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Had my apt. at Charlotte Colon and Rectal Surgery Associates this morning. I had Dr. Morrison. I was very impressed and happy with the service. I was in/out in under 30 minutes. Really liked the Dr. he seemed very smart and understanding and easy to work with. Our Physicians
Its Propofol, which = Diprivan, which is VERY commonly used and (as an MD) is what I would use as well. In the scheme of things it is not expensive, and yes, you should be on cardiac/bp/sat monitor the entire time.
Agree with above, if you don't feel comfortable with the MD visit, get a 2nd opinion, or a different group entirely.
I rarely see reason for a 40yo to have a scope unless you have some other Sx/Sx/FHx that is worrisome.
Lastly, EVERYONE needs to have some introspection when posting things like this. Some people (not everyone) definitely want more time that others. While I agree that all questions should be asked/answered, it is NOT realistic to spend 30+ minutes asking questions that can be answered elsewhere (i.e. in the handout, or the RN has gone over). We sometimes get labeled as "brusque" when realistically we're trying to avoid that "1hr late with no apology" situation.
At the end of the day, some MD's are short, but ALSO some patients are long :-) Most of us (MD's) try to stay in the middle.
I was a RN in the UK for 23yrs. I know all about lack of time!
However, I would never not intoroduce myself to a patient ( read my first post). She may have been a PA, NP or RN , don't know.She spent 5 mins with me during which she weighed me and took my BP. Nothing else.
Additionally (again as I posted) info sheets aren't a substitute for the chance for questions and answers.
The info sheet as given to me by the appointment scheduler(non medical), so no chance to ask questions.I did post that the info sheet (which was only instructions about the prep, not the colonoscopy) was inadequate.
The doctor told me they would answer all my questions prior to the procedure. I had to turn up at 10 for the scope at 11. Assume that's when the anesthesiologist would have seen me.
I fail to see how a MD can write on a form that his consult involved moderate to complex decisin making when he spent 10 mins with a patient and didn't take a full history or do any examination.
I was an anesthetic nurse (and dept co ordinator) in cardiothoracic OR for 6 years so do have some knowledge of MAC.
I still think it's overkill to give a GA for a colonoscopy.
He wasn't particularly brusque. An easy way to avoid part of the 1 hr late and no apology would have been for someone to apologise!
I did post that I have had symptoms and have a family Hx of colon cancer, so I know that I need the scope. That serves to raise anxiety levels.
I went to this same practice last year for a consult and never went back. The physician I saw had the initials PP. I sat in the waiting room for an hour and ten minutes without any update from the office personnel. Then after my weight and BP were checked, I was told the doctor would be in. The next person was a young woman. That was puzzling! She said she was a PA, but again didn't introduce herself. At that point I wasn't sure if I was ever going to see any doctor!
When the doctor came in, he seemed to want to talk about things other than my questions. I heard about his children, his hike in the Grand Canyon and even his recent colonoscopy! Only had time for a couple of my questions.
The scheduler was busy at the conclusion of my visit. By the time they called me, the name I had been given for the scheduler was wrong. She had quit. Another office person called and she grumbled about working conditions.
All in all, it was a very uncomfortable experience. For me, I trusted my intuition that something was wrong in this office (what it was, I'm not sure!) and I certainly didn't want to have them do my procedure. I haven't had it done yet, but mine was just a screen.
Sounds pretty typical to me. Overall, I would say 90% of the physicians (IMs or specialists - all the same with the attitude) act like patients are a "bother" and are condescending, sending out the message that we are all imbeciles, incapable of understanding anything about procedures, meds, etc. That paternalistic attitude is not gonna fly with me. I have walked out of probably 4 doc offices to every one I stayed in b/c of this ridiculous attitude of non-disclosure or impatience with my asking questions, especially in re: to side effects, contraindications, mortality rates, etc.
There are good docs; you just have to keep hunting.
Docs refuse to see patients here (typically) unless they have already established themselves as a patient and had a full physical . . . cause the full physical is another reimbursement mechanism, lol. So if you are sick and don't have a doc, GOOD LUCK. Most refuse to see you - and that is from firsthand experience that my family has dealt with since moving back here to Charlotte.
Sorry, missed this!
Yes - I did feel that he treated the whole thing with a very casual attitude. An anesthetic is never to be taken casually!
Something that I wonder too, since speaking to people, is that they want full ansthesia so that they can remove a polyp there and then.
If this is the case, when was someone going to tell me this is what they would do? Half an hour before the procedure? Is it normal practice for them to do that?
The full physical at my PCP was an eye opener. I don't know when it became acceptable practice to listen to someones chest through their clothing. Or to take someones BP with the cuff over their clothing.
At no point did anyone examine my abdomen.
