How does your doctor "doctor"?

[KSera]

6 hours ago, sheryl said:

Yes, observation from the pet parent but I'm referring to the "thoroughness" of exam.  I believe Katie is saying that (correct me if I'm wrong).  I also agree with Katie that these little assessments of eyes, mouth, ears - those in particular, are so quick!  It's just so worth it imo.

My experience has been that doctors who run down the list of rote assessments have been less likely to spend much time talking with me and getting a good feel for how I’m doing and what my full health picture might be. Those have frequently been pretty short visits (but I also have very rarely gone “just because” as an adult, so they usually do those quick things and then ask a few questions about whatever issue I’m there for and then say whatever they think I should do next and that’s it). I have had other providers, including my current, who spends most of the time talking with me, usually spending 45minutes to an hour, and I feel much more like they are getting a full picture and make decisions on what to do next accordingly. 

6 hours ago, sheryl said:

It is a preference but let me ask you - why were those exams even performed if at some point it wasn't deemed valuable?  Sure, people have changed much since 1920.  

There are a lot of medical practices that were previously “standard” that were not necessary and are not routine anymore—think enemas and shaving before childbirth and episiotomies. I think some of the things are your list still show value—bp check, listening to heart, but I’d be surprised if something like checking reflexes in absence of a problem has value. 
 

Oh, the above made me think of an example of over testing/treating issue due to listening to the heart.  It’s not very unusual, particularly among young women, for listening to the heart to reveal a murmur indicating mitral valve prolapse. That is usually referred to for an Echo to confirm and then the patient is told they need prophylactic antibiotics whenever they have dental work. Some portion of those will have a negative response to the antibiotics. Frequently, the murmur and prolapse resolve in the future, though there may be a big lag between when that happens and when the person discovers it and knows they can stop using the antibiotics before dental work.  Fast forward and it’s no longer even recommended to use antibiotics this way, because it was never shown to actually be necessary or helpful. A lot of dentists took a long time to get this memo though and still required them. 

1 hour ago, chocolate-chip chooky said:

I'm in Australia. As previous Australians have already pointed out, we don't have annual physicals here, for adults or children. 

We do have scheduled things at various points in life eg pap smears, childhood vaccinations, bowel cancer screening at 50 etc

But other than that, we just go to the GP if we feel the need. Things like BP are only checked if it seems necessary, either in the context of the visit, or if the person has risk factors. I had my BP checked at the ER last week, but that was the first time in maybe 15 years, and was done as part of the routine ER intake. My husband, on the other hand, has his BP checked regularly by the GP if he goes in for anything. 

Blood sugar? I have no idea when I would have had that last checked. During my last pregnancy maybe, which is now over 16 years ago. And I really don't feel concerned that it hasn't been checked.

The differences between health systems is interesting.  I really couldn't say which ones are better or worse, but I've never felt like I didn't have health care when needed, and I feel no need for regular physicals. But I guess it could just be what we're all used to.

 

I think in general that sounds like the way it most often works out in practice here. Most people go when there’s something they need to have done. The lack of blood pressure screening for that long does seem problematic though. It’s so often some thing with no symptoms. As you say, there are things that are better and worse with both systems. Much better that everyone be able to get care, regardless of ability to pay. I have also had multiple relatives in a country with National healthcare have to wait very long wait to see specialists, even when the problem was relatively urgent, or of unknown urgency until they could be seen (mostly in the case of cancers where they had to wait several months to even have a biopsy). In general, it has seemed that healthcare for elderly people in that country has not been as good as for elderly people with the means to pay private insurance in the US. It has almost seemed like there come a point where elderly people are too expensive for the system? (FWIW, I have gotten exactly the same vibe with certain HMOs in the US—I think there are some parallels). But, at least everyone has access to healthcare. 

[AmandaVT]

My physicals have turned into much more of a talking session in recent years. Discussing when to get my first mammogram, colonoscopy, etc. My Dr. answers questions I have and we talk about health stuff. At my last physical, I had bloodwork done, and vitals, but that was it for anything physical. The rest of the appt was a conversation that led to a scheduled mammogram and colonoscopy and brainstorming about other things we could try to help me lose weight. I felt listened to and like my dr. was collaborating with me on my health. I don't see a ton of value in the knee banging thing or her looking into my ears when I wasn't ill. 

[ktgrok]

46 minutes ago, AmandaVT said:

My physicals have turned into much more of a talking session in recent years. Discussing when to get my first mammogram, colonoscopy, etc. My Dr. answers questions I have and we talk about health stuff. At my last physical, I had bloodwork done, and vitals, but that was it for anything physical. The rest of the appt was a conversation that led to a scheduled mammogram and colonoscopy and brainstorming about other things we could try to help me lose weight. I felt listened to and like my dr. was collaborating with me on my health. I don't see a ton of value in the knee banging thing or her looking into my ears when I wasn't ill. 

Mine are 85% conversation, and then an exam to finish up.

[ktgrok]

2 hours ago, chocolate-chip chooky said:

I had my BP checked at the ER last week, but that was the first time in maybe 15 years, and was done as part of the routine ER intake. My husband, on the other hand, has his BP checked regularly by the GP if he goes in for anything. 

Blood sugar? I have no idea when I would have had that last checked. During my last pregnancy maybe, which is now over 16 years ago. And I really don't feel concerned that it hasn't been checked.

 

 

Yikes! Both high blood pressure and high blood sugar can cause serious, permanent damage before someone ever notices any symptoms. And they are such common problems, it seems odd they are not part of the general screenings advised, even if a full physical exam is not. 

[ktgrok]

Ok, it actually looks like Australia advises having blood pressure checked every 2 years ages 18-45, and after that it advises regular Heart Health Checks, which include blood pressure as well as risk factors are discussed, and labwork or EKG may be done. Blood sugar is advised to be checked every 1-3 years depending on risk factors. I feel better now, lol. 

[bookbard]

11 minutes ago, ktgrok said:

Ok, it actually looks like Australia advises having blood pressure checked every 2 years ages 18-45, and after that it advises regular Heart Health Checks, which include blood pressure as well as risk factors are discussed, and labwork or EKG may be done. Blood sugar is advised to be checked every 1-3 years depending on risk factors. I feel better now, lol. 

