My PCP has definitely changed over the years. I used to get Pap smears when I got my physical, now I have to make a separate appointment. Everything seems rushed. They also moved their office from a place that had plenty of parking to one that has none. They expected me to love the fact that I now have to drive twice as far and pay for parking? I just don’t get it. My husband left the practice years ago, but I’m not convinced I’d like his doctor any better.
@abasket Yes, I also work in a medical practice and am quite aware how medicine has changed and @deb922 is correct. Once the practice I work for was bought out, it is all about the numbers and money; I have a feeling the doctors that sold out, and still working, are kicking themselves, although the money they made on the sale might soften the blow just a bit.
My previous PCP when concierge, which is why I am no longer with him. At the time, and even now, I really use my PCP for little, so didn’t bother me. It wasn’t until I went through a few other PCPs that I realized how different they each practice. As I mentioned, even my oncologist visit leaves a lot to be desired.
I have always felt labs should be done before the visit so the results could be discussed at the visit. This is how it is done at my nephrologist for all her regular patients. She was ordering most of the labs I get done at the oncologist, but wanted me to keep regular visits there, so I asked that I see the oncologist yearly. I am going to switch to another oncologist she recommended, who she said is near impossible to get into. I have a year since I was just seen, so hopefully I can get an appointment by next year! The only additional lab my PCP currently orders that is not ordered by the other doctors is my cholesterol panel.
A new PCP is also on my list, although finding one that will take Medicare for a new patient might not be easy.
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My husband was in the hospital last week. He’s doing much better.
Topic A B C & D was about being too stretched. My husband was right outside the desk and I could overhear. I’m curious 
Lots of talk that hospitals had to get used to less during covid. And now corporate has decided if care could be done with less during covid, then that should be the model going forward.
One of the nurses cried because she just can not give the level of care her patients need. So many are quitting. They get a bonus to move to another hospital and have no loyalty.
That these corporations hire administrators to cut, cut and more cuts. Their bonuses are based on how much they can save. Once the CEO has cut as much as they can, they move and let someone else make more cuts.
So I do think things changed with covid. Corporate decided less was working so now that’s the permanent solution.
I do want to say that the level of care my husband had was top notch. All of the nursing staff worked like crazy. They were wonderful. We are grateful, husband was a lot of work. We made sure to profusely thank everyone.
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My mom’s PCP was beyond awful, and it took awhile to finally convince her to switch. My in laws’ PCP was even worse, and my H almost lost it with the doctor when he accompanied my FIL to an appointment. They refused to switch doctors, and he was basically ignoring her telemetry results from the service that monitored her pacemaker. We finally convinced her to switch to the PA that services the assisted living facility she was in. What a difference. I guess it’s hard for older people to switch from what they’ve known, but sometimes it’s necessary. Both H & I switched from an internist we used to really like, when he basically stopped listening to us. We both like our new doctors, and we understand that they are changing because they have to. But I miss the days when I could get into the doctor pretty quickly for an issue. I don’t always want to see a PA, and I don’t necessarily want to wait weeks to discuss my issue with the doctor. But I know that she is doing her best to run a good practice, and I do trust that I will get good care.
Yeah, that’s how annual exams seems to be going. I go to a larger clinic and the selling point years ago was that with many specialists under one roof if you needed to see one then your doctor would talk to their colleague instead of you having to flip thru the phonebook and find a specialist on your own. These days I imagine they don’t even talk, they just send an electronic “referral”.
Anyway, now I see my regular doctor for a physical and then he tells me he’s ordered some labs (the usual routine blood work) and then I go to a different office to get them drawn. When the results show up online then a few days later he’ll tack on a short comment.
I’ve long wondered why they can’t order the annual blood tests in advance so that during the visit the doctor can discuss them instead of leaving a one sentence note on the results. My guess is that it’s the result than many doctors, their clinic often owned by large conglomerates like mine is, want to maximize billing. The front desk is very clear at each annual physical that the purpose is only for routine screenings and if I were to have the temerity to ask a specific question, why, that would be billed as an office visit for an issue and create a separate bill (not covered by the insurance for an annual visit). I actually have to sign an acknowledgment each year that I agree or at least am aware of this.
So the annual visit in medicine has sadly become an assembly line. You go in for an annual screening. Don’t ask about any issues even if they’re long-standing. This visit is just to check you against the norms as you bump along the line. Anything shows up out of the ordinary then they’ll let you know and then you can schedule a separate visit around that issue or issues.
Apparently concierge medicine is a way to get back old-style medical care where you saw a doctor who took the time to get to know you and handle your care, referring out as needed. Unfortunately I don’t have the income to be able to afford it, unless I have the lucky 6 numbers on Powerball tonite 
So hospitals cut nursing staff and keep nursing pay levels down… but then have to fill in the gaps with expensive travel nurses and wonder why nurses who have mobility leave to become better paid travel nurses?
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My lung doc pre-covid would spend a lot of time with me (about an hour). He would address whatever I wanted to discuss and would often order testing before the visit so we could discuss. We did a facetime conversation in 2019 and one telehealth visit in 2021, and I’m going to have another telehealth visit 2/2023.
