General medicine vs Internist
 

I'm looking for a doctor and was going to choose a regular family doctor. A friend told me it's better to internist. I said internist is for older people, to which she replied that I'm not exactly young and am just going to get older. I'm hoping to find a doctor for now and to keep for the long run. So, I'm asking for Dwellars' opinion to whether I should find an internist or just go with a doc in general medicine?

Demand warm hands. ;)

Ugh...Bruce, that's no help.

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As far as I've always known, an internist and a general practitioner are the same thing. An internist doesn't specialize in old people, that's geriatrics. But regardless, I think the far more important question is whether the doctor is a good one. I'd ask for name recommendations from people in your area and go with that, nevermind the specialty.

sounds like a question for orthodoc

an internist is a specialist, like a otolaryngologist (ENT doc). They specialise in internal medicine. They are not the same as a GP. I would prefer an internist over a GP, but it would not me the overriding factor in my decision.

I ain't buying it. There are plenty of places online that try to differentiate between the two, but they all give different (and conflicting) reasons. The only thing they all agree on is that Internists don't see children.

Psychiatry and dermatology are the opposite of internal diseases. And anyone who can follow up with a subspecialty is "general" enough for me. Your ENT does not have a subspecialty in dermatology, because being an ENT is already a specialty. I maintain that whatever the technical definition is or used to be, being an internist is a specialization without a practical meaning.

Wow. We see the GP our postcode determines.
I'd never even heard of an internist.

No help to you, Lola.
All I will say is when other people are offering their advice be aware of the why.
I've known some parents who consider a good Doctor to be one who gives their child medicine every time they go with a complaint. Hello? Way to make antibiotics disease resistant. Ditto anti-depressants used as a placebo. And yes, I take anti-depressants, so I am not questioning their value where necessary. But hearing someone say, "I knew today would be a hard day so I took extra Prozac [or whatever]" does make me cross.

Of course there is the flip side where a bad Doctor dismisses important symptoms. Again and again. Sadly seems more prevalent for women as they get older, so many cases of late-diagnosed cancer et al.

So just good luck and keep asking questions.
WHY is an important one.

See, I feel like I know a fair amount about the UK, but then every once in awhile a statement about your country just floors me. I cannot even fathom being assigned to a doctor based on neighborhood, and having no recourse for a second opinion. Please tell me there are at least private GPs you can go see if you choose to pay out-of-pocket, right?

General medicine vs Internist
 

Most GPs in the UK work in a practice with a number of other GPs. Although you are nominally assigned to one GP at the practice you can see any one of them you like (or who is available when you need an appointment). It can be quite hard to be seen by the same doctor all the time.
If you want a second opinion you can ask for one from the same practice.
A GP will refer you to a specialist for treatment/diagnosis that is more specialist. Some stuff at a practice is dealt with by the practice nurse (routine blood taking, things like asthma clinics/monitoring etc).
Oh, and you can always pay for private treatment, if you have the money.


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Just to throw some extra confusion into the mix ... Look for a board certified family practitioner.

Yeah, the ones I looked at are board certified. I made sure I read their bio. Talk about adding confusion to the mix, there's this one doctor with good reviews, but she's a D.O., not an M.D. What's the difference? They basically have the same training except...except....I have to do more googling. I didn't quite get it.

Oh yeah, I want a woman doctor. Few people I've asked go to a prescription happy doctor. Hmmm....I don't really like that.

Right now, I would KILL for a prescription-happy doctor of ANY speciaty.

I fired my endo for gross incompetence and arrogance. And my insurance company gerrymandered me out of my regular doctor's area and assigned me another one randomly. I have to call them and find out who it is again (I misplced the letter),, make an appt (6-8 weeks), see that doc, get referrals to another endo, make another appt (6-8 weeks again) before I can get my meds again.

I get a mite testy when off my thyroid meds. Also I run the risk of a thyroid storm again, which can be dangerous when behind the wheel.

For the patients, it means not having to sit in a waiting room with a bunch of whiny kids. :D

In the US, internists are primary care physicians who only see adults. Family practitioners see all ages, from infants to geriatrics. Both are primary care physicians.

For what you want, Lola, I would look for someone who sees women in your age range, someone who will address your concerns and who you feel comfortable with. It could be an internist or a FP.

DOs are Doctors of Osteopathy; they learn techniques of musculoskeletal manipulation in addition to medical information. They are a sort of hybrid between chiropractors and doctors and are unique to the US; there are none in Canada. MDs come from the allopathic, or traditional, medical school model.

In the US there's a great deal of variation in quality between schools of osteopathy (and to a lesser extent, between schools of medicine). Schools of osteopathy can be started on an independent, for-profit basis, and that has led to some very inadequate educational situations. There are also some respectable DO schools. In terms of traditional MD schools, there's also a variation in the US, but less than for DO schools. There's more variation in residencies (graduate training). The US spans a huge spectrum in terms of quality, from literally the best on the planet to minimally-adequate single-hospital programs.

