[Villages PL]

Have we been lulled into complacency by those who would model themselves after a fictional doctor and say, "trust us, we know what's best for you?"

In last Sunday's Daily Sun there were about 12 questions or points that the new doctors had to measure up to. Things like, "were they good students in medical school and would they relate or interact well with other doctors and patients." Do they enjoy or love their work? It seemed as though the questions covered all the bases.

But there's no indication that anyone is asking this all important question: Do you (or will you) like working with patients who are old and sickly. How do you feel about old people in general? Do you value them? Would you look upon a 90 year old patient as having a future, or would you look upon that person as having lived long enough already? As a family doctor, what do you know about the special needs of the elderly? You haven't specialized in Geriatrics, so what makes you think you will know everything that you need to know to provide the best possible care?

A doctor could have had the best grades all through medical school and that still wouldn't make him or her a geriatrician. In order to become a doctor one must have a superb memory but a GP can't remember something that hasn't been learned in the first place. Specialties exist for a reason but will we be told we can have any specialist we need as long as it's not a geriatrician?

I propose that each clinic have at least one geriatrician. We have been told that what's new about these clinics is that they will put the patient first, rather than money or the welfare of the attending GP. If they really mean it, why shouldn't they provide doctors who are specially trained to care for those who have reached an advanced age?

[misky]

Originally Posted by Villages PL

Have we been lulled into complacency by those who would model themselves after a fictional doctor and say, "trust us, we know what's best for you?"

In last Sunday's Daily Sun there were about 12 questions or points that the new doctors had to measure up to. Things like, "were they good students in medical school and would they relate or interact well with other doctors and patients." Do they enjoy or love their work? It seemed as though the questions covered all the bases.

But there's no indication that anyone is asking this all important question: Do you (or will you) like working with patients who are old and sickly. How do you feel about old people in general? Do you value them? Would you look upon a 90 year old patient as having a future, or would you look upon that person as having lived long enough already? As a family doctor, what do you know about the special needs of the elderly? You haven't specialized in Geriatrics, so what makes you think you will know everything that you need to know to provide the best possible care?

A doctor could have had the best grades all through medical school and that still wouldn't make him or her a geriatrician. In order to become a doctor one must have a superb memory but but a GP can't remember something that hasn't been learned in the first place. Specialties exist for a reason but will we be told we can have any specialist we need as long as it's not a geriatrician?

I propose that each clinic have at least one geriatrician. We have been told that what's new about these clinics is that they will put the patient first, rather than money or the welfare of the attending GP. If they really meant it, why shouldn't they provide doctors who are specially trained to care for those who have reached an advanced age?

I believe these facilities are based on the Mayo and Cleveland clinics. So, I'm not concerned about what name they use. I would guess that any doctor considering on working in these Villages facilities would realize that the patients would be older.

[ilovetv]

But there's no indication that anyone is asking this all important question: Do you (or will you) like working with patients who are old and sickly. How do you feel about old people in general? Do you value them? Would you look upon a 90 year old patient as having a future, or would you look upon that person as having lived long enough already? As a family doctor, what do you know about the special needs of the elderly? You haven't specialized in Geriatrics, so what makes you think you will know everything that you need to know to provide the best possible care?

By choosing internal medicine as their specialty years before this, they have chosen to specialize in the specialty that takes care of the elderly and branches out into geriatrician subspecialty, and that's why the others did not choose that specialty.

And by applying for the job in this community of 100,000 people over 55, it's quite obvious the applicants know what the patient population will be.

And by the way, I think we all know that the "Marcus Welby" label is just like the jingle, "Pop Pop Fizz Fizz Oh What a Relief it IS" that Alka Seltzer ran on television and radio in the 1960's. The point is......we REMEMBER it and what the product was/is.

[Villages PL]

Originally Posted by misky

I believe these facilities are based on the Mayo and Cleveland clinics. So, I'm not concerned about what name they use. I would guess that any doctor considering on working in these Villages facilities would realize that the patients would be older.

I've been reading all the articles in the Daily Sun and went to most of the U.S.F. lectures and I have never heard that the clinics will be based on the Mayo & Cleveland clinics. Instead, what they have been saying is that this is going to be something totally new.

