32 votes

How best to get a thorough inspection after avoiding doctors for a decade?

The last time I ran off to see a doctor was about 10 years ago when I got a concussion shortly after graduating college. After that, I have visited optometrists and dentists, but not an MD. I had my own insurance at my first big boy job after school, but I didn't schedule any appointments [early 20s with plenty of other priorities] before I got fired after a couple years and lost employer coverage (ain't nobody got money for COBRA nonsense).

After that, I've been rather chronically underemployed and thus avoided the medical system entirely (with the above exceptions of my eyes & teeth) to avoid being told to go fix expensive problems [and not wanting the monthly drain of premiums].

Anyway, I (for better and worse) had an hours cut that got me eligible for Medicaid. I'd like to know what to say to get a head-to-toe physical (including mental health) with minimal hassle and needing to re-clarify what I want. Mental health-wise, I can state a suspected primary complaint: undiagnosed ADD due to lacking the H as a child as well as seasonal depression [the chronic depression was entirely downstream from the abovementioned ADD].

However, I have no idea what to tell the doctor to look for physically. Probably should get some kind of comprehensive blood screening done. Make sure my hormones, iron, etc… are all within normal bounds. Perhaps I have some conditions that should've spooked me into seeing a doctor five years ago, but I'm still alive and well, so they're no longer causes for alarm [even if they should be].

35 comments

  1. [16]
    updawg
    Link
    Usually people don't go to the doctor unless they have specific concerns and doctors generally don't like to just run tests for no reason as it feeds hypochondria. Just tell the doctor if there's...

    Usually people don't go to the doctor unless they have specific concerns and doctors generally don't like to just run tests for no reason as it feeds hypochondria. Just tell the doctor if there's anything bothering you or anything that you feel is out of the ordinary. It's not like people need to constantly get diagnostic tests run on them, and it's entirely possible to go your who 20s without having much of a reason to go to the doctor.

    35 votes
    1. [14]
      GenuinelyCrooked
      Link Parent
      I'm in a similar situation, not this one exactly, but similar. How do I know if something is "out of the ordinary" when I never had a baseline of ordinary be established? For example, I think...

      I'm in a similar situation, not this one exactly, but similar. How do I know if something is "out of the ordinary" when I never had a baseline of ordinary be established? For example, I think everyone sometimes gets a bit dizzy when they stand up too fast, but how do I know if it's happening more than it should? I know it's not happening more often than is usual for me, but that might just mean that I've had low blood pressure for several years rather than meaning that I'm fine.

      I think what OP wants, and what I've wanted for years, is a way to establish a healthy baseline from which I can note deviations in the future. Are these random aches and pains normal? Is this level of fatigue normal for my 30s? Is this frequency of headache normal? I know that it's normal for me, but does that mean that it is normal, or that I've had a problem for years? My mom doesn't trust doctors, so I didn't go when I was a kid either, even when I had things happen that definitely weren't normal for me. Some of those things went away, and some I just got used to. It's not impossible that I'm dealing with some health issue that's been harming me for 20 years and I've just never realized that it shouldn't be happening.

      I did try to see a PCP a few years ago and go over some things that had been of particular concern, but she was spectacularly unhelpful. She just asked if I wanted prescriptions for drugs or referrals to other doctors, and refused to understand that I was trying to determine if I needed drugs or referrals, I didn't just want her to dispense them at my request.

      11 votes
      1. [12]
        R3qn65
        Link Parent
        If it makes you feel better, there is no universal normal for any of this stuff. This is part of why doctors always ask if there's been a change - they're trying to establish if something is new...

        I think what OP wants, and what I've wanted for years, is a way to establish a healthy baseline from which I can note deviations in the future. Are these random aches and pains normal? Is this level of fatigue normal for my 30s? Is this frequency of headache normal? I know that it's normal for me, but does that mean that it is normal, or that I've had a problem for years?

        If it makes you feel better, there is no universal normal for any of this stuff. This is part of why doctors always ask if there's been a change - they're trying to establish if something is new or normal for you.

        9 votes
        1. [11]
          GenuinelyCrooked
          Link Parent
          I understand that they're doing that, but I'm worried about the assumption that "normal for me" means that there's no disease process happening. Just because it's been happening for a long time...

          I understand that they're doing that, but I'm worried about the assumption that "normal for me" means that there's no disease process happening. Just because it's been happening for a long time doesn't mean that it's healthy or unproblematic. Lots of very bad things can go on for a long time without killing or hospitalizing you!

