Medical Problems - suggestions appreciated

[Cudedog]

Not quite sure where to start, and want to keep this short. This is probably WAY off the mark for topics central to this forum, but since a lot of you ladies are around the age I am, I'm looking for guidance and advice, as I am not sure where to turn.

I live in an area that has been over-taken by a large medical conglomerate (Sutter North Medical Foundation). Most physicians in the area have been forced to join this foundation due to (I think) escalating costs (insurance, paperwork, etc.) for private physicians. My primary care physician is affiliated with, and employed, by this foundation.

I haven't written much here, but my quest for medical care for my leg infection last summer (Cellulitis - sounds innocuous, it isn't - Google it) was extremely difficult. I was very ill (mostly unable to walk, also a fever of around 102+ for several days) for about four weeks, about twice that to be (almost) fully recovered. I'll spare you further details. I have Medicare and a generous Medicare Supplement plan, which I pay for out-of-pocket. I am not uninsured.

During this time I was unable to get an appointment with my primary physician. He was "booked up" for many weeks while I was ill, and I could not get an appointment. So the only way I could get care was by multiple trips to my local Urgent Care office (four trips) and to my local Emergency Room (two trips).

This is probably just me ( I am kind of weird about such things) but (bottom line, here) I felt that those who saw me thought I was either "faking it" or that, because I am a senior citizen, my medical concerns were unimportant. It was mostly just "take this pill and shut up" kind of thing. Also I should point out here that my only option for many weeks (before I could get in to see my primary care physician) was to go to "Urgent Care" where I was seen (usually - every time I went it was someone different) by a "medical practitioner" and not a certified M. D.

For about the last eight weeks or so, I am having increasing pain in my hips to the extent it is painful to walk, to go up steps, to bend over to pick something up, to step up into my van. I have never had this kind of pain before. I am a person who has walked a mile or two, just about every day, for the last 30 (yes, thirty) years.

This has come on very suddenly, over the last eight weeks or so (as I said above) and I can't help but think that it is related to the leg infection I had last summer. This may (or may not) be Lyme disease. Lyme disease is pretty rare in my area of California (to the extent that they don't usually test for it), but on my trip to Yellowstone last summer I camped in areas where Lyme disease is present.

To make a long story short, the pain increases on an almost daily basis. This morning I tried to make an appointment with my regular physician, and was told his first available appointment was January 15. Six weeks away. The way this thing is going, by that time I will either be recovered, or dead.

Sorry to bore all of you with these kinds of details, but my question is this (LOL! I do finally come to a question, after paragraphs of whining ): as you have gotten older, and have entered your "Golden Years" (I guess they are called Golden Years because of the amount of gold one needs to shell out to stay healthy):

1. Have you had a medical problem that alarmed you?

2. Do you think you experienced any kind of "age discrimination" in trying to obtain health care for this (or any other) medical problem?

3. If yes, what did you do to overcome your obstacles to health care?

Sorry if this is all a bit more personal than perhaps posts should be on here. But I would like to know, and I don't know quite where to turn.

Thank you.

Anne

[BirdbyBird]

I don't have the circumstances of limited medical options. I have used a Nurse Practitioner for the past 8 years maybe. After my MD left the practice to join a boutique practice which was much better for her family life. When I worried about my leg two weeks ago, they got me in that day and I was send directly to the hospital to rule out a DVT. It turned out to be an infection, which we know can be or become cellulitis so easily. She immediately called in a strong antibiotic. It took about 24-48 hours before I breathed some relieve that it was working.

A week later I turn up calling with the Bells Palsey isse. Again after talking to their nurse in reception they got me in. The NP did an assortment of neurological evaluations to rule out a stroke issue. Gave me prescriptions and I was on my way till the end of this week when I have scheduled my 6 month recheck blood work and she can check up on me anyway. Getting into see an MD might have taken longer but from experience I trust my NP judgement and she has a record of sending my on for additional consults as needed and because her office calls I get in.

I agree that having good insurance means nothing if you can't get an appointment. Having a continuum of care with the same professional also means that they know your history and your intelligence and what is real and made up.

