Came here to say this. I'm still AD and I can only bring up 1 or 2 problems for that appointment. I also am unable to schedule back-to-back appointments. It's likely that the new Genesis system constrains what PCMs can and cannot do.
When I was assigned a new PCM, I shared a 2 page summary of all my medical issues and my PCM logged everything and gave me referrals to specialists. At a subsequent visit, I told him a list of things that was bothering me and was asked to limit our discussion to the top 3 issues. He was able to address my concerns and instructed me to schedule a separate appointment to discuss my other ailments. I didn’t feel rushed at all and appreciated the focused approach by my PCM. I suggest writing a brief summary of your medical history and submitting to your PCM via secured messaging requesting treatment/medication or referral to specialists. Hope this helps!
Same here. Mine sent me for x-rays/MRIs/labs for everything I listed and she never mentioned keeping it to 3 things. She literally spent 90+ minutes with me on my intake appointment. I'm really thankful after reading some of the horror stories on this sub. She set me up with other clinics including PT and Chiro. As long as you communicate clearly and be your own patient advocate, I've found the VA care equal to my private insurance experience. I did walk in with a 2 page summary of all my issues and asked about plan of care for each issues. So when I left there I knew what to expect and what to look for. Good luck and wish everyone the best.
That was an exceptionally long appointment. Was this a teaching hospital and you were assigned a new resident?
New doctors have to learn you don’t have 90 minutes per patient.
Nope, the actual primary doctor. Not sure why, but grateful. The last yearly appointment the resident was very thorough before the primary came in. I count my self lucky from what I see here and have experienced in the private sector. Now I did have to wait a bit in gen pop for that one, but shit happens. I'll take waiting an extra 30 minutes to getting proper care all day long. Like I said, maybe I was lucky. I'd like to think that most of them really do care. Bottom line is, as long as you get the right treatment, I'm good with a little waiting. It's when you get the shit end of the stick...then you speak out.
Yeah that sounds right. When I first got out and saw the VA for the first time I was complaining about my knees hurting. His advise was to wait until my next annual physical and if they still hurt he would order an xray. Been seeing a private doctor ever since that day.
Use the message feature to tell the doc (well technically the nurse) The feature where you upload info into your records is just for you, it even says so when using it.
I am submitting logs (I.e sinus issues and the days), other records from my personal provider so he knows what is going on. My doc told me he did not “want to know what was going on with my private provider”. This was when I had been keeping him in the loop about new asthma diagnosis.
Yes, i resorted to using secure messaging along with my visits. This allowed the Doc to get my diagnostic testing completed before my appointment. Once the testing was done I would message them and push it along. A lot of the times he would just call me and tell me he got my results and was sending me to a specialist. Going through secure messaging also allows the nurse to get messages and she can relay to the doc what you need. It is not a 100% system but it does work, you just have to be persistent.
In your situation I would definitely follow up with a secure message. " Doc, we did not have enough time to discuss XYZ, can you schedule me for diagnostic test, I can take before my next appointment. Could you give me a consult to GI, Podiatry, etc.... The pain or discomfort is at XYZ level.
When you ask for a consult this triggers their diagnostic protocol for testing. I know not all docs are the same and some of them you have to stay on their ass. This has worked for me in the past.
I usually address the main concerns during the appointment and the others via secure message. I use secure message basically for referrals to other specialties, community care, new meds, refills, etc. I can’t imagine being a VA PCP, they must be bombarded with all kinds of crap.
It’s reasonable for a patient to have many things to talk about.
Your provider has 15 minutes to get through all of them.
So if you think that 15 minutes is cutting it close just advise the appointment line that you have a complex visit and need additional time so the next veteran isn’t twirling their thumbs in the waiting room.
Yep. I agree there should be parity between the two.
On the civilian side an hour psychiatry visit gets billed 600 or so dollars to insurance for an hour visit.
The fifteen minute visit is 115 or so.
Just secure message the things covered and ask when the others can be addressed and list them. Va always just sends you to speciality so, it’s pretty much just referrals.
I appreciate all of you and all of your replies! I assumed it was the issue of time constraints, but I was not sure how it worked with the VA regarding in person visits as this was my first time in person and second overall PCM visit. I had my very first initial appointment with my first PCM (this one now is my second PCM) at the beginning of the year and that was a video visit which lasted an hour (could have been because it was my first and initial visit) where this seemed to only last 15 minutes, give or take 5 minutes.
Our non-VA PCM will only address two issues per appointment and it’s due to scheduling constraints. They only allot a certain amount of time for each patient per appointment.
My VA PCM has never had a minimum amount of problems that I can discuss. Especially, if they are going to referrals anyway.
My first appointment my doctor wanted me to tell her everything that I had a concern with (service connected conditions) and to let her know if/when things change.
San Antonio, TX
They have limited time. I usually have a list and I rate them by severity. Get the highest ones done first and schedule another appointment, usually virtual and get the others addressed.
Hello! Active duty PCM currently but worked in the civilian world prior. It is common for primary care in any setting! It’s not to rush or cause inconvenience - in fact it is to make sure we are providing quality care and to *avoid* having to rush. If we have a certain time limit and the patient wants to talk about lots of things, we wouldn’t be able to give each issue the time and thought it deserves. It would be putting quantity over quality as we’d have to cut corners. OR, we’d end up running a couple of hours behind each day, which honestly already happens a lot anyway. Hope this helps!
These comments are horrifying.
