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Old 08-18-2014, 07:38 PM
 
Location: Mid-Atlantic
22,833 posts, read 21,884,037 times
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Quote:
Originally Posted by fisheye View Post
Actually I don't know how many problems with specialist are caused by the new health care? We had our family physician, that just retired, that told us (when I asked about the new health care system): "Don't get sick!" I do know that programs like 'EMTALA' (EMTALA) have hurt the whole system - somebody always has to pay.
I've been running into this with my "health care provider" for more than a few years now. There are a lot of people in that office, and every time I go, I see a few new faces. I don't like that at all. When I was kid, our family physician knew everything about me. He was in the delivery room when I was born. He also assisted in my two surgeries when I was a teenager. He didn't need to look at a file; he knew everything about me.

I went to see one of the doctors recently. In addition to a couple of required tests, he also ordered a colonoscopy and a mammogram. Can't that wait until we've figured out the other problems? He failed to order basic lab work. He wanted to send me for a hearing test before a major wax impaction was cleared from one ear. What are these people thinking... or not thinking.
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Old 08-19-2014, 06:52 AM
 
1,482 posts, read 1,398,345 times
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Quote:
Originally Posted by Gerania View Post
I've been running into this with my "health care provider" for more than a few years now. There are a lot of people in that office, and every time I go, I see a few new faces. I don't like that at all. When I was kid, our family physician knew everything about me. He was in the delivery room when I was born. He also assisted in my two surgeries when I was a teenager. He didn't need to look at a file; he knew everything about me.

I went to see one of the doctors recently. In addition to a couple of required tests, he also ordered a colonoscopy and a mammogram. Can't that wait until we've figured out the other problems? He failed to order basic lab work. He wanted to send me for a hearing test before a major wax impaction was cleared from one ear. What are these people thinking... or not thinking.
If you're over a "certain" age, the colonoscopy and mammogram are routine tests.

Regarding the old time doctors and comparing them to physicians of today, it's an unfair comparison. Doctors today really have so much more on their plate than ever before... A larger population to serve, an aging population in general. If they're affiliated with a teaching hospital- there's med students, residents and interns to teach both onsite and in the confines of a classroom. There's CME credits to earn, the ever changing medical literature to keep up on, conferences to attend, etc.

Honestly, I'd rather have a doctor current on the literature than one who doesn't need my file for review. I like a doctor that takes a focused history and performs a intensive physical exam.

With that being said I work in medical education and have first hand experience about all the things doctors are required to do outside the scope of direct patient care.
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Old 08-19-2014, 07:19 AM
 
Location: Swiftwater, PA
13,260 posts, read 10,647,373 times
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Quote:
Originally Posted by charmed hour View Post
With that being said I work in medical education and have first hand experience about all the things doctors are required to do outside the scope of direct patient care.

I do think that Gerania has some points. While it is great that our physicians are up to date with all of the latest meds and treatments; it is also great if they know your name! How many times have you been to one of your physicians and they did not know your name until they pulled your files on the computer or the nurse handed them your folder? I am not just talking about first visits - I am talking about doctors that I have seen many times over the years.

We have one physician's assistant that I cannot praise enough. Both me and my wife feel that she really cares about us as people and not numbers or paychecks.

Almost no doctors or specialist leave us with that feeling. Many seem to just be pushing the latest meds and samples that they received from their well versed and over paid pharmaceutical sales people. What kind of perks do doctors get from the pharmaceutical companies? It has to be lucrative for both the companies and the doctors to have so many salesmen/women lined up to see our doctors? Of course I did not like it when the FCC allowed the drug companies to advertise.
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Old 08-19-2014, 10:46 AM
 
2,675 posts, read 2,835,214 times
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IMO (I'm NOT a med pro...just a patient who knows other patients.)

Doctors, PAs, nurses and other health pros see many more patients today than years ago. For example PAs, clinics, and some specialties/ists didn't exist. Many of today's tests were unheard of.

Today, the pace is accelerated. Simple chats are about all one can expect from most practitioners, especially specialists. Decades ago, a doctor might stop by a house carrying his tool-bag and have coffee and pie. He (very few shes back then) got to know the pet's names. He probably saw 10 people a day, had 20 meds to prescribe, and read the latest medical info a few hours a week in a magazine/journal mailed to his office.

Insurance, lawsuits, technology, meds, government, specialists, computers, and knowledge/information make modern health care different and more complex. These 'tools' speed up diagnosis, treatment, and improve outcomes...but of course it still isn't perfect...this could take a while.

