What do Primary care Doctors train for nowadays anyway?

ritaweeda

I remember when the family doctor could pretty much diagnose and treat most things. Now the only thing I can see that they do is either send you for tests or a specialist and coach you on general health issues like weight and exercise, etc. Maybe write a script for antibiotics for a simple infection or cough, etc. The Dr.'s assistant does all the actual work like take vitals and notes before the Dr. comes in. They even hand out pamphlets on weight and general info. Do primary care doctors have to train in other areas during their schooling, such as ER, Lab, surgery, etc.? Or is it strictly basic anatomy and then diagnostic and basic treatment skills? I lost half a big toenail due to an infection and my primary care doctor won't even look at it. And I don't have anything serious going on like diabetes.

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Chi

I think that's exactly what they are for - seeing the issue and deciding if it warrants a specialist visit, though it's strange that he won't even see you about your toe. Mine will do antibiotics and other prescriptions, order blood work, schedule tests and refer to specialists if necessary

HMO insurance won't cover a specialist without a referral so there's that too. I think back in the day there were less specialists so the family doctor had to do everything, from dealing with coughs to delivering babies. But I think today's system is better.

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schoolhouse_gw

I got a new doctor three(?) years ago. He has yet to do a physical. He'll listen to my heart, ask me to breathe in and out, go over meds, type on his computer, order a blood test, then remind me to lose weight as he goes out the door. He noted on my chart that I was "a healthy adult". So I guess I should just accept that.

Like mentioned above, a nurse does all the vitals and asks questions before he even comes in. I explain about my aches and pains and any other concerns. Apparently what I'm concerned about doesn't sound that important to she or my doctor.

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blfenton

My GP still does a physical and takes all the vitals.

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quasifish

At the HMO facility we use, a lot of the primary care docs are internal medicine specialists or similar. A few years ago I needed a quick appointment to get a tetanus shot and the primary care doctor they scheduled me to see was also a gastroenterologist. You can tell where they are trained because those are the areas they focus on, but you are right, for the most part it is basic human care and hope for a referral. It use to be ladies could use OB/GYN as primary care years ago, but that has changed as well.

Before the ACA, we got treated for a lot of things in a primary care appointment, and then that changed- for example, DH had an issue with warts at one point and the primary care doctor froze them off on the spot in the appointment. A couple years later after the ACA had taken effect and everything had to be accounted for, he could no longer get those taken care of at a regular appointment by a regular doctor. Now he had to get a referral to a specialist and go to an office 1.5 hours away. :^s

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Elmer J Fudd

schoolhouse, if you tried to schedule an appointment for a comprehensive physical and that hasn't happened, or you did and that isn't what was done, you need to find another doctor. Most docs want to do that with a new patient but beyond that, a good doc wants to do a comprehensive physical annually. Certainly Medicare and most insurance coverage provide for free or low cost annual physicals because prevention and detection of problems is cheaper than treating undiagnosed ones later.

Some of you are ready to indict an entire profession when really, the problem you're facing is that you have a crappy doctor and perhaps it's because you're living in an area where good docs and good specialists are few and far between. Such is often the case in small towns and rural areas.

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Lars/J. Robert Scott

My primary care doctor does my physicals, and his specialty is geriatrics. I didn't know this when I started seeing him, but as I get older, it makes more sense for me. I've been seeing him for 20 years, I think. I have an HMO supplemental to my Medicare, and that has worked out very well for me because my doctor is associated with UCLA Medical Center, and that is one of the top five hospitals in the country with many excellent specialists. I'm not crazy about driving to Westwood or Santa Monica to see doctors (my primary care doctor is in Pacific Palisades, and I do like driving there, as it is very scenic), but my HMO (which is SCAN) allows me to schedule a free ride with Lyft, but I have to schedule it 24 hours in advance. My brother has PPO, and his primary care doctor is associated with Cedars-Sinai, which is also very good.

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ritaweeda

First of all, I don't know what is supposed to be included in what you term "comprehensive physical" - if it's just taking the vitals and listening to the heart and breathing then, yes I've had one but if it's more than that then no, I haven't. And you are probably right about the area and the quality of doctors, here it's one-half the county is very rural (that's where I am) and the other half is mostly residential but also almost all over-retirement age. And most of those people probably need to see specialists for all their health problems. I don't intend to throw them all under the bus but everyone I talk to around her says the same thing. How complicated could a half-gone toenail be for heaven's sake?? If I wasn't such a big chicken I'd pull the other half off myself - that's pretty much all I want from a doctor right now.