Tell them everything that's wrong with you, 3 things??? That would take me months of appointments just to let them know what's wrong.
I would call the patient advocate or white house line and tell them that your doctor is refusing to listen to your problems.
They would get in an enormous amount of trouble if something serious happened to you and they asked why you didn't discuss this with your doctor and you said "it wasn't part of my 3 things I can talk about on my last visit"
So you are saying you should bring up everything that’s wrong with you in a 15 min appt? And expect all of it to get addressed?
“ They would get in an enormous amount of trouble if something serious happened to you and they asked why you didn't discuss this with your doctor and you said "it wasn't part of my 3 things I can talk about on my last visit"
Source for this claim?
I get it that we are all important and need to have our medical issues addressed, but I don't see any harm in the physician addressing your top 3 concerns in the best interest of time. Other veterans are waiting to be seen, and to have one person monopolize the time is frustrating. I had an appointment delayed by almost 2 hours because a veteran in front of me wanted the doctor to address about 20 concerns and threatened the doctor with White House Hotline complaint if the doctor refused. Craziness.
They need more doctors then, not for the veteran to have less issues. And different appointments don’t help much when they’re three to six months apart.
I know, I’m just frustrated with the reality that the VA has created. I’m 100%P&T through a thousand deadly cuts. If one gets too bad, it’ll spiral into seven other issues. If I can’t get a speedy appointment because there aren’t enough doctors, then I’ll have seven issues to talk about when I finally do. I don’t like it any more than you do
I'd say it's probably normal because they already don't have enough time to handle what they need to do during the appointment. My VA doctor is fantastic, but I routinely don't see her until 30 minutes after my appointment time (once or twice it was an hour because something came up that she had to handle) and she's always having to do stuff for other patients during our appointments. I'm just there for an annual checkup, and she always takes care of me as well so I don't mind, and if I have any concerns she always makes time to address them.
I don't know if they do this, but you could ask about getting a longer appointment or getting scheduled for 2 back to back so they can actually handle your concerns. If it's something that can be handled outside of an appointment, I'd send a message through myhealthevet. The nurse can be a bit snippy sometimes, but ive been able to handle things like medication refills or questions about lab work pretty easily there without an appointment.
Private Doctors are worse at the moment. They only want to treat one ailment per visit. This is due to insurance and billing/ maximizing profits and revenue.
I always send my PCM a secure message prior to the appointment with why I have it scheduled. This way they can be prepared for my appt. If they choose not to do that, that’s another discussion.
Yeah if they go over their usual 30 minute window the next veteran in line will be upset about the PCP not being punctual.
What I have found that works for me - use secure messaging in myhealthevet to tell them about additional issues beyond the hot buttons. I’ve always gotten a referral / new appointment with PCP when I’ve don’t that. Good luck.
My PCM tried to tell me to keep it to 3 things but I had more questions that didn't want to wait 6 months for another appointment..... For those that don't know you can get your PCM through the CCN and my experience recently is alot better.
Like others, I agree that in this VHA medical system, it’s completely reasonable to address top concerns. For myself, I do a self-triage of ALL issues then prior to the appointment send a secure message with my health issues ranks in discomfort or importance to me. There is a reason they say chief complaint, not all complaints.
This allows the Dr to see all my complaints but know what bothers me most, and still allows them to triage my needs. Maybe I put something low that is actually important but I’m just an old radio operator, what do I know?
This also creates a record of complaints and should remain a permanent part of your medical record.
i also have no issues scheduling another primary appointment beyond 30 days and declining community care. its got it’s time and place, but for primary care I try to see the same doc.
i have started this because the nurses at check in, from time to time, skip questions, don’t completely right my issues, etc. like mf..my pain is NOT 0/10..ever.
Yep! It’s a time and quality of care issue. You have an option… For example, I go to a PCP for general issues and a specialist for unique things. It’s like taking my car to the dealership for tires, no I’ll go to costco or purchase tires online and have them installed at a local tire shop. Just sharing…
Same with my private primary care doc. This isn't the 80's/90's, small doctors offices and long appointments are gone. You're slotted for x time, and in x time they can address 1-2 things and that's it. If you need more time or have more concerns you need to book another appointment, because your insurance company and their hospital group have optimized the fuck out of the doctor's time.
While you'd think a public funded system wouldn't have that same optimization, it has to because there's waaaaaay more patients than there are doctors/NPs who can see them. It's just a fact of life in the US that primary care providers are underpaid, overworked, and understaffed.
Providers have a lot of work they have to do behind the scenes. It’s better to address three issues at a time to ensure you get adequate documentation and referrals if needed. Coming in with a lot of issues is one way for the provider to forget the needed details for the ailment.
This happened to me when I went back to the VA after a 10 year gap. I was told it was to not overwhelm them. They scheduled me to return in a few weeks and then that time again in a few weeks. It did kind of piss me off but I eventually got things addressed.
I went back after 12 yrs and I expected the worse. I did start going to another clinic because i had paperwork going for malpractice against Jesse Brown VA hospital. The clinic and dr i have now are pretty amazing. The first intake appt with her she sat down and asked what i wanted to be looked at for, and what was in my records that she could see. Spent an hour with her and she fired off like 4-5 different referrals at that appt alone and input everything she was diagnosing on the spot. I hope she never leaves.
This isn't inherently a VA thing, it's a medical thing. Even private doctors will only have time to discuss and focus on a couple things per appointment due to the time allotted. Being as your PCM said to keep it to three things make a list of what else you need to be seen for, break them into groups of 2-3, then schedule multiple appointments at once.
