Have you considered an physician who is an osteopath? Both my PCP and cardiologist are osteopaths. Both are very focused on the total patient rather than focusing on a specific disease or ailment. Both have been very good at referring to other providers when necessary, but I like their team/collaborative approach to medine as well as their way of looking at everything as interconnected.
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Yes to a good geriatrician! One of their great benefits is looking holistically at your health, including quality of life, which includes assessing what all of the various specialists are doing, including how medications you are taking may interact with each other. They often end up reducing the number or dosage of medications, especially because as you get older your response to medications may change.
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Does a geriatrician effectly replace a PCP?
yes
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Thanks @Mom0f3 and @rockymtnhigh2.
I will activate my network of docs and hospital execs (mostly former hospital execs) to see if we can locate a few geriatricians. We are lucky to know quite a few folks. I recall meeting a geriatrician at a party who wanted to offer ShawD a job.
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My PCP for many years (starting when I was in my 50s) was a geriatric specialist (this was in NJ). She was part of a large health conglomerate that I already used. Her and the NPs that worked with her were great. They were thorough and looked at the whole person. They also listened to me and understood my perspective when I was in conflict with an endocrinologist (about bone loss medication).
Then we moved to outside of Boston, where there are no PCPs (one of the biggest providers has not taken new PCP patients in their network in over 2 years.) We picked a local doctor who is terrible, just to get references to the specialists we needed (oncologist, derm, etc. - the specialists were all terrific) My husband has since moved on to a new one (not close, but the only one currently taking new patients). Honestly, I don’t know what the new doctor specializes in (internist, etc.), we were just so happy to get a new body.
It is easy to have disconnects with specialists. They are only looking at what they know.
The healthcare system definitely needs an overhaul. I wish that those interested in overhauling it would think critically about what actually needs overhauling. We really need public health specialists leading the conversation.
H just lost his longtime PCP, who will be serving a different role within the hospital system. There is no one to replace her yet, and the other doctors at that location aren’t taking new patients, even though these patients of the doctor who is moving on are not actually new. No doctors in the system accepting new patients anywhere near us within the system - he can get a doctor outside the hospital system, but he has found it really helpful to have all of his doctors within the system so that they all have the same information (and getting in on a referral is easier). At least he can see the PA until they get a new doctor, but there is no timeline for a new doctor at this point.
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I hear your complaints, and “feel for you,” but I hope you realize you have it better than 99%+ of “the regular people” who don’t have all those connections, don’t have the money to see the docs they need to see, can’t advocate for themselves and have nobody to help, don’t have insurance because they can’t afford it, etc.
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Well, the geriatrician said to have 2 hours and caregiver at 1st appointment and 1 hour visits thereafter. I do believe the geriatrician is supposed to help us coordinate our myriad of specialists and help us be more wholistic. Before thalia year, when we had fewer specialists and H’s memory was better, he wanted to go to appointments solo and could remember the Qs & As. Now I go with him to help be sure we get the Qs & As covered and he and providers are happy.
Just in terms of the time allocated to visits, it seems that geriatricians are having more time to spend than internists and even APRNs.
H’s geriatrician came highly recommended by my friends, an RN and her MD husband. The geriatrician helped with aging elder in their lives.
With my (in their 90s) folks, the geriatrician was very helpful and available and helped us navigate even with skilled nursing & hospice. I found her very helpful.
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We have never paid for concierge service but I have always been able to reach my mds or their APRNs as needed. With MyChart, it’s even easier. I also have emails and cell phones of my lung docs but try not to use those numbers except when I’m stuck (like pretty ill in another country and trying to get healthy enough to fly home).
At this time, I feel I can coordinate pretty well, but felt H’s issues are getting a bit tough for me to untangle do I felt that a geriatrician can help us and the APRN agrees. H is very tired and that’s a side effect of several of his treatments plus aging, so tough to untangle. Anyway, he’s 83, so if not now, when start with geriatrician?
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I had made an appointment for my dad with a geriatrician when he was 83. He was living alone in Florida, and I was worried about him. He was in town for my niece’s wedding, so I called a geriatrician and explained the situation … they had no problem with evaluating him even if he was from out of town. I was really impressed with my contact with them, and I was hopeful that they would be an asset for my dad. He passed away during the night before his appointment, unfortunately. I would not hesitate to contact a geriatrician in the future for myself or a loved one.
