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General Category => General Discussion => Topic started by: Gliderjohn on March 03, 2016, 06:53:55 PM
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I recently lost my primary physician as he moved on to a bigger and better gig. I was very comfortable with him. He was a good listener, asked questions and was pleasant. When he left I looked over the bios of the docs in my area and one stood out as far as seeming to meet my needs and is a GP.
Had my first meeting and what was suppose to be my annual physical todayl. He came in and introduced himself. Without looking or asking about my history or the stats his nurse just took, he asked me what my concerns were. I said BP (been on the borderline from what I understand and this suppose to be one of his focus areas), frequent urination, a skin spot and ear wax build up which is chronic with me.
His first response was "Giving me a laundry list once a year does not cut it with me." Acting put out he checked my ears. Other than discussing and suggesting some treatment changes for my bladder/prostrate and ordering labs, he did none of the usual checking my heart and lungs, rectal exam (not like I look forward to it), etc. that usually happens at annual exams.
How do you all go about finding a good doc and what is your definition of one?
GliderJohn
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Good luck with that. My internist, Dave the doc sez he's fed up with guys that all they want to do is make money. Schedule way too many people, don't take time to do a proper exam or *listen.* Unfortunately, Dave is the same age I am, and who knows who will be left standing. Dave just got back from his vacation in Haiti, where he volunteers every year. I don't know if there are any more like him.. I hope so.
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Been going to the same Family Medicine practice for 45 of my fifty years. Gone through 6 or 7 different doctors. Don't expect to be treated for all your issues at a yearly physical. Since ins. only pays a certain amount, they only give you a certain amount of time and tests. When I go for my yearly physical, I feel like a head of cattle.....move 'em on through!!! Feel like I need to find a new one myself. I think the doctors spend much more time playing w/ their Ipads instead of focusing on the patient. Would probably start asking friends for referrals. Might try scheduling another visit w/ your current doctor and see if things don't improve.
Wish my sister didn't get divorced from her "Harvard Docta" husband as if we had any issues, he would call the attending physician and go over the case with them and follow up.
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As far as I'm concerned the best way is to ask people you trust, hopefully another practicing physician in the area who would know the doc professionally.
A lot of people make assumptions about doctors. Like over-scheduling as a money grab. But there are a few things that generally go against this.
1. If money was the most important concern they'd not have gone into primary medicine in the first place, especially if they are younger (like trained in the past decade or so). Primary care physicians make a fraction of specialists. And they are largely being pushed out of the business by even cheaper mid-level providers (NPs and PAs with a fraction of the training).
2. I'm sure there are bad ones (greedy or burnt out), but generally speaking no physician WANTS to over book their schedule. It happens because they were held up on rounds or called to check on an emergent patient, or they are trying to accommodate the needs of their patients, or they have patients who schedule an appointment for one thing then add a second or third and they get behind. In Pediatrics the parent may bring a sibling and try for a 2-1 (oh could you just look at him too, he's had this cough for a week...). Or some combination of the above. But it's not uncommon for a physician to work an 8-10 hour shift without having enough time to eat a lunch.
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John,
I feel your pain. Just lost the kindest, most caring doc I ever had. She was supportive and encouraging.
Back to my old pcp.
He's kind of curt. I called him on it at our last visit and I thought his resident was going to shit himself.
That said I know he's a good doc and he has helped me manage my health well. So I'll do my best to follow his advice.
I also know that between his teaching load and patient load he is slammed most of the time, so we discuss decisions through email and schedule labs before visits to make the most out of our appointment time.
If you see this guy again and his attitude bugs you tell him.
Ask him to specify how he plans to address your medical concerns. Let him know that you're willing to put in the work to follow his suggestions, but the bottom line is he works for you.
I'm not a real doctor, but I play one on the forum.
Dave
Galveston
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Wait until the doc sees the lab results. Then you can have a more informed conversation.
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Doc here.