I am thinking that your idea to move can't come quick enough, except that you are having difficulty moving.

Is there a patient advocacy person within the conglomeration? You know you body. Strong advocacy for yourself is what you can do. I try not to think about what notes some doctors and professionals add to out patient records that then color the perception of us by others that read them.

Good luck and keep us posted. The Lyme is a great hunch to start with. It can be so insidious.

[BarbaraRose]

Lymes disease can be very serious if not treated right away. I have a friend who died from it because he was misdiagnosed until it was too late.
No advice on your doctor situation but maybe find a second "primary" doctor who isn't as busy as the first one that you can get in sooner to see when you need to. Sometimes there are new doctors who are looking for patients to build up their schedule.

[MelissaD]

Due to reporting requirements in the Affordable Care Act (ie everything required to be in computer systems now) just about every small practice was grouped into a larger group to offset this cost. Every doctor in our area is now associated with a local hospitals physicians group or part of some other conglobate like a orthopedic group.

I can still get in to see my GP without much problem but specialist can sometimes take a while.

As for Redi-meds or ER's, they are just to patch you up till you can see your doctor. Think assembly line.

[Shirlv]

Anne, I retired from a hospital pharmacy. I always consider adverse reactions to medication first. Since you have seen multiple doctors who have given medication you should check side effects carefully. Medlineplus is a good resource. Over the counter medication can cause problems too. Allegra relieved my allergies but made every joint in my body hurt. Has any of the medical staff ordered blood work to check for infection?

P.s. Tina has appointments with a nurse practitioner. Most nurse practitioners are very knowledgeable and sympathetic. If there is one in your primaries practice you might be able to get a quicker appointment.

[Bethers]

I have been using a physician's assistant. Regular appts can be a couple weeks out, but on the occasion I've called with an immediate concern I've been fit in. Since he works different offices on different days, I might have to see someone different if the immediate problem is a day he's not at the office I prefer OR I can go to the other city. I'm needing to find a doctor here in Arizona and hopefully I'll be as lucky.

[JudyJB]

I know that cellulitis is VERY serious. I once had it and got into see someone in 15 minutes--literally the time it took to drive the four miles to her office. My regular doctor was not there, but another one took one look at my leg and wrote out a prescription in five minutes and sent me on my way to a pharmacy! Fastest in and out on a Saturday morning ever!

Are you being a "good" and polite patient? Maybe you should not be. Have you told them that you are having more and more pain and difficulty walking? Tell them you think you might have

And I agree that a physician's assistant is likely to listen longer and more. My experience with them is excellent, including this last kidney stone episode. (They could not get me into one of the urologists, but the PA saw me and even got me scheduled for surgery in four days.)

Call your regular doctor and tell them you think you were exposed to Lyme disease this past summer and want to be tested before it becomes more serious, etc. If they make up excuses, ask them where you CAN be seen fast.

[OregonLuvr]

I think part of it depends on the area you live in ie: very populated, limited family docs, etc. Living in a smaller town definitely has its benefits. Most cities now are having a shortage of family docs, even the bad ones are very busy.

Last year I had to find a family doc. Most are not taking new patients. I was used to just asking either the midwives or OB docs for a script or a problem I had. I did find a great surgeon here when I had surgery a couple of years ago, lucked out. I have had kidney and bladder problems a couple of times so went to Urgent care. We have a good one here that is connected with the Providence system that my surgeon belongs to. The doc I had there I really liked. Found out she was taking new patients and also works at Urgent care a few times a month. I have only seen her once in her office to get established but we agreed that I could call and let her know I had a bladder infection and she would just call the lab, and then a script if indicated. I have my own dipsticks so I KNOW with certainty when I have one. I cant wait 6 weeks and dont want to abuse the urgent care but when you have no options I will. I see her this Thursday it has been 6 months. She is young and I like her alot. Have not felt any discrimination regarding age so far. Last time I saw her I had a lipid panel drawn and my cholesterol was up so she said "lets just wait and see what it is in 6 months". I like that idea. I probably wont have another one drawn because I dont see the point I refuse to take statins so there ya go. She did insist on a bone scan...I did it it was fine. I dont know why I did it because again not taking those drugs. I am so not interested in most of the drugs unless they are life saving. Antibiotics are the exception because I did try and do natural remedies for my bladder/kidney infection and I was sooooooo sick.....lesson learned.

