What to Expect From a Doctor Today?

[Dawg52]

How do you guys get bloodwork? My doc doesn't order any and claims they've always been normal so why repeat them. I'd just like to be aware if there are any changes. Guess I have to get sick for him to dig any deeper.

In my case I take a statin so he runs a cholesterol test every year along with a few other markers. And last year my PSA number jumped up quite a bit but returned to normal 6 months later. So I want another one run this time(Oct) to make sure it is still on the low end range. I may have to pay for it but that's ok.

 

[MRG]

I went to our "patient portal" and saw that my last blood work was in August of 2016. I think I remember the doc saying that I could get another one at five years.

You need a new doctor.

 

[braumeister]

You need a new doctor.

+1

Who works for whom?

 

[Goonie]

I switched doctors a little over a year ago because I was very dissatisfied with the care that I was receiving. I'd been going to him for almost 30 years, and for most of those I felt that I was getting the care and attention that I needed. However, for the last couple of years, it became a 10 minute visit for b/p and a cold stethoscope, with very little inquiry into how I feeling or if I had any concerns, and he'd gotten very crotchety and kind of rude.

I was talking with an older couple that I know, and the conversation turned to doctors. I mentioned my dissatisfaction with my then correct doctor, without naming names, and they said they'd experienced the same thing with their former doctor, and said it sounded like the same guy. He said who theirs had been, and it was the same one. They recommended their new doctor, so I made an appointment to go in and talk to him. I switched that day, and couldn't be happier with the care I receive. He obtained all of my medical records from my old doctor, and was astounded by the lack of thorough exams and routine tests or bloodwork through all of those years. He changed that and gives thorough exams and has performed all of the necessary routine tests. Plus, he sits down and actually visits before he gets down to business....and he's never in a hurry or rushing to get rid of you. A normal visit is about 25-30 minutes, or bit longer with bloodwork. One other thing that I'm quite happy about is that he's a D.O., which is what I was looking for.

Feeling bad/guilty when dissatisfied with your doctor seems common, because we sometimes tend to build a fairly personal relationship with them over time. But I think that's unnecessary. Your car is also important to you, and nobody would think twice about deciding to switch to a different mechanic/repair shop.

I had a 25 year relationship with my PCP and switched a few years ago because I was no longer satisfied with the level of care I got (and a couple of other reasons). I really liked the guy, and still do, but he no longer met my needs.

I interviewed 4 or 5 new docs, and picked the one who ticked all the right boxes. Several years later, I'm still sure I did the right thing.

 

[RetMD21]

+1

Who works for whom?

Precisely, your doctor works for the insurance company and is more responsive to their desires than yours. Also they may be judged by metrics that encourage less utilization.

 

[MrsHaloFIRE]

I go to a family practice FNP as my PCM. Her office will supposedly do pelvic exams and pap smear but I'm not interested. I want someone who all they do is pelvic. Last time at the gyn my NP who I love asked if her student could observe. He was a family practice MD and they were trying to move normal pap smear to them. Yes he can observe. No I would never go to him for that. (Military medicine teaching hospital).

 

[MrsHaloFIRE]

How do you guys get bloodwork? My doc doesn't order any and claims they've always been normal so why repeat them. I'd just like to be aware if there are any changes. Guess I have to get sick for him to dig any deeper.

I think you can order some yourself thru labcorp etc. DH has thorough bloodwork twice a year. Blood and urine.

 

[target2019]

How do you guys get bloodwork? My doc doesn't order any and claims they've always been normal so why repeat them. I'd just like to be aware if there are any changes. Guess I have to get sick for him to dig any deeper.

As others have mentioned, I'd be worried about this. Ideally you'd want to have a baseline of normal results (since you're well) over time. When you get sick and bloodwork is ordered out-of-range results will set off more "investigation" that may not be necessary. Say you have low LDL, but know this is genetic and have had the low result forever. That's an easy one, but there are more serious things that happen to everyone as they age.

 

[RAE]

I think you can order some yourself thru labcorp etc. DH has thorough bloodwork twice a year. Blood and urine.

