I need a lot of opinions on this question...

[JanusAscending]

if there are any MD's that read this forum, please chime in. Can someone please tell me what the professional duty's are of a Primary care Physician? I was always under the impression that if a patient had a problem out of the realm of their expertise, they were referred to specialist's, who in turn consulted with the PCP and then they agreed on a treatment or plan for resolving the problem, and the PCP would contact the patient with a plan of treatment. They would act much like a conductor leading an orchestra to benefit the patient. Am I wrong in this assumption? I am at my wits end, and need some answers regarding the protocol involved here!!!! Help....please!!!

[sandnsea]

1. How it is here

My ENT treats me on his own and doesn't really communicate with my primary doctor at all. He just tells me what not to let them do to my ears, lol.

They sent my mammogram results to my ENT when I was transitioning to my new primary care doc, that was funny. My primary care doc did give me info about the results, but not much different than what I was given by the mammography doctor.

I had some shoulder pain a few years ago and was sent to a specialist. Again, no coordination with the primary doc at all on that one.

My hubby's primary care doctor doesn't do too much with his specialists either. The specialists call the shots. That's been true of his gastroenterologist, pain doc, surgeon, etc.

I don't know if that helps, but that's how it's done here. Hope you're not having anything too terribly serious.

:hug:

[JanusAscending]

5. I guess I've got it all wrong then!

but why is it that they send him all of the results of the tests I've had done, and I've never heard back from any of them with results or plans for treatment? I'm on the verge of being in a wheel chair due to nerve compression in my left hip. Saw a Neurosurgeon who suggested a conservative approach via epidural shots to the spine with cortizone and was going to set it up with his partner whose specialty that is and have yet to hear anything from them. I have been seeing a Rheumatologist for my Sjorgrens syndrome (sicca) dry mouth since an oral thrush infection I got nine months ago. Can't taste anything and I've lost 50 lbs. since because nothing is appetizing. I'm barely eating to exist. I was in the hospital last month for an accute attack of colitis, and have been home bound ever since. I have seen at least 10 different specialists since last Sept. and I'm still getting worse!????? I am now officially on title 19, and want to stay in my home and not a nursing home. I have home health visits and a homemaker twice a week. If I can get my back taken care of maybe I could get out and about again, but as it is I can't drive my car because it's a standard transmission, and my left leg is useless! I have to get around the house with a walker for now.

[sandnsea]

11. Well damn that is not good

I would just call that neurosurgeon back, hourly.

My primary doctor's nurse does sometimes call me to remind me to make routine check-ups I should have, eyes because of diabetes, PAP, the stuff I put off. But they never once called me about anything to do with my ENT or my follow-up mammogram which were way more important.

Maybe you can ask your home health worker if there is someone to coordinate your care. I think they're called hospitalists, if I understand right.

And you can PM me and I'll be glad to raise hell for you to whoever you want, any time you want. You need to get into that neurosurgeon!

:hug:

[JanusAscending]

18. Good idea about the "hospitalists"

I will broach the subject this week with my medical social worker. We had a meeting when I first came home from my last hospital stay, that my daughter (POA) attended explaining all of the benefits I would be eligable for once I was on title 19, as I signed over rights to a lien on my home which I own outright, to repay whatever the state pays for my care once I can no longer live in it, or I die . My daughter is also my executrix. She's recovering from a hysterectomy at the moment and has a 4 yr. old, so I won't be able to ask her for help 'til she has the clearence from her Doc to drive and resume full activities. Thanks for the advice.

[Quantess]

19. You have heard the cliche "get a second opinion"?

GET A SECOND OPINION!

Seriously, I have wasted my time and money hoping for medical professionals to diagnose me properly. Maybe you need to see a specialist. Demand it!

[DURHAM D]

2. I can only speak with regard to my Father but -

his PCP and his specialists did not pay attention to what the others were doing. We had to point out various things to all the doctors and ask for a review. Over the last five years of my father's life we repeatedly caught mistakes on similar medications being prescribed by three different doctors. In other words, it was up to us to ask questions and point out possible mistakes.

[JanusAscending]

7. That is so sad!!!....

it's a joke really!! Everything I say and everything that is done in my PCP's office is on computer records. If they were all connected to each other how could this happen?? There has to be a better way!!

[SharonAnn]

3. Perhaps, in theory. But in practice, a referral seems to be a "hand-off".

The PCP receives copies of the reports and the diagnostics, but is not usually involved in the care that the specialist provides.

At least that's been my experience with my health care and that of my husband, who has seen many specialists due to his cataracts, cancer, and heart problems. The PCP was never involved in the treatment plan or action.

We have been the ones who had to coordinate treatments and medications between the specialists.

Realistically, unless the PCP were to be reimbursed for his participation, I don't think he/she could afford to participate in these activities.

[midnight]

4. K&R in hopes that you can get some answers....

[Warpy]

6. Once you are referred to a specialist, that specialist determines the care

for whatever you're seeing him about. The primary care physician is kept advised of the treatment plan via dictated notes.

While it might seem a little fragmented to have different parts assigned to different docs, remember that your PCP isn't really qualified to treat you beyond a certain level. He can manage your hypertension but he can't manage complications like kidney disease or the need for cardiac intervention, nor is he in a position to decide which course of specialized treatment is the right one. He can and should raise an alarm when several specialists are involved and their treatments conflict.

Your PCP is definitely part of the team, but he's not the leader.

You do need to review everything with him from time to time to make sure he's doing his job of making sure the treatments don't conflict with each other.