I hope to see him in person again this fall and fly to SF to see him in person. My internist was excellent the 1st few visits—2016 and thereafter. Since then she’s been a lot more rushed and shorter, more abrupt visits due to time pressures. I still like her and she still orders blood tests before I see her so we can discuss. I’m sad she’s so rushed but don’t know any good concierge docs I want to switch to.
My mom has an excellent geriatrician and she’s has been excellent the entire time mom’s been seeing her.
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Reimbursements from Medicare to physicians are cut every year. With inflation rising, there was a 2% cut in 2023. If you look at the amount that Medicare pays your physician, especially primary care physicians, the amount is sometimes less than a plumber’s visit. If our government doesn’t recognise that PCPs need to be paid more, we will be seeing PAs,NPs or virtual visits in our wellness checks.
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I’m very happy with my doctors. I see my PCP once a year for a physical; he orders the labs in advance so we review them when I see him. He also comes in knowing my bone density status and reminds me when it’s time for a colonoscopy, mammogram, etc.
When I had a cough, he first ruled out anything pulmonary, concluded it was probably related to the vocal cords, and sent me to an ENT.
He’s also available through his portal for quick questions – I had a tick bite and wanted to know if I should take antibiotics; he called the order into my pharmacy. I sent him pix of my face after a bee sting as I was completely swollen; he sent a script for steroids into my pharmacy. I feel that he’s doing exactly what I want him to do – an annual complete physical, and being available to deal with quick issues during the year.
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I do wonder how much of this depends on how regularly one interacts with the medical system. As a fortunate healthy person, my interactions are few. And that means I am not navigating the system with ease or practice.
Parents whose kids had asthma, for example, had a facility with the pediatrician’s office I did not.
I even find scheduling difficult!
The virtual and visual options in health care - even just the ability to send a photo - should be seen as a big positive in the last several years.
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H’s doctor offers a kit that allows her to examine virtually. I saw a piece on the news that explained it … it’s a huge win for people who can’t easily get to a doctor’s office. They interviewed a mom with a young adult autistic child who says it has been a lifesaver not to have to try to physically get her son to the doctor. There are so many great applications, although not all insurance covers virtual visits. If one good thing came from Covid, it’s increased use of/coverage for virtual visits. They definitely have their place.
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I only see my PCP if I am actually sick. Once in a blue moon she’ll hold up my thyroid meds for a bloodtest, but doesn’t have me come in. I have had a few bouts of allergic reactions to plants, and those were “examined” virtually by a PA on call at the office. Otherwise, nothing.
My parents are 89 and their PCP only sees them post-crisis, and then only does the minimum of work.(he loves to send them to specialists) I have had to clarify his directions to them several times as he does not seem to get that verbal instructions for the elderly are not a grand idea. And he never questions obvious things like “why is your weight so low” or “have you fallen” or “are you still driving”. In small town America, you don’t have many options.
I have to sign a form when I check in for my physical that says that I acknowledge that any medical-related questions I ask during my physical, are billable outside of my physical. I literally ask nothing. I barely conversate - just nod my head.
My adult daughter’s PCP charges a line item of $75 on her yearly physical because they ask a general mental health question (insurance won’t cover the mental health question so the practice sends her a bill for the $75). My daughter flat out refuses to pay it and has instructs them not to even ask it.
I have decided that my yearly physical is unnecessary. I come in for yearly bloodwork, the results of which my PCP posts to my electronic chart, and she also posts a letter explaining the results. I have a yearly mammogram and a female exam once every 2-3 years.
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Depression screening is supposed to be a covered item in a wellness exam for all ACA compliant plans.
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I will contribute later and a doctor also but I sorta agree. I have seen like hospital care go down. Left hand doesn’t know what the right hand is doing. If I didn’t help my family members they wouldn’t know what to do. Also the younger doctors besides being just employed by the hospital and check in and out on time don’t know how to do proper explanations that non medical people can understand. They need a class in this. We actually made one sit down and explain something to my mother so she would understand. I told him that I am a doctor but he needs to use words she can relate to. I have seen this in multiple states
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Only for some things. For my practice it’s usually a waste of money for the patient since most of what I do is hands on but great for going over non complicated reports etc. My office will tell them and give them a choice and almost 100% come in. Afterwards they are like "Yep, couldn’t do this on Tele health.
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For those rushed visits - would having a list of prepared questions and posing them to the doctor help? I know there are structural issues and limits on time imposed on the doctors (not their fault) .
But I’ve always been that person (either w/my parents as their advocate or for myself) that has a ton of questions, read a bunch of articles, blah blah. Likely annoying but I am determined to (deliberately - very, very nicely and respectfully) get the info. I don’t know if that would work in all cases, though…
PS My hub has a concierge doc too. Lots and lots of time devoted to his holistic well-being…
If the physician has an email portal, could giving a detailed description of the symptoms and concerns to the physician by email before the visit help allow the physician to better prepare for the visit and not spend time asking questions that are already answered?
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My docs seem happy when I have a list of prioritized Qs (most important at the top). I leave space below each so i can write the answers and give the md a copy and keep a copy. It forces me to prioritize my concerns.
At the top of the sheet, i summarize my meds and any changes since last visit.
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