2 Off Topic Rants

Rant # 2 first:

Pratoman said...
There is something very wrong with our healthcare delivery system.

Yeah, no ****. I don't know what else to say. Not sure anyone does know what to say or do about it, given the political divide. My annual Uro appt. for this year has been cancelled twice now (on their end), and they are trying to get me in in early 2022. Glad I'm not having real uro type problems at the moment.


Rant #1: Wife and I had the opportunity to transfer along with a family doc who was moving to concierge approach. This was about a decade ago. It seemed like a new thing in our locale back then. We did not follow, for financial reasons at the time. But I saw online recently that he was still doing that, so guess it worked for him and, by extension, his patients.

It seems you would be in an ideal position to try a concierge doc for a year. I think you may be a little better off financially than some other posters, so the $2k or so annual fee might be worth trying for a year. Just looking on the web now,

"A concierge care or direct primary care practice might average between 450 to 600 patients, while a typical primary care practice might average closer to 2,500 patients."

If you leave your current internist, you could do it gracefully and keep channels open in case you wanted to go back after a year of concierge. Have them send just copies, not originals, of medical records to the new concierge doc, so going back would be easier if needed.

I would be really interested in what ideas a new doc, who is spending longer appts. with you, could come up with with regards to triglycerides. That, imho, is something that making progress on in 2022 would be really key for you.

-- For the months you spend away from the place your doc is physically located, perhaps you could do some virtual appointments. I've done that with two docs the last year, and it worked out pretty well.

-- Seem to recall you used to be in a state that did not allow online scripts and walk in blood draws. Maybe you could start doing some of those in one of your two "alternate" states, if allowed in that one. You can get your own LabCorp or Quest draws and monitor some of your stuff on your own, to minimize your routine doctor visits. They have many blood draw offices in most cities. Most doctors use those two processing labs, anyway. My local doctor's affiliated hospital just outsourced their whole in-house lab to Quest.

Robert

Bobbiesan, thanks for the response, some very good suggestions. One of the things that holds me back from going conccierge is that its only primary care. I still have to deal with all the BS when i see a specialist, like a gastro, cardio, etc. Relating to your suggestion, i suppose i could keep seeing my primary who is also my cardiologist and just see him for cardiology visits, and tell him i am going concierge for primary care. Need to think this through.

Mel, its very sad, it seems we are all just numbers in the system. Thats the problem. The way doctors, especially PCP's get reimbursed today, they are forced to see an inordinate amount of patients. So by necessity we become numbers. Glad your SIL is ok.

Recently diagnosed with IBD by a GI I’ve seen for 20 years. Even though this ailment is within his specialty, he told me flat out I’d get better care somewhere else. He told me he would not have the time it would require to manage it. He also said this is a disease most GI’s want nothing to do with. Too time consuming for that type of patient.

This is why I’ve been going to him for so long. His profound honesty.

I’m checking out the places he suggested.

IT, thats a crazy story. As Logo said, thats his specialty. Makes no sense. I can only guess that its the type of condition that will not require expensive procedures so the time he has to spend with you vs the amount he will get reimbursed is not worthwhile. So a business decision. Which just validates my comments above. Nuts.

Of course doctors wouldn't be involved with concierge medicine if it wasn't advantageous to them. But, it can sometimes be advantageous to patient care too -- if you've got the bucks. Usually, you get what you pay for.

Apparently it's stressing health care by effectively reducing the number of doctors.

https://www.scientificamerican.com/article/many-doctors-are-switching-to-concierge-medicine-exacerbating-physician-shortages/

I understand that many/most people want to have a doctor with whom they have a personal relationship, who has a good bedside manner, is familiar with the case, and takes as much time as the patient desires. That would be great. For me, my expectations are much lower. This is probably because I was raised as a navy brat and then spent a spell in the military myself and never saw the same doctor twice. It’s like taking my car to the dealer for work (which I don’t because I do my own work) and I don’t care who works on it as long as they are competent. But that is the rub, isn’t it? How does one judge the competency of a professional when the problem to be solved is beyond our own level of expertise. I have VERY mixed feeling about the medical people I have dealt with in that past 3 years and figure that, for me, it’s basically a crap shoot.

Pratoman said...
IT, thats a crazy story. As Logo said, thats his specialty. Makes no sense. I can only guess that its the type of condition that will not require expensive procedures so the time he has to spend with you vs the amount he will get reimbursed is not worthwhile. So a business decision. Which just validates my comments above. Nuts.

You and Logo nailed it. I told my sister, “He’s not making any money off of me. He makes his money doing colonoscopies. He’s wanting to retire and he’s cramming as many colonoscopies in as he possibly can before he does.”


Miami has an Ulcerative Colitis research center. That’s where he recommended. It’s where I’m going.

Same issue as you Prat. Winter in FL, Summer in TN. It’s not easy getting a network of doctors set up when you’re a newcomer for a few months a year. (Especially at our age lol)

Pratoman said...
IT Where in Florida are you?

Stuart. Here ‘till end of March or maybe April.

University of Miami has a very good, maybe excellent, Colitis and Crohn's center, in my experience.

Patients who like to win lotteries by suing medical professionals, physicians who get 'incentives' from big pharma, the medical industrial complex that has no real performance metrics, Medicare and Insurance that pays charges haphazardly and clever medical cost accountants all are working against good medical care in the USA, in my observation and experience.

Post Edited (garyi) : 1/5/2022 8:59:28 PM (GMT-7)