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Old 12-01-2012, 02:45 PM   #21
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Perhaps healthy folks receiving physicals and routine innoculations from work (or another source) and not regularly seeing their GP should talk to their GP about the situation. I wouldn't just assume that your doc considers you his patient after many years of unexplained absence have gone by. Or, make an effort to have your own data base of your medical records and have no need to refer to "your" GP.
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Did you send him the results of the employer-provided physicals you had been receiving in lieu of seeing him?
I think that would be a good idea. Now that I'm retired it's not an issue, and when I went in for my first annual physical after retiring I did bring a copy of my previous year's physical report and blood work results.

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I'd say the flu shot cost you $30!
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I wonder if this has something to do with the requirment for electronic records? It must cost something to convert records to an electronic form and why do it for somebody who hasn't been seen for many years?
In my case I believe they had upgraded from one system to another, and even though DW had been attending every year they copied her records over but not mine.
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Old 12-01-2012, 02:46 PM   #22
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That already exists in the case of patients who receive maintenance prescriptions, and many health ins. policies cover annual checkups (and other wellness items) w/o requiring copays, which makes it kind of hard not to see a doctor at least once a year.
Yeah, I understand that. Renewing prescriptions and an annual physical is what keeps me seeing my doc regularly. But, look at Midpack's and Alan's situations. No prescription renewals. Physicals and routine innoculations provided by their employer. So, no family doc visits for years at a time. Are they still considered a patient there? Would it be fair, or even logical, for a med practice to have some sort of "keep in touch" provision in order for you to be considered an active, ongoing patient?

In Midpack's case, it's the med practice not publishing a policy and dropping him without notice that's the issue. I understand his angst. But I'm wondering should med practices have such policies and make them well known?

My guess is that a ridgid policy could not be written that would apply appropriately to all situations. For example, are there other close relatives seeing the doc? How long was the person a patient before the absence took place? Did the patient inform the practice they'd be gone for a while (overseas assignment, etc.)? If the patient is receiving routine services elsewhere, is he keeping the practice informed (perhaps at a modest fee to keep records reviewed and updated)?

I dunno. If the millions of currently uninsured folks that are about to be insured create a wave of demand for GP services, it will be interesting to see how med practices pick and choose among current (but absent for years) patients and the requests to be new patients.
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Old 12-01-2012, 02:51 PM   #23
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There are different types of medical and dental practices. Some are task oriented and are concerned with treating disease. Others are relationship centered and are concerned with treating patients. It's very difficult to be both. I'm sure if you asked to become part of the practice he would welcome you.
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Old 12-01-2012, 04:25 PM   #24
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I grew up going to military doctors. One never had the same doctor twice even for the same problem like broken leg. Then after college, I never went to a doctor for anything for many years. I also worked in a hospital for a time.

I just didn't care about relationship-centered treatment. Nowadays, I have had the same internist for more than 10 years, but see him about once every 3 years. My spouse uses the same doctor and she goes more often. I suppose he could dump me, but so what?

Now if I was on statins and thyroid medicine or taking other medication regularly, I can see where a relationship would be helpful. Otherwise, I don't think so. I think medicine has changed with all the "Doc-in-a-Box" store fronts, so getting in to see someone is no big deal anymore.
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Old 12-01-2012, 05:11 PM   #25
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Maybe that relationship with your doc could come in handy at critical medical condition events. I haven't been in that position but would rather have a GP that knew me and had seen me somewhat regularly. He just might take my situation a little more seriously if I've been a long time patient with a good relationship.
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Old 12-01-2012, 05:33 PM   #26
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I grew up going to military doctors. One never had the same doctor twice even for the same problem like broken leg. Then after college, I never went to a doctor for anything for many years. I also worked in a hospital for a time.

I just didn't care about relationship-centered treatment. Nowadays, I have had the same internist for more than 10 years, but see him about once every 3 years. My spouse uses the same doctor and she goes more often. I suppose he could dump me, but so what?

Now if I was on statins and thyroid medicine or taking other medication regularly, I can see where a relationship would be helpful. Otherwise, I don't think so. I think medicine has changed with all the "Doc-in-a-Box" store fronts, so getting in to see someone is no big deal anymore.
I don't believe that your doc would dump you for not seeing him or her for a few years. However, if I thought my patient believed there was no difference between me and a doc in the box, they would get referred to one.
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Old 12-01-2012, 05:50 PM   #27
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I was only going to the doctor once every 5 years or so. I changed insurance companies about once a year so got a HMO a few years ago so went to thier doctors two years ago. So I hadn't seen a doctor at "my doctor's office" for about 7-8 years. My office doesn't keep doctors so usually you get a new one. They hire residents for 2 years then they move on so I never know the name of a doctor. This year I got a problem so went to a doc in the box who took blood. They wanted to send the results to my doctor but I didn't have one. So I called my doctor's office and got a new doctor. I have seen her several times this year and been referred to a few specialists. At least I have a name now so if she moves on they will give me to the next resident. When I get older I might get a real doctor but for now the residents seem fine and their boss helps them make decisions.
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Old 12-01-2012, 06:25 PM   #28
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I understand the doctor is also a business and if they'd told me what their expectations were/are, I could decide whether I wanted to see him annually (or whatever minimum frequency/$ amount they expect) whether I need it or not. Hopefully they'll share their expectations when I talk with them next week, and give me a second chance.

