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An under appreciated asset: The General Practitioner


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Our medical world grows in complexity. There are now doctors with titles like thoracic oncologists and interventional radiologists. All this specialization has a place in our increasingly convoluted world of unpronounceable drugs and obtuse procedures. Amid this world of complicatedness toils the general or family practice physician. In my mind, they are the most important physician in the medical system. Why?

Last night at about 7:30 PM, I was notified that my first dose of COVID vaccine would arrive at my GP's clinic today. Moreover, the practice nurse would contact me today (and did) scheduling my injection. Think about that. An after hours call from a real human being (my GPs wife) who was making many phone calls getting the word out. One won't get that kind of care and attention from a "Minute Clinic."

General medicine is an important resource for everyone; it is vital for lung cancer survivors. Audition one soon!

Stay the course.

Tom 

 

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Thoracic oncologists and interventional radiologists? I saw one today and will see one next week. They both have large departments with schedulers, nurses, PAs and expensive equipment. Talk about an overkill that keeps our health care cost skyrocketing with no end in site.  What makes things worse, the more they specialize the slower they get. Adding more people is a sure way of adding deficiencies and administrative overhead.  

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8 minutes ago, GaryG said:

Thoracic oncologists and interventional radiologists? I saw one today and will see one next week. They both have large departments with schedulers, nurses, PAs and expensive equipment. Talk about an overkill that keeps our health care cost skyrocketing with no end in site.  What makes things worse, the more they specialize the slower they get. Adding more people is a sure way of adding deficiencies and administrative overhead.  

All the more reason for us to be our own advocates and caretakers. IMHO

 

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Rock and Roll Dude!  Very excited for you to get vaccinated!!  Whoo hoo.   Totally agree with your perspective on primary care physicians.   It's the sole reason we switched PCP's last year.  As the pandemic was starting last February, we got on a seven month waiting list to transfer to KU.  Now that we're finally established, I'm relieved to have all my medical care under "one roof".   

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Excellent post sir. An old time GP was the first one to recognize my son had some serious issues. He immediately called OHSU and had us take him in ASAP.

The result of that single move got my son diagnosed within days and treatment started within a week. I firmly believe that saved my sons life because it wasn't an easy diagnosis.  My son is a fine man now and completely healthy.

Bless all good GP's. Wish I had one now...😶

Peace

Tom

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Congrats, Tom! I just "registered" for NJ's vaccine program, and the only question I could say "yes" to was whether I'd EVER had one or more of numerous conditions, including obesity. So how does having a history (non-current) of obesity--or cancer, for that matter--necessarily suggest where you should be in the queue? There were no followup questions (e.g., which specific condition, how long ago, how severe, what type of cancer). All it said at the end was that I was eligible for a "later" phase. Seems to me someone currently under treatment for lung cancer with chemo is a lot more concerning than, say, having a history of smoking (but quitting 30 years ago).

I think I'll have a better shot (so to speak) in PA if Penn pushes to get all its lung cancer patients vaccinated. Till then, just gotta hang in there and remain cautious.

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Lexie,

Texas published vaccine eligibility guidelines here. As defined by those guidelines, my category was 1b, so I was allowed a vaccination.

I would think New Jersey would be way ahead of us in devising its roll-out plan.

Stay the course.

Tom

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Jersey looks like a total cluster.  My Mom doesn’t use a computer for anything & won’t let my Dad schedule any medical appointments on her behalf.  
Each town is designated to a “local” vaccination center.  Somehow my parents town was aligned with a center about 40 minutes away while there is a closer center about 15 minutes away.  Given my Mom doesn’t drive anymore & Dad is pretty local (coming up on 80 years), I don’t see how this is going to work out right now.  The parents will probably wait until the vaccine is available at CVS.   Total craziness! 

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My prediction....they should have started and will end up...give the vaccine to as many people as possible as soon as possible and forget about targeting a subgroup.

Just my opinion 

Peace

Tom

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I can't understand why this is so difficult. Isn't everyone managing logistics distribution by spreadsheet these days? Today I found a spreadsheet on the Texas Dept. of Health website. This data shows every vaccinating location in the state with the number of doses received in week 4 of the roll out. This will be published each week so citizens know where to go to receive doses.

Why given these modern tools is communicating availability so hard?

