And that’s why I always hated taking the kids to the doctor. $150 in the early 2000s was a huge amount for us. To come away with its viral. Argh!!! I hate everything doctor related
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Contagious illness is a part of medical practice. We isolate them as best as possible if we think it is a serious contagious illness(ie ebola, measles), and then we have procedures in place to be able to notify all families who were in the waiting room (if it ends up being a reportable contagious illness)—the health dept gets notified and it isa whole thing.
Routine colds, flu, RSV, gastroenteritis all spread in waiting rooms (exam rooms are cleaned between each patient so have minimal risk for spread in 99% of germs). That is just part if medical practice. Our physicians , nurses, staff all get sick from being accidentally coughed on all the time(and no, masks do not prevent all illness, and we care for babies who have no control over coughs:even crying loudly spreads germs). It comes with the job of primary care. Patients who are high risk are strongly encouraged to come in with a mask and we do have procedures to have them come in a different door and go right to the exam room(patients on chemotherapy or other severe immunocompromise).
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I have a $40 copay for urgent care. Telemedicine covered. PCP free, virtual visits with any provider free, specialist in person free. Medicare Advantage, $0 premium beyond Medicare Part B. AARP UHC, NYC.
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My experience with the urgent care center near my home (it’s affilitated with a local hospital, but it’s a separate facility in a shopping center) has been excellent. A few weeks ago, I got an insect bite that became infected. I drove to the urgent care, filled out the paperwork, and, initially, saw a nurse who took my blood pressure/vitals. Fifteen minutes later the doctor came in and looked at the infected wound, treated it (won’t go into details) and sent a prescription for antibiotics to my local pharmacy. I was out of the care center in an hour. My D (who was visiting us from out-of-state) last month was certain she had a UTI; she went to the center and was seen quickly and given a prescription. I paid nothing (have Medicare and a BCBS supplemental plan); my D paid her regular co-pay.
Is it typical to consider patients on chemo to be significantly immunocompromised? I was never told that!
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Well, in general yes. it can depend on the chemo—there are some lower dose chemos for adult less aggressive cancers that are not quite as hrsh on the immune system. In pediatric cancer patients on chemo, they are all considered severely immune compromised .
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How much does staff getting sick disrupt scheduling? I ask because I had a PCP appointment cancelled the morning of when the PCP called in sick.
My MD had to postpone my last physical because he had covid. That was the first time I ever had an appointment cancelled because of a physician illness.
Well, I can tell you that the pediatrician was just as frustrated. Most of the illnesses that a pedi sees are viral, but parents feel that the visit was thrown out money unless they leave with an unnecessary antibiotic and an unnecessary cough elixir. The most popular practices in town would diagnose “bronchitis” for every cold, confirm ear infections on kids with crystal clear eardrums, and hand out prescriptions for antibiotics and cold and cough elixirs, that were ineffective and occasionally dangerous. Not good for the patients, but fantastic for business.
Ouch
There is value in seeing a physician to find out that the sickness is a minor viral infection that does not require medication or anything else special to recover from (meaning not something serious). But it seems that many people do not see it that way and want unnecessary antibiotics or whatever.
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RE; coughs and stethoscopes
D is an EM physician. She just recently bought a new stethoscope because she had lost hers and hadn’t used one in 3 years–all during covid. Stethoscopes aren’t all that useful of a diagnostic tool for persistent coughs. X-rays are much better.
Also per a pulmonologist friend of d2’s, persistent coughs are a typical post-viral responses and there’s really nothing they can do for them. Steroids really don’t help much --if at all-- and often do more harm than good. Covid has apparently sensitized many people’s lung tissues and they’ve become over-reactive to more common viral infection like colds and flu. Now instead having a post infection cough last a week or two, they can persist for 6 weeks or longer.
And I’ve had physicians cancel appointment because of illness before or other family emergencies. Just ast month, my PCP’s office called at 9 am to tell me that my appointment for 11 am was being cancelled because the doctor’s 8 year old son was in the hospital. The appointment was for a routine, non-urgent issue and I didn’t begrudge her cancelling the appointment at all.
Unnecessary antibiotics --don’t get me started. while I’m not a doctor, I’ve heard far too many rants from my in-house EM doc (daughter) about patients expecting antibiotics for everything whether it’s appropriate or not. She even had a patient file a complaint with the hospital administrator about not getting an antibiotic prescription for a covid infection. (He was a lawyer and had apparently been denied an antibiotic prescription at 2 urgent care facilities before he landed in her ER waiting room. He came in disgruntled and left furious because she too would not write s 'script for a Z-pac.)
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When it is us (providers), it is a hot mess because normally patients do not want to see someone else and the other docs are often full. We have to cancel. Most of us work through almost every illness, as long as no fevers or horrible symptoms. The GI bugs are the most likely to suddenly and unexpectedly knock us off the schedule , sometimes the illness comes on mid-day and there is no way to work through that. For our staff illnesses, we move nurses around and have floats for callouts. Just part of practice.
YES. We have a known popular practice who does just that. We do not and most do not. Lots of time spent educating. But also, lots of kids have asthma and if a cough is not responding they need to be seen asap and listened to ( the sounds are different for asthma flare vs croup vs fluid in lungs).
But you don’t actually need to do a physical exam in person to tell the difference between clear lungs, asthma, or pneumonia, or even pneumonia in both lungs, do you? You don’t need to administer a bronchodilator in the office and gauge the response by re-examining ten minutes later, do you? Nah. Telemedicine is just as good. And after all, if the patient thinks that they’re really, seriously sick, they’ll have the good judgement to go to an ED, right?
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Actually, a good exam with a stethoscope by an experienced, well-trained doctor is often better than an x-ray, because x-ray findings tend not to appear until a day after the process - I have heard pneumonias on auscultation which were not yet evident on X-ray. Also, radiologists way over read pathology on X-rays, so I’d see patients who were absolutely fine with totally clear lungs on exam, afebrile, whose x-rays 12 hours prior in the ED were read as pneumonia.
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I’m fully aware of that. I didn’t want antibiotics if it wasn’t necessary. It’s just paying 10% of your monthly take-home pay for nothing is hard to swallow, not to mention 4 hours of vacation time off from work, when you only get 2 weeks a year! This is why I always did the wait and see method
This is also why I would never want to go back to the toddler/pre-school years! Way too stressful.
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I totally get it. My spouse often said that there was no way that he could have raised kids, had he not been married to a pediatrician. And it’s just not right that people should have a high price barrier when seeking medical care. A copay? Sure. But knowing that it’s going to be a hundreds of dollar deductible for that visit? There oughta be a law.
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You did not get “nothing”; you got some indication that it was not something more serious that needed more medical care.
Granted, the cost may have been too high for your situation, which is a common problem with US medical care.
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I’ve only heard cases as you described in Asia where if the doctor says the disease is self-limiting, and dispensing no medication, people lose trust and think money spent was wasted. Less of that happening in US, particularly how the new doctors are trained.