Is anyone else really sick of being forced to see Physician Assistants and Nurse Practitioners when you go to see a DOCTOR?

That’s never happened to me. But if you have a common problem, they should be able to help you or determine that you need more advanced care.

I am, too, OP. They're fine for small things, but I had to use the office PA for my annual physical and my annual cardiology appointment. The cardiology PA was...lacking, to say the least.

And you guys want the government to run our health care. Feds will have you being screened by ghetto Boqueshias before being seen by nurses/doctors.

You think that's bad? My last prostate exam was performed by a Home Depot day laborer.

I went to my knee surgeon for shots in my knee. When the PS showed up to do it, I was skeptical. It hurt like fucking hell, which never happened with the doctor. After that, whenever I make an appointment there, I tell then I want an appointment with the doctor and no one else. What nonsense!

It's good to see here that the American Medical Association is pushing back on the trend of Nurse Practitioners going into totally independent practice. The profession is essentially bossy ass nurses. According to this article, many are beginning to refer to themselves as "doctor" which is confusing patients and angering physicians. An NP has a "doctorate of nursing". It's kind of like Jill Biden having a "doctorate" but not being the typical type of academic doctoral graduate. They're all very educated professions but there's a thin line with this stuff that some are apparently beginning to cross.

Sorry. link

Obamacare is what happened…. Insurance companies made more money and reduced physician reimbursements. Doctors needed to see more patients to cover the same if not more costs associated with healthcare (e.g. the government mandate to have an electronic medical record system). With only so much capacity to provide care, they’ve been forced into hiring physician replacements.

Unhappy about it? Write to your senator and congress people to break up the insurance monopolies that are working against providing healthcare and for increasing returns for their shareholders.

OP IS ANGRY AND WANTS HER DAD'S COPAY BACK!

(As well as the private mobile number of Nurse Practitioner Dan)

I've had enough of my time and money wasted by inept NPs (who, among other things, order a lot of unnecessary testing) that I generally won't see them anymore. An exception is the NP at my rheumatologist's office who handles medication-monitoring checkups where all that's done is a quick physical exam and routine blood draw.

What you want from any type of healthcare provider is someone who knows what they don't know, and that's unfortunately been a blind spot for most of the NPs I've seen as a patient. It doesn't matter as much when the issues are minor, but if you have anything complex going on it can be a roll of the dice.

He's cute though.

Well R9.... You're half right. Bitch. ;)

Yeah, I'm tired of it. The office now basically keeps my doctor from seeing many of his patients. I'm also tired of having to try to 'qualify' for an appointment, running the gauntlet of the people on the phone, and to keep telling my story to them all.

Just before lockdowns, I got something in my foot. I mentioned it to my physician during my visit (for something else). He went and got a kit, had me show him the spot, and he removed the splinter of plastic.

A couple of months ago I had something in my foot again. After the series of back and forth phone calls, I was told by the Nurse Prac that the office doesn't do that, go to Urgent Care. Four hours and an x-ray later, Urgent Care said they don't do that. Told me to make an appt with a podiatrist. Had to call about 8 of them before I got the appt, 2 weeks in the future. Cost me a lot to see the specialist, who removed it.

This is not progress.

SOrry R11, not him. And you really shouldn't be doing that to that guy.

[quote]I'm also tired of having to try to 'qualify' for an appointment, running the gauntlet of the people on the phone, and to keep telling my story to them all.

YES. THIS. This is what keeps happening! These office fraus who've become gatekeeper nazi's. You essentially have to tell them ALL of your private business and they seem to have some power or influence who or if you are seen. This shit needs to stop. It really does.

My PCP is a PA. I had no choice in who was assigned to me. At my last physical, the PA's assistant did most of the work. The PA came it at the end and reviewed the results. Appointments with the specialists are scheduled out months in advance. Too bad if you can't happen to make the appointment when you've already waited six months to get in to see a specialist.

R4, 😄😄😄😄

R13, wear shoes maybe?

If Marcus Welby MD were around today, the whole show would consist of him sitting in his office while a Nurse Practitioner sees his patients. On the rare occasion when he sees a patient, Marcus would refer them to a specialist.

In my case, no, because my Doc isn't very personable.

When I get my knee shots, I hope PA Nick is who gives them to me. He's gorgeous, funny, kind, and I love when he touches the back of my knee. And I haven't been this close to someone who has such nice hair in decades.

