How have your visits to the doctor changed?

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This may turn into a rant as I type, so I apologize in advance. :face_with_hand_over_mouth: I shouldn’t complain about how medical care has changed as both my husband and son are physicians, but I really am feeling the lack of care.

I rarely need my PCP as I have several specialist I see. My current PCP is ok, and she is good for med refills and a general glance at my health. No longer is an EKG preformed as the literature shows it isn’t necessary; the physical exam is limited to a node check, and a quick look in the throat and ears. I liked having an EKG done in the event it showed some change as I don’t have a need for a cardiologist at this time. Curious if my visit will change now that I am on Medicare; previously I have coverage with my plan from work. My previous PCP, I am talking 10+ years ago, was spent talking in his office first, then put in a gown for an EKG, and to the exam room for a complete physical exam. Lab orders were given to have drawn at the labs, and written prescriptions as needed.

I have had bouts of tennis elbow (don’t play tennis) where I have had a couple of injections to help with the pain. Physical therapy and dry needling helped some, but at the almost 2 year mark, I wanted one more injection to maybe get over the last hump. I know my ortho is a man of few word, and he is out of the room in 3 minutes! I asked about another injection at my visit a couple of weeks ago; he called for the nurse to bring one, injections my elbow, and as we are walking out, says, as longs as you understand the risk! :scream: Now he did tell me last year that the newer studies show that too many injections can weaken the area, but if I didn’t want surgery, it was fine to get the one I had at that time. No mention this time that he didn’t think it was a good idea! He is the physician, not me, so if he thinks another injection is not warranted, I would have liked him to say so before he injected!

When to my yearly with my oncologist/hematologist. While I started with this group 30 years ago with breast cancer, I now see them for an issue where they are watching some blood counts. My previous 2 providers that have both retired, spent a good bit of time with me; I would have a physical exam, we would talk about what was going on with my health, and what to expect if my labs changed, and where they were now. The current provider, and I believe the entire practice, has you have your labs drawn with the nurse prior to going into the exam room. The doctor walked in with a piece of paper, I guess with some of my information. She asked how I was, touched the nodes under my right side after I lifted my shirt, and said she would see me next year. No discussion about why I was there, or how my labs were trending. I asked if my labs would be on the portal, and she said she would mail them. Such a waste of a visit, and I would rather have my labs drawn in advance and then have an appointment to discuss them.

Lastly, my favorite doctor is my nephrologist; she acts more like a PCP and looks at the entire picture. She took care of my dad for years, and now my mother also sees her. She spends as much time with you as needed and gets to know the patient. As I see her twice I year, I feel like I am in good hands. If I had a problem, she would lead me in the right direction. She was the one that found my dad’s blood cancer that others had missed. I have some of the same values, so she is invested in my overall health, not just my kidneys.

My rant is not over! Are others seeing a change in their visits or am I getting to be that old crotchety person?

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I’m on Medicare, and my PCP still does all of this.

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My annual well exam has become something very different than it once was. She checks my neck (I have Hashimoto’s), listens to my heart, does a manual breast exam, and asks a bunch of questions. Bloodwork is limited to what insurance will cover for well exam (standard lipid, comprehensive metabolic, CBC) + thyroid panel. Urinalysis. EKG. She used to do a more thorough physical exam, and she used to check more with bloodwork (such as vitamin levels). She still takes time with me and will answer any questions I have … friends’ doctors limit them to one or two questions, while one friend can’t ask anything during a well exam. She has to schedule a separate visit for questions.

I have no problem with this YET. I do think it could be a problem as I age. My understanding is that a Medicare well exam is pretty much a hey, how’s it going quickie. I wonder how well that works as people get old. Maybe it doesn’t make any difference. I don’t know. I do have to go twice a year in order to get thyroid med refills, so I will continue to have regular contact with my PCP, even if it’s different than it used to be.

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Our neighbors were told by their HMO, Kaiser that they only needed a physical once every 5 years. They were in their 60s or 70s. They both ended up diagnosed with cancer the same year (different types) and needed a lot of expensive treatment. Both are in remission.

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Well, my rant: had a video call with a PA about my Dexi scan results. The first thing she asks me is what have I heard about treatments. I mentioned that I had heard of scary side effects from some of the medications. She then went on to talk about how rare that is and what dosage they would use on me. I finally was able to ask if we had to go right to that as I am borderline. Oh, yes, I could just up my calcium, exercise more and get scanned again in two years. Do I want to do that? No advice, no pros or cons. And at the end as we were signing off, she said, " Oh by the way, are you in any pain?" I felt like I should have been conducting the call. I am glad I see the doctor in a few weeks for my yearly physical.

