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Yet another knee injury question-- what would you do?

AmyPJ

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Yeah, my understanding is the wiggle test usually gives a pretty good indication. And at least Aspen clinic diagnosis indicates you would need to see a orthopedic specialist. I don't understand all these stories of sending people on their merry way and telling them come back if the knee doesn't seem to get better. Especially when significant swelling has occurred.
I test positive for ACL instability because I'm hypermobile. (Creeps me out!) I have a reflexive swat to anyone who gets near my patellas :roflmao:

@skiki , I am so sorry this happened! Not fun at any time, but especially on a long trip. Hang in there!
 

Andy Mink

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crosscountry

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@mdf you've posted disparaging remarks about primary care doctors on this thread and in previous threads especially regarding orthopedics evaluation. I'm wondering if you'd be willing to share your experience to give others a better perspective on why you have a negative opinion regarding primary care doctors.
Ortho are ortho for a reason. So do heart specialist, or ophthalmologist... the list goes on.

Example of non-specialist doctors missed injuries and illness are endless. The best PCP are those who refer their patients to a specialist at the first sign of issue! Basically, one of the most valuable quality of a good PCP is his/her awareness of his/her own limit in knowledge/experience.

I had a thyroid issue some years back. My PCP, which I think was already better than average, missed it. It was fortunate that I had a vague recollection that one of my family member had that same symptom and the cause of thyroid (many thyroid disease are hereditary). My PCP didn't believe it's the case. But he being a good PCP, refer me to a specialist just to be thorough. The Endocrinologist was shocked at my thyroid level. Had I not gone to see him, had I waited till my next physical months later, it could have caused irreversible damage to some organs (eye, bone, heart...)!

Moral of the story(ies)? If you think you had something (illness, injury), ask your PCP to refer you to a specialist. Better yet, if you have the option, opt for an insurance plan that doesn't require referral to see specialist. If your PCP resists referring you to a specialist? It's time to shop for a different PCP!
 
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Prosper

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Ortho are ortho for a reason. So do heart specialist, or ophthalmologist... the list goes on.

Example of non-specialist doctors missed injuries and illness are endless. The best PCP are those who refer their patients to a specialist at the first sign of issue! Basically, one of the most valuable quality of a good PCP is his/her awareness of his/her own limit in knowledge/experience.

I had a thyroid issue some years back. My PCP, which I think was already better than average, missed it. It was fortunate that I had a vague recollection that one of my family member had that same symptom and the cause of thyroid (many thyroid disease are hereditary). My PCP didn't believe it's the case. But he being a good PCP, refer me to a specialist just to be thorough. The Endocrinologist was shocked at my thyroid level. Had I not gone to see him, had I waited till my next physical months later, it could have caused irreversible damage to some organs (eye, bone, heart...)!

Moral of the story(ies)? If you think you had something (illness, injury), ask your PCP to refer you to a specialist. Better yet, if you have the option, opt for an insurance plan that doesn't require referral to see specialist. If your PCP resists referring you to a specialist? It's time to shop for a different PCP!
I will respectfully disagree with you on a number of your above points. Absolutely a good PCP should know his or her limitations and should refer you to a specialist when further expertise is needed. A good PCP should be able to perform a thorough evaluation of just about any symptoms. That evaluation and the PCP's knowledge, comfort and experience will determine whether specialist input is needed. Certainly not ever illness or injury should be seen by a specialist. For example, should every cold or flu or UTI or gastroenteritis be referred to infectious diseases? Should all patients with high blood pressure or high cholesterol see a cardiologist? Should all back pain be managed by a spine clinic? Should all patients with joint pain be seen by rheumatology or orthopedics? Should all headaches be managed by neurology? Should all abdominal pain be initially evaluated by general surgery or GI? The list goes on and on. You should have a good relationship with your PCP built on mutual trust and respect. Of course you should advocate for yourself and you and your PCP should work together to determine a reasonable and acceptable plan. If you trust your PCP you should trust when he or she determines if/when you need to see a specialist. If you don't have trust in your PCP, find another one. Hate to say this, but we already have the most costly health care system in the world. If you think your insurance premiums are high now, if we have specialists see every routine case of everything, your premiums will skyrocket. What our medical system needs is more, highly skilled and knowledgeable PCPs who can effectively evaluate symptoms, appropriately manage a vast array of routine medical issues and properly refer to specialists when needed. Ask any specialist and I'm quite certain they will agree.
 

