One major concern lymphedema patients have is in how to find a primary care doctor when you have this condition.
There are a few “rules of thumb” I use.
First, do they know enough to recognize lymphedema?
Secondly, do they know enough to refer you to a certified lymphedema therapist for the correct treatment?
Third, are they willing and knowledgable enough to call in other doctors when needed. For example, they will need to be willin to refer you to a wound clinic, should you have persistent problems with those lymphedema wounds we so often get. Are they willing to refer you to an infectious disease doctor if you are continually have problems with cellulitis or with other infections associated with lymphedema?
Fourth, are they doctors of internal medicine? I personally prefer these doctors as they have a broader and more complete understanding of our internal “workings” then a regular GP.
One technique you might use to find a PCP is to contact your local lymphedema clinic and ask them if they know of a primary care doctor that refers patients to them. Many times, they can give you some names.
Another thing is to have an “interview” visit with them. That will give you a good opportunity to see how much they know about lymphedema and how willing they are to listen to you as a patient and do as much as they can to help.
One of the most important decisions that you will make is who will be your primary care provider. This person will be responsible for approximately 90% of your care, while seeking appropriate consultations with specialists if or when the medical problem is beyond the realm of his or her expertise.
We speak a great deal these days about “preventive maintenance” whether in discussing our cars, homes, or our health. Seeing a doctor who knows you and your medical history is your best preventive maintenance plan because that physician is well-equipped to spot your potential health problems before they become dangerous.
Provide preventive care and teach healthy lifestyle choices Identify and treat common medical conditions Assess the urgency of your medical problems and direct you to the best place for that care Make referrals to medical specialists when necessary Primary care is usually provided in an outpatient setting. However, if you are admitted to the hospital, your PCP may assist in or direct your care, depending on the circumstances.
Having a primary care provider can give you a trusting, ongoing relationship with one medical professional over time.
The AAFP describes a primary physcian as a primary care physician is a generalist physician who provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient's care. Such a physician must be specifically trained to provide primary care services.
Primary care physicians devote the majority of their practice to providing primary care services to a defined population of patients. The style of primary care practice is such that the personal primary care physician serves as the entry point for substantially all of the patient's medical and health care needs - not limited by problem origin, organ system, or diagnosis. Primary care physicians are advocates for the patient in coordinating the use of the entire health care system to benefit the patient.
Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the “undifferentiated” patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis.
Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.
Primary care provides patient advocacy in the health care system to accomplish cost-effective care by coordination of health care services. Primary care promotes effective communication with patients and encourages the role of the patient as a partner in health care.
Vanderbilt Medical describes primary care as An essential element of any health care system is primary medical care. All Americans should have access to a health professional trained to provide quality primary medical care as their entry point to the system. Such primary care physicians provide:
first-contact care for persons with any undiagnosed sign, symptom, or health concern; comprehensive care for the person which is not organ- or problem- specific; longitudinal or continuous care for the patient; responsibility for coordinating other health services as they relate to the patient's care.
General practitioners – doctors who have completed an internship but not a residency.
Family practitioners – doctors who have completed a family practice residency and are board certified, or board eligible, for this specialty. The scope of their practice includes children and adults of all ages and may include obstetrics and minor surgery.
Pediatricians – doctors who have completed a pediatric residency and are board certified, or board eligible, in this specialty. The scope of their practice includes the care of newborns, infants, children, and adolescents.
Internists – doctors who have completed a residency in internal medicine and are board certified, or board eligible, in this specialty. The scope of their practice includes the care of adults of all ages for many different medical problems.
Obstetricians/gynecologists – doctors who have completed a residency and are board certified, or board eligible, in this specialty. They often serve as a PCP for women, particularly those of childbearing age.
Physician Assistants/Nurse Practitioners – practitioners who go through a different training and certification process than doctors. They are often referred to as “physician extenders.” They may be your key contact in some practices. All PAs or NPs consult with physicians.
· What is your education? · What did you study as an undergraduate? · Where did you attend medical school? · When and where did you do your residency? Any training beyond that? (You can also look up a doctor in the Directory of Medical Specialists at the library for certification and training information.) · What is your primary hospital affiliation? · How many partners (if any) do you have? If you are unavailable, will they be able to see me? · Do you respond to calls at night or on the weekend? · What are your office hours, and are extended hours available? · What is your primary patient mix? Typical age range of patients? Do you see more women or men? Are you comfortable treating men? Do you have any special training, experience or interest in men's health care? · What hospital emergency department do you recommend? · What health insurance plans do you accept, and are you familiar with my health insurance plan? · Will you treat other people in my family as well? · Do you offer any special or specific treatments or procedures in your office or practice? · If I get really sick and end up hospitalized, will you be able to treat me there? · Do you make hospital rounds personally, or does someone else in your practice handle it? · In your opinion, what makes you and your practice different or better in any way? · How to get the most from your primary care physician. Once you've chosen a physician, there are specific steps you can take to optimize your healthcare partnership with your doctor. (1)
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1. List your needs. Do you want your doctor's office to be near home or work? What's the most convenient time of day for appointments? Do you have a medical condition that requires a specialist?