          3 votes
          1. [10]
            updawg
            Link Parent
            You're overthinking it. Imagine you'd been going to the doctor the past several years. Would you have told them anything at those visits? Have things changed for you? Doctors generally want to...

            You're overthinking it. Imagine you'd been going to the doctor the past several years. Would you have told them anything at those visits? Have things changed for you? Doctors generally want to know about changes from your baseline or things that give you physical discomfort.

            That doesn't mean changes from the day you first start going to see the doctor. Was something never an issue before but now it is? Bring it up. Was something always an issue? Bring it up. Do other people talk about something that happens to them like it's silly but it seems serious when it happens to you? Bring it up.

            You don't need to test everything, just ask about the things that don't seem like they're the way a body is supposed to work.

            4 votes
            1. [9]
              GenuinelyCrooked
              Link Parent
              Yes, absolutely. I don't know if it's an issue, or just a normal amount of pain to be in. I also don't often remember when things started. I don't know how a body is supposed to work! I've never...

              Would you have told them anything at those visits?

              Yes, absolutely.

              Was something never an issue before but now it is? Was something always an issue?

              I don't know if it's an issue, or just a normal amount of pain to be in. I also don't often remember when things started.

              just ask about the things that don't seem like they're the way a body is supposed to work.

              I don't know how a body is supposed to work! I've never experienced living in one that I was confident was working correctly.

              1 vote
              1. [8]
                updawg
                Link Parent
                I didn't say "do you think it's normal?"; I asked if it's an issue. Only you can decide if it's an issue. Normal pain can be an issue. Bodies are supposed to function properly. If yours is not,...

                I don't know if it's an issue, or just a normal amount of pain to be in.

                I didn't say "do you think it's normal?"; I asked if it's an issue. Only you can decide if it's an issue. Normal pain can be an issue. Bodies are supposed to function properly. If yours is not, discuss it with them.

                I don't know how a body is supposed to work! I've never experienced living in one that I was confident was working correctly.

                They're just supposed to work smoothly. They are not supposed to have complications, joints that don't have a full range of motion, unexplained pains, etc. Millions of years of evolution have given us bodies that are supposed to do everything well.

                1 vote
                1. [7]
                  DefinitelyNotAFae
                  Link Parent
                  Except childbirth. And wisdom teeth. And a bunch of stuff. Evolution doesn't have to be perfect, just good enough for reproduction... Most of the time. But "is it hurting or causing you distress"...

                  Except childbirth. And wisdom teeth. And a bunch of stuff. Evolution doesn't have to be perfect, just good enough for reproduction... Most of the time.

                  But "is it hurting or causing you distress" is a good metric if you don't have a baseline to go from.

                  3 votes
                  1. [6]
                    updawg
                    Link Parent
                    To be fair, way too many people get their wisdom teeth removed—I still have three out of five of mine, if you can believe it, with the two being removed due to a cavity—and in countries that use...

                    To be fair, way too many people get their wisdom teeth removed—I still have three out of five of mine, if you can believe it, with the two being removed due to a cavity—and in countries that use evidence-based extraction and only remove them when it becomes an issue, rates hover somewhere below 50%, so it really is typical for wisdom teeth to not cause issues. Additionally, wisdom teeth would be less of an issue if we ate the diet we evolved to subsist on, so our bodies mostly function smoothly in that regard.

                    Plus idk about you, but I'd call a parasite growing in your tummy something out of the ordinary (just act like this helps my argument).

                    1 vote
                    1. [5]
                      DefinitelyNotAFae
                      Link Parent
                      I mean 50% is approximately the amount of folks who have to worry about childbirth so.... Is it diet or just that normally in nature we'd lose a few teeth and have room? And personally I do feel...

                      I mean 50% is approximately the amount of folks who have to worry about childbirth so.... Is it diet or just that normally in nature we'd lose a few teeth and have room?

                      And personally I do feel similarly about parasites but evolution seems to want them for some reason. Then again my niblings are cute so I'm glad someone does it.

                      1 vote
                      1. [4]
                        updawg
                        Link Parent
                        We have evolved smaller jaws, but eating softer foods means that we aren't strengthening and giving our jaw the stimulus to encourage it to grow to provide more chewing and grinding power.

                        Is it diet or just that normally in nature we'd lose a few teeth and have room?

                        We have evolved smaller jaws, but eating softer foods means that we aren't strengthening and giving our jaw the stimulus to encourage it to grow to provide more chewing and grinding power.

