I hate my PCP

Not angel dust but my primary care physician. I’ve been suffering from some erectile dysfunction issues. At my age I know it could be low testosterone, blood pressure, stress, diabetes or in my case a reoccurance of epididimitis. My PCP refused to order the T test saying:

  1. The idea of testosterone is the new “in thing”
  2. T test have no diagnostic value since T levels vary.
  3. Even if I have low T, he won’t order HRT since apparently if I do get extra T (extra if it is low?) my prostate will immediately get the cancer or explode or something.
  4. Instead I should treat my symptoms with some $16 pill if I plan on having sex in 30min to an hour

Add to this:
He never asked me about my stress levels in life.
He never pursued that I tend to have ED when suffering from epididimitis. That correlation was dismissed.
My blood pressure is borderline, usually around 135/95 … and has been ever since I was a teen.
I was told basically to lose weight however testosterone in instrumental in men’s weight control and my weight has been creeping up since my ED problems started.

Obviously I went to get a second opinion. The doctor explained a lot and he said it was important to get a T test because if I have ED and don’t have low T, that means I’m suffering from a periphial vascular disorder from my history of high blood pressure.

Now a man’s T level should be at minimum 300. Yes the Low-T center uses 350 as their baseline to sell more T shots and Kaiser uses 250 as the minimum since they hate providing HRT. The real important number is Free Testosterone (the amount of unbounded T in the blood) with a Kaiser minimum level of 35.

My T level is 84, FreeT is 19.2
And he’s going to wonder why I’m changing my PCP today.

WTF was the doctor doing not addressing your blood pressure all that time? 95 is definitely a high enough diastolic that he should have been at least recommending you cut down on sodium, or prescribing medication.

You’re doing exactly what you should do under the circumstances and have nothing to apologize for.

As I say;

Professionals work for you.
If they don’t work for you, find another.

Good for you! I’m happy to hear you sought another opinion, thank goodness, since you clearly did have an issue!

I am always astounded by people who take the time and trouble to schedule an appointment, and visit a doctor, who’s opinion they don’t respect. Why waste everyone’s time? If you have no confidence that they are hearing you, addressing your issues, being dismissive or uninformative, why would you go back?

I mean, aren’t you going to eventually face some sort of health crisis? And you’re going to turn to a person you don’t trust already? That seems crazy to me.

Doubly so in a country where you actually pay, out of pocket, for any consultation!

So you’re saying you’re getting this shoddy non-service as a K member? If so, that sounds about par for the course.

Not sure what you might accomplish by changing your PCP if you continue getting your medical service from K. Are you relatively new at being a member of K?

My feeling is that, as an institution, they routinely provide superficial and perfunctory, assembly-line, one-size-fits-all medical treatment. At least for out-patients. I don’t know what it’s like to be in their hospital for anything major. This attitude seems to agree with opinions I hear from a lot of other people too.

OTOH, I’ve often heard that, as far as HMO’s go, K is pretty much the least bad of them all.

I’m changing my PCP because he already decided to not treat the condition before the diagnosis then refused to get the data to make a diagnosis. At least the other doctor ran tests.

I’m changing my PCP because whenever I call and leave a message, he never calls back. I had a really nasty infection on my leg a while back, and thanks to him it went untreated for several days . . . until I finally gave up and went to the ER.

The real problem, though, is finding a new PCP. The good ones aren’t accepting new patients. And the ones who are, have months-long waiting periods.

I guess it can be difficult to be a doctor when people are coming to you with lists of medications the TV ads told them to try, or lists of vague symptoms and internet printouts proving they point to some rare condition. Note: I am not saying that you are one of these patients. It’s just possible that this doctor sees enough hypochondriacs and misinformed individuals that he’s become a little wary of anyone asking about a newly “popular” disease or test. “Low T” is definitely in the category of aggressive marketing by the drug companies and a whole lot of “ask your doctor” ads. I have to wonder which is worse - the doctor who unilaterally decides all the “fad” stuff is crap, or the doctor who hands out meds like candy. Seems to me it’s harder these days to find a doctor who’s in between the extremes and who will evaluate a patient in context and make a decision based on good labs.

Still, if he’s not listening to you and trying to find the cause of (and solution to) your problems, then he’s not doing his job, and you’re absolutely right to seek another doctor.

I finally found a PCP who listens to me when I’m in the exam room. Makes eye contact, asks questions, and pays attention to what I’m saying. She doesn’t just nod and type on her tablet and hand me a scrip before hustling out the door to the next appointment, and it’s so refreshing! I saw her for bronchitis this spring, and she said it usually goes away on its own, but if it got worse, or wasn’t gone in a week, I should take an antibiotic - and she gave me a scrip so I wouldn’t need to come back a week later just for that. When I went back to see her two months later for a different issue, the first thing she asked me was how my bronchitis cleared up and whether I’d needed to fill the antibiotic prescription or not. I’m keeping her forever.

If you get on a waiting list, it’ll be months, right?

How long will it be if you don’t put yourself on a waiting list?