As long as her fat ass can prescribe the good stuff, I don’t rally care. I definitely prefer a tall, sexy doctor though whenever I can get it, tho.

The Physician Assistant or Nurse Practitioner enters with her computer, takes my blood pressure, weight on the scale and tells me the doctor will be in shortly, he arrives computer in hand, takes my blood pressure, inquires about my medication, and decides another appointment is needed in x months. My Medicare Notice arrive and I see two listings for that visit, both amounts paid.

I changed doctors because of this. They also want multiple televisits to charge my insurance company. Called the insurance company only to find out the nurse charged insurance at doctors rate. The new scam

Worse when they force you to see the DO instead of an MD.

[quote] And you guys want the government to run our health care. Feds will have you being screened by ghetto Boqueshias before being seen by nurses/doctors.

BS.

Who is asking for a government run health care. No One. We're asking for universal healthcare that is funded by government--you know, like Medicare.

[quote]Worse when they force you to see the DO instead of an MD.

They’re the same thing and have the same training.

[quote] Obamacare is what happened…. Insurance companies made more money and reduced physician reimbursements. Doctors needed to see more patients to cover the same if not more costs associated with healthcare (e.g. the government mandate to have an electronic medical record system). With only so much capacity to provide care, they’ve been forced into hiring physician replacements.

Prior to Obamacare, we had 15% uninsured, which meant when you take 15% of people out of the healthcare marketplace, fewer people means everyone can get everything. The problem is that didn't lead to better health outcomes. Doing alot of tests led to alot of drugs and procedures, but the big chronic diseases like hypertension and diabetes didn't get much better.

The use of PAs and NPs as screeners leaves the most complex cases to MDs. Medical care is learned by doing it over and over, and often, a doctor's right hand man/woman is a very experienced PA or NP. They know what they're doing.

There are new medical schools popping up to train more docs but that will take a while to graduate more docs.

R27, I agree, but DO's mainly couldnt get into MD schools

The quality of care is more important than the credentials of the provider. Experience & attitude matter too.

Wrong, I could get into MD schools in the Caribbean if I wanted the MD letters that much.

It's kind of absurd. My doctors office switched physicians and it was months before I even met him.

Doctor shortage in many parts of U. S. contributing factor

[quote]Doing alot of tests led to alot of drugs

Oh, DEAR!

[quote]And you guys want the government to run our health care. Feds will have you being screened by ghetto Boqueshias before being seen by nurses/doctors.

[quote]Who is asking for a government run health care. No One. We're asking for universal healthcare that is funded by government--you know, like Medicare.

Also, as someone from a country with universal health care, I have NEVER experienced what the OP is talking about here, I don't even exactly understand why that would be a thing at all.

Also, this:

[quote]I'm also tired of having to try to 'qualify' for an appointment, running the gauntlet of the people on the phone, and to keep telling my story to them all.

Never experienced this either.

This all sounds horrendous.

no mater who you see you are charged the price of seeing a Dr. It is a scam.

This has been standard practice at the VA for years. I don’t mind if they can prescribe. Also I think VAs are training places where new doctors start so there’s a huge turnaround.

There are not enough physicians (MD or DO) and very few physicians go into primary care. So yes basic primary care is largely going to be handled by PAs and NPs.

The way it works and is going to keep heading that direction is actual doctors are specialists that handle the more complicated cases.

[Quote]The use of PAs and NPs as screeners leaves the most complex cases to MDs

This.that said I can't argue that there is a level of intelligence when you are talking to a real physician that you often don't see with a NP/PA.

OP, you must have one of those cheap managed care insurance companies, I live in shitsville and never experienced this.

Most NPs are smug insufferable cunts who think they are better than everyone else in the healthcare field.

[quote] I used to work in healthcare and I know that a lot of medical office people eventually think they know all kinds of things about medicine.

I agree with you, OP. It's also true for my area of specialization (history). I was a professor and became a teacher. Some teachers think they know as much as actual professors, but they really, really don't. I just smile and nod-- I mean, I don't give a shit. But it's infinitely worse in medicine. No matter how much experience a nurse or PA has, they lack the higher level training and study that MDs go through. Somewhat surprisingly to me, MDs always have treated me with utmost respect when they find out I am a Ph.D.

PAs are always at least a tiny bit white trashy.

You can just tell there was a pit pony involved somewhere in the not too distant past.