This is my understanding of a clinical assessment
1. History of the complaint including
Symptoms
duration
risk factor assessment inc Family history
Other illnesses, current and previous
Drug history
2. Physical examination
3. Investigations.
I also like to know the benefit/risk of a treatment and will ask questions.
On this occasion after I had asked about sedation I got the impression that it wouldn't be met with approval.
Then when I went home the more I thought about it the more unsettled I felt.
As I said I even called the endoscopy center to ask if an anesthesiologist would be present.
I went to this same practice last year for a consult and never went back. The physician I saw had the initials PP. I sat in the waiting room for an hour and ten minutes without any update from the office personnel. Then after my weight and BP were checked, I was told the doctor would be in. The next person was a young woman. That was puzzling! She said she was a PA, but again didn't introduce herself. At that point I wasn't sure if I was ever going to see any doctor!
When the doctor came in, he seemed to want to talk about things other than my questions. I heard about his children, his hike in the Grand Canyon and even his recent colonoscopy! Only had time for a couple of my questions.
The scheduler was busy at the conclusion of my visit. By the time they called me, the name I had been given for the scheduler was wrong. She had quit. Another office person called and she grumbled about working conditions.
All in all, it was a very uncomfortable experience. For me, I trusted my intuition that something was wrong in this office (what it was, I'm not sure!) and I certainly didn't want to have them do my procedure. I haven't had it done yet, but mine was just a screen.
Had my apt. at Charlotte Colon and Rectal Surgery Associates this morning. I had Dr. Morrison. I was very impressed and happy with the service. I was in/out in under 30 minutes. Really liked the Dr. he seemed very smart and understanding and easy to work with. Our Physicians
Sorry, missed this!
Yes - I did feel that he treated the whole thing with a very casual attitude. An anesthetic is never to be taken casually!
Something that I wonder too, since speaking to people, is that they want full ansthesia so that they can remove a polyp there and then.
If this is the case, when was someone going to tell me this is what they would do? Half an hour before the procedure? Is it normal practice for them to do that?
The full physical at my PCP was an eye opener. I don't know when it became acceptable practice to listen to someones chest through their clothing. Or to take someones BP with the cuff over their clothing.
At no point did anyone examine my abdomen.
This is my understanding of a clinical assessment
1. History of the complaint including
Symptoms
duration
risk factor assessment inc Family history
Other illnesses, current and previous
Drug history
2. Physical examination
3. Investigations.
I also like to know the benefit/risk of a treatment and will ask questions.
On this occasion after I had asked about sedation I got the impression that it wouldn't be met with approval.
Then when I went home the more I thought about it the more unsettled I felt.
As I said I even called the endoscopy center to ask if an anesthesiologist would be present.
I think your expectations are exactly as they should be.
I have Von Willebrands so it really upsets me when I feel I am being rushed into something that includes any amount of blood-letting at all, lol. I mean - can you imagine? So scary. Not to mention all the severe reactions I have had to meds over 45 years.
So for a doc to brush me off means . . . I'm walking.
Plus, I have done a lot of medical reporting over 25 years, and just b/c the mortality w/ a procedure is "only" 3 %, don't tell me that the procedure is "no big deal" when I am not even convinced I need that particular diagnostic procedure.
Oh - as for the polyp removal . . . that is the whole point - examination and snip snip of any polyps, to send to the path lab and make sure they are not cancerous.
You can ask for a virtual colonoscopy but most docs will refuse (unless you are working w/ an interventional radiologist) cause they want to get biopsies of anything they may find on the spot. For me, virtual seems the sensible way to go . . . b/c I really cannot imagine having something snipped with a bleeding disorder. I will want to make special arrangements for that situation and have things set up ahead w/ the right drugs to be adminstered and in the right setting (i.e. hospital).
Don't settle for any situation w/ a physician practice that makes you feel you are not getting answers. I flat out refuse to deal w/ arrogant or impatient docs. As I said in another posts, docs who must move quickly from patient to patient should have an attentive PA or nurse who will answer questions and provide info and resources (and take good notes). I totally understand the time restraints physicians in busy practices have. But there are waaaaaay too many docs out there to settle for a situation (including staffing and office procedures) that you don't really feel good about, i.e. that they are not really paying attention to your concerns.
I think your expectations are exactly as they should be.
I have Von Willebrands so it really upsets me when I feel I am being rushed into something that includes any amount of blood-letting at all, lol. I mean - can you imagine? So scary. Not to mention all the severe reactions I have had to meds over 45 years.
So for a doc to brush me off means . . . I'm walking.
Plus, I have done a lot of medical reporting over 25 years, and just b/c the mortality w/ a procedure is "only" 3 %, don't tell me that the procedure is "no big deal" when I am not even convinced I need that particular diagnostic procedure.
Oh - as for the polyp removal . . . that is the whole point - examination and snip snip of any polyps, to send to the path lab and make sure they are not cancerous.