2. Talk to friends and relatives. Ask people you know and trust if they have any recommendations. If you've just moved from out of town, ask your previous doctor for a recommendation.
3. Narrow your choices. Use the CareFirst BlueCross BlueShield (CareFirst) provider directory to create a list of potential doctors. Make sure they participate in your medical plan and are accepting new patients. Research information about a provider.
4. Visit the doctor's office. a. Set up an introductory visit b. Is the staff attentive and organized? c. Are phones answered in a reasonable amount of time? d. Observe how long patients are waiting e. Ask how far in advance you need to make appointments f. What days and times does the doctor see patients? g. Who provides care in the PCP's absence? h. What hospital does the doctor admit patients to?
5. Review your decision.
After you've visited your new PCP, consider if you're happy with your choice. If not, you may want to consider a new PCP. CareFirst's medical plans allow you to change your PCP anytime during the plan year.(2)
Is the office staff friendly and helpful? Is the office good about returning calls?
How easy is it to reach the provider? Does the provider use email?
Do you prefer a provider whose communication style is friendly and warm, or more formal?
Do you prefer a provider focused on disease treatment, or wellness and prevention?
Does the provider have a conservative or aggressive approach to treatment?
Does the provider order a lot of tests?
Does the provider refer to other specialists frequently or infrequently?
What do colleagues and patients say about the provider?
Does the provider invite you to be involved in your care? Does the provider view your patient-doctor relationship as a true partnership?
Friends, neighbors, or relatives.
State-level medical associations, nursing associations, and associations for physician assistants.
Your dentist, pharmacist, optometrist, previous provider, or other health professional.
Advocacy groups – especially to help you find the best provider for a specific chronic condition or disability.
Many health plans, such as HMOs or PPOs, have websites, directories, or customer service staff who can help you select a PCP who is right for you.
MedPAC's chair calls the trend “worrisome” and says it's another argument for repealing the SGR formula, which is keeping some physicians from accepting new patients. By CHARLES FIEGL, amednews staff. Posted Jan. 9, 2012. PRINT|E-MAIL|RESPOND|REPRINTS| SHARE Washington – A federal survey of Medicare beneficiaries shows that slightly more patients are having difficulty finding new primary care physicians to care for them.
Searching for a new family physician or internist who is accepting Medicare patients was more difficult than scheduling an appointment with a new specialist, according to an annual survey on physician access conducted by the Medicare Payment Advisory Commission. The 2011 survey found that 3.6% of Medicare patients reported having no problem finding a new primary care physician, while 2% had what they considered small or big problems finding one. All other patients surveyed were not looking for a new physician last year.
In previous years, surveys showed patients having relatively fewer problems scheduling appointments with new primary care physicians, said Cristina Boccuti, a MedPAC principal policy analyst, during a Dec. 15 commission meeting. Non-Medicare patients also reported more trouble last year.
“In general, for both Medicare and the privately insured groups, access to primary care physicians is trending down, which has been concerning the commission for a number of years,” Boccuti said.
MedPAC Chair Glenn Hackbarth called the trend “worrisome” and said the new data reinforced the need to eliminate the sustainable growth rate formula that helps determine Medicare pay rates. The SGR was scheduled to reduce Medicare payments by 27.4% on Jan. 1, but Congress in December 2011 delayed the cut by two months, establishing a new deadline of March 1. The uncertainty caused by the SGR has dissuaded some physicians from accepting new Medicare patients or has prompted them to limit new appointment slots.
Federal lawmakers have continued to defer on a decision to eliminate the SGR by enacting temporary patches for the last decade, Hackbarth said. As a result, the cost of a repeal that would simply maintain current Medicare rates over 10 years has grown to $289.7 billion, according to the Congressional Budget Office. Repealing the formula and providing annual payment updates pegged to the increased costs over time of providing care would cost $352.7 billion, the CBO said.
The fiscal and political climate in Washington is not conducive to writing off these costs, Hackbarth said. The committee also has had concerns that any savings found in Medicare would continue to be used for purposes other than payment reform. For instance, the 2010 health system reform law was financed in part by more than $400 billion in Medicare cuts.
“So our fear as we discuss the SGR over the course of this calendar year is that we were getting closer and closer to the point where continuing the SGR could become a destabilizing force in the Medicare program, and hence the urgency of moving ahead with repeal,” he said.
Commissioners discussed renewing their October 2011 recommendations to Congress for repealing the SGR. One recommendation suggests that Congress replace the SGR formula with a 10-year pay freeze for primary care, while reducing payments for other services by 5.9% for three years and then holding rates steady for years four through 10.
The American Medical Association has opposed that recommendation because it says the drastic cuts and freezes to physician pay would not preserve patients' access to care. Many physicians already are facing pay cuts related to Medicare requirements on electronic prescribing, electronic medical records and quality reporting. Reducing base pay or freezing rates would leave doctors unable to care for Medicare beneficiaries and unable to transition to new payment models that better coordinate patient care, the AMA has said.