Yes, I've had blood pressure and blood sugar checked each year at my Dr, but I don't get reminders - when I visited this year, she pointed out that I hadn't done it since 2020, although I was sure I had. On the other hand, my husband never visits the Dr unless he basically needs the hospital (last 2 times that's what's happened). But I've accepted that I can't make him do it. He hasn't got his 4th Covid booster yet either, although he said if he need surgery for his latest 'need hospital' thing, he'll get it. I feel like it's pretty selfish not to take care of your health, but basically I've accepted that there's nothing I can do about it. 

[Kassia]

3 hours ago, ktgrok said:

Yikes! Both high blood pressure and high blood sugar can cause serious, permanent damage before someone ever notices any symptoms. And they are such common problems, it seems odd they are not part of the general screenings advised, even if a full physical exam is not. 

My friend's DH is active and healthy and didn't go for a physical for a few years.  When he did, they found that his blood sugar was dangerously high and he ended up being diagnosed with Type 1.5 diabetes (which I've never heard of before).  He had no symptoms at all and still doesn't even with wide blood sugar fluctuations (he now tests regularly and is on meds).  It's really scary since he lives such a healthy lifestyle (very little to tweak with diet and exercise after diagnosis) and no symptoms.  

My DH just went for his physical and his blood sugar was just over the normal range.  Not sure if it's just a fluctuation or something to be concerned with.  He's thin but his diet is terrible so it might be easy to drop that number with a few changes if he's willing to do it.  But it's good to know before things get worse.  His blood sugar used to always be on the high side of normal.

 

[Ausmumof3]

We don’t have annual physicals. I haven’t been to a doctor for myself in years (I have taken the kids as needed). I do have a lot of anxiety around going due to a few factors. In some ways, I think an annual checkup might be good for me just because it would force me to deal with that once a year and hopefully reduce the anxiety when I do really need to go. The reality is though, most practices are so busy that they don’t really want to see you unless you need to be there. Last time I had to take one of the kids in they assumed she’d moved practices because we hadn’t been in a couple of years. Nope, just haven’t needed it. Don’t need sick certificates for work or school etc.

A lot of careers do require medicals so I think a lot of people get checked up that way. And when I was on birth control that was a prescription that I had to get renewed every six months.

They’re actually trialling a DIY Pap smear test here now because so many people aren’t doing them. 

[bookbard]

1 hour ago, Ausmumof3 said:

n some ways, I think an annual checkup might be good for me just because it would force me to deal with that once a year and hopefully reduce the anxiety when I do really need to go.

See if you can find a really nice female Dr (ask on your local FB groups) and it is a good experience, you feel like you've ticked stuff off your list, and mine at least always congratulates me on stuff. I'm overweight and she's never been awful about it, in fact she enjoys discussing peer-reviewed studies with me lol. 

[Ausmumof3]

22 minutes ago, bookbard said:

See if you can find a really nice female Dr (ask on your local FB groups) and it is a good experience, you feel like you've ticked stuff off your list, and mine at least always congratulates me on stuff. I'm overweight and she's never been awful about it, in fact she enjoys discussing peer-reviewed studies with me lol. 

This would be nice 😊 

we just go to one of the clinics and other than a few old faithfuls they seem to have a lot of staff turnover (just out of uni!). I’ve had a couple of good ones but by the time I go back they’ve usually left. 

[TravelingChris]

20 hours ago, KungFuPanda said:

 

It sounds like you both have definite health reasons that determine your frequency of care. So, it’s not as simple as ‘Americans get physicals every year because they don’t know better and their system is messed up.’  The actual schedule is determined by the patient and their doctor and it’s not even an official recommendation for everyone. It’s more of a range. “Go every 1-3 years if you’re x age.”

Exactly.  And I am not one for mandatory anything to do with health.  When we lived in FL, and I was homeschooling two, but all three kids plus me had major health issues which meant lots and lots of medical visits, I didn't do annual physicals for my two who were still in school. All the aspects of the annual were covered by all their other appointments.  But Florida required either annual physical or religious or moral objection--I had moral objection to wasting my money, the govt's money, our time, and medical resources so I wrote I had a spiritual or whatever objection.  I think I did that when we moved to VA too.  So I am not saying everyone has to do whatever.  

After all, the current candidate for Senate in PA-he had a physical or other kind of doctor visit 2 years ago and he was found to have atrial fibrillation and needed to go on blood thinners.  Well Mr. So Smart thought, no-- I know better that he knew better than medical professionals and decided to lose weight and exercise as an alternative---and he had a massive stroke this Spring.  If I was in PA, I would never, ever vote for such a moron---first of all, if he had checked even Dr. Google, he would have found that being overweight helps you survive blood clots, being thin is a risk for survival of blood clots (I am talking about when they happen, not the risk of happening-though with atrial fibrillation or with my genetic and autoimmune clotting, weight has no bearing on whether they will develop).  And in his case, with Afib, exercise has no bearing on clotting either.  With me, it does.  (as an aside, I am not a PA voter, but in the past, I have definitely voted against or withheld a vote at all because I thought the candidate was too stupid and those were R candidates in primaries or general elections).

The point of the above story is it doesn't even matter a lot of times who gets annual or regular visits because a significant portion of the population aren't interested enough to care for their own health or are arrogant but also ignorant so are doing the actual wrong things for their health, or in even more cases, the advice is simply stupid---lose weight or something like that-when study after study say bouncing weight is a lot more dangerous and also, it is almost impossible to lose and keep the loss after 50/

[Soror]

I don't know anyone that gets a physical just because. Everyone I know goes because they have an issue or have to for medication. I just got one in June because I had to establish care to get a mammogram. It's stupid bureaucracy. You shouldn't need a Dr to get basic preventative care. I nearly wrote a letter to the mammogram center about it. That policy is just keeping people from getting that care. I know lots of people without a dr. Now I have Dr for my thyroid I have to see twice a year but they are too expensive and far away for run of the mill stuff. And 2 months after my physical I  had to go back for a mini one for HRA money. Again stupid bureaucracy a to waste of my time and their money.

