I recently had an appointment for an annual physical and I went and saw a new doctor for the first time, this was at a VA hospital by the way if it matters. This new (to me) doctor is a Muslim woman (I know she is Muslim because I asked her while making chit-chat while walking with her in the hall, because of the name and accent). Anyway I’m not going to automatically assign a motive, but whenever I’ve seen my old male doctor for an annual physical at the same hospital my shirt would come off and he would feel around my back and abdomen, he would check my testicles, all that kind of stuff.
I also had a small skin cancer a few years back and my old physician always would have me remove some clothing and have a look around my skin. Anyway I asked her if she would do a skin examination, and made a slow motion toward the bottom of my shirt to take it off and she quickly said she would give me a referral to a dermatologist, and she seemed to me anyway visibly uncomfortable (I know my subjective interpretation) when I made the motion to remove my shirt.
Now granted, dermatologists do specialize in the skin but in my years in the Army or with my old doctor I have never had anyone basically refuse to even take a look at least at any freckles or anything I thought looked weird. I even made a second request like “Well do you think you could just check anyway to save me the trouble of another appointment”, to which she reiterated that she was putting in a consult for a dermatologist and they would call me. Now I don’t know maybe I’m reading too much into it and I’m assuming she must have other male patients but somehow I feel like she gave me an incomplete medical exam and gave me the runaround, now whether it was due to religious reasons and she just felt like she could get away with it, maybe because I’m far younger than most of her patients, or maybe she just didn’t feel like doing her job out of laziness I’m not sure. I mean this lady didn’t check my ears, eyes, look for hernias, didn’t look in my mouth or anything. About the only thing she checked was my heart and breathing. So do you think this doctor was neglecting her job duties because of religious/cultural reasons or do you think she’s just a half-assed doctor? I mean I’m not going to call up their and complain and make trouble for her or anything, I may just see if I can see somebody else in the future.
Could be either. Do you attend a clinic where you have a choice of doctors? If so, I’d be asking for another one.
No GP should be referring to a specialist UNLESS in their medical opinion, they aren’t equipped to deal with the issue presented. And that’s MEDICAL opinion, not social or, ‘I can’t be arsed to deal with this’ reasons.
Does the VA have anything to do with the ACA? When I last had a physical my PCP didn’t do anything like she used to, like ask me to pee in a container or go to the lab for a blood test. She just basically listened to my heart/lungs and checked my reflexes. We then sat there and talked until time was up. She explained that she no longer can do any of those “usual” tests unless it’s needed for something specific…something about insurance and the ACA, the specifics of which I can’t recall at the moment.
No as far as I know nothing in the Affordable Care Act had anything to do with the Veterans Administration. I do know that access to VA healthcare while technically not health insurance, makes you exempt from the ACA fees. They put in order for labs on bloodwork and urine at each of my annual physicals, including this physical I mentioned in my OP.
FWIW, my PCP is a Muslim woman from Iran, and she had no qualms about examining my groin when I asked her to. She’s an excellent doctor, and very thorough.
If she cannot bring herself to do the routine exams my GP does every year (including prostate exams), I would take away her medical license. Not fit to practice. I try to be tolerant, but I have a hard line on this one.
I know some docs, frankly more of the newer grads, who are pretty much referral sieves, not trusting themselves for much. Patient history of skin cancer, needs skin exam? To derm. Let them be responsible for declaring that none of those spots are funky enough to warrant biopsy.
In the VA I would also suspect time constraints. An adequate skin exam with history of skin cancer should take a while. If not scheduled with enough time for that better to have the specialist do it.
QFT. This is how medicine is operating more and more in the real world. Not enough time to do what’s necessary, not and adhere to your schedule AND do all the necessary data entry into the computer. Sad, & not necessarily a quirk of the MD.
This is exactly what’s happening here. Resident work hour restrictions mean less exposure to many medical problems and subsequent lack of experience with anything remotely outside the realm of everyday practice. Combine that with new-grad risk aversion and everything gets a referral to a specialist. I’m even starting to see patients with uncomplicated high blood pressure and diabetes getting referred to cardiology and endocrinology.
And that’s tragic, IMHO. A primary care MD who can’t handle those basic diagnoses would be useless in my system. A well-trained primary care specialist should be able to deal with 90+% of their patient’s issues. Even moreso now, with modern medical information being readily available at our fingertips, via the web.
Hijack here, feel free to ignore it, but Qadgop has me wondering; when a veteran is seen in your prison, how is records continuity maintained? Does the VA get billed for your seeing a vet?
When a veteran is in prison, he’s no longer under the care of the VA, he’s under the care of the Dept. of Corrections. If I think I need any old records from the VA on him, I’ll order them sent. Mostly I don’t need old records.
And neither the VA nor private insurance cover the cost of health care for those convicted of felonies and incarcerated, as a rule. The financial costs are covered by the state, if convicted by a state court, or by the Feds, if the felon is in a federal prison.
Thank you for the concise answer! After they leave prison, is it on the former inmate to have the records sent to the VA or does the VA need to request them from the facility?
The VA can send for them if they want them. Medical facilities send records to other medical facilities for free. The patient has to pay if they want a copy.
Most of the time, old records really aren’t all that helpful, frankly. Oh, it’d be nice to have a concise page or three with a summary of past significant diagnoses and meds. But most time I request some info, I get either a package or an electronic dump of 60-100+ pages of completely useless info, with 1 or 2 pages worth of useful info scattered throughout it.
90% of the time or more it’s easier to just talk to the patient, and examine them, than to comb through old records.
Makes sense. I was thinking of how there’s a greater overlap among younger veterans and criminals than maybe 15-20 years ago, to the point there are veteran courts in some states. And after their military service many men aren’t likely to go to a doctor unless they’re very unwell or face an intake like in prison.
My husband is a VA patient with no history of skin cancer, but a lot of Dermatology referrals. While his PCP might have glanced at it and made muttering noises, he would have been given a Dermatology referral anyway, so really your PCP just saved you about 10 seconds.
He sees a PCP, a Doctor of Pharmacy (which I actually really, really like; not enough medical systems make good use of their pharmacists), Dermatology, the Surgical Clinic (for annual checkups of his abdominal hernias, to see if they’re bad enough to risk surgical correction), the GI clinic (GERD and a history of diverticulitis with surgery including colostomy and ileostomy), the Cardiac clinic (congestive heart failure, atrial fibrillation, hypertension), the Pulmonology clinic (COPD), the Sleep clinic (sleep apnea), the Psych clinic, the Physical Therapy clinic, Podiatry, and some sort of Diabetes clinic which includes a dietician.
I can’t think of an actual drug or diagnosis that the PCP is directly responsible for. Those visits are an absolute waste of time, from the patient perspective. The PharmD is actually the person he speaks to most often, as she watches for drug interactions and tells him what his labs were, calls and reminds him if he missed his lab appointment, and if he should change his warfarin dosing. In my nursing opinion, she acts more like a traditional PCP than the PCP does.
At least with the VA, everyone can see everyone else’s notes.