Dilemma: Finding a Primary Care Physician
Wednesday, 30 November 2016
About a month ago, I woke one morning with a mystery malady: randomly placed aches on the front, sides and back of my torso in about half a dozen specific locations which change from day to day.
These are entirely different from muscle pains I get when I occasionally overdo my fitness workout.
Because I hardly ever get sick and when I do, it is easily identifiable and not terribly important; and because I spend as little time with doctors as I can get away with, I followed my usual procedure when something goes wrong: wait and see.
By mid-afternoon that first day, I still hurt. I tried a pain pill, went bed and waited an endless 90 minutes for the medication to kick in.
This routine continued for next couple of weeks. The aches would be there for a day or two and then I would wake the next day feeling, unless you count general lethargy, almost my normal self again and got on with life believing that whatever had caused the aches was resolving itself.
But nooo. After one pain-free day – or two sometimes – the aches returned. Finally I broke down and went to the doctor. And this is where the story I came to tell you today begins.
Over a period of 15 or 20 minutes, the pleasant and clearly competent physician's assistant took my vital signs that, she said, were all within normal range and asked about any changes from what she read out on my chart. The doctor then arrived, sat down at the computer and started typing.
I had a written list of my mystery malady symptoms so I could be concise, along with a couple of unrelated, minor symptoms I wanted to check on while I was there.
Reading off my list, I explained my mystery symptoms and noted that for the previous day and that day, I was pain free but I'd been there before and didn't think the malady had corrected itself.
The only time the doctor looked at me directly and touched me was when he felt the glands under my chin pronouncing them, after a few seconds, to be normal. He returned to the computer and, I assume, entered that information.
The following conversation ensued (paraphrased):
DOCTOR: I can't see that there is anything going on we need to be concerned about and you said that the pain has subsided so you're apparently getting better. Give the MT a urine sample so we can check for a virus.
The doctor then walked toward the door.
RONNI: Wait. I have two other small things I want to ask about.
DOCTOR: Sorry. We're out of time.
And he left after being with me for 10 minutes - probably more like seven or eight minutes.
I peed in the cup and drove home in growing fury – and a little bit of fear. (Two days later, I was informed that the urine test indicated no infection or virus.)
FINDING A NEW PRIMARY CARE PHYSICIAN
For a couple of days I thought the pains had finally gone away but they returned and have continued that haphazard schedule of a day or two on, a day or two off.
Clearly it was time to find a new primary care physician. I'm 75. There is an old folk tale I'm unwilling to dismiss entirely that no matter how healthy you are, after 75 it's one damned thing after another.
A year or so after moving here, I used online listings of both primary care physicians and geriatricians to find a new doctor. My preference was for the latter but there are fewer of them every year so there's not much chance of finding one with room in his or her schedule.
These days, the web pages of most physicians list what kinds of insurance coverage they accept and I quickly learned that if Medicare is not listed, it is not a oversight. It means they won't consider you.
It took me several days to call all the physicians who listed Medicare and in every case the phone conversation went like this:
RONNI: I'm looking for a primary care physician and would like to make an appointment.
PHONE PERSON: What kind of insurance do you have?
PHONE PERSON: I'm sorry, we are not accepting new patients at this time.
I kid you not. Every single one said this.
(I did not find a doctor until I needed cataract surgery a couple of years ago that could not be performed without a full physical exam first. When I explained I did not have a primary care physician, the eye doctor made an appointment with the one I now see.)
A week or ten days ago, I asked a friend who has lived here for decades about finding a physician and she said, “Good luck with that. In this town, they all have waiting lists.” A neighbor I spoke with agreed.
Before long, I will need to repeat the exercise – it's been several years since last time – of calling the list of primary care physicians (and maybe take a stab again at the geriatricians) within a somewhat reasonable distance from my home to see if any will accept Medicare AND a new patient.
(One list is the Physician Compare Directory at the Medicare website where all the doctors do take Medicare. There are other online lists from various sources, often local, usually searchable by Zip Code in addition to specialty.)
Before that, however, another friend has offered to make an inquiry for me and we'll see how that goes.
But the point remains that if Medicare is your health coverage and you need a new physician for whatever reason, you may be out of luck. Of course, when/if I find one, there is no reason to believe he/she will spend any more time with me than my most recent encounter and we don't get to do job interviews before choosing a doctor. It's more like, if one will take you and he or she is still breathing, don't say no.
A fairly short trip around the web turned up multiple stories of elders with Medicare unable to find a physician willing to accept them.
A 2013 NPR story about this dilemma noted that between the year 2000 and 2012, the number of Texas doctors accepting Medicare dropped from 78 percent to 58 percent. There is no reason to believe it is any different in the other 49 states and god knows how low the percentage is now, four years later. Further:
”Seventy-eight-year-old Nancy Martin is one of the seniors who had a tough time finding a physician.
“'I felt frustration, disappointment and I would say, despair. A lot of days I would get to the point where I would think, I'm never going to find a doctor in Austin,' she told the NewsHour. It took a full two years for Martin to find one.
