Comments on: Why Primary Care Matters http://distractible.org/2009/07/29/why-primary-care-matters/ Thoughts of a moderately strange (yet not harmful) primary care physician. Sun, 01 Aug 2010 02:44:35 +0000 hourly 1 http://wordpress.org/?v=3.0.1 By: Martha http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4920 Martha Tue, 11 Aug 2009 05:14:37 +0000 http://distractible.org/?p=2747#comment-4920 Dr. Rob, Because of my being one of your patients for 7 1/2 years, I am very thankful for the balance you have shown in helping me with my chronic condition. I appreciate the fact that you do listen to me and that you do what is necessary to try and solve the mysteries of some of my physical complaints. Your knowledge and caring spirit have helped me get the medical care I have needed or you have sent me to specialists to get the medical care that was needed. You are brilliant in my opinion, yet humble about what you know. I appreciate you! For those who read this reply, one of the things on my part that has helped Dr. Rob to have wisdom in taking care of my medical needs is that each time I have an appointment with Dr. Rob, I give him a list (usually typed) of my medical concerns for which I need his help. The list includes, not just my medical concerns, but the symptoms I am experiencing, the time frame that I have experienced the symptoms, as well as the severity of the symptoms (pain level --from 0-10 with 10 being the worst pain I have ever experienced; and the type of pain--sharp, dull, piercing, burning, etc.). These specific explanations of the symptoms helps Dr. Rob to come to a quicker diagnosis. Dr. Rob can read the list and then decide what symptoms need his attention the most. I have a copy of the list so that I can see what he covers and how he covers the symptoms. He looks forward to my list because he knows that I have tried to carefully think about what needs to be covered. The majority of the time, I don't leave the examination room thinking that I have forgotten something. Dr. Rob works hard to listen and understand my symptoms. He treats my whole person, not just 2 or 3 symptoms. I have recommended Dr. Rob to quite a few of my friends. Some of them are now patients of Dr. Rob. Not one of my friends, who are his patients, have said any negative thing about Dr. Rob. All of them, including me, are very appreciate of Dr. Rob's help and care. I thank God for using a friend of mine to recommend I see Dr. Rob 7 1/2 years ago when my other PCP moved out of town. I believe that one of the reasons that my condition has greatly improved is that God has used Dr. Rob to be a catalyst in my life; physically, mentally, and spiritually. Thank you, Dr. Rob! Dr. Rob,

Because of my being one of your patients for 7 1/2 years, I am very thankful for the balance you have shown in helping me with my chronic condition. I appreciate the fact that you do listen to me and that you do what is necessary to try and solve the mysteries of some of my physical complaints. Your knowledge and caring spirit have helped me get the medical care I have needed or you have sent me to specialists to get the medical care that was needed. You are brilliant in my opinion, yet humble about what you know. I appreciate you!

For those who read this reply, one of the things on my part that has helped Dr. Rob to have wisdom in taking care of my medical needs is that each time I have an appointment with Dr. Rob, I give him a list (usually typed) of my medical concerns for which I need his help. The list includes, not just my medical concerns, but the symptoms I am experiencing, the time frame that I have experienced the symptoms, as well as the severity of the symptoms (pain level –from 0-10 with 10 being the worst pain I have ever experienced; and the type of pain–sharp, dull, piercing, burning, etc.). These specific explanations of the symptoms helps Dr. Rob to come to a quicker diagnosis. Dr. Rob can read the list and then decide what symptoms need his attention the most. I have a copy of the list so that I can see what he covers and how he covers the symptoms. He looks forward to my list because he knows that I have tried to carefully think about what needs to be covered. The majority of the time, I don’t leave the examination room thinking that I have forgotten something.

Dr. Rob works hard to listen and understand my symptoms. He treats my whole person, not just 2 or 3 symptoms. I have recommended Dr. Rob to quite a few of my friends. Some of them are now patients of Dr. Rob. Not one of my friends, who are his patients, have said any negative thing about Dr. Rob. All of them, including me, are very appreciate of Dr. Rob’s help and care. I thank God for using a friend of mine to recommend I see Dr. Rob 7 1/2 years ago when my other PCP moved out of town. I believe that one of the reasons that my condition has greatly improved is that God has used Dr. Rob to be a catalyst in my life; physically, mentally, and spiritually.

Thank you, Dr. Rob!

