I've just entered the general practitioner (GP) transfer portal

I've just entered the GP transfer portal, not to be confused with the football, basketball, or baseball transfer portals you have become more familiar with. GP is for general practitioner.

For the record, I don't frequently change doctors.

• Growing up in a rural community, I recall a time that every medical situation was handled by my dad's cousin, Dr. Ross Fowler . He delivered me at home, and he was the only doctor I had any contact with until college. He would occasionally contact specialists to get questions answered. My most exotic disease was Rocky Mountain spotted fever (RMSF), which I found later is?the most common?tick-borne disease?in Arkansas.
• My dad with his service station products and services and later with his TV and Appliances business bartered a lot with his cousin doctor. Not sure costs of a home delivery or visit costs? Gallons of gas, tires, oil changes, TV's, washer, dryer, refrigerator, freezer? Well before insurance, or going to his office.
• Frequent use of specialists have created a rural game changer.
• My GP handles lab tests for type 2 diabetes quarterly, A1C, flu shots, and other health needs as necessary. including annual checkup. Prescribes medication for aches and pains.
• My pharmacists handles coronavirus vaccines and boosts.
• My local cardiologists handles tests, schedules pacemaker checks, and checks and manages my INR level. Prescribes medication. My pacemaker was embedded in Fayetteville.?so I go there for major needs.

My prescriptions are made by at least 4 doctors. All interactions are checked by my pharmacist. No interactions have been reported. I have talked directly with pharmacists to confirm.

Although Drugs.com lists 1 major and several moderate interactions.

Suggest checking at least annually by sending a complete updated list to each doctor for their review.

Drugs.com?provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 5 July 2022), Cerner Multum? (updated 27 June 2022), ASHP (updated 16 May 2022) and others.

My current health issues?

• Type 2 diabetes?Diabetic neuropathy can cause numbness or tingling in your fingers, toes, hands, and feet. Another symptom is a?burning, sharp, or aching pain?(diabetic nerve pain). The pain may be mild at first, but it can get worse over time and spread up your legs or arms. Can impact your ability to drive. I had a minor accident at a car wash, so I took the state driving test in Little Rock to assure myself and family that I was still a competent driver. I passed, many fail it, but I changed a few things to avoid feet numbness fatigue, while searching for a better permanent solution. Another was eliminating occasional double vision with prisms in eyeglasses after cataract surgery.
• Parkinson’s?- Rock Steady Boxing?is a boxing program designed for people with PD, based on exercises that are adapted from the world of boxing that emphasize agility, speed, endurance, accuracy, hand-eye coordination, footwork and strength. Recommended by my neurologist. Many more women participate locally than men. The social impact is by far my biggest takeaway. Everyone encourages, no one is negative, just realistic. There is not a cure for Parkinson's. Best audience yet for my subtle (sometimes dark) sense of humor.
• Atrial fibrillation (Afib) - found that I am constantly in it based on pacemaker readings? Where abnormal was normal for me.
• Pacemaker - Single chamber for atrial fibrillation. I drove to Fayetteville (80 miles), and back after pacemaker was implanted. No need for a driver. Used creative borrow a friend in Fayetteville.
• Removed cancerous (grade 2) tumor from kidney lining, no reoccurrence. My daughter takes credit for saving my life.?Found at NIH in DC, when she was there on a trial program /study for her birth defect. Oral-facial-digital syndrome type 1 (OFD1) is a rare disorder comprising malformations of the face, oral cavity, hands, and feet.?Polycystic kidney disease (PKD) is a more recently recognized feature of the syndrome.
• Had at least 6 epidural steroid injections to treat back pain caused by a herniated disc (slipped disc). Those were hit or miss (mainly miss). You are put to sleep for those as well. I was working in Little Rock at the time, so found creative ways to handle outpatient driver requirements.
• Numerous physical therapy sessions. All good, but prefer boxing.
• Lumbar discectomy and laminoforaminomy. Removal of L4-L5 disc with scar tissue replacement. Best immediate relief !
• Major back surgery fusion with titanium rod and screws./Unfortunate result was drop foot. Nerve damage from major surgery may be another reason to try spinal cord stimulator procedure first. I would recommend avoiding major back surgery as long as possible. Too many possibilities for nerve damage. Early stage undiagnosed Parkinson's another.
• High blood pressure controlled with meds. Also Warfarin for blood thinner to avoid strokes. "patients who were taking (newer anticoagulants) or warfarin were 35 to 44 percent less likely to experience severe stroke,?21 to 25 percent less likely to die, and 40 to 50 percent more likely to function independently after a stroke,”?Something my parents and brother failed to take as prescribed, probably leading to their untimely demise.
• Botox injections in feet ever 4 months - for nerve damage. Some might say a big waste of Botox. Spinal cord stimulation success might eliminate it? Appendix A
• Lasik in 1999. No eyeglass hassle for 23 years.
• Cataract surgery in 2022, also need for glasses (prism lenses) to correct double vision.
• Prior to spinal cord stimulator?surgery, insurance companies require a?psychological evaluation to helps identify your strengths, weaknesses, and motivation for surgery. The goal is to help identify good candidates for surgery and to increase your chances of success post-surgery.
• Another one of those tests, "do you really, really want to do this? Your decision or did someone force you to do it?" "Are you on drugs or an alcoholic?"
• Wow what a gauntlet!
• Finally spinal cord stimulator surgery,?Reached full cyborg status. I consider pacemaker only half status.
• Next? AI and closed loop! Whatever the next big thing is?