R31, that is not reassuring.

I always check where my doctors went to med school. Dr. Rico Copacabana can lambada on someone else’s dime.

[quote]You can just tell there was a pit pony involved somewhere in the not too distant past.

A what now?

Flippant, arrogant, and of course overworked those P As, but good luck finding a physician in bumbfuck

R25 A DO has the same education/training as an MD and has nothing to do w/ inadequate schooling.

By the way Physicians Assistants now call themselves Physician Associates (still PA)

I’ve had docs that were DOs and I’ve had MD’s that were Caribbean trained—they were both very good actually

Doctor on Demand

Yesterday, I called to make an appointment with a dermatologist (a DERMATOLOGIST) everyone in the "group" was booked until October 3rd (OCTOBER 3RD). What the fuck!?

Years ago, I kept telling the doctor I was seeing that I didn’t feel right. He was a nice guy, but he would just chat, tell me to take my shirt off, and basically just wanted to put me on antidepressants. Never any tests. I kept feeling horrible and one day called and begged to come in for an appointment. Since it was last minute, they had me see the NP. After listening to me for a few minutes, she sent me for an ultrasound that day. 3 days later, I was having my gallbladder removed. I was lucky she took me seriously. I never went back to that doctor.

My experience with my physician's current NP is her appointments are no more than 10 minutes long, if that. And first you have to see *her* assistant, who then reports to the NP everything you've told her so the NP can have the shortest possible interaction with you, apparently. Also, she tends to talk way more than she listens. By contrast, the doctor usually will take 45 minutes to an hour with me. He also makes me wait an hour (because he takes a long time with everyone) but I actually don't mind if I get that kind of attention.

I recently moved and was only able to find a NP as my primary.

But you know what? She spent a half hour listening to my history and discussing my last blood work (the nurse for my primary care doctor relayed that “the doctor said it all looks fine” without discussing why, when some of the numbers were high).

Honestly, there’s a lot to be said for having access to someone who has time to discuss my situation.

And when and if I develop more serious concerns, I can seek out specialists.

I'm OK with general practices using NP and PAs. Most things a primary care doctor can handle should and can be handled by them.

But a specialized thing, or a more complicated case, should default to a doctor. The NP/PA can triage the case, do fact finding and present findings to the doctor, but the doctor should actually see you for 5 minutes.

[quote] My experience with my physician's current NP is her appointments are no more than 10 minutes long, if that. And first you have to see *her* assistant, who then reports to the NP everything you've told her so the NP can have the shortest possible interaction with you, apparently. Also, she tends to talk way more than she listens. By contrast, the doctor usually will take 45 minutes to an hour with me. He also makes me wait an hour (because he takes a long time with everyone) but I actually don't mind if I get that kind of attention.

That's unusual because my experience is precisely the opposite and has been for years at various practices. The NP or PA is usually willing to spend far more time with me, while the doctor comes in, looks, nods, pokes me, asks a few questions and then goes to the next patient. (He's like a top in Dawson's 50 load weekend, but not nearly as hot - poke me and move on to the next one.)

I have a PA who does my annual wellness visit. He is phenomenal. Good listener. Had a bad Cologuard and referred me to a GI physician. Had Two colonoscopies, removed a non spreading cancerous polyp, AFTER I had a 90 minute medical history taken by his LPN. She is likewise phenomenal. Because of my history taken by the LPN, the Dr ordered an endoscopy . And discovered esophageal ulcers. They are now healing. My GI wanted to get a view of the neighborhood and ordered an abdominal CT scan. My GI LPN, read my results, and said that everything was looking good but that I should discuss a couple of enlarged abdominal lymph nodes that showed up on the CT Scan with my PCP. Probably something that might need to be monitored. Love her

I have a UHC Medicare Advantage plan and could not be happier.

NP's are paid roughly 1/3 of what an MD makes. Simple economics at work.

The trick is to find a MD > NP >PA > RN > LPN > MA team that actually works well together and which is strongly led by the MD. Unfortunately managing people is not something taught in medical school.

R6 Not all NPs have doctorates, they can have a master's. A DNP - doctor of nursing practice - is what you're thinking of, and they do have doctoral degrees, just not in medicine.