[TravelingChris]

19 hours ago, Pawz4me said:

My guess is that if we moved away more from the annual physical model that medical providers would order more lab work when patients are in for a sick visit or a medication check. My provider has a thing about cholesterol and my numbers have been creeping up for awhile. So when I go in for a thyroid check she often says let's go ahead and check your cholesterol while we're at it. I'm often not fasting so it's not totally ideal. But it still gives some insight, and no extra visit required. I suspect we'd see more of that when patients come in for fairly routine sick visits like sinus infections, etc.

Unfortunately, it wouldn't, I think.  That is because so many of the younger generations can't even get in with a good physician and rely on urgent care, etc,  My dsil1 is a diabetic whose diabetes specialist just dropped him because he feels he needs to focus on diabetics with worse cases so he now has no doctor for his diabetes at all as of August. We do know of an excellent CRNP--I used to use her in my internal medicine doctor's office before she left due to pregnancy for maternal leave and I ended up w/ the concierge doctor.  She came back to work but the knowledgeable know how fantastic she is and there is a 2 year wait.  She could very well manage his diabetes. DD1 uses her psychiatrist to order tests, etc  but even though he is also dsil's psych, I don't know that he would be comfortable also managing his diabetes.

My ddil was dropped by her psychiatrist practice because she was 10 minutes  late, and then we had an emergency since she is bipolar2 and ran out of meds so urgent care to the rescue.  Idk if she has a new one.  DS has urgent care and yearly allergist visit or bi annular testing--- he has meat allergy due to tick.  Dgdds' have a pediatrician through their father's insurance but that pediatrician refuses to take cash payments (or checks or debit or ccs-- basically wants only insured patients) and that leaves out dgs since my son can't afford to add him to his insurance, which has a very high deductible too. 

And finally, dd2  who is using my concierge doctor and/or urgent care till she is 26. She also has allergist who monitors her very serious allergies and her bad asthma, gyn doctor-- who is following her for massive amounts of breasts lumps too, and psych doctor--maybe, not sure, she may have dropped the psych and also trying to find a more local one. and is desperately searching for rheumatologist who is good and accepting patients.  Her husband also is using urgent care mostly since they moved to our more local area last fall.  

And these are my smart family members, who know a h**** a lot more about medical matters than the average person let alone the below average person.---

In our area of the country, there is a huge shortage of physicians, CRNPs, PA,  most medical staff and it is worse than useless to settle for a bad doctor or CRNP, PA , etc. 

 

[heartlikealion]

1 hour ago, Soror said:

I don't know anyone that gets a physical just because. Everyone I know goes because they have an issue or have to for medication. I just got one in June because I had to establish care to get a mammogram. It's stupid bureaucracy. You shouldn't need a Dr to get basic preventative care. I nearly wrote a letter to the mammogram center about it. That policy is just keeping people from getting that care. I know lots of people without a dr. Now I have Dr for my thyroid I have to see twice a year but they are too expensive and far away for run of the mill stuff. And 2 months after my physical I  had to go back for a mini one for HRA money. Again stupid bureaucracy a to waste of my time and their money.

I use the term physical to refer to those appointments kids get for sports clearance. It might be done during their annual wellness visit. My insurance covers one annual “Healthy U” wellness visit so I get that one. I’m overdue for my annual eye visit… worried it will just tell me to order new glasses. I got a new prescription last time. 

[ScoutTN]

Very well.

I am sad he is moving to a concierge format practice where I cannot afford to follow. 

[ktgrok]

2 minutes ago, ScoutTN said:

Very well.

I am sad he is moving to a concierge format practice where I cannot afford to follow. 

My "official" doctor, as in the guy that signs my scripts, has two pratices next door to each other in the same building. One is his concierge practice, where he himself sees patients. The other is staffed with several nurse practitioners and PA's, and that's where I go. Pretty sure he never actually sees patients there, just signs off on the stuff that requires an MD. They actually have to take my ADHD med scripts next door for him to sign! (other scripts the ARNPs and PAs can do themselves, controlled drugs he has to sign). 

[shawthorne44]

On 8/20/2022 at 6:44 AM, HomeAgain said:

My two best doctors have been female. 

I strongly prefer female doctors.   I had horrible periods as a teen.  As in bled myself very anemic and I've prayed for death. Mom and I kept looking for a doctor to help.   They all dismissed my problems as "in my head."   Finally we stumbled on a female doc.  She was the first one to actually believe me!    She was able to help.  Since then I've been pleased with every female doc I've had.  

 

 

[shawthorne44]

I have to think that there is some benefit to an annual physical.  Otherwise my insurance wouldn't insist on my doing it every year.  They do it, of course, to save money but that is fine by me since that means less medical problems for me. 

I probably went two decades only seeing specialists.  I had a dermatologist for skin problems, a podiatrist for foot problems and my OBGYN.   And doc-in-the-box for minor emergency stuff.  Somewhere in there I paid for a much of blood tests looking for misc problems, basically any test that might apply to me.  I think they took 6 vials of blood.  Cost less than $200.  
 

[sheryl]

Oh my, I had no idea this was going to receive so many replies.  Things got busy - deep cleaned our refrigerator and freezer!  I have not had time to read these replies but will over the next few days.

After I read them though I will still hold my opinion.  Checking ears, ears, mouth and reflexes only takes less than 5 minutes.  It will not detract from the rest of the appt and if the doctor needs to address something then he/she will add that to the conversation!  

Edited August 21, 2022 by sheryl

[Soror]

20 hours ago, heartlikealion said:

I use the term physical to refer to those appointments kids get for sports clearance. It might be done during their annual wellness visit. My insurance covers one annual “Healthy U” wellness visit so I get that one. I’m overdue for my annual eye visit… worried it will just tell me to order new glasses. I got a new prescription last time. 

I've seen it used interchangeable--- physical for clearing kids for sports and also adults for a yearly visit. Same basic stuff except the kids don't have to do labs and typically adults do. I'm not so concerned with labs except my thyroid ones and vitamin levels (as I've found certain ones I need to keep an eye on and supplement). 

 

[vonfirmath]

On 8/20/2022 at 3:15 PM, ktgrok said:

My point was more for those without chronic health problems (that they know of), who are not going to see a doctor other than for a well visit/physical. If someone is say, age 45 and has no known medical problem, when would they have their blood pressure or blood sugar checked?

