Disappointing Reality of Primary Care

[medicienne]

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1. Uninsured patients with a specific demand for a certain drug (seen on TV, usually addictive or requiring monitoring) trying to give you a guilt-trip & have you prescribe that drug & absolutely not agreeing to bloodwork or monitoring.
2. Patients on low monthly cost but high deductible health plans blaming you for the high copayment.
3. Demanding automatic refills of narcotics, sleeping pills & accusing you of greed for calling them in for a visit.
4. Uninsured patient with a serious problem needing specialist but no one will take him & he can't afford care.
5. People with viral sore throat & URIs demanding antibiotics

It's just been 2 months of practicing as a primary but I'm already getting fed up of this thankless, far-from-ideal real world where >50% patients think you're greedy & do not really want your counsel but
just the script for the exact dose of oxycontin they want.

What do you all feel?

 

[deleted6669]

1. Uninsured patients with a specific demand for a certain drug (seen on TV, usually addictive or requiring monitoring) trying to give you a guilt-trip & have you prescribe that drug & absolutely not agreeing to bloodwork or monitoring.
2. Patients on low monthly cost but high deductible health plans blaming you for the high copayment.
3. Demanding automatic refills of narcotics, sleeping pills & accusing you of greed for calling them in for a visit.
4. Uninsured patient with a serious problem needing specialist but no one will take him & he can't afford care.
5. People with viral sore throat & URIs demanding antibiotics

It's just been 2 months of practicing as a primary but I'm already getting fed up of this thankless, far-from-ideal real world where >50% patients think you're greedy & do not really want your counsel but
just the script for the exact dose of oxycontin they want.

What do you all feel?

just an observation but the fp docs I know who work in rural settings and practice full scope medicine( manage inpts, low risk ob, cover the er, etc) seem to me to be a lot happier and more contented than their urban colleagues.....

 

[deleted87716]

1. Uninsured patients with a specific demand for a certain drug (seen on TV, usually addictive or requiring monitoring) trying to give you a guilt-trip & have you prescribe that drug & absolutely not agreeing to bloodwork or monitoring.
2. Patients on low monthly cost but high deductible health plans blaming you for the high copayment.
3. Demanding automatic refills of narcotics, sleeping pills & accusing you of greed for calling them in for a visit.
4. Uninsured patient with a serious problem needing specialist but no one will take him & he can't afford care.
5. People with viral sore throat & URIs demanding antibiotics

It's just been 2 months of practicing as a primary but I'm already getting fed up of this thankless, far-from-ideal real world where >50% patients think you're greedy & do not really want your counsel but
just the script for the exact dose of oxycontin they want.

What do you all feel?

The only one of those things that I see as a real problem is #4. You're not going to solve that one. That's a larger societal issue.

As for all of the others, you do what you feel is medically appropriate. It's as simple as that. If the patient doesn't agree with you, they can go elsewhere. Don't be a "doctor feelgood."

 

[VA Hopeful Dr]

1. Uninsured patients with a specific demand for a certain drug (seen on TV, usually addictive or requiring monitoring) trying to give you a guilt-trip & have you prescribe that drug & absolutely not agreeing to bloodwork or monitoring.

Then either a) don't prescribe it or b) document heavily and educate the patient on the risks if they don't agree to bloodwork monitoring. You're the doctor now, put on your big boy (girl) pants.

2. Patients on low monthly cost but high deductible health plans blaming you for the high copayment.

Never happened to me, but whenever cost does come up I have a standard "I have no control over that" 20 second speech ready

3. Demanding automatic refills of narcotics, sleeping pills & accusing you of greed for calling them in for a visit.

Depending on how rude the patient is being, I would have no problem stopping the drug in question or firing the patient.

4. Uninsured patient with a serious problem needing specialist but no one will take him & he can't afford care.

Yeah, that does suck.

5. People with viral sore throat & URIs demanding antibiotics

Yeah, just gotta deal with that. Have your viral spiel ready, lots of handouts.

 

[EdibleEgg]

It's hard when you are just starting out and are building a practice. The reality is a lot of patients are just testing you. Draw your line in the sand now. Don't be scared to fire some and let some leave. If you give in now, you will be doing it as long as you are in practice. In the long run, it is much better to have a smaller practice with lots of good patients than a larger practice with lots of headaches. And make anyone that gets a refill sign a controlled substance contract (pm me and i will send you a copy of mine if you want). Setting some expectations on the first visit really helps.

 

[smq123]

1. Uninsured patients with a specific demand for a certain drug (seen on TV, usually addictive or requiring monitoring) trying to give you a guilt-trip & have you prescribe that drug & absolutely not agreeing to bloodwork or monitoring.

Not at all specific to primary care. Patients come in wanting the latest OCP, the latest PPI, the latest statin.

2. Patients on low monthly cost but high deductible health plans blaming you for the high copayment.

Also not specific to primary care. I saw patients get into screaming matches at the OB office for the same thing.

3. Demanding automatic refills of narcotics, sleeping pills & accusing you of greed for calling them in for a visit.

Once again, not specific to primary care.

5. People with viral sore throat & URIs demanding antibiotics

I've seen patients badger their oncologist for abx for no particularly good reason. Again, not specific to primary care!