In my experience, some prescription-happy doctors are only so because that's what the majority of their patients expect. They quite enjoy the challenge of a patient who wants to fix things without drugs if at all possible.

If you can't get a decent recommendation from a friend with similar feelings about doctors, pick a group practice relatively nearby that has several female doctors. then choose whichever one can see you soonest. If you don't like her, it's usually fairly easy to switch to another one in the same group -far less hassle than starting the hunt all over again.

Remember, if you hate them you don't have to go back, but you really should get your current issue checked out asap, and maybe get a pap smear and boob exam done too just to get it out of the way, seeing as it sound like you haven't had a physical in a while. It's going to be unpleasant whoever the doc is, so it might as well be one you may not want to see again ;)

I go to a group practice affiliated with a teaching hospital and let the internal medicine residents practice on me. They tell me what they think is causing my issue and I ask them what atypical causes there are for my presentation. Sometimes they politely leave and come back with their attending who usually comes up with something the resident hadn't considered and asks the right questions to rule it out. The residents' diagnoses stand so they feel good about themselves while they learned something. They seem to like this old military instructor who remembers how it was competing for patients to practice on (during core rotations).

Yeah, I found a group practice and trying to decide which of their female docs I want to choose. I am going to get a full check-up and get everything done. It's been over 10 years since I got a check-up. :p: Actually, I would really like to get my heart checked too, but I'm sure it's not really necessary. My heart rate occasionally would spike, but I'm sure it's due to stress.

Orthodoc: Thanks! You say DOs learn techniques of musculoskeletal manipulation. Do you know how that affects how they treat you or how it could help treat the patients?

My doctor is a DO. He is in a practice started when I was a teenager, by two other DOs. There are also a couple of MDs and PAs and NPs, and women and men so I have a choice, depending on what I'm being seen for.

In my view, I like the DOs because they look at the whole person, not just current individual symptoms. My medical history matters, and they ask a lot of questions about my life in general too. Also, I was there once for something else and my doc saw that my hips weren't exactly lined up so he cracked me in half and I felt all around better. (Really, the back cracking was awesome.)

Thanks, Infinite!

Pam - I hope you find some way to get your meds. I know how rough things can be.

Lola B - Sounds like you got your answers. I wish I was close enough to have Ortho as my doc. She is someone I have complete faith in

Thanks everyone for your inputs. I just made an appointment for Wednesday. :)

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Gettin' it over with on hump day, that's A-OK.

Um ... DOs don't have the corner on looking at the whole person. What they have is some aspects of chiropractic theory, which has no evidence-based support, and an EXTREMELY variable education in some of the aspects of allopathic medicine. Some DOs are very good, in spite of their training. Many are significantly lacking.

As an example - I attended a national convention two months ago, and signed up for a small group session on low back pain that was conducted by a DO. He told us that most low back pain is due to pelvic infirmity. He wouldn't elaborate on what he meant. He had a volunteer lie down on a table and, after palpating, triumphantly declared that the volunteer's symphysis pubis was at least 1 cm displaced. I commented that a 1 cm displacement would be easily visible on plain x-ray, correct? He replied that x-rays are always normal in spite of the 1 cm displacement. This is impossible.

He can't have it both ways; either there are measurable displacements or there are not. He admitted that no displacement that he assures his patients is present is ever provable on x-ray.

To conclude a horribly long story, Lola, I have talked with DOs, I have watched them do their manipulations, and I have done manipulations under their supervision, and not a single patient has ever felt better afterward. I don't agree that their medical training is equal to MD training. And they certainly don't have any basis for a claim to 'look at the whole person' more than an MD. My opinion is that they spend precious training time learning 'crack the back' techniques that help for a few minutes, if that, but don't do anything long-term, except get the patient to come back for more 'crack the back' stuff; and the time they spend doing this is time lost from learning more evidence-based material.

Ugh...I made the appt with the DO doc because she has the highest rating among other MDs and internists in that particular clinic. Go figure. Btw, the DO that you just described sounds like a quack. :p

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Shut up fake doc. You lie so much you don't even know when you're doing it.

I've had two DOs I was happy with, but then I didn't see them for anything serious.
Chiropractors? The first one performed miracles, then I shuffled through four who were complete charlatans, before I found another good one close to me. Both good ones were Palmer School grads, which may be significant.

:confused: I don't even ...
Have a good day, IM.

Rereading my post from last night, my statement early on that there are very good DOs gets lost in the story about the charlatan. Story notwithstanding, there ARE very good DOs. If you made an appointment with one who is highly recommended and meets your other criteria, Lola, I'd keep it.

