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Re: Dream j*b for doctors
Old 06-06-2006, 10:54 AM   #41
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Re: Dream j*b for doctors

I feel for you OAP.
I have been very fortunate so far that I have not had to visit a hospital or have taken very little medicine for the last 30+ years. As I continue to age, I don't look forward to my 1st extended visit especially as a vagabond with very little family/friend support. I see the arm twisting, I have had to do, to help my father when he has occasional gone to the emergency room.
When you are alone, those places can kill ya!
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Re: Dream j*b for doctors
Old 06-06-2006, 11:04 AM   #42
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Re: Dream j*b for doctors

vagabond,
the more aloner I become and more isolated, the admittance to a hospital seems eerily like I may never come out. And what goes on in there is up to them.

During my last imprisonment inpatient stent, I asked to get transferred to UCSF Hospital and they ignored me. They had all my personal items, keys,wallet, money, backpack, clothing, etc locked up. Presumably to safeguard it. I asked to get it and they refused until the doctor said "release" me.

"Release" kinda implies some sort of imprisonment.

I can see where having a good family doctor that actually cared about you and your health is a Godsend.
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Re: Dream j*b for doctors
Old 06-06-2006, 11:32 AM   #43
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Re: Dream j*b for doctors

Quote:
Originally Posted by OldAgePensioner
I can see where having a good family doctor that actually cared about you and your health is a Godsend.
Right.

Nowadays in many hospitals, the equivalent of the outpatient primary care doctor is the hospitalist. These are usually internists who concentrate on inpatients only, and generally value the importance of knowing their patients, coordinating their care, etc. If you have an option, request admission by a hospitalists and they can arrange any necessary subsubsubsubspecialty care while keeping an eye on the big picture.

Surgical admissions are different, but hospitalists can consult should any nonsurgical issues arise.

Just a thought for the future, hoping it will never be needed.
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Re: Dream j*b for doctors
Old 06-06-2006, 11:40 AM   #44
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Re: Dream j*b for doctors

Quote:
Originally Posted by Rich_in_Tampa
Nowadays in many hospitals, the equivalent of the outpatient primary care doctor is the hospitalist.
Educate me. Do you find hospitalists at the hospital, or how do you locate them? Does insurance typically cover their fees?
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Re: Dream j*b for doctors
Old 06-06-2006, 11:47 AM   #45
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Re: Dream j*b for doctors

Rich,
I did initially have a hospitalist and he was the one who ordered further testing which found cancer and coronary artery blockage. But once I got involved with the Urologist Surgeon and the Cardiologist, I lost contact with him. Not knowing what you've just told us, I missed the boat and dropped making appointments with him.

Now I see what value he would have been. Could have kept me informed and coordinated the two specialists.
Thanks
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Re: Dream j*b for doctors
Old 06-06-2006, 11:51 AM   #46
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Re: Dream j*b for doctors

Quote:
Originally Posted by Rich_in_Tampa

Right.

Nowadays in many hospitals, the equivalent of the outpatient primary care doctor is the hospitalist. These are usually internists who concentrate on inpatients only, and generally value the importance of knowing their patients, coordinating their care, etc. If you have an option, request admission by a hospitalists and they can arrange any necessary subsubsubsubspecialty care while keeping an eye on the big picture.

Surgical admissions are different, but hospitalists can consult should any nonsurgical issues arise.

Just a thought for the future, hoping it will never be needed.
Hmmm, my SIL is a D.O. in training and wants to become a pediatric hospitalist. Good career move, Rich?
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Re: Dream j*b for doctors
Old 06-06-2006, 11:57 AM   #47
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Re: Dream j*b for doctors

I'm not familiar with the role of a hospitalist and just found this definition on http://www.hospitalist.net/

Although in Europe and Canada most hospital care has long been provided by specialists in inpatient medicine, only recently in the United States has the potential advantages of using hopitalists been considered. Robert M. Wachter, MD proposed the following definition for the term "hopitalist": Hospitalists are physicians who spend at least 25 percent of their professional time serving as the physicians-of-record for inpatients, during which time they accept "hand-offs" of hospitalized patients from primary care providers, returning the patients back to the care of their primary care providers at the time of hospital discharge. ("Introduction to the Hospitalist Model", The Emerging Role of Hospitalists in American Health Care: A National Conference, December 5-6, 1997, San Francisco, California, presented by Department of Medicine, University of California, San Francisco School of Medicine)

The ability to rapidly coordinate inpatient care and react in real time throughout the day to clinical data and changes in patients medical status by full-time hospital based physicians has distinct advantages both in terms of quality of care and potential cost savings. Potential disadvantages include patient dissatisfaction secondary to being "assigned" a new physician during an acutely stressful time and potential lack of adequate communication between inpatient physicians and outpatient primary care providers both at the time of hospital admission and discharge.