Stay the course.

Tom

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Congrats to you Tom...glad to hear it.  In NC Phase 1b is everyone 75+.  People like me are in Phase 2 and there is no plan for when and how.  In addition, my PCP won't be administering the vaccine, it's all being done via a couple of the medical conglomerates here (and likely pharmacies later).  There is talk here about prioritizing "essential workers"...to my mind that is a tricky proposition.  It could mean a 19 year old kid working at the supermarket would get it before folks like me (us).  We'll see how it all comes out, but glad you're getting yours now.

Lou

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Huh. I just got an email this evening from Cooper Hospital (where I was previously getting my cancer treatment), telling me that NJ has JUST changed the guidelines and that, starting tomorrow, adults between 16 and 64 who have certain conditions (including cancer) can get the vaccine.

By the time I was able to get to the schedule, Jan 29 was the earliest available appointment. And I can get it at the community college right up the road from me. 

I was sure it was gonna be weeks/months till they got around to us. Nice to get some good news!

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I'm glad I jumped on this last night when I did. It occurred to me this morning to post the info on FB and the NextDoor app, for those who might not have gotten an email, and one of my friends told me March was the earliest she could get an appointment. 

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It took 25 minutes to get the shot. 10 minutes to fill the papers and receive the shot and the rest a mandatory 15mn wait after the shot to make sure there is no side effects. You also get a bottle of water and a snack to boot. I was very impressed by the organization and efficiency of everybody involved. The cancer center where I receive my treatment is top notch personnel wise. Everybody id friendly, knowledgeable  and accommodating. The only knock is there is always waiting involved before appointments. Hey, we can't have it all.

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I got my first dose of the vaccine the last week of December. My husband and I registered with the county - we thought - as a placeholder. We both had appointments within days. I won't complain because I'm very fortunate to have received the vaccine but it was a mess. I was able to stand for 3 hours but there were seniors there who had issues. Line was outside with NO place to sit. I'm scheduled to get my second dose in a couple of weeks. 

I am thankful that the vaccine rollout - as rough as it is - is underway.

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I just heard from one of my task force members at KDHE that even though I live in the most populated county, we received the fewest amount of vaccines.  In fact some of the frontier counties got more vaccines than actual residents.  This left those frontier health departments scrambling with how to manage the excess supply and no ability to ship to the eastern side of the state.  Seriously you can’t make this stuff up!   

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And then, of course, we now learn that some of this "opening up" of eligibility criteria was based on a supposed hold-back of second doses by the feds. Which they were supposedly going to release so more people could be vaccinated and which, it turns out, no longer exists.

No, you COULDN'T make this sh*t up (as we used to say when I was a prosecutor).

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Well, NJ hasn't yet announced that they can't distribute vaccines as scheduled (so far, at least), which hopefully suggests they expect to have them on hand from a reliable source. 

Apparently I will be getting the Moderna vaccine, which means the second dose will be 28 days later, rather than three weeks.

Fine by me--the Moderna vaccine isn't as much of a challenge to store, so fewer opportunities for it to go bad.

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To clarify the "held back" doses, I believe that was cleared.up. The manufacturers have them in storage not the FEDs. And they have 10s of millions because we are not the only customer. All they need is a ship to.

And to those who are so frustrated please consider the difficulty of the task. As a manufacturer in industry for the majority of my career, and a very diverse history, I can tell you two FACTS. First, the plan never goes as planned and usually the problems are end of pipe issues. Second, the last mile (final delivery) is almost always the most expensive and difficult.

And the CDC guidelines are naive I have been a proponent of mass vaccination without many targeted groups. If the goal is jabs in the arm you would get a lot more. That would be my desire.  By having stringent targets you throw a whole lot of worthless gunk into a simple process. Think that is the direction we are headed.

I have been involved in 5 very large projects. Only one was flawless and it had few outside stakeholders. The rest were all disasters on initial roll out. Funny thing is, a year later all were considered great sucesses.

So please have some compassion for those poor slobs rolling this out. They were DOA because the talking heads ignored the last mile. They never had a chance and we do not want to demoralize them. Nothing good comes from that.

Call me...waiting patiently.

A bonus prediction (Guessing mid to late Feb) we will be awash with doses and jabbers. I'll get mine then.

Peace

Tom

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