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My previous PCP always spent a fair amount of time talking with me to understand/explain health issues in the context of how I lived. Advice on everything on how to endure flying with a cold (unavoidable business trips) to baseline titers on lyme based on high incidence where I live to how to avoid mishaps duringhospitalstays… Plenty of information on treatments, etc. A move required a change.

My current PCP has a nice manner but clearly doesn’t know me or my history particularly well. I feel like it is my job now to say “should I do xyz for an update” or “I’m concerned about this because of this thing in my history”. She always responds in a way that makes me trust her judgment, but if I don’t bring things up, it’s a more “check the box” approach.

T o be fair, my old PCP refused to participate in any medical network because she felt it constrained her from proving excellent care, so she was always out of network. My current one is being reimbursed on their terms. But overall, I felt better when someone was overseeing the whole deal.

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This is probably a controversial statement, but if you can afford concierge medicine, you might want to try it. Our PCP got tired of not having enough time with patients but was not yet ready to retire, so he joined a concierge network.

Every year I have a 2 hour physical that is in 2 parts: a lot of tests, including some more lipid profiles than the standard CBC. And then a long conversation about all the areas. It includes the usual palpating and EKG etc.

The other benefit is accessibility to the doc. This paid off for us 100% when my DH had some issues and we had trouble deciding on a treatment plan. He and his doc had time to discuss the pros and cons of a procedure, his doc was able to recommend several specialists to see and he checked in along the way after all the various tests etc.

Ethically, I do not like the concept of this. It is not fair that those with more means can pay for what might be better care. I think this is always the case, even without concierge medicine, as well-employed people often have better medical benefits etc.

I have resigned myself to the fact that I alone cannot change the US medical system and I am lucky to be able to have the coverage I have.

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The wellness check once a year on Medicare is just limited to that. You are well. However, if you have another complaint, like your heart beats fast sometimes, there is a surcharge if the physician is alerted to the problem.
I have complained previously to my multi-specialty medical organization that in my annual exam (before Medicare), it’s literally a no touch visit. New physicians are trained differently in the last 20 years.

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I love the idea of concierge medicine, but where we live there aren’t any I would want to sign up with (looked before).

Right now it seems quite likely that I have a form of PTSD from previous health issues, so I’m toying more with just stopping all appointments in order to keep my mental health. It helps some that my son is a doctor. Last time I ended up letting him handle communication when things started to go off script.

It’s really, really “freaky” to me (for lack of a better word) that I can walk into a class of teenagers and be just fine even if it’s a class with a couple of troublemakers, but can’t feel comfortable in a doctor’s office at all. I had an annual appointment for earlier in this month and put it off until May. I guess I’ll see what I can handle when April comes around.

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Concierge medicine is something I would pay for if it were available. A sibling used it and loved it. And I agree that it represents so many things that are wrong with the system, including equity.

Recently had a conversion about expensive screenings, such as colonoscopies, involving lots of personnel, and difficult access for more routine and immediate needs. I have a PCP but have used urgent care in a pinch. It feels like the whole balance is off.

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I started with a new PCP 4 years ago when we moved states. It’s a small husband and wife practice and they rock. My first visit I filled out zero paperwork. Doc allocated an entire hour - the most thorough history I’ve ever had and a top to bottom exam. Yearly physicals are now 30 minute telehealth to discuss any changes and 30 minutes in the office for the in person exam.

I’m feeling very lucky after reading some of these posts!

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Medicare annual “physicals” are preventative only, which really limits what can be done or discussed. This is true of Advantage Plans as well.

I have a relationship with the NP in my doc’s office. I have barely ever seen the doctor.

@Creekland I also have some PTSD about medicine, partly due to one of my kids’ medical challenges. It helps to keep expectations low, do my own research, and only do appointments that are really necessary.

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I think things are changing. Physicians no longer own their own practices, they are employees. And with that they have no control over staff. And care is by a rubric. You have a prescribed number of patients to see. Lots (and lots) of paperwork to do. And maybe you would like somewhat of a personal life.

Managed care is all about the profit and bonus structure for the CEO. Do I sound cynical, absolutely!

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I like my PCP, who we’ve seen for about 10 years now. I let him do my ob/gyn work. We are pretty easy patients and don’t see him a lot. For our annual exams or some in-depth he will ask scheduling to block out a half-hour. My last visit he was with me (he might have run out to attend to something) for almost an hour. I was shocked.