You can ask for a virtual colonoscopy but most docs will refuse (unless you are working w/ an interventional radiologist) cause they want to get biopsies of anything they may find on the spot. For me, virtual seems the sensible way to go . . . b/c I really cannot imagine having something snipped with a bleeding disorder. I will want to make special arrangements for that situation and have things set up ahead w/ the right drugs to be adminstered and in the right setting (i.e. hospital).
Don't settle for any situation w/ a physician practice that makes you feel you are not getting answers. I flat out refuse to deal w/ arrogant or impatient docs. As I said in another posts, docs who must move quickly from patient to patient should have an attentive PA or nurse who will answer questions and provide info and resources (and take good notes). I totally understand the time restraints physicians in busy practices have. But there are waaaaaay too many docs out there to settle for a situation (including staffing and office procedures) that you don't really feel good about, i.e. that they are not really paying attention to your concerns.
Thanks
Can imagine Von Willebrands complicates matters and raises anxiety.
I agree that in this system there doesn't seem to be a need to settle for not being completely happy with things.
I wonder when they were going to tell me they would remove polyps there and then.
Means that what I think of as a diagnostic procedure becomes a surgical procedure. The MD never mentioned that.
I agree with everything that was noted. Always feel good about your MD, if not, WALK AWAY. There are plenty of other MD's that are good, wan't business and will happily answer your questions.
I was a RN in the UK for 23yrs. I know all about lack of time!
However, I would never not intoroduce myself to a patient ( read my first post). She may have been a PA, NP or RN , don't know.She spent 5 mins with me during which she weighed me and took my BP. Nothing else.
Additionally (again as I posted) info sheets aren't a substitute for the chance for questions and answers.
The info sheet as given to me by the appointment scheduler(non medical), so no chance to ask questions.I did post that the info sheet (which was only instructions about the prep, not the colonoscopy) was inadequate.
The doctor told me they would answer all my questions prior to the procedure. I had to turn up at 10 for the scope at 11. Assume that's when the anesthesiologist would have seen me.
I fail to see how a MD can write on a form that his consult involved moderate to complex decisin making when he spent 10 mins with a patient and didn't take a full history or do any examination.
I was an anesthetic nurse (and dept co ordinator) in cardiothoracic OR for 6 years so do have some knowledge of MAC.
I still think it's overkill to give a GA for a colonoscopy.
He wasn't particularly brusque. An easy way to avoid part of the 1 hr late and no apology would have been for someone to apologise!
I did post that I have had symptoms and have a family Hx of colon cancer, so I know that I need the scope. That serves to raise anxiety levels.
First, I can assure you that the person you saw first was probably either a CMA or an RMA. Certainly no excuse for rudeness, but all too common.
Second, I am willing to bet dollars to donuts that somewhere on your chart or in conversation it came out that you are (were) an RN. Having been in the profession for 15 years, I learned long ago to never disclose my profession. First, it creates tension with those who are your peers- feeling they are being judged in the performance of their job, and more importantly, because of what happened to you. While I certainly cant defend it, I suspect this is why the physician engaged you in healthcare reform discussion, rather than answering questions- he simply assumed you'd know what to expect.
Third, in regards to anesthesia- the standard for sedation for colonoscopies used to be versed and demerol. The standard seems to be shifting to diprivan. Having given both in the ED, the propofol would certainly be my first choice, either as the nurse, or the receiver.
Finally, in case you (collectively) have not noticed, nearly all of the physician practices in this area have been bought out by either the CMC or Presby systems. Subsequently, the leadership of these practices set productivity goals. Typically, across the family practice spectrum, a physician is alloted 15 minutes for a normal office visit, and 30 minutes for a physical. This does not take in to account the typical pt who (a) shows up at exactly their appointment time, knowing they need to be wighed, have vitals taken, review meds, etc (b) the pt who shows up 10-15 minutes AFTER their appointed time, and still expects to be seen, and (c) the pt who tells the scheduler they're coming in for a routine follow up, and then presents a laundry list of problems for the physician to address.
It is not at all uncommon for the physician I work for to be 30+ minutes behind. It's also not uncommon for our pts to not say a word about it because they know if they require an additional 5,10,15 minutes of his time, he'll gladly give it to them. I cannot tell you how many times my 8:30-5:30 work day has extended to 7:00 or later, as he and I handle messages, refills, and other pt needs accrued throughout the day. I also know that Ive come to work, and found messages from my doctor that he sent to me at midnight or later-meaning he's up that late meeting pt needs.
All things considered, I think that the typical billing done by a physician is generally very reasonable. When you factor in that (a) most insurance companies do not pay anywhere near what is billed, (b) the amount billed has to cover all of the overhead of an office- lights, rent, employee compensation, malpractice insurance, and something for the doctor, (c) pt's who pay cash, on the day of service, are generally given a generous discount (ours is 20%), Im sure we can all agree that pricing really isnt that outrageous.
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