Specialists, a new way of life

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Have you noticed that the ranks of medical generalists is going the way of the dinosaur? I keep getting referred off for what I consider inconsequential things. I was at the eye doc this summer. Typically when I go, they check the health of the eyeball, do a refraction (for prescription lenses) and dilate for a better look at the retina. This year I got the health check of the eyeball (healthy) but my eye doc doesn’t do refractions. That’s another doc which means another appointment at another time with another co-pay. I opted to wait out another year and just to the refraction doc. Other than dry eye (which they can’t seem to help) I don’t have any eye issues.

I visited my breast cancer surgeon for an annual checkup and mammogram. They changed the protocol so I had to get a chest x-ray. They saw scar tissue from my original radiation 18 years ago so they ordered a CAT scan. At the end of the day, I was fine. My primary care shrugged and said tests without symptoms usually show stuff that doesn’t impact anything. Worse yet, they want the scan done again in six months to ensure there is no change. The scar tissue has been there for 18 years and it hasn’t changed.

My ob-gyn monitored my bone health and prescribed a medication for decades. I was switched to an injection instead of a pill and that had to be given by an endocrinologist.  Yet another doc to see twice a year.

The same is true of dermatologists. Each has their specialties so everything has more visits, takes longer and costs more.

I understand that specialists are necessary. They are focused on their specialty so they can give you the best treatment. If I had a serious issue I would certainly want someone well versed in the specialty. If nothing is wrong, I hate to make extra trips (and incur extra charges).

I’m allergic to doctor visits. It’s on a long list of things that I don’t like to do which includes haircuts, dental cleanings and buying underwear. I much prefer having a nice latte with a good friend (or by myself) to most anything these days. I’m becoming a curmudgeon. Just like my mom! She would consider me lucky. Back in her day they would plop you in the hospital “for observation.” They rarely do that anymore. Progress.

68 thoughts on “Specialists, a new way of life”

  1. Dito on all the referrals to someone else. Part of it is result of changes in the health care systems – docs are mostly on salary by hospitals or “groups”, and insurance companies are really picky about what they will pay for – GPs may not be “approved” for some services or paid very little, so they don’t want to waste time (hospitals and “groups” tell docs that actual art of time the are to spend with each patient…or I should say their bean counters) or do/talk about stuff that means little income ( like give basic shots/flu shots/shingle shots…that’s outsourced to drug stores now and we are told not to complain…) Really like it better when a trip to the doc was when you were sick or when it was one visit would cover all your issues and concerns. We left one doc because she started “padding” the visit bill/insurance statement saying we discussed issues that were not even brought up.
    Our term group has all their specific specialists all in one office, so if there’s any issues they can walk down the haul and talk to the other guy who did that specific part…which saves time and I think more continuing info about care. But the other docs – it’s all you have to travel over here or there – once you manage to get an appointment – usually for nothing gained. Annoying. One stop shopping docs were better – and gave better whole person care, I think.
    One note, a lot of specialist were out of work during lockdown – they either sat home without pay or volunteered in covid fight. Docs of all specialties can be ordered and mandated by feds, or gov or medical boards to come in and work if there’s a crisis. No choice. My daughter was glad she was officially on maternity leave for most of it – was able to limit exposure by only going 3 days a week into senior nursing homes doing wound care and stuff they couldn’t risk transport to contagious hospitals – she was suited up like an astronaut but said someone had to care for these people or they wouldn’t make it for normally minor problems. She also did a lot of tele doc visits.
    Medical care has really change. The fewer docs I see right now, the happier I am HAHA

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  2. When we moved 900 miles, we needed to find new doctors. I created our “ist-list” and was shocked how long it was. I asked every “old” ist if he/she felt it was necessary to continue seeing their equivalent, and a few actually said to ask my new PCP if they would be OK monitoring things. So we are actually down a couple of -ists (between hubby and me) since PCP said yes to a couple of things. Put yeah, there’s still been a lot of specialist appointments on the calendar past 3 months!

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    • I keep trying to whittle them down too. I got rid of my heart specialist because I don’t have a heart problem. I went once for a workup and they put me on the “come every year” list. My gyno is down to every two years.

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  5. I have done nothing but Dr. stuff last month and this month, Thinking of this blog post made me chuckle out loud while once again sitting in the waiting room of another DOCTOR! I hate going to the Dr…. my blood pressure hates docs. Call me clueless but I just found out yesterday from a psychologist that doctors are paid for referrals… really???? Both SSNS and I said NO to the Medicare annual Wellness visit just on principal with respect to the cognitive impairment tests given by a 20 year old that knows nothing about the mini-cog and how to assess dementia. Isn’t that one of the benefits of having SSNS around all the time to tell me if I put my phone in the fridge? I am sure our PC will give us a kick to the curb… and that is fine with me!

