Doctor shopping is possible but you've got to have a really fucking good hustle to get anything more than SSRIs and the odd benzo. Self-referring to specialists without a GP is just insanity to me
I grew up in a 'socialised healthcare' country, and now live there again after living in the US for a decade. When I had great insurance in the US, I loved it - I had a PPO plan so I could self-refer to any specialist whenever I felt like it, and it was very, very easy to get fun drugs (I was younger then, so I only saw the good side of being able to refer myself to a psych who would write me up for Adderall, Valium/Xanax, Ambien, and whatever other drugs I sometimes found useful to get me through my very busy life.)
Now I'm back in sensible land and I can get in to see a GP tomorrow, but if I wanted any of those drugs (the ones that aren't banned here, anyway) I'd need a GP's referral to a psychologist first, then likely several months of therapy before the psychologist
might write me a referral to a psychiatrist who could actually prescribe meds. The problem is I don't actually have any psych problems - my US psych wrote me Adderall because 'it helped me focus on work' and benzos 'to help with my fear of flying,' there was never any suggestion from either of us that I
actually had ADHD or a genuine anxiety disorder. Just 'mother's little helpers'...
So, no more easy drugs for me, bummer (not actually true, I travel back to the US often and still see the same psych, he takes $100 cash since I don't have insurance anymore and writes me for at least six months' worth of all the good stuff)- but in general, needing a referral to a specialist makes sense and it's insane that PPOs like mine would have let me book an appointment with
anyone for a $5 copay - IMO the only specialist anyone should be able to self-refer to is a psychologist/psychiatrist, simply because not everyone wants to tell their GP (especially in a small town where they might know them socially) that they're having mental health problems - but a cardiologist? A neurosurgeon? An infectious diseases (i.e. Lyme, without the woo) specialist?
Of course, these should be 'gatekept' by GPs and/or the emergency room. It's no wonder healthcare expenses in the US are so out of control when my plan would have let me go waste any brilliant specialist's time just for kicks whenever I felt like it.
Apart from privacy re: mental health care, the only argument in favor of being able to self-refer to specialists is that some people truly are zebras (and I get it, I had three doctors write off my very serious heart condition when I was younger as "anxiety" before one took it seriously and got me an ECG and a 24-hour Holter monitor - and I was in surgery just two days later for the first of several operations to fix it.) Still, that was mostly my fault - I was young, I'd just moved away from home and didn't have a regular GP who'd seen me before, and my heart condition
was zebra territory - nowadays I do have a local GP who knows me and that I'm a reliable/credible 'historian' when it comes to how I'm feeling, and for anything out of the ordinary, they've had all the right referrals and tests scheduled for me straight away. I do often hear complaints about male GPs, especially, being dismissive of women's pain or physical symptoms as 'stress/anxiety'... but if your GP doesn't take you seriously, ask your friends and family for a recommendation and find one who does. If
no GP takes your symptoms seriously, the problem is probably not with them...
It's also cultural. In this country, if you'd tried every doctor and hospital in your area and not one believed your disease/symptoms were real, the people around you would be urging you to see a psychologist,
not raising $40k for you to go waste the resources of the Mayo Clinic or the like. We do have quack naturopaths in private practice (not covered by Medicare-for-all or most private 'extras' health plans), but when you meet someone who swears their naturopath cured their 'systemic candida' or 'adrenal fatigue' or whatever you just nod and smile and think 'good for you, placebos are awesome, whatever gets you through the day.' (If the quack tells them they 'need' more than one or two appointments or some $$$ OTT supplement regime? Intervention time.) Quack private
surgeons and quack 'lime literate'
medical doctors? They don't exist here, they'd lose their licenses.
I also wonder how much of the US healthcare excess is end-of-life care... Americans
really hate dying. In my country, if someone is on life support and they're not going to 'come back' or get better, it's rarely even an argument - you pull the plug, knowing that's what they would have wanted. In the US I saw friends keeping braindead elderly relatives on life support for months 'hoping for a miracle,' and ending up with a million-dollar bill. Or with cancer - here, if one last round of chemo or radiation might keep you alive just a little bit longer but you're going to feel wretched the whole time, the vast majority of people say 'no thanks, ready to go' and have a peaceful goodbye with their families. In the US, if it will keep you alive another day, who cares if that day sucks, your family will remember you vomiting and moaning in pain, and it will cost them $40k after you're gone... I don't want to be dead! I'll take it!
stop it.