Ten thousand people a day turn age 65 so this problem isn't going away any time soon.
PRE-EMPTIVE NOTE: We are not here for any long-distance diagnoses of my mystery malady so please don't. The issue at hand is important – our experience, discussion and advice (if any) on finding a physician.
Your post today is very timely, big discussion on this subject going on in my house. My husband has a very good primary doctor; I do not. (Like you I only go to a doctor if really, really sick.) Hubby's doc is not taking on new patients. Some friends who recently moved to our town can't find doctor, even though they are financially comfortable and have excellent insurance coverage.
I have gone to one of the mini-clinics in CVs for ear problem and our hospital Urgent Care a couple of years ago. When my ship filled with gold comes in I'd like to get a "concierge doctor.
Posted by: Linda C | Wednesday, 30 November 2016 at 06:01 AM
I still maintain a relationship with my PCP when I lived in LA County who is now 75 miles away, but am conscious that if I get into trouble down here he won't be a viable option. Modern health care is apparently no longer a calling but a business with which I became all too familiar over the last 20 years of my career in health care administration. For now living with the occasional ache or pain and self-medicating when necessary have been working for me, but I've got a 70th birthday coming up.
Geriatrics is a challenging field of medicine and no provider worthy of the name likes to lose patients, but here we are and our "best by" date wasn't our expiration date after all.
Posted by: Harold | Wednesday, 30 November 2016 at 06:29 AM
Your story is a familair one . . . In the past 10 years we have lived in Wyoming, Georgia, and now Florida. In every new location we sought out a local physician. When asked whether we had insurance we offered up, "Yes. Medicare".
The conversations always then began, " . . . and we are not taking . . . " at which point we said, "and we have a secondary".
The appointment was then made.
Fortunately, I have the VA Medical when things get expensive. But for the general kinds of things we use the local MD.
I am beginning to think a lot of people are now expected to show up at the hospital ER. Passing an even greater expense to the local tax burden, and at the same time creating a very crowded ER.
Think about it - nothing has changed . . .
The ill informed people have spoken! Those that voted with the intent of cutting taxes and building a bigger military now are faced with (if available 'in your area') an even more expensive medical program.
For those of us who didn't vote with the follow-the follower mob - we suffer the same.
Thanks to all who did vote knowing what was in the 'best interests' for all of us.
Posted by: Yellowstone | Wednesday, 30 November 2016 at 06:56 AM
A big concern for all of us. We've been with the same medical practice here in the Northeast for years. I have Medicare and secondary, and had no problem finding a new PCP when my old one retired a cpl of years ago. We also get all the referrals to specialists that we need, no problem. However . . . we're worried if we move, and have to find new doctors, the picture may change. The problem is easy to identify: Too many sick people, too many old people, not enuf. doctors and a lot of expensive equipment; therefore the costs are astronomical. The problem is that there's no easy answer.
Posted by: Tom Sightings | Wednesday, 30 November 2016 at 07:15 AM
Linda C. mentions the phenomenon of "concierge doctors," which has grown exponentially over the last decade. It's too bad that this has removed many competent and physicians from the accessibility of the general population but if I were a recent medical school graduate looking for the best ROI on my hundreds of thousands of dollars of debt, I would probably be tempted to do the same thing. Plus, they don't have to operate within the constraints of those scripted 10-15 minute visits.
Over the years that I worked in social services, the majority of the people we served who were on Medicaid or nothing got their children's medical care by going to the emergency room, even to the point of taking their children in for head lice. After several hours, they generally left with confirmation of the problem, and what they needed to treat it. As for the adults, they did the same in extreme situations, but more often went without care. Our country has allowed health care to become as polarized as most things, and I shudder to think what we may be facing over the next few years.
Why our country cannot provide decent, affordable and adequate physical and mental health care for all is beyond me. I suppose, as with most things, it's because it's not a priority for those in power, and those who have influence with those in power have the means to retain those "concierge doctors." And so it goes.
Posted by: Cathy Johnson | Wednesday, 30 November 2016 at 07:34 AM
This is really important. Thank you for sharing, Ronni.
Posted by: Kirsten Jacobs | Wednesday, 30 November 2016 at 07:56 AM
Lots of truth in your post.
One recommendation, if they are in your area, is Kaiser. They accept Medicare and they offer pretty good care. My kids live in the bay area and the Kaiser hospitals and drs there have been outstanding. In Fresno, some drs are good, some not so much. But, they accept Medicare.
Posted by: dkzody | Wednesday, 30 November 2016 at 07:59 AM
At 68, I have a Medicare Advantage Plan. I must see a "Plan" doctor; that usually isn't a problem. The problem is that my experience has been that these doctors just don't seem to really care. Robotic, busy typing at their computer, and generally don't touch me. Whatever happened to a doctor who actually examines one's body and asks questions? And as you referenced, if one's list of questions/issues exceeds one's allotted time (which is very short), one is left with having to make another appointment. Then this necessitates another trip to the doctor's office. Those of us living just on Social Security are left with difficult decisions: how bad do I feel and can I put off going to see the doctor.