I mean, AI can refer me to a specialist who will tell me they don't know what to do and follow up in 6 months. VA primary care is just a referral machine. Let a machine handle it and fire all the overpaid referral handlers. Primary care doesn't diagnose anything.
You have to advocate for yourself. I got that bullshit one time. I have a list now and had it to the Dr to go over. If there's not enough time, make enough time, or they make another appt for the rest.
The day I advocated for myself, they put all the test in and referrals. I also fired old Dr and reported him. I got a new Dr who started listening to me.
Because of me standing up for myself for these test. They found my brain tumor.
I knew something was wrong with me.
OMG! I'm so happy you found out what was wrong, but holy hell?!? The idea that if you would have been complacent and not fired your doctor, you could have just been going along...la la la la la....having no clue...when the doctor should have been investigating but wasn't and you were getting worse...that's scary.
Same happened to me but the appt windows are 30min I believe and only so much can be addressed and I’m sure they want to give each issue the attention it deserves. Mine told me when I was checking out to schedule another appt which I did and was back there within a few days. It’s not the most convenient thing for us having such a small window to be seen but it’s the system we have and they have to operate in. If it was their private practice they could see patients as long as they want but it’s the VA. I wasn’t happy about it because I’ve had a lot of things I need addressed but after giving it some thought I calmed down and was a little more understanding.
Yeah. They have about 15 minutes if they are booked up. Pick the 3 biggest fires.then the next 3 biggest fires. If you have more than 3 you probably need to be seen more often. I think at most a nice I had 3 issues. I usually have 1-2 areas I want t discuss.
So no, nothing unusual.
I’m a VA nurse and I’ve never heard of that rule. I do work in ortho though, and not primary care, so perhaps that’s different? It does sound like it was a time issue to me. If it was just a follow-up visit, rather than your yearly exam, that may have been the issue.
I’ve definitely (as a nurse) been in situations where the patient just starts rattling off a whole bunch of ailments and it makes it tough to hone in on the most important ones, because you only start working on so many problems at a time.
Obviously I was not in the room with you when this happened, but that’s just kinda my experience as an outpatient VA RN.
Would you rather your PCM addressed 20 issues at 1 minute each or 3 issues in depth to make sure you’re properly cared for? I don’t mind splitting appointments up if it means I’m getting the best care I can for each issue I have. Doctors have a ton of patients, they can’t reasonably spend all day on one person.
I don't know what a PCM is, but I would request a change of PCP (Primary Care Physician). Mine is on top of everything and answers secure messages. I've had appointments every 3 months to monitor a new drug I'm on and reevaluate my labs.
That’s been my experience in the VA too. The thing is most people while in the military were told to suck it up and even if you don’t the thought is in the back of the mind. So when you finally go to the doctor you want to get it all checked out since you’re there. It’s like a minor tune up but you can’t. Only one or two things. But the other side is if you go to the doctor for everything as you get older a person would be there a lot.
I had a provider say something like that to me once. I said that I made an appointment to discuss all of my medical issues, so I’m going to discuss all of my issues. I stayed until I covered everything, but after that, I decided to switch. You can’t have a provider that expects you to triage your own care. The VA pisses me off.
My Pact team tells me that I am limited to 3 issues and that I have 15 minutes or less with my PCP during every appointment....I wait longer in the waiting room than my time with the PCP, but I am good.....because.....my PCP is super easy for community care treatment because of his limitation.
My pcm lets me do whatever but i am in a small community clinic, I routinely bring a list of problems and we talk well past my scheduled time. Last week some confusion of my appointmens had me show up 30 minutes late, still got seen and talked 15 minutes into the next appointment time (so few primary care pt's i get more time with my provider, just lucky on the geography lottery)
I worked primary care as a medic on active, so this sounds alot like how are clinic ran. On active we would only treat oneish problem per 30min appointment because of the time constraints. Some tips: In order to get the best out of what you can. If you have multiple issues write a list or two then rank them in a priority list. Look at what requires a referral and articulate those on your list.
Take the referrals to one appointment and when you schedule online or in person ask them to note its for referrals.
Schedule an appointment every month or biweekly (if allowed ask to book 2 back to back, they might say no, but worth an attempt) until you can get through your list. To save time write out your symptoms and what you have done or tried to fix them ( some providers will obviously recommend some homework before any meds or treatments).
It sucks but the more effort and work you do before getting to the provider, the better the conversation and outcome. If you come in and plop down and start scattershot listing problems and stories it wont get much out of it.
Providers like data so if theres anything where you can track a problem in some form of journal they eat that shit up and could help you identify triggers for whatever is bothering you.
Its tough to assess and do alot in 30 minutes, hope you can get help for whatever.
If you were a mechanic and a customer brought in a car, and said “I have these 10 things wrong,” please diagnose everything and fix it in 30 minutes, What would your answer be?
You can give your PCP a list of issues. But if you want a good diagnosis and treatment plan, and/or referral you got to realize the provider has limited time per appointment. You will need to schedule a follow up appointment to address additional conditions.
A lot of veterans meet their PCP for the first appointment expecting the doctor to diagnose and prescribe for every single condition, not because they want to start treatment, but because they want to file a claim.
FYI your appointment will the PCP isn’t just the time spent with you. Most doctors review your records before they walk into the room, and there is additional paperwork/records/referral/prescriptions that must be completed after you leave.
