So I had that CT scan last month, ordered by PCP to investigate possible kidney stones. And stones there are. Two weeks ago, I finally saw urologist, who informed me of the stones. But that is all he said, perhaps that is all the info he had. I did, however, have a regularly-scheduled visit with the PCP last week, and he had the full CT report. CT test was essentially on my entire torso, and the nature of the circling all around CT test means of course that it picks up whatever might be there. I did not realize this, but the PCP informed me that, in addition to the stones, I have a pair of intestinal hernias, and a pair of swollen lymph nodes in the general neighborhood of my aorta (and my PCP also has a subspecialty as a cardiologist, too). This test was a month old by the time I saw the guy, but I confess I was surprised to learn these things, in retrospect stupidly failing to realize the obviously comprehensive nature of a CT scan. And any time 'aorta' is mentioned in context with 'your', well, my interest peaketh. So I asked him about both of these issues. He explained in general what the hernia was, sortta, and said it was nothing to be concerned with. As to the enlarged lymph nodes, he also seemed very unconcerned, telling me to remind him to send me off for a repeat of the CT scan in six months. I asked him what might be causing such enlargement, and he mentioned something about the possibility of my having, or having had, some sort of infection. Now in deference to him, this course of action (along with the corresponding lack of concern wrt those hernias) was seconded by an MD in my church I mentioned this to on Sunday), but I remain less than perfectly enthusiastic about my own PCP's response, esp since, even as I was asking him these questions, he was already opening the exam room door to depart. This reminded me of the reality that, even though he virtually always runs really late in seeing me each time I have an appt (last week, for instance, he saw me probably 35-40 minutes after the scheduled time, even though there was no one else in the waiting room when I arrived), and he regularly runs through my visit pdq, and generally rushes me through any questions, making me often dummy up (I did finally also ask a question last week, that I had been putting off for at least a year, about why it might be that I know for absolutely certain that I mind the cold vastly more than I used to, and do not really want AC to be installed, etc., but his response was similarly dismissive). Am I missing any tricks, with regard to how to force a doc to stick around long enough to listen carefully to one's questions and then give detailed, comprehensible responses (and the doc of course knows that I have a PhD and have been a college teacher)?
Shop around for a better doctor. Perhaps see what can be done via telehealth where much of the goal is discussion with the patient.
Telemedicine has its advantages, but I need in-person visits, where a doc can check out my BP, heart, etc. Preexisting med conditions necessitate it.
You're allowed more than one doctor at a time. You go in person to get tests etc. and then find a different doctor or nurse practitioner who believes in discussion of those results.
It does seem like your relationship with your primary care provider isn't working very well for you, and you should maybe look around for another, to the extent that's possible with insurance limits and the rest.
My best friend (who also has a PhD) had a devil of a time getting diagnosed with a rare illness. It took years, in particular years of doctors not taking her or her symptoms seriously. She recently told me two things that made a big difference in her case: (1) not being alone with the doctor, but having someone else along, preferably male, but even another woman made a big difference, and (2) taking notes, and being very obvious about it (even better if the accompanying friend was quietly but obviously taking notes). She said the note-taking seemed to scare them a little, and the result was that they spent more time listening and answering questions.
What you need to know is how enlarged the lymph nodes are and how often this happens. My own lymph nodes, the ones in my neck, get enlarged and somewhat painful at a moment's notice, several times a month. This has been going on for decades. I had one doctor who got very alarmed and did all kinds of tests, one of which showed up general inflammation but not much else. Nothing particular transpired. They have continued to swell, to go back to normal, to swell, to go back to normal, etc. for many decades now. Not to say that yours are necessarily harmless, but that enlarged but otherwise harmless lymph nodes seem to be quite common. That may be why your doctor was so dismissive. Nevertheless, he should have explained that to you, rather than just sort of shrugging and dropping the subject. So I agree that a replacement doctor, or consulting another doctor for a fuller story, is in order.
Bring a written list of the questions you want answers to any appointment. Not pages and pages, but the few items that most concern you. Write down the answers you get.
Shop for a new PCP.
I have a lot more to say on this topic if you want to hear it.
Quote from: spork on August 27, 2020, 02:32:04 AM
Bring a written list of the questions you want answers to any appointment. Not pages and pages, but the few items that most concern you. Write down the answers you get.
Shop for a new PCP.
I have a lot more to say on this topic if you want to hear it.
Agree on the list of questions. I had a "dump test results and run" specialist many years ago. After a few appointments, when he finally came into the room (more than an hour late), I pulled out the paper and said, "I have a list of questions. You will not leave the room until you have answered them. And you will allow me time to carefully take notes." He looked shocked. We spoke about my test results and different options for about 45 minutes that day, and I never had a problem with him again.I suspect he was still an asshole with most of his patients.
Also agree with others...shop around for a new primary.
Some of the advice here reminds me of a recent book that I liked a lot:
How to Be a Patient
The Essential Guide to Navigating the World of Modern Medicine
By Sana Goldberg
It has a lot of good tips about getting good care.