Wealthiest nation on earth! And we cannot provide healthcare for our people. It is beyond frustrating.
Posted by: Shirley Thompson | Wednesday, 30 November 2016 at 07:59 AM
I, too, have a Medicare Advantage plan, and must be one of the lucky few who has a great primary care doctor. He cares, he takes his time, he answers my questions and concerns, and I followed him when he moved from one practice to another about a year ago. Maybe because I live in an area with a very large number of seniors, but I've never had a problem finding a specialist. The only one I see regularly never makes his patients wait, and I'm the one who worries that he's taking too much time for me.
I do feel sorry for the people who don't share my experience, and know it's not going to get any better any time soon.
Posted by: Joyce | Wednesday, 30 November 2016 at 08:08 AM
I am very lucky. I have a wonderfully intelligent and compassionate woman doctor five minutes from my house. I've got Medicare with supplemental insurance Plan F (best type I think) BC/BS. When I have an emergency, I've had good results at a hospital First Care place which can stitch up cuts. When I had something that looked like a stroke, they got the ambulance there in 10 minutes to take me to the hospital for an MRI.
All this is luck, I think. Oh, and the fact that I retired from the University of Georgia. They've got a good set up for retirees now; I think my monthly insurance payment is fairly reasonable. But I suppose it could change at any time.
Posted by: Rosemary Woodel | Wednesday, 30 November 2016 at 08:12 AM
Very scary not to be able to find a doctor. I see an internist twice a year who is farther away than I want but he spends almost too much time with me. I wanted to find a primary care doctor closer to home and found one who would take me, but they told me I'd have to give up the internist to do it. (Both are with the same hospital so they'd know when they look at my records online.) Never having met the new guy I didn't want to chance the change sight unseen. I figure I will use an urgent care place or drugstore client if needed to supplement the internist.
Posted by: Jean R | Wednesday, 30 November 2016 at 08:16 AM
Same problem here in SC. I went to see my new doc with a list of a couple of concerns. Ten minutes would have been generous. I recently read Being Mortal. It told of people visiting wonderful geriatric doctors who took time to diagnose by looking at patient's feet and hands. My doctor only glanced at my face.
Posted by: Debra Davis | Wednesday, 30 November 2016 at 08:24 AM
Ironic that in Costa Rica, there are doctors in even remote villages because the government helps fund medical school for those willing to serve a few years in underdeveloped areas. We have ex-pat friends who operate a B&B in difficult to reach tourist destination Drake Bay. They have been quite happy with their health care for the many years they have lived there. Other friends who used to live in San Jose, C.R., spoke very highly of the specialists they dealt with while living there.
We as a country need to learn so many lessons the hard way. We are letting politics rule without reason.
Posted by: Norma Hall | Wednesday, 30 November 2016 at 08:29 AM
Not certain where you live but look for a FQHC health clinic in your area. (Federally Qualified Health Clinic). They accept EVERYONE, uninsured, underinsured, medicare, Medicaid, private pay, etc. They offer sliding scale pricing, etc. I'm on the board of our local FQHC (town of 4500 people) and most large cities have one or more.
I recommend you check to see if there is one in your area. Excellent care, and a great program to care for those of us over 65. Most FQHC's have pediatricians, family practitioners, OB/GYN, behavior health, and even dentists. Depends on the facility.
Posted by: Margo Johnson | Wednesday, 30 November 2016 at 08:32 AM
I'm one of millions that have an advantage plan. Without it I wouldn't have my really good GP at Scripps here. My husband has Kaiser, and when he reaches 65, he will add add Kaiser Senior Advantage plan to his days. I didn't like the dentist...so I pay cash. I like all my other referred docs, thank heavens.
Posted by: Mage Bailey | Wednesday, 30 November 2016 at 08:40 AM
The next time I see my brother-in-law, a retired physician aged 87, I plan to ask him to give me the doctors side of the problem. I know his experience is out of date but maybe he can shed some light on it. We have no doctors in the younger generation of family. Genie
Posted by: Genie | Wednesday, 30 November 2016 at 08:59 AM
I read your good words, Ronni, plus the great number of revealing comments, and once again feel despair. All of this is so utterly timely - especially since * has just chosen Rep. Tom Price, who has sworn to kill the ACA, Medicare, Medicaid, and no doubt social security as soon as he can. And of course Planned Parenthood. So if we think we have it bad now! --- just think ahead a few months.
I used to go regularly to a clinic made up almost entirely of women doctors, and I was always lucky, insofar as those I then went to were competent, helpful, attentive, etc. Then the last one I had decided to leave [many had just burned out--], and the New Era began. Your account of the doctor whom you most recently saw, who stayed no time at all and touched you only briefly reminded me of the person I saw once my doctor had left - she was pleasant enough, but she concentrated on her computer and never touched me at all. And left promptly.
Nothing really has improved. She did most recently have someone else there to be at the computer, but I felt awkward with a strange person there and, as I tend to do, kind of shut up..
