I absolutely can't believe there isn't a mandated age on physicians like there is on airline pilots. Our cognition, speed and agility declines as we age and imo there is a time to retire. Unfortunately in my experience I have seen more than a few elderly physicians who were forced to finally retire but only after a fairly significant history of poor patient care was documented.

I personally I prefer younger providers. Not necessarily a newly minted Doc but one with a few years experience is my preference. I fully plan to retire early 60s, if I'm blessed to work that long and prefer my providers have the insight to know when it is time for them to retire also.

I, respectfully, disagree. First, I was NOT talking about "life threatening" issues.

When a patient places the call to the doctor's office, the nurse can triage if the physician needs to speak to the patient THEN, or if it can wait until later in the day. That is the only "triage" I can see of a phone call. That does not explain why the physician can not speak to the patient directly at the end of the day.

As you will note in my post, I almost lost my life due to MIS-communications by going through a third party and the information relayed back and forth not being accurate.

This only became a life-threatening issue AFTER being denied direct access to speak to the physician, which at that point in time, I DID seek care from the appropriate source as necessary for the newly created life-threatening issue that followed.

My point was if the nurse or person to whom you speak rather than the physician is incapable of answering your questions without consulting the doctor, then consulting the doctor directly, would save time as there would not be additional back and forth interruptions of the physician for questions that arise due to the responses relayed by the nurse.

One two minute conversation between doctor and patient is not only more accurate, but also more efficient than the nurse going back to the doctor with a follow-up question(s) over and over.

I do not ask to interrupt the physician. I am more than satisfied to wait for his call at HIS convenience, but I do wish to speak directly to the physician.

Just my personal requirement, based on life experiences of the past, but I feel that if the doctor is not willing to take the time to speak to me, (at his convenience) then maybe he does not care enough about me as a patient and I should seek someone that will call me personally.

Below is just ONE example of problems that arise when physicians do not speak to patients directly. This is not the one that almost cost me my life but yet another example of wasted time.

I was sent to a specialist by a physician for an opinion. My first and ONLY encounter with this specialist was a quick exam and an order for a test. I was told that we would discuss the test results and decide upon a course of action based upon the results when they came in.

I got a phone call from a nurse and was told, "The doctor said you need surgery, do you want to book it now?" Are you really thinking that I want to book some surgery, of an unknown nature, based upon this phone call? I asked if I could book an appt. to discuss the matter or at least speak to the physician. Both were denied. The ONLY option given me was to book the surgery and see the surgeon post-op.

Needless to say, that was the END of that. I sought care from another source and low and behold, I did NOT need surgery.

I value a physician's time, but I also value my life and my well-being.

I would love to hear a valid reason that a physician can not take the time to talk to a patient at the end of the day?

My question, whether stated with MY voice or the nurse's voice takes the same amount of time. The physician usually has a question for the patient so then it becomes a back and forth, constant interruption of the physician, if being conducted through a 3rd party.

Hopeless, although I agree that a personal phone call would be ideal, most doctor's offices around here have so many patients, that MD would never be able to go home and have a life. My own PCP used to be a small office. It was just him, an RN, tech and one person in the office. Of course I have no idea whether they employed any outside staff for billing, etc. Then came Obamacare. Now he has 4 nurse practitioners, 2 RNS, 2 techs, one for him and 1 for the nurse practitioners, 2 office staff and a billing service. Most appointments are with the nurse practitioners. Here in town this is widespread. The only time you talk to a physician is if you call after hours and maybe your own doctor is on call. my doctor's office will call right away if there is something really wrong with a test and you will be scheduled as his last visit of the day so you can have unlimited time with him. So I wish you good luck and I totally understand why you feel the way you do.

Yes, Doydie, there have been many changes in health care and not for the better.

I recently had surgery and when I reviewed the amount of reimbursement from insurance to the hospital and doctor, I just don't see how hospitals and doctors will be able to stay in business financially. The anesthesiologist received LESS than 10% of his bill.

With my age climbing and my health declining, I am really fearful of the future of our healthcare system. Three of my docs just made drastic changes to their practice just to cover overhead.

I guess I am just old school but I just desire my doctor to be the one with whom I communicate.

Thanks for your response. It is interesting to hear about other areas of the country and the effects outside of one's own community.

Hopeless, I feel sorry for the very elderly. My Mom was hesitant enough to have an 'exam' by her own male doctor that she had been going to for years and years. I don't know how she would have tolerated all the nurse practitioners. She also was very hesitant with foreign doctors although I have never met one who I felt uncomfortable with.

my husband had a colonoscopy done April of last year. I assume it was done by a doctor, he wasn't awake. They found out he has severe ulcerative colitis so he is at the office a lot. A nurse practitioner has seen him every single time he has been in, every single time. If he hadn't gotten meningitis and we didn't know if the infection was going to interfere with his upcoming IV treatment for the colitis, I don't know if we ever would have seen him again. And the charge to see the NP is the same as seeing the doctor. But those NPs are smart as a tack. I would trust them any day. Plus the are very personable.

Hi Doydie,

Enjoyed reading your last post very much. I find that the older I get, the less I like change. So far, I have only seen two nurse practitioners and the first encounter was only because I had a simple acute problem and it was "faster" to get to see them, than a physician. It was quite a few years ago when they were just starting to appear on the scene. I had a terrible ear ache and saw the NP. One of the WORST encounters I ever had with a medical professional. The bedside manner was atrocious and I am not sure about the expertise but it was something that simply needed a prescription for ear drops so how difficult could that be for anyone. She pulled on my ear, jammed the scope inside, grabbed my chin and nearly gave me whiplash, and when she hurt me, she chastised me for pulling away from her. I had been treated on many occasions for the very same thing by physicians and NEVER had them hurt me like she did.