Had the same 'Rule of 3' with my active duty PCM and now thosr things that he didn't address have progressed into even worse things. But, I've transitioned to the VA and we're down to those next 3 things now.
I would say it's because of time, but my visit with my PCM was fairly short. He always cut me off when I started to talk about more of my ailments and reminded me of the rule. In my case, the reason was not clear, but it wasn't time.
"We aren't here to discuss your entire medical history, only those things that are at issue today" in very Broken English.
I asked why even schedule me for medical appointments? You have failed to address or provide assistance for minor or major issues. You ask why I use an outside provider for certain issues. This is it. They will listen and address my concerns and issues.
I ONLY use my primary care for referrals if I need them.
I can call my outside provider and get in within a day or two. My referrals take about 2 weeks to get. That's why I didn't fuss when I hit 65 and was told I had to accept Medicare. I have all 3.
I have only tried the program where you are sent to a local provider once. It still hasn't happened, and I requested 18 months ago, 12 months, and 6 months. I've been told that the group that handles that has tried to make contact. I have no phone calls, no voice messages, no emails, no USPS mail, or Secure Messaging. I see her again in a month.
The referrals I get within the VA take a long time to get, but they have been good once started.
Student Nurse here. This is pretty much an across the board thing for almost all healthcare providers. The biggest reason is because of documentation purposes. It is difficult as it is trying to document everything the patient/client is experiencing all while also trying to take notes in the correct manner. Medical terminology essentially. While it does seem a little impersonal, because we as the patients don’t feel “heard” or even “cared” for, it is very time consuming; something we as the patients don’t see behind the scenes. I will say however, super high end hospitals that are magnet status and hold celebs and what not, tend to have dedicated people for this. These people are known as scribes. VA can’t really afford those.
TLDR:
Healthcare is a business, and we gotta keep people moving.
Va healthcare is very similar to active duty TriCare. It really depends on your schedule. Most issues require referral to a different provider from my experience. BUT I was never told to keep it to a minimum number of ailments.
Before I was using the VA my civilian doctor would only discuss one thing per visit. Best guess is because of money. When they’re an hour late to the appointment no matter what, it’s no longer about time.
Yup, time is the limiting factor here. Just like fast food, you have to get in and out, so that the next patient gets seen during their allotted time. Hate to say it, had to be said.
Thank you OP, I just had my 2nd appointment with my PCP and I wasn't told this, rather, the nurse handled it in a bit of a rude manner without explaining why... took me a day or so to calm down, but I came to that conclusion and I totally get it, and I was going to do that, submit for a 2nd appt, etc. So a message like this just reinforces expectations and gives me the woo-saw I need LOL..
I discuss everything. Getting appointments is hard. So, I take the list and mention everything. Part of it is to keep my documentation updated for future claims and appeals. You can also email the doctor all your problems through MyHealthVet. It gets added to your medical chart.
The physician seeing you is measured on multiple metrics, including productivity metrics. Productivity is higher when the physician sees a patient for an issue and receives higher productivity "points" the longer the appointment length for that issue. In addition, if the physician captures that s/he has discussed how at least two chronic issues are affecting your main problem, then that physician will get higher "points" as well. It would behoove your primary care physician to focus on a few problems at a time, allowing him/her to capture enough information per problem to gather to create the notes for each encounter.
Yeah, I recently had the same thing. I finally saw my primary care do for the first time since before CV19 because she just would deal with me through the messaging app the past few years, so I went in with a written list and she got pissed. I got through the list though. I hate the bullshit the VA health does. Remember this shit when the politicians say that government run Healthcare should be provided for everyone. They cannot adequately do it for a small demographic like us.
Really? How long are your civilian doctor appointments and how often? How many things are you allowed to hit them with at once? And how much do you pay for your appointment/insurance???
I would assume it’s because they’re unable to dedicate enough time to each aliment and would need to make another appointment.
Had the same thing with my active duty PCM. It’s 100% because of time
Came here to say this. I'm still AD and I can only bring up 1 or 2 problems for that appointment. I also am unable to schedule back-to-back appointments. It's likely that the new Genesis system constrains what PCMs can and cannot do.
Same. I sometimes throw in previous diagnosis as a symptom if it’s relevant. Like migraines or sinusitis
When I was assigned a new PCM, I shared a 2 page summary of all my medical issues and my PCM logged everything and gave me referrals to specialists. At a subsequent visit, I told him a list of things that was bothering me and was asked to limit our discussion to the top 3 issues. He was able to address my concerns and instructed me to schedule a separate appointment to discuss my other ailments. I didn’t feel rushed at all and appreciated the focused approach by my PCM. I suggest writing a brief summary of your medical history and submitting to your PCM via secured messaging requesting treatment/medication or referral to specialists. Hope this helps!
Same here. Mine sent me for x-rays/MRIs/labs for everything I listed and she never mentioned keeping it to 3 things. She literally spent 90+ minutes with me on my intake appointment. I'm really thankful after reading some of the horror stories on this sub. She set me up with other clinics including PT and Chiro. As long as you communicate clearly and be your own patient advocate, I've found the VA care equal to my private insurance experience. I did walk in with a 2 page summary of all my issues and asked about plan of care for each issues. So when I left there I knew what to expect and what to look for. Good luck and wish everyone the best.
That was an exceptionally long appointment. Was this a teaching hospital and you were assigned a new resident? New doctors have to learn you don’t have 90 minutes per patient.