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@1214mom, I completely agree. First world problem for sure.
US society is increasingly K-shaped. I’ll post something below that addresses this.
I have always said that the US has a three tier health care system. The bottom tier are those that are uninsured or have pseudo-insurance. The middle tier have HMOs and PPOs that deny coverage routinely and make you fight to get coverage that should be clear. Then there is the top tier, where the insurance seems to work and the specialists are as good as anywhere in the world.
The US health care system is so flawed that we spend way more than anywhere else per capita and only the top tier gets really good care. Even there, preventative medicine is under-funded and the system is completely siloed. We also pay for the development cost of drugs for the entire world. And the systems for pricing drugs, the PBMs, are incompehensible. Once I hit Medicare, I found that I have to check about six different ways of buying the drugs (what does my Medicare Part B insurance cover, Good Rx, Costco Pharmacy Plan, …). I see highly variable pricing ($80 to $150) for the same drug. If someone were not tech savvy, having some cognitive issues, or just too tired or ill, he/she would likely pay a lot more for the drug than I do. That’s the opposite of progressiveness.
@1214mom, I feel very fortunate about how my life has worked out so that my problems are first world problems. ShawWife says, “We landed in lucky.” Some of it was luck. I married an absolutely wonderful partner, who was also in sync financially with me (e.g., we were savers more than spenders). Some was genetics (I think I’m pretty smart and my dad was definitely a genius). Born to a middle class Jewish family, so no big advantages or connections but a culture of academic achievement in an era when antisemitism was in decline and then largely went away (alas no longer true). Some very hard work. I probably have slept no more than 6 hours a night since I started college. In my first job, I’m pretty sure I averaged well under 6 hours a night. Before kids, I worked seven days a week trying to create the foundation for the life I have now and now that kids are gone, I still work parts of most weekends. Definitely some luck in terms of people i met who have become colleagues and opportunities that have arisen.
I am not retiring because I love my work but have always done pro bono projects and my version of retirement involves increasing the percentage of my time that goes to pro bono projects. I shoot big – helping to end a civil war, currently working on mechanisms to prevent the destruction of the Amazon rainforest.
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This is from a free newsletter I get from Semafor. Generally very thoughtful stuff (I recommend it).
Two data points on my mind this week: Delta Air Lines’ prediction that its sales from premium seats will overtake sales from coach as soon as next year, and the swift collapse of an overleveraged retailer of windshield wipers and spark plugs. They may not seem connected, but they hint at what Goldman’s John Waldron told me on stage is a “two-speed economy.”
High earners are doing just fine. They own most of the assets now appreciating in today’s everything rally. So are their corporate equivalents, blue-chip companies that can borrow insanely cheaply and at least partly control their tariff pain through purchasing muscle.
The unraveling of auto-parts supplier First Brands, meanwhile, is better understood not as an indictment of private credit — a lot of the lending to First Brands and Tricolor, another unfolding debt mess, came from banks, not their lightly regulated competitors, as Blackstone’s Jon Gray noted — but as a sign of problems in the bottom leg of an increasingly K-shaped economy. “Those on the lower end of the economy are suffering, and there’s been a lot of lending in there,” Waldron said in a wide-ranging interview that’s worth watching (Investors are looking at China again!) “So if there’s been a lot of lending in there and there’s weakness in consumer capability and wealth and health in there, we’re going to have more of a problem.”
For consumers, the dividing line, Navy Federal Credit Union’s economist told PBS, is an income of $175,000 a year. For companies, it might well be an A- credit rating. Companies like Microsoft, which can now borrow more cheaply than the US government, and wealthy travelers splurging on leg room are in one camp. The record share of credit-card users behind on their bills are in another, along with First Brands, which is now in bankruptcy protection, sorting through a rat’s nest of debt it could never afford and never should have taken on.
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Anyway, the way I see it, we have not much to lose and potential to gain some coordination by working with the geriatrician. As I understand it, there’s no extra cost and we can change our mind and stop using her or switch to the one who helped with my folks if we prefer.
