I choose doctors by their faith and how committed they are to its practice. I choose doctors who I parish with, largely, or who my friends from other parishes parish with. I have a deep, detailed understanding of that doctor’s performance over a long period of time from actual patients who are disposed to be honest with me.
Ignore Alien Orders
Your choice will be likely limited by your network coverage. For primary care docs, I would recommend MDs that are graduates of internal medicine programs. Better health care systems do provide doctor's rankings and patient reports accessible; they are not always fully accurate but are a reasonable guide. Beware of docs who have been in practice for a long time yet have a very short wait times. Generally, a good bet is a relatively recent graduate but not super fresh doc. They generally are still up to date, eager to work and build a practice and not entrenched into practice habits, but already have practice experience. I also do not like solo or small practices, they usually have a lesser potential for ideas exchange.Originally Posted by GreggW
That's a wrong approach and here is a gun analogy: I generally don't use 1911s or don't have problems with mine but I want Chuck Rogers to fix it when I need it. Get on with it starting with a regular annual wellness checkups when you're fine. This will give you an opportunity to sort things out before you actually "need one".
Doesn't read posts longer than two paragraphs.
re: DOs vs MDs, the long and short of it is that in the modern world they are functionally equivalent and can perform all kinds of surgery in all 50 states (if they are appropriately trained/board certified). You don't really learn how to be a doctor in medical school - that happens in residency (+/- fellowship). Many DOs apply for allopathic (MD) residency programs andshortly the match for both DO and MD residencies will be fully integrated. All this to say that a DO and an MD train at the same residency or fellowship together, you have no reason to believe the one will be "better" than the other.
That said, DOs are slightly stigmatized in the medical world as being 'not as good' as MDs (DO school applications are typically less competitive) and so they often end up in less competitive jobs/specialties (primary care), but this is definitely just a stigma. As I said, you don't really learn your craft until residency, so if they attended a good residency training program they will be a well trained physician. I've met DOs at academic medical centers on services like trauma surgery, interventional radiology, nephrology, and emergency medicine, among others; that said, they are the exception and no the rule.
I'd say probably the real difference between an MD and a DO is that a DO is more likely to have had a little fun in college than an MD
Unfortunately, at least as far as I know based on my experience as a lifetime patient, it is becoming less and less likely you will directly see with an attending physician for routine outpatient care. If it hadn't been a resident, it likely would have been an NP/PA.
For a while I didn't have a specific physician with my subspecialty care team - I usually just saw the fellow or whatever attending had a slot in their schedule - but now that I am assigned a specific attending (who was, funny enough, one of my small group leaders in medical school), I only see the NP. It does kind of suck, and I am sure some of practicing MDs on this forum have more insight, but ultimately it comes down to economics.
Last edited by Nephrology; 09-04-2019 at 08:22 PM.
I don’t like this response because I’m stubborn and generally regard doctors as glorified plumbers. And I apologize to any plumbers for the insult. But you’re right. I do get an annual physical but I’m ready for a doctor that I can build a relationship with. Someone that knows me by name and at least makes me think they actual give a shit about my health. Someone that will give me good advice and not reach for a pill bottle as a first COA.
“If you know the way broadly you will see it in everything." - Miyamoto Musashi
You should probably google doctors offering concierge primary care services in your area. Most 3rd party payer plans will keep you from financial ruin if you get really sick, but they are unlikely to reimburse a doctor enough to provide the level of customer service that you seek for routine preventative care. That is why primary care offices are increasingly driven by PAs and NPs.
You can probably find a concierge doctor willing to see you for a $1000-2000 retainer per year; you will need to compare providers to see who is offering more preventive testing and procedures for that retainer. You may even be able to downgrade your employee insurance to a higher deductible/out-if-pocket plan to recover some of that cost since your routine office visits will be covered by your retainer.
Last edited by Sensei; 09-04-2019 at 10:46 PM.
I like my rifles like my women - short, light, fast, brown, and suppressed.
One reason I like DOs so much is over the last 5 years or so as I firmly entered my 40s I was doing a lot of decoying for a local guy who was training working dogs. It had been about fifteen years since I decoyed, and then I decoyed once a week for four dogs for four or five hits per dog. Those were all experienced street dogs, where the local guy was training green dogs, so you have to be really on top of your game as a decoy because the dogs are new to the game and are just learning. Frequently the most dangerous martial arts students are not the black belts, but the white belts that know nothing, and the green belts who think they know something. The dogs aren't too different. Anyway I was taking hits from 4-6 50-75 pound dogs three or four times per dog, three to five days a week. My spine and shoulders took a hell of a beating.
Because I always preferred DOs, thinking of them as MDs with chiropractic skills, I went to my employer's urgent care where the clinic director is a DO. Making an appointment for the following day I paid 35 dollars for 45 minutes on the table and my spine sounded like a popcorn popper as he adjusted me. I learned that he knew exactly what I was doing because he previously did schutzhund, and even imported a dog from Europe. We discussed long term strategies as well as short term tactics to limit the abuse my body was taking . I went from ignoring some pretty serious chronic pain, just referring to a pinched nerve, that I had carried for six weeks or so, and was normal after the post adjustment soreness left. The exercises and stretches he gave me helped as I continued to decoy. I have been back less than once a year for adjustments.
