I had been satisfied with my internist. She once saw me on short notice for a problem, which I really appreciated, but unfortunately left the mega-group to join a smaller local practice. I decided to stay with the mega-group, since my records were there and I was seeing 3 other specialists there as well. A retired internist told me that a lot of doctors came to the mega-group and didn’t stay long.
On the appointed day, I arrived for what I thought was a Medicare Wellness Exam, taken back to the exam room by the medical assistant. I gave her my unclothed weight, so as to avoid the issue I had at cardiology, where they took my weight fully clothed and then used that to compute my BMI to two decimal places. One is plenty; too many feel that adding decimal places improves accuracy. In some circumstances, it does. This wasn’t one.
The medical assistant then took my history. I am a surprised these days how many non-physicians not only have access to my medical information, but take it from me. There was a time when we physicians actually did all this ourselves. We didn’t have scribes, we dictated notes, and some of us even read them before signing. It may have been slower, but all those people have to be paid, too. I called people in from the waiting room myself, because neurologists learned a lot about a patient by watching how they arose from a chair, walked, spoke, shook hands, and sat down. I diagnosed many with Parkinson’s before they ever reached the exam room. I diagnosed myopathies when patients couldn’t get up easily from a chair, foot drops and hemiparesis from their gait. Now, the exam room has become almost an inner sanctum, given by some of the routes I take to get into one.
Anyway, in these days of extremely busy physicians, I figured I better say whatever was on my mind in a hurry so it got into the record. The assistant then recommended a DEXA scan for my bones, which I thought odd, since I don’t have any risk factors I know of for osteoporosis except age. But knowledge changes. She finished and said the doctor would be right in, since the latter was done with the previous patient.
I waited 20 minutes. That’s a lot in the inner sanctum. Yeah, I know. Doctors keep patients waiting. I seldom did.
The physician came in and introduced herself. I stood, as I always do, then sat down. She then placed herself in front of the computer and started reading from the screen, first concern being my diazepam dosage. I told her I took it for a GU condition where it was the only thing that worked (leaving out the story how I had discovered that, nobody else). I told her I had tapered the original low dose more than 60%, but she was still bothered, because of federal regulations about this sort of drug. She barely glanced at me, eyes instead fixed on the computer screen.
Diazepam is quite safe in low doses, yet we allowed Oxycontin to be marketed as a first line drug for musculoskeletal and chronic pain, which anybody with sense knew was a bad idea. My internist, fixated on Diazepam, couldn’t find it in my records who prescribed it for me. I finally said who had, but it wasn’t in the computer, and during this time, she continued to be look more at the screen than at me. This is apparently the new medicine. Everything is electronic, which can be good. I get neatly typed records online, which are helpful, except for BMI to 2 decimal places and no comment about the little things in aging, like hearing, vision, sleep, and moods, affect me, and a diagnosis of Chronic Pelvic Pain, when I had no pain, only discomfort, which is a significant difference, trust me. I almost didn’t get my needed blood work, because she didn’t appreciate that the last I had was in 2015, not this year. At least the DEXA wasn’t necessary. Nobody asked about dental care. It matters now, because we know now that periodontal disease affects health a great deal. The human cost of medicine by screen is failure to look at the patient, from whom much information comes.
Additionally, if something is inputted wrong, it tends to stay there. Imagine if you are my age, not a physician, with a lot of medical problems, and aren’t thinking clearly. What happens to you if something is missing, not noticed, not picked up, not addressed?
At my age, I start answering questions like that with, “You die.”
By now, I felt like a major drug abuser. I stopped mentioning my other concerns, like what she thought about statins. She dismissed my concerns about weight and waist with “do crunches,” which don’t fix the problem. She felt a little edema in my leg, assured me it wasn’t heart failure, which I knew, and said it was probably venous insufficiency, and I should lift my legs up when sitting. I decided that wearing support hose, like I did when I was an intern, was better. She quickly listened to my heart and lungs and I was done. At least I thought I was. I was told to call a week prior to wanting the nasty drug I was taking, because these things took a week to fill. Why? This stuff should be done electronically in seconds. I filled requests the same day when I practiced, and I often called the pharmacy myself.
In her position, I might have moved from the computer to where I was sitting to directly across from the patient, asking about retirement, Medicare, money, meditation, depression, sleep, support systems, what it’s like when your body can’t do what it once did or does what it once didn’t. She would have heard a lot, and that’s the problem, because hearing a lot takes precious minutes that could be used to …. well, do what, pray tell? Help a patient?
A few minutes later, yet another medical assistant came in to hand me the papers that were printed. I certainly get nice notes at the end of my visits, which my patients never did. Indeed, if I had a question about my BMI to 2 decimal places with my clothes on, I could request a change at my next appointment. The problem was I wasn’t given any other appointment. I was told to see her if I needed to. The appointment time to get into see a new internist in Eugene is 11 months. Followups? For GI, 5 months. For Derm, 4 months. For GU 2 months.
Four days later, I got a call telling me that my doctor wanted me to come in in March—only four months’ distant—for a Medicare Wellness Exam. I thought that is what I had had. Did they want it in a new calendar year? Or was there something else I didn’t know about? I’m not sure what to do at the moment.
If I only had that screen, it would tell me.
Boreal B[l]og 
December 31, 2016 at 13:33 |
Welcome to generic geriatrics. Can this service fulfill any outcome criteria? I think not.
Denise Helmkay helmkay@aol.com