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I think @deb922 is pretty spot on and the OP probably knows this having medical people in the family (and working in a medical office, right?)

Much is out of their control. And especially in primary care, meeting the metrics rules the day and appt calendar- because that is what the health system or insurance says. Having to schedule additional visits for new problems is becoming more the standard. Today’s schedule allows for A, B and C, which are part of a WCV, but anything else will need another time slot on the calendar (of course some questions are allowed within reason).

Specialists MAY have more leeway to spend extra minutes with a patient.

That said, back to the original question, I have a new PCP in the last year. She generally will come in the room while I’m clothed and do a short introductory conversation and then leave the room while I gown and then she comes back. To be honest, I’m almost prefer they NOT leave the room - sometimes it takes them too long to get back!

I think a questions to ask or observe with your doctor is….is the issue you have with the doctor or the system? If you and your doc don’t mesh you can look for a better fit. If your issues are with the system, well, that is not likely to change even if you switch providers.

Overall I feel since COVID my doctor appts of any kind have been more time efficient - less waiting room time, less exam room time - things move along pretty quickly. But maybe too quickly for some people???

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I have been going to a continuity clinic for medical residents for about four years and I’m very happy with the attention and care I receive. While the residents come and go fairly often, they are supervised by a wonderful doctor who comes in to talk to the patients after they’re seen by the residents and she is so caring. She listens and takes time to answer any questions I have and explains things thoroughly.

My daughter goes there also, and loves the amount of time that they spend with her.

My visits to specialists are a different story. I was having significant back pain after a fall and and had to go to a Ortho PA to get an X-ray. She referred me to a doctor who I saw a couple of weeks later. I then got an MRI. Was sent to PT which did nothing. Went back to the Ortho Doc who spent like two minutes with me and said the MRI showed moderate disc degeneration with arthritis and told me to continue PT. As I left, I saw him in the hallway and asked if there was a possibility to get steroid shots as I had been in considerable pain for weeks and couldn’t sit or stand comfortably and it was affecting my work. He gave me some excuse that patients had to follow all the steps before insurance would pay, plus he didn’t give steroid shots. I went home and cried on the way. When I got home, I sent him an angry email via the patient portal about the situation and to his credit he soon called me and set me up with another doctor who gave steroid shots. I have received two in the past four months and they’ve helped tremendously. So I went trough hoops for weeks and only got the care I needed after I basically threw a fit.

BTW, the doctor who does my steroid shots treats me like an inanimate object as I have to lie face down while she does the procedure. She talks to the assistants but never to me. I’m happy with the results, but not happy with her not taking time to explain anything, or her not even attempting to have have any interaction with me.

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I have a few physicians in the family. They work very hard and are very conscientious.

One owns his own practice and the other is an employee. They both have mountains and mountains of paperwork. The one who is an employee will spend time calling insurance companies trying to get care for his patients. Calling patients (this doesn’t get any credit and is extra work load without any compensation for the practice). Writing consults for surgery and oncology. Doing public service announcements to publicize the practice. Meetings. Continuing education. It goes on and on. Also has a ton of debt that he gets to pay off.

The one that owns his own practice has a little more leeway but has to hire staff which cuts into his profit. This practice operates more like a traditional one. But insurance reimbursements get smaller, overhead goes up. In a practice owned by a corporation, they cut costs to maximize profit. Our family member has decided that he’d rather be a good practitioner instead of making a ton of money. Not every physician does that. I would say that not many make that decision.

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Seems like it would be preferable to do any “standard” labs before the associated wellness / exam visit, so that they are ready for discussion then, if they show anything unusual. Obviously, labs may be needed afterward if the visit was for some symptoms, or if the first set of lab result suggested something that more labs would help diagnose.

But pre-visit labs do not seem to be the norm.

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All of our labs are done before the visit. Same with EKG. Done a week before.

I have a new PCP. She’s great. Took time to explain to me questions I had about my daughter’s cancer. I was quite grateful.

I want all the information. I wonder if some people don’t or if physicians don’t have the time. I know every time I go for my annual physical, there are lengthy appointments before me and I’m usually the patient that eats into their lunch period. Which they never get.

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I don’t have complaints about my doctor but more about my insurance. I also have hashimotos and my doctor listens to how I feel. She used to do the whole shebang with blood tests and now it’s just TSH. She prescribed me Armour and my insurance which switched on 1/1 won’t cover it. I have been on it for 8 years. Her staff wants me to come in again to talk about alternatives. I was just there! Ugh!