I've transitioned to primary care from hospital medicine and boy has it been a transition. Overall I love it but coming from an academic bubble to hospital medicine and now to outpatient has been eye opening.
Both jobs are difficult, and I hate the pissing match about which is harder (Primary care vs hospitalist). I can have a ton of complaints about hospital medicine but I wanted to rant for a bit about what outpatient medicine has seemed to become or be in my neck of the woods.
I have a new practice, opened doors in 2018. So far I've seen about 2500 new patients in about 9 months. I would consider myself well trained and open to discuss many evidence based non traditional techniques with patients if they are interested.
I've noticed quite a few patients who come from other doctors who have what I would consider BS diagnosis such as
- "leaky gut syndrome"
- "seronegative chronic lyme disease"
- "adrenal fatigue"
- "HPA axis mismatch/dysregulation" (with all normal blood tests. Theory is that the mismatch occurs at various times of day and that labs don't always pick up on that so I'm told by some patients who were told by their other doctor)
- "chronic EBV infection"
These diagnosis appear to be pushed by local doctors who bill themselves as functional medicine doctors. I've looked up all of these doctors online and they all are cash pay, are board certified MD's, and all sell their own supplements. One is an OBGYN, one is an ENT, and 2 others in my area are family practice all practicing as functional medicine doctors giving patients these types of diagnosis.
Many of these patients keep buying these supplements pushed by these doctors and stool genetic assay tests to determine "how healthy their gut biome is" and to me this is bordering on unethical since I don't know exactly what seems to be going on. I've requested records from their clinic but not once have they ever faxed me a record. One clinic in particular has a print out of the same 5 diagnosis and 5 treatment plans. He circles whichever he diagnosis the patient with, circles treatment plan and which supplement of his they should buy. I only found this out after a patient brought the form in to my clinic from what one of these doctors gave them.
Another group in town deals with mental health but has started to do bio identical hormones and botox.
Coming from an academic center, what in the hell has happened to outpatient medicine? Is this just isolated to my area or is this a problem all over the US?
I have to spend so much time talking these people about why they don't have adrenal fatigue and the fact that they are tired all day is most likely from being on their phone/computer, and having terrible sleep hygiene or anxiety.
Dealing with chronic pain and benzos seekers seems to be so much easier than dealing with these patients who are convinced that all labs are wrong and that their functional medicine doctor knows better than every other doctor.
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