PCP's not seeing their own patients.

[HmTwoPA]

Has anyone else that this issue through COVID. Currently working in the UC. Many PCP's over the last 2 years refusing to see anyone with COVID symptoms. I have patients with a cough for 2 years coming in. Saying that their PCP wont see them if they have any COVID symptoms. I remember last summer when we were still doing car side visits. A local family med clinic sent their patient to get COVID tested, because they had a fever. It was breast feeding mom with redness and swelling of the breast, no other symptoms. I ended up bringing her into the clinic seeing her and getting her antibiotics. I've had similar things happen multiple times over the last 2 years. I feel like Family med atleast in my area really dropped the ball with COVID. Even some of the family med providers in my own organization have been refusing to see patients for follow up if they have any URI type symptoms. 

[newton9686]

I 100% agree. Maybe if you are like 95 years old and a PCP, but really you should just retire. I don’t want to know how many people died or dx got missed because PCPs either stopped seeing patients or seeing people in person. Patients may of actually gone to see there PCPs, but they closed up shop and left it to the urgent cares and ERs to do their job.  I remember being in the urgent care and having all the patients PCPs wouldn’t see thinking its okay for me to bring covid home to my family, but not you. Plus because mine is a walk in I have patients sitting in the lobby for 3 hours spreading it to everyone versus the pcp who could actually do a better job keeping patients separated by having a set schedule. 

 

I get everyone has to make the best decision for themselves in and their family, but there’s also an unwritten rule in medicine that you do your job and don’t expect others to do it for you. And I think there were more than a few PCPs that broke this rule. 

 

[doubledose]

This was implemented where we I work in beginning due to supply issues, and other hospitals trying to get all the COVID patients. I remember one time we had 4 COVID PCR's and we're expected to cover the area to include local kitchen and couple of other high priority areas. Needless to say the ultimate decision was they we were lowest priority to hospitals and other resources. Best we could do was establish local resources for testing to meet demand/symptoms. 

Funny thing about about COVID is in some cases it is text book and other cases no symptoms, no real way to triage those with only "URI" symptoms. In the beginning had one guy test positive for 3 months, we obviously know what happened now. Simple answer was UC/ER. We tried to swing open and then half our staff got sick in a two week span. 

So we still have this in place, and it makes people mad. But as I have said on this forum before and will point out again: this is an administration problem that could easily be solved with adding practitioners. We could have opened a drive through clinic like other clinics and demanded resources but I was told manning didn't permit. Then people get mad at me for saying they need to be tested before coming in. 

Bigger picture here; identify the limitation?

If it's any consolation I still see those who have neg rapid test, while other facilities will only see if they have neg PCR. I too have been tested by both and had neg rapid and pos PCR. 

Moral of the story. Not always the PCP fault.

Edited April 10, 2022 by doubledose

[ventana]

Having been in primary care through the whole thing....

1) this was not a choice we made lightly

2) even though the hospital owned or building, we had no info on air turn over, filtration or anything else

3) we had basically no PPE for the first year - private practice with no funds to fall back on to pay overinflated prices to PPE.  We literally bought the last to work respirators from the local hardware store.

4) we were the only clinic still doing DOT, CDL and School Bus physicals in the entire county.  

4) primary care is a resource to be protected. YeaH we all know the specialist can't get sick cause then there is no specialists to work, but PCP medicine is the same thing. I stayed very busy (to busy) with just keep the practice going. Granted I was in a practice that went from 5 providers to 2 (not due to covid but just life) and if one of the 2 providers (myself and doc) got covid it would have been the kiss of death for the practice, stranding all our patients

5) hate to be cold about it, but you signed up for urgent care, and URI/viral illness is in your bailiwick.  I have to figure out what is the next latest greatest DM med and balance HF patients and everything else under the sun to keep my patients as healthy and well as possible to keep them out of the ER and hospital

6) most PCP are old, older then dirt, nearing retirement and therefor should not be seeing covid + early on in the pandemic.  Not so much now though

 

 

Now the counter point

The development of UC is really crappy for our system and the patients - we loose the ability to have teachable moments, the patients typically get zpak and pred for any little URI complaint (recently got a px dx with Viral URI that got Augmentin and pred - no kidding).   Patients don't like not being able to go to their PCP.  But now patients seem to "want it their way" and we have justified this "needing to be seen" mentality as the last time they got augmentin and pred in order to feel better.  

Then throw in the need to keep "Same day" appointments that the patients can't seem to show for - even when they make them the same day!! and you have PCP's employed by large corps whom are paid based on RVU and you really want to avoid no shows, and lightly booked schedules literally cost them pay.  So the PCP's fill up their schedule with routine patients to maximize their RVU and pay (because lets face it PCP don't get paid crap) and BOOM UC clinics are everywhere.

 

 

So I drone on for and against and see where both sides are coming from.

 

I think UC has come about as the PCP world has just melted down. The

[HmTwoPA]

34 minutes ago, ventana said:

Having been in primary care through the whole thing....