Jwrags

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I will respectfully disagree with you on a number of your above points. Absolutely a good PCP should know his or her limitations and should refer you to a specialist when further expertise is needed. A good PCP should be able to perform a thorough evaluation of just about any symptoms. That evaluation and the PCP's knowledge, comfort and experience will determine whether specialist input is needed. Certainly not ever illness or injury should be seen by a specialist. For example, should every cold or flu or UTI or gastroenteritis be referred to infectious diseases? Should all patients with high blood pressure or high cholesterol see a cardiologist? Should all back pain be managed by a spine clinic? Should all patients with joint pain be seen by rheumatology or orthopedics? Should all headaches be managed by neurology? Should all abdominal pain be initially evaluated by general surgery or GI? The list goes on and on. You should have a good relationship with your PCP built on mutual trust and respect. Of course you should advocate for yourself and you and your PCP should work together to determine a reasonable and acceptable plan. If you trust your PCP you should trust when he or she determines if/when you need to see a specialist. If you don't have trust in your PCP, find another one. Hate to say this, but we already have the most costly health care system in the world. If you think your insurance premiums are high now, if we have specialists see every routine case of everything, your premiums will skyrocket. What our medical system needs is more, highly skilled and knowledgeable PCPs who can effectively evaluate symptoms, appropriately manage a vast array of routine medical issues and properly refer to specialists when needed. Ask any specialist and I'm quite certain they will agree.
Totally agree. Very few specialists want to see and evaluate the least little thing related to their specialty. A very under appreciated and old fashioned relationship is that between the PCP and the specialist. Pick up the phone, call me, and lets discuss if I actually need to see the questionable referral or can I just give some helpful advice over the phone or direct the PCP to the correct test before I see the patient so the first visit is more valuable.
 

crosscountry

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Totally agree. Very few specialists want to see and evaluate the least little thing related to their specialty. A very under appreciated and old fashioned relationship is that between the PCP and the specialist. Pick up the phone, call me, and lets discuss if I actually need to see the questionable referral or can I just give some helpful advice over the phone or direct the PCP to the correct test before I see the patient so the first visit is more valuable.
You respond to phone calls? That's a novelty!

Even my beloved but now retired PCP didn't do that. I had to wait for an appointment to see him. Though thankfully never too long a wait.

It takes days, sometimes weeks to get an appointment to see any doctor! So waiting for an appointment with PCP, only to have to wait some more for appointment with the specialist? If I'm not dead or crippled by then, I probably don't need to see them after all!

What our medical system needs is more, highly skilled and knowledgeable PCPs who can effectively evaluate symptoms, appropriately manage a vast array of routine medical issues and properly refer to specialists when needed.
The brutal truth is, those kind of PCP only exist in rarety!

My previous PCP was able to coordinate my care with specialists he referred me to, even get me a quick appointment with one when it's needed. But since his retirement, I have gone through several replacements who either don't communicate well, or didn't even bother to communicate due to "time pressure"!

Trust? It needs to be earned. If the multiple PCP candidates I've been through were any indication, I can't trust them! If the choice is between higher cost for care vs having my illness misdiagnosed and treatments delayed? I know which I'd choose.

Say what you want about PCP vs specialists. Almost all of the specialists I've seen were quite willing to explain to me why and what I have, far better than the many PCP's I've tried. I don't know what medical schools are doing in training doctors. The younger ones aren't what they used to be.