In any case, I join those who fear the new world of * and the * adminstration. He seems determined to pick precisely the people who will destroy whatever department they will head, whether it is Health, Interior, Education, or anything else that we desperately need to be functioning and improving. How often I read now how this or that appointee will "take [you name it, health care, whatever] in a fundamentally different direction." And you better believe it won't be a better direction.
I recently read about a woman in the south somewhere who voted for Trump and at the same time participates in the Affordable Care Act. The reporter who spoke to her reported that she had never connected the two of them, * and the ACA, she likes both of them. I can't even come up with a comment on that one.
Maybe it's the lowering winter weather outside, but gee, this is all pretty scary.
Posted by: Ruth-Ellen B. Joeres | Wednesday, 30 November 2016 at 08:59 AM
Ronni, as the other comments attest, your dilemma is quite common. A few years ago I mentioned to my GP of more than 15 years that I may not have private insurance and that there would be a gap of a few months before I got Medicare. He said to not mention that to any of their staff, since the practice (15 physicians) does not accept "new" patients who are on Medicare. I asked, "Even me, after 15 years in your practice?" Looking at his laptop (yes, the same hands-off style of medicine!), he shrugged, "Yes, after all, it's a business." This sad state of affairs will surely get worse.
Posted by: Bob Harootyan | Wednesday, 30 November 2016 at 09:22 AM
I can say Ronnie, don't drop your current Doctor till you locate one...I'm sure you won't. I have been with same practice for years; have no chronic health matters, so don't see Doctor often. Last year I had a minor thing come up, called for an appt. and was told doctor retired. Really??? No notice was ever received by me. So I began the search, ran into no doctor taking medicare. Back to original practice and since I was a prior patient, I could choose another doctor in the practice..ok fine, can I make an appt.? Yes but she's on maternity leave till this winter. So I see her PA for the Wellness ck up and she spent plenty of time with me and any of my concerns. In short, the system is a mess and at times, I think "they" just as soon see us pass into the sunset. In my area also are rumblings of concierge practices. More and more of my friends use urgent care for minor issues. I have excellent coverage, but what the hell is good about it if no doctor accepts medicare etc. The situation demands seniors be proactive and not all can.
Posted by: Kate R | Wednesday, 30 November 2016 at 09:42 AM
Same thing here, mine is not an original tale. We have two hospitals here in a town of 30,000 with some small satellite clinics, both faith based which means they accept Medicare but getting an appointment is something else. Fifteen minute appointments and 5-7 of that is with a medical tech. My last visit with my PCP, an internist, was a drive by. She is a great person, a geriatrician and I like her but the hospital administration has driven off so much staff that even a 10 minute appointment is almost impossible. I am really worried she will leave too. The saving grace is the hospital clinic I go to has a well staffed Urgent Care walk-in clinic. More and more that is where I end up and my doctor's office often sends us over there. If it's worse than I thought the ER is across the street. Because I can get most of the prescriptions I need over the phone I just go in less and less.
I used to see a great pulmonologist (I have serious COPD) but he and one other of the 3 pulmonologists here have quit. One moved to a large city and a boutique medical service. The second pulmonologist just quit and went home to regroup. Now there is one and he is also a hospital admin. He is not taking appointments anyway but will show up if you are hospitalized. The next set of pulmonologists is 65 miles away and not accepting Medicare patients. I'm okay for now, care is routine for now, but I am worried for the future.
At 74 facing a future with no or little Medicare and SSI that will probably never go up is daunting. But I am really scared for my children and grandchildren. ACA has provided my eldest son with predictable insurance for the first time in his life. He's an insulin dependent diabetic, and also has serious liver disease making needing a new liver quite likely in the future.
Posted by: Celia | Wednesday, 30 November 2016 at 09:46 AM
I am still with the GP I first found back in 1973 (benefit of living in same place). He is getting elderly, about ten years older than I am -- and I worry about a replacement. He's of the old school: sits down, listens to everything you tell him (even emotionally) and then it's hands-on. He checks lymph glands, looks in mouth, ears, abdominal area, etc. I dread the day he retires, though he keeps saying they'll be taking him out of his office in a body bag before he retires. He also was my mother AND grandmother's primary doctor!
I did see a younger GP a couple years ago, thinking I might need another doctor at some point. He was young, acted as if I was taking all his time and attention away from his computer. Then when I told him specifically of a problem, he very RELUCTANTLY looked in my ear. That made me feel...I don't know, just icky, as if there was something contagious with me, that he couldn't be bothered to actually do an exam. I was actually there for a full physical. Needless to say, never went back. And oh yeah, spent about ten minutes with him. Sigh.
Posted by: Cara | Wednesday, 30 November 2016 at 09:47 AM
I am so sorry this happened to you. I am 78 and had this problem until we switched to Kaiser Permanente. First of all, you can not be turned away. I didn't like the first Dr I went to and was able to change without a problem. Secondly, they take elder care very seriously. I have had the best care of my life with them. My husband is prone to forgetting to have his check ups. They call him and get him in for blood work and other necessary tests. I could go on and on about the quality of care we get and the time they spend with us. We live in Portland. The Kaiser NW has the highest customer satisfaction of all HMOs here.