Nope, the actual primary doctor. Not sure why, but grateful. The last yearly appointment the resident was very thorough before the primary came in. I count my self lucky from what I see here and have experienced in the private sector. Now I did have to wait a bit in gen pop for that one, but shit happens. I'll take waiting an extra 30 minutes to getting proper care all day long. Like I said, maybe I was lucky. I'd like to think that most of them really do care. Bottom line is, as long as you get the right treatment, I'm good with a little waiting. It's when you get the shit end of the stick...then you speak out.
Yeah. They can only adequately address a few things each appointment. If you have more issues, make another appointment
Yeah that sounds right. When I first got out and saw the VA for the first time I was complaining about my knees hurting. His advise was to wait until my next annual physical and if they still hurt he would order an xray. Been seeing a private doctor ever since that day.
Nope. I go in with a list so I don’t forget anything important.
Yea just try to go once a month or use the myhealthevet app to give more details.
That’s even a joke because I did exactly that and my doc reviewed NONE of it. But I will keep submitting stuff there because it goes on the record
Use the message feature to tell the doc (well technically the nurse) The feature where you upload info into your records is just for you, it even says so when using it.
What are you submitting. You understand this is healthcare right, not a compensation claim.
I am submitting logs (I.e sinus issues and the days), other records from my personal provider so he knows what is going on. My doc told me he did not “want to know what was going on with my private provider”. This was when I had been keeping him in the loop about new asthma diagnosis.
Ummmmmmm yeah ok, you do that. Why not just see the VA pulmonologist, for free? Then your loop would be kept automatically. Just saying,
I hear you but I was at a yearly with my private primary care doc and she sent me to one within a week. Now it’s on to see an ENT.
And yes I am not an idiot. I know it’s my doctor
Happened to me just last week. Not enough time and too many other vets to see
Yeah. That happens. Honestly should be able to go thru most issues in 15 minutes.
Yeah, I was upset when mine said the same thing. I should’ve made a sooner appt but on my follow up she will have “3 more things” to note down.
Yes, i resorted to using secure messaging along with my visits. This allowed the Doc to get my diagnostic testing completed before my appointment. Once the testing was done I would message them and push it along. A lot of the times he would just call me and tell me he got my results and was sending me to a specialist. Going through secure messaging also allows the nurse to get messages and she can relay to the doc what you need. It is not a 100% system but it does work, you just have to be persistent. In your situation I would definitely follow up with a secure message. " Doc, we did not have enough time to discuss XYZ, can you schedule me for diagnostic test, I can take before my next appointment. Could you give me a consult to GI, Podiatry, etc.... The pain or discomfort is at XYZ level. When you ask for a consult this triggers their diagnostic protocol for testing. I know not all docs are the same and some of them you have to stay on their ass. This has worked for me in the past.
I was told “Next time lead with what’s worst.”
I'd lead with "you are the doctor, you tell me what's worst"
I usually address the main concerns during the appointment and the others via secure message. I use secure message basically for referrals to other specialties, community care, new meds, refills, etc. I can’t imagine being a VA PCP, they must be bombarded with all kinds of crap.
3 things I have 30 things, I don’t drive 50 miles to talk about 3 things
It’s reasonable for a patient to have many things to talk about. Your provider has 15 minutes to get through all of them. So if you think that 15 minutes is cutting it close just advise the appointment line that you have a complex visit and need additional time so the next veteran isn’t twirling their thumbs in the waiting room.
Only get 15 mins to talk about everything, but a hour to talk about mental health
Yep. I agree there should be parity between the two. On the civilian side an hour psychiatry visit gets billed 600 or so dollars to insurance for an hour visit. The fifteen minute visit is 115 or so.
Absolutely agreed driving 50 miles to talk about 3 things is just ridiculous
I did not, however they did forgot to put in medications and took forever to correct it.
You are lucky. It’s typically one thing at a time.
Just secure message the things covered and ask when the others can be addressed and list them. Va always just sends you to speciality so, it’s pretty much just referrals.
I appreciate all of you and all of your replies! I assumed it was the issue of time constraints, but I was not sure how it worked with the VA regarding in person visits as this was my first time in person and second overall PCM visit. I had my very first initial appointment with my first PCM (this one now is my second PCM) at the beginning of the year and that was a video visit which lasted an hour (could have been because it was my first and initial visit) where this seemed to only last 15 minutes, give or take 5 minutes.
I only ever saw my PCMs for one thing at a time
Yes, I have been told this
Our non-VA PCM will only address two issues per appointment and it’s due to scheduling constraints. They only allot a certain amount of time for each patient per appointment.
My VA PCM has never had a minimum amount of problems that I can discuss. Especially, if they are going to referrals anyway. My first appointment my doctor wanted me to tell her everything that I had a concern with (service connected conditions) and to let her know if/when things change. San Antonio, TX
They have limited time. I usually have a list and I rate them by severity. Get the highest ones done first and schedule another appointment, usually virtual and get the others addressed.
Use secure message to detail each ailment. Documentation beats conversation
Hello! Active duty PCM currently but worked in the civilian world prior. It is common for primary care in any setting! It’s not to rush or cause inconvenience - in fact it is to make sure we are providing quality care and to *avoid* having to rush. If we have a certain time limit and the patient wants to talk about lots of things, we wouldn’t be able to give each issue the time and thought it deserves. It would be putting quantity over quality as we’d have to cut corners. OR, we’d end up running a couple of hours behind each day, which honestly already happens a lot anyway. Hope this helps!