Yes, doctors can well imagine that their patients will be somewhat older but that doesn't mean that it shouldn't be part of the interview to see how they respond. There were other questions on the list where the answers could also be assumed but they still ask them to see how the applicant responds.

Do the Mayo & Cleavland clinics employ geriatricians? Maybe they do or maybe they don't, I don't know. But I'm asking about The Villages Clinics. Why has there never been any mention of hiring geriatricians?

[Bogie Shooter]

[QUOTE=Villages PL;694553]I've been reading all the articles in the Daily Sun and went to most of the U.S.F. lectures and I have never heard that the clinics will be based on the Mayo & Cleveland clinics. Instead, what they have been saying is that this is going to be something totally new.

Yes, doctors can well imagine that their patients will be somewhat older but that doesn't mean that it shouldn't be part of the interview to see how they respond. There were other questions on the list where the answers could also be assumed but they still ask them to see how the applicant responds.

Do the Mayo & Cleavland clinics employ geriatricians? Maybe they do or maybe they don't, I don't know. But I'm asking about The Villages Clinics. Why has there never been any mention of hiring geriatricians?[/QUOTE]

This would have been an excellant question to ask at one of the "most lectures" you attended.................probably better answered there than posters guessing on TOTV.

[Mudder]

I happen to agree with you, VillagePL. I noticed in one of the interviews the physician said he enjoys getting to know the whole family and watching them grow, etc.... my thought was , well that will not be the case in The Villages at all. There are so many differences in older people as oppossed to younger people, I hope they will be aware of those differences. One thing that comes to mind is medication dosage, what's good for a 35 year old may not be correct for a 65 year old. If I decide to go to one of the health centers I will be asking about the experience level with older people. I do think these centers are a step in the right direction, we'll have to wait and see.

[ilovetv]

I'm pretty sure that the only similarity to Mayo Clinic or Cleveland Clinic mentioned as a template for the new TV medical home clinics is: That the physicians would be paid a decent salary instead of having to try to stay solvent in private practice relying mostly on Medicare payments that are under actual cost of running a practice.

Salaried pay is where similarities would end, I think, considering the research and residents in training who treat the patients at Mayo......

"Mayo Clinic in Rochester is a 1,595-physician group practice which, along with Rochester Methodist Hospital and Saint Marys Hospital, form an integrated medical center in Rochester, Minn. offering comprehensive diagnostic and treatment services.

World-class programs in medical education and research enhance the quality of patient-care.

Facts and Figures (based on 2010 data)

Personnel
Staff physicians and scientists: 2,016
Residents, fellows and temporary professionals: 2,789
Allied health staff (clinic & hospital): 27,544
Total: 32,349

Patients
Unique patients: 334,000
Outpatient visits: 1.46 million"

Mayo Clinic in Minnesota - Mayo School of Graduate Medical Education - Mayo Clinic

[gomoho]

I believe the "geriatric question" is legitimate and have never seen it addressed in all the blah, blah, blah that has been in he Daily Sun.

[Villages PL]

Bogie Shooter: This would have been an excellant question to ask at one of the "most lectures" you attended.................probably better answered there than posters guessing on TOTV.

Well, of course. I was at the lecture that was given by the doctor who is now in charge of all the Villages Clinics. There were lots of questions that day and I got caught up in listening. I'm not sure if I had even thought of that question back then. That was quite a while ago. By the way, nothing was said about care for those of an advanced age....the frail elderly.

[Villages PL]

Originally Posted by Mudder

I happen to agree with you, VillagePL. I noticed in one of the interviews the physician said he enjoys getting to know the whole family and watching them grow, etc.... my thought was , well that will not be the case in The Villages at all.

I was thinking the same thing. Many of these doctors have experience with whole families and are not from retirement communities. They may have had some older patients but how good were they at taking care of them?

There are so many differences in older people as oppossed to younger people, I hope they will be aware of those differences. One thing that comes to mind is medication dosage, what's good for a 35 year old may not be correct for a 65 year old.

That's right. There's a long long list of medications that should never be given to older patients. Gerontologists are aware of this but not all family doctors are. I read about a survey that was done to prove it but I don't remember where I read it. The dosage is another thing that's important, even for vitamins.