Patients now see ads all day and night for the latest drugs...they can go online and pretty well do self diagnosis for many conditions and self recommend treatment with better results than many doctors ten or twenty years ago. Over the counter meds are a lot better too...

To me, practice of today's 'medicine'/health care is more science than 'art' compared to decades ago. (The term 'bedside manner' to describe a doctor's skills/value isn't as important today.) 'Success' with common problems was probably more dependent on the individual doctor 'back then' vs. now (BUT it DOES still matter...a lot).

Despite the critics, there must be a HUGE difference in treatment quality and results compared to even 10 or 20 years ago in many disease areas...and based on progress now being made...will continue to improve rapidly in many of these.

Unknown and scary (to me) are the affects of the tinkering with the system by insurance and government, which control/influence the two critical areas of cost and access to treatment. Time will tell...

In retro/future-spect, it's unlikely doctors will stop by your house again but, never say never, technology advancement is amazing. Someday he/she may 'visit' after your smart phone alerts his system and suggests a treatment. S/he can contact you and chat about it. I'm not sure about the pie and coffee.

Oh, and I believe many aspects of 'routine' health care in NEPA are adequate and comparable to anywhere, sufficently so to make it 'unnecessary' to travel long distances for them. For the tougher stuff it is probably often better in (and nearer to) NYC and Philly...or even Boston, Houston, etc. These metro areas are centers of progress with a critical mass of doctors, researchers, universities, hospitals...and not incidentally patients and $$$$. Even so, NEPA is comparable to, or better than, many other areas of the country and the world, and close enough to access the big guns if so required. BUT the bottom line is nothing in health care is yet perfect, even in the biggest and best cities.

Sorry for the tome...it just happened. (I don't recall the OP so if off topic I apologize.)
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Old 08-19-2014, 12:12 PM
 
1,482 posts, read 1,398,345 times
Reputation: 1991
Quote:
Originally Posted by fisheye View Post
I do think that Gerania has some points. While it is great that our physicians are up to date with all of the latest meds and treatments; it is also great if they know your name! How many times have you been to one of your physicians and they did not know your name until they pulled your files on the computer or the nurse handed them your folder? I am not just talking about first visits - I am talking about doctors that I have seen many times over the years.

We have one physician's assistant that I cannot praise enough. Both me and my wife feel that she really cares about us as people and not numbers or paychecks.

Almost no doctors or specialist leave us with that feeling. Many seem to just be pushing the latest meds and samples that they received from their well versed and over paid pharmaceutical sales people. What kind of perks do doctors get from the pharmaceutical companies? It has to be lucrative for both the companies and the doctors to have so many salesmen/women lined up to see our doctors? Of course I did not like it when the FCC allowed the drug companies to advertise.

I can agree with some of what you're saying. It would be wonderful if I walked in the door and it was Cheers-eque: "NORM!!" Unfortunately, that's not the case anymore. The average PCP has about 1,500 patients in their practice and for some that's a low end number.

Considering most patients maybe visit yearly, if that, it's an unrealistic expectation for a practitioner to know your name. Now, if you're there weekly for close monitoring of a condition, then yes I'd expect the entire office to know me on sight.

Regarding pharmaceutical incentives, gone are the days of big "presents" from the reps. Most physicians' offices receive pens, clipboards, some exam table paper from reps along with the samples. Some may drop off a couple of pizzas for the staff.

Most doctors prescribe medications based on a patient's insurance and what is covered. They may offer you some samples to take but if it's a maintenance medication they're going to prescribe based on what your insurance will cover. Ever been to the pharmacy and been told the prescription requires a prior authorization or that the specific drug isn't covered? That's your insurance coverage kicking in rather than the doctor wanting to prescribe only certain meds. My PCP routinely checks my insurance info before prescribing. Only once did I have something kick back and her office called immediately to do the authorization.

Last edited by charmed hour; 08-19-2014 at 12:24 PM..
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Old 08-19-2014, 01:32 PM
 
Location: Swiftwater, PA
13,260 posts, read 10,647,373 times
Reputation: 9452
Quote:
Originally Posted by charmed hour View Post
Some may drop off a couple of pizzas for the staff.