This is when DL is valuable--because I've started running into this same phenomenon. I had an appt. with my dermatologist who was a new person. Fine. On my follow-up I talked to another new person, who asked me questions and left, after telling me my "provider" would soon be in. Then I heard her right outside the door, telling my "provider" everything I'd just told HER. WTF???? Then the"provider" came in for a brief visit. Finally I realized that my "provider" wasn't a doctor at all--I don't know what she is--a nurse practitioner? Or something?

WHAT is going on?????

Also, these people are not doctor-like at all. They are humorless and just want information. Then they leave.

Heaven help us all.

Mid-level providers are perfectly valid and many can prescribe medicine. A PA has a four-year undergrad degree plus a family medicine PA has a master's program with clinicals, involving 26-30 months of course work. If you specialize in something like OB, Emergency, etc that is additional training. An OB NP master's program with clinicals is 27 months. These providers are trained to treat, diagnose and prescribe in their field.

Formerly, in CA NP's were not allowed to practice without physician oversight on premises. However, that law recently changed (2020). A PA traditionally has been allowed to practice without physician oversight. They are licensed by a state board, just like nurses and physicians.

You don't need a surgeon for routine family, geriatric or OB/GYN wellness medicine.

A real issue is that the old school, thorough, strong bedside manner physicians, are getting old and retiring. Covid accelerated this immensely as did the ever changing and increasingly bureaucratic reporting and practice expectations.

Are your patients getting their flu shots or colonoscopies? Follow up visits within three days post hospitalization? How are you rated: on time, friendly, all questions answered? Did you meet your appointment quota? If not why not. Explain in detail any overtime. You get a scorecard monthly and then take time out of your practice day to hold meetings to review the data. Eventually you dedicate up to a third of your nursing staff to JUST MAKE SURE YOU HAVE GOOD NUMBERS which then starts to drive medical practice. Wring every possible efficiency you can and then reduce staff to match.

The problem of course is that patients are actual humans: who want to talk, ask questions, are scared/angry/confused. And unlike an actual widget factory your day is never smooth and the unexpected always happens. Tell your medical staff long enough that the numbers matter more than care and they will eventually believe you- then get resentful as hell when the patient doesn't follow OUR rules and expectations. Going the extra mile, running less standard tests, reaching out to check on a worrisome patient, taking 15-20 minutes to thoroughly explain and comfort--- are now not expected and often discouraged. Medicine on the assembly line.

OP, no one is going to do anything with your father at his age unless he is dealing with something spreading fast, and even then it would be better not to make his last year(s) more miserable.

ALL men get prostate cancer eventually, if they live long enough, and something else usually kills them before the prostate cancer does once they're over 80.

Giving injections / using a needle is a skill that depends on the person. My dentist is horrible at giving novocaine shots. When I donated blood on a regular basis, I could tell the difference between the people who drew the blood. Some were very good at it (no pain), others were more ham-handed (painful & slow extraction of blood).

And none of that training is equivalent to going through medical school and residency r60.

PAs and NPs are medical professionals, but they are not physicians. There is a difference.

I didn't say they were, R64. And I stand by my point you don't always have to be seen by a physician. If you need a specialist or surgeon - then yes. When you do "see" a family MD or DO they spend about 5 minutes with you, 10 tops, the whole time charting on their computer, barely looking at you. So, I'm not that impressed by the difference.

[quote]And you guys want the government to run our health care.

You mean like every other country in the world? Yeah, that's crazy.

Unfortunately, most of us live in America, where our health care system most closely resembles the Hunger Games crossed with a hedge fund.

I have had some bad experiences with PAs too. The last one I had kept telling me that I had a heart murmur. I told her it was my lungs and that she was hearing not my heart. She kept insisting I go to the heart doctor. So I went to the heart doctor and he could not find anything. I said it is my lungs. Meanwhile, she put me on statins and I couldn't tolerate them. My muscles hurt and I had brain fog and other symptoms and would not take them anymore. She got really mad at me. Even though the heart doctor said my heart was fine she ordered more heart tests saying I had a heart murmur. She sent me back to the cardiologist and he couldn't find anything again so I complained to him that the PA wouldn't listen to me and I had terrible breathing problems. Finally, I got a call from a lung doctor that was referred to me by the cardiologist and the lung doctor said I had 3rd stage COPD. After that, I demanded a real doctor and they gave me one. The PA was extremely bossy. She isn't there anymore. The PA I had before her was always trying to push alternative medicine and herbs.

I refuse to see a fuckin’ NP. One time my dr’s office tried to get me too see one of those bitches. I told them no fucking way am I gonna see that bitch.