Posted by: Gerrie Congdon | Wednesday, 30 November 2016 at 09:55 AM
I'm 73. I've always thought it very important to have a regular doctor that I like, have a long-standing relationship with, and see for check-ups on a regular basis (even more important after 65, when declining health is inevitable). My current doctor is a family practice doctor (recommended by my son) in a group practice that accepted my Medicare Cost plan. I see her every six months and she devotes as much time as we both need for a thorough check-up with all questions answered (30+ min last time). Referrals to wonderful specialists when I've needed them have been generous. And my one day in the hospital last year allayed somewhat my fears about being handed off to some unknown hospitalist who didn't know me or my history.
Posted by: PiedType | Wednesday, 30 November 2016 at 09:59 AM
I have an HMO and they have a list of primary care physicians. Mine is just like others have described. Limited time and all he does is make referrals to specialists and write prescriptions. He does keep track of my thyroid and orders blood work as he thinks is needed.
He spends about 15 minutes with me asking questions and the only time in all the years I have been going to him that he touched me is to listen to my heart. As the others have said, his face is glued on the computer monitor and not me. I think today's crop of doctors would make good secretaries, since their computer skills seem to be better than their medical skills.
I wanted a geriatrician, but there isn't one this year. Last year there was one doctor in the list, but she wasn't taking new patients. I guess she had so many patients that she opted to drop Medicare.
Yes, a concierge doctor is the way to go if you can afford it. I lost my wonderful primary care doctor years ago when he went that route. Who can blame the doctors? They are limited by the rules of the HMO's and have to set a number of patients per hour so the Insurance companies can feather their bottom line.
Posted by: Darlene | Wednesday, 30 November 2016 at 10:19 AM
Further evidence that anyone who talks about healthcare becoming a consumer-driven marketplace is living on Pluto.
Posted by: ag | Wednesday, 30 November 2016 at 10:33 AM
Ronni: Your symptoms, which I gather involve(d) localized and ever-shifting locations of pain, seem to be the same as my 77 yr-old wife had recently. She even had to use a walker. Her doctor quickly diagnosed her problem. She was drinking a lot of tea. But very little water. As water seems to be the lubricant our bodies need, she immediately started drinking lots of water, - - and the pains haven't re-occurred.
Posted by: Tim Hay | Wednesday, 30 November 2016 at 11:27 AM
I recently became aware of a trend in clinic practice that bypasses much of the insurance mess. It's called direct primary care. The system is being put in place around the country as states pass laws allowing it. Basically, it involves cooperatives of medical Clinics that charge a lower monthly fee to allow unlimited access to primary care providers. Oregon does allow this. I noted three in the Portland area.
Under the system, the direct primary care coverage plus a high deductible plan, which I presume Medicare would count towards, meets ACA rules. Here in Minnesota, the network closest to me cost $75 per month. Now, I rarely see a doctor, but I can see that as I age it would be to my advantage to have such access.
Not free, and maybe not the solution, but it is interesting that docs are coming up with this themselves.
Posted by: Elizabeth | Wednesday, 30 November 2016 at 12:03 PM
My husband was active duty military for 20 yrs. As soon as I turned 65 I was ushered out of their care. I know exactly what you mean. I have Medicare and Tricare for Life. Few wanted you. Now some will not take Tricare.
Now my fear is what happens when the Republicans abolish Medicare? I am diabetic, 77 yrs. old and history of spinal stenosis, etc. I will have NO care.
Posted by: Bonnie | Wednesday, 30 November 2016 at 12:11 PM
Now that we have normalized relations with Cuba, I'll bet there are plenty of those supposedly well-trained "Castrocare" docs down there that would love to get some of that Gringo Medicare $$.
You could combine a trip to the doctor with a Caribbean vacation.
Posted by: Bruce Cooper | Wednesday, 30 November 2016 at 12:25 PM
Thanks to those who posted favorable comments about Kaiser Permanente. They just acquired Group Health Cooperative in WA State, and I've been apprehensive about the change although Kaiser appears to be highly rated. My biggest fear is that they swoop in and cancel the outstanding Group Health retiree health plan we now have or modify it so that it becomes unaffordable for us. Both GHC and KP are HMOs and they take Medicare which is a good start. We currently have a Medicare Advantage plan that we have tried to use judiciously but will probably need somewhat more often in our 80s.
I seriously hope that there are wiser heads somewhere in government that will stand strongly in the way of abolishing Medicare and S/S. Even Congress, which consists mostly of the well-off (and stopped being representative of "ordinary people" long ago) has to comprehend on some level that without these two programs, adult children will become financially responsible for their aging relatives! Except for the uber-wealthy, that would put a sizeable dent in most peoples' bank accounts!
Posted by: Elizabeth Rogers | Wednesday, 30 November 2016 at 12:51 PM
Did you skip reading the final paragraph???
