Handcuffed by the standard of care. Twelve minutes or less with each of her 2,500 patients. Pushed to prescribe drugs she knows aren’t the answer. This is the reality of primary care today. Dr. J, as we’ll call her, is a two-decade veteran of primary care, a good friend, and an amazing doctor. In this episode of Gott’s Gulch, she tells us what so many of her peers whisper about between exam rooms or keep bottled up until burnout incinerates them. She describes the difficult choices primary care docs face today: spending twelve minutes or less with each patient, frantically typing every CPT Code they can into electronic medical record systems, feeling pressured to prescribe medications that may not be the best option, and facing the harsh reality that homogenized protocols often lead to deadly overtreatment. She discusses what it’s like to be restricted by the so-called “standard of care,” overworked, sleep-deprived, and constantly forced to make difficult decisions between her conscience and the system. This is a raw, honest account from a physician who still loves medicine and her patients. But nonetheless, a doctor who’s had enough of pretending everything is fine. If you want to understand why primary care is collapsing, and why good doctors are leaving, you’ll want to hear this one. In This Podcast Medical errors are the 3rd leading cause of death in the U.S. In the United States, three in 10 people report having difficulty accessing primary care. A shortfall of more than 13,000 U.S. primary care clinicians today is expected to worsen in years ahead, with the Association of American Medical Colleges predicting it could grow to as much as 40,400 by 2036. A 2008 study estimated that imaging services accounted for 14% of healthcare spending in 2005. Think Fast. The 252nd Evolutionary Lens: DarkHorse Podcast Episode 252, released November 20, 2024. In that one, Bret and Heather describe completing a seven-day dry fast and discuss the biology and traditions around dry fasting. Timestamps 02:20 - Most patients don’t get to keep one doc anymore 05:32 – Dr. J still has a few primary care patients 06:45 – Primary Care docs in the system work more than 100 hours a week 08:30 – Primary Care docs are responsible for 2,500 patients/year 15:00 – The worst part of her job when a patient has an HMO 19:44 – Capitation vs. Fee for Service 24:00 – How I met Dr. J 26:50 – How much does the Standard of Care suppress creative medicine? 28:00 – Overtreatment kills 34:00 – Medical errors are the 3rd leading cause of death in America 36:52 – Did you ever feel pressure to overprescribe? 46:45 – How is/will AI impact primary care? 56:15 – Average doctor pay 01:07:00 – The Obamacare “free” annual physical 01:18:15 – How referrals work in modern medicine 01:21:30 – Compelled imaging 01:26:30 – Cost of malpractice insurance by specialty 01:27:45 – Vax schedules, how about those ingredients? 01:36:45 – The Iron Law of Bureaucracy 01:42:05 - Fasting and Dry Fasting This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit gottwals.substack.com