I see an NP for dermatology. (I had a suspicious mole removed a while back, so I have to go on a regular basis.) He's great and really checks my entire body / skin for changes (moles, etc.).

r70 is he hot?

R71, yes, he's nice-looking. Very kind and caring, as well.

He’s getting off on seeing you naked.

This fucking heat is turning me into a raging bitch.

My NP for derm is nice but very Johnny Weir.

....

r68 regarding Statins.

My mom had open-heart surgery and was put on statins and had a HORRIBLE muscle reaction. My mom had lead legs, could not move them.

She was taken off of them and the side effects disappeared.

Six months later, he wanted to place her on statins again, BUT he wanted her to acclimate to them gradually.

one pill the first month, two pills the second month, then one pill a week for two months, then two and then three and finally one pill a day near the sixth month. NO PROBLEMS!

We love our NP & have gotten more work done the past year than in the past ten years with Kaiser, who absolutely refused to see/treat us during the pandemic; we nearly bought the farm with Covid but escaped from LA after 42 years to the mountain in SoCal; she has correctly followed through on extracorporeal shock wave lithotripsy for my partner, has successfully controlled his diabetes; I’ve had a colonoscopy/polyp removal, abdomen MRI for prostate issues, bladder imaging, correct diagnosis/treatment of cataracts, and lots of labs. All the work was done by specialists; it would have taken literally years for Kaiser to get any of it done. We do miss the “one stop” Kaiser convenience, but it’s so refreshing to return to getting real results from specialists. We even found a great dentist—the thing out here is that you have to really be aggressive/take charge of your own care & be demanding—no one will do it for you.

My PCP is excellent, takes time with me to listen to what I have to say about my general health and any symptoms, then explains his advice to me so I understand the reasons as well as the directions. I often have a long wait, but I know that's because he's taking the same care with others and don't mind at all. His practice used to have a great nursing staff (except for the one doddering ancient who used to apply the blood pressure cuff like a tourniquet and get ridiculously over-inflated BP numbers—if my resting blood pressure were 160/115 I'd feel it pounding in my ears and temples!), but all the old familiar faces have retired or moved on, and I haven't gotten much of a feel for the new ones yet. The front-of-office administrative staff are a revolving door of incompetents and people who obviously don't want to be there, but at least once I clear that hurdle the actual medical care is good.

I had a great PCP for years, but his practice was bought out by a corporation. They promoted him to manage a region of clinics, so he (overnight) stopped seeing patients. He had a rather odd and emotionally blank NP who took over seeing patients, at which point I found another PCP. A couple of weeks later, I got an email from my insurance company that visits to that NP were no longer being covered. A couple of weeks after that, I got an email from my former doctor's office that she was gone. I wonder what happened, but glad I left.

R77 I Don't have any reason to be on satins I don't have heart problems. My Cholesterol is fine. They seem to push statins on everyone after a certain age but they can cause permanent damage to you. I can understand it if someone has heart problems and they are supposed to help you from having a second heart attack but I have read that they don't really help with anything if your heart is in good shape.

My guess is, because of the general shortage of docs, especially in rural and inner city areas and the financial issues, that, in the future, primary care will be done by NP’s and PA’s.

Only complex primary care and specialties will be performed by doctors.

[Quote] When you do "see" a family MD or DO they spend about 5 minutes with you, 10 tops, the whole time charting on their computer, barely looking at you.

You hit it on the head.

America’s doctor payment system incentivized seeing as many patients as possible, doing as many procedures as possible, and spending as little time with each person as possible. No where is there any incentive to make people who are sick better.

Apparently American doctors write 300% more in their electronic medical record charts than their European counterparts. This is because only in the US, does the number of diagnoses and procedures lead to the final billing amount.

I feel like I spend 90% of my office visit watching my doctor type. It’s awkward.

I have a physician assistant and I don't feel that the care is even close to that of a decent physician. I swear she speaks from rehearsed scripts or something. I don't even know the proper way to address her. I call her doctor, but she is not.

Just call her ma’am, or sir.

I’ve noticed this seems to have started over the past 10 years. It used to be you only saw a NP/PA if the doctor was out sick or on vacation, but now they always act like the doctor is booked up for months and encourage you to see a NP/PA. This can’t be a coincidence.

I will say that thankfully my PA for my general practitioner is amazing and one of the best medical professionals I have ever had treat me, so I am lucky.