I first got tested for vitamin D3 because I read that most older people are deficient. Was the doctor aware of most older people being deficient? I don't think so because I was going to him for a couple of years and he never included it on my blood test. So I had to ask for it and sure enough I was very very low. 30 would be normal and I was at 8. So he suggested I take a large dosage of 50,000 IU weekly, presumably to catch up. But, thankfully, he forgot to give me a prescription for it. It was way more than I would have been able to tolerate. I bought some over the counter and found from experience that I can only tolerate about 600 IU per day. And that's the standard amount that's recommended in most vitamin books.

If I decide to go to one of the health centers I will be asking about the experience level with older people. I do think these centers are a step in the right direction, we'll have to wait and see.

Yes, good for you for your willingness to ask, but I doubt they will ever admit that they don't have enough experience. And if we wait to see, all the doctors will be hired and it will be too late.

[Villages PL]

Originally Posted by gomoho

I believe the "geriatric question" is legitimate and have never seen it addressed in all the blah, blah, blah that has been in he Daily Sun.

Several years ago, when my aunt was still living, I was visiting her in south florida and she asked me if I wanted to go with her to her doctors appointment. I gladly agreed to go. While we were in the waiting room we started a conversation and she started telling me how expensive her medications were ($500.00 per month). I asked, "how many medications are you taking?", and she said, "6". I was amazed to hear that.

I told her that each drug is tested separately for safety. But when you take several drugs in combination, it can be risky. There's usually a risk for liver or kidney failure, especially for an older person. And I asked her to ask her doctor if there might be a way to cut down. And she said, "Oh, he's a GOOD doctor and I trust him, he wouldn't give me anything that would hurt me. So that was the end of that conversation.

A few years later, she suffered kidney failure. When your kidneys fail, you're not allowed to take any drugs at all. And one of the drugs she had been taking was a cancer drug. So, without the cancer drug, the cancer came back and it wasn't long before she died.

This is what happens when people say, "Oh, I trust my doctor!" And they won't even consider alternatives. Her son was and still is a doctor of pharmacy living in another state. I even asked her to check with her son but she said she didn't want to bother him.

I think there would be a lot less kidney and liver failure for seniors if they were in the care of geriatricians, not to mention other conditions that may come about from drug interactions.

[jrandall]

I have one of the great "Marcus Welby" doctors and she is terrific. Instead of being so skeptical and anticipating failure instead of success, consider either trying one of the doctors or just wait and see how others that are going to these doctors feel about their experiences. I am very satisfied with the Colony Care Center, doctors, staff, and attention I have received.

[fb32162]

Excellent points. I find it facinating how much they promote that these doctors are salaried and not paid based on percentage of charges. What most people don't understand is salaried physicians typically receive what has been dubbed "pay for performance" bonuses. They get financial bonuses for a variety of things. Some receive financial rewards for good HEDIS (Healthcare Effectiveness Data and Information Set) scores which measures the quality of the care they deliver. Unfortunately they also often receive bonuses for keeping referrals to specialists low, keeping hospital admissions at a set number, or limiting expensive lab or diagnostic tests. Having worked in health care administration most of my career and I always ask any provider I see if they have any financial incentives to limit the number of referrals to specialists or for testing? If they say yes, I ask what is the time frame of these measures? Monthly? Quarterly? and then schedule my visits accordingly. (You'd be surprised how many more lab tests are ordered or referrals to specialists made at the beginning of the measuring period vs towards the end, when the provider knows they have exceeded or are close to exceeding their expected numbers). There are pros and cons to every system used to compensate medical providers. As a patient, I simply want to understand what system my provider is under so that I can manage my care accordingly.

[gomoho]

and I always ask any provider I see if they have any financial incentives to limit the number of referrals to specialists or for testing?

I would be amazed if any doctor would honestly answer that question!

[Jerseygirl08]

I agree gomoho. I can't imagine any doctor would answer this question honestly. I can't even imagine a doctor being hired to work at one of the clinics WITHOUT extensive
senior care experience. I personally would prefer a NP who specializes in Geriactrics; a specialist who loves working with seniors. I think the biggest problem with the doctors in and around TV is they expect a certain kind of "senior" and what they get is a patient who is assertive and challenges them and some just don't like working with that kind of patient. I can think of a few doc's right away - I've seen or someone I know has seen. It will be interesting to see how it plays out.