Posted by: Ronni Bennett | Wednesday, 30 November 2016 at 12:56 PM
You might consider a PA as your PCP. I've been seeing one for many years now with no complaints at all. She diagnoses problems and prescribes meds. A PA is a Physician Assistant. This is not the same as the person who takes your vitals, etc. Most likely that person was a medical assistant, LPN(licensed practical nurse or in some cases, a RN (registered nurse).
You may be able to find a PA you like more easily than a MD you like. Whether or not a PA can be your PCP may also depend on state law. But from my experience, I would highly recommend your looking into this.
Posted by: Lucy | Wednesday, 30 November 2016 at 01:02 PM
Like Dkzody I have Kaiser. So does my husband. There is quite a turn-over of doctors, but my basic care is OK. I can get my meds and regular blood work, etc. They were great with my late mother-in-law, who died at the age of 97. well cared for right up to the end.
Our premiums have gone up, but they are quite affordable for us, and they are on a sliding scale.
Posted by: Hattie | Wednesday, 30 November 2016 at 03:01 PM
Reading down, I see that Kaiser has acquired Group Health. I'm glad, because we spend a fair amount of time in Seattle, which means as a Kaiser patient I presumably will be able to use the services of Group Health.
Posted by: Hattie | Wednesday, 30 November 2016 at 03:11 PM
I have basic, not Medicare, and finding a good PCP is still a problem. For years I had a marvelous, caring doctor who left the large teaching hospital system with which my HMO is affiliated. My current PCP is, like Ronni's, a robot who spends most of his time typing on a computer with only a cursory examination. But the doctors I had in the interim before I found him were even worse, so I'm stuck with him. He's mostly a traffic director anyway,referring me to this or that specialist in the University system where the specialists are almost always the best in their field. Fortunately for me, nost of my specialists---heart, vascular, eye---are women. I don't want to seem sexist but women doctors, in general, are, in my opinion, smarter and more caring. On the plus side, the medical system allows half-hour appointments for older patients, so I see him three to four times a year for regular checkups. Hmmm. Is more of a bad thing a good thing?
Posted by: EmmaJay | Wednesday, 30 November 2016 at 05:01 PM
In my rural community,the majority of primary care practitioners are nurses. Certified nurse practitioner, family nurse practitioner, etc.My personal provider is also Doctor by virtue of having a PhD. She allows minimum twenty minutes per patient, listens, touches, examines, and has a wide scope of knowledge. If more time is needed she takes it. The trade off is knowing I may have to wait an hour past my appointment time because she is being thorough with someone who's appointment is ahead of mine.
Worth checking for equivalent in your area.
Posted by: Niki | Wednesday, 30 November 2016 at 05:53 PM
I just felt the need to vent about the modern practice of medicine. I know the young folk don't want to hear about the good old days, but we are old farts and presumably we can handle it.
I remember during my entire growing up period in a small town that we never even heard of health insurance. At the rare times when whatever we had didn't go away, we would go to one of the two or three local doctors. He (it was always a he in those days) would look straight at us, touch or probe various body parts as necessary, prescribe or advise something, and we would pay our $10 or $15 to his all-purpose assistant. We knew him and he knew us.
When we had a baby or something that required hospitalization, we saw our local OB regularly as above, then went to one of two hospitals in a nearby town for the actual event. The bill was usually in the hundreds---a tab nearly anyone could either save up for or pay on sight. I had only one major surgery with a hospital stay in my first 30 years, and although I don't remember the exact cost, I know it wasn't a disaster. In other words, we wouldn't have had to take out a mortgage to pay the bills. As with our GP, our surgeon knew us by name and "dropped in" to see us regularly.
Later, when I had a husband whose employer provided health insurance, it seems to me that medical costs grew to meet the available payments and they have been growing ever since. Of course by that time we had become accustomed to a very large disconnect between service and payment. I don't know what the moral of this story is, but I do know for absolute certain that life and healthcare have not improved over the years.
Posted by: EmmaJay | Wednesday, 30 November 2016 at 06:22 PM
I, for one, intend to try Tim Hay's tip. I drink tea continually, rarely drink water. For the next month it's water only. Maybe those mysterious pains that come and go will give it a rest.
Posted by: Charlotte Dahl | Wednesday, 30 November 2016 at 07:02 PM
Thanks for this post. This is a common problem for elderly people as well as everyone else. What would solve it and reduce the cost of health care is a single payer system- like Canada. Everybody in and everybody gets the same care.
Would not solve all the problems but would help with this issue and reduce costs. I am disabled and my insurance is Medicare and Medicaid. Here is how I find a good medical team. Shop around and diplomatically get rid of doctors and other medical professionals who are not contributing to your health.
Once you find a good doctor, she or he will likely have a list of other doctors and Physical Therapists and other members of the team that she or he likes.
This is a gold mine. Nurses are a great source of accurate recommendations but you have to ask them appropriately. For example, ask the nurse if she had a family member with your particular issue- who would she recommend. Or ask her who a good primary care doctor is.