Kev is correct. Ask around. Better yet, ask a nurse or another doctor. If it's not working out with a particular doc, don't be afraid to "fire" him or her and then to move onto someone else. If possible, think a little bit about what concerns you have and maybe write them down prior to your appointment. If it's been your experience that doctor A spends too little time with you, you can try to book a longer visit or stress at the outset that you have two or three specific issues which you'd like addressed and that the appointment time allotted, although brief, is plenty of time to get that done. And then smile. If your concerns are not met, or you have additional ones which weren't discussed, make another appointment or find a new doc.
Some notes from our side: we're all overbooked. That doesn't mean we're merely busy, it means that three or four patients have the exact same appointment time as you. There's several people with whom we work and on whom we depend and, just like any workplace, some are better/more dependable/more efficient than others. A routine 20 minute thing can easily turn into an hour, test results may not be available even though the blood was drawn two hours ago and now the patient is sitting in front of you, and the electronic medical record, on which we all depend at all times, may, at any moment, go down. There are patients added to our schedules throughout the day and if I'm on-call, I may have to go to the OR 10 minutes ago. Throw into this mess the gravity of the decisions that are being made and the severity of missteps, and, it's a wonder that anyone is going into medicine at all.
Must be that we like to help people.
Even the old grumpy ones.
Just sayin.
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Doc,
That makes a world of sense. I had a doc that was great. I would ask a specific question and he would say "let me think about that" and continue his work, then answer my question very clearly - frequently referencing recent research. He was solid and human. He lost a patient to prostate cancer that shook him up and later decided to move to the emergency room. Now he sees really sick people for very short periods of time - helping when they need it the most. I asked him who he would recommend to replace him and he gave me two names, one of which is my current doc and also very good though I don't yet feel the same attachment.
Doctors are really taxed by our medical system (a zillion things to do and a ton of responsibility in 10 minute chunks) and yet I've found a couple really good ones that will take the time to explain it to me and make it make sense.
Thank You.
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I have had four doctors in a year. Found the last one by "tracking down" a doc that I saw a few years ago. Sticking with him. Liked him then and still do. Involves a bit of travelling but he is the best for me.
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My doc at the VA has something like 6,000 patients , most of us Korean to Viet Nam vets , with some WW2 fellas mixed in. so a bunch of grouchy old bastages . I make an effort to be courteous and complimentary on my visits , his team of nurses , NP's ,and PA's are usually cheerful and efficient . Don't know how they do it :bow:
Dusty
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Thanks for the responses guys. My previous doctor that I really liked was recommended to me by an RN that was also an English teacher at one of the schools I worked at. Problem is I no longer know anyone working in the medical field around here.
GliderJohn
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Thanks for the responses guys. My previous doctor that I really liked was recommended to me by an RN that was also an English teacher at one of the schools I worked at. Problem is I no longer know anyone working in the medical field around here.
GliderJohn
I'll assume you have no way of getting in touch with your old doc.
If that's the case, it's time to start asking friends and family in the area.
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Quote from Kev M:
If that's the case, it's time to start asking friends and family in the area.
Yea, that's the next step. Ironically, the first three people I have talked with about this were also using the same doc I was. I think I can get in contact with my old doc. The last time I saw him he was still working at the clinic and did not seem comfortable about making recommendations. Maybe now that he is no longer affiliated he may be more open about it.
GliderJohn
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It's nice to see some balance in the discussion--too often it's "money hungry MD's" and that's that. I am a DVM married to a family medicine goddess, and I wouldn't trade with her for anything. The poor compensation for PCPs and insurance pressures to move patients through would give me ulcers. She's a fantastic, caring doctor and most frustrated by the lack of time allowed for REAL healthcare. She's not in it for the money and never has been in 25 years...but when I get 20-30 minutes face time with my patients and owners to talk through diagnostic and treatment options and she gets 10 minutes to talk with a new patient with obesity and heart disease, it's pretty obvious sum'nz outta whack. We live comfortably, but two kids in college and two in high school means there isn't a lot of discretionary income in the bank ('cept for the 2013 Stelvio I just bought and haven't even taken delivery on yet...spring hits Ohio on Monday I hope!)