 

I get my blood pressure checked at every dentist appointment

 

[Ellie]

4 hours ago, Soror said:

I've seen it used interchangeable--- physical for clearing kids for sports and also adults for a yearly visit. Same basic stuff except the kids don't have to do labs and typically adults do. I'm not so concerned with labs except my thyroid ones and vitamin levels (as I've found certain ones I need to keep an eye on and supplement).

I think "wellness check" is a snowflake term for "physical." Maybe "snowflake" isn't exactly the right term, but something along those lines. Or maybe it's a dumbed-down term for "physical."

I'm 71yo. (!) This is the first doctor I've ever had that scheduled "physicals." And some things he won't check except at the physical. I'm haggling with him over thyroid issues, and I need labs *now,* but he wanted to wait until October. Absolutely not. I'm going in tomorrow, because I was able to argue him down.

[ktgrok]

7 hours ago, vonfirmath said:

I get my blood pressure checked at every dentist appointment

 

i have never had my blood pressure checked at the dentist - interesting!

[kbutton]

 

On 8/20/2022 at 4:57 PM, Pawz4me said:

Another way it could be handled is for people to go have labs w/o having it tied to a provider visit. So you get an electronic or snail mail notification every year (or two or three, depending on age/interval recommendation) that it's time for routine lab work, you go have it done and only go to see a provider if it shows a problem. I just don't see this is a hard or insurmountable issue. ETA: It might result in more people getting more regular lab work done, since a lot of people really don't like the in-person exam, particularly the weigh in.

That would be great, but it's not covered without seeing a doctor. If I have something going on and could really use labwork BEFORE getting in to see the doctor (because I'd like to discuss the results or something was missed by another provider who won't listen, etc.), they won't order it (and say insurance is the reason, but I don't think it's totally the reason). 

On 8/20/2022 at 6:23 PM, bookbard said:

but how does that work - you've got to start somewhere, right? Do you mean they can't treat them if they haven't had a physical? 

Anyway, definitely not the law in Australia. You can go to any doctor you want, if they have a space, and they'll treat you. There are some doctors who won't take on new patients because they're busy, I  hear about issues in certain areas of Australia where people struggle to find a GP, but I have been to a lot of different doctors in my local area without problem. If my kids are sick, I can get in that day to someone, even if my usual Dr is busy. 

I am not the person who made the statement you are responding to, but here in the US, you can't get in for a sick visit if you don't have a primary care doctor--you have to go to the ER, urgent care, or something like The Little Clinic that is in Kroger (grocery store). The Little Clinic has caught on so well that you can't get in there either. If you get in, they really don't want to do anything other than the one tiny thing you came in for--no asking for your cholesterol to get checked while you're there, etc. 

If you do have a family doctor, but you haven't needed to see them yearly, they won't see you for a sick visit. You're out of luck. They won't refill for a stable issue without a yearly. They won't give you a referral for a specialist. They won't write a script for even a routine test without a yearly.

In case people are wondering why you wouldn't just go in for an appointment to get something like a referral, sometimes the reason for the referral is that one of the kids has an issue, and their doctor says you must be screened, but they can't write the referral because they are in the children's hospital system. So, when my son had a genetic disorder, and my dad had a related issue, I was supposed to get a specific test. I had to go in to see the family doctor, and grovel--DH is a provider (but a midlevel, so different rules for who he can Rx for or order tests for), so unless we get something that would require an antibiotic, we don't go in for sick visits; at that time, we got yearly health screenings for insurance discounts from his employer (outpatient labwork); when I did see her periodically for a real issue, she'd tell me it's in my head. So anyway, I needed this test because of genetic issues...I go in, and she tells me that she can't order that test unless she does another one first. And what reason was she supposed to give for that test? She basically made me say that I had a condition that I didn't have so that she could do that test and then order the one I needed. I am pretty sure that if she had taken a few minutes to google the ICD (diagnosis) code for my son's issue, it would've been fine. I was, and still am, pretty pissed that it had to be this way. We no longer go there, but this is really, really typical. 

I hate the yearly physical thing, but I don't understand why insurance, which often wants to cover nothing, insists on it if it's not of benefit. I also don't understand why overworked HCW's would insist on crazy policies if they yearly doesn't help either. It's a total pain in the rear.

[kbutton]

Oh, and it can take up to a year to get into a GP/family doctor IF they are taking new patients. Seriously. 

[bookbard]

1 hour ago, kbutton said:

Oh, and it can take up to a year to get into a GP/family doctor IF they are taking new patients. Seriously. 

That whole situation sounds really hard esp for people who already are struggling. I have to say Australia does have issues with GPs in rural area and at the moment there are a lot of Drs who charge money on top of the govt payment which can be a huge disincentive to people. There's been a lot of media about it recently and hopefully the govt will step up and increase the payment. It is odd that in one practice I've never had to pay at all, while at the other I'll have to pay $100. But the second one is my nice female Dr who I'll visit once or twice a year, she takes her time and is lovely. The other place, the guy is great, but super quick and pushes you out within 10mins so he can get the next person through. So we go there if we're sick and need a prescription or whatever. 

[ktgrok]

1 hour ago, kbutton said:

 

That would be great, but it's not covered without seeing a doctor. If I have something going on and could really use labwork BEFORE getting in to see the doctor (because I'd like to discuss the results or something was missed by another provider who won't listen, etc.), they won't order it (and say insurance is the reason, but I don't think it's totally the reason). 

I am not the person who made the statement you are responding to, but here in the US, you can't get in for a sick visit if you don't have a primary care doctor--you have to go to the ER, urgent care, or something like The Little Clinic that is in Kroger (grocery store). The Little Clinic has caught on so well that you can't get in there either. If you get in, they really don't want to do anything other than the one tiny thing you came in for--no asking for your cholesterol to get checked while you're there, etc. 

If you do have a family doctor, but you haven't needed to see them yearly, they won't see you for a sick visit. You're out of luck. They won't refill for a stable issue without a yearly. They won't give you a referral for a specialist. They won't write a script for even a routine test without a yearly.