For your information, offices that take Medicare alone,
not a Medicare Advantage plan are subject to the following problems:
First, Medicare pays them six months after they submit the bill and often does a very poor job. For example, my name is Mary Ellen Greenlaw. If the doctor submitted the bill as M. Ellen or just Ellen Greenlaw, Medicare would deny the claim. I had to get my senator to get my name consistent throughout Medicare, Medicaid and Social Security and I make sure that each office knows how to submit claims in my full name. If you have a Medadvantage
plan, the plan will cover what Medicare covers and usually nothing else but they pay more promptly. So more medical offices will take Medadvantage plans. Try this to see if you can get better care for your insurance dollar.
Second, offices who take plain Medicare are subject to Medicare audits.
The auditing companies are separate from Medicare. I had a technician who made my braces - small independent office that did great work. When the firm doing the Medicare audit started in- they looked for small billing errors,
not did the practionner do a good job. If there was the slightest billing error, he had to pay back the full amount of the bill- and the money paid back did not go back into the Medicare trust fund. The company doing the audit got to keep the money. So Medicare audits, in my opinion are another form of fraud.
My technician had to close up his shop, now he works for a big hospital who have a billing department to deal with Medicare.
There is an opening in the new administration for some changes. All of us need to be active citizens and advocate at every level for better service from
Medicare and I'd suggest making Medicare for all a serious option. Please talk about this and be very outspoken rowdy citizens. Most people in the country did not vote for Trump and would like better health care just like all of us in this discussion.
Posted by: Ellen Greenlaw | Wednesday, 30 November 2016 at 10:03 PM
I, too, am now looking for a new doctor. I had the same great doc for 30 years and at my last visit he told me he was retiring the first if the year. Well that time is fast approaching. I gave one more visit with him towards the end of Dec to get all my prescriptions for the next year at least. And to say a sad goodbye.
I have a Medicare HMO for seniors thru Providence Health Plan. They run the hospital closest to me and it's where I have ended up following fractures, for specialists etc.
Not sure, Ronni, what if any gap insurance you use but Providence docs are taking patients with Providence Insurance. I plan I'm making a new patient appointment with a woman doc who my daughter uses and who she likes a lot.
Meanwhile I am following the dismal news from D.C. about the future of Medicare and that of our way of life as seniors. Vouchers. The whole idea is upsetting.
Can't seem to shake the depression following *s election and a visiting friend has had it with me. I'll be glad to see him leave really. I think I'm entitled to be depressed and I'm so tired if being told to get over it.
Take care all
Posted by: Elle Hayes | Thursday, 01 December 2016 at 10:51 AM
I live in Canada. I don't get turned away because of my health insurance, we're all pretty much in the same boat insurance-wise here. But finding a GP is just as hard. It took a couple of years after moving to my current location to find one, and a few more years after that to find a good one. In the meantime I did walk-in clinics. One visit to the ER involving a 5-hour wait time in great pain cured me of going there voluntarily. My doc is older than me and says he has no plans to retire, but he has recently taken on a younger female partner ("to do the female stuff") so hopefully I'm covered if his plans change.
Posted by: Annie | Thursday, 01 December 2016 at 01:00 PM
I live in a major NE city, am disabled, aged 60 and my insurer is Medicare administered through a well-known company. I have to prioritize which condition is the most urgent because I have to pay $50 co-pay for each visit for each specialist. I need knee replacement and have been stretching out my visits to have knee injections to save money. Recently I became dizzy and fell down on the pavement in the business district, gashed my forehead and ended up in the hospital for stitches, CT and observation. The care I received was excellent; however, since they recommended I see two other specialists for symptoms they noted, I have to now decide which treatment can wait: the ortho doctor, the pulmonologist for whom I see for sleep apnea, or the 2 specialists to which I was referred after my fall. A while ago I asked the insurance for some help (!), they filled out a request to the state to have them pay my Medicare deduction. I was denied because I was $25.00 over. I'm trying to have a positive attitude but it's a challenge.
Posted by: Cheryl | Thursday, 01 December 2016 at 10:30 PM
In my view, the best way to find a good Primary Care Physician or any other physician (specialist, for example) is by word of mouth. Ask friends, relatives, acquaintances, people at your house of worship, or coloring drop-in group, or senior center or anywhere else if they go to a really good primary care physician that they would recommend to you. And be sure to name-drop: call the physician's office and mention that so-and-so is a patient of the physician and recommended the doctor to you for a primary care doctor.
When I decided to part ways with a formerly good primary care physician who decided to become a Concierge doctor - meaning he was charging $1800 per person per year plus what he got from insurance for consults, etc. - to do what other primary cares doctors do for whatever insurance pays and no Concierge fee (the fee that raises serious ethical questions), I wasn't about to put up with his plans to change to Concierge care.
I asked friends at my house of worship and immediately found a female women's health specialist/primary care doctor who sets aside times for more urgent appointments that are on shorter notice, listens, explains things, does any tests she feels are appropriate, etc. and has ethical objections to Concierge doctors. I have been going to her for 4 years.