We recognize we have been very fortunate in having good access to providers who are supporting us through H’s rather challenging year, with surgeries, radiation and testosterone suppression but it is a bit much for all of us to untangle what may be causing which side effect and what should be done.
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I have not considered an osteopath, though we saw one a couple of times in Quebec. She was more holistic.
One of my nieces is an osteopath. We haven’t talked much about how her training may have been different from others but she’s at the local medical system, doing her residency with MDs and APRNs and everyone at local med center.
To each their own, of course, but the differences between a MD and a DO are largely philosophical in the approach to patient care. Much is made of osteopathic musculoskeletal manipulation, but it’s not a prominent aspect of the care I receive. My cardiologist DO doesn’t believe manipulation is going to help with my cardiac issues but an average appointment with him is close to an hour where we review my systems and symptoms. Why is something happening now? What has changed? How can further issues be stopped? It’s not just prescribing more medication or switching meds.
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My husband’s new internist is a DO. My internist is an MD. So far, we are happy with both. So much (unfortunately) is dictated by the place where the provider works. Where medical centers make each provider see xx number of patients in yy time, it’s hard to have a wholistic view of anything. My old lung doctor was a researcher AND a clinician, so he’d see me on his research days so he could spend longer with me and our appointments often ran an hour or so. The lung docs he referred me to are also researchers and clinicians and have more control over their schedules, so they can spend as much time as needed with me as well.
I try to be as organized as possible and have a list of issues, symptoms and questions prepared ahead of time to guide any discussion so we can be efficient. I do this with H’s providers as well, and they are all pleasantly surprised at how efficient we are at presenting history to date and questions we have so we can cover what we’d like in a timely manner (since we recognized they’re all under time crunches due to the medical system they work within). In making my list of issues/questions, I try to group things in a logical order but do start with the one that we are most concerned with 1st, so we can be sure not to give it short shrift. This strategy always surprises/shocks the medical assistants and providers but it allows a lot to be covered in a condensed amount of time and we tend not to forget to discuss issues we consider important.
At this point, it seems internists & MDs/DOs mainly see patients pretty much only for the 6 or 12 month checkups or visits and see the APRN/NP for any visits between those scheduled visits. Only on very rare occasions are they able to squeeze us in to be seen by a MD/DO when it wasn’t scheduled months in advance.
The cardiologist I saw for my Postural Orthostatic Tachycardia Syndrome (POTS) after nearly a year told me on the visit that he was moving to TX and referred me to his APRN because he said they weren’t replacing him and she knew more about POTS than anyone he knew in the state. I was lucky and grateful to at least have her.
I agree that the system is broken. When H’s internist suddenly was no longer seeing patients with no explanation, I frantically called everywhere to try to find him a new internist as he had several medical procedures and needed prior authorizations. I got one appointment for a new internist 11 months from the date I called to try to make an appointment as the next available. My internist had her staff call me back and say that they just hired a new DO to help with the internal medicine load, so were able to have H be seen by her and also her APRN. I also got an appointment for D to be seen by her in December, in case D moves back I want her to have an internist and we really (fortunately) like this new internist.
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I saw a geriatrician in my 50’s (I am now in my 70’s) and even then he scheduled me for every 3 months and that was great, we stayed on top of things.
In recent years I mainly see a nurse practitioner who knows me well, avoids potentially harmful meds and procedures and I see fairly frequently but not scheduled in advance.
I have a Medicare Advantage PPO through BC/BS and can see specialists without referrals but I am basically coordinating my own care.
Furthermore, my plan is now considering my PCP to be out of network so I will pay around $43 to see the PCP if I stay. PCP’s in the two major hospital networks are going to be out of network. It is impossible to find a PCP so I will probably stay with my plan. Anyone else dealing with this change?
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Depending on how well things go with H’s geriatrician, I may consider one as well. I’m 68. I was lucky my lung doc referred me to his internist so she accepted me even though she had too many patients. I like her a lot but she’s VERY busy. I just met her APRN because she was too busy to see me.
Our network is huge and covers nearly everything in our state except Kaiser, HMO.