 

[elfmonkey]

1. Uninsured patients with a specific demand for a certain drug (seen on TV, usually addictive or requiring monitoring) trying to give you a guilt-trip & have you prescribe that drug & absolutely not agreeing to bloodwork or monitoring.
2. Patients on low monthly cost but high deductible health plans blaming you for the high copayment.
3. Demanding automatic refills of narcotics, sleeping pills & accusing you of greed for calling them in for a visit.
4. Uninsured patient with a serious problem needing specialist but no one will take him & he can't afford care.
5. People with viral sore throat & URIs demanding antibiotics

It's just been 2 months of practicing as a primary but I'm already getting fed up of this thankless, far-from-ideal real world where >50% patients think you're greedy & do not really want your counsel but
just the script for the exact dose of oxycontin they want.

What do you all feel?

1,2,3,5 You always can, should, say No. Either they trust you or go somewhere else.

4. is not specific to primary care. Actually it is worse in specialty practice, because it`s more expensive to see a specialist. Try an oncologist or an ENT.

"thankless patients" is kind of an "American" phenomenon that is spreading now, world wide. When students start to respect their teachers and stop chewing gums at class, then you can expect them to show some gratitude to the physician who is trying to save their lives and keep them healthy.

 

[tiotropium]

just an observation but the fp docs i know who work in rural settings and practice full scope medicine( manage inpts, low risk ob, cover the er, etc) seem to me to be a lot happier and more contented than their urban colleagues.....

+1

 

[MOHS_01]

1. Uninsured patients with a specific demand for a certain drug (seen on TV, usually addictive or requiring monitoring) trying to give you a guilt-trip & have you prescribe that drug & absolutely not agreeing to bloodwork or monitoring.
2. Patients on low monthly cost but high deductible health plans blaming you for the high copayment.
3. Demanding automatic refills of narcotics, sleeping pills & accusing you of greed for calling them in for a visit.
4. Uninsured patient with a serious problem needing specialist but no one will take him & he can't afford care.
5. People with viral sore throat & URIs demanding antibiotics

It's just been 2 months of practicing as a primary but I'm already getting fed up of this thankless, far-from-ideal real world where >50% patients think you're greedy & do not really want your counsel but
just the script for the exact dose of oxycontin they want.

What do you all feel?

I don't think this is unique to primary care. Look at it this way, maybe it will make you feel better: every time I see one of these peaches, I lose 15-20% of my revenue for the day, 1/3 to 1/2 of the day's profits. Given where I live, it happens a few times a week (simply must keep the referring peeps happy, you know). What you described sucks for everyone. 🙁

 

[JustPlainBill]

I agree that a lot of what you describe is less than pleasant, to put it nicely --- I'm assuming, since in your post, you indicate that you're out in practice now that you didn't do residency in a large county hospital where what you're describing is the norm, not the exception ---

I'm at a very large county hospital for my residency and I can tell you from experience that happiness is a state of mind, not necessarily derived from your patients. Overall, I'd say about 20% fall into the categories you outlined, 60% are middle of the road and 20% are really great people who are grateful for what you do for them....Persevere, remember why you went into medicine and remember the awesome opportunity to do so much for so many people who are all dealing with their own stuff.....and yes, I'm over 40 and yes this is career #2 for me so no illusions with rose colored glasses here.
It''s not going to change and you can only control your reaction to it...

Buck up or it'll be a really long day...

 

[MJB]

That's what my experiences have been in residency and I hate it. I'm hopeful that it will be better in the 'real world' where I'll at least be working with Medicaid patients.

And, it will be really hard to convince me you "need" Oxycontin. I've got WAY too many chronic narcotic users in residency.

I absolutely LOATHE "chronic pain".

 

[cabinbuilder]

That's what my experiences have been in residency and I hate it. I'm hopeful that it will be better in the 'real world' where I'll at least be working with Medicaid patients.
And, it will be really hard to convince me you "need" Oxycontin. I've got WAY too many chronic narcotic users in residency.

I absolutely LOATHE "chronic pain".

Don't get your hopes up. The medicaid group is so needy and entitled it's not even funny. They want and expect everything for free. I use the example of the mom with five kids toting her coach bag and cell phone bringing her kids in for a fever because she "can't afford" to buy tylenol over the counter since medicaid pays for an Rx of it.

Also, you will find that medicaid rules vary from state to state. I was shocked to learn in Oregon, the narcotic of choice on the medicaid plan is METHADONE!!! So everyone in the practice I inherited was on it. I just about flipped out.

 

[EndersRebutal]

Don't get your hopes up. The medicaid group is so needy and entitled it's not even funny. They want and expect everything for free. I use the example of the mom with five kids toting her coach bag and cell phone bringing her kids in for a fever because she "can't afford" to buy tylenol over the counter since medicaid pays for an Rx of it.

Also, you will find that medicaid rules vary from state to state. I was shocked to learn in Oregon, the narcotic of choice on the medicaid plan is METHADONE!!! So everyone in the practice I inherited was on it. I just about flipped out.

Was your predecessor also trying to ween them off of serious heroin addictions cause that's the only excuse I would understand. Yikes!!

 

[cabinbuilder]

Was your predecessor also trying to ween them off of serious heroin addictions cause that's the only excuse I would understand. Yikes!!

No heroin addicts here. Just little old ladies with chronic pain, overweight broken down men with chronic pain, poorly controlled diabetics with chronic pain, etc.

 

[deleted87716]

You don't have to see Medicaid patients unless you want to (or unless you work for somebody who makes you).

I don't. Haven't since residency.

 

[cabinbuilder]

You don't have to see Medicaid patients unless you want to (or unless you work for somebody who makes you).

I don't. Haven't since residency.

Well, that was the nature of the job. Fortunately I quit that job a long time ago. Am very happy doing locums. Don't anticipate taking a perm job anytime soon.