In case people are wondering why you wouldn't just go in for an appointment to get something like a referral, sometimes the reason for the referral is that one of the kids has an issue, and their doctor says you must be screened, but they can't write the referral because they are in the children's hospital system. So, when my son had a genetic disorder, and my dad had a related issue, I was supposed to get a specific test. I had to go in to see the family doctor, and grovel--DH is a provider (but a midlevel, so different rules for who he can Rx for or order tests for), so unless we get something that would require an antibiotic, we don't go in for sick visits; at that time, we got yearly health screenings for insurance discounts from his employer (outpatient labwork); when I did see her periodically for a real issue, she'd tell me it's in my head. So anyway, I needed this test because of genetic issues...I go in, and she tells me that she can't order that test unless she does another one first. And what reason was she supposed to give for that test? She basically made me say that I had a condition that I didn't have so that she could do that test and then order the one I needed. I am pretty sure that if she had taken a few minutes to google the ICD (diagnosis) code for my son's issue, it would've been fine. I was, and still am, pretty pissed that it had to be this way. We no longer go there, but this is really, really typical. 

I hate the yearly physical thing, but I don't understand why insurance, which often wants to cover nothing, insists on it if it's not of benefit. I also don't understand why overworked HCW's would insist on crazy policies if they yearly doesn't help either. It's a total pain in the rear.

This must vary by place. Here if I didn't have a doctor, and was sick, I could call around and schedule a sick visit with  someone  - but established patients take priority, so a new patient might not be able to be seen in any kind of decent time frame. But you can absolutely be seen for a sick visit without a physical/routine check first. It just may not be timely, in which case most people yes, would go to urgent care or other. 

The issue I was referring to about not being able to get medications without being seen annually is that the doctor has to have seen you in some fashion, be it well visit or sick visit, in the past year to legally be able to write your prescription refill. Because you have to be "under their care" which most interpret to be having been seen in the past year. 

[Jean in Newcastle]

Part of being responsible for your own health is establishing a relationship with a doctor. For healthy people this would be through an annual physical. Of course you can’t suddenly find a doctor on the spur of the moment. Just my opinion. 

[Laura Corin]

On 8/20/2022 at 6:45 PM, TravelingChris said:

That is the choice of the patient-not the guvmn't and we don't want that choice gone.

I just realised I forgot to respond to this. People sometimes think that privately paid medicine is illegal in countries that have a national health system.  In the UK you are entirely free to go to a private doctor or hospital and pay for whatever care the doctor feels ethically able to provide. This care just won't be covered by the NHS - like all insurance it has its own criteria for coverage.

So if you wanted, you could top up the low tax-cost of NHS care with out-of-pocket or privately-insured treatment to reach a US-level of expenditure.  That would be your choice.

[Melissa in Australia]

2 hours ago, Laura Corin said:

I just realised I forgot to respond to this. People sometimes think that privately paid medicine is illegal in countries that have a national health system.  In the UK you are entirely free to go to a private doctor or hospital and pay for whatever care the doctor feels ethically able to provide. This care just won't be covered by the NHS - like all insurance it has its own criteria for coverage.

So if you wanted, you could top up the low tax-cost of NHS care with out-of-pocket or privately-insured treatment to reach a US-level of expenditure.  That would be your choice.

Same here in Australia. Some people pay for their own private health cover insurance. 

[TravelingChris]

4 hours ago, Laura Corin said:

I just realised I forgot to respond to this. People sometimes think that privately paid medicine is illegal in countries that have a national health system.  In the UK you are entirely free to go to a private doctor or hospital and pay for whatever care the doctor feels ethically able to provide. This care just won't be covered by the NHS - like all insurance it has its own criteria for coverage.

So if you wanted, you could top up the low tax-cost of NHS care with out-of-pocket or privately-insured treatment to reach a US-level of expenditure.  That would be your choice.

Yes, I know you can.  I went to the private hospital in Thessaloki  for my knee injury, because the wait there would be very small, and the wait in the public hospital would be hours.  As the reason for my injury was that I was exhausted after staying up for for more than 36 hours--it was the day we didn't get much sleep before a 4.5 hour bus ride to the Atlanta airport, then hassles with the TSA because of my disabilities, then flight to Frankfurt, then to Vienna, and then finally to Thessaloniki, and another bus ride to the hotel, unpacking, dinner, and then falling off the raised dining platform and injured my knee.  

As to Canada, all I could find for my pneumonia was a private clinic that mostly dealt with Canadian travelers who wanted vaccines for travel, which aren't covered.  

Canadians, please chime in===are there normal, private doctors and hospitals  you can use??? Cause I don't think that is allowed there. I have a friend who was born in Canada but moved to the US with her family since her father, a surgeon, did not want to join the national health plan there so moved the family to this state, which had and still has a shortage of many types of physicians.

[TravelingChris]

6 hours ago, Jean in Newcastle said:

Part of being responsible for your own health is establishing a relationship with a doctor. For healthy people this would be through an annual physical. Of course you can’t suddenly find a doctor on the spur of the moment. Just my opinion. 

That is very true of my dh.  He got bad care in the military health system- ignored his complaints of depression, fatigue, etc which were all signs of his sleep apnea.  Also, he grew up with a mother who eschewed medical care for herself (and died at 64 because she did that), and a but of that attitude sometimes turns up in dh.  He definitely has used his annual physical to start getting better health, and taking care of items he never does until his physicals.  

That isn't so with me, but then I am a very high user of medical resources since I am such a complicated case that needs lots of different specialists and adjacent resources like braces for back and neck, all sorts of tools for disabilities, many different health auxiliaries-like swim PT, lymphadema PT, regular PT, OT, speech therapy, etc, etc, etc.

[Melissa in Australia]

14 minutes ago, TravelingChris said:

Yes, I know you can.  I went to the private hospital in Thessaloki  for my knee injury, because the wait there would be very small, and the wait in the public hospital would be hours.  As the reason for my injury was that I was exhausted after staying up for for more than 36 hours--it was the day we didn't get much sleep before a 4.5 hour bus ride to the Atlanta airport, then hassles with the TSA because of my disabilities, then flight to Frankfurt, then to Vienna, and then finally to Thessaloniki, and another bus ride to the hotel, unpacking, dinner, and then falling off the raised dining platform and injured my knee.  

