My PCP was both a GP and a cardiologist in addition to teaching medicine. My main problem was cardiovascular so it was a good fit. On occasion he would refer me to other specialists. On one occasion I recall I went directly to a Dermatologist to get rid of warts.
It pays to be flexible.
The Captain
Then again, given my experience over the past couple of decades with PCPs (occasional PAs) and what I know now about appropriate diagnostics with “mildly elevated cholesterol”, I’m starting to revise my opinion a bit.
Our new PCP (new to the practice not a new practice for us) even admitted that she wouldn’t have imagined that I was a candidate for such advanced cardiovascular disease, all things considered.
Mind you, the “all things” under consideration were the items on a standard lipid profile…the Lp (a), Apo-b and CAC scan were my requests (**in the assumption/hope that they’d all be as inconsequential as my LDL-C was assumed to have been) Per current guidelines…which my intervention cardiologist considers to still be about 20 years out of date…these are now included for follow-up on questionable lipid profiles. I guess the only conclusion to draw is that, if they’re not being utilized at primary care for refining risk assessment, opportunities for primary prevention are being missed. There’s a reason why hesrt disease is still the #1 killer.
** one of the articles that influenced me to suggest the CAC scan in addition to the extra lipid tests. The “flaneur” had a lipid profile similar to mine so I certainly hoped my Agatson score would be close to his. See how that went?!
I should note that, since this went down, 2 of the newsletters sent out by the practice has mentioned these as an adjunct to assessment to ASCVD so at least, on that, there’s some catch-up!
@Leap1 …what was this archived video from, and when? Just wondering about the technology involved rather than the cardiology.
Purely by coincidence, the latest article on CAC scans from the Skeptical Cardiologist appeared in my email
I see mine annually for a physical. Those are scheduled months in advance, and include bloodwork. I also go in, usually the same day or on one day’s notice (sometimes if he’s out I see an associate or nurse practitioner) for something like a sudden rash or tick bite or whatever.
On an annual basis I see a dermatologist (occasional “suspicious” growths, all negative so far), a urologist, and if my back flares too much a neurology surgeon. I also have physical therapy for my back occasionally, maybe less than once a year.
Except for my back I’m in pretty good health, so YMMV.
If your tap water is hot enough, a normal temperature for most of us in the US, you can get rid of warts with hot tap water. Simply dab the very hot water several times on the wart. The skin surface virus won’t survive. You won’t burn yourself in the process. My hot tap water is about 180 F coming out of the tap. It cools off in a moment.
Verruca warts might be more difficult at times.
In this scenario a PCP would probably not be a good person to trust on the decision then and the dermatologist might wait and watch or biopsy is my guess. This is why the PCP is a gatekeeper and refers to specialists…doc
December 2019. It was the calcium test. The same cardiologist was adamant there was zero plague at that time. So was the first cardiologist just as adamant. The legs were tested the year before as I have some allergies possibly causing redness on my left ankle. My BiL’s immediate statement about the ankle leaky vessels because of allergies.
The main thing is no chest pain, shortness of breath, or sweating.
Family history no such problems in my parents, grandparents, or sisters. My cousins are free of this on both sides of the family as well.
At this point, the testing is considered optional.
This is true. If your cardiologist works you up and your health history is negative (no obesity, cardiac history, not obese, nonsmoker, no diabetes), your EKG is normal, your ultrasound and stress test are normal - then you won’t gain any information from a calcium score because this test has a high false positive rate on this particular patient. If the cardiologist recommends this and one gets a high calcium score then the cardiologist will suggest a heart cath which is one of their most highly reimbursed procedures. Its an ethical dilemma for the cardiologist.
This happened to my FIL and a family friend (attorney). Both had all the tests above and they were normal, the cardio suggested a calcium score and they both did it against my recommendation. The calcium scores were high in both these octogenarians with normal everything else so the cardio suggested the heart cath on both of them, they decided yes and they had clean coronaries imagine that. Both said it was a one time cath and it was good to know the cath was clear. The cardiologists were happy because they made their Mercedes payment yada yada…doc
I have Type 2 Diabetes but my sugar was never above 128. I have it under control with a larger weight loss. I have been off the PB med for a few years now because of the weight loss. I have a 162 on the calcium test. The video of that test clearly shows two cardiologists that I have zero plaque. Both adamantly say no plaque. The calcium is scattered there is no blockage. The cardiologists say they see people with higher levels of calcium and no artery problems. That is not true for everyone. That is true for me.