Recently I dislocated a rib during a coughing fit during a bout of bronchitis. I attended Cecil's IAJJ before I had fully recovered and dislocated it even worse, front and back in the first six hours of the class. There was a two week period of hell, where breathing hurt bad, and sneezing or coughing felt like I was being stabbed. With bronchitis there was a lot of coughing. My new urgent care MD gave me prednisone and antibiotics for the bronchitis, and codeine to reduce coughing. I went back to my DO, and in 10 minutes he had the rib back in place, giving me a 85% reduction in pain. He explained the physiology of what I experienced, and gave me stretches that actually allowed me to reduce the much more seriously dislocated rib. I wasn't trying to reduce it, just trying to stretch it out for some relief. There was a snap as it went back in place, and I ultimately did not need another appointment when Tom Jones jacked me up during Cecil's class. Now almost 4 months later I am 100%.
I lead a fairly physical life. Pleasing a wife, raising three kids and a working dog, and chasing and subduing kids less than half my age at work are all part of my reality. I have a couple of black belts, and work overtime regularly at the local emergency room where I go hands on pretty regularly with drunks and the violent EDPs. Even if the science isn't there, manual adjustments by skilled DOs are invaluable for musculoskeletal problems that pop up . It definitely does not work on everything, but as a part of treatment it is a huge help.
pat
Last edited by UNM1136; 09-04-2019 at 10:49 PM.
Good, fast and cheap: choose only 2. Unfortunately this applies to medicine. My wife is an internal medicine doctor so I have some insight into this. Being a primary care provider (PCP) is a low margin gig compared to a subspecialist that can do procedures and thus earn more for the same hours of work. This is why PCPs have to see so many patients with a limited time slot: high volume x low margin = enough to cover overhead and pay self. This is the reason a lot of PCP's sell their practice to hospital networks or medical insurance companies. Once you sell your practice, the way you practice is usually dictated by a guy who never graduated medical school. For those who remain in private practice, they sometimes have to side gigs like weight loss programs, testosterone clinics, minor aesthetic/cosmetic services. Those side gigs make more money, so they are less likely to be interested in dealing with hypertension or diabetes. Sometimes practices will hire 'mid-level providers' (ie nurse practitioners or physician assistants) to provide that first line of care. They have a shallower foundation of training and knowledge but they still can provide great care depending the complexity of the patient and experience of the provider. If you are a sick puppy with a lot of co-morbidities, they may be limited in the care they can provide. You can of course seek out a concierge doctor like Sensei mentioned. They will spend more time with you; provide deep thorough care; and can be at your beckon call 24/7. Of course they are not cheap. A lot of practices are using technology to try to keep costs down; man power use down and to provide better communication to the patient. There are electronic medical records that allow you to log on to see your lab results; schedule; med list and to direct message your PCP. In the end, I recommend asking yourself this when you see your new PCP for the first time:
1. Is he/she nice and personable?
2. Does he/she communicates well?
3. Does the front office seem to have their shit together?
If yes to all above, you probably will have a good PCP.
Wow, someone can actually choose a doctor? In the USA? I am envious. I can choose a doctor, if am going to pay cash.
We have CIGNA insurance. They are without any shred of honor or integrity. Our primary care physician assignments get changed often, like it or not. I am on my fourth PCP, since early 2018. Not that I have seen any of them; I only go to urgent care, or an ER, as needed, when I am injured.
“Annual physical?” I think my last voluntary, stand-alone check-up was in my early forties; I am almost 58, now.
My “health plan” ID card is incorrect; the named doctor is no longer in the state, or in the network. We were then arbitrarily re-assigned a new PCP, who cannot make referrals to my wife’s cardiologist. Every time we get reassigned primary care doctors, my wife has to get on the phone, to make sure the newest new PCP is in the same referral chain as her cardiologist. When she was employed, she could see her cardiologist directly, but since switching to my insurance, when she retired, she has to get a referral from her PCP.
Last edited by Rex G; 09-05-2019 at 01:52 AM.
Retar’d LE. Kinesthetic dufus.
Don’t tread on volcanos!
I used a DO as a young adult, when I had aged-out of my parent’s health insurance, and had not yet been hired by the PD. I paid cash. Costs were quite reasonable. I tended to get sinus infections during those days, if I remember correctly; glad to have aged-out of that.
Retar’d LE. Kinesthetic dufus.
Don’t tread on volcanos!
I wouldn't ask friends or neighbors unless they have some real insight into medicine. If you can get other medical professionals to tell you who is competent and who isn't, that's a good start.
"Gunfighting is a thinking man's game. So we might want to bring thinking back into it."-MDFA
Beware of my temper, and the dog that I've found...
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