But does anyone else think it's ironic that if you're healthy, you can expect to find yourself a new doctor every time (more than a year apart) you need something? I was also an Army brat like an earlier post, probably never saw the same doctor twice (they got orders as often as we did), and they managed our health care just fine even though we moved from country to country all over the world!

And we wonder why US health care is basically twice as much per capita (with measurably inferior outcomes) vs the rest of the developed world? Better left unsaid?
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Old 12-01-2012, 08:02 PM   #29
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Maybe that relationship with your doc could come in handy at critical medical condition events. I haven't been in that position but would rather have a GP that knew me and had seen me somewhat regularly. He just might take my situation a little more seriously if I've been a long time patient with a good relationship.
Another thing is that it is more comforting to be under the ongoing care of a Doc that you have come to respect for his knowledge, judgment, and warmth. Although I had no doctor for years, I appreciate having someone in my corner now. Few of us make it to 85 and keel over, usually there is some greater or lesser period and degree of morbidity. Also, I believe it may be hard on docs to not get any loyalty or appreciation. We patients expect them to care about us, not to just perform reasonably well to avoid lawsuits. So I think we should respect doctors, and show that respect to our doctors. Particularly those of us on Medicare, as the Docs sure don't make much money seeing us.

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Old 12-02-2012, 04:16 AM   #30
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Please go to see them and politely ask questions. It may be too late anyway as they may have started the process by contacting your insurance company already.

Please understand that patients we don't see for SIX years may be potential timebombs / litigation waiting to happen : now you may have hypertension, diabetes, COPD, elevated PSA, and be morbidly obese for example at the same time - which may be harder to manage than if caught six years earlier. If you like the guy then follow his recommendations. Don't be a difficult patient, be compliant with meds if any, go once a year, don't be argumentative when they need blood tests, pay for the services provided, and be polite with the MAs / RNs.

I have not read the rest of answers, not sure what others have suggested.

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I plan to drop in personally next week to schedule a physical, politely ask some questions, and see how they react.
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Old 12-02-2012, 09:30 AM   #31
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Please go to see them and politely ask questions. It may be too late anyway as they may have started the process by contacting your insurance company already.

Please understand that patients we don't see for SIX years may be potential timebombs / litigation waiting to happen : now you may have hypertension, diabetes, COPD, elevated PSA, and be morbidly obese for example at the same time - which may be harder to manage than if caught six years earlier. If you like the guy then follow his recommendations. Don't be a difficult patient, be compliant with meds if any, go once a year, don't be argumentative when they need blood tests, pay for the services provided, and be polite with the MAs / RNs.

I have not read the rest of answers, not sure what others have suggested.
How could he be held responsible for any health problems I might encounter of I haven't gone to see him? That seems far fetched.

He never made any recommendations regarding frequency or types of maintenance visits. If he had, I'd have no one to blame but myself for not complying. Being dropped came as a complete surprise, casually mentioned to my DW! If they agree to reinstate me if I agree to annual physicals at a minimum, I'd be fine with that as I mentioned earlier.

We have not been difficult patients in any way, and we have followed his treatment recommendations fully (though it's been much longer in my case). And the relationship has always been cordial, in addition to being a good GP, he's just a nice person.

Again, we'll see what happens when I go attempt to schedule a physical next week. And I have two trivial health questions to ask him about, though they're both a feeble attempt by me to give him something to treat potentially. That's pretty sad IMO, not ideally what 'health care' should be about, but I know people are happily treated unnecessarily all the time.**
**FWIW my Dad was an orthopedic surgeon, my Mom a nurse, I got involved in case management with employees for over 30 years, and I've been reading about health care systems around the world for more than 10 years. Not claiming I'm an expert by any means though.
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Old 12-02-2012, 09:47 AM   #32
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Let me take an extreme example. Let's assume, for argument's sake, you have put 30 pounds on in the last six years. Your doctor does not know this because he has not seen you. You are now morbidly obese, your BP is like 150/90. After six years, you go back today to your clinician for a sinus infection. You get a z pack, go home happy. Within a week, you die of a massive heart attack. In your chart, your encounter today shows " acute sinusitis " + discussed life style changes re: morbid obesity + repeat BP check in 3 weeks, scheduled for annual check up.

Within five weeks, your family takes your doctor to court saying he was negligent, claiming he should have started you on HCTZ or other BP med (take your pick). Who do you think will win in court ? This is adapted from a real life case.


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How could he be held responsible for any health problems I might encounter of I haven't gone to see him? That seems far fetched.
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Old 12-02-2012, 10:56 AM   #33
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All this talk of getting fat reminded me of a shirt seen on a fun-walk recently....
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Old 12-02-2012, 12:23 PM   #34
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All this talk of getting fat reminded me of a shirt seen on a fun-walk recently....
I love it!!
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Old 12-02-2012, 12:59 PM   #35
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Maybe that relationship with your doc could come in handy at critical medical condition events. I haven't been in that position but would rather have a GP that knew me and had seen me somewhat regularly. He just might take my situation a little more seriously if I've been a long time patient with a good relationship.
The current trend is for hospitals to employ physicians called 'hospitalists" (or something similar) so that your primary care physician does not manage inpatient treatment. Hospital care has become so complex most family practice or internal medicine physicians are uncomfortable trying to navigate it because the length of stay paid by insurance is so brief, and the regulatory agency requirements for hospital services are so rigid.