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When the Doc I was comfortable with decided to head east because the cost of living here was doing him in, prior to leaving he provided referrals and a transition plan for me including an intro to his replacement. Everything went off without a hitch and although some things are now handled by a NP, care provided has been great.
When professionals leave for some reason other than death, you'd hope they understand the implications it has to their clients or patients. They might have many but unless they are bugging out with the midnight express, referrals is too much to ask?
Maybe I was lucky but at least I know there was some thought put into the process and I wasn't left in the lurch.
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Possible good news this morning. Ran into an acquaintance in the exercise room this morning. Got talking and he had also lost the same doctor I did. He just went to a new one for him, also for his annual and was very pleased. The experience he described sounded much better than mine was. At least I have a lead on a possible good one now. Thanks all.
GliderJohn
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Possible good news this morning. Ran into an acquaintance in the exercise room this morning. Got talking and he had also lost the same doctor I did. He just went to a new one for him, also for his annual and was very pleased. The experience he described sounded much better than mine was. At least I have a lead on a possible good one now. Thanks all.
GliderJohn
Hey great! Good luck.
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Not directly related, but, a few years ago the wife & I had a MD together who over time we decided wasn't that good. I contacted a different MD to make a switch and when I told him who my current MD was and why I wanted to change, he wouldn't take us because he played golf with our current MD. :huh: So I ended up having to find another MD to switch, who later moved out of state. And since then we moved out of state so we have not had the same MD for long for quite a few years now for different reasons. I no longer assume a MD is always right on what they say. I would like to have a MD I totally trusted their judgment on but the older I get the less possible that seems to be. We now spend more time with specialists than our GP.
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I no longer assume a MD is always right on what they say. I would like to have a MD I totally trusted their judgment on but the older I get the less possible that seems to be. We now spend more time with specialists than our GP.
Dead Right :thumb:
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Well gentlemen, a good physician is going to (as much as they can) listen to your concerns and express their opinions hopefully without generally saying or sounding like they are 100% certain if they can't be.
That sad, look at the other side of the coin.
Think of some of the anti-science nuts they have to deal with these days like the anti-vaxxers. Doctors are human too, they have bad days, they even make mistakes. But let's be honest unless they're incompetent the tend to make mistakes on the little things. There are always exceptions but still, they're not the rule.
Currently popular and floating through the medical community:
(https://img1.etsystatic.com/116/0/10453318/il_570xN.916582191_a7eh.jpg)
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Do not.. I repeat.. Do not google your symptoms. :shocked: :smiley:
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Doctors are the only people I know that get paid in full whether their diagnosis/implementation is successful or not. Even if you(patient) die they still get paid for their effort.
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Doctors are the only people I know that get paid in full whether their diagnosis/implementation is successful or not. Even if you(patient) die they still get paid for their effort.
Aw hell, you're kidding me right. There are a hell of a lot of professions that get paid regardless of "success" from many lawyers (unless billing on contingency), to most administrators and managers, to the military and law enforcement.
What most of those people have in common with doctors is that they are dealing with forces that are not completely under their control so success cannot always be guaranteed.
But thank God for a lot of their efforts.
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I've had four GPs in the last 20 years. My favorite one I got back twice but he run oft about 8 years ago.
I am not sure I trust the one I have now. I don't dislike him but I have 60% confidence. So it goes. I still have my butt doctor and my PT.
Even worse is a 30 yo urologist- just say no.
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I've had four GPs in the last 20 years. My favorite one I got back twice but he run oft about 8 years ago.
I am not sure I trust the one I have now. I don't dislike him but I have 60% confidence. So it goes. I still have my butt doctor and my PT.
Even worse is a 30 yo urologist- just say no.
I'm not kidding. That is why there are law suits and liability insurance. The other titles you reference don't have near as many opportunities for negligence nor do the others get paid as much for every incident they deal with. Incidents of war cannot be compared to civilian casualties. If a medical Dr. is incompetent they should be barred from practice. Passing tests to become a professional MD is not the same as applying what they have been taught correctly. There are good & bad Dr.s just like any other profession.