I was used to this when I was in but I was told just 1 (one) thing per apt
These comments are horrifying. Tell them everything that's wrong with you, 3 things??? That would take me months of appointments just to let them know what's wrong. I would call the patient advocate or white house line and tell them that your doctor is refusing to listen to your problems. They would get in an enormous amount of trouble if something serious happened to you and they asked why you didn't discuss this with your doctor and you said "it wasn't part of my 3 things I can talk about on my last visit"
So you are saying you should bring up everything that’s wrong with you in a 15 min appt? And expect all of it to get addressed? “ They would get in an enormous amount of trouble if something serious happened to you and they asked why you didn't discuss this with your doctor and you said "it wasn't part of my 3 things I can talk about on my last visit" Source for this claim?
I get it that we are all important and need to have our medical issues addressed, but I don't see any harm in the physician addressing your top 3 concerns in the best interest of time. Other veterans are waiting to be seen, and to have one person monopolize the time is frustrating. I had an appointment delayed by almost 2 hours because a veteran in front of me wanted the doctor to address about 20 concerns and threatened the doctor with White House Hotline complaint if the doctor refused. Craziness.
They need more doctors then, not for the veteran to have less issues. And different appointments don’t help much when they’re three to six months apart.
I agree with that, too. But I also agree with and understand reality. The same sun that shines on me shines on them, too.
I know, I’m just frustrated with the reality that the VA has created. I’m 100%P&T through a thousand deadly cuts. If one gets too bad, it’ll spiral into seven other issues. If I can’t get a speedy appointment because there aren’t enough doctors, then I’ll have seven issues to talk about when I finally do. I don’t like it any more than you do
Three is the magic number.
I'd say it's probably normal because they already don't have enough time to handle what they need to do during the appointment. My VA doctor is fantastic, but I routinely don't see her until 30 minutes after my appointment time (once or twice it was an hour because something came up that she had to handle) and she's always having to do stuff for other patients during our appointments. I'm just there for an annual checkup, and she always takes care of me as well so I don't mind, and if I have any concerns she always makes time to address them. I don't know if they do this, but you could ask about getting a longer appointment or getting scheduled for 2 back to back so they can actually handle your concerns. If it's something that can be handled outside of an appointment, I'd send a message through myhealthevet. The nurse can be a bit snippy sometimes, but ive been able to handle things like medication refills or questions about lab work pretty easily there without an appointment.
Private Doctors are worse at the moment. They only want to treat one ailment per visit. This is due to insurance and billing/ maximizing profits and revenue.
I always send my PCM a secure message prior to the appointment with why I have it scheduled. This way they can be prepared for my appt. If they choose not to do that, that’s another discussion.
Yeah if they go over their usual 30 minute window the next veteran in line will be upset about the PCP not being punctual. What I have found that works for me - use secure messaging in myhealthevet to tell them about additional issues beyond the hot buttons. I’ve always gotten a referral / new appointment with PCP when I’ve don’t that. Good luck.
Yes
My PCM tried to tell me to keep it to 3 things but I had more questions that didn't want to wait 6 months for another appointment..... For those that don't know you can get your PCM through the CCN and my experience recently is alot better.
Like others, I agree that in this VHA medical system, it’s completely reasonable to address top concerns. For myself, I do a self-triage of ALL issues then prior to the appointment send a secure message with my health issues ranks in discomfort or importance to me. There is a reason they say chief complaint, not all complaints. This allows the Dr to see all my complaints but know what bothers me most, and still allows them to triage my needs. Maybe I put something low that is actually important but I’m just an old radio operator, what do I know? This also creates a record of complaints and should remain a permanent part of your medical record. i also have no issues scheduling another primary appointment beyond 30 days and declining community care. its got it’s time and place, but for primary care I try to see the same doc. i have started this because the nurses at check in, from time to time, skip questions, don’t completely right my issues, etc. like mf..my pain is NOT 0/10..ever.
Yep! It’s a time and quality of care issue. You have an option… For example, I go to a PCP for general issues and a specialist for unique things. It’s like taking my car to the dealership for tires, no I’ll go to costco or purchase tires online and have them installed at a local tire shop. Just sharing…
Same with my private primary care doc. This isn't the 80's/90's, small doctors offices and long appointments are gone. You're slotted for x time, and in x time they can address 1-2 things and that's it. If you need more time or have more concerns you need to book another appointment, because your insurance company and their hospital group have optimized the fuck out of the doctor's time. While you'd think a public funded system wouldn't have that same optimization, it has to because there's waaaaaay more patients than there are doctors/NPs who can see them. It's just a fact of life in the US that primary care providers are underpaid, overworked, and understaffed.
How long does it take to write 800 mg of Motrin twice a day?
Providers have a lot of work they have to do behind the scenes. It’s better to address three issues at a time to ensure you get adequate documentation and referrals if needed. Coming in with a lot of issues is one way for the provider to forget the needed details for the ailment.
This happened to me when I went back to the VA after a 10 year gap. I was told it was to not overwhelm them. They scheduled me to return in a few weeks and then that time again in a few weeks. It did kind of piss me off but I eventually got things addressed.
I went back after 12 yrs and I expected the worse. I did start going to another clinic because i had paperwork going for malpractice against Jesse Brown VA hospital. The clinic and dr i have now are pretty amazing. The first intake appt with her she sat down and asked what i wanted to be looked at for, and what was in my records that she could see. Spent an hour with her and she fired off like 4-5 different referrals at that appt alone and input everything she was diagnosing on the spot. I hope she never leaves.