As to Canada, all I could find for my pneumonia was a private clinic that mostly dealt with Canadian travelers who wanted vaccines for travel, which aren't covered.  

Canadians, please chime in===are there normal, private doctors and hospitals  you can use??? Cause I don't think that is allowed there. I have a friend who was born in Canada but moved to the US with her family since her father, a surgeon, did not want to join the national health plan there so moved the family to this state, which had and still has a shortage of many types of physicians.

I can assure you that the doctors and hospitals here in Australia that are  public are all normal.

[TravelingChris]

1 minute ago, Melissa in Australia said:

I can assure you that the doctors and hospitals here in Australia that are  public are all normal.

Hahaa! 

I meant that the only private doctors I could find in relatively nearby area in a major city in Canada was a private vaccination clinic-which did take pity on me and did see me and prescribe antibiotics for my pneumonia that arose during our vacation.  I couldn't find any kind of private, normal, (meaning non-vaccine) medical practice.

[Soror]

8 minutes ago, TravelingChris said:

Hahaa! 

I meant that the only private doctors I could find in relatively nearby area in a major city in Canada was a private vaccination clinic-which did take pity on me and did see me and prescribe antibiotics for my pneumonia that arose during our vacation.  I couldn't find any kind of private, normal, (meaning non-vaccine) medical practice.

We didn't have any trouble finding dental care for dh on vacation in London. He went to the NHS clinic but he had to pay OOP. It wasn't an issue. @Laura Corin actually helped giving us the number. Dh got excellent care from the "government" dentist and even with us paying OOP was a fraction of the cost we pay here.

[skimomma]

7 hours ago, Jean in Newcastle said:

Part of being responsible for your own health is establishing a relationship with a doctor. For healthy people this would be through an annual physical. Of course you can’t suddenly find a doctor on the spur of the moment. Just my opinion. 

This seems simple enough on paper.  I would say I am about as well-equipped as one can get in the US for keeping on top of my health care.  I have insurance, I have time, I am healthy,  I am educated, I speak English as a first language, I am not poor, I have my own transportation, and I am comfortable making phone calls and advocating for myself.  And yet, this still does not happen.  I live in an area in which HWCs of all levels turn over at an alarming rate.  I cannot even count how many doctors have simply been gone within a year after I have been established as a "new patient."  Some have handed me off to another provider (with or without notifying me), while others are simply gone when I call to make an appointment.  I have never had any sort of doctor-patient relationship (as an adult) where the doctor actually recognizes me at any point and no continuous records of medical care or lab results. The longest continuous doctor-patient relationship I have ever had as an adult was three years.  More than once, by the time one former provider warehouse finds my records to send to the next, the next is already gone.  It is exhausting.  I still try.  I have a new doctor now that has "stuck" for 18 months now.  I have had one physical with her and have managed to go in for an issue once in that time.  But I have no illusions that she will be the next time I call.  Repeat all of this for dh and dd.  Thanks goodness (so far, anyway) none of us have any medical issues.  And I imagine the situation only gets worse if you eliminate one or all of the well-equipped advantages I have.

OTOH, I have seen the same dentist every 6 months like clockwork for the last 25 years.  So I know *how* to do it if the landscape allowed it.

I can also say, since I have had many PCPs over the years, that some do all of the things the OP would like to see happen and others barely even break a 5 minute dialog during a physical.  I find that my personal experience aligns with the evidence that a traditional physical is a waste of time.  But as others have stated, I have to get one to establish myself as a patient in order to be seen for other issues.  Sometimes I know I need a new doctor and schedule a physical.  Other times an issue arises, I learn my doctor has ghosted me, then schedule a physical with a new provider with the real intent of getting my issue resolved.  Often this means going twice.  Once as a "new patient physical" and then again for the issue.  I find myself scheming to try to slip my issue in during the physical just to save time (and money), but most times, they are on to me and immediately tell me I must schedule a follow up appointment.   No one has time for this.

 

 

[wathe]

In Canada this may vary by province.  In Ontario, it is illegal to bill privately for services that are covered by the public insurance plan.  May not bill privately, and may not bill extra, for any insured service.  Most things that one would usually seek care for are publicly insured.  We do not have a parallel privately-billed system.  There are very, very few private specialty hospitals (like Shouldice hernia hospital), but even they must bill the public system for insured services (doctor's fees, procedure fee, ward accommodation) and cannot bill the patient for those, but can bill extravagantly for uninsured services (upgrade to private room), and $$$$$$ for out of county patients who aren't covered by the provincial insurance plan.  (And they cherry pick the easiest cases, and their complications end up in the public hospitals)

Uninsured services are billed privately.  That would include things like cosmetic procedures, third party visits (work , camp, or school physicals required by a third party), travel medicine

[SKL]

Honestly don't remember the last time those things were checked on me.  I think they do that for kids still, if they have an annual physical vs. a visit for some specific reason.  I could see doing it again for ageing patients.

They do like to check weight, bp, pulse, heart rate type stuff for every kind of visit (and height for the kids).

Maybe your retiring doctor was doing these things because that's how they did it when he started out.

Did anything ever come of those things he checked that the new doc doesn't check?

I don't put much stock in annual physicals for folks in general good health.

[SKL]

15 minutes ago, skimomma said:

This seems simple enough on paper.  I would say I am about as well-equipped as one can get in the US for keeping on top of my health care.  I have insurance, I have time, I am healthy,  I am educated, I speak English as a first language, I am not poor, I have my own transportation, and I am comfortable making phone calls and advocating for myself.  And yet, this still does not happen.  I live in an area in which HWCs of all levels turn over at an alarming rate.  I cannot even count how many doctors have simply been gone within a year after I have been established as a "new patient."  Some have handed me off to another provider (with or without notifying me), while others are simply gone when I call to make an appointment.  I have never had any sort of doctor-patient relationship (as an adult) where the doctor actually recognizes me at any point and no continuous records of medical care or lab results. The longest continuous doctor-patient relationship I have ever had as an adult was three years.  More than once, by the time one former provider warehouse finds my records to send to the next, the next is already gone.  It is exhausting.  I still try.  I have a new doctor now that has "stuck" for 18 months now.  I have had one physical with her and have managed to go in for an issue once in that time.  But I have no illusions that she will be the next time I call.  Repeat all of this for dh and dd.  Thanks goodness (so far, anyway) none of us have any medical issues.  And I imagine the situation only gets worse if you eliminate one or all of the well-equipped advantages I have.