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I'm not kidding. That is why there are law suits and liability insurance. The other titles you reference don't have near as many opportunities for negligence nor do the others get paid as much for every incident they deal with. Incidents of war cannot be compared to civilian casualties. If a medical Dr. is incompetent they should be barred from practice. Passing tests to become a professional MD is not the same as applying what they have been taught correctly. There are good & bad Dr.s just like any other profession.
There are lawsuits and malpractice insurance policies more because of the overly litigious society in which we live where people far too often feel they are due compensation by the world no matter what the reason something bad happens to them.
That's not to say that mistakes don't happen.
But the thing about medicine is that we're all dying. It's just s matter of from what and when. And no matter how good a doctor is they can't fix everything. The amazing shit that surgeons and OBs do every day carries some risk with it, some unpredictable outcomes.
Don't get me wrong there are real tragedies, but I'm not even convinced they are the majority of lawsuits.
My comparison to incidents of war or even to law enforcement or fire/rescue is that just like a doctor the soldier, cop, fireman can do everything right but still have a poor outcome. That's because in all instances the outcome is determined by more than just their skills, they are dealing with forces out of their control.
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PS, I think the general public doesn't realize how much it takes for a doctor to practice medicine.
It's not enough to just get into medical school.
While in school they need to pass 3 separate tests (Step 1, 2, & 3) which they have finite chances to do or find another career.
After school they spend 3-7 years as a resident (basically an apprenticeship mentored and followed closely by long time practitioners).
After completion of this they are board eligible meaning they can pay many thousands of dollars to take an all day long test for board certification.
Then specialists will spend another 1-4 years with a fellowship (basically a second apprenticeship).
Then they are board eligible for the specialty test.
By the end if residency and, if applicable fellowship, they've basically been away from their families for a year or two (one overnight shift at a time). They are in their mid 30's, have 25-30 years or so in school including 7-15 years of medicine to get where they are. Plus they are quite likely a couple hundred thousand dollars in debt for student loans. While their peers graduated college or a trade school, started careers and likely enjoyed their 20's.
And then they get the privilege of basically remaining in school the rest of their lives with required annual Continuing Medical Education (CME) credits and recertification exams every 7-10 years as long as they wish to practice.
It's a long and unforgiving road which would be moronic to take just for the money because there are better opportunities for that in the legal and business sectors that begin paying dividends a decade sooner with a fraction of the time commitment never mind the lifelong CME/recertifications.
Again, that's not to say there aren't some that make mistakes or that just plain aren't nice people, but I bet many of those are just burnt out by the system.
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Kev is right. It's no walk in the park.
I have some issues with the medical proffesion's 'Closed Shop' but I'm not suggesting any alternative to modern, scientifically proven, medicine.
If you want that just look in the yellow pages under 'C' for charlatan and 'M' for mountebank!
Please, don't get me started, I'll get banned!
Pete
PS. Jude asked me to add 'S' for snake oil salesman.......
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not to stir the pot but it's actually pretty hard to successfully sue a doctor. Just because someone loses a lawsuit doesn't mean it was frivolous.
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not to stir the pot but it's actually pretty hard to successfully sue a doctor. Just because someone loses a lawsuit doesn't mean it was frivolous.
Just cause someone settles doesn't mean they were wrong either.
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Some US Dr.s come from other countries and I doubt they have to go thru the same tedious method US trained Dr.s do. I've had foreign trained Dr.s and some were good and some not.
So why would a young Dr. want to go thru all the time, effort, cost and in the end get paid poorly because of socialized medicine?
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Some US Dr.s come from other countries and I doubt they have to go thru the same tedious method US trained Dr.s do. I've had foreign trained Dr.s and some were good and some not.
So why would a young Dr. want to go thru all the time, effort, cost and in the end get paid poorly because of socialized medicine?
Actually the term for them (sometimes not kind) is FMGs (Foreign Medical Grads).
There may be exceptions based on country and certifications, but most are required to enter the US system at the point of residency or fellowship, even if they have been practicing in a foreign country for years. And in competing for those residency spots they are often at a disadvantage.
So right or wrong they are forced into the system at what would have been the point of graduation from medical school.