I broke my elbow earlier this year and saw the NP at the Ortho clinic quickly as in 2 days. Very thorough and I liked him. I would have had to wait much longer to see the MD. I happen to be someone who usually really likes NP and PA's. I do have a Rheumatologist I see every 6 months for an infusion for RA and I like him too, he said because I am doing so well I am on half dose infusion yippee

I currently take no medications just a few supplements and of course Vitamin D. I eat pretty well and my exercise is walking the dog. I do have aches and pains LOL but just from the aging process.

[Othersharon]

Anne, I agree with what the other gals have said. I had the same issue right after Thanksgiving. Got up with a very sore swollen jaw but couldn’t get into to my dentist for a week when they reopened following the holiday. (I had called on Wednesday, the day before Thanksgiving. In retrospect I should have pushed harder.) Anyway, with some pushing from a friend I called my doctor’s office. This is a large medical group in this part of PA. They couldn’t get me into the clinic here but got me in to the larger facility in State College that day. I saw a PA, spent a fair amount of time with her and left with an antibiotic prescription. She actually wanted to check me the next day but with the weather forecast I agreed to Sunday. She really pushed me to understand my tongue could swell and I was to call 911. Really pushed! I have heard so many horror stories about large conglomerates but I guesss I’ve been lucky. Granted I haven’t seen my primary physician that often but sometimes I think I’d rather see a PA or NP. One other thing I have in my advantage is their messaging system on their website. I can check lab results, appointments and so on. Right now I’m dealing with the sleep clinic trying to get pressure levels to where they need to be. If I had to wait for an appointment it would probably take forever but by messaging they can access the data and make changes. So all in all they really seem to be patient friendly. And when DH needed care I was usually about to get appointments same day. I feel bad that the climate of medical care for you is so bad. I really think they don’t give us enough credit for knowing our own bodies or circumstances. They always asked if I’ve traveled out of country but think they just need to ask out of area. Somehow I could push for husband or kids but never did it for myself. Still getting used to the idea of advocating for myself. Good luck and sending good thoughts your way.

[monik7]

Since it’s during the Medicare enrollment timeframe (until 12/7 I think), can you consider changing your coverage? I’ve had Kaiser my entire adult life and went on Kaiser Senior Advantage when I started Medicare. Never any problem getting an appt. Five star rated. I do realize you’d have to consider whether there are facilities near you or where you might relocate.
Sandi

[OregonLuvr]

They always asked if I’ve traveled out of country but think they just need to ask out of area.

They have to by law ask if you have been out of the country . This happened with the Ebola virus scare. I always felt silly asking a pregnant woman in labor this question LOL

[JudyJB]

Still thinking about your problem. Actually, I did have one situation where I could not get medical care. That was in Napa, where my older son lives. I had had an internist in my old home town in Michigan who was a lady who was on the teaching faculty at the U of Michigan. I had seen her for many years, and continued seeing her for four years after starting full-timing. Then I decided to try to get an internist in Napa. I made several calls, and they were either not accepting new patients or did not accept Medicare, which really shocked me because I had never had this problem before. I was also being a little picky because I wanted someone who did not see a lot of kids. Basically, I wanted a doctor without dozens of little germ-factories running around the waiting room.

Basically, no one I wanted to see would see me, so I found someone connected with Cleveland Clinic near my younger son's house in Ohio. No problem whatsoever. And she is a female doctor, which is my preference.

So, I suspect maybe your situation is very location specific. Too many people moving into that area???

So, have you considered looking farther away? Like Davis? Or Sacramento? It seems like it might be worthwhile to drive an hour or so to get in to see someone you know as opposed to ending up at various urgent care facilities all the time.

[Cudedog]

Thank you to all of you who have responded to my post. Very much appreciated.

I am thinking that your idea to move can't come quick enough, except that you are having difficulty moving.
Is there a patient advocacy person within the conglomeration? You know you body. Strong advocacy for yourself is what you can do. I try not to think about what notes some doctors and professionals add to out patient records that then color the perception of us by others that read them.

Thank you. It's helpful to know that you have had good luck with your NP. You are correct - since I have been feeling unwell, moving is not something that I am able to contemplate just now. I think I might give an NP a chance, and maybe try to get a meeting with a patient advocate. In person is better than on the telephone.

I can still get in to see my GP without much problem but specialist can sometimes take a while. As for Redi-meds or ER's, they are just to patch you up till you can see your doctor. Think assembly line.

Thanks, Melissa. I have had the same physician for more than 30 years. It's just been in the last year or two that I have problems getting in to see him. Frankly, I'm starting to wonder what the point is in having a primary care physician if one has to wait six weeks for an appointment, which makes Urgent Care my main option when I am ill. I agree with you about ER's. But Urgent Care sent me to the ER. I was not able to get an appointment with my primary care physician during my cellulitis issue until I personally walked into his office and begged his receptionist for one.

Anne, I retired from a hospital pharmacy. I always consider adverse reactions to medication first. Since you have seen multiple doctors who have given medication you should check side effects carefully. Medlineplus is a good resource. Over the counter medication can cause problems too. Allegra relieved my allergies but made every joint in my body hurt. Has any of the medical staff ordered blood work to check for infection?

Thanks, Shirl. I am not on any medications at the present time, since my cellulitis resolved in mid-July. But you made good suggestions, thank you.

No medical staff has ordered blood work for my current issue because - I can't get an appointment with my primary care physician (who might order blood work). I try to avoid going to Urgent Care here because the person you get to see is a crap shoot. With my cellulitis issue, the first visit I saw an actual M.D. The second visit I saw a "practitioner" that looked to be barely out of high school. The third visit I saw another practitioner whose English was so poor I could barely understand her. It was the young guy that referred me to the ER. I spent seven hours in the ER, mostly sitting and waiting. This did my let absolutely no good, because I was supposed to keep it elevated. No place to elevate my leg in the ER.

I made several calls, and they were either not accepting new patients or did not accept Medicare, which really shocked me because I had never had this problem before.

So, have you considered looking farther away? Like Davis? Or Sacramento? It seems like it might be worthwhile to drive an hour or so to get in to see someone you know as opposed to ending up at various urgent care facilities all the time.

Interesting, Judy. Thank you. I think this not taking Medicare thing might be the key to my problem as well. If they asked your age right out of the box, they could assume you were a Medicare patient, thus "we are taking no new patients". Medicare only pays part of "usual charges" because Medicare has pre-negotiated what it will - and will not - pay. Or maybe this not taking Medicare is a California thing, medical care might be more expensive here than in other places - thus even less is received (comparatively) from Medicare than in other places. Napa being a very expensive area might explain why they won't take Medicare or new patients .

Davis is a good 1 1/2 hours from me (one way), Sacramento a bit less than that. The problem being, that if I am very ill (and I tend not to seek care until and unless I begin to feel pretty darn bad) I'm not sure I would have the stamina (when ill) to maybe make a three-hour, round-trip, drive to see a doctor.

Last year I had to find a family doc. Most are not taking new patients.

Thanks, Karen. That pretty much seems to be the case in my area, as well. I do wonder, though, if they are just not taking on "older" patients like us. Medicare and Medicare supplement only pays fees and expenses at a previously-negotiated (and greatly reduced) rate. Medical conglomerates make a LOT more $$ from individuals and insurance companies in general, than they do from Medicare.

Wish I could find a doc like the one you are talking about.