Forget about the physicians, In some areas of the country even the PAs are booked up months in advance. Kind of off subject, but there’s a shortage of veterinarians now, so book early for routine pet care…

It doesn’t matter how long DOs, PAs or NPs train, their training is laughable.

DOs are trained by other DOs, who couldn’t get into medical school themselves, and who don’t have that extra amount of intelligence or ambition to succeed. When is the last time a DO win a Nobel Prize, published in prestigious medics journals, innovated the field? Not often.

Nurse practitioners are trained by other nurses. They may be great at following protocols, but they don’t think like doctors.

PAs do rotations with medicinal students, but are treated with kid gloves. No one really considers them part of the team and no one has any expectations of them. They may see how medicine “works” but they are not the same as a doctor.

If you want the best care, see an American-trained MD. If you need a simple lab test or a medication refill, anyone is fine.

This rather feels like people asking for a 4-star chef at McDonalds, or perhaps more grossly entitled pricks, wanting a real chef to work at McDonalds. But oblivious to the standards and practices of McDonalds that render it moot. Besides, when they're on lunch break, they just want to their food served in a timely matter and not sweat the details.

Those concerned about it are the types that leave bad reviews for perceived personal slights and neglect it when the service goes above and beyond their expectations. You see, most people are cunts. Hence, why so few MDs stay in any one place.. well, that and the people that want the best care, also, tend to want it at the lowest price. Hence, they eat out at McDonalds and then bitch about the 1% - which is basically anyone that earns more money than they do... like their precious doctors. Heck, we could break this down even further on all the tirades to the crowd that screams demands for universal healthcare, if you want to see how much more of a shitshow this can all be.

I would say as a np or former np, and one in a situation where the bulk of the employees have been on strike since December, (and not entirely sure I have any desire to go back.) that largely I was just viewed as a prescription pad and filler wherever needed. And, that was with shadowing an MD directly. He was the only person in his specialty at the hospital and out-patient clinic. The standard time to see him directly in the hospital was weighted by need but averaged once a month per client. Out-patient, once every six months, but this is a relatively small area - the national average is once per year. . . and that's where NPs come in. Now, not every NP is cut from the same cloth. . . most are FNPs which are a dime a dozen; the most prolific because they come from the most generalized programs which tend to be focused on family practice but it's low background diversity with most taking the usual route of rn to np with few detours. . . not a lot of standouts in the crowd and a lack of diversity in professional experience. Though covid did shake some things up with the shortage and a few radicals were swept in the tsunami of demand. . .

If we're going from sheer economics. . . here medical professionals only make a fraction of what we would be our worth in other locations. This is another prominent factor that relates to why there are so few MDs to go around as well as why so few NPs stay in any one area. . . most cities, public or private, can't afford to pay for our services. I have anchors which keep me here but the difference in pay is 130% for the top cities in my field with my level of experience and education.

I doubt the insurance companies have different payments if you saw a physician, a PA or a NP.

That’s what gets me. I’m paying (they’re paying) for a god damn doctor. Why aren’t I seeing a doctor?

Insurance companies pay less for mid-level provider visits; that's the primary reason they love NPs and PAs.

Is that right?

Then I stand corrected. I truly had no idea.

Yes, not only do insurance companies pay less (as does Medicare), large health systems don't have to pay as much to employ NPs and PAs as they do doctors. Some major systems have, in fact, almost completely replaced their primary care docs with NPs and PAs.

If you notice new office equipment or the very latest in everything while sitting in the doctor's waiting room, you know they are going to push all sorts of tests to be done even if you don't need them. Someone has to pay for all those office upgrades.

I scribed (did the typing) for a primary care MD at the start of my nursing career and I must say SHOULD be the future of health care. The MD could actually focus on the patient as I noted symptoms. He could then dictate the bulk of his notes as he responded to their concerns. As he noted patient instructions or RX's i would order them in real time. At the end of the visit he would turn to me and ask, 'is there anything i missed?" which was a great way of circling back to any topic the patient had told me- then forgot to mention to the doc.

Of course my notes were closely reviewed and I had to adapt to the doc's style. What really helped is that I actually felt a part of the visit (my satisfaction) and felt ownership of that person's care. It also built bonds between us as a health care team and our patients. Corny I know- but it felt like 'family'

Then the healthcare system decided it cost too much and killed the program