"Hi. I'm here for a full head-to-toe annual physical exam and five other issues."

[Aristus]

Whoa, whoa, whoa, whoa! Back up. Time out.

How long do you think a physical exam takes? We barely have time to do that. Your other issues are going to have to wait. And if they can't wait, we'll talk about them first, and postpone your exam until another time.

Seriously, dude; I want to help. But you're not the only patient on my schedule today.

[intrepidity]

1. Ok, so what does it take to get such an appt with a doc?

For some of us, finally making an appt and getting to a doc is a major event. Why can't we book multiple consecutive appts to get a 1-2 hour block of time, to do a real thorough exam like used to be normal 40 years ago?

[Aristus]

3. Forty years ago, primary care clinics weren't owned by major corporations who demand

more visits with less time than in the old days. Although my organization is ostensibly a not-for-profit, they want a billable visit every fifteen minutes.

[GoneOffShore]

4. The NYT had a piece today about medical professionals 'burning out'

Here's the no paywall link - https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html?unlocked_article_code=iKcseB_y2PPlSCEIjDj-UjUIS31RXaIpIG2ILQZDnTPH_EnQNf-JmNxqCtzEPyOleUnM33w1Vhviu-Blz6qMv8UfvCWvQ7vflj242vGJGUyv2n8t0Ip2c2Ygd4o3PC_4kfbK5tsJMiHet2cfw-eROK9J84SPbRJlYTPrdZCK4DF0ZGFhw1i6Jl9CTraLUcHcJMvM9N9Rkm4buwgDd4itmTwk-4g4BrUuAvZCZsRYGXEtjH5wyLJR7YOuLNJEYV6h2k3KE1G6uJYZ9php2YanNXGwqELk9hX4kof_Yp4c6iPB31d6tOTyYrTl0IRRJGCyJlJuvRZcSbXWFfTGc1fJGf5HVs5oDxQ&smid=share-url

[MOMFUDSKI]

5. I had a really good doc

for years. He would take all the time it took to cover whatever needed to be discussed. About 7 years ago he went Concierge and wanted $800/yr for my age group. Couldn't go along with that. Now I hear he is back in the meat grinder of, like you say, 15-minute visits. That just isn't who he is and I see a good doc going to waste in this messed up system we call healthcare.

[malthaussen]

18. One wonders how that differs from a for-profit organization.

I suppose they expect you to log your pee breaks, too.

-- Mal

[2naSalit]

2. My appreciation for...

Medical professionals has been boosted a bit today after seeing my GP. She had to extract some things from the skin on each leg for biopsy, then stitched them back up. My only request is that I can't see what she's doing and that serious numbing was done first. It took about an hour and I was glad when it was over. I suffered the minimum of discomfort for which I thanked her profusely... and for the actual cutting event which we finally decided to do.

You just have to help them see that priorities are important, somehow.

Hats off to doctors! We couldn't all that well without you!

[sorcrow]

6. Then there's the Colombo moment

Then there's the Colombo moment as the doctor starts to leave. Uh, doc, there's one more thing....

Best regards,
Sorghum Crow

[Aristus]

7. I DREAD "one more thing..." !

Especially on a busy day. However, on a slow day, with no patient waiting, nothing gives me greater pleasure than to reply "Let's hear it!"

[Ocelot II]

8. The other day I went to my clinic only because I had to see the doctor

in order to get a prescription refilled. I figured I'd be in and out within 15 minutes or less, since I wasn't having any issues with the medication, but she and her PA insisted on interrogating me, testing me, all kinds of stuff that I wasn't expecting. I'm fine (just old), but I was surprised and appreciative that she took more time than I'd expected or thought I needed. I've always had good experiences with this clinic, which is affiliated with the university; I fear and loathe medical procedures but these people are great at putting me at ease.

[Aristus]

9. Are you sure that wasn't your doctor's Medical Assistant you were talking with?

I haven't visited with a patient with an MD present since I was in school. I don't know of any PA who does that. We have a great deal of autonomy and our own caseload.

Is it possible you confused Physician Assistant with Medical Assistant?

[Ocelot II]

10. Possibly; I didn't notice what his title was on his name tag. He wasn't present

during the conversation with the doctor but if PAs are autonomous then he was probably a medical assistant or an RN. He seemed very knowledgeable, though, so I guess I just assumed he was a PA.

[Aristus]

11. 'Assistant' is a pretty loaded word. Most PA's don't like it.

The profession is coming around to the idea of calling us Physician Associates, because the word 'Assistant' makes it sounds like we follow the MD around, carrying out his orders. That's for Medical Assistants and LPN's.

PA's are fully-licensed medical providers with our own patients, and our own method of medical practice. We don't have MD's staring over our shoulders.

My supervising physician works in an office two blocks away, and I haven't seen him in person in over six months.

