Wednesday, April 30, 2014


Doctor's role


I have a new Primary Care Physician (PCP). My former PCP's practice was cancelled by AvMed, my longtime Medicare Advantage provider. The former PCP was an excellent diagnostician; the office operation was, to be kind, a disaster on the way to happen.

My old PCP and I had, I thought, a good relationship; it was close to a partnership.

My new PCP thinks the physician is god.

And he's not even a surgeon.

I think - and I'm adamant about it - that the PCP is a consultant and the patient - me - is the client. Since I "own" my body and since I am responsible for its health, that consultant-client relationship seems appropriate.

I don't know if we reached an understanding today.

If not, I'll be looking for a new PCP. Since the office is so well run, that would be a shame, but I go to the practice for the physician, not the office staff.

The bone of contention - besides having to wait more than 2 and a half hours after arriving for my scheduled appointment - was the fact that based on my latest lab reports he told a medical assistant to call me with a change of medicine order.

What's the problem?

I had seen him one time.

He had one lab report from my interim PCP (the one who refused to refer me to my ophthalmologist) - in other words, he lacked my history.

Based solely on the lab report he had the assistant call me with the medication change.

No one talked to the patient (me). No one asked about a history; I have been going to the medical lab every three months for several years for the same tests, and I have had the same results - plus or minus - every time. My first PCP knew that; the current PCP did not.

When I told the PCP du jour I wanted to repeat the lab test he was shocked. If he let everyone who wanted to redo a lab test my "until December 31 Advantage provider might cancel its relationship with the PCP's practice.

An "ah hah" moment - I thought Medicare, into which I paid a portion of my wages since its inception, was supposed to provide medical coverage. OK, I know that insurers and the government only care about income and profit, but it was nice to think, if only briefly, that my medical concerns were considered worthwhile by the people who got my Medicare money all those years.

I suspect the reason my previous PCP's practice was cancelled by AvMed was that the PCP put the patient's welfare ahead of AvMed's bottom line.

I finally convinced the current PCP that the test should be repeated, but I don't think he has yet realized that "MD" does not spell "god."

I was a consultant for many years and I know that even if I, the expert, told my client that something should be done or avoided, it was the client's prerogative to accept and act on my advice or to ignore the advice.

If my recommendations were not to the client's liking, we both knew the client could engage another consultant.

So it is with PCPs.

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