My second encounter was with a PA in the office of one of my specialists. I now ask to book my appt. with her, rather than the physician for anything that is routine. She is VERY smart and has a little better bedside manner than the doc. The doc's manner is fine, the PA's is just a little better. When I first met her, I wasn't sure she was old enough to be in high school. Tiny and cute as a bug, but it sure makes her look much younger than her years. (Lucky girl) She probably doesn't think so at this stage in time as it is probably hard to be taken seriously when you look so young, but if she continues to appear younger than her age as time goes on, she will be very appreciative. Sorry about the side-track.

And as you mentioned, the co-pay for me is the same as for a physician and so is the reimbursement rate from the insurance company. I just do not understand that. If I were a physician, I would not be happy about that. A physician DOES have more training and should be compensated as such, not at the same rate.

At the large medical institutions, there seems to be a big move toward more PA's and NP's in my area but you can still see a physician in smaller clinics. The number of smaller clinics are being swallowed up by the bigger ones so finding a "doc" may become more difficult in the near future in my area.

I love the nurse practitioners, but then I'm biased about them. My aunt that lives across the street is one of the best NP's in Omaha. (she gets awards all the time, and just about every NP in town that I've talked to knows who she is).

So, I'm kind of lucky, when I have something that I think might be serious, or is at least concerning me more than usual. I call up my aunt, tell her what's going on, ask if I should be concerned. She'll tell me what's probably happening. What they'll do to treat the problem, and if I can wait on it or not.

She can't treat me, because she's a family member, but at least she's helpful so I know how to ask for something, or what to expect. She also interprets medical tests for me. Something that I can hardly ever get the people at the doctor's offices to do for me.

She has sort of treated me a couple of times. She took stitches out of my hand for me when I sliced my hand open back in my 20s working at Burger King. Saved me from having to go to the doctor to get the stitches removed. It was kind of weird to find out back then that she keeps a stash of scalpels, and has a massive stash of all sorts of bandages, splints, a stitch kit, surgical super glue.

She's diagnosed a bunch of things for me before I went to the doctor to get officially diagnosed. She told me I had mononucleosis (PA at the doctor's office went on to misdiagnose me with a sinus infection, gave me an antibiotic that you're not supposed to give to a person with mono. Now I'm forever considered allergic to that antibiotic). She's explained things about MS, and other stuff so that I could understand it.

When I was having a lot of weird issues this winter, my aunt said she wondered what my thyroid and vit D levels were. So when I went to see the NP at the doctor's office the next day, I waited until the NP suggested that she test for the thyroid and vit D before I told her about my aunt, and that it was what she suggested too. Told the NP that I think they're really good at diagnosing patients because they seem to actually listen to the patients complaints. Because you know what was wrong with me that time? I was so vit D deficient that it barely registered on the blood test. I'm still deficient (just had it tested two days ago). So I'm still taking vit D supplements.

My regular doctor's office has several NP's. One of them worked with my aunt, so I really prefer to see the NP's if I can't see my doctor. I don't like the other doctor's at his office. So if it's not Dr C, I want one of the two awesome NP's. Or, I'll accept Kathy, the RN. Kathy is Dr C's nurse, and the one I want to talk to if I ever need anything from him, and can't get in to see him. Next to Dr C, Kathy is probably my other favorite person at his office.

I changed my insurance just so I could keep my doctor. (because I like my doctor, was told I could keep him if I liked him. So, as soon as I could follow him to his new office I did)

Dear Erin,

Oh, how lucky you are to have your Aunt. There have been so many times I wish I had a family member like that so I could ask questions that no one else has time to answer.

Will you share her with me? The house next door to me is for sale. She could move in and then I would have the access you have.

I was so glad when I encountered the PA to whom I referred in my prior post, otherwise, I would have been left with a very bad general impression from the NP I had seen for my earache.

I really enjoyed reading about your experiences and your aunt. I am a little envious.

I believe there is a place for PA's and NP's, but I don't want to replace docs completely.

Every situation is different and the quality of care is not always consistent with the initials behind one's name. Sometimes, better care comes with a PA or NP than with some docs. Other times, I would want a doc to be making the judgment. Not all docs are good docs so I look for the best care, not just the initials behind the name.

I chose my insurer based upon the docs I would be allowed to see, --- the ones I wanted and needed to be in the "network". One of the 8 was not in network so I was cash pay to see that doc. When I needed surgery, I had to change docs as I could not afford the "cash pay" bill. That all worked out for the best in the long run as I like the NEW doc even more, AND the other doc just changed networks, again.

There are no guarantees that an insurer will not change the make-up of the network, nor that the doc will want to stay in the network. The patient is subject to the choices of the providers and the insurer when it comes to "networks" and their choices can change at any time.

I am very OLD school and prefer the simpler times when the patient had more choice and option. If you liked your doc, then you could see him no matter what insurance you had. Yes, I am going WAY back. (To times before HMO's ever came about, before networks ever existed. Not to mention more recent changes to health care in the USA.)

Got any other medical relatives you can send my way?

Thanks for your post. I really enjoyed reading it.

So Starz.......have you had any luck finding a doctor? Have you thought about Shepherd Center in Atlanta?

We really, really like our PCP. We have been with him from the time he finished his residency training and started his own practice. But apparently he does to much and insurance carriers don't like him. If there is a skin tag or small lesion to be removed, her does it. A diabetics nails need to be trimmed, he does it. He doesn't immediately refer you to a specialist for something that he was trained to do so insurance companies are dropping him as a provider. Our specialist co-pay is $45 but since he is our PCP we are charged $35 each time we see him. To us it is worth it to stay with him especially since my husband has so many illnesses now. He has 5 specialists now and we feel Dr. C can just put the whole picture together for us. But it's still bad that he is punished for doing things he was trained to do.