Andy,
The PCP screens your problem and determines if your problem warrants a referral to a specialist is how the system is supposed to work. A more agressive PCP might try to treat some of the lesser lesions before referring you to a dermatologist. IF your PCP doesn’t send the lesions off for biopsy, then I would ask for the referral because the most benign looking skin lesions can be squamous and basal cell cancer which are easily treated if the biopsy is positive. Without the biopsy its just a guess if the doc got the whole lesion…doc
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That is good to know. I think I will stick with my dermatologist. I like my PCP but I think he might be to aggressive. He also does colonoscopies, which I was surprised with.
Andy
Must add if you feel you need to stand up to a doctor which can happen do so forcefully. Do not be shy. Doctors can take it easily. Then decide if you are in a position where you need to stand up to a doctor if he is a quack. He might be regardless of his reputation.
That is not a political fight that is getting oneself out fo Dodge.
NO NO NO he should not be doing colonoscopies. No way unless you are so far from civilization he has to do so.
Sorry about high jacking the thread but I do appreciate all the information. I was confused on exactly what a PCP does and doesn’t do.
Andy
You think I am shy? LOL
Andy
This is different than being shy. Doctors have a different status. You just called a PCP an expert. Your view of doctors is purposely led differently than your view of anyone else.
Part of getting better is believing in your doctor. It has to be this way.
And you said don’t be shy. LOL. But seriously the PCP is an expert to me, because of my lack of knowledge in the Medical field. But, even on the internet, after talking to people I can tell who the experts are.
Andy
The PCP should not be doing Colonoscopies.
The specialists are often wrong. It is confusing.
You need to believe in your doctor. But more confusing you need to choose your doctors.
Yes, PCP’s are looking for ways to make more revenue and the only way to do that is to do procedures done by specialists. When I was in Houston, the family docs were going to a surgery center and doing spine injections for chronic pain patients. Colonoscopies and EGD (upper scope) are being done by general surgeons too where it used to be Gastroenterologists only. Everyone wants to make more money including docs…doc
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Well, that’s not quite true. They can try cramming more and more patients into existing time slots and do a sloppy job of even basic doctoring.
Alternatively, look at being more business like with practice management. Utilising PAs , NPs and MAs appropriately, avoid signing up with insurance companies that are consistently reimbursing at lower and lower rates (something I did in my practice). Unfortunately, that suggestion makes us Medicare beneficiaries more vulnerable but, unlike a few decades ago, most primary care practices are not hurting for patients so this ought to be totally doable.
My PCP office appears to be one of a diminishing number of holdouts in maintaining a private practice against the corporate behemoths like Optum etc. In chatting with our physician, it sounds like she’s spent the last few years in practices that’ve sold out and made it difficult to do what she thinks is a decent job. I think they try to incorporate some elements of concierge care as a bit of a money maker and have also incorporated something called Chronic Care Management which allows for billing Medicare an extra amount for managing patients with multiple co morbidities (not sure if it stretches to MA plans…probably not)
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The better doctors put the patients first. There is still plenty of income.
The idea of a PCP doing a colonoscopy does not sit right. S/he can perforate the intestine wall. The patient can bleed out. Things happen. It is not kosher.
That said many doctors live up to and beyond their means. They may need the money that of course is even more irresponsible.
Just a note, all the promises of concierge care the care got much worse. According to my dad. The service did not tie things together for well-advocated care as was intended. The generalists offering the service did not nearly know enough. The problems created by the doctors stopped talking to each other.
I can see my PCP relatively quickly. Specialists are a different manner. My PCP sent me to a cardio after my annual showed a murmur, and that took over 2 months to see him. Turns out I have a bad heart valve. He sent me to a surgeon a month ago and not seeing the surgeon until next week.
I tried to see my neurologist, of whom I’m a returning patient, and that was going to be near 3 months. And he already knows me!
Anymore we have the high cost of a private health care system, with the poor access that 'Muricans keep telling me the socialist health care plans are hobbled by.
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[quote=“bjurasz, post:52, topic:96363”]
He sent me to a surgeon a month ago and not seeing the surgeon until next week.
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I rest my case. Thanks.
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He is eventually going to see his doctor. Under a privatized system, you ONLY see a doctor AFTER you prove you can pay. Absent that, you NEVER see a doctor.