Right, but insurance doesn't pay for that (at least mine). If my doc refused to order blood tests that I thought were important, I'd find a new doctor. One of the main reasons I have my annual check-up is to get some blood tests done (which I monitor myself for changes). I pay plenty for health insurance...........the least they can do is cover my annual blood tests (and they do).

 

[RetMD21]

Insurance will probably only pay for recommended tests
No urine test
PSA for men
blood sugar and lipids for men and women
very limited physical exam
Colon/cervical/breast ca screening and counseling (ie stop smoking)
Here is the Cleveland Clinic's version which is more extensive than some: https://my.clevelandclinic.org/ccf/media/files/Health/health_maintenance_guidelines.pdf

 

[OldShooter]

Insurance will probably only pay for recommended tests ...

This will be a concern for many, but for some of them -- especially the FI -- I think it shouldn't be.

What better to blow the dough on than our health? I'd fight a disallowed claim tooth and nail but in the end if it is something important to my health I will pay. I will also pay up front for a non-covered test if my doc tells me it's important.

 

[RAE]

Insurance will probably only pay for recommended tests
No urine test
PSA for men
blood sugar and lipids for men and women
very limited physical exam
Colon/cervical/breast ca screening and counseling (ie stop smoking)
Here is the Cleveland Clinic's version which is more extensive than some: https://my.clevelandclinic.org/ccf/media/files/Health/health_maintenance_guidelines.pdf

I have quite a few more blood tests done every year than those on your list, and more than the Cleveland Clinic's list also, and Blue Cross/Blue Shield has always paid for all of them. And they should, considering what I pay them every year for health insurance!

 

[grasshopper]

My experience with lab test and YMMV, is that once diagnosed repeat testing that is medically necessary are covered.

 

[RetMD21]

This will be a concern for many, but for some of them -- especially the FI -- I think it shouldn't be.

What better to blow the dough on than our health? I'd fight a disallowed claim tooth and nail but in the end if it is something important to my health I will pay. I will also pay up front for a non-covered test if my doc tells me it's important.

Sure even if they aren't generally recognized as useful there isn't much harm. I get HgbA1c in addition to blood sugar. Insurance doesn't pay (as a screening test) but I benefit from the 90% discount from list price. I could order zinc levels and all sorts of things but I doubt the utility so I just take a supplement.

 

[Happily Retired2019]

Medicine has become a business-patients have become an account number and what kind of insurance you have. You are lucky if you do not have to wait at least 45 minutes to see your doctor when you make an appointment. I have worked in the field of healthcare for 35 years and watched it go from good to horrendous -and it is not finished yet. Help us all

 

[Mansderm]

I order my own blood work through Life Extension during their annual blood test sale every year. I pay for it but it's a bargain. Plus I can request screening for things I worry about. I can check all my hormones. You prepay, then a lab request for Lab Corp is sent to you. You make an appointment at the lab Corp near you at your convenience. I still pay for insurance. Since there is no qualifying diagnosis submitted to insurance to check all this, I don't see my insurance rates increasing dramatically. I have a high deductible plan anyway so I'd likely pay anyway. I take the results with me to my doctor to review at my annual physical.

 

[davebarnes]

You are lucky if you do not have to wait at least 45 minutes to see your doctor when you make an appointment.

Not for me.
Kaiser. Medicare.
9 minutes.

 

[Dash man]

I rarely have to wait more than five minutes. Love my doctors!

 

[RAE]

Medicine has become a business-patients have become an account number and what kind of insurance you have. You are lucky if you do not have to wait at least 45 minutes to see your doctor when you make an appointment. I have worked in the field of healthcare for 35 years and watched it go from good to horrendous -and it is not finished yet. Help us all

You are right that medicine has become a business........no doubt about that. I don't have to wait that long to see the doctor, but the short wait is not the problem. The real problem is that the insurance companies and big pharmaceutical companies are in control of medical practice these days. So, the insurance companies tell your doctor what tests they should be ordering, and what meds are approved/not approved for each diagnosed condition. The big pharma companies tell the doctors what meds they should be pushing (statins, for example), because they are the big money-makers, whether or not the latest research supports their use. It's a mess, as you say, and not likely to change much as long as big money continues to drive the system. I'm sure you know more about all this than I do, since you worked in the field for a long time.

