Dr. Work question . . .
Question:
Thanks for explaining! In terms of the kids, I think they only go to one here if there’s something seriously wrong, or has a child-specific problem that the GP isn’t prepared to deal with. The usual scrapes & bruises, illnesses etc everyone marches off to the GP, who usually treats the whole family. — Katharine Maxwell spamblock in action. Work it out!
As they used to be here. But "specialists" make far more money, normally. Insurance reimburses "specialists" at a higher rate. As such virtually all US doctors became "specialists". The GP’s rapidly disappeared.
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Response:
Dr Work! You are in Fresno??? My God, this may be a sign!? I live in Winton, just north of Merced!! Could I come to see you??? Should I privately email you? Oh please give me some hope here. — Much love, Diane – Hide quoted text — Show quoted text – I have seen this happen here in Fresno as well. Everyone wants to sub-specialize and because I do not, I am considered inferior. The problem is that many medical problems are multi-faceted and I have been able to see problems in other "spheres" that the specialists could not see because they didn’t practice that form of medicine. When I get female patients and they tell me that their OB/GYN does their Pap and breast exams, I tell them that it is okay with me and just have them fax over the results to me so I can have a comprehensive record. I then ask them about doing an annual physical exam…they tell me that their GYN does it. So I ask her, "Does he do a breast exam? (Yes) Does he do a pelvic exam? (Yes) But does he do an abdominal exam? (No) How about neuro exam? (No) Does he check your joints? (No) Does he ask you about any pressing problems you may have? (No)…" So their complete annual physical is a breast exam with a pelvic. God help them if the patient has IBS… — Bill Work <SNIP She also painted, had a wonderful garden and would share both with her patients. When I moved to NJ seven years ago, she gave me a painting of a lighthouse as a going away gift. I got here and suddenly I had to have a specialist for everything. When I was assigned a doctor by my medical plan here, he told me immediately that he didn’t do OB/GYN stuff, my kids (13 & 15 at the time) needed a pediatrician that specialized in teens (in his building of course), didn’t give out narcotics and told me I had to see an endo for my thyroid problem. Made me really appreciate the comprehensive care my old doctor provided. Sue
Response:
This is exactly why I love my family physician. I have lupus and fibro but the rheumy would only handle certain things connected w/that….. any skin problems, go to the dermotologist, allergies, ENT, etc etc….. I like getting all my care by the same dr who knows everything that is going on w/me! Physically, I’m a mess but it’s easier only having one appt to go to…. and if/when I need a specialist, he tells me. Dr Work, your patients will appreciate all the hard work you do for them. You really seem to care (and in my book, that’s the most important part of medicine). Thanks for all your help on this newsgroup. Nicole – Hide quoted text — Show quoted text – I have seen this happen here in Fresno as well. Everyone wants to sub-specialize and because I do not, I am considered inferior. The problem is that many medical problems are multi-faceted and I have been able to see problems in other "spheres" that the specialists could not see because they didn’t practice that form of medicine. When I get female patients and they tell me that their OB/GYN does their Pap and breast exams, I tell them that it is okay with me and just have them fax over the results to me so I can have a comprehensive record. I then ask them about doing an annual physical exam…they tell me that their GYN does it. So I ask her, "Does he do a breast exam? (Yes) Does he do a pelvic exam? (Yes) But does he do an abdominal exam? (No) How about neuro exam? (No) Does he check your joints? (No) Does he ask you about any pressing problems you may have? (No)…" So their complete annual physical is a breast exam with a pelvic. God help them if the patient has IBS… — Bill Work <SNIP She also painted, had a wonderful garden and would share both with her patients. When I moved to NJ seven years ago, she gave me a painting of a lighthouse as a going away gift. I got here and suddenly I had to have a specialist for everything. When I was assigned a doctor by my medical plan here, he told me immediately that he didn’t do OB/GYN stuff, my kids (13 & 15 at the time) needed a pediatrician that specialized in teens (in his building of course), didn’t give out narcotics and told me I had to see an endo for my thyroid problem. Made me really appreciate the comprehensive care my old doctor provided. Sue
Response:
I have seen this happen here in Fresno as well. Everyone wants to sub-specialize and because I do not, I am considered inferior. The problem is that many medical problems are multi-faceted and I have been able to see problems in other "spheres" that the specialists could not see because they didn’t practice that form of medicine. When I get female patients and they tell me that their OB/GYN does their Pap and breast exams, I tell them that it is okay with me and just have them fax over the results to me so I can have a comprehensive record. I then ask them about doing an annual physical exam…they tell me that their GYN does it. So I ask her, "Does he do a breast exam? (Yes) Does he do a pelvic exam? (Yes) But does he do an abdominal exam? (No) How about neuro exam? (No) Does he check your joints? (No) Does he ask you about any pressing problems you may have? (No)…" So their complete annual physical is a breast exam with a pelvic. God help them if the patient has IBS… — Bill Work
<SNIP – Hide quoted text — Show quoted text – She also painted, had a wonderful garden and would share both with her patients. When I moved to NJ seven years ago, she gave me a painting of a lighthouse as a going away gift. I got here and suddenly I had to have a specialist for everything. When I was assigned a doctor by my medical plan here, he told me immediately that he didn’t do OB/GYN stuff, my kids (13 & 15 at the time) needed a pediatrician that specialized in teens (in his building of course), didn’t give out narcotics and told me I had to see an endo for my thyroid problem. Made me really appreciate the comprehensive care my old doctor provided. Sue
Response:
Maybe the super specialized areas are mainly a "big city" thing. For 16 years I lived in a little town in NE PA and had a family practitioner who delivered my kids, did GYN care, did my tubaligation, took care of my babies, diagnosed, treated a endocrinological problem of mine and she even sat at the bedside of her patients as they died. When I was having OB problems (high risk pregnancy) and went into labor, she was at a party, left immediately and arrived at the hospital before me! She was an accomplished surgeon who left NYC because "it was getting to me" and took up practice in our town. She also painted, had a wonderful garden and would share both with her patients. When I moved to NJ seven years ago, she gave me a painting of a lighthouse as a going away gift. I got here and suddenly I had to have a specialist for everything. When I was assigned a doctor by my medical plan here, he told me immediately that he didn’t do OB/GYN stuff, my kids (13 & 15 at the time) needed a pediatrician that specialized in teens (in his building of course), didn’t give out narcotics and told me I had to see an endo for my thyroid problem. Made me really appreciate the comprehensive care my old doctor provided. Sue – Hide quoted text — Show quoted text – Excellent point…I don’t know how many times a young mother would come in to see me for some ailment and have children in tow. I would ask her where her children are getting care and she would name some pediatric clinic. I then told her that I am able to care for her children as well as her and her husband (if she had one). Most were surprised that there were doctors like that. Later, I would ask her the date of her last Pap smear and other GYN questions and she would again be surprised that I do routine GYN care and I, personally, also do some invasive GYN procedures, like colposcopies with biopsies, cryotherapy, etc. — Bill Work As they used to be here. But "specialists" make far more money, normally. Insurance reimburses "specialists" at a higher rate. As such virtually all US doctors became "specialists". The GP’s rapidly disappeared. I remember a time not to awfully long ago (this references my kids — the oldest will soon be 24) when most "medical people" looked at you like you were guilty of child abuse if your child did not have a "pediatrician" — it was as if you were doing something terribly neglectful if you used a "family" doctor. Family Practice is the "specialty" that practices medicine like the GP’s of my childhood used to do. And this is not an attack on Dr. Work — just the view of one who remembers when there was no such thing as "Family Practice. And sincerely prefers that type of medical care — it is a bit ridiculous to have to involve 3 or 4 doctors when a child brings strep throat home from school and everyone catches it. — Ruada
Response:
Bill, didn’t mean to open a can of worms . . . I only meant "generalist" in terms of a broader training and practice. I meant it in the best sense, too, and not in any way demeaning. I even refer to my internist as a generalist at times. Thanks for your response. I have to wait until mid-September to have a chance to talk it over with my doc, which is why I asked you about it. I’m not particularly good at waiting! I want a REAL diagnosis and not some wishy-washy syndrome, like they told my mother at Mayo’s in the 70s — an Addison’s-like syndrome. Not good enough for me. You’d think in a town with 5 hospitals and a university medical school we would be swarming with specialists. Not so with endocrinologists, for some odd reason. I’ve been to one in St. Louis but was on a pretty high dose of prednisone at the time, so that was a pretty big waste of time. There are two at the University, but both are members of our synagogue, and I have kind of an unwritten rule about not seeing people I know as friends. Plus, both specialize heavily in diabetes and both are, well, idiots. The wife of one told me we are getting a new endocrinologist in the fall, so I guess I’ll see one then. In the meantime, I’m taking prednisone (again, after fighting so hard to get off of it) and I am concerned about the stress that the chronic pain puts on the body and how that may affect the dose. It’s a fine-tuning thing I guess we’ll have to go through. I took a bit extra when we traveled to Portland last week, and did pretty well all things considered. Thanks for the advice. I really appreciate it. mary – Hide quoted text — Show quoted text – As a "generalist" (never been called one before – I am Family Practice), I would make the diagnosis of Addison’s Disease and send you off to an endocrinologist for fine-tuning of your meds. It is starting to get beyond the level of my comfort for treatment. The cosyntropin (sp?) IV test is what you were talking about and if you get no response, then you have Addison’s and need to be careful when under stress, ill, etc. You could go into a crisis and require some mineralocorticoids…of course, isn’t pain stressful? If so, are you taking a chronic mineralocorticoid, e.g., hydrocortisone, etc? Need an endocrinologist…
Response:
Excellent point…I don’t know how many times a young mother would come in to see me for some ailment and have children in tow. I would ask her where her children are getting care and she would name some pediatric clinic. I then told her that I am able to care for her children as well as her and her husband (if she had one). Most were surprised that there were doctors like that. Later, I would ask her the date of her last Pap smear and other GYN questions and she would again be surprised that I do routine GYN care and I, personally, also do some invasive GYN procedures, like colposcopies with biopsies, cryotherapy, etc. — Bill Work
– Hide quoted text — Show quoted text – As they used to be here. But "specialists" make far more money, normally. Insurance reimburses "specialists" at a higher rate. As such virtually all US doctors became "specialists". The GP’s rapidly disappeared. I remember a time not to awfully long ago (this references my kids — the oldest will soon be 24) when most "medical people" looked at you like you were guilty of child abuse if your child did not have a "pediatrician" — it was as if you were doing something terribly neglectful if you used a "family" doctor. Family Practice is the "specialty" that practices medicine like the GP’s of my childhood used to do. And this is not an attack on Dr. Work — just the view of one who remembers when there was no such thing as "Family Practice. And sincerely prefers that type of medical care — it is a bit ridiculous to have to involve 3 or 4 doctors when a child brings strep throat home from school and everyone catches it. — Ruada
Response:
As a "generalist" (never been called one before – I am Family
Practice snipped That’s interesting – our doctors over here are called GPs, ie General Practitioners. — Katharine Maxwell spamblock in action. Work it out!