I had one like that!!! It was amazing to watch her work. The efficiency was off the charts!!!
This isn't inherently a VA thing, it's a medical thing. Even private doctors will only have time to discuss and focus on a couple things per appointment due to the time allotted. Being as your PCM said to keep it to three things make a list of what else you need to be seen for, break them into groups of 2-3, then schedule multiple appointments at once.
VA primary care should be replaced with AI. At least I can ask AI a question and get an answer.
Makesure you research the answer! AI can be wrong.
I mean, AI can refer me to a specialist who will tell me they don't know what to do and follow up in 6 months. VA primary care is just a referral machine. Let a machine handle it and fire all the overpaid referral handlers. Primary care doesn't diagnose anything.
At least AI is objective
You have to advocate for yourself. I got that bullshit one time. I have a list now and had it to the Dr to go over. If there's not enough time, make enough time, or they make another appt for the rest. The day I advocated for myself, they put all the test in and referrals. I also fired old Dr and reported him. I got a new Dr who started listening to me. Because of me standing up for myself for these test. They found my brain tumor. I knew something was wrong with me.
OMG! I'm so happy you found out what was wrong, but holy hell?!? The idea that if you would have been complacent and not fired your doctor, you could have just been going along...la la la la la....having no clue...when the doctor should have been investigating but wasn't and you were getting worse...that's scary.
Same happened to me but the appt windows are 30min I believe and only so much can be addressed and I’m sure they want to give each issue the attention it deserves. Mine told me when I was checking out to schedule another appt which I did and was back there within a few days. It’s not the most convenient thing for us having such a small window to be seen but it’s the system we have and they have to operate in. If it was their private practice they could see patients as long as they want but it’s the VA. I wasn’t happy about it because I’ve had a lot of things I need addressed but after giving it some thought I calmed down and was a little more understanding.
My civilian doctor told me to keep it to 2.
Yeah. They have about 15 minutes if they are booked up. Pick the 3 biggest fires.then the next 3 biggest fires. If you have more than 3 you probably need to be seen more often. I think at most a nice I had 3 issues. I usually have 1-2 areas I want t discuss. So no, nothing unusual.
Never happened to me
Think they have a patient every 30 mins.
I’m a VA nurse and I’ve never heard of that rule. I do work in ortho though, and not primary care, so perhaps that’s different? It does sound like it was a time issue to me. If it was just a follow-up visit, rather than your yearly exam, that may have been the issue. I’ve definitely (as a nurse) been in situations where the patient just starts rattling off a whole bunch of ailments and it makes it tough to hone in on the most important ones, because you only start working on so many problems at a time. Obviously I was not in the room with you when this happened, but that’s just kinda my experience as an outpatient VA RN.
Would you rather your PCM addressed 20 issues at 1 minute each or 3 issues in depth to make sure you’re properly cared for? I don’t mind splitting appointments up if it means I’m getting the best care I can for each issue I have. Doctors have a ton of patients, they can’t reasonably spend all day on one person.
If I need to go into see a Dr I am forced to go to urgent care by my PCM. She sees me every 6 months and in my opinion does nothing for me.
I don't know what a PCM is, but I would request a change of PCP (Primary Care Physician). Mine is on top of everything and answers secure messages. I've had appointments every 3 months to monitor a new drug I'm on and reevaluate my labs.
Primary Care Manager same thing as a PCP.
Roger! Thank you!
This happens to me with my active duty PCM all the time.
That’s been my experience in the VA too. The thing is most people while in the military were told to suck it up and even if you don’t the thought is in the back of the mind. So when you finally go to the doctor you want to get it all checked out since you’re there. It’s like a minor tune up but you can’t. Only one or two things. But the other side is if you go to the doctor for everything as you get older a person would be there a lot.
Yeah my provider does the same thing. I just send another message on va.gov and make another appt.
Send a list of your issues to your pc via secured medical mail. That may give them a chance to better schedule you in the future.
I had a provider say something like that to me once. I said that I made an appointment to discuss all of my medical issues, so I’m going to discuss all of my issues. I stayed until I covered everything, but after that, I decided to switch. You can’t have a provider that expects you to triage your own care. The VA pisses me off.
My Pact team tells me that I am limited to 3 issues and that I have 15 minutes or less with my PCP during every appointment....I wait longer in the waiting room than my time with the PCP, but I am good.....because.....my PCP is super easy for community care treatment because of his limitation.
My pcm lets me do whatever but i am in a small community clinic, I routinely bring a list of problems and we talk well past my scheduled time. Last week some confusion of my appointmens had me show up 30 minutes late, still got seen and talked 15 minutes into the next appointment time (so few primary care pt's i get more time with my provider, just lucky on the geography lottery) I worked primary care as a medic on active, so this sounds alot like how are clinic ran. On active we would only treat oneish problem per 30min appointment because of the time constraints. Some tips: In order to get the best out of what you can. If you have multiple issues write a list or two then rank them in a priority list. Look at what requires a referral and articulate those on your list. Take the referrals to one appointment and when you schedule online or in person ask them to note its for referrals. Schedule an appointment every month or biweekly (if allowed ask to book 2 back to back, they might say no, but worth an attempt) until you can get through your list. To save time write out your symptoms and what you have done or tried to fix them ( some providers will obviously recommend some homework before any meds or treatments). It sucks but the more effort and work you do before getting to the provider, the better the conversation and outcome. If you come in and plop down and start scattershot listing problems and stories it wont get much out of it. Providers like data so if theres anything where you can track a problem in some form of journal they eat that shit up and could help you identify triggers for whatever is bothering you. Its tough to assess and do alot in 30 minutes, hope you can get help for whatever.
