You guys are great, as usual. Special thanks to all who sent PM’s with your favorite PCPs name and contact info. I’ll thank each of the latter individually as I get to them.
Many of you seem to have the same concerns, frustrations and desires that I have.
For me, it’s not that I necessarily want all the benefits that a concierge doctor provides, but I want something better than the experience I’m getting. It’s too much like a fast-food joint with me walking out with a [-]burger[/-] prescription in hand and the suspicion that I got a one-size-fits-all outcome – and a slew of questions that are just starting to arise. A follow-up visit to answer those questions is expensive and time wasting. A telephone call to ask for clarification is actually three telephone calls over two days before you
maybe talk to the doctor, or
maybe a nurse, or maybe
somebody named Gloria who is patronizing and clearly just passing on a response that she doesn’t understand and can’t explain. Email a question?
We don’t do that here.
Do you have any docs among your friends? Maybe a PM to Rich_in_Tampa?
He will be along soon.
Concierge medicine is a business model. It has no bearing on quality of care or outcomes in my experience.
Speak of the [-]devil[/-] doctor...
No disagreement here. However, while I concur that just because you paint the word “concierge” next to “Dr. Bob Dog” on the front door of one’s office does not make it what I would think is actually a concierge practice. At least not in the sense of what I’m looking for.
However, on the opposite side of all this is that other than the clinic inside my local grocery store, few docs are hanging out shingles proclaiming themselves, “Medico Rapido!”
Which leaves the giant faceless crowd of all the others.
I suggests calling the nurses at a local emergency room and asking who their favorite internists are. Certain names will probably pop up over and over. That's your doctor.
That sounds like a great idea, but, my past experiences tell me the odds are against me on that working out. That past experience being onetime boss of the “Doctor Squad”, which was the guys that went around investigating pharmacists and physicians and their drug dispensing proclivities. Like most other professionals (and regular folks), there was no bad-mouthing of peers until you handed them the federal grand jury subpoena. Only then would Dr. Bob Dog admit that maybe his colleague wasn’t actually a “fine physician” and - truth be told – Bob wouldn’t want her near his kid’s hamster much less an actual human being (an actual quote). My suspicions my call to the ER as Mr. Leonidas would be a different experience than Dr. Tampa’s similar request. Not that I think I would get bad information as much as I suspect I would get nothing with a cold call like that.
Edit to ad: I've overcome my callous cop attitude and am going to give it a try.
However, I have been to other doctors in that 18 months. Since the internal med guy is all about arteries, when you break a bone he cannot help you. If you get a kidney stone, he cannot help you. If you have something wrong with your heart, he sends you to a cardiologist. So while he is a good listener and a good health coach, he is mostly into preventative medicine (think statins, exercise, and don't smoke). He will prescribe antibiotics if you need them. But the reality is, he is sending you to someone else.
I had not considered the internist vs some other kind of doc as the PCP question. Thanks for discussing it.
How to find them? Just ask your friends and colleagues. If one of these doctors exists near you, someone knows about them. They do not have to have concierge plans. They just need to be happy talking to patients.
That’s one of the directions we’re working on. My dentist is a former neighbor and he runs his practice similar to what I would like to see from a physician, and I will ask him or recommendations at my appointment next week. The DW is going to toss out the question tomorrow night at the neighborhood ladies’ dinner.
I'm not sure he knows he's my PCP, but he does include what I ask in my blood tests, or other diagnostics, and seems very willing to discuss any health issues with me or make referrals to specialists. He's a smart guy. But he is only reactive -- I have to bring things up, or they don't come up. I'm really not sure whether I should be looking for a better arrangement.
Having the responsibility of bringing stuff up is okay with me, but the reaction I’ve been getting from my soon-to-be former PCP is terrible. “Oh, and I wanted to ask you about X”, almost always gets a nod and a response that’s not very responsive. Like I said, the dude moves so fast that the last couple of times I have found myself standing by the elevator short some cash, holding a scrip, and realizing, “Hey, he never answered my question.”
What is needed is a health coach with the power to prescribe medications, the know-how to work with the specialists, the time to devote to the problem, and a steady focus on a plan of action that is longer than 10 minutes.
Agree. The group that I have received multiple recommendations about makes this as one of their premier attributes. The old insurance required referrals to specialists, and my PCP forgot all about it once the referral was made. With no referrals needed on my new plan I really want someone who is going to keep track of what I may have going on with outside treatments.
Have you considered a nurse practitioner?
Not at all. I’ve googled the term and see it’s a wide field. How would I work such a professional into the picture in conjunction with a PCP?
My doc (internal medicine) started a sort of halfway-concierge practice (he calls it "priority access") a couple of years ago. His main goal was simply to limit the number of patients he has to see, as he was feeling overstressed by the workload.
It works this way: He still sees anyone, but limits his availability. For those of us who want to be in the program, we pay a $350 fee at the start of the year. In return, we are guaranteed same-day appointments when we need them, and he spends as much time with us as we need during visits. He also takes care of any paperwork (letters to employers, etc.) and will handle phone inquiries. He also has a habit of calling to check up on progress after any significant interaction.
He's a great guy, and a superb diagnostician, and we really like him, so we're very happy with this arrangement.
While all the ease of access benefits are nice, I’m really looking for that last set of characteristics (great guy, superb diagnostician – and I assume takes his time to listen and explain).
I would also be informed about generally accepted time lines for testing, like colonoscopy after age 50 (earlier if there is a family history), mammogram annually, body check by dermatologist annually for skin CA, etc.
Excellent point. I have not been as assertive about this with my current PCP as I should have been. However, as I mentioned above, the few times I have tried to bring some of these things up it has been pushed aside. One of my biggest complaints about the guy is that he is focused on getting me out of his office. Usually I get a two-five minute talk about whatever I made the appointment for and then he jets out of the room. There I sit thinking, “maybe he’ll answer that question when he comes back in.” The next thing I know the nurse is handing me a scrip and pushing me toward the check-out line.
We all know about diet and exercise. My health plan encourages me periodically to call my "personal health advocate" to discuss my health goals (I ignore this suggestion), even though I am given a name and number in Pittsburgh for this health advocate.
My new plan has something similar, and I’m not sure I will use it either. Something more consistent and more personal is what I would prefer, and I think what they’re offering is going to be someone reading from a script displayed on their screen.
You just have to ask around. You can also check out healthgrades.com and find out what other patients are reporting.
Looking at healthgrades, AngiesList – healthcare, and some other resources. I’m not being over inspired by any of them as comprehensive resources.
One of the hardest things about moving is finding new dentists and doctors. I had the same doctor for 30+ years in the megacity. When I retired we moved to the ranch. We tried a few doctors in the local area and wound up with a family practice in Shreveport. The nurse practioners are just as good as my former long-term doctor.
So, does the nurse work in your physician’s office, or is he/she an outside resource?
You guys are all being a fantastic resource. I’m working on refining my goals/desires on this and will report back if anyone is interested.
Interesting related tidbit: Cigna wants my blood pressure, cholesterol, glucose, weight and height, by July as part of an online assessment.
The assessment analyzes your answers and produces a personal-health report with details about your most important health issues. The report will include suggestions for health screenings and information about wellness and other health programs that may help you improve your health. Based upon your responses, you will also receive an invitation to participate in an online coaching program. You can print a summary of the report to take to your next doctor’s visit. Use it to ask your doctor questions and to learn more about your health.
The results are confidential – they won’t be shared with the city of (MegaCityUSA). CIGNA will, however, use them to identify programs that could potentially benefit you. The personal health team can then help you improve those numbers.
I wonder how useful that will be.
Does anyone else think it noteworthy that the insurance carrier wants to give me advice on my BP, blood sugar, weight, etc?
Is it because they know that PCPs aren't doing such a good job of discussing this simple stuff with their patients?
-ERD50