Response:
As they used to be here. But "specialists" make far more money, normally. Insurance reimburses "specialists" at a higher rate. As such virtually all US doctors became "specialists". The GP’s rapidly disappeared. I remember a time not to awfully long ago (this references my kids — the oldest will soon be 24) when most "medical people" looked at you like you were guilty of child abuse if your child did not have a "pediatrician" — it was as if you were doing something terribly neglectful if you used a "family" doctor. Family Practice is the "specialty" that practices medicine like the GP’s of my childhood used to do. And this is not an attack on Dr. Work — just the view of one who remembers when there was no such thing as "Family Practice. And sincerely prefers that type of medical care — it is a bit ridiculous to have to involve 3 or 4 doctors when a child brings strep throat home from school and everyone catches it. — Ruada – Hide quoted text — Show quoted text – As a "generalist" (never been called one before – I am Family Practice snipped That’s interesting – our doctors over here are called GPs, ie General Practitioners. — Katharine Maxwell spamblock in action. Work it out!
Response:
A GP is someone who went through medical school and did one year of internship before entering into the "real world". They only had enough supervised training to get licensed and that is IT. I am a Family Practitioner. I did three years of residency, rotating through various areas of medicine. I have worked with psychiatrists, delivered babies, done minor surgeries, assisted in major surgeries, did ambulatory medicine, occupational medicine, pediatrics, newborn care, OB/GYN stuff, emergency medicine, geriatrics, neurology, radiology, cardiology, orthopedics, trauma, (these were some of my REQUIRED rotations…we also had electives…my electives included hospice). FPs are trained in doing C-sections, simple tonsillectomies, vasectomies, and "lumps and bumps" surgeries. I know of FPs who are addiction docs and run psych units for addiction rehab. The goal of Family Practice is to be a comprehensive doc and to be exposed to so many areas of medicine that you can handle the "bread and butter" type situations and know when to refer to a specialist. So you see, I have had a bit more training than one year of internship. But Family Practice is foreign to many other countries. I know that they are trying to set up a program in Japan, but they are having a hard time. I am not sure about Australia. — Bill Work
– Hide quoted text — Show quoted text – As a "generalist" (never been called one before – I am Family Practice snipped That’s interesting – our doctors over here are called GPs, ie General Practitioners. — Katharine Maxwell spamblock in action. Work it out!
Response:
Bill, This isn’t strictly a pain question, but it’s part of my whole health picture. As a generalist, if you had a patient who had a fasting serum cortisol that showed low levels of cortisol to begin with, then no response to the ACTH challenge, would you make a diagnosis of Addison’s disease? If not, what else would you order to make the diagnosis? Would you expect to find an Addison’s patient with some level of chronic pain? I’m grabbing at anything to get some kind of answer. Thanks in advance. mary
Response:
As a "generalist" (never been called one before – I am Family Practice), I would make the diagnosis of Addison’s Disease and send you off to an endocrinologist for fine-tuning of your meds. It is starting to get beyond the level of my comfort for treatment. The cosyntropin (sp?) IV test is what you were talking about and if you get no response, then you have Addison’s and need to be careful when under stress, ill, etc. You could go into a crisis and require some mineralocorticoids…of course, isn’t pain stressful? If so, are you taking a chronic mineralocorticoid, e.g., hydrocortisone, etc? Need an endocrinologist… — Bill Work
– Hide quoted text — Show quoted text – Bill, This isn’t strictly a pain question, but it’s part of my whole health picture. As a generalist, if you had a patient who had a fasting serum cortisol that showed low levels of cortisol to begin with, then no response to the ACTH challenge, would you make a diagnosis of Addison’s disease? If not, what else would you order to make the diagnosis? Would you expect to find an Addison’s patient with some level of chronic pain? I’m grabbing at anything to get some kind of answer. Thanks in advance. mary
Response:
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