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    • I haven’t had a dementia check…yet. I save all my questions for my wellness check up. The answer to almost all of my question is “it’s part of the normal aging process.” I hate the normal aging process. I am still trying to regain confidence to drive because of that. I get cranky that sending me for further testing kicks up the worry thing. Fortunately my PC doc can talk me off the wall. (Like when the breast CAT scan showed someone on my lung.) For the most part he isn’t a fan of testing for nothing (which he thought the whole breast thing was). There are a few things he will manage. After a complete heart check up a few years back (I have an extra beat — many people do but I can feel it), he is doing an annual heart check as a part of the wellness visit. That eliminated one specialist who did nothing but ask how I was doing. I’ve kicked a few to the curb if I didn’t think they were doing anything and I rarely go back for follow-up unless it’s something critical or there is a problem. Those “let’s see you in 6 weeks or whatever” are usually a waste of time for both of us!

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  6. I have definitely noticed this in the past ten years. I wondered is it because I’m older so I “need” more specialists, or because GPs are just generalists now? I think its the latter. My eye doctor in CA could take care of all my eye problems. I had to leave her when I moved out of state. Now I have one “regular” eye doctor (MD) and two other eye specialists! On the other hand, now that we’re “older,” the gyn says we don’t need yearly pap scans, and the physicals are called “wellness exams” and are short and sweet …(ie, you’re still alive!”) I’m being facetious, but you know what I mean. 🙂

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  7. You are so right. It used to take one doctor to tell you you were sick. Now it takes a dozen to tell you that you are not. I suppose all the things we skipped due to the pandemic are now catching up with us. I have had so many x-rays lately I’m certain I glow in the dark.

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  8. I’m very glad you are generally in good health, but if you weren’t, you’d write marvelous posts about it.

    My GP has handled many things herself rather than sending me to a specialist, which I appreciate. The eye surgeon referred me to a retina specialist, and I am thrilled to be under his care. I wouldn’t want just anyone giving me an injection directly in the eye!

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  9. That’s terrible. I don’t get the dilation drops for my eyes anymore as I had a bad reaction once and couldn’t drive home eight hours after the drops were put in and had to call a neighbor/husband to come rescue me (and my mom – she had an appointment too and she did not drive). I now go to an eye doc who has an Optomap machine … it’s great as it take computer images of your eyeballs to detect changes year to year (they compare it on the screen). I have a dental cleaning on the 18th, not looking forward to the visit and being unmasked. I’ve been cutting my own hair since the pandemic … I was thinking of returning for a professional cut, but still wavering. It is just two people run the shop, a husband and wife – they were only allowed to have one chair occupied for one hour, giving them time to sanitize afterward. I assume that’s still the deal.

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    • I would love to not get dilated. I didn’t know there was another option. I’m going to ask. Last year I had it done in the morning in the summer and when I walked out of the office, the sun was so bright I couldn’t open my eyes. I had to feel my way to the car. Fortunately I had some very dark sunglasses in the car. This year I had my apt late in the day and that was better but next time I’m going to have my husband drive. It gets scary. I’ve gotten 3 haircuts since the worst of the pandemic and felt safe enough until my hair stylist said she isn’t vaccinated and doesn’t believe in that sort of thing. Haven’t been back although the salon was doing all the safe practices.

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  10. I am not a “good” patient. One time when I was at the doctor for a yearly physical…he did the physical and then started out the door. I told him to come back and sit down! I had questions! After that visit, every time I saw him he would ask if I had anything I wanted to talk about before he left. 😊
    It really is like a revolving door at a doctor’s office. The average visit is scheduled for 10 minutes. Ridiculous!

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  13. Hi, Kate – I’m completely with you in trying to keep my doctor appointments to a minimum — especially specialists. I am fortunate to have a wonderful GP who does a great job for what I need. Also fortunately, our doctor visits don’t require payment or copayment. I am incredibly grateful for that.

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  14. Great points, Kate. A couple of years ago I asked our physician if he could refer us to a dermatologist. “Why?,” he asked. “I can look you over.” And look my complexion and skin over he did — like literally for 10 seconds. I decided to find a dermatologist on my own. So I guess I added to our doctor list! But I agree with Jill, all of this does add to the co-pay and co-insurance costs. – Marty

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  15. “Thanks” should be passed along to the ligituous portion of our society for a lot of these specialists visits. That and a greedy healthcare system. I recently had my own annual and was referred to a dermatologist for what is a mole that I’ve had for ages. Puleez. I resent multiple trips with multiple copays for what should be a routine visit.