From Wikipedia:

http://en.wikipedia.org/wiki/Compari..._United_States

I hope this sets your mind at rest, Lola, and I hope you're as happy with your physican as I have been for longer than my entire adult life.

I will come back on Wednesday to tell y'all about my experience with the doc. :)

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If they do any imaging, get copies to post in the NSFW thread.

Sounded a little like you were describing DOs as you would a family member. Love them, respect them, but they do have one tiny annoying habit. :haha:
As you said, the bigger difference is the quality of the school they attended.

Let's see. The doctor I made the appointment with earned her medical degree from Touro University College of Osteopathic Medicine in 2001. I googled the school but couldn't tell if that's a good school or not. She completed her Family Medicine internship and residency at ​Memorial Family Practice Residency Program.

I intend to get a mammogram. Is that the image you would like to see? :eyebrow: :D

I see what Infinite Monkey mean by a DO doc treating the patient as a person. The doctor was really nice and sweet. Not much going on with annual check-ups, I guess. Doc: Do you smoke? What? Do you smoke? How much? What's stressing you? Is it recent or long time ago? Then she gave me advice and consoled me on my personal problems. :lol:

Anyways, I felt comfortable with her, and I liked the facility. I need to come back for my well-woman check-up and mammogram. Waiting on the results of my blood work. :)

I hope your blood worked well.

Lola! I'm so glad it worked out for you. :)

Being proactive about your health is important. When you get that clean bill of health it's a moment of relief.

Thanks. I'm still waiting on the results. I'm going to give them a week before I nag them. :D

Infinite Monkey: Thanks for your opinion. It was really helpful. :)

LB - I'm glad you are pleased with your D.O. I think the VA has me seeing a DVM. They don't have that great of a bedside manner, but they give really big doses of meds.

Panda-sized, no doubt.

I don't know, in my experience veterinarians seem to have more empathy than people docs.

You just have to find the right doc. MDs have as many mad skillz as any others, plus the odds are better that they actually know what they're talking about.

I'd back veterinarians over DOs or DCs or midlevels any day, however.

I forgot to come back here when I received the results. The doc gave me a comprehensive blood work, including thyroid. According to the doctor, everything, including lipids, is normal, no diabetes, anemia, thyroid problem. Great. However, my cholesterol is 259. When I asked the doctor about it, she said it is only a slightly elevated number for a person my age. Eat healthy, and come back in 3 months to recheck my lipids and thyroid. Oh, okay. Am I coming back in 3 months? Nah, I don't think so. My cholesterol has been that high for years, and I don't have any symptoms of thyroid problem. What is going to change in 3 months when I'm not going to be doing anything different? If I'm "healthy" now, what does the doctor expect for me to do differently? Anyways, I personally don't feel my lipids is normal especially when I noticed my LDL level (bad cholesterol) is way over the range level. I'll deal with my cholesterol and come back next year for the annual check-up. Or not? Maybe come back in 3 years. :D

The 3 month check is to make sure what the lab reported is a steady level, which she feels is acceptable, and you're not trending.

A total cholesterol of 259 in someone your age is NOT okay, Lola. Your personal take on it is correct. That's all I can say online, where I can't give medical advice. But no, 259 is not okay. Fire this doc and find someone who will guide you to better health.

Bruce: What do you mean by trending?

Ortho: While I find this doctor super sweet and nice, I'm actually thinking of changing to someone else next year although I may stay with the same clinic. I'll see what I want to do next year. The doctor did recommend me taking the whooping cough immunization. If I do decide to take it, I can always go to the pharmacy for it to save time.

I heard there's a whooping cough epidemic and that its immunization is recommended for adults. Has anyone taken it?

That 259 could be just a snapshot of a skyrocket, you have to determine if it's moving up, down or steady.

I had the TdaP in 2010, Lola. It felt no different (no side effects) than the regular Td. The 'aP' stands for acellular Pertussis. It's not a live vaccine and cannot give you the disease.

Just realized I forgot to thank you for your response.

Anyways, I just had my mammogram the other day. Made sure I shaved my armpits and all. :lol: Anyways, I went over to the screen to look at the pix while the technician was checking them over before letting me go and everything looks fine. I was going to try and ask for copies to humor Sexobon since he asked for pics but I forgot while chatting up with her. However, Sexo, they don't look sexy! You ain't missing out. :p:

Have you considered seeing a gerontologist?

No because I'm never getting old. :cool:

very true! looking at your pics I think you are stuck at 22 or 23. I don't know how you do it.

It's the attitude, man. It's the attitude. :joint: Ah yes, remember to smile and laugh often even when you're not happy. And don't ask much to be happy. For example, you can make my day with a piece of brownie or chocolate cake. :D

You can make my day with some cheesecake, in a photo.

I want some milkshake!

Lola can have mine!

I'm waiting for Big Sarge to go into his own rendition of ...

Don't you know I'm waiting for IM?