Reasons to change your GP

• No longer meets your medical needs
• Most of your time is spent with nurse (or waiting on receptionists).
• Efficient use of your time, not just theirs.
• Lab work scheduled at time of doctor appointment causing delays. Better scheduled separately.
• Reentry of historical data on each visit
• Receptionists give priority to phone conversations over patients in office
• Taking surveys, and / or taking action on feedback.
• Failing to realize there are competitive options

Narrative on why I entered the GP portal

A few years back my local GP retired, and I transferred to his recommendation. Both were paid by local hospital NARMC. Easy transfer of records? Besides most of my more difficult health issues were handled by specialists.

Sidebar

Why are nonprofit hospitals so profitable?

They pay no property tax, no state or federal income tax, and no sales tax. In exchange, these charitable organizations are supposed to plough what they would have paid in taxes back into the community, largely by way of lowering healthcare costs or providing free care for those who can't otherwise afford it.

Several pro's and cons - doctor salaries are publicly available from nonprofits. How are they reviewed? For quality of service? Results of reviews? Actions taken? Not taken?

My background is in customer service, software development, R & D, installation, conversion, training, and later customer experience consulting which creates a tendency to overlap with any of my current day consumer and professional experiences.

Treating people how you want to be treated is a bottom line starter.

OK back to my narrative

Recently I went to my GP for my regularly scheduled quarterly lab work for A1C, since I had been diagnosed with type 2 diabetes. "Studies show a direct correlation between high A1C and severe diabetes complications. An A1C level?above 7%?means someone is at an increased risk of complications from diabetes, which should prompt a person to make sure they have a plan in place to manage their blood sugar levels and decrease this risk." Mine has been running slightly above 7. No major issues.

I arrived at doctor's office at 8:30 for a 8:45 appointment.

Line was longer than normal (than previous visits), so had time to overhear frustrations expressed by others waiting. So as time stretched to 15-20- 30 minutes, the person ahead of me was upset that the one primary receptionists was constantly on the phone. Even saying if that happened at an auto parts store, he would immediately leave, and go to a competitor.

After finally getting to receptionists, I was told that there was additional information I needed to complete. I responded that I had gone to their Healow portal, and wasn't aware of anything I had missed. Frustration on both parties surfaced, and I noted I had made a living developing customer service systems, and data entry. Only stating that I wasn't a novice at it. Listening is rule#1 in customer service!

But I did take the iPad and started reviewing the questionnaires. The online information requested was essentially for a new patient - surgery history, family history, etc. were all blank. Not an update to old information.

After seeing they must be switching to a new system, where conversion of old data wasn't being provided or not paid for, I returned the iPad and asked if there was any way I could get my routine lab work without doing the questionnaire at this time, which would have been impossible to do off the top of my head (accurately). Also my GP was included on MyChart where surgeries had been done.

I made the comment that I didn't want to spend 2-3 hours answering questionnaires, getting routine lab work, and waiting on doctor; so must be time to find another doctor? Music to receptionists ears. OK there is selective listening! After a few minutes a nurse confirmed the receptionists response, and I left.

I did call the nurse at my cardiologists, and got lab work done in a matter of minutes. Good news it was 6.9. Note my cardiologists had moved from Walker Heart to Baxter Regional. Still had a local office. Record transfer was not an issues. Must I repeat there had been no transfer from retired doctor to his replacement (all at the same hospital).

As far as communications, I did discuss with my GP's nurse, GP, and NARMC CEO before taking action. I did notice that I had already been disabled from my GP Healow, and his connection on MyChart was removed. Which further indicates communications were more CYA than attempts to discuss and resolve any issues.