Most doctors prescribe medications based on a patient's insurance and what is covered. They may offer you some samples to take but if it's a maintenance medication they're going to prescribe based on what your insurance will cover. Ever been to the pharmacy and been told the prescription requires a prior authorization or that the specific drug isn't covered? That's your insurance coverage kicking in rather than the doctor wanting to prescribe only certain meds. My PCP routinely checks my insurance info before prescribing. Only once did I have something kick back and her office called immediately to do the authorization.
Heck; I would sell out my patients for a few good pizzas!

I still do not like the idea of salesmen or advertisements to our medical professionals. I would much rather see our doctors educated, at the university, as to which medication is best for any individual or particular disease. The idea of taking the company's word, for the value of the medication, just doesn't sit right with me.
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Old 08-19-2014, 05:24 PM
 
1,482 posts, read 1,398,345 times
Reputation: 1991
Quote:
Originally Posted by fisheye View Post
Heck; I would sell out my patients for a few good pizzas!

I still do not like the idea of salesmen or advertisements to our medical professionals. I would much rather see our doctors educated, at the university, as to which medication is best for any individual or particular disease. The idea of taking the company's word, for the value of the medication, just doesn't sit right with me.
The issue with staying educated on medications is an ongoing conversation in med ed. First year med students take an intensive pharmacology course and that's it thru the 4 years. The clerkship year will give them some further education and experience specific to patient population. Many younger graduates will carry a pocket guide and refer to it frequently during residency and internship.

Beyond that staying up to date is expected thru reading medical literature and hands on experience. That's where Big Pharma comes into play.
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Old 08-20-2014, 08:31 AM
 
Location: Mid-Atlantic
22,833 posts, read 21,884,037 times
Reputation: 27891
Quote:
Originally Posted by charmed hour View Post
If you're over a "certain" age, the colonoscopy and mammogram are routine tests.

Regarding the old time doctors and comparing them to physicians of today, it's an unfair comparison. Doctors today really have so much more on their plate than ever before... A larger population to serve, an aging population in general. If they're affiliated with a teaching hospital- there's med students, residents and interns to teach both onsite and in the confines of a classroom. There's CME credits to earn, the ever changing medical literature to keep up on, conferences to attend, etc.

Honestly, I'd rather have a doctor current on the literature than one who doesn't need my file for review. I like a doctor that takes a focused history and performs a intensive physical exam.

With that being said I work in medical education and have first hand experience about all the things doctors are required to do outside the scope of direct patient care.
Yeah, I know. I learned a lot about modern medicine when my friend decided to go to med school in her thirties. All of her friends felt like they went to school with her. I still don't like it.

Doc was a terrific diagnostician. He was written up in med journals a couple of times for finding rare disorders in a patient. He sent them to NYC or Philly for confirmation and treatment. He worked ER nights because he was bored.

I just looked him up online and found that he died in March at the age of 88. He really was one of a kind.

I'd still take him over the guy I'm seeing now. The old doc knew his meds. The old guy knew what he could do and what he couldn't do. I avoid going to my health care provider, my management team. I am just one cow in a herd.
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Old 08-20-2014, 12:39 PM
 
Location: Mid-Atlantic
22,833 posts, read 21,884,037 times
Reputation: 27891
Quote:
Originally Posted by fisheye View Post
Heck; I would sell out my patients for a few good pizzas!

I still do not like the idea of salesmen or advertisements to our medical professionals. I would much rather see our doctors educated, at the university, as to which medication is best for any individual or particular disease. The idea of taking the company's word, for the value of the medication, just doesn't sit right with me.
Pizza'a OK. They used to get trips to Vegas and Florida.
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Old 08-20-2014, 03:00 PM
 
Location: Swiftwater, PA
13,260 posts, read 10,647,373 times
Reputation: 9452
Quote:
Originally Posted by Gerania View Post
Pizza'a OK. They used to get trips to Vegas and Florida.

That, in itself, could make some chose any medication over another. I am not sure if our doctors do not get more than a free calendar. I cannot picture any 'specialist', that gets paid fantastic money, to donate their precious time to pharmaceutical companies - just to get better educated and a calendar and a few pens. I have been in a few doctor's offices that the salespeople outnumbered the patients.

I am not even crazy about the 'free' samples. I love 'free'. But free could give you not the best alternative to treat your particular affliction. Even physicians, that want to save you money and help you, might not prescribe what is actually best for you.

I don't know - I guess that I am a hard sell. I would still take the advice of our physician's assistant over many doctors here in NEPA. I know that she is in close contact with our primary physician; it is just that she reminds us of the caring 'old' system (that we are not willing to throw away).
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