Now retired, I'm more sensitive to expenses. In particular, doc appts. Sometimes I need to see a doc for various health issues. And I understand some labs / imaging work is necessary to diagnose and monitor conditions.

But how do you decide which / when doc follow-up visits are warranted? Lab / imaging work?

Is a follow-up visit based on time (ie - 1 month? 2 months) really warranted? Often it's just "things look as expected" and nothing new is learned or prescribed. Many times, I know how the appt will go just be looking at the lab results beforehand (ie - all results normal as expected).

I'm skeptical I need these time based follow-up visits. Seems like a money maker to me. Shouldn't appts be more event driven? Or is it good to have time based appts? I get that in some cases it's perhaps warranted. But by the rule?

I'm not a doctor but I think that medically speaking, it's a balancing act. For a patient who is overall fairly healthy, I think a longer interval between "routine" appointments is appropriate. Specific screenings (cancer, etc.) fall outside that. But for people who have a history, or family history in some cases, more frequent checking can be life saving. I know. I was 47 when I was diagnosed with colon cancer, and that was before they dropped the recommended screening age from 50 to 45. I had no outward symptoms, it was detected via a very circuitous route. I.e., if I hadn't woke up with a stiff neck one morning, I probably wouldn't be here now. I had an uncle who died of the same thing. He had no outward symptoms, and no stiff neck, until it was too late to do anything about it, and six months later he was dead.

That said, I also believe there's a significant amount of "more appts = more revenue" bean counter thinking involved as well.

Are you on Medicare yet (65 or over)?
If you are, that should take the expense part out of the equation, since once you've paid the small annual deductible you pay little to nothing.
Beyond that, I don't want to wait for an event if it's something I can catch earlier. In fact if a doctor suggests almost any sort of test then I'm all for it in most cases.

The purported reason for regular "follow-up" visits is to spot and track marginal conditions before they become an actual health concern that requires treatment. Seems like this kind of makes sense, especially if you want to catch something before it seriously degrades your health.

But, nobody can tell the future, therefore there's no definitive way to evaluate the usefulness of such practices.

I have become very cynical about the health business as I age. Seems like the entire hierarchy is stacked in favor of the providers, and against the patient. Once you get a fish hooked, the most frustrating thing is for him to slip the hook, and immediately be caught by another angler. Follow-ups help keep that hook firmly set.

two months follow-up seems overly conservative and excessive unless you're in frail health or are undergoing some treatment.

Six months apart is more than enough if you're concerned. I think most people get by with once a year if you have nothing going on with you. And under Medicare, that wellness check up is free to you.

Since we're on the topic of Medicare, here's one thing you should remember: Medicare will only pay for tests to DIAGNOSE a condition, they won't cover SCREENING tests. So, it's a matter of wording and procedure number. There are exceptions for preventive services such as colonoscopies.

quote:

Originally posted by architect:

I have become very cynical about the health business as I age. Seems like the entire hierarchy is stacked in favor of the providers, and against the patient. Once you get a fish hooked, the most frustrating thing is for him to slip the hook, and immediately be caught by another angler. Follow-ups help keep that hook firmly set.

I had a bout at work where I forget if I had chest pains or couldn't breathe. I went to the doctor who had me take xrays. I got a call from her to go to urgent care because they found nodules in my lungs and she was on vacation. That got me referred to an oncologist who had me go through several things like biopsy, mri, etc. I forget the others but a couple involved taking a sample through my back with a syringe. I'm glad I didn't see how big it was.

After each test, I go see the oncologist.
"The test was negative."
"So I don't have lung cancer?"
"Well... I can't say that."
"So I have lung cancer?"
"Well, I can't say that either."
"Well, what do I have?"
"I can't say. It could be nothing; it could be something. Do you go hiking? Have you ever hiked in the desert?"
"Do I look like I go hiking???"
"Anyways, I think you should see me every six months."

That's when I get the sense this guy just sees me as a residual stream of income for him.

I stopped going at that point and stayed alive since. At least, I think I'm still alive.

Yea, sometimes I get the feeling this is more about revenue stream than actual value add appt.

I think I'll schedule the appt but then push them out as the date gets closer if I'm not feeling there is a need to meet.

If there are lab tests beforehand then perhaps I'll keep appts if something looks like it's trending negatively. But absent that, and especially if the appt is just a "check to see how I'm feeling" then I think it's not really warranted.

At this point, I go to the doctor to make sure the doctor I went to last time didn't screw up.

It's a timely thread I have a follow-up visit tomorrow afternoon. I had a test, they didn't call me. when I called them they said come in. I'm thinking to myself if they didn't call me why do I have to come in, and I thought about the time and copay part so I told the office that if I did not need to come in I did not want to. I don't want to get there just to hear everything's fine. So if I go in tomorrow for no good reason it would be the last time.

If you feel it is about revenue stream you should see someone else. The key is asking intellegent questions just like when you visit the dealership. Office visits are paid at a pretty low rate. The money is in procedures.

My office visits are typically $500-600. That's a pretty penny for me across 3-4 docs.

PSA don’t ask your doc any questions about injuries or what not during your annual physical, because they will bill you for an office visit and the injury. And you’ll get billed for it.

I treat my doctor like a visit to a medical used car salesman now because the bean counters found they were missing out on money when you ask about stuff during the visit. I’ve begun asking, is that necessary.

For example, last year before May I over worked my shoulder and had some slight pain(washed and waxed 3 cars in one day). Well I went to see her, and she talks about “maybe some PT will help that” I said I remember the PT I did when I hurt it years ago-is that the “cheapest/easiest approach for this injury” and she says yeah I like that for the insurance reasons……

I said well wouldn’t a short dose of steroids be cheaper for the patient vs having to schedule PT visits? She relented.

Then I jacked it up while overseas.

I dealt with it till i couldn’t anymore, so in Jan I went in, told her what was going on, she says, “maybe e we can do an in office ultrasound “ (her new MD partner used to teach it and does it in house (think money guys). I said, and after that what’s the treatment?

Steroid injection into the shoulder.

Let’s do that and skip the ultrasound-if you wanna do it to practice or gain skills I’ll gladly be your Guinea pig-but I ain’t paying for it.

/drift

Manage your doc

Let’s do that and skip the ultrasound-if you wanna do it to practice or gain skills I’ll gladly be your Guinea pig-but I ain’t paying for it.
^^^^^^^^^^^
After that remark most docs would have discharged you as a patient.

Chronic or Progressive Diseases + Age = more frequent visits. The more of those = more frequent visits = longer functional lifespan. Generally speaking, up to a point.

Don't forget to shoot.

I work in orthopedics and primary care / internal medicine is a different ball of wax, so apples to oranges.
My approach is if I see a patient, order tests etc, I call them on the phone, let them know what the results are and offer options, which may or may not require an additional visit. If I offer treatment options - injections,PT for example, and the patients needs to think about it, if they call back and say they want PT, I just order it without an additional visit.
After surgery, typically see people 2 weeks ( staple or suture removal , wound check) 6 weeks - often with Xray to assess healing when needed.typically we build in a 12 week final check. But if the patient is doing well at 6, I don’t make them come back at 12.
People also don’t realize the pressure some providers/ practices are under. Some are paid based on RVU’s - relative value units- so often it is self interest generating RVU’s to gain income, or more often enough RVU’s to justify the position. Don’t generate enough RVU’s the organization starts looking to reduce the resources you get- office staff ,Assigned OR block time,etc.
my RVU’s are in the tank, despite seeing a higher number of patients than a lot of other people in the practice, because I do a ton of post op care, which is bundled into the original surgery fee- called the global period. When we do surgery, any revisit related to the surgery for the next 90 days is part of the original surgery fee. When it is brought up, I just shrug and say if you keep paying me, i’ll keep showing up. Worked ok so far.
Some practices are predatory though. My wife was seeing a group and went to a routine appointment. Got home and realized she didn’t ask for an order for an annual mammogram- called back they said she had to come back for another visit to get the order- utter BS.
Also CMS ( centers for Medicare and Medicaid services) sets certain criteria they grade your practice on - which in turn decides how much they reimburse you ( and once CMS sets a standard, it is typically adopted by private insurances too)
For example, annual flu shots. If your chart reflects you gave or offered the shot, you get paid more than if this is not included.
Doesn’t matter if the person’s sick visit was for a twisted ankle, which obviously has zero to do with flu shots- but if the flu shot info isn’t documented, you get paid less for treating the ankle. How wel you treated the ankle becomes almost irrelevant as that is not part of the grading system for reimbursement.

You know what you’re being treated for and how big of a deal it is. For an annual physical I have my labs scheduled beforehand so we can discuss any results as needed during the appointment. For chronic issues I see my specialist and very 3-6 months depending on how I’m going. Labs done two weeks prior. Follow up for one offs are play it by ear. I have an arthritic toe. Podiatrist made me an insole. It solved my issue for now. There’s no need to go back until there’s an issue.

quote:

Originally posted by ZSMICHAEL:
Let’s do that and skip the ultrasound-if you wanna do it to practice or gain skills I’ll gladly be your Guinea pig-but I ain’t paying for it.
^^^^^^^^^^^
After that remark most docs would have discharged you as a patient.

Tone and inflection are lost in the written word, you can say what I said with a sneering tone and it comes across bad, or the opposite.

And I gotta go see her on Thursday-so she didn’t boot me to the curb.

It's a balancing act, especially as others said we age, up to age 60 it was rare for me to be in a doctors office unless I was sick, which, was rare.

Since turning 60 its been a revolving door of things to deal with, labs, imaging, procedures, more than my whole life up to 60...

You have to base it on how you feel, but at a minimum having a blood test annually, a review and probably seeing a PCP twice makes sense, you'll have to do that for refills on medications anyway.

I am 70 going on 71. In reasonably good health. I see my doc every 6 months for a health check, covered under Medicare. I have a blood draw once a year. I have high blood pressure, watch my cholesterol and have a family history of diabetes, cancer, heart attack and stroke.

Every visit I remember my mother's words. My dad suffered a stroke at 70. My mom, a nurse for over 40 years, contended that had the doc checked his carotid for a bruit, the stroke may have been avoided. My doc checks my carotid every visit and the other tests would show any indication of problems. Death is inevitable but I have no intention of facilitating it's arrival.

quote:

Originally posted by HRK:
You have to base it on how you feel, but at a minimum having a blood test annually, a review and probably seeing a PCP twice makes sense, you'll have to do that for refills on medications anyway.

Unless you have an unstable or new condition, 2x/year seems excessive at age 60. More like annual labs and office visit every 1-2 years if labs are stable and within normal ranges. There was a study at Harvard that showed that the "annual visit" in the absence of symptoms did nothing to decrease all cause mortality.