[Ocelot II]

12. "Associate" is definitely a more accurate description. It should be adopted officially.

[3catwoman3]

13. Do you think that name change will take place?

When I went to my NP certificate program way back in 1975, some programs used the title "PNP - pediatric nurse practitioner," and others, my own included, used "PNA - pediatric nurse associate." There was no difference in what was taught, and I no longer remember, if I ever knew, why there were the 2 terms. The whole new role had only come into being a mere 10 years earlier, so much was still evolving. I don't think I ever saw anyone use the term PNA after I completed the program.

The public, in general, understands little to nothing about nursing education. Many times, over the years, I was asked one or another variation of, "Nurse practitioner - is that like a practical nurse?" My mouth would issue a polite reply, while my brain would be shouting, "Hell no - not even close!" (1-2 years of education versus 5-6.)

Seeing as you are the only one seeing patients in your clinic, I'm going to hazard a guess that you don't get very many, if any, people refusing to see you because you are not a doctor. That used to happen in my final place of employment. There would usually be 2 of us seeing patients - either 2 docs, or one doc and me. I'd walk into an exam room and introduce myself as "Mrs. XXX, the nurse practitioner," and get met with what I came to call the "Oh, shit, you're not the doctor" facial expression.

This was strictly the fault of my employers, who, for reasons unclear to me, did not use dedicated schedules. Unless a family specifically requested a particular provider, they booked time slots not providers, and whoever got done first, went onto the next open room, and so on and so on, all day long. You never knew what your work load was going to be, and they also did what they called "3 across" - 3 patients in every time slot, with only the 2 providers. It was a set up to fall behind right from the get-go.

The parents who refused to let me see their kids would always say, "No offense, but...". Well, excuuuuuuse me - you've just told me you don't think I'm good enough to care for your child. Pardon me, but I'm offended. (Thought but not said.)

Being dismissed from an exam room is very insulting.

A few years ago, I finally convinced the partners to establish dedicated schedules, which largely fixed the "No offense, but..." encounters. There'd still be a few who would book with me just to get in, and then insist on pulling the old switcheroo once they got there.

Do your patients call you by your first name?

(Apologies for rambling on.)

[Aristus]

14. My patients all call me Bob.

A lot of times, they call me 'Dr. Bob', even though they know I'm not a doctor, and I always let the ones who aren't sure know that. It's a little gratifying, and very overwhelming that my name is known on the street. If there's a homeless person out there who doesn't have medical care, one of my patients will tell them "Go see Dr. Bob! He'll take care of you." It's one of those little things that gives me the strength to keep going.

[3catwoman3]

15. When I started my first civilian NP job after 4 years in the Air Force, I found the switch...

...from being addressed by rank (Lt. Ball, then Captain Ball, and finally Major Ball in the reserves) felt awkward and too familiar. None of the pediatricians were called by their first names, and it seemed to me if the premise was comparable levels of care whether seen by the doc or the NP, then a comparable formality of address was in order. Also, once out of infancy and toddlerhood, most of my patients were in school, where they don't call their teachers by their first names.

When I first started working at my final place of employment, I was the first NP they ever had. If parents would inquire as to who was working, I had to get the receptionists not to say, "Would you mind seeing the nurse practitioner?" Let's not plant the idea that maybe they should mind.

[malthaussen]

19. You call me by my first name, I call you by yours.

I can't remember the last time anyone called me "Mr," and I'm old enough to resent the presumption. But if that's the way of the world, so be it: I just insist it be equal.

-- Mal

[3catwoman3]

21. I did not call the parents by their first names, with a handful...

…of exceptions involving moms I had become quite close to after seeing their kids for many years. I don’t recall ever calling a dad by his first name.

There was one dad, who was pretty much a strange and obnoxious jerk, who always called me by my first name, even tho that was not how I had introduced myself to him, nor had I asked him to do so. It felt very condescending and presumptuous. No one in the office liked him.

One example of how odd he was showed up on his kids’ patient information forms. The mom had died. In the section on family info where the space was for her name, date of birth, etc, he just wrote DEAD in all upper case letters that were very large - no name, no nothing. I’ve never seen anyone else do that. If a parent had died, people typically wrote down the name, used the word “deceased”, and included the dates of birth and death, and often the cause of death - cancer, car accident, etc, etc. It was creepy. Kind of like he was glad. His sons were very nice - must have learned it from their mom.

I did call my patients by their first names, just as classroom teachers do with their students.

It’s interesting that if a doctor walks into an exam room and says, “Hello, I’m John/Jane Jones,” pretty much no one calls the doc by their first name. The title is automatically used.

[malthaussen]

20. At least it's not Doctor Robert.

-- Mal

[jmowreader]

16. Doctor Bob, I'm sure this isn't the first time this has happened to you!

[panader0]

17. Your title made me think of this song: