hypertension with its own unique treatment can not only be cheaper in the long run, it can improve quality of life
and make a lot of money with an increase in productive life.
The problem with that is doctors are already trained and equip to diagnose patients based on various symptoms they present. you would be opening a can of worms to say :censored::censored::censored::censored: it he might have liver failure because of a chronic pain, the simplest answer is usually the most correct..
There is no such thing as uncomplicated chronic pain. Nociceptive pain is caused by injury. Discovering and treating the source of injury is far more efficent than simply writing a script for pain meds.
If the doctor is incapable of thinking on his own after the many years of study than it falls on the education he/she was provided that made the doctor incompetent...
That doesn't quite work either. The medical reimbursement system has demanded "evidence based" diagnostics and treatments. Which means, if you want paid, you will follow the guidelines, even when you know they do not apply.
Furthermore, particularly in the US, not following a guideline, even if you know prior to starting will not work, you open yourself up for potential litigation.
It is in the doctors financial and professional interest not to deviate from the guidelines, but to run through them in order. It doesn't mean they do not know or are incapable.
Let me give you an example.
In septic neonates, a late complication is abdominal distension. Long story short, when you see it, it is probably too late to do anything, however, several treatments are recommended. (including peritoneal dialysis despite the pathology being from gut ischemia, which means the blood flow doesn't work anyway)
In adults it is permissible (read paid for) to put a urinary catheter that measures bladder pressure. The increase in bladder pressure clues to a subclinical increased interabdominal pressure. Which permits early identification and treatment.
There is no guidelinefor the same technique in neonates, and consequently not only may the cost not be reimbursed, but again, by doing something not in the guidline, causes exposure to potential liability.
You know why the treatment isn't in the guideline? Because nobody I know will deviate from it or can get ethical approval to try.
It isn't so much as treatment by numbers as it is treatment by fact, the fact is majority of the cases are always going to be the same so they treat accordingly.
:rofl::rofl::rofl:
a majority of presentations are usually from the most common disease process, but that does not excuse a physician from ruling out other differentials. That requires entertaining less common pathologies to some degree.
You "chronic pain" being a common diagnosis, will not excuse a misdiagnosis of mets in the liver. Nor will treating a neoplasm in the liver as primary colon cancer (the most common reason for neoplasmsin the liver) excuse you if the actual problem is hepatocellular carcinoma.( a primary liver cancer often associated with hep B)
Bogging down the system by treating everyone like an individual only slows the process of treatment and effective treatment. You are not tied down to your family doctor, that is why they let you get a second opinion...
That is simply not true.
Do you think diet and exercise modification is not a better treatment for primary HTN than an ace inhibitor?
If you do not look at the individual in detail, how do you plan to come up with a proper modification?
People should take control of their own health and if they feel the treatment or diagnosis is inadequate than they should do something about it
Really? Tell me then, without medical education, how does a person decide a diagnosis or treatment is inadequete?
What is the definition of inadequete?
To whom?
but to have doctors start throwing out multiple diagnosis that would lead to confusion and more cases of misdiagnosis.
Actually, it doesn't.
You see, at some point, it may be impossible to settle on a final diagnosis. So the only solution is to attempt to treat one from the list you have.
It may not be the proper Dx, it will certainly be a treatment that likely won't work if it is. When it doesn't, on the follow up you then make alterations.
You explore if the treatment is actually not affecting the pathology or if the individual doesn't tolerate the treatment well.
Have you ever seen a patient with CHF, COPD, pulmonary HTN, and chronic smoker complain of difficulty breathing or caugh?
Tell me?
What is the Dx causing it and what is the treatment?
) experience including as a case manager, and working in a very pressured primary care environment.