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georgysmom2

Eighteen years ago I decided to switch Doctors because for four years I never got undressed and had a physical with the doctor I had been seeing. It was take my blood pressure, listen to my heart and re-issue my then prescriptions. I was in my 60's and while this was a convenient set-up, I decided, at my age, I needed a more thorough visit. I'm so glad I switched. My present doctor gives me a physical once a year, I go in for a six month check-up unless there is an on going problem which she thinks needs attention sooner, and she spends a minimum of 45 minutes with me discussing medications, how I'm feeling, etc. I feel you gain more insight into a persons health by listening to them, especially if the patient is honest and forthcoming. I love my doctor!

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Elmer J Fudd

For a toenail problem, you may just need to see a podiatrist.

My annual comprehensive physicals take 45 minutes or more, involve a lot of thoracic organ and lymph node poking and neck and limb feeling, a rectal and physical poking prostrate exam, a check of my reflexes, looking in my eyes, ears and mouth, and a fair amount of talking. I get blood and urine work done in advance. Everything is discussed. For women, I think it should include a breast exam and a gynecological exam too, whether by the primary care doc (some do it, especially the female ones) or a gynecologist. And periodic mammograms following whatever schedule the doc recommends.

Maybe other things should be done too, or in other circumstances? I don't know, my knowledge is very limited and anecdotal only.

I don't think there's anything exceptional about my experiences. My doc works in a medical school practice, where she's also a part-time faculty member. She's excellent, as is the care I get from other departments when needed. It sounds like Lars and his brother have similar access as I do, though him at a different medical school and his brother at a highly regarded teaching hospital (Cedars-Sinai).

Everyone is different but for me, I want the best care available. I have one life and I don't want it compromised by getting less than the best possible medical attention. No amount of inconvenience stops me from seeking that out, including having seen a few docs at a different medical school more than an hour away (with traffic) that offered more expertise with the a few different problems I was having.

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DawnInCal

I love it when I call to make an appt and tell the person on the phone why I am making an appt., arrive at the appointed time and fill out paperwork including the reason I am there, explain once again to the nurse/assistant who takes the vitals why I am there and then the doctor comes in and says, "so, why are you here today?" Hello???


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raee_gw zone 5b-6a Ohio

Something that has changed over the decades, that has thus changed what PCPs do, is the simple fact that medicine is now much more complex, with a vast increase in knowledge, diagnoses, medications, treatments, diagnostic tests, and so forth. It is impossible for a PCP to be as well versed as we might like in all areas -- so although one can diagnose and treat common problems (simple infections, Type 2 Diabetes, osteoarthritis come to mind, of course there is more) one could also have more of a role of screener for more complex issues rather than be the one most qualified to treat or manage.

That is one reason in larger cities and hospitals inpatient care is managed by hospitalists instead of the patient's PCP.

A comprehensive physical should be more than just listening to heart & lungs and checking labs and blood pressure. A head to toe skin exam, a check of balance, gait and coordination, questions about changes in eyesight, hearing, exercise tolerance, stool check for blood -- all important screenings. And yes, some time for talk.

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Elmer J Fudd

I think the hospitalist specialty developed as PCPs stopped overseeing the admission and hospital stays of their patients and started remaining office-bound. Surgeons, ER docs and other docs treating patients who are hospitalized want to do their thing and move on, they don't want to spend time before or afterwards (at lower rates of compensation) overseeing the hospital care of their patients. For internists, working as a hospitalist often offers better compensation than working in a primary care practice.

In the olden days, PCPs had hospital privileges and could admit their patients to the hospital. This is often no longer the case,

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lukkiirish

Schoolhouse, I’m really surprised that you haven’t been encouraged to have a physical as most insurance companies want to see that documentation when they are doing their annual audits.

Please do not trust that your doctor knows best and if they aren’t suggesting something like a physical, then well, maybe it’s just not needed. In today’s healthcare environment you really do have to be an active participant and advocate for the best care available. If you don’t speak up, both you and your physician could be putting your health at risk.

I doubt they’d reject your request for that physical, but if for some reason it’s not met with a response that you’re comfortable with, then please seek the care of another doctor.


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desertsteph

not much. mostly all my last 2 out of 3 have done is refer me to specialists, the lab, imaging etc. in the offices of the those 2 out of 3 they couldn't keep things straight. not my allergies, insurance. the one I have now doubled the dosage on a refill I've been taking for several yrs (I've only been going to him for about 6 months). he said nothing to me about changing it. it was an error. when they re - refilled it, they recalled it in to Walgreens rather than W even tho I'd talked to the office person and even discussed where my W was located. later that day I got a call from Walgreens to pick up my prescript.

the last time I was in there he said nothing to me about giving me 2 prescripts but a few hours after I got home, Walgreens called to tell me I had 2 of them ready to pick up. I had no clue and I was allergic to one of them.