Now here's an interesting difference. Many foreign countries don't require their doctors to waste time in college. I mean Jenn's 27 years of school and training would have been 4 years shorter if she didn't have take two more years of calculus, organic chemistry, biology etc. along with marine bio in Belize, women's studies, English literature, scuba diving and Shotokan karate (though that was an unbelievable opportunity to TA a class with the world leader of our organization). Instead the framework is laid in high school, the academic talents identified earlier, and they basically go straight to medical school.
It's an interesting difference in systems and probably reduces debt too. Although I think Jenn's undergrad only cost her in the $20k range (of the total $200k debt load) thanks to scholarships and grants.
Still, that would have put her at about 30 when she started her post training career instead of closer to 35.
Oh interestingly enough one of her mentors (and close family friend) is a pediatrician who when she was in school got into a rare compressed 5 year undergrad/medical school program at Penn State/Jefferson University Medical School right out of high school.
Being Chinese (many Asians look very young to non-Asians) and 4' 10" she often got the Doogie Hauser comparisons. But it's an interesting alternative approach to education.
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Most the foreign Dr.s I've encountered are of India, Pakistan type countries.
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Most the foreign Dr.s I've encountered are of India, Pakistan type countries.
Yeah, that would agree with Jenn's experience/observation (I just asked to be sure).
It sounds kinda that a lot of the older doctors of that ethnicity were educated elsewhere and then trained here. But in Jenn's peer age group it's split more 50/50 educated here or even born and educated here.
Bottom line though physicians that practice here have been vetted here. I'd be more worried about the ones that are still being vetted (FMG residency and fellowship).
Speaking of, I've heard some stories of Russian FMGs (while doing residencies here) that just look at things from a different perspective, not ordering certain tests or eliminating certain diagnosis on the seeming basis of acceptable losses for the rare missed diagnosis. Yikes, but they were being supervised (and over ruled) by their attendings.
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Doctors are the only people I know that get paid in full whether their diagnosis/implementation is successful or not. Even if you(patient) die they still get paid for their effort.
Yes, we get paid for our services. Would you prefer to live in a society where those services were only available to patients with essentially no chance of dying? My job would be a hell of a lot less stressful, I can tell you. Um, heart murmur? Case cancelled. What's that? You once had a "minor stroke." Case cancelled. You're on a blood thinner...cancelled .
Or do you propose that the entire reimbursement structure be based on the subjective interpretation of a treatment or a procedure's success? Can you imagine the difficulty of that? Well, mrs smith, since you're still having occasional groin pain after the repair of your massive and debilitating inguinal hernia six years ago, we here at Massive Profits Insurance see no reason to pay for that procedure and will not raise you premiums (very much) this year, thank you very much.
I'm happy that MDs and DOs are paid based on their efforts, time, and expertise. There really isn't another way to do it without either a) not paying docs and therefor disincentivizing them (we do live in a world where mortgage payments and college tuition payments are real) or b) accepting that complex or difficult patients go untreated which is manifestly unacceptable and amoral.
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Some US Dr.s come from other countries and I doubt they have to go thru the same tedious method US trained Dr.s do. I've had foreign trained Dr.s and some were good and some not.
So why would a young Dr. want to go thru all the time, effort, cost and in the end get paid poorly because of socialized medicine?
All MDs and DOs practicing in the U.S. must be either boards certified or boards eligible. In the latter classification they've passed examinations which make them eligible to take the oral boards and thus go onto licensure. In the former, they've done both.
It doesn't matter if the foreign MD is a Pakistani CardioThoracic Surgeon with 15 years experience or if he's a neurologist from Mozambique who once treated the royal family. They all must fit nto one of the two above categories.
And I've met both, by the way.
My favorite was a colorectal guy from Scotland, a full-on consultant specialist surgeon 20 years into practice who decided to marry an American lass. They moved to Arizona and he spent the next 7 years of his life going through all of the steps that American surgical residents and fellows go through. Just to get to the same place, professionally, that he was in Scotland. He was, by the way, a pretty amazing surgical resident.