For what it's worth, the rise of imaging tests such as CAT scans and MRIs has resulted in the discovery of a lot of abnormalities that would have previously gone unremarked. If no one who saw the results rushed to have you get follow-up, there is a good chance that the findings are insignificant and/or transient. If your PCP otherwise gives you good advice and acts quickly with emergency situations, I would let this go.
Quote from: fleabite on August 27, 2020, 07:03:17 AM
For what it's worth, the rise of imaging tests such as CAT scans and MRIs has resulted in the discovery of a lot of abnormalities that would have previously gone unremarked. If no one who saw the results rushed to have you get follow-up, there is a good chance that the findings are insignificant and/or transient. If your PCP otherwise gives you good advice and acts quickly with emergency situations, I would let this go.
Doctors anymore are also under a lot of pressure to rush as many patients through as possible. They're not happy about the situation either. Spork's suggestion about having a list of questions prepared ahead of time to facilitate things sounds like a good one.
Yes. I changed doctors after he...
- Diagnosed a cold sore from across the room. I mean dude, at least come up close and pretend to look at it.
- Gave me a prescription for antibiotics when I just had a really really bad cold. When I asked him "Will this cold just go away on its own?" He answered "Yes. But people get annoyed when they walk out without a prescription."
- Said he would just do the necessary Pap Smear to refill my birth control pills instead of sending me to the gyno. Comment "wow, your cervix is really tender. I mean I am just touching it with the swab and it's bleeding!"
A good friend of mine is an MD, and he says to always remember that there is no such thing as a healthy person, they just haven't been worked up enough!
That is likely the deal with the swollen lymph nodes. They may just be bigger than normal, or swollen because of the kidney stones. It depends on how swollen and if there are other issues.
Over many years of blood testing, I have discovered that my Thyroid runs slightly high. Just above the normal, by 2-3 units, level high. No need to do anything about it, but I have to explain this to every new medical professional I see. My normal is not normal.
I also second the vote for a written list of questions. You can even email them to your doctor in advance. Last year I was having a rather alarming medical issue and discovered how effective it was to write out all the symptoms and events. I had an excellent consultation with my PCP at the appointment after I sent a long email. I rack this up to her being able to think about my problem in advance of the appointment, rather than just expecting an off the cuff response.
I feel your frustration. My wonderful PCP moved this past year, so I'm back to a doctor I don't really know all that well.
Thanks for the rec wrt the Goldberg book.
My PCP is essentially 64-5yo, so I am not expecting to have him around for the long-term. I do not dispute the general consensus that he is not the greatest practitioner on earth, but I somehow do not want to try to break in a new guy when it would not be necessary. And, of course, were I to decide to do so, then HOW to do so? My insurance co's www site of course will list all the available GPs, and I could try to find one that way, but it would not be the same as what I just did to locate a urologist whom I will hopefully never have to see again after the cystography test next week. Several years ago, when I decided to seek some psychological counseling, I did essentially the same thing, and ended up making an appt for a consultation with the first guy who returned my call. I have been with him for almost 4 years now, and he has been fantastic. IOW, I hit the jackpot with him, but I may well have crapped out, instead, and if one craps out with a PCP selection, a lot of harm could be done before you could rectify things, *a problem which is exacerbated when one does not have any money or social status*. So anyone have any ideas as to how to figure out which doc to seek to try, rather than just shoot blind?
The idea of writing down a list of questions is a good one-- I have actually done this for him on several occasions, but this results in only a wee bit more of his attention before he's out the door. I cannot see myself saying anything like 'you are not leaving until you answer all these questions fully and in a manner I can comprehend'. Really, I cannot think of doing something like this, and I wonder what his reaction would be if I tried it? Am I missing something? It may be hard for some of the long-term members here to guess, but I am actually a pretty severe introvert and extremely non-confrontational (this has been an issue I have worked on on and again over the years with my counselor, for instance), and the power relationship with a doc is one that I see myself losing any such confrontation over. Indeed, the counselor has noted to me on several occasions, based largely on what has happened to me in my professional life, that 'your self-esteem has taken a pretty big hit', and I have acknowledged that he is exactly right. Picking fights is not something I suspect would add to this...
Does your insurance/employer offer the services of 2nd MD? (Some have a nurse or nurse practioner you can talk to as well).
You may want another PCP. You need to manage your doctors, they will not coordinate themselves! But IF you can get to 2nd MD, you will have another opportunity to ask questions.
BY the way, here is one more question to add to your list:
"What other Questions SHOULD I be asking about this?"
You can always ask other people for recommendations on a PCP. The psychologist/psychiatrist. A nurse. Friends/colleagues. I had surgery as part of my ongoing medical travails. One of the physicians I see recommended a particular surgeon. Every nurse I spoke to described the same person in glowing terms, and he had operated on many of them. So he was my choice.
Generally I have better results when I use physicians affiliated with major academic medical centers. They are not under as much pressure to limit office appointments to 15 minutes per patient, they are familiar with the latest clinical research and treatments, and often you'll interact with multiple physicians (resident, fellow, attending) in one appointment, so there is more than one set of eyes looking at your case. Don't know if your insurance gives you that option, but if it does it's worth looking into.