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Re: Dream j*b for doctors
Old 06-06-2006, 12:03 PM   #48
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Re: Dream j*b for doctors

I've got an appointment today at UCSF and will discuss the hospitalists role with my cardiologist.

Here is the cardiologist at UCSF that I'm seeing and his colleages give him rave reviews.

http://cardiology.ucsf.edu/clinical/.../TomPorts.html

He did the first angioplasty at UCSF.
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Re: Dream j*b for doctors
Old 06-06-2006, 12:07 PM   #49
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Re: Dream j*b for doctors

Quote:
Originally Posted by justin
Quote:
Originally Posted by Rich_in_Tampa
Nowadays in many hospitals, the equivalent of the outpatient primary care doctor is the hospitalist.
Educate me. Do you find hospitalists at the hospital, or how do you locate them? Does insurance typically cover their fees?
Justin, this all takes place at the time of admission. If you are coming through the Emergency Room, they arrange it. If you are referred by your PCP, she arranges it. Yes, it is covered by insurance.

Not something you set up on your own, but clearly something you can request if available.

OAP - you did not drop any ball - you probably got transferred from the hospitalist service to the Urology Service. That's usually OK once the diagnoses become clear and the surgery issues are the main focus. Still it's nice to have one involved if available.
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Re: Dream j*b for doctors
Old 06-06-2006, 09:33 PM   #50
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Re: Dream j*b for doctors

Rich,
Went to UCSF Medical today and visited a very will respected Interventional Cardiologist. This gentlemen also asked if I need refrerral to a Urology Oncologist.

How the heck does "Referral" work?

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Re: Dream j*b for doctors
Old 06-06-2006, 09:43 PM   #51
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Re: Dream j*b for doctors

Quote:
Originally Posted by OldAgePensioner
Rich,
Went to UCSF Medical today and visited a very will respected Interventional Cardiologist. This gentlemen also asked if I need refrerral to a Urology Oncologist.

How the heck does "Referral" work?
Some HMOs and PPO type insurance will only cover specialty care if it is referred by your primary doctor but that doesn't seem to fit here (i.e. a cardiologist).

Might also mean referral in the sense of a "recommendation" to a subspecialist.

Hard to tell. Maybe he was just offering to send you to someone he knows is good.
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Re: Dream j*b for doctors
Old 06-06-2006, 10:06 PM   #52
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Re: Dream j*b for doctors

Rich,
Thanks, I really appreciate the insight you have.

I usually do research on where I'm moving and choose a Doctor with good credientials and recommmendations.

I always get asked "How were you referred to me"? I usually say I felt they had the background that covered my health problems.

It seems BCBS wants me to have a Primary Doctor doing this.

Am I entitiled to do what I'm doing?
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Re: Dream j*b for doctors
Old 06-06-2006, 10:40 PM   #53
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Re: Dream j*b for doctors

Quote:
Originally Posted by OldAgePensioner
It seems BCBS wants me to have a Primary Doctor doing this.

Am I entitiled to do what I'm doing?
Don't know, boss. Time to call BCBS "customer service." Why do I feel another health insurance anecdote coming on ?
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Re: Dream j*b for doctors
Old 06-06-2006, 10:42 PM   #54
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Re: Dream j*b for doctors

Quote:
Originally Posted by Rich_in_Tampa
BCBS "customer service."
Jumbo shrimp.