]]> By: Rob http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4704 Rob Thu, 30 Jul 2009 16:27:23 +0000 http://distractible.org/?p=2747#comment-4704 Agree with your change. The dilemma is that good docs tend to be busy. Good luck! Agree with your change.

The dilemma is that good docs tend to be busy. Good luck!

]]> By: Laura http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4703 Laura Thu, 30 Jul 2009 16:16:34 +0000 http://distractible.org/?p=2747#comment-4703 I love everything you say. I have one small quibble. Perhaps your could change this: Our goal is to keep people away from specialists and hospitals. To this: Our goal is to make sure people don't need specialist and hospitals. It reflects better what you say on this point and keeps people from reading your bullet point and making the knee-jerk assumption that you want to prevent patients who need it from seeing specialists or going to the hospital. Another thing that your post has me thinking about. I love my kids' pediatrician. He does many of the things you describe, and I trust him. But so do (seemingly) ten thousand other moms in Atlanta. So, I have a devil of a time getting my kids in to see him, and when I do, he's in a terrible hurry. It's very frustrating, and I'm beginning to wonder if he's become too popular and that it's time for me, however reluctantly, to find a pediatrician who has a little more time available to maintain that quality relationship you're referring to. I love everything you say. I have one small quibble. Perhaps your could change this:

Our goal is to keep people away from specialists and hospitals.

To this:

Our goal is to make sure people don’t need specialist and hospitals.

It reflects better what you say on this point and keeps people from reading your bullet point and making the knee-jerk assumption that you want to prevent patients who need it from seeing specialists or going to the hospital.

Another thing that your post has me thinking about. I love my kids’ pediatrician. He does many of the things you describe, and I trust him. But so do (seemingly) ten thousand other moms in Atlanta. So, I have a devil of a time getting my kids in to see him, and when I do, he’s in a terrible hurry. It’s very frustrating, and I’m beginning to wonder if he’s become too popular and that it’s time for me, however reluctantly, to find a pediatrician who has a little more time available to maintain that quality relationship you’re referring to.

]]> By: Abbi http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4696 Abbi Wed, 29 Jul 2009 23:26:52 +0000 http://distractible.org/?p=2747#comment-4696 Love you Lindsey!! And Dr. Rob, I can help with the "Finding a Pediatrician Who Cares" if you ever want someone who works in peds to help out! ;) Love you Lindsey!! And Dr. Rob, I can help with the “Finding a Pediatrician Who Cares” if you ever want someone who works in peds to help out! ;)

]]> By: Rob http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4694 Rob Wed, 29 Jul 2009 22:05:00 +0000 http://distractible.org/?p=2747#comment-4694 No, I am not acting as a specialist. The specialist's job is to take care of the exceptional/difficult cases. My view on chest pain is actually more accurate than that of the specialist for the general population. The cardiologist is no more qualified to diagnose chest pain off of the street than me - in fact, they probably have done it less. They rarely get someone walking in with chest pain who has no previous cardiac history or has not been seen by a PCP or emergency physician. The same is true with neurosurgeons and sciatica. I see far more first-presentation sciatica than a neurosurgeon. The patients they see are usually already worked-up by a PCP and have an MRI ordered (in fact, most of them require that they have one before they are referred). In terms of diagnostic skills, PCP's are generally more qualified than specialists. As far as research goes, here's a good reference: <a href="http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.97v1.pdf" rel="nofollow">http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.97v1.pdf</a> - there are lots of studies that show the cost of care goes down with more PCP's and the mortality rates drop. No, I am not acting as a specialist. The specialist’s job is to take care of the exceptional/difficult cases. My view on chest pain is actually more accurate than that of the specialist for the general population. The cardiologist is no more qualified to diagnose chest pain off of the street than me – in fact, they probably have done it less. They rarely get someone walking in with chest pain who has no previous cardiac history or has not been seen by a PCP or emergency physician. The same is true with neurosurgeons and sciatica. I see far more first-presentation sciatica than a neurosurgeon. The patients they see are usually already worked-up by a PCP and have an MRI ordered (in fact, most of them require that they have one before they are referred). In terms of diagnostic skills, PCP’s are generally more qualified than specialists.

As far as research goes, here’s a good reference: http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.97v1.pdf – there are lots of studies that show the cost of care goes down with more PCP’s and the mortality rates drop.