What clean says about management is correct. I learned the hard way many years ago that I have to manage my own health care because no one else will do it for me. This often means telling physicians the results of tests ordered by other physicians because they don't bother looking at information that has originated elsewhere. Sometimes during appointments I have pulled up a history of past lab tests on my laptop and said "I have been out of the normal range of X for Y amount of time despite doing Z. What might be the cause of that?" In other instances I have used a patient portal to send electronic messages to physicians about test results to save myself the hassle of an appointment. Usually I find that physicians are very responsive to written queries.
Ask the people at the church for recommendations on physicians. Make a particular point of asking the picky people who complain about everything. If they've found someone who makes time to listen to them, then that's probably a medical professional who will listen to you.
If you need backup to be more assertive, then get one of the church ladies who bulldoze everyone to advocate for you with the doctor, receptionist, or anyone else who is pushing for too little time. For example, booking an appointment for a given duration to have a lengthy discussion can be done. Your advocate doesn't have to go in the exam room with you, but can watch the clock and confront the doctor who leaves the room too soon.
Don't be shy about speaking frankly to the doctor. He's working for you--you're paying for his time. Why would you pay good money (yours and that of your insurance company) for poor service?
Power is something you give other people over you.
I've been known to say firmly "Wait. I am not finished."
Only had to fire one doctor over it (and related behaviors).
I will also emphasize something alluded to upstream. You can ask for a longer appointment time. Some appointments are scheduled to be as short as 10 minutes. Things like physicals get longer appointment times. When scheduling your appointment, tell them the minimum length you want. It gets coded slightly differently for the insurance (encounter level 3 or something), but if your insurance is half way decent, the extra time should be covered.Then come with your list of questions and concerns.
Quote from: spork on August 28, 2020, 03:52:04 AM
In other instances I have used a patient portal to send electronic messages to physicians about test results to save myself the hassle of an appointment. Usually I find that physicians are very responsive to written queries.
I initially disliked the concept of a patient portal, because I want to talk with doctor. But I've grown to appreciate it, because my PCP puts visit notes and test results with notes in the portal, responds to questions via the portal, and walks into exam room saying "I know you wanted to discuss [whatever] and you need three prescriptions refilled. Let me check a couple of things, then we'll do that."
I suspect the medical practice has expectations about response time, possibly with financial incentives. When my PCP was sick, another doctor responded to a portal question the day I sent it.
Random thoughts:
1) It would stun me if this doc, a sole practitioner, has anything resembling a patient portal. Indeed, it would pretty much stun me if he were to read anything I sent him via any media, and indeed be aware that I had sent it. How common would it be for any overworked PCP to do otherwise?
2) I could ask for recs, yes. But I would have to be pretty darn careful wrt the judgment of the person whose recs I sought. One could easily get burned this way too.
3) I suppose it is possible that there would be varying length of appointments, outside of my annual physical, which the guy does spend at least somewhat more time on (largely because he does an EKG and a prostate exam). But I would not necessarily count on it, nor on its making much of a difference given how far behind he almost always is.
4) now for the biggie-- what exactly is it about MDs that inspires such fear and reluctance to speak up? Obviously I am paying for his time, he is not offering charity, etc. Were he a JD... or a plumber, well, I would speak up, but I am actually afraid of being 'fired' by him, and thus forced to immediately find an alternative GP....
Replying to #4: Fear of speaking up. I get it. My opthomalogist (sp) calls me sweetie. I asked him not to. He did it anyway. I have a followup appointment with him next month, which I will keep, after which I will consider finding another eye doc....not an easy thing to do here in a medical desert. I already drive an hour and a half to see him, in another state. And he's a good clinician.......except for sweetie.
K16.....I'm neither shy nor an introvert, and I GET IT!!!
QuoteMy opthomalogist (sp) calls me sweetie.
Reply to 'sweetie' with something like 'sugar lips' and see if that changes the conversation. (Hopefully for the better!)
Quote from: clean on August 29, 2020, 08:18:00 AM
QuoteMy opthomalogist (sp) calls me sweetie.
Reply to 'sweetie' with something like 'sugar lips' and see if that changes the conversation. (Hopefully for the better!)
It didn't.
"sweetie" would indeed probably be a one-strike you're out deal-breaker, yes. And I am a guy. I saw recently one of those PSAs on TV, talking about sexual harassment, with a staged example scene of a boss kissing a female coworker. I saw it and thought--- this is not harassment, it is sexual assault. Maybe I am liberalizing, but yes, it was sexual assault. There ain't no call for docs treating people like this 'sweetie' nonsense. Things have changed.
Now anyone else want to weigh in on the issue of how not to be intimidated by an MD? Part of it seems actually to be that I do have the PhD. I rarely tell docs that, until/ unless I have been their patient for a while, or they ask leading questions that would force me to lie if I wanted to avoid telling them this. I find that docs generally do not really know how to act around PhD patients, and this may well create an overreaction on their part, perhaps to maintain their self-perceived status or authority? Anyone else see this?
I agree with the list of questions. And I really like the idea of asking the doc "What else do you think I should know." Finally, (as with my dilemma about sweetie doc) it may be time to find another doc.