Anyhow, to get to your second point, the one about socialized medicine. With the possible exception of Venezula, societies with socialized medicine are not doctor-poor. There simple aren't waves of Canadian docs streaming into America to make a killing (ha!) in medicine. People go into medicine for innumerable reasons and money, albeit necessary and important and fun to have, is but one of them.
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I do not play a doctor on TV, did not stay at an Holiday Inn last night, and haven't read all responses to this post, but:
- all the many responses that say something like "the doctor is only given 10 minutes to see me/you" are bullshit! - I just retired from 30 plus years as a physician dedicated to quality of care, and a doctor can and should TAKE AS MUCH TIME AS HE/SHE NEEDS/WANTS to see each patient. There is no regulatory requirement for limitation of time spent. If the physician gets pressure from Clinic to limit time then he/she needs to push back or move to a better environment.
Doctors blaming some vague system for poor care are rationalizing to their own financial benefit.
Off my soap box now - spent plenty of time there preaching to my feckless younger associates prior to my retirement.
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I had posted to this thread but somehow it went awol. :undecided:
The best doctor I ever had lost quite a few patients because he dis not have a good bedside manner. Did not worry me a stuff. With both sports injuries and sickness in general he always got it right and I was quickly on the road to recovery. That's all I need. lost him when I shifted towns.
Present doctor is pretty good, and if he is unsure does not guess but will refer me to a specialist who will know. Unfortunately, some issues in the last 5 years have had the specialists buggered. Once in desperation I went to Dr Google (sorry Chuck) and worked out what it was when the experts couldn't. I was able to minimise the effects while they buggarised around. :rolleyes:
My best Dr has been a physiotherapist, where I learnt more in two sessions than I did with 5 years of specialists and a helluva lot of money.
My advice would be to find a Dr who does the job and gets it right. Don't be put off by a lack of a good bedside manner.
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I do not play a doctor on TV, did not stay at an Holiday Inn last night, and haven't read all responses to this post, but:
- all the many responses that say something like "the doctor is only given 10 minutes to see me/you" are bullshit! - I just retired from 30 plus years as a physician dedicated to quality of care, and a doctor can and should TAKE AS MUCH TIME AS HE/SHE NEEDS/WANTS to see each patient. There is no regulatory requirement for limitation of time spent. If the physician gets pressure from Clinic to limit time then he/she needs to push back or move to a better environment.
Doctors blaming some vague system for poor care are rationalizing to their own financial benefit.
Off my soap box now - spent plenty of time there preaching to my feckless younger associates prior to my retirement.
I got through most of this thread, up to this post actually, and I'm sorry, but your ten minutes is up. Maybe we can set something up for 6-8 weeks out and revisit your concerns?
:evil:
:laugh:
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How do you all go about finding a good doc and what is your definition of one?
GliderJohn
How do you all go about finding a good doc
Network with friends and medical professionals if you know any.
I know an awful lot of medical professionals after working in a university based medical center and still find it hard to get a good GP. Specialists are easier to parse out.
and what is your definition of one?
A good doc (or any medical practitioner) is someone who knows what he/she does not know.
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I got through most of this thread, up to this post actually, and I'm sorry, but your ten minutes is up. Maybe we can set something up for 6-8 weeks out and revisit your concerns?
:evil:
:laugh:
This is how it was when I was with Kaiser Permanente and every visit you saw a different Dr. Half the time the Dr. you saw didn't have your file so the visit was worthless. :boxing: And when you got a prescription there it was only for 3 weeks. :rolleyes:
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I recently retired from the VA. Overbooked and overregimented is the name of the game in primary care any more. Give the guy a chance.
Make an appointment to review your labs. Write down questions in advance. Ask whether he is going to give you an exam (heart, lungs, abd, prostate). If he is still rude, tell him to think about his bedside manner and look for another doc. The good ones are out there.
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I would check the golf course. :grin:
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Apologies for interrupting the debate with an on-topic reply, :wink: this is a pretty cool online tool for finding a physician near you:
https://amino.com/
I've used it successfully to find a new physician when a practice I was using shut down.