Military intelligence.
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Re: Dream j*b for doctors
Old 06-07-2006, 09:52 AM   #55
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Re: Dream j*b for doctors

Quote:
Originally Posted by Rich_in_Tampa
Deep blood clot (thrombosis) posing as infected leg, calf injury


Caveat emptor, big time.
I've had deep venia thrombosis in the calf 20 years ago and I thank my "think out of the box" internist to this day for suspecting what the emergency room doctors did not. I was dismissed twice for a "calf injury" from too much exercise by other doctors.

Caveat emptor, big time is right.
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Re: Dream j*b for doctors
Old 06-07-2006, 10:02 AM   #56
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Re: Dream j*b for doctors

Quote:
Originally Posted by cube_rat
I've had deep venia thrombosis in the calf 20 years ago and I thank my "think out of the box" internist to this day for suspecting what the emergency room doctors did not.
Internists are a good thing; get one if you can.

Alas, they are now the most actively recruited specialty as primary care docs. Few are entering the field and those that are in it are hassled to the bone with bureaucratic requirments, diminishing reimbursement and crushing work-hours. Ironically, it is one of the most rewarding fields of medicine at an intellectual and interpersonal leve. <Sigh...>

At least I know that part-time work after FIRE should be easy to find.
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Re: Dream j*b for doctors
Old 06-07-2006, 10:12 AM   #57
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Re: Dream j*b for doctors

Just to add for those who never had a deep vein clot.....when you have a deep blood clot in the leg it HURTS LIKE BLOODY HELL!! The pain does not compare to any type of superficial leg injury. Imagine your limb boiling in a pot of hot acid, that's what deep venia thrombosis felt to me. That said, the doctors just thought I did too much aerobic exercise. What's scary ( I was young and stupid beyond belief) is that the several clots that I had in my leg could've broken off and traveled to the lung or heart and killed me instantly. A smart, young internst and10 days in the hospital on a 24/7 IV of heparin saved my life.

Sorry, I got off topic a little bit. :P Carry on...
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Re: Dream j*b for doctors
Old 06-07-2006, 10:38 AM   #58
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Re: Dream j*b for doctors

Quote:
Originally Posted by cube_rat
Just to add for those who never had a deep vein clot.....when you have a deep blood clot in the leg it HURTS LIKE BLOODY HELL!! The pain does not compare to any type of superficial leg injury. Imagine your limb boiling in a pot of hot acid, that's what deep venia thrombosis felt to me. That said, the doctors just thought I did too much aerobic exercise. What's scary ( I was young and stupid beyond belief) is that the several clots that I had in my leg could've broken off and traveled to the lung or heart and killed me instantly. A smart, young internst and10 days in the hospital on a 24/7 IV of heparin saved my life.
As many as 50% of DVTs can be totally asymptomatic. They first present when a chunk breaks off, travels up the veins, through the right side of the heart, and lodges in the lung (a pulmonary embolism) -- pretty urgent and treatable if gotten to on time.

Long airplane trips, immobility, edema, obesity, estrogens are among its causes though some are just spontaneous. So unexplained leg swelling on one side, or painless redness would be good enough to have it checked out, too. Just for the record .
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Re: Dream j*b for doctors
Old 06-07-2006, 10:46 AM   #59
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Re: Dream j*b for doctors



Thanks for the info, Rich. I had none of the possible causes outlined in your post, so it was a seemingly spontaneous situation. However, now that I'm a woman in my mid-40's, HRT has been presented as an option for *women issues*. I will be seeing a hemotologist in order to rule out any underlying blood disorders which may have caused the clots 20 years ago. Even with a clearance from a hemotologist, I will probably will never go on HRT for other reasons. I would like to be tested anyway just to ease my mind if I happen to have a blood disorder.

Did I go off topic again?!? My bad. Carry on folks
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Re: Dream j*b for doctors
Old 06-07-2006, 10:51 AM   #60
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Re: Dream j*b for doctors

Ouch, I just woke up with a knot on my head, apparently I hit something as I fainted from reading this thread! *I was never meant to be a doctor, I get woozy just talking about blood.

I can't imagine doctors being more overworked than they already are. *I've had to be a constant advocate for my daughter just to keep issues from being written off by the first innocent diagnosis they could think of. *She's gone in for her lung problems more times than I can count, every time they have a new diagnosis. *A WalMart jiffy lube may be o.k. for 60% of people, but do you want to gamble that you are in that 60%? *Don't you only learn when it's too late?
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