OTOH, I have seen the same dentist every 6 months like clockwork for the last 25 years.  So I know *how* to do it if the landscape allowed it.

I can also say, since I have had many PCPs over the years, that some do all of the things the OP would like to see happen and others barely even break a 5 minute dialog during a physical.  I find that my personal experience aligns with the evidence that a traditional physical is a waste of time.  But as others have stated, I have to get one to establish myself as a patient in order to be seen for other issues.  Sometimes I know I need a new doctor and schedule a physical.  Other times an issue arises, I learn my doctor has ghosted me, then schedule a physical with a new provider with the real intent of getting my issue resolved.  Often this means going twice.  Once as a "new patient physical" and then again for the issue.  I find myself scheming to try to slip my issue in during the physical just to save time (and money), but most times, they are on to me and immediately tell me I must schedule a follow up appointment.   No one has time for this.

This has been my experience as well regarding turnover of health care professionals, particularly PCPs.  I do have myself and my kids "established" at the nearby mega-practice, so I guess we are not considered "new patients" when we need something.  But I don't recall ever seeing the same PCP twice in this mega-practice.  They move on quickly.  I guess being a PCP isn't very satisfying around here.

[Jean in Newcastle]

1 hour ago, skimomma said:

This seems simple enough on paper.  I would say I am about as well-equipped as one can get in the US for keeping on top of my health care.  I have insurance, I have time, I am healthy,  I am educated, I speak English as a first language, I am not poor, I have my own transportation, and I am comfortable making phone calls and advocating for myself.  And yet, this still does not happen.  I live in an area in which HWCs of all levels turn over at an alarming rate.  I cannot even count how many doctors have simply been gone within a year after I have been established as a "new patient."  Some have handed me off to another provider (with or without notifying me), while others are simply gone when I call to make an appointment.  I have never had any sort of doctor-patient relationship (as an adult) where the doctor actually recognizes me at any point and no continuous records of medical care or lab results. The longest continuous doctor-patient relationship I have ever had as an adult was three years.  More than once, by the time one former provider warehouse finds my records to send to the next, the next is already gone.  It is exhausting.  I still try.  I have a new doctor now that has "stuck" for 18 months now.  I have had one physical with her and have managed to go in for an issue once in that time.  But I have no illusions that she will be the next time I call.  Repeat all of this for dh and dd.  Thanks goodness (so far, anyway) none of us have any medical issues.  And I imagine the situation only gets worse if you eliminate one or all of the well-equipped advantages I have.

OTOH, I have seen the same dentist every 6 months like clockwork for the last 25 years.  So I know *how* to do it if the landscape allowed it.

I can also say, since I have had many PCPs over the years, that some do all of the things the OP would like to see happen and others barely even break a 5 minute dialog during a physical.  I find that my personal experience aligns with the evidence that a traditional physical is a waste of time.  But as others have stated, I have to get one to establish myself as a patient in order to be seen for other issues.  Sometimes I know I need a new doctor and schedule a physical.  Other times an issue arises, I learn my doctor has ghosted me, then schedule a physical with a new provider with the real intent of getting my issue resolved.  Often this means going twice.  Once as a "new patient physical" and then again for the issue.  I find myself scheming to try to slip my issue in during the physical just to save time (and money), but most times, they are on to me and immediately tell me I must schedule a follow up appointment.   No one has time for this.

 

 

Yea, I was referring to those people who actually have a choice but it does appear to be regional. I even had established care with a low cost medical clinic for those who don’t have the advantages you mentioned. 

[vonfirmath]

1 hour ago, skimomma said:

This seems simple enough on paper.  I would say I am about as well-equipped as one can get in the US for keeping on top of my health care.  I have insurance, I have time, I am healthy,  I am educated, I speak English as a first language, I am not poor, I have my own transportation, and I am comfortable making phone calls and advocating for myself.  And yet, this still does not happen.  I live in an area in which HWCs of all levels turn over at an alarming rate.  I cannot even count how many doctors have simply been gone within a year after I have been established as a "new patient."  Some have handed me off to another provider (with or without notifying me), while others are simply gone when I call to make an appointment.  I have never had any sort of doctor-patient relationship (as an adult) where the doctor actually recognizes me at any point and no continuous records of medical care or lab results. The longest continuous doctor-patient relationship I have ever had as an adult was three years.  More than once, by the time one former provider warehouse finds my records to send to the next, the next is already gone.  It is exhausting.  I still try.  I have a new doctor now that has "stuck" for 18 months now.  I have had one physical with her and have managed to go in for an issue once in that time.  But I have no illusions that she will be the next time I call.  Repeat all of this for dh and dd.  Thanks goodness (so far, anyway) none of us have any medical issues.  And I imagine the situation only gets worse if you eliminate one or all of the well-equipped advantages I have.

OTOH, I have seen the same dentist every 6 months like clockwork for the last 25 years.  So I know *how* to do it if the landscape allowed it.

I can also say, since I have had many PCPs over the years, that some do all of the things the OP would like to see happen and others barely even break a 5 minute dialog during a physical.  I find that my personal experience aligns with the evidence that a traditional physical is a waste of time.  But as others have stated, I have to get one to establish myself as a patient in order to be seen for other issues.  Sometimes I know I need a new doctor and schedule a physical.  Other times an issue arises, I learn my doctor has ghosted me, then schedule a physical with a new provider with the real intent of getting my issue resolved.  Often this means going twice.  Once as a "new patient physical" and then again for the issue.  I find myself scheming to try to slip my issue in during the physical just to save time (and money), but most times, they are on to me and immediately tell me I must schedule a follow up appointment.   No one has time for this.