CEO --

"I certainly appreciate the frustration.?I know there has some work been done on the registration process and it sounds like we may have some additional opportunities.?The various systems that different medical systems use also create some difficulty when they don’t effectively communicate.?I am not sure, but this may also have created some of the frustration.?I have shared this concern with Dr. xxxx and he is going to be reaching out to you.?I have also reached out to our Information Technology team to see if there is anything we can enhance there in the systems communication."

Doctor --

"When you were asked to check-in for your appointment last week, at first you argued with my staff on why you should be treated differently than every other patient I have and then declined to check in and also stated that you were going to find another doctor. At that point you effectively fired me as your physician. One thing I do not tolerate is being disrespectful or arguing with my front office staff or nursing staff.?"

Respect shown to longtime patient? Treated as though I was first time patient. Where were the loyalty points? As long as I had been a patient there was never any record previously of any negative comments. I wasn't wanting special treatment, I got that, without asking, when I went to my cardiologist's nurse and got immediately handled by their lab. Handled locally by another hospital.

Never wanted to be treated differently, just fair! Knowing patients (customers) critical to competing against online doctors (Amazon) as well.

One of the cons of a small hospital paying their doctors is lack of accountability. Appearance or otherwise. As noted tone of doctor totally different than CEO.

Just an unfiltered observation, the merger of NARMC with a larger hospital (most likely CoxHealth) is becoming a stronger possibility. Maybe the new registration process and information reentry? Maybe a few *golden parachutes being created in advance as well? Inflated salaries for 40 hour week versus 60 hours at another hospital?

*a large payment or other financial compensation guaranteed to a company executive should the executive be dismissed as a result of a merger or takeover.

Peruse following information, and I'll let you be the judge!

Most Food Stamps?by Place

Food Stamp recipients as a percentage of all households.

Scope:?population of Arkansas, selected places in Arkansas, and entities that contain Arkansas

North Arkansas Regional Medical Center (NARMC) is an innovative, non-profit healthcare system consisting of a central hospital in Harrison, Arkansas, and 18 clinics serving the rural communities of North Arkansas. More than 850 NARMC employees, including 32 physicians, physician assistants and APRNs, work together to provide a comprehensive range of healthcare services. NARMC is a not-for-profit hospital guided by four sets of values: safety, quality, integrity, and community. These values go hand-in-hand with the mission of our Medical Center which is to provide comprehensive healthcare in North Central Arkansas and to our vision which is to be the most trusted and preferred healthcare provided in the area.

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"Baxter Regional Medical Center is a nonprofit hospital, located in Mountain Home, Arkansas. As a fully integrated health care organization, they have been serving residents of Baxter, Marion, and surrounding counties since 1963. The 268-bed short-term acute care facility offers a wide range of services and specialties to meet the needs of the communities they serve. With more than 180 primary care, mid-level and specialist physicians on medical staff, and approximately 1,700 employees, Baxter Regional is the region's leader in friendly, quality healthcare. Baxter Regional is consistently recognized as one of the nation's top heart programs and one of Arkansas' best places to work."

Comparisons

?NARMC 850 employees, 32 physicians, physician assistants and APRNs,

?Baxter Regional, approximately 1,700 employees, ??180 primary care, mid-level and specialist physicians on medical staff??

CoxHealth is the only locally owned, not-for-profit health system based in Springfield, Missouri. In September 2020 it entered a partnership with North Arkansas Regional Medical Center to bring medical specialties to Harrison. NARMC purchased the old Bear State Bank building and engaged CoxHealth to manage the renovations necessary to convert it to a medical office complex. The health systems will jointly provide services when the facility opens. That could be as early as December.

CoxHealth will also be bringing specialists to help fill the space for 15 physicians. There will be facilities for laboratory and imaging, as well as an urgent care. The project has been delayed due to the COVID-19 pandemic. The facility has been used as the hospital’s COVID-19 testing clinic.

During the Boone County Quorum Court’s regular meeting Tuesday night, Boone County Judge Robert Hathaway asked NARMC’s interim CEO Sammy Cribbs to detail the relationship shared by the two health systems. “I know there are some rumors going around,” he said. “I think it is better to squash them now before they get out of hand.”

Cribbs said the hospital leased about 20% of the space in the medical office plaza to CoxHealth. The intent is to bring specialists into the market to help support NARMC patients and their families and to keep them from having to travel outside the area. She added it will promote economic development as patients will be able eat and shop locally rather than in other localities where those specialists practice.

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