1) this was not a choice we made lightly

2) even though the hospital owned or building, we had no info on air turn over, filtration or anything else

3) we had basically no PPE for the first year - private practice with no funds to fall back on to pay overinflated prices to PPE.  We literally bought the last to work respirators from the local hardware store.

4) we were the only clinic still doing DOT, CDL and School Bus physicals in the entire county.  

4) primary care is a resource to be protected. YeaH we all know the specialist can't get sick cause then there is no specialists to work, but PCP medicine is the same thing. I stayed very busy (to busy) with just keep the practice going. Granted I was in a practice that went from 5 providers to 2 (not due to covid but just life) and if one of the 2 providers (myself and doc) got covid it would have been the kiss of death for the practice, stranding all our patients

5) hate to be cold about it, but you signed up for urgent care, and URI/viral illness is in your bailiwick.  I have to figure out what is the next latest greatest DM med and balance HF patients and everything else under the sun to keep my patients as healthy and well as possible to keep them out of the ER and hospital

6) most PCP are old, older then dirt, nearing retirement and therefor should not be seeing covid + early on in the pandemic.  Not so much now though

 

 

Now the counter point

The development of UC is really crappy for our system and the patients - we loose the ability to have teachable moments, the patients typically get zpak and pred for any little URI complaint (recently got a px dx with Viral URI that got Augmentin and pred - no kidding).   Patients don't like not being able to go to their PCP.  But now patients seem to "want it their way" and we have justified this "needing to be seen" mentality as the last time they got augmentin and pred in order to feel better.  

Then throw in the need to keep "Same day" appointments that the patients can't seem to show for - even when they make them the same day!! and you have PCP's employed by large corps whom are paid based on RVU and you really want to avoid no shows, and lightly booked schedules literally cost them pay.  So the PCP's fill up their schedule with routine patients to maximize their RVU and pay (because lets face it PCP don't get paid crap) and BOOM UC clinics are everywhere.

 

 

So I drone on for and against and see where both sides are coming from.

 

I think UC has come about as the PCP world has just melted down. The

My original complaint wasn't about PCP's not seeing COVID patients. Its about all of the things they refuse to see because it "could" be COVID. LIke the examples I gave. A cough x 6 months. Fevers in a breast feeding mother whose here for breast redness and pain. I have read your examples of UC providers giving out ABX for common URI's in other posts too. In my experience it is the exact opposite. All of the old PCP's who have been doing this a long time time continue to give Zpacks for "bronchitis" over and over again because its what they always do. Then when the patient cant get in to see their PCP because they're booked out and come and see me and say "I get this every year around the same time and my doctor gives me a ZPack." I've even seen 2 PCP's at my clinic somehow do telehealth for URI symptoms and then give a Zpack.  I think your perspective comes from where you stand. In your opinion as a PCP you see patients who went to the UC. In my position I see patients whose PCP's poorly manage them or choose wrong medications. 

[ventana]

"could be" versus "is" covid can not be determined till after you see them.

Anyone in this field knows that the story of the patient always changes changes changes, right up to and including during the visit.....

I get your point, and I am not arguing one stance or the other.  Maybe a good thing to come out of covid is retirement of all the PCP's that were long overdue to retire - (who were giving zpaks and such for nothing)

 

At bout 10 yrs left to my career my fortitude is a little less to have patient pissed off at my, bad PG, make a stink about not getting their zpak.   I still don't give them one, but I do say they can follow up if they need to.  I can see how a worn out tired, at end of career PA, NP, DOC could just give up the fight...  not that it is right.

\

most def some selection bias by whom and where we see them.  two decades ago I almost went to work with the PEDS rotation site. till I realized she thought everyone had asthma and PNA and treated every kid with abx and inhalers.....  passed on that job.   Yet she just retired about 5 years ago - so she did this pattern for another 15 years beyond when I saw it as totally wrong.

[HmTwoPA]

1 minute ago, ventana said:

"could be" versus "is" covid can not be determined till after you see them.

Anyone in this field knows that the story of the patient always changes changes changes, right up to and including during the visit.....

I get your point, and I am not arguing one stance or the other.  Maybe a good thing to come out of covid is retirement of all the PCP's that were long overdue to retire - (who were giving zpaks and such for nothing)

 

At bout 10 yrs left to my career my fortitude is a little less to have patient pissed off at my, bad PG, make a stink about not getting their zpak.   I still don't give them one, but I do say they can follow up if they need to.  I can see how a worn out tired, at end of career PA, NP, DOC could just give up the fight...  not that it is right.

\

most def some selection bias by whom and where we see them.  two decades ago I almost went to work with the PEDS rotation site. till I realized she thought everyone had asthma and PNA and treated every kid with abx and inhalers.....  passed on that job.   Yet she just retired about 5 years ago - so she did this pattern for another 15 years beyond when I saw it as totally wrong.

I agree with you on putting up a fight for every patient. I personally dont mind confrontation with patients, so I have no problem saying no and educating as much as possible about why. I can see if someone didnt like confrontation, or was just burnt out why they would give them out despite it being the wrong thing. It would save you half the time in a visit just to hand it out.