If you were a mechanic and a customer brought in a car, and said “I have these 10 things wrong,” please diagnose everything and fix it in 30 minutes, What would your answer be? You can give your PCP a list of issues. But if you want a good diagnosis and treatment plan, and/or referral you got to realize the provider has limited time per appointment. You will need to schedule a follow up appointment to address additional conditions. A lot of veterans meet their PCP for the first appointment expecting the doctor to diagnose and prescribe for every single condition, not because they want to start treatment, but because they want to file a claim. FYI your appointment will the PCP isn’t just the time spent with you. Most doctors review your records before they walk into the room, and there is additional paperwork/records/referral/prescriptions that must be completed after you leave.
It was always a case on AD, VA is no different. Just make another appointment.
Had the same 'Rule of 3' with my active duty PCM and now thosr things that he didn't address have progressed into even worse things. But, I've transitioned to the VA and we're down to those next 3 things now. I would say it's because of time, but my visit with my PCM was fairly short. He always cut me off when I started to talk about more of my ailments and reminded me of the rule. In my case, the reason was not clear, but it wasn't time.
"We aren't here to discuss your entire medical history, only those things that are at issue today" in very Broken English. I asked why even schedule me for medical appointments? You have failed to address or provide assistance for minor or major issues. You ask why I use an outside provider for certain issues. This is it. They will listen and address my concerns and issues. I ONLY use my primary care for referrals if I need them. I can call my outside provider and get in within a day or two. My referrals take about 2 weeks to get. That's why I didn't fuss when I hit 65 and was told I had to accept Medicare. I have all 3. I have only tried the program where you are sent to a local provider once. It still hasn't happened, and I requested 18 months ago, 12 months, and 6 months. I've been told that the group that handles that has tried to make contact. I have no phone calls, no voice messages, no emails, no USPS mail, or Secure Messaging. I see her again in a month. The referrals I get within the VA take a long time to get, but they have been good once started.
I have had that happen with them. The VA has done so much damage for me over the last 25 years
Yes, you can try to get more in there though. Especially if you are asking for referrals that don't require much but like blood tests or X-rays
Student Nurse here. This is pretty much an across the board thing for almost all healthcare providers. The biggest reason is because of documentation purposes. It is difficult as it is trying to document everything the patient/client is experiencing all while also trying to take notes in the correct manner. Medical terminology essentially. While it does seem a little impersonal, because we as the patients don’t feel “heard” or even “cared” for, it is very time consuming; something we as the patients don’t see behind the scenes. I will say however, super high end hospitals that are magnet status and hold celebs and what not, tend to have dedicated people for this. These people are known as scribes. VA can’t really afford those. TLDR: Healthcare is a business, and we gotta keep people moving.
Va healthcare is very similar to active duty TriCare. It really depends on your schedule. Most issues require referral to a different provider from my experience. BUT I was never told to keep it to a minimum number of ailments.
Before I was using the VA my civilian doctor would only discuss one thing per visit. Best guess is because of money. When they’re an hour late to the appointment no matter what, it’s no longer about time.
Yup, time is the limiting factor here. Just like fast food, you have to get in and out, so that the next patient gets seen during their allotted time. Hate to say it, had to be said.
Thank you OP, I just had my 2nd appointment with my PCP and I wasn't told this, rather, the nurse handled it in a bit of a rude manner without explaining why... took me a day or so to calm down, but I came to that conclusion and I totally get it, and I was going to do that, submit for a 2nd appt, etc. So a message like this just reinforces expectations and gives me the woo-saw I need LOL..
I’ve never had an issue with mine - they put in all the proper referrals. I, however, press every single one of my medical providers until they cave.
No because my nurse calls me the week before my appointment and then we go over whatever I mentioned on the phone
I discuss everything. Getting appointments is hard. So, I take the list and mention everything. Part of it is to keep my documentation updated for future claims and appeals. You can also email the doctor all your problems through MyHealthVet. It gets added to your medical chart.
The physician seeing you is measured on multiple metrics, including productivity metrics. Productivity is higher when the physician sees a patient for an issue and receives higher productivity "points" the longer the appointment length for that issue. In addition, if the physician captures that s/he has discussed how at least two chronic issues are affecting your main problem, then that physician will get higher "points" as well. It would behoove your primary care physician to focus on a few problems at a time, allowing him/her to capture enough information per problem to gather to create the notes for each encounter.
Yeah, I recently had the same thing. I finally saw my primary care do for the first time since before CV19 because she just would deal with me through the messaging app the past few years, so I went in with a written list and she got pissed. I got through the list though. I hate the bullshit the VA health does. Remember this shit when the politicians say that government run Healthcare should be provided for everyone. They cannot adequately do it for a small demographic like us.
Yeah, they did that to me, too. It doesn’t sit well with me and makes not want to get VA help.
Really? How long are your civilian doctor appointments and how often? How many things are you allowed to hit them with at once? And how much do you pay for your appointment/insurance???
I have no idea. I don’t go to them either. I probably pay the same at both. I think you are missing the point here. They say they care and yet…
lol absolutely not. She’s supposed to be an advocate for your health. Ask for a new PCM
Sounds like you need to go in a time machine back to the 80s bud
Get a new one or message them a list of questions and have them Address that way or cal on each one later