 

[Ian S]

The big pharma companies tell the doctors what meds they should be pushing (statins, for example), because they are the big money-makers

Folks keep claiming statins are big money-makers but I don't see how. I have the cheapest Part D drug plan available and my cost for generic atorvastatin is $0.00 i.e ZERO cost. Also my cost for metoprolol is, you guessed it, $0.00. Likewise for my prescription ppi for reflux.

 

[momoftwo]

Im glad to be retired.
But my new part time job is battling for correct processing of my medical claims.
I have excellent actual coverage via a retiree medical plan from ex-employer. For which I am very grateful.
But today I spent about 3 hours speaking with Dr office, Doctors billing office, insurance customer service and finally with my Dr office business manager.

Was hospitalized recently. Several days of inpatient dr visits. Then followup outpatient visits, some telemed, some in person.
Each claim had errors. All processed as though dr was out of my provider network when he is not.
Several handled as telemed that were not. One telemed visit denied completely as my employer had not updated CPT code for telemed visit in their system as being a covered code.

And this all is just for dr claims. Still need to address hospital and ER and urgent care claims.

Time for a swim.

 

[street]

Every year in the month my birthday is, when the local small hospital does blood work for a very low cost to anyone that wants one.

I believe it is a 24 panel and you can have the PSA also. Then those tests are sent right to your doctor for them to review and filed.

 

[fruitful]

My new (5years so far) PCP is a DO. The only time she was not available to me was during her pregnancy with twins. The app for her practice allows me to send emails directly to her and she responds quickly. She orders bloodwork if needed or if I request something specific. She will look at anything I ask her to look at during a visit. She coordinates with my two specialists so I do not have to repeat bloodwork. This DO is part of a large hospital/medical care business - same as my previous PCP.

Previous PCP (30 years) was an MD but he always (30 years) spent adequate time with me and he knew my history. He would also order bloodwork if needed or if I requested it. He would still be my PCP if he had not retired early.

I have federal BCBS medical coverage and I live in a large metropolitan area so I am privileged to have many choices.

If service becomes an issue, I will look for concierge care.

 

[NeverBored]

Last year, DH and I switched to a local internist who is not affiliated with Medicare. She does not bill insurance for office visits, but will give you a superbill so you can submit a claim yourself. She spent over an hour with each of us at our first visit, ordered bloodwork and suggested some tests. After getting test and blood results, we had follow-up visits that were 40-60 minutes. She spent quite a bit of time discussing lifestyle, diet, supplements (sent us home with a few pages of what she recommends) - all the things that the former internist wouldn't address in his seven-minute visits.
She also communicates by email, and will call us with test results if she doesn't think a visit is necessary. Everything she has ordered has been covered by Medicare, including Coronary Artery Calcium Scans.

Friends of ours complain about their doctors constantly, but balk at the thought of paying $225 for an office visit. That's the price of a nice hotel room for a night - my health is worth it.

 

[Venturer]

Medicine has become a business-patients have become an account number and what kind of insurance you have. You are lucky if you do not have to wait at least 45 minutes to see your doctor when you make an appointment. I have worked in the field of healthcare for 35 years and watched it go from good to horrendous -and it is not finished yet. Help us all

Funny that I can totally relate to your comment. I just had my 6 mo. check up. Week 1nurse visit,8:30am appt.arrive at 8:15 called back at 9:00 am sit in room till 9:25 nurse comes in takes BP draws blood,ok see you next week.week 2 get call from Dr. office to change appt. time from 8:30 am to 11:45 because of scheduling conflict. Ok I inform them that I already have another Dr. appt. with Orto. Dr.at 1:30; no problem she says. I get to appt. at 11:30 & sign in. at 12:10 I go up to window and remind them I'm here.Then at 12:18 I'm called back to exam. I tell nurse how long I've been there and remind her I have another appt. with ortho.Then at 1:05 I open door and start to leave. Nurse says you need to go back in room, I tell her to just email me my test results because I ahve to get to me other appt. that I told them about,and that if I get charged for this time sitting in his room I will contest it. I get to my ortho pre op visit at 1:25 and am leaving his office by 2:20 with all paperwork instructions in hand. I will be trying to find a new PCP before my next 6 mo. visit.-----Rant over sorry!