I might have to change mine too. He’s a long-term colleague of my late father’s, so I’ve known him for years, but last time he “warned” me about all the rationing that will be happening under Obamacare in a few years (I heard him listening to Rush one day too). <sigh>

Damn dude, maybe your doc has a shitload of stock in Viagra or something. What a stooge! That’s holyshitlow. :frowning:

Glad you didn’t take no for an answer and got it figured, though!

I go a a PCP at Marymount who’s got a really great diabetes specialist nurse practitioner that I see regularly, if you’re interested. PM me if you want.

I posted before about my mom who had a PCP whose office informed her he does not speak to patients on the phone or outside the office period. When she wanted some mild pain meds she was told he does not call in scripts, she would have to make an appointment, so she did. At the appointment the doctor just told her he does not prescribe pain meds at all period, but he would give her a referral to a pain management clinic. :mad:So she needed to make an appointment and have her insurance pay for a office visit to be told he doesn’t prescribe pain meds for any reason!

Oh and the pain? It was hemorrhoids, or so he diagnosed her. She was in so much pain from it she could sometimes not sleep, so she wanted some mild pain med better than OTC stuff.

It was actually anal cancer diagnosed via biopsy with another doctor.

Medical advice, anecdotes, and diagnoses go in IMHO, so I’ll move this from MPSIMS thither.

I need to fire my PCP too. I don’t think she even knows my name, after 10 years; she’s never actually called me by it. And I do not ever get to speak to her outside the office. She does not have voice mail; her assistant does and if I have a problem I have to share it with the assistant’s voice mail and have the assistant call me back. I should not have to explain my medical problems to a medical assistant. And god forbid I forget to say and spell my last name and give my date of birth or she won’t even bother to look for my file OR call me back to clarify who I am so she can get the right file.


That makes me totally mad. What is her situation now?

I need to change PCPs as well, but am leery of getting into a practice that is less responsive than the one I deal with now. My PCP is great, but so overbooked that if I called today, the closest appointment I could get with her would be 4 or 5 weeks from now. If I have an emergency, I need to see her Nurse Practitioner, who is not only a bitch, but is not a good health care provider either.

I just thought of something on the way home tonight. Isn’t implied with “informed consent” that the doctor is obligated to collect all of the data, lay the options in front of the patient and let them make the decision? Wouldn’t the lack of testing my doctor did and the a priori decision to not treat my condition (that we don’t even know I had for sure because the tests were not ordered) be an ethics violation?

Your ex-doctor sounds like an arrogant ass and perhaps not the sharpest knife in the drawer but informed consent does not create an obligation to collect all the data or even to present all the options since as a practical measure such is imposible to do. It requires a doctor to present the risks and benefits and alternatives of a proposed treatment course for a diagnosis (if known). What you as a patient may really want is what is being called “shared decision making” - an example of the distinction demonstrated on this page from a cancer site. But that also does not imply that more testing is better.

In this case it seems that testing was the right thing to do (and I also have to wonder why your blood pressure has not been addressed better) but the error docs make more often (in their anxiety about avoiding the “missed diagnosis” lawsuit) is testing too much, not testing too little. Usually the quick and easy (and somewhat mindless) thing to do is to order another test.

Every test, even a simple blood test, comes with a risk in addition to its cost. Every test has a false positive rate and if the true positive is fairly low even a reasonably specific test will give a wrong result quite often - sometimes resulting in a cascade of care that was not required and with consequences. And if it was true that a test result is not going to change the treatment approach either way then ordering it is a silly thing to do.

Sometimes doing nothing is the best medicine; the key is to do nothing but to do it well. (And that does not sound like such was the case this time.) That requires what you did not experience this doctor doing at all: listening and discussing; considering each interaction as an individual circumstance not a guideline to be followed.

Changed my PCP today and got the doctor that gave me the second opinion.

I also need a new PCP. My current one has never done anything close to what you guys are mentioning. He seems like a great pulmonary doctor. The problem is that my pulmonary system is fine.

When I got my current insurance, I called the hospital to find out which doctors were accepting new patients. I specifically said I wanted a PCP. They told me that he was a pulmonary specialist who also does primary care and that he was accepting new patients.

He doesn’t know what PCOS is and didn’t think my MRI showed a problem (but the doctor at my school was the one who ordered it so he took her advice and gave me a referral to a neurologist anyway - I have pseudotumor cerebri and almost got kicked out of school because of it. Now I’m medicated and actually able to function, thanks to my school doctor). He treats me for depression (which I appreciate) with the medication I requested, without even looking into my mental history (which seems odd). He has never seen me without my clothes off. My GYN does the vast majority of the stuff he’d do in a physical so he checks the stuff above the neck and my reflexes.

I was ok with this. He’s useful if I get an ear infection or a sinus infection.

Then my doctor came into the vet clinic where I work and demanded that his dog be seen immediately because he’s a very busy medical specialist and doesn’t have time to make an appointment. My boss (the vet) refused because she already had two patients in the exam rooms and two waiting but he could come back in an hour, when we had an emergency time slot open or in 3 hours when we had a regular slot open. He refused and left, bitching about bad service and never brought his dog back to be checked.

I get really pissed off when people put their ego ahead of their pet’s well-being.