 

 

I have consistently been with the same practice in our local city for the 14 years we have lived here. Different doctors -- but they have locations all over the city (When I lived down south I got established with them and have been able to move doctors to locations near me when we moved south and now to be closer to work, etc.) They keep all the records and I can be seen faster if I take the next available doctor.  I am TERRIBLE at keeping track of records (or even remembering when things are done) So I love I can point them back to their records

Edited August 23, 2022 by vonfirmath

[SKL]

Oh also I'm not sure it's even standard to have an actual doctor for annual well visits.  My kids only saw nurse practitioners for "wellness" in our practice.  Myself, I don't think I've had a"well visit" in the past 10+ years, so I don't know.

[shawthorne44]

It is weird how different people's experience is.   

For example, my dentist has always checked my blood pressure.   In fact, my dentist saw my MIL for a regular appointment and sent her to the hospital across the street because of a super mild heart attack.  She complained of a tooth pain that was weird in some way.   

I also get my labs done ahead of time.   I go into the office a few days in advance, I don't even need an appointment since I don't need to see the doc or the N.P.   

[Pawz4me]

13 hours ago, kbutton said:

 

That would be great, but it's not covered without seeing a doctor. If I have something going on and could really use labwork BEFORE getting in to see the doctor (because I'd like to discuss the results or something was missed by another provider who won't listen, etc.), they won't order it (and say insurance is the reason, but I don't think it's totally the reason). 

 

I think this must be regional or an issue with your provider. It's not uncommon here to have blood work done prior to a visit. My previous PCP was fine with me coming in a few days before a visit to have blood work done. Or I could do it after meeting with him. He left it up to the patient. DH always has blood work done before seeing his oncologist. And in any event--it would be an easy policy to change if the will was there to cut down on in person medical visits and overall costs.

[heartlikealion]

On 8/22/2022 at 8:44 AM, Soror said:

I've seen it used interchangeable--- physical for clearing kids for sports and also adults for a yearly visit. Same basic stuff except the kids don't have to do labs and typically adults do. I'm not so concerned with labs except my thyroid ones and vitamin levels (as I've found certain ones I need to keep an eye on and supplement). 

 

The standard labs don’t tell me much. I have to ask for extra labs for vitamin levels and those cost money. One time I combined the office visit (wellness + extra labs) just to skip the office visit fee but that didn’t go over well for me because I had to fast for the annual visit and I made myself physically weak/had a bad reaction during the blood draw. I probably would have been fine if the office didn’t tell me no drink after midnight including water — when in fact water is fine! They gave me surgery directions 🙄

[Jean in Newcastle]

Re labs. My doctor sets up labs before my visit. In the case of regular monitoring lab work he puts it in the computer to be scheduled for the next appointment while I am finishing up my current appointment. For new issues I contact him on MyChart, tell him what I am scheduling an appointment for (ie symptoms) and ask if he could schedule any general labs that would be helpful to him so that I can get them done prior. It’s always worked well. Of course he may order more labs after he sees those results and examines me but we have the general screening ones out of the way. 

Edited August 23, 2022 by Jean in Newcastle
Stupid autocorrect

[heartlikealion]

13 minutes ago, Jean in Newcastle said:

Re labs. My doctor sets up labs before my visit. In the case of regular monitoring lab work he puts it in the computer to be scheduled for the next appointment while I am finishing up my current appointment. For new issues I contact him on MyChart, tell him what I am scheduling an appointment for (ie symptoms) and ask if he could schedule any general labs that would be helpful to him so that I can get them done prior. It’s always worked well. Of course he may order more labs after he sees those results and examines me but we have the general screening ones out of the way. 

Finances have been a driving force in why I schedule things the way I do. My current insurance has a copay but lab work itself is $. I specifically requested labs to test vitamins for fatigue and they ran a panel based on that.. then I did follow up after increasing Vit D. Still tired. But exercising and eating better and probably less tired. They didn’t tell me to increase B12 but I did because it was in the lower end and I told him and he said that’s fine. Honestly they aren’t very proactive. They wait til you’re in the bad zone to say maybe do something. I’m becoming my own advocate. 
 

ETA: In their defense they offered a sleep study but I can’t afford that right now. It’s done at home but still $600 or so. 

Edited August 23, 2022 by heartlikealion

[vonfirmath]

7 minutes ago, heartlikealion said:

Finances have been a driving force in why I schedule things the way I do. My current insurance has a copay but lab work itself is $. I specifically requested labs to test vitamins for fatigue and they ran a panel based on that.. then I did follow up after increasing Vit D. Still tired. But exercising and eating better and probably less tired. They didn’t tell me to increase B12 but I did because it was in the lower end and I told him and he said that’s fine. Honestly they aren’t very proactive. They wait til you’re in the bad zone to say maybe do something. I’m becoming my own advocate. 
 

ETA: In their defense they offered a sleep study but I can’t afford that right now. It’s done at home but still $600 or so. 

If sleep is the issue, the vitamins are not going to help much. My husband could tell the difference from the first night of having a CPAP. Night and day.

[heartlikealion]

2 minutes ago, vonfirmath said:

If sleep is the issue, the vitamins are not going to help much. My husband could tell the difference from the first night of having a CPAP. Night and day.

I am a long sleeper, need 9+ hours to feel refreshed. Then I seem to need naps. So that's why I don't know if I have sleep apnea or what. But they also say fatigue can be due to vitamin levels. That reminds me, I need to record myself sleeping to see if I am snoring. 

[Jean in Newcastle]

27 minutes ago, heartlikealion said:

Finances have been a driving force in why I schedule things the way I do. My current insurance has a copay but lab work itself is $. I specifically requested labs to test vitamins for fatigue and they ran a panel based on that.. then I did follow up after increasing Vit D. Still tired. But exercising and eating better and probably less tired. They didn’t tell me to increase B12 but I did because it was in the lower end and I told him and he said that’s fine. Honestly they aren’t very proactive. They wait til you’re in the bad zone to say maybe do something. I’m becoming my own advocate. 
 

ETA: In their defense they offered a sleep study but I can’t afford that right now. It’s done at home but still $600 or so. 

Good for becoming your own advocate. I think that’s always been necessary. 
 

Allopathic doctors (regular MDs) are not generally proactive. And they aren’t as well versed in things like vitamins. I like my naturopathic doctor much better for that. But it isn’t cheap and not all insurance covers it. (Mine does but I have seen insurance coverage that doesn’t).