I spoke indirectly by phone just now with my PCP. He has some things in the record wrong. But considering the variables he thinks I should take the test. I will take the stress test next week. It is pain but whatever. The good that can come of it, if there is anything they will find it. I expect a clean bill of health. I have no reason as of today to expect anything.
Its really good that you have that communication and relationship with your PCP. That is an important part of the physican patient relationship.
I just recently went through all this with my cardiologist. My health history is negative, EKG was normal, Ultrasound was normal, Stress test was normal and he said he wanted Ca score. I protested about the false positive rate but he said its a good test. My score was 40 something. The xray tech said it was one of the lowest he had seen. My cardiologist did not suggest a heart cath and I see him because he is excellent. The average person doesn’t have any idea about their physicians unfortunately and the sites that one goes to to rate their docs are pretty much worthless IMHO…doc
I loved my primary care physician. So much so, that even though he wasn’t on my insurance plan for many years, I still used him for 25+ years and paid cash. He was a terrific diagnostician, perhaps the best my wife and i have ever encountered. And he literally saved my life once in 2010 (I’ve posted that story here more than once since then). He also saved my wife from possible lifetime disfigurement by rapidly diagnosing Bell’s Palsy and having her immediately go to the nearby hospital for immediate treatment.
Unfortunately, while I was out of the country for the last month and a half, he retired and someone else took over his practice. I’ve been afraid of this since finding out that he was more than 10 years older than me (For 25+ years, I had thought he was max 3-4 years older than me, until I asked him about his age a year or two ago).
My new PCP is incredibly good at diagnostics. He is 65 but he seems to have a well-paced practice that he loves. Part of that, he is not advertising himself correctly. In his online bio for the practice, he talks about returning to practice after a mid-life career in a hospital computer room. There is nothing that would recommend him as a doctor in his bio.
I called the office last month about something I needed a referral. I was told to come on it but make it 20 minutes early to see the doctor. LOL He is roaming around the practice seeing the patients the other doctors can not fit in their schedules.
He is very direct and to the point. That would throw off many patients. Yet is a sign of a huge capable diagnostics on his part.
Hi Physician, thanks. I am not a medical professional so when I found out liquid nitrogen was actually considered cryosurgery, I was surprised. It is only a can of spray that is used to take off precancerous cells. Seemed rather benign and easy to use. My PCP told me he could do it and has nitrogen but I was never sure that he would be able to spot all of the different skin problems. But nitrogen doesn’t seem to be that high tech so maybe I was wrong. I guess what I am asking physician would you consider a PCP to be able to handle checking skin legions as well as a dermatologist or would you skip the PCP and go directly to the dermatologist?
Andy
My PCP has used a scalpel to take off skin legions.
Andy
You do not want to do that. The cells are not necessarily pre-cancerous. The better way with the scalpel is to get the biopsy.
A doctor visually can not be totally sure the cells are pre-cancerous.
That is the problem with a PCP performing procedures.
Even with PT it is best not to rely on the PCP.
This comes down to a couple things for me: with my insurance, I am/was required to go first to a PCP for the referral. Once the referral is/was made, though, I can have annual visits to a dermatologist (or other specialist) without PCP intervention in many cases. In general, I would tend to go to the specialist for most specialist needs - that’s the field in which they were trained and are doing as a regular practice, after all.
The other consideration is cost: going to your PCP may be (a lot) cheaper than going to a specialist. For me, this is not the case since all my co-pays are standardized.
Pete
Outdated information.
Ct angiography now gives as much useful insight into degree of coronary artery blockage…and, is non invasive and doesn’t make a difference to levels of reimbursement to an intervention cardiologist. Ignoring a high CAC score, however, is probably far more likely to be associated with a boost to the finances if/when ongoing ASCVD proceeds to heart attack and stent placement.
If you believe that cardiologists (or any physician…other than yourself, of course😉) is so motivated.
I have always trusted the medical field to do what is best for my health but am starting to be much more active. When the PCP used a scalpel, I thought it was normal. That is the problem with trusting experts.
Andy
The PCP is not the expert. Or better put not the specialist.
Think of the PCP as triage.
The PCP has less training and is a generalist.
There are choices often in treatment. The outcomes can be dependent on the choices.
It is good to network here and elsewhere. But it can be very confusing information. Decide why an opinion is correct or even matters but do so respectfully. This is medicine where political fighting does not belong. That is for the insurers and pharma stuff.