Since it’s during the Medicare enrollment timeframe (until 12/7 I think), can you consider changing your coverage? I’ve had Kaiser my entire adult life and went on Kaiser Senior Advantage when I started Medicare. Never any problem getting an appt. Five star rated. I do realize you’d have to consider whether there are facilities near you or where you might relocate.
Sandi

Thanks, Sandi. I would consider going with Kaiser (my parents had Kaiser when I was a child, and they were always happy with Kaiser) but the nearest Kaiser facility to me is about 60 miles from me, at least an hour's drive, probably more. 120 miles, round-trip. My Medicare supplement plan doesn't show Kaiser as an option. . . because it is 60 miles away. I wish it were closer.

****
Here is the latest. I went online this morning to see when my doctor might be available, so that I could make an appointment (the medical group encourages people to do this stuff online) which is how I found out he had no openings for almost the next six weeks (it was posted online). There was a button on the page, to click if I needed an appointment (hoping this might get me in quicker - there was no text box to put in what your ailment might be), then I logged off. And waited for about three hours for a telephone confirmation, or an email confirmation.

Nothing. I then logged back onto the site, and found that an appointment had been made for me for January 10.

So I phoned the office to see if maybe I could be seen by an NP (thanks again for the suggestion!). I explained the problem I was having to the woman on the phone, and she said that my doctor would be in the office on the 6th, and could I wait until then, or did I wish to be seen sooner. I asked if this was to be December 6th or January 6th. She said December 6th (!?), I said I could probably wait until the 6th (a lot better than January 10th, plus I would be seeing my own doctor).

She said, fine, and that someone would call me back later today with the appointment time. (?) I guess they needed to work me in.

I waited the rest of the day for the call-back. If you are thinking right about now that maybe this call-back never came, you would be 100% correct. No call-back.

If you might also be thinking that this tends to reinforce my paranoia about not being able to get a doctor's appointment when I am ill, maybe because I am a senior citizen and a Medicare patient, well, yes, you would be right about that one, too.

I'll call again in the morning.

If I can't get an appointment, or if I get the run-around, I will politely hang up and then call back to see if I can get a sit-down with a patient's advocate (if there is one - I will need to find that out).

Why does this have to be so hard?

Very glad to know that most of you do not seem to have trouble finding medical care.

Thanks to all of you. Apologies for not responding to each one of you. Everyone provided very useful information, and I appreciate it.

Again, thanks.

Anne

[Acadianmom]

The town I live close to only has a population of about 13,000 and it's not too hard to get an appointment with a GP but if you need a specialist you need to go to Lafayette. Lafayette has a population of about 130,000 and I have trouble getting an appointment with a doctor there. I often get the medicare runaround too. I don't really want to see a doctor in Abbeville because if I have to go in the hospital I don't want to be in the local hospital.

The walk-in clinics are just about useless unless you have a cold or want a flu shot. As small as Abbeville is there are 4 walk-in clinics.

I don't think if you are in pain you should have to wait weeks or over a month to see a doctor. I hope you can get to see the doctor soon.

Martha

[JudyJB]

Actually, while the people in the valley tend to be wealthy, Napa itself is not. In fact, it is full of vineyard workers and is heavily hispanic. (DIL is also partly Hispanic, so my grandkids are also. And Ohio grandkids are 25% Persian (Afghanistan), so I have a multicultural family!) I have no idea what poor people do for medical care, but I think it must be very difficult.

I was just thinking of a promise I once made myself after having dental surgery to remove a cyst at the root of a tooth. They went through a root canal and it got infected. Had a huge lump in my cheek. Called the dentist and the young thing answering the phone kept insisting it was normal swelling and I did not need to come in. Well, of course, in the middle of the night, it burst, and I had a mouthful of pus. Rinsed it out as best as I could, but not pleasant.

And I thoroughly chewed out the young girl receptionist and the nurse and let the dentist know this was NOT acceptable when I went in later that day. And would you believe they had to do the surgery all over again??? Except this time they sent me home with antibiotics and pain meds.

Anyway, I swore to myself that the next time I had a problem with something and got blown off, I was going to drive to the office and sit in the lobby until they saw me!! I still think that is a good idea.