Some physicians also feeling the pain of dropping incomes

[Guest]

I was diagnosed last August with cancer and I do not yet qualify for treatment. The standard care for my type of cancer is to take blood test every 3 months until I do qualify for treatment. I "should" have had blood drawn in March. But, I didn't go to the lab for blood draw due to the "shelter in place" order where I live...

Labs are considered essential services, and people should still go there. They're probably safer than the grocery stores, where some assholes bring their snotty coughing kids. Unlike grocery stores, the labs have the ability to sanitize after each patient and truly maintain "social distance" between patients. I was somewhat surprised to find out that I was still required to get my car smog checked (registration is due in early May). I suspect that one of the biggest helpful aspects of the shelter in place is closing the schools, since children spread colds like wildfire (Covid-19 is essentially just a really bad cold). I would discourage people from avoiding needed lab tests, especially for potentially serious health issues such as yours. Good luck to you!

[+ Charlie]

My spouse and I both had appointments this month for cleaning at the dentist. Today I got a call saying the appts must be rescheduled. The earliest I could get for my spouse is in July, and for me it's the 1st of September. I'll be flossing and brushing assiduously this summer.

 

My spouse also has an appt in two weeks with the neurologist who monitors his Alzheimer's. I wonder how they will handle that. I don't know whether telemed will work.

[+ nycman]

Don't cry for me Argentina.

 

There are plenty of shifts available in the Emergency Department and Intensive Care.

 

Come on down!

[Rudynate]

I doubt a doctor would do a virtual visit for someone they have not already examined. However, I can tell you how valuable they have been for me since I got Kaiser -- and not just since this pandemic started. When I had Blue Shield insurance, every little thing required a trip to the doctor's office (where I always had to wait way past my appointment time for the doctor and where, of course, I had to pay a copay). Need to review the results of labs and potentially start treatment with something? Go to the office just to get a prescription. Have an ongoing issue like asthma and need another inhaler? Go to the office to get a new prescription. Have a concern that you might have an STD? Go to the office just to express that concern in person, and then get referred to a lab for screening. With Kaiser, my lab results are posted on their website. My doctor will message me if something is of concern, and I can order a prescription to be delivered via mail if I need something. If I need a refill of something, I can request it on the website and it either gets filled (if there are refills available) or a message is sent to the doctor requesting him to authorize refills. For something like STD screening, I assume that if the patient's report is murky a provider might want that patient to come in first for screening, but most STDs require lab work and not just visual inspection anyway. Why not just have the person go to the lab?

 

I have saved a lot of time and money by switching to Kaiser and feel like I get better care. My doctor is responsive. I can see him (or someone else) if I want, usually the same or the next day -- I'm talking pre-pandemic here; I think right now they are trying to keep everyone away who doesn't absolutely need to be seen right now -- but if the delivery of care can be done via message, phone call, or video call then I can do that as well to save everyone time and money. I think the difference is that Kaiser doctors are employees of Kaiser and get paid the same whether they see you in person or provide care in some other way. There is no financial incentive for a doctor to insist that someone come into the office for something as simple as getting lab results. For providers, I can see this has a downside -- if you have a busy independent practice, I assume you can make much more money than you would as a Kaiser doctor. For a patient, however, I see no downside. I always had difficulty finding a doctor I liked who was accepting new patients when I had other coverage, and once I was an established patient it was frequently difficult to get an appointment without waiting at least a few days if not a week.

 

 

Kaiser Physicians are not employees of Kaiser. They are all members of the Permanente Medical Group, which contracts with the Kaiser Foundation Health Plan to provide care for Health Plan members

[Rudynate]

My spouse and I both had appointments this month for cleaning at the dentist. Today I got a call saying the appts must be rescheduled. The earliest I could get for my spouse is in July, and for me it's the 1st of September. I'll be flossing and brushing assiduously this summer.

 

My spouse also has an appt in two weeks with the neurologist who monitors his Alzheimer's. I wonder how they will handle that. I don't know whether telemed will work.

 

 

I had an appointment for cleaning a couple days before the Bay Area lockdown was announced. My dentist called me on a Sunday and asked me if I wanted to keep the appointment. That was when things had begun to get scary and I said no. He said he would be back in touch to reschedule.

[+ Charlie]

I had an appointment for cleaning a couple days before the Bay Area lockdown was announced. My dentist called me on a Sunday and asked me if I wanted to keep the appointment. That was when things had begun to get scary and I said no. He said he would be back in touch to reschedule.

And has he been back in touch?

