How to choose a doctor?

[Gun Mutt]

I had trouble with false high blood pressure readings too. Turns out there are different sizes of blood pressure cuffs. I just needed a bigger cuff.

A couple of months ago, an 2017 article from T-Nation about the inaccuracies of blood pressure testing made it's way onto my screen, so I read it...very interesting indeed!

Last month I'm at my first visit with my new PC, the first nurse takes my bp and says I'm something like 153/98...wtf? I live a pretty healthy life and I'm so very much not stressed about a dr visit...seriously, wtf? Second nurse comes in, says: that cuff is too small, let me get another one. 2min later, I'm 130/88 which exactly where I tend to land.

I'm a fit guy and a longtime lifter, but I'm not gunned up like a bodybuilder; still standing 6' at 225lbs with a 34" waist, I'm not small by any stretch. The morning of my surgery earlier this month, my bp was stupid high again. I said I doubted those numbers and asked her to get a bigger cuff...134/92, I said: yeah, I guess I am a little more stressed than usual this morning.

[Nephrology]

A couple of months ago, an 2017 article from T-Nation about the inaccuracies of blood pressure testing made it's way onto my screen, so I read it...very interesting indeed!

Last month I'm at my first visit with my new PC, the first nurse takes my bp and says I'm something like 153/98...wtf? I live a pretty healthy life and I'm so very much not stressed about a dr visit...seriously, wtf? Second nurse comes in, says: that cuff is too small, let me get another one. 2min later, I'm 130/88 which exactly where I tend to land.

I'm a fit guy and a longtime lifter, but I'm not gunned up like a bodybuilder; still standing 6' at 225lbs with a 34" waist, I'm not small by any stretch. The morning of my surgery earlier this month, my bp was stupid high again. I said I doubted those numbers and asked her to get a bigger cuff...134/92, I said: yeah, I guess I am a little more stressed than usual this morning.

A single elevated BP reading isn't a big deal.

Best way to evaluate BP if you are worried about it is to get an electronic home cuff (not super accurate FWIW) and take a few readings first thing when you wake up in the AM before you have breakfast or coffee. Seated position, cuffed arm relaxed and at chest height, legs uncrossed.

If those are consistently high then it's worth talking to your PCP about it. HTN is a silent killer, definitely not something to ignore.

We have CIGNA insurance. They are without any shred of honor or integrity. .

This is true of every insurance carrier I've ever had.

Only exception was when I was on mayo clinic insurance while i worked there and getting all of my care at same institution. They were fantastic and easy to work with. Very much the exception and not the rule

[Rex G]

One thing CIGNA did, was to send follow-up mail after we completed an on-line annual survey. These were not sent in plain envelopes, but had writing on the exterior, that REFERENCED HOW I HAD ANSWERED SOME VERY PRIVATE QUESTIONS.

To be clear, this may not have been “big” CIGNA, that sent this privacy-violating mail, but might have been a joint city/CIGNA entity, in the city’s Human Resources department.

Completing that survey was necessary, to avoid hundreds of dollars in surcharges, per year, added to our bi-weekly premiums. So, yes, I have paid hundreds of dollars in surcharges, per year, to protect my privacy.

I have considered getting a post-retirement job, specifically for the health plan, so I can drop CIGNA.

[RoyGBiv]

Another quality I expect from my Dr. is being on time. Sure, emergencies happen, I get it. Before leaving for the Dr, I call the office. Is Dr running on time today? I expect a truthful answer. I suck at waiting. You definitely want me to wait at home/office. If I show up at the office 20 minutes later and don't get seen until an hour past my appointment, buh-bye. (I do ask about what's happened between my call and my arrival).

I had that discussion with my kids PCP a bunch of years ago after waiting almost 90 minutes past our appointment time (after calling before the 5 minute drive). I let him finish the exam and write the prescriptions (ear infection) before I told him why I'd never be back to his office.