Now I'm "settled in" with my current PCP. But no, there's no coordination of my multiple issues that I'm seeing different specialists for. Still, at least we understand each other and
I can bring those together to her. She's more my "health advisor" from my point of view. She consults me on how to live well and healthy. But she sends me to specialists as soon as she identifies an actual illness.
 

crosscountry

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Should all back pain be managed by a spine clinic? Should all patients with joint pain be seen by rheumatology or orthopedics?
Those are the exact issue that I'd prefer to be treated by a specialist!

I've heard too many stories of PCP's telling patients (my family members) that's "just aging". Like everyone should have back or joint pain just because they're over 40?

When reality is those pain is a sign of some physical changes that needs to be investigated early rather than just muffled by pain medication (or just "put up with") until some real & permanent damage happened!

One of the most valuable (and sadly underappreciated) "specialist" is physical therapist! There, the different between good ones and mediocre ones are huge! But PT guided by ortho are the best combination! There's no reason most people need to live with back/joint pain even at 80!
 

dovski

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I will respectfully disagree with you on a number of your above points. Absolutely a good PCP should know his or her limitations and should refer you to a specialist when further expertise is needed. A good PCP should be able to perform a thorough evaluation of just about any symptoms. That evaluation and the PCP's knowledge, comfort and experience will determine whether specialist input is needed. Certainly not ever illness or injury should be seen by a specialist. For example, should every cold or flu or UTI or gastroenteritis be referred to infectious diseases? Should all patients with high blood pressure or high cholesterol see a cardiologist? Should all back pain be managed by a spine clinic? Should all patients with joint pain be seen by rheumatology or orthopedics? Should all headaches be managed by neurology? Should all abdominal pain be initially evaluated by general surgery or GI? The list goes on and on. You should have a good relationship with your PCP built on mutual trust and respect. Of course you should advocate for yourself and you and your PCP should work together to determine a reasonable and acceptable plan. If you trust your PCP you should trust when he or she determines if/when you need to see a specialist. If you don't have trust in your PCP, find another one. Hate to say this, but we already have the most costly health care system in the world. If you think your insurance premiums are high now, if we have specialists see every routine case of everything, your premiums will skyrocket. What our medical system needs is more, highly skilled and knowledgeable PCPs who can effectively evaluate symptoms, appropriately manage a vast array of routine medical issues and properly refer to specialists when needed. Ask any specialist and I'm quite certain they will agree.
I think the real challenge is that these days there are so many different types of doctors in the US as compared with other countries i.e. Naturopaths, Osteopaths even Chiropractic Doctors .... not to mention all the different specialists. Navigating healthcare in the US is a challenge and often times your insurance's preferred providers may not be the best fit for you. Just like any profession there good practitioners and great ones ... as well as some terrible ones, so we should not generalize. That said like anything do your research and pre-qualify the medical professionals you work with and ensure they have the skills, mindset and bedside manner that best suites your needs. Bottom line is if you are active in sports and you get a sports injury, you may want to see a GP who has a sports medicine background as their approach may be to get you back to your sport at peak performance vs. recovered enough to function on your own. Likewise when it comes to PT and surgery you want someone who works with athletes vs. geriatrics as what they recommend and what they do will be very different. My key point here is that you need to do your research and find the right medical team to support your needs. Just like boot fitting the way you fit a world cup racer is very different than they way you fit and intermediate skier who just wants comfort. It is very easy to blame the doctors, but lets be honest you are the one responsible for choosing so lets not ignore the responsibility you bare for making an informed choice upfront. I find many folks just throw caution to the wind and don't go that extra mile. Do your research, get recommendations and if after all that you are still unhappy make a change and find the right fit. Oh and please stop making generalizations like " I have heard many stories that .... " that is hear say which really means nothing, recommend you lead with facts and first hand experiences. Bottom line if you did not see it first hand you really do not know what happened.
 

crosscountry

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From your PCP: yes. From you, random patient off the street: :roflmao:
None of the PCP I've had respond to phone calls unless it's "urgent".