[handiacefailure]

I was lucky enough to have my cleaning with my dentist right before all this happened. I had an eye doctor appt two weeks ago and they rescheduled to June. eye doctors have to really be hurting right now. My endocronologist appt is in two weeks anxc will be done electronically and that will be interesting since he does an A1C which is crucial for diabetics when they check my stats and wont have that number and also checks feet which he won't be able to do. At least they won't be able to see how much weight I gained during this:)

 

There's a couple that lives in my building that are both residents and he is a Urologist and she's an ortho doctor and he was telling me the other day when I ran into him in the lobby that they are only seeing urgent cases. They are both at a teaching hospital and all the corono testing and cases are going there and he said if it keeps up most of them will be pulled to the ER and if that happend his wife is going to stay at her parents house (they are snow birds and staying in florida until this is under control) and he's going to stay at their place here because they're going to isolate.

 

My GP sent out an email saying she is handling all visits through telemed if possible.

[Rudynate]

And has he been back in touch?

 

No. But if you think about it, the safety measures for dental procedures are going to have to be completely re-imagined. Im not in a hurry to get back into the dentist's office.

[+ purplekow]

I was lucky enough to have my cleaning with my dentist right before all this happened. I had an eye doctor appt two weeks ago and they rescheduled to June. eye doctors have to really be hurting right now. My endocronologist appt is in two weeks anxc will be done electronically and that will be interesting since he does an A1C which is crucial for diabetics when they check my stats and wont have that number and also checks feet which he won't be able to do. At least they won't be able to see how much weight I gained during this:)

 

There's a couple that lives in my building that are both residents and he is a Urologist and she's an ortho doctor and he was telling me the other day when I ran into him in the lobby that they are only seeing urgent cases. They are both at a teaching hospital and all the corono testing and cases are going there and he said if it keeps up most of them will be pulled to the ER and if that happend his wife is going to stay at her parents house (they are snow birds and staying in florida until this is under control) and he's going to stay at their place here because they're going to isolate.

 

My GP sent out an email saying she is handling all visits through telemed if possible.

At the hospital at which I work, the residents in orthopedics, surgery, pediatrics and pathology are being trained as back up to the medical residents They spend one week shadowing a medical resident. There is no elective surgery so the surgical residents are doing emergency care and minor procedures on hospital in patients as well as placing central venous access. OB GYN residents are still caring for obstetric cases but only emergency GYN is being done, Orthopedic residents and surgical residents in particular are generally felt to be a rather smug group. This down in the trenches without the glory of the OR has helped increase camaraderie among the residents. That would not have been my guess when they first started this.

One thing that has been very problematic is for non-covid patients who are discharged from the hospital, follow up clinic is not available. The clinic has been closed and is doing telemedicine or established patients, but new patients are more difficult to fit into the system. Also, patients who need post hospital testing has been a challenge. We are working through it but it is ever-changing in an attempt to find something that works well.

[+ purplekow]

I have a regular meeting with the Chief of Medicine to discuss ongoing issues in this crisis. One thing he has mentioned to me on more than one occasion is that surgeons in particular are desperate as they try to keep their practices going. They are laying off staff and without income or with decreased income, they are having difficulty meeting rent, insurance payments for malpractice and health, and maintaining their households. Most of these doctors live opulent lives by average standards, so I am not asking for charitable donations or for a telethon. but rather an understanding that even the well off among us may be suffering financially,

[+ WilliamM]

I was diagnosed last August with cancer and I do not yet qualify for treatment. The standard care for my type of cancer is to take blood test every 3 months until I do qualify for treatment. I "should" have had blood drawn in March. But, I didn't go to the lab for blood draw due to the "shelter in place" order where I live.

 

Got a call on Friday from my oncologist. He set up an appointment for me to go to his office for the blood draw. He emphasized that only me and lab tech would be in his office (no other patients). He also said that all rooms used are thoroughly sanitized after each patient.

 

We then set up a phone visit (2 days after the blood draw) to review the results. I think this is a perfect way to deal with this cancer issue. Also have a telecon with my PCC the same day for Rx renewals.

 

God speed. Traffic that you shared with everyone.

[Rudynate]

but rather an understanding that even the well off among us may be suffering financially,

 

 

Even to the extent of having to reinvent themselves.

[mike carey]

Even to the extent of having to reinvent themselves.

All of us tend to adjust our lifestyles to match a reliable income at whatever level that might be, so reinvention after a sudden change of circumstances can be difficult especially with expenses that are fixed like mortgages and fixed expenses on properties. It's never impossible, but it can be difficult.

[Guest]

Even to the extent of having to reinvent themselves.

Maybe all of us will wind up reinventing ourselves before it’s over. But no one is helping the high income person do so. Even the biggest gold rush in modern history - the CARES Act - limits subsidy to those with incomes of $100K or less. It is what it is...but the observation is relevant when coupled with the reality as noted by @mike carey above.

 

and remember, high income and wealth are two different things. high income may lead to wealth, but in a high tax environment, it takes a long time to make wealth. Wealthy people will be able to make money out of the CARES Act gold rush...but high income people may not even break even.