Yes, this sort of system is a potential minefield for people with complicated medical conditions requiring different teams of specialists. However, it's the way it works now. Perhaps a better system will be devised in the future, one certainly should be. But that's the way it is.

[uppityperson]

8. I have wished there to be someone coordinating it all, making sure they know what is going on

That is how I see the OP's question. It seems like it used to be that way, but now with so many specialists, care can be very fragmente. I can see the PCP being the one everyone reports back to, but that doesn't always happen, or the PCP isn't able to take the time to put it all together for you until you make an appointment, go in and make sure all is reviewed (as you say).

Too many PCP's get overwhelmed with the system now and aren't able to provide the overall care they used to. Wayyyy back 35 yrs ago, there was the problem of care dragging on and on and on, so they took a look at how much, how long, generally and averagely, something took to recover from and made that a standard. Now it seems care is divided up into so much, so many little bits that all have to validated to be paid for, that so much time is spent documenting and billing for bits of care that the care part has decreased.

Not sure what will happen next, it sill be interesting to see and I'm glad we are getting more GP/FP docs again.

[Warpy]

10. I know how you feel, but medicine has gotten so incredibly complex

that no one person can possibly know it all. That's why care has gotten so fragmented.

I have pieces of me apportioned out to docs all over this city. I'm just glad I went through nursing school so I can spot the most obvious conflicts.

[uppityperson]

12. I know. People have to be much more proactive about their care (I hate that word)

First off, I HATE "proactive" as a stupid idiotic asinine overused buzzword.

OK

I remember back when you couldn't see your medical record/chart. Then you could see it, but had to submit a request in writing and give them 2 weeks to let you see it. Nowdays you really should be getting copies of everything you have done everywhere because although they are supposed to be sent to the referring PCP, who knows if they have been in a timely manner or if you move then what? Or if your insurance drops that PCP (or PCP drops that insurance).

My recommendation to everyone I deal with is get copies, keep a file of whom you've seen, any test results, etc. And MAKE SURE you get in touch with your PCP occasionally to go over everything.

It is good to be a health care provider, or educated in health care, isn't it?

[Warpy]

13. I never have trouble getting copies

I've told all my docs that I'm perfectly capable of being a menace to myself, so fork it over. They're too busy laughing to refuse.

[uppityperson]

15. When I started nursing, I got in trouble for telling people their bp since "they weren't capable of

accurately interpreting that information". Gee, how about I tell them what the numbers mean and what their numbers are and etc etc etc?

Educating, advocating, coordinating have always been strong interests of mine.

[petersjo02]

9. Call that doctor's office and get an appointment

for your spinal injection. If any doctor, primary or specialist, says you need an appointment for tests or to see another doctor, make that appointment before you ever leave the building. Sitting at home and expecting that any of these doctors will call you about the things you want to know isn't realistic. Take charge of your own medical care. No test results? Call the office and ask to have copies of your lab/x-ray reports sent to you. If you have questions, call or return to the doctor who ordered the tests to discuss the results. You must take the roll of the facilitator here unless you have a relative or friend who is open to doing it for you. Always remember, YOU are in charge of your medical care, so step up to the plate and don't sit home feeling neglected because someone from some office somewhere hasn't called you. It's in your hands.

[sandnsea]

14. If you happen to be in medicine

That is really not fair. There is a certain amount a patient does need to do, make sure the lab reports have been done, make sure they've got an appointment.

But at the same time, there comes a point when the care is so complex that it's just not realistic to expect a layman to "take charge of your own medical care". My husband was laying in the hospital with severe 2nd degree burns and possibly some 3rd degree, on his feet, legs and hands. We had so many questions about whether he was getting proper care. We're pretty sure he we kept in-state because of a new medicaid rule about sending people out of state. So he probably should have been to a burn center, but we didn't know. We're supposed to "step up to the plate" about medical treatment we know NOTHING about?? Now that is what is not realistic. And the hospital nurse said that's what we were supposed to do too. Yeah Right.

So be careful when you say that to people.

[JanusAscending]

17. Easy to say when it's not you isn't it? I am HOUSBOUND

I can no longer drive my car because my left leg is almost useless, and I have a stick shift. I can get rides now that I'm on Medicaid and title 19, but I have days when I open my mouth to speak and nothing comes out, so phone calls don't always "cut it"! I have no saliva, no tears, no nasal mucous and when my sinuses get blocked up and my broncial tubes are blocked with such thick mucous that I can barely breath ( oh I also have COPD and am on oxygen 24/7) it makes it even more difficult. Yes I have a daughter who is my power of attorney who can help me with this, but at the moment she is home recovering from a hysterectomy with a 4 year old child, and can't drive for a while yet. so please...walk a mile in my shoes before you put on your high hat...OK? Thanks for nothing!! Oh and did I say I'm 71 years old, live alone and am fighting like hell to stay in my home and out of a nursing facility??

[bbgrunt]

16. this, indeed, is an essential question. I think that

this is where medicine is failing us today. Even if you have good insurance, the hand-off to specialists is fragmenting treatment and care and there is no one to help the patient put it all together.

The individual is left floundering after having to wait weeks or months to see specialists who will only concern themselves with one particular problem. In complex cases this means that people can spend their whole lives running from doctor to doctor and having tests done and then returning to get results. You have to see a different doctor for every different symptom. Woe to anyone who has a work schedule.

Supposedly hospitalers coordinate treatment, but that is only if you are IN a hospital.

I don't know what the solution is but it would seem to me that the pcp should take some responsibility here. If it is not vialble for pcp physicians to concern themselves the overall well being of their patients, then what is their role besides being a referral agency?