]]> By: Stephen Kardos http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4693 Stephen Kardos Wed, 29 Jul 2009 21:52:17 +0000 http://distractible.org/?p=2747#comment-4693 Interesting perspective, however, when a general practionser takes care of someone they are acting as the specialist for the medical condition they are treating. Except, they do have the perpective and training of a specialist. For most common conditions that is ok, however, for other conditions that may go unrecognized and become very costly in human sufferring and financial expense, it is not ok. There needs to be a balanced use of primary and specialty physicians. What is most important however, for whomever is rendering care and for whomever is receiving care that known guidelines for health be followed. Often times recommendations for appropriate care are not followed either by specialists or generalists with poor patient outcome and reulting suffering and expense. performance is measureable and I would like to see th data that substantiates or disproves this argument. For further discussion see recent posting on Healthgadfly.com Interesting perspective, however, when a general practionser takes care of someone they are acting as the specialist for the medical condition they are treating. Except, they do have the perpective and training of a specialist. For most common conditions that is ok, however, for other conditions that may go unrecognized and become very costly in human sufferring and financial expense, it is not ok. There needs to be a balanced use of primary and specialty physicians.

What is most important however, for whomever is rendering care and for whomever is receiving care that known guidelines for health be followed. Often times recommendations for appropriate care are not followed either by specialists or generalists with poor patient outcome and reulting suffering and expense.

performance is measureable and I would like to see th data that substantiates or disproves this argument.

For further discussion see recent posting on Healthgadfly.com

]]> By: Lindsey http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4692 Lindsey Wed, 29 Jul 2009 21:29:02 +0000 http://distractible.org/?p=2747#comment-4692 I agree with you. Completely. My primary care physician is a push over. It's true... p-u-s-h over. I can tell him what's wrong with me and what I need... and he listens. It sometimes bothers me, but in all actuality it's sort of nice. I have looked around for a "good" PC physician but always seem to head back to the push over doctor. With medical background in my family I know when I have a sinus infection, ear infection, etc. so it's convenient for me to say, "Yo. Doc. I need this". I do think it's dumb that my PCP didn't see that I had 6 sinus infections in 2007 and try to get to the root of the problem.... which was allergies! I had to go to a "specialist" to get my allergies under control. Kind of dumb. And more money for me (and my insurance company). It would be nice to have a primary care physician that cares about me... That remembers my name or remembers that I walked on a broken ankle for 6 months before getting x-rays. But I don't have that, and I honestly don't know where to find that. My OBGYN is the closest thing I have to that, which I am very thankful for. Maybe you should do a post on "how to find a Primary Care Physician that CARES". So until you pack your bags and move to West Texas, I'll continue to "get by" with my Primary Care Push Over Doc. I agree with you. Completely.
My primary care physician is a push over. It’s true… p-u-s-h over. I can tell him what’s wrong with me and what I need… and he listens. It sometimes bothers me, but in all actuality it’s sort of nice. I have looked around for a “good” PC physician but always seem to head back to the push over doctor.
With medical background in my family I know when I have a sinus infection, ear infection, etc. so it’s convenient for me to say, “Yo. Doc. I need this”.
I do think it’s dumb that my PCP didn’t see that I had 6 sinus infections in 2007 and try to get to the root of the problem…. which was allergies! I had to go to a “specialist” to get my allergies under control. Kind of dumb. And more money for me (and my insurance company).
It would be nice to have a primary care physician that cares about me… That remembers my name or remembers that I walked on a broken ankle for 6 months before getting x-rays. But I don’t have that, and I honestly don’t know where to find that. My OBGYN is the closest thing I have to that, which I am very thankful for. Maybe you should do a post on “how to find a Primary Care Physician that CARES”.
So until you pack your bags and move to West Texas, I’ll continue to “get by” with my Primary Care Push Over Doc.

]]> By: Value of Primary Care « GE Adventure http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4691 Value of Primary Care « GE Adventure Wed, 29 Jul 2009 21:04:01 +0000 http://distractible.org/?p=2747#comment-4691 [...] Via Musings of a Distractible Mind. [...] [...] Via Musings of a Distractible Mind. [...]

]]> By: Abbi http://distractible.org/2009/07/29/why-primary-care-matters/comment-page-1/#comment-4690 Abbi Wed, 29 Jul 2009 19:42:52 +0000 http://distractible.org/?p=2747#comment-4690 Preach on! I'm going to print this out for the pediatrician I work for! Preach on! I’m going to print this out for the pediatrician I work for!

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