And a big plus: the former doctor was way up in Chicago when we are way out in the far south suburbs. My current primary care doctor is about a 25 minute drive from my house. And she has a couple of good associates who cover for her when she goes on vacation for a week once or twice a year.
If you have a really good specialist whose opinion you trust (ear-nose-throat, neurologist, eye doctor, whatever), you may also want to ask the specialist for a referral to a good primary care doctor.
Posted by: Vicki | Friday, 02 December 2016 at 11:25 AM
"Sorry, we're out of time?" Unacceptable. A violation of the Hippocratic Oath IMO.
I had no idea so many doctors were reluctant to take Medicare.
I changed Dad's doctor from the VA to a physician who was board certified in geriatric medicine. She was great. Loved her. Heard about her from a coworker whose MIL suffered from depression due to over-medication. This doctor correctly diagnosed the reason for the depression.
Posted by: NatashaM. | Friday, 02 December 2016 at 01:13 PM
Be careful what you wish for. Canadian care is fantastic if you want to be 20 years behind the curve ball, think 1995. It's great if you have the sniffles but everything else gets rejected as "experimental." We currently have all pancreatic cancer patients that want to live more than a few months hightailing it to Germany for nano knife therapy. We have two tier cancer coverage with many chemotherapy drugs not covered - just die already. My husband had a 9 month wait for a diagnosis for a knee injury - yep nine months. He went to Buffalo instead and it was cheaper than the vet bills for my cat, state of the art very accommodating orthopedic center. Amazingly good care compared to up here.
We are the only country in the world besides North Korea that doesn't allow private pay but the chinks are coming in the dyke with a lawsuit before the Supreme Court in B.C. There is a generational shift with Boomers and younger not being satisfied with "free" as the deciding factor. I would rather pay for a new hip or knee or cataract surgery then wait for years when I don't have that many years of quality life yet.
Posted by: Vera | Sunday, 04 December 2016 at 05:36 PM
"Be careful what you wish for. Canadian care is fantastic if you want to be 20 years behind the curve ball, think 1995. It's great if you have the sniffles but everything else gets rejected as "experimental."
What?? Where the heck do you live? I'm Canadian and don't recognize the country you're describing. If you actually live in a place in Canada that rejects everything but the sniffles as "experimental", please let us know where it is. I'll report them to the authorities :-)
I've lived in wildly differing parts of B.C. all my life: from way out in the country on a remote, hard-to-reach Island to the heart of Vancouver to the suburbs of Vancouver Island, to name a few. Nobody I know of or have ever heard of has experienced anything like what you're describing. I count my lucky stars every day that I live in this blessed country of free health care. North Korea? Give me a break.
Over the last few years my husband has gone through double hip replacement surgery with follow-up home care and extensive physiotherapy; plus cataract surgery; plus carpal tunnel treatment surgery; plus hospitalization and treatment several times for atrial fibrillation and congestive heart failure. We didn't pay one red cent for any of it. I still marvel at that. The treatment in each and every case was top notch. He's still roaming the earth because of it. Every 6 months he has (free) follow-up appointments with his cardiologist to make sure he's doing okay. He is.
I rarely go to the doctor, because like Ronni, I feel I'm better off staying far away from the medical system unless there's a really urgent need to include it in my life. But most people I know go regularly and are treated well. Almost too well, given that blood tests, CT scans, MRI's and the like seem to have become almost routine, at least for older people with any health problems at all.
To compare our system with the hoops that Americans have to jump through to get health care coverage, strikes me as more than a bit outrageous. In my opinion, we have absolutely nothing to complain about compared to what they go through. However I HAVE figured out one reason why Ronni and her readers are so sharp, smart and well-informed. I figure they have to be, to understand and navigate their health care system. Just listening to them talk about it leaves me with my eyes crossed in confusion and my mouth gaping in admiration :-\
Posted by: Katie | Sunday, 04 December 2016 at 07:56 PM
You are permanently banned from commenting at Time Goes By. Everyone is allowed to critique whatever the topic is on any given day but racial slurs are never allowed under any circumstance. Goodbye.
Posted by: Ronni Bennett | Monday, 05 December 2016 at 06:10 AM
Your life is going to be a sad commentary on the state of Medicare in the US. The Republicans have been trying for years to change it, make it go private but you libs have fought them tooth and nail.
You reap what you sow.
It is the Democrats who want to throw grandma off the cliff. Never the Republicans.
I am so so sorry for what you are going through.
I hope this is a great lesson to all who encounter your medical journey, to support President Trump when and if he makes the much needed changes to both Medicare and Social Security.
Unfortunately, as it stands now, Medicare doesn't really care if you live or die.
The doctors are instructed to feel the same.
That is why so many new doctors today will NOT take on new Medicare patients. Only the quacks do. And you have no recourse, unless you have the cash to pay for your own out-of-pocket medical care.
You are in my prayers.
I only wish you the best.
Unfortunately, other than your family and readers, no one else will.
Posted by: ALICIA | Saturday, 17 June 2017 at 06:54 AM