Amateur 
. Mine was 750. Even with this high score, a cardiac cath wasn’t the next step but rather CT angiography. Provides enough diagnostic information in the absence of symptoms of cardiac insufficiency as a more invasive approach, apparently. I’d been hoping for a false positive (which is a rare enough occurrence, it seems, that it’s worthy of publication…yes, I checked at the time)
No unicorns for me…
This report arrived via email directly to me on a Sunday evening. By mid morning Monday when my cardiologist called partly to apologise for/complain about the direct communication and to explain the report, both my husband (who, up until my experience, was on the fence about the clinical significance CACs…) and I were basket cases…assuming as we did with our outdated thinking and copious Googling on that Fractional Flow Reserve, that stent placement was the inevitable next step. Nope, apparently aggressive lipid lowering is showing all the signs of putting the stent manufacturers out of business.
As I’ve mentioned before, my PCP’s e-newsletters have subsequently explained the use of CACs in risk stratification. You can kind of see why.
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Ideally your PCP is the one that keeps track of the overall picture. I can’t tell you the number of times on a professional level I’ve dealt with specialists that only see “their” problem and not fully aware of all the other issues a patient might have or how they have been changing over time.
Use my internist for annual check up and not much else since I have no issues. However, he is good at reminding about time for flu shot, time for this, time for that, since recommendations about doing certain things change. Also use him to bounce ideas off of since we seem to be reading similar studies about nutrition and exercise.
As far as getting to see my internist, not an issue. Two days out at most. Seeing a specialist, have never tried.
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A Calcium Score doesn’t necessarily lead to a Heart Cath, in fact, no. First off, a Calcium Score can establish cholesterol management, i.e., if your LDL is over 130 under 140. I doubt any seasoned Cardiologist would take you to the Cath Lab for a high Calcium Score alone.
Symptoms?
Family History?
blood pressure control?
Weight? Fatty Liver? Fat distribution?
Diabetes?
Lifestyle? Conditioning?
Age?
I would say, anyone with a strong family history of CAD should get a stress echo or Myocardial perfusion stress test. A calcium score is recommended if the patient is borderline in above categories. Anyone presenting with exercise angina should get a non-invasive study, and a (+) result should result in a visit to the cath lab.
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About a year or so ago I was scheduled for a stress test so I figured I better get in shape for this thing. I did extra treadmill stuff for about a month before the test. Anyway the day of the test I’m already to go and I start walking to the treadmill and the tech says sit on that bench. So I sat on the bench and a while later she comes up and says the test is over. What do mean the test is over. I have COPD and it seems when you have COPD they give you a shot of something that simulates your heart being under a lot of stress. Pretty cool. No treadmill. I’m scheduled for another one October and I’m assuming it will be the same routine.
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At age 49 I bang my leg on an outside table leg. I cut the leg. My leg gets a staph infection and blows up. I am diagnosed with type 2 diabetes at this time. My weight is 250 pounds. I am a good 80 pounds overweight. I have been powerlifting a lot of it is muscle.
My sugar never tests above 128. My A1C never tests above 7.0. Usually the scores are lower. I started on metformin, bp, and statin meds. Things are a constant till the pandemic. I go on a diet and lose 50 pounds. Bp med dropped, metformin minor dose, and Crestor minimal dose.
Back when this began while I have the leg infection I under go a stress test. I pass the test. There is not enough oxygen in the room when I get off the machine.
This time around I realize the doctor will want to see if there are any heart problems. In all likelihood, there are no problems. There are no current symptoms.
The CAC was a good enough test for me because my calcium is fully scattered. There are no blockages. Two cardiologists have seen the results and let me know. Scattered calcium can read higher with no blockages.
By blockages I mean plaque. Plague is the problem more so than calcium.
@ImAGolfer your condition is hard. I hope you feel good most days.
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Let me clarify what a “stress test” entails. “Stress Test” is simple nomenclature used by people in the field (cardiology). What a “Stress Test” actually does is measure how well your heart is able to perfuse oxygen to your muscle in your heart (myocardium). At rest, your heart can perfuse sufficient oxygen to the myocardium even if you have a blockage in one of your coronary arteries. If you exercise the body and your heart rate increases and the heart works harder to contract and keep up with the blood flow that your body is demanding, then your myocardial oxygen uptake increases dramatically.
If you have a significant blockage, then the perfusion study will look different under stress than at rest. The imaging system is able to differentiate which part of the heart is not receiving sufficient oxygen.
Getting in shape before a cardiac perfusion stress test will not alter these results. If the physician determines that you don’t meet criteria to have a functional exercise (treadmill) stress induction test, then a pharmacologic stress test is done.
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