My present doctor gives me a physical once a year, I go in for a six month check-up unless there is an on going problem which she thinks needs attention sooner, and she spends a minimum of 45 minutes with me discussing medications, how I'm feeling, etc. I feel you gain more insight into a persons health by listening to them, especially if the patient is honest and forthcoming. I love my doctor!

that sounds like my doctor before I had to switch from him because he left the care center where I went. I'd had him for 20 yrs. he left private practice (after OC was put in place). He was a long distance for me to drive and it was hard on me to drive that far, so I had to find one close to me and the options around here were very slim. that one seemed good for a time, then about 2 or so yrs in, he seemed to go bonkers. But, it was a blessing to get away from him. the next doc found I was depleted in B12 and D. but within the yr, he too left that practice leaving them w/out a doctor certified by my insurance. so now I've got another one but will be looking to change in the near future. I'd go with the most recent prev doc but he doesn't take insurance in his new practice. It is difficult (at least in this area) to find a good doctor. My sister (who lives close to me) is going thru the same thing with her doctors.

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C Marlin

Lars/J. Robert Scott - You are fortunate to live near and use UCLA. Many years ago I started going there, I lived in Manhattan Beach but worked in Century City. UCLA opened offices in Manhattan Beach so it became very convenient, but last year we moved to South Orange County and don't go there anymore. UCLA is one of the best in the nation in many specialties. If I have a serious need I won't hesitate to drive there.

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mdln

If you are not happy with care provided, please find a new primary care provider. There are many excellent PCP's. Continuing to see someone you are not happy with, is not good for either the patient or PCP.

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ritaweeda

Whoa! Never have I ever had a physical exam like that, ever. Not even on first visit.

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arcy_gw

Women are directed to an exam yearly for breast and cervical cancer. The necessity for these tests and their accuracy is constantly changing. Your lifestyle and past history directs some of this. The exam above has always been done the first time I see a new doctor. Once I settle in with one, things are glossed over a bit. They know me. They would see changes. My thyroid med which I need to stay alive would not be renewed if I did not go in once a year for an exam. I live in a not large town. I have to agree a few of the stories above to not track as expected or usual medical treatment. If ever you are not satisfied with your care you should always seek out a different doctor. Always go with your gut and keep looking for doctors until that small voice in your head is satisfied.

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Elmer J Fudd

Thanks, mdln. for sharing this professional info.

What's described is what I've always experienced in my annual physicals. Everyone should have a great PCP and get an annual physical.

Unfortunately there are too many crappy doctors around. Some are capable but have strayed from having a empathetic and patient-centric attitude, others were never capable and are nincompoops. I echo her recommendation and will add that there's no better piece of mind than to receive ongoing services from and to having a relationship with a caring and capable primary care physician.

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Raye Smith

Here's your answer: https://www.forbes.com/sites/brucelee/2016/09/10/time-to-change-the-15-minute-limit-for-doctor-visits/#295f70c03477

The middle of the story is quite funny! The first paragraph under "This Leaves Four Minutes" is a riot.

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Elmer J Fudd

The writer of that piece may have been trying to make a point with humor but I think he's quite ill informed. I personally have never experienced a rushed or time-curtailed doctor visit. They always last longer than I think will be spent. And docs tend to run late in their schedules for that reason, they spend the time necessary, and that's why waiting never bothers me so long as it's not too long. I figure patients ahead of me are getting the kind of attention I too want to have.

If the serious parts of the article describe your experience with a physician, it's time to find another one.

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bleusblue2

Up to five years ago we had family in Switzerland and while visiting them my husband often had to make appointments with a family doctor, usually to update some medication. Occasionally to check something that worried us. When entering the office we gave our info to the receptionist, then went to the waiting room. The doctor himself came to the waiting room and invited us into his office. In the large office was his very nice desk -- an antique? I don't know, very solid and elegant. Some paintings on the wall, very comfortable. He sat at the desk and we talked about whatever the issues were. At the other side of the room was the examining table. The doctor did the whatever examination was called for -- oh, blood pressure and hands on check up. Some of the blood tests could be done in an adjacent office. I'm sure the doctor kept track of the time. He would escort us out of his office and say something to the Secretary which would be the amount of time to be charged. There was never any hurry or overbooking. It was never an outrageous fee I can tell you that. We never felt rushed. We didn't use travel insurance and occasionally the fee would be as much as 60 dollars. It's been five years since the last visit and I doubt anything has changed. This may have been the same in North America at one time. When?

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Elmer J Fudd

I'm not sure that the musings of academics are a useful reference to offer to people getting lousy and inattentive services from crappy docs. These folks who haven't had a physical in recent memory should just pass on doing something about it?. Someone who hasn't had a physical lately, reading "you may not need one every year", will come to what conclusion?

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