[YVK]

^^^
That reminds me (this is for the OP, in regards to doc's selection): if you find out that your doc is superbly punctual for appointments, you may want to find out why. 90% of situations where I am late during my office hours are due to two reasons:
- There is a problem with someone's else patient in the lab and they call me to come over and help.
- I choose to spend more time with preceding patients than what they are scheduled for, naturally, because their problems merit that. Two-three consecutive patients with multiple active problems can easily put you behind by 45+ min.

I hate to have my patients wait and I am selfish enough too that I really wanna get out of the office on time and without a stack of dictations to be finished at home. Reality of working with real people with real problems has a say in that too. Most patients figure that out and realize that when their own shit hits the fan, they will also get more than 20 min for a visit, charting etc included, from me. Those who value their time and can't wait can see the midlevel providers who don't get pulled out for somebody's else trouble or make any tough calls on their own, and hence are usually very punctual.

[OlongJohnson]

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.

My mom chose to be a nurse, among other reasons, so she'd know who the good doctors were. It worked out pretty well, as long as I lived in the area where she worked (which ended after high school).

I've had relatively poor luck relying on recommendations from coworkers for doctors and dentists. Some are just spectacularly bad from the first visit, some take time for you to realize they are unethical hacks.

I'd say it's worth getting a second opinion from time to time even if you think you have a good doctor. I once had a doctor tell me for a few years that a spot on my back was fine. I thought he was a good doctor; unlike most, he actually seemed to listen and think that the person who had 24/7 observation of the body he was examining just might be able to provide useful information. When he changed to another institution, I had to find another doctor. The one I went to referred me to a dermatologist for the spot, who immediately cut it off. I'd been nursing a carcinoma; knew it wasn't right, but the doctor said it was fine.

Another doctor I've seen more recently diagnosed the pain I was having in my foot as Morton's nueroma and recommended surgery. I read on the surgery and decided if I could avoid that, I should. After several years went by, that foot pain turned out to be related to a deteriorating disc in my spine, nothing originating in my foot. So he'd have hacked apart my foot (in ways that never really grow back) to accomplish nothing.

[willie]

Corporate medicine predominates. The company imposes policy and procedures on its doctors. They have less authority than those of yesteryear who owned practices. My opinion is that they may have less satisfaction in practicing medicine. Burnout rate for primary docs is high. You should make certain that your doc enjoys seeing you. Seeing you should soon equate to having a pleasant visit. Remember that he or she hears complaints all day long. Many are bullshit. Some patients are rude. Many are non compliant. The best doc I ever had was female. Brilliant, kind, and sensitive. I don't like my current physician. He's a sawed off little prick who is dense. I hope to find another lady doctor. The last lady doctor I had told me that Willie for a man your age you are in good health, and you're hung like a racehorse. I miss her.

[Hambo]

^^^
That reminds me (this is for the OP, in regards to doc's selection): if you find out that your doc is superbly punctual for appointments, you may want to find out why. 90% of situations where I am late during my office hours are due to two reasons:
- There is a problem with someone's else patient in the lab and they call me to come over and help.
- I choose to spend more time with preceding patients than what they are scheduled for, naturally, because their problems merit that. Two-three consecutive patients with multiple active problems can easily put you behind by 45+ min.

How much time to you allot per patient? In other words, do you plan to see a patient every fifteen minutes? More? Less?

[pangloss]

Regarding hypertension, "white coat hypertension" is a thing. I was "pre-hypertensive" for years. I finally started taking medication, and my blood pressure is well-controlled now at home. However, it's always higher at my physician's office.

How I choose my physician depends on the market. Mississippi is a very medically-underserved state. So often ridiculous wait times are unavoidable. I've had to wait a couple of hours before for a morning appointment before. We don't have enough doctors and the vast majority of the ones we have graduated from the same med school and attended residency at that medical school. In a better market, I looked for a doctor who was at a different institution for medical school and residency. Depending on the situation, I'd chose someone who had completed a fellowship. All that went out the window when I moved back home, so I chose my current PCP based on the fact that his last name is the same as my middle name. After some research, it turns out that he is my ~5th cousin. So far, so good.

[YVK]

How much time to you allot per patient? In other words, do you plan to see a patient every fifteen minutes? More? Less?

My time template is twenty minutes for return visits and one hour for new consultations.