This is kind of off topic, but I often preach to friends and family that I feel this is half of why the country has such a bad narcotics problem. Everyone likes to blame the medical providers for giving this stuff out, but the persistence and aggressiveness in patients is often overlooked by people. I remember taking a class in undergrad and a student stated that ER docs and docs at the VA just give this stuff out like candy and thats why. Then within 30 minutes another student said that he got in an MVA and the ER did nothing for his pain, and all the students were agreeing with him about how bad the ER is. Kind of an off topic tangent, but your statement made me think of it. 

[ventana]

I was just conversing with a friend how we have lost the ability to handle the scrapes and boo boos in the house.  It is "run off to the doctor" for anything.  Bruise, scrape, head ache......   

I was asking her her thoughts and rather the melt down in PCP field might have contributed (my working theory)

PCP's micromanaged and disrespected for so long and dumped on by the specialists that they just churn through their day. No same day apts due to needing their schedule to be full to try to make a living cause PCP reimbursement sucks, then UC pop up, and many are also just looking for a buck, and don't care rather they do or do not follow guidelines.  

My theory is that this in part has contributed to the patients that need a ton of hand holding and guidance from medical professionals that would have been given out by Grandma or Grandpa or Mom or Pop in the past. But since the family unit is gone, it all flow s down to the PCP who can't take the time cause insurance companies have made them have to see 25-40 patients a day to keep practice afloat, and boom you are where we are at.

 

I have no answers, only questions

[Reality Check 2]

Here are two perspectives:

1. Corporate owned Family Medicine or Internal Medicine:

Corporate may have told the 'offices' to avoid COVID cases - send them ONLY to this place > THEIR ER or UC or county/city facilities. 

The offices may NOT have a licensed nurse - mostly MAs - some good, some not so good. They may have lost their nurses to higher paying jobs in the post pandemic wave. Either way - these offices do not have the PPE, testing equipment, negative pressure rooms, etc.

They don't routinely do the protocols for dealing with COVID such as donning/doffing PPE and they just can't handle it - seriously - no one really in charge. No triage protocols or knowledge. 

IF they saw a COVID patient - no mask or no equipment -  half the staff may have to quarantine or claim symptoms or whatever based on "exposure" - no common sense and some milking it. 

Not condoning this but this is the local reality in my world. 

They still panic and don't want to deal with it - real or not. They don't know how to truly triage a patient such as the mastitis patient and they fail the patient miserably by not actually practicing medicine. 

Again, not condoning but this is the state of the mindset in some places.

2. Privately owned FP Clinic - 2-3 Providers

NO nurses at all - MAs and super lax office policies and procedures.

NO PPE or lame PPE that is reused in appropriately. No testing equipment. ZERO negative pressure rooms.

The waiting rooms are petri dishes of ick.

Private doc (at least the one I worked for) would not have quarantined himself at all and would NEVER have paid anyone to be off for quarantine or testing. 

If their office was affected by COVID and someone FORCED them to close or quarantine - folks would lose their jobs.

Again, not condoning their behavior but have witnessed it. 

We have a new reality

I am not saying it is a reality that makes sense or is sustainable.

Folks are polar - COVID is over, it was always fake or very burp, fart, sneeze and runny nose is COVID and they are going to die. 

Offices have not adapted very well - humanity has not adapted very well.

Common sense was already on life support pre-COVID - now it an endangered species on the brink of extinction.

We have to go back to Medicine 101 - take a history......... But moreover - we have to go back to the ART of medicine and being human

Just my crusty old 2 cents 

[sas5814]

Corporate medicine... the bane of my existence. This weekend a local UC started advertising on FB to be people's PCP!

I wrote a missive about why that was a horrible idea including inability to make referrals and order diagnostic testing outside the facility. I went on for a while. It got deleted and I live in a town of 9000 so I imagine I'm going to hear from someone.

People have lost any basic ability to care for themselves in my observation and , with the advent of patient satisfaction scores and Press-Gainey, have become demanding and unreasonable. Then we circle back to corporate medicine which is more concerned with happiness than good medicine.

It boggles my mind when I tell someone with a cold to drink fluids and treat their symptoms and they say "treat it with what?" like I asked them to remove their own appendix. Cough medicine for a cough.....decongestant for congestion..... Tylenol for fever aches and pains. What kind? What brand? Where can I find it?

Its no wonder life spans are shortening in the US.

[iconic]

My PCP for a long time stopped seeing anything in office and would refer everything out that required a physical exam to diagnose

[ChrisPAinED]

Same in the ED. Have patients who can't see there PCP until has a neg covid and only has enough money to cover PCP co-pay not urgent care. So they come in to the ED for COVID testing. 

[Mayamom]

38 minutes ago, ChrisPAinED said:

So they come in to the ED for COVID testing.

This is why I got out 2 years ago.  The health care system is just broken.   Stay strong..... your patients need you.

[ChrisPAinED]

1 minute ago, Mayamom said:

This is why I got out 2 years ago.  The health care system is just broken.   Stay strong..... your patients need you.

Will do thanks