The hospitalist overseeing your hospital care will usually forward a discharge summary to your primary care physician so they can be appropriately involved in any follow-up. But that's about it.

My guess is that the practice manager of the physician you see made the decision about discharging you from the practice assuming you were receiving health care elsewhere. The physician themself most probably didn't know....it's just business...nothing personal.
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Old 12-02-2012, 02:30 PM   #36
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The doctors that DW and I go to will not let us out of their offices until we have made our next appointments.

When one of my doctors left the area, his former office seamlessly made arrangements for me to see another doctor.
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Old 12-02-2012, 02:54 PM   #37
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Let me take an extreme example. Let's assume, for argument's sake, you have put 30 pounds on in the last six years. Your doctor does not know this because he has not seen you. You are now morbidly obese, your BP is like 150/90. After six years, you go back today to your clinician for a sinus infection. You get a z pack, go home happy. Within a week, you die of a massive heart attack. In your chart, your encounter today shows " acute sinusitis " + discussed life style changes re: morbid obesity + repeat BP check in 3 weeks, scheduled for annual check up.

Within five weeks, your family takes your doctor to court saying he was negligent, claiming he should have started you on HCTZ or other BP med (take your pick). Who do you think will win in court ? This is adapted from a real life case.
I'm not an attorney, and I don't doubt that some families might attempt to take a doctor to court under the circumstances you describe. But if the patient had not seen the doctor in 6 years, I have a hard time believing the doctor could be held liable in the end. Are you suggesting the doctor was actually held liable in your "real life case?"

So you know, I exercise 5-6 times/week, eat a balanced/moderate diet, don't abuse drugs/alcohol, very low HR/BP, 6'1" 195 lbs. This thread was about my circumstances, not someone like you've chosen to describe. If I was having problems of any kind, I'd have been to see him then...
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Old 12-02-2012, 02:59 PM   #38
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The current trend is for hospitals to employ physicians called 'hospitalists" (or something similar) so that your primary care physician does not manage inpatient treatment. Hospital care has become so complex most family practice or internal medicine physicians are uncomfortable trying to navigate it because the length of stay paid by insurance is so brief, and the regulatory agency requirements for hospital services are so rigid.

The hospitalist overseeing your hospital care will usually forward a discharge summary to your primary care physician so they can be appropriately involved in any follow-up. But that's about it.

My guess is that the practice manager of the physician you see made the decision about discharging you from the practice assuming you were receiving health care elsewhere. The physician themself most probably didn't know....it's just business...nothing personal.
Not disputing your view at all. But would it not be reasonable to expect the practice manager would alert the patient of their intent to discharge before evidently doing so? Or that the practice would make their expectations known? Maybe others see it as common sense, but if they expect me to have an annual physical with them, I am fine with that - just clue me in.
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Old 12-02-2012, 03:24 PM   #39
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The current trend is for hospitals to employ physicians called 'hospitalists" (or something similar) so that your primary care physician does not manage inpatient treatment. Hospital care has become so complex most family practice or internal medicine physicians are uncomfortable trying to navigate it because the length of stay paid by insurance is so brief, and the regulatory agency requirements for hospital services are so rigid.

The hospitalist overseeing your hospital care will usually forward a discharge summary to your primary care physician so they can be appropriately involved in any follow-up. But that's about it.

My guess is that the practice manager of the physician you see made the decision about discharging you from the practice assuming you were receiving health care elsewhere. The physician themself most probably didn't know....it's just business...nothing personal.
Interesting comments.

Note I have not been in a critical medical condition situation. But I'd hope my doc would pick up on symptoms (pre-hospital, perhaps life threatening) better if I had been seeing him regularly and he was more familiar with Lsbcal's body (then a doc I'd never seen). Seems to make intuitive sense.
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Old 12-02-2012, 03:42 PM   #40
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Not disputing your view at all. But would it not be reasonable to expect the practice manager would alert the patient of their intent to discharge before evidently doing so? Or that the practice would make their expectations known?
I think it can go either way, but in my experience it is common for a medical practice to discharge a patient they have not seen in several years, and not communicate that to the patient. It's certainly courteous if they do, but not the norm I have seen.

I think physician practice managers are used to patients changing physicians without the patient letting the office know they want to be discharged from the practice. My guess is that the practice manager's experience has led them to believe that it's a waste of time and money to try and communicate with patients that have disappeared. The practice manager's job is to make the practice as profitable as possible, and leverage it with active, well-paying clients, so that's where the effort goes.

Again.....nothing personal at all. Probably no one in the practice realizes you are the husband of an active patient, but if you mention this when you visit the office, hopefully they will be able to readmit you to the practice if that's what you want.
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