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    • Actually taking my car in for service is a breeze. They give me a time estimate they are always accurate (better than the weather folks). I can drop off or wait. The waiting area is comfortable with food and TV although everyone is on their phones. That is the one thing my car dealership does right. Medical practices could take some lessons from them.

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  18. Glad to hear your mammo was OK…. I’m waiting for the results of mine and the ultrasound I had on Sept 27th. I am also waiting for my bone density results from 15th September which have apparently been sent to the wrong GP. I have a diabetic eye screening appointment next week, which was shelved by our previous surgery as I was considered ‘stable’ (yet they made a fuss about my cholesterol which is now being monitored by our new surgery). Then on the 27th, I have an appointment with the breast cancer history specialist to ascertain whether I should have the test to see if I carried the gene. I’d asked about it after both of my surgeries because breast cancer ran in my family on my father’s side, but was told No, I didn’t need it. At least I am being monitored again.

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  19. Taking care of our bodies – especially as we age – is like picking your way through a mine field. I know I spend a WHOLE LOT more time on the phone confirming/making appointments than ever before. Part of that is what used to be a yearly visit for something is now a six months visit because I’ve aged so they keep closer tabs. Sigh. Health care is not for the faint of heart (literally and figuratively!).

    Hugs, Pam

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  20. I am grateful I have medicare and supplemental insurance and accessible health care providers but I still get bounced around. What I really hate is getting appt reminder phone calls, emails and mychart reminders too about a dozen times for each visit to each doctor. More aggravating is that if there is an issue with immediacy there are no immediate fit-me-in appts and they say “go to the emergency room” and then insurance reams me out for going to the emergency room.

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  21. I completely agree with you! My family doctor allows 30 minutes per visit, and insurance really likes it when you don’t have more than one visit 3-4 months at a span. Because I’m diabetic, I get blood tests done before each visit to compare to the previous ones… that takes at least 10 minutes of the allotment. I’m then asked if I need new prescriptions for any of my ongoing meds, and that can take another 10 minutes to get them logged in and sent to the pharmacy. That gives me 10 minutes to talk about whatever symptoms are new and my question as to whether they are another side effect of growing older or a signal for something. Mostly they get documented in my chart, and it takes 3 visits of repeating the same suffering symptom before it’s actually talked about. I had cataract surgery in both eyes in February, 2016 so I go to the eye doctor about every 3 years to be checked for glaucoma and diabetes in my eyes. My vision hasn’t changed enough to warrant anything more than reading glasses – OTC or by prescription if I prefer. I have a mammogram when absolutely pushed and prodded by my PCP and am still refusing a colonoscopy for personal reasons. Working with Medicare is, in my opinion, a nightmare! But hey, I’m retired, so what else do I have to do except spending an hour looking for a preferred partner that takes my Medicare plan that isn’t more than 30 miles away!

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    • It is complicated and work. I have an apt in December to measure my droopy eyelid. It will involve two visits. One for the field of vision test, then the following week with the doc. I used to get field of vision tests routinely but haven’t had one in the last 5 years. It was part of the exam done by a tech but the doc would comment on it before I left. All these trips are annoying.

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  23. If you have good insurance they seem to want to run ever test under the sun. Of course, that doesn’t mean we’re aren’t responsible for a portion of that charge. In the end, it all adds up and it’s money out of our pocket. In the past couple of years, my annual physical seems to be dropping tests. I had to beg to pee in a cup which used to be standard in a physical. Okay…now you’ve raised my blood pressure, Kate! 🙂

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  24. Yeah, my husband has retinas that would like to detach and has to see a specialist yearly, but at least it doesn’t seem a wasted trip…unlike the one for your scan.

    It’s hard to tell when a doctor has concerns–and when they see you have good insurance.

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    • My breast cancer doc changed this year and the new one brought new protocols. Although I like him, I’m hoping I don’t have to do extra tests every year. My PC wasn’t happy about it all. He says it all adds up to extra radiation from the testing.

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    • After my auto accident this summer, they did a CAT scan from head to pelvis. It showed that my organs are all normal and nothing is lurking. I imagine there will be a day where an annual checkup is just blood work and a scan. The fewer trips to make, the better.

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    • The eye doc this year took me over the edge. This is new. Last year he did the 10 minute refraction too. This year nope, nada, not his thing! I lost my favorite eye doc and I feel rudderless finding someone who listens and doesn’t make me make repeat visits for nothing. I’m approaching the 6 month mark to redo the scan. Thinking of either cancelling or postponing.

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