Fall off your bike? Go to an ER. Not bad enough for an ER? Make an appointment. It's a shorter wait to get an ortho appointment than to get one from the PCP. Guess which one I see first? :roflmao:
 
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Crank

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I had a knee/leg issue 2 years ago. Went to an older ortho thinking he might understand my aging bod. He pretty much dismissed me and basically said I needed more exercise. Issue persisted and became more painful so I went to a different ortho. He diagnosed it as an I. T. Band thing caused by overuse and prescribed PT and stretches which healed it. Although I did not do the PT thing as it was in the midst of the Covid Pandemic and pre vaccine. I figured the PT was mostly going to be stretches anyway and I did not want to be in close proximity to a therapist for an hour a couple of times a week.

Just an anecdotal addition.

Right now I am dealing with what I think is a slight MCL strain but against my own advice I am waiting to see a doc as it doesn't seem too bad and I have a ski trip in 3.5 weeks! I will be skiing softly and carefully.
 

neonorchid

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You respond to phone calls? That's a novelty!

...and lets not act as if we didn't see it coming

FWIW, my elderly moms PCP left the practice she was with and informed my mom she is now a concierge doctor. One of my sisters and I went ahead and signed mom up for it, we think it's worth it. The other sister's PCP did this a couple years ago, she found a new one, felt the old PCP was overestimating his value to her
 
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Prosper

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It sounds like some of you and/or your family members have not had a PCP who has earned or deserved your trust which is unfortunate. I would hope that your minds might be changed should you find a good, caring and capable PCP. I’ll add that how much primary care manages vs refers can vary significantly from one geographic location to another and from one health system to another. In general, in more urban areas, especially ones where there is one or more medical schools, the medical culture tends to skew towards referring lots to specialists. There are health care systems and communities where primary care is more highly valued and PCPs manage lots more in urban, suburban and rural areas. Oftentimes, by necessity especially in rural or urban underserved areas primary care does lots more. After I finished family medicine residency I worked in the inner city of Chicago for 12 years where we had little access to most specialties. For the past 10 years I’ve been working for a large multi specialty group in the Denver area where primary care is the backbone of our organization. For me, being able to build long term relationships with patients and helping them improving their health through preventative health and diagnosing and managing common medical conditions is extremely rewarding. I would not enjoy just doing routine physicals all day long and just referring any patient with a medical complaint to a specialist and can’t see how that would be satisfying to anyone. PCPs who are referral machines IMHO should reevaluate their career choice.
 

Guy in Shorts

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My PCP spent a year as ski instructor out at Jackson Hole. He understands skiers. Asked him if I needed a stress test and he said carrying my skis up hill everyday is the best stress test.
 
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skiki

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I have had the unfortunate experience of feeling like my symptoms were being dismissed by my previous PCP, in addition to never being able to get an appointment. After the first visit it was see his assistant or wait 3 months. It took a while, but when I realized I was avoiding even trying to make appointments because I didn't trust the care I was getting, I found a different PCP (who grew up in VT and skis) in a different practice (where I can get an appointment with my PCP in a timely fashion), and am much happier. The first one had great ratings, so must have been a good fit for some, just not for me. I consider it a learning experience, and feel like I am now better at self advocating. Just unfortunate that it can be a trial and error process to find the right fit for both dr and practice. I admit I have been wondering if my knee already had an issue that 1st dr and ortho from the same practice pretty much dismissed (felt a pop and can't straighten your knee? You aren't in pain, your insurance likely won't want to pay for an MRI, so just stop limping, you're fine.)
 

Jerez

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There is a superb knee specialist in Taos. He works with the US Ski Team. Holy Cross Taos is a small hospital with a good reputaion. You can find top notch docs in NM but in general the health care here is not the best.

I know you said Albuquerque but in case you want another option....

 

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