                        1. [3]
                          DefinitelyNotAFae
                          Link Parent
                          So babies need chew sticks.... check.

                          So babies need chew sticks.... check.

                          1 vote
                          1. [2]
                            updawg
                            Link Parent
                            Just...make sure they aren't bully sticks.

                            Just...make sure they aren't bully sticks.

                            1. DefinitelyNotAFae
                              Link Parent
                              The next all natural craze. Probably safer than raw milk I guess.

                              The next all natural craze. Probably safer than raw milk I guess.

                              1 vote
      2. doctor_avoider
        Link Parent
        That is very close to what I'm after. If my mood tracking is anything like my physical health, I can distinctly remember being at a -3 (on a -3 to +3 scale) at noon, yet my overall mood for the...

        That is very close to what I'm after. If my mood tracking is anything like my physical health, I can distinctly remember being at a -3 (on a -3 to +3 scale) at noon, yet my overall mood for the day is ±0.25. Similarly, unless a problem bothers me on the day of my appointment, there's a good chance I'll report that my physical health is “fine” or “good enough.”

        Even the suspicion of ADD didn't get uncovered until some lifestyle changes a few years ago washed away the coping mechanism that (barely) masked the negative effects. For the longest time, I thought it was just regular depression.

        6 votes
    2. doctor_avoider
      Link Parent
      Part of my rationale is that I'd like to get as much as possible diagnosed and treated while I'm still on Medicaid to minimize out-of-pocket expenses. I strongly expect that once I get the MH...

      Part of my rationale is that I'd like to get as much as possible diagnosed and treated while I'm still on Medicaid to minimize out-of-pocket expenses. I strongly expect that once I get the MH aspects treated, I'll be employed at the level of my natural talents again and have to deal with private insurance again.

      3 votes
  2. [3]
    DefinitelyNotAFae
    Link
    Suggestion for the phone call: "I haven't seen a doctor in a long time and I'm wanting to make sure I have a primary doctor for the future and set up a wellness visit so I can get checked out."...

    Suggestion for the phone call: "I haven't seen a doctor in a long time and I'm wanting to make sure I have a primary doctor for the future and set up a wellness visit so I can get checked out."

    With the doctor, letting them know your history of avoiding doctors, including with depression and you think ADHD (the diagnosis includes the H now and just comes in 3 types, with "inattentive" fitting the "ADD" label the best, not important just helpful info), you can see what they say, but if they don't suggest it, asking for a standard bloodwork panel to be done is reasonable and gives the doctor a good idea if there's anything wrong. Depending on your age there are a number of possible recommended tests and vaccinations you could be due for.

    Mostly that wellness visit is going to be what you're looking for, I think, with any future visits being referrals or follow ups to anything found on that one. Some primary care docs do more mental health than others, so they'll probably recommend a therapist - maybe they have one in their practice or encourage you to find one yourself - but most will handle seasonal depression. ADHD can require more when you don't have an existing diagnosis.

    If you're not having any current complaints, then I'd say the bloodwork panel is probably key and i'd be surprised if the doctor didn't want to do that that themselves.

    30 votes
    1. [2]
      doctor_avoider
      Link Parent
      This is tangental, but what's the third presentation of ADHD? As you mentioned, there's inattentive (formerly ADD) and classic (formerly with the H). That's only two. Definitely need a tetanus...

      This is tangental, but what's the third presentation of ADHD? As you mentioned, there's inattentive (formerly ADD) and classic (formerly with the H). That's only two.

      overdue vaccination

      Definitely need a tetanus boost. May as well get my flu & COVID updates while I'm getting jabbed. Probably some others that only the physician would know.

      no existing ADHD Dx

      I was extensively tested for something and put on an IEP in late elementary school. However, I was never told any specific Dx, and the IEP was removed at the start of high school because I was academically successful without using its accommodations. That all said, who knows if such files are recoverable or if they're long past the data retention limits.

      2 votes
      1. DefinitelyNotAFae
        Link Parent
        Hyperactive, inattentive and combined are the three subcategories. They're mostly diagnostic categories. How much anyone cares about that depends on if you need to go to a...

        Hyperactive, inattentive and combined are the three subcategories. They're mostly diagnostic categories.

        How much anyone cares about that depends on if you need to go to a psychologist/psychiatrist for the diagnosis. Getting a copy of the childhood records would be rough but mentioning your history with that is worthwhile! I have shared in the past that my depression also comes from not meditating my ADHD and I think that's useful info.

        Definitely let the doc know about your desire to get vