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Doc Office Visit Needed to Review Lab Results?
Old 01-27-2010, 04:20 PM   #1
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Doc Office Visit Needed to Review Lab Results?

I recently went to the doc for a problem that he thinks can be remedied with antibiotics but suggested I might want to have an ultrasound, just to be safe. I'm OK with that, even though it is on my dime as I have a high deductible policy. After the ultra sound was completed, the office staff said I needed to have a second office visit to "review the results". To me this feels like more of a money generator than a necessity. If the results warrant it, surely they can just call me, and if not, what is there to discuss?

Is this standard practice or am I being squeezed?
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Old 01-27-2010, 04:49 PM   #2
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Originally Posted by travelover View Post
I recently went to the doc for a problem that he thinks can be remedied with antibiotics but suggested I might want to have an ultrasound, just to be safe. I'm OK with that, even though it is on my dime as I have a high deductible policy. After the ultra sound was completed, the office staff said I needed to have a second office visit to "review the results". To me this feels like more of a money generator than a necessity. If the results warrant it, surely they can just call me, and if not, what is there to discuss?

Is this standard practice or am I being squeezed?
And what if there are options to discuss? Would you rather do that on the phone or when looking the doctor in the eye?

Its standard practice.

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Old 01-27-2010, 04:57 PM   #3
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Can't speak to your particular situation, but if I have normal or trivial results to share with a patient, my nurse usually initiates that call, no charge. OTOH, if the results are such that they require longer explanation, discussion of alternatives, risks or even careful reassurance, and if I need to spend 15-20 minutes with the patient and another 10 charting, I charge.

My lawyer charges me for any time he spends (I once got a bill for time spent responding to my prior question about his bill). My accountant charges me for going over routine tax tasks. The advice I give is based on decades of training and experience and entails some liability if the advice should not work out ideally.

Every situation is different, but time spent in education, counseling and decision making is in my opinion legitimate. Hope that gives you a little perspective.
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Old 01-27-2010, 05:02 PM   #4
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My doctor mails me a letter with an explanation of the results as in:

Quote:
Dear Mr. LOL!:

Your results look fine. See you next time.

Sincerely,

Your Doctor
I imagine that he might want to talk to me in person if he thought I had cancer. At my last physical we talked for about an hour about things because we are both very wordy. I appreciate the follow-up letter because it usually also summarizes our conversation.
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Old 01-27-2010, 05:13 PM   #5
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I think maybe your doctor likes you better than mine likes me. I recently visited my PCP as I had not had fasting blood work for almost 10 years. Also my right shoulder was hurting a bit after a gym work out. I followed through with the blood work and also had the X-rays of the shoulder. Got back a thick envelope from her with all the results and her recommendations plus referral for physical therapy (for tendinitis of the shoulder) and a script to repeat blood work in 6 months to a year(good cholesteral and CRP and triglycerides all excellent but bad cholesterol was 210).
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Old 01-27-2010, 05:50 PM   #6
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My lawyer charges me for any time he spends (I once got a bill for time spent responding to my prior question about his bill).
Ouch! I once got a very large institutional client just because their prior big shot lawyer charged them to close a file.
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Old 01-27-2010, 06:07 PM   #7
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I recently went to the doc for a problem that he thinks can be remedied with antibiotics but suggested I might want to have an ultrasound, just to be safe. I'm OK with that, even though it is on my dime as I have a high deductible policy. After the ultra sound was completed, the office staff said I needed to have a second office visit to "review the results". To me this feels like more of a money generator than a necessity. If the results warrant it, surely they can just call me, and if not, what is there to discuss?

Is this standard practice or am I being squeezed?
This is so interesting--I usually just get my physical when appropriate, and then the doc mails the report to me.

But I am having a little knee trouble, so I went to the ortho. He checked it out, diagnosed it, said it needs some minor out-patient surgery, ordered an MRI, and said surgery would be scheduled thereafter (he himself will do the surgery). I had the MRI last week, called for the results which show the surgery is warranted, the office assistant asked if I want to come in for an appointment. I repeated what the doc had told me re the office just going ahead and scheduling the surgery, office assistant said "hmmm" and that she would tell the physician assistant to call me (that was two days ago).

Anyway, I get the impression that the office expects there to be a second visit between the MRI and the actual surgery.
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Old 01-27-2010, 06:21 PM   #8
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Originally Posted by Gotadimple View Post
And what if there are options to discuss? Would you rather do that on the phone or when looking the doctor in the eye?

Its standard practice.

-- Rita
I'm fine with a call or note that says results need explanation, please come in. On the other hand to say, "looks great, nothing wrong, $80 please" would rankle me.

I had a prior physician that wanted me to come in after every physical and go through the PSA and blood work and all he did was basically read the results to me, which had an interpretative scale, anyway.

Quote:
Originally Posted by Rich_in_Tampa View Post
Can't speak to your particular situation, but if I have normal or trivial results to share with a patient, my nurse usually initiates that call, no charge. OTOH, if the results are such that they require longer explanation, discussion of alternatives, risks or even careful reassurance, and if I need to spend 15-20 minutes with the patient and another 10 charting, I charge.

My lawyer charges me for any time he spends (I once got a bill for time spent responding to my prior question about his bill). My accountant charges me for going over routine tax tasks. The advice I give is based on decades of training and experience and entails some liability if the advice should not work out ideally.

Every situation is different, but time spent in education, counseling and decision making is in my opinion legitimate. Hope that gives you a little perspective.
Thanks. I do appreciate the investment that Docs have, but also agree that some tasks can be and should be handled by support staff.
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Old 01-27-2010, 06:46 PM   #9
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But I am having a little knee trouble, so I went to the ortho. He checked it out, diagnosed it, said it needs some minor out-patient surgery, ordered an MRI, and said surgery would be scheduled thereafter (he himself will do the surgery). I had the MRI last week, called for the results which show the surgery is warranted, the office assistant asked if I want to come in for an appointment. I repeated what the doc had told me re the office just going ahead and scheduling the surgery, office assistant said "hmmm" and that she would tell the physician assistant to call me (that was two days ago).
Anyway, I get the impression that the office expects there to be a second visit between the MRI and the actual surgery.
If this is for a meniscus or an ACL, have you read Jolie Bookspan?
Surgery for Knee Arthritis, Meniscus, Not Needed To Stop Pain, Restore Function
Anterior Cruciate Ligament (ACL) Surgery Unnecessary

Admittedly small samples, selection bias, and a bunch of other less-than-objective evidence. But the more I learned then the less I wanted surgery, and the physical therapy proved to be at least as important.

If you decide to have the surgery, ask the doctor to put you through the physical therapy first. Proper PT shouldn't cause any further damage, you'll need to build up your quads/hamstrings before the surgery anyway, and you can always have the surgery after the PT...
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Old 01-27-2010, 06:55 PM   #10
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Docs vary, that's for sure. Anyway, I hope your treatment plan is a simple one travelover.
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Old 01-27-2010, 07:39 PM   #11
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Ouch! I once got a very large institutional client just because their prior big shot lawyer charged them to close a file.
Yep. Those absurd examples are probably due to overzealous billing systems. In my case, the phone system the firm owned had a deal where the lawyer could press a button to turn the billing clock on or off. Intended to document billable phone hours, the system got so ingrained that the lawyers hit the button reflexively.

Years later I heard a story from the divorcee of a lawyer in that firm: she would call her husband to see what he wanted for dinner that night, and "he" ended up sending her a bill after the automated phone billing system logged her in.
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Old 01-27-2010, 08:16 PM   #12
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When I have had routine physicals, both through work and when I was in Texas 2004 -2007, the results and Dr summary of findings came in a letter. This included the occasional screen test such as stress test, colonoscopy, etc.

I would expect only to be called in if a test required further explanation or investigation



Quote:
Originally Posted by Nords View Post
If this is for a meniscus or an ACL, have you read Jolie Bookspan?
Surgery for Knee Arthritis, Meniscus, Not Needed To Stop Pain, Restore Function
Anterior Cruciate Ligament (ACL) Surgery Unnecessary

Admittedly small samples, selection bias, and a bunch of other less-than-objective evidence. But the more I learned then the less I wanted surgery, and the physical therapy proved to be at least as important.

If you decide to have the surgery, ask the doctor to put you through the physical therapy first. Proper PT shouldn't cause any further damage, you'll need to build up your quads/hamstrings before the surgery anyway, and you can always have the surgery after the PT...
I had knee problems in my 20's and had PT over a 6 month period and it fixed the problem. I didn't expect PT would help as I could sometimes feel a lump on the side of my knee which I could push back into the knee - freaky!!

When I had knee problems again at age 40 I tried PT on and off for 18 months before finally going in for surgery and the results were excellent.

Good luck going forward, but I would explore non-invasive options first.
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Old 01-27-2010, 09:56 PM   #13
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Thanks for the suggestion re physical therapy. I have had PT for my back several years ago and the results were amazing (I was so convinced it would not make any difference--wrong). I was diligent at doing the prescribed exercises at home, too. So I am certainly open to that. The ortho drs.' office has a full physical therapy department, and I imagine they would suggest that if it would be effective.

My knee is in constant pain in a very specific spot (so bad it wakes me up at night, no matter what position I am in). It locks up on me, and it makes lots of interesting clicking and popping sounds. The diagnosis, confirmed by the MRI, is a torn meniscus with no osteoarthritis. It's been bad for six weeks now and not getting better. The surgical procedure sounds minimal and straighforward (they said it could be done under local anesthesia, too), but I would love it if PT alone would be the answer--I'll discuss that with the physician's assistant or the doc. when I talk with them.
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Old 01-27-2010, 10:58 PM   #14
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My knee is in constant pain in a very specific spot (so bad it wakes me up at night, no matter what position I am in). It locks up on me, and it makes lots of interesting clicking and popping sounds. The diagnosis, confirmed by the MRI, is a torn meniscus with no osteoarthritis. It's been bad for six weeks now and not getting better. The surgical procedure sounds minimal and straighforward (they said it could be done under local anesthesia, too), but I would love it if PT alone would be the answer--I'll discuss that with the physician's assistant or the doc. when I talk with them.
It's understandable for a surgeon to see corrective action in terms of surgery, but you might ask them about this study:
Knee Surgery - Arthroscopy Results No Better than Pretend Surgery A good surgeon won't be threatened by the discussion.

Even if the surgery is a raging success, strong muscles are essential to stabilizing the joint so that things don't bang together or get out of alignment. I went through your pain phase for several months, and even a year or two later I could have a flareups from significant exertion. I'd go for some sort of anti-inflammatory (800mg of ibuprofen three times a day, depending on body weight, if tolerable) for several weeks to beat the swelling back into submission, along with the very gentle quad/hamstring exercises that don't even hardly bend the knee. The PT will stabilize the knee to stop putting pressure on the meniscus sore spots, and the PT will also teach proper motion (tracking, flexion) to avoid grinding it down any more than it already has. As the muscles get stronger you'll be able to progress to squats & lunges. The stronger the muscles get, the less floppy the knee gets-- and there's less pain, less swelling, less noise, and less funny stuff that can be pushed around with your fingers.

When I get up in the morning, or after an hour in a recliner, the synovial fluid still sounds like popcorn in the microwave. But that's no worse than cracking knuckles.

Cb has had pretty significant knee surgery, including an attempt to rebuild cartilage, and Deserat has finished rehab from her ACL reconstruction. You might want to PM them about their meniscii.

Surgery is a personal decision, and whatever makes you comfortable. If the loose cartilage has worked its way into a joint and is preventing range of motion then surgery is probably a good idea. But every time I approached a surgical decision I felt like I was turning myself in for sentencing, and I finally met a martial-arts conditioning coach who'd come back after a bad car accident. His first knee surgery didn't go well but he did the post-surgical PT on both knees at the same time, and the second knee responded so well to the PT that he didn't need surgery.

There's also a lot of shared misery & good advice at Knee1.com - Community, Knee Blogs, Knee Forums, ACL Injury, Patient Stories
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Old 01-28-2010, 08:59 AM   #15
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Thanks for the suggestion re physical therapy. I have had PT for my back several years ago and the results were amazing (I was so convinced it would not make any difference--wrong). I was diligent at doing the prescribed exercises at home, too. So I am certainly open to that. The ortho drs.' office has a full physical therapy department, and I imagine they would suggest that if it would be effective.

My knee is in constant pain in a very specific spot (so bad it wakes me up at night, no matter what position I am in). It locks up on me, and it makes lots of interesting clicking and popping sounds. The diagnosis, confirmed by the MRI, is a torn meniscus with no osteoarthritis. It's been bad for six weeks now and not getting better. The surgical procedure sounds minimal and straighforward (they said it could be done under local anesthesia, too), but I would love it if PT alone would be the answer--I'll discuss that with the physician's assistant or the doc. when I talk with them.

It is a pretty simple procedure . It usually takes about a half an hour and the Surgeon basically shaves the meniscus . When the meniscus is torn it gets caught in the knee joint and that is what causes the locking and pain . They usually do it under local anesthesia with sedation . Afterward you are given instructions and sent home with instructions to keep the knee elevated and iced . They'll also give you some pain medication . Patients usually need that for the first two days and then they return to Ibuprofen .They most important thing is to keep it iced . Good Luck with your knee !
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Old 01-28-2010, 06:10 PM   #16
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Travelover,

If you haven't done so already, you might call and ask to speak to your doctor's assistant or secretary - or someone in a similar capacity - and ask "Why is a follow-up visit required? I pay full freight and am trying to watch expenses." Most dr's offices that I have dealt with, will understand. If your dr. needs to make you aware of more than, "Here are your results! Aren't they fascinating! See you next year," they will probably tell you so.

Good luck,

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Old 01-28-2010, 06:58 PM   #17
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Travelover,

If you haven't done so already, you might call and ask to speak to your doctor's assistant or secretary - or someone in a similar capacity - and ask "Why is a follow-up visit required? I pay full freight and am trying to watch expenses." Most dr's offices that I have dealt with, will understand. If your dr. needs to make you aware of more than, "Here are your results! Aren't they fascinating! See you next year," they will probably tell you so.

Good luck,

Amethyst
Thanks, I'm thinking along the same lines. I may just ask them to mail me the results to ensure any really bad news doesn't just fall into a crack.
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Old 01-28-2010, 10:07 PM   #18
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Interestingly enough I got a call from my Drs office today and they have asked me to go in tomorrow to review my blood work results, specifically hormones and cholesterol. I think because of the hormones she feels the need to see me in person to go over it and I am expecting that if she mentioned the cholesterol it must be bad which I find surprising.
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Old 01-28-2010, 11:52 PM   #19
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This sparked a memory of a blood test I had a couple years back. I was told that the results couldn't possibly be faxed to me or read over the phone-- I had to come in. So I made an appointment.

When I arrived, "my" doctor wasn't available and a different doctor came in. She looked at the numbers for what was obviously the very first time and didn't notice the HDL/LDL/TGL spreadsheet of my last 20 years that I'd helpfully tucked into the record. But she launched right into the "lower your cholesterol" lecture, provided a couple flyers, and offered to write a Lipitor prescription plan right there...

So maybe there's not actually any bad news. Maybe there's just a policy of making the most of every opportunity, whether it be due diligence or medication marketing.
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Old 01-29-2010, 05:49 AM   #20
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I think maybe your doctor likes you better than mine likes me. I recently visited my PCP as I had not had fasting blood work for almost 10 years. Also my right shoulder was hurting a bit after a gym work out. I followed through with the blood work and also had the X-rays of the shoulder. Got back a thick envelope from her with all the results and her recommendations plus referral for physical therapy (for tendinitis of the shoulder) and a script to repeat blood work in 6 months to a year(good cholesteral and CRP and triglycerides all excellent but bad cholesterol was 210).
Correction: my total cholesterol was 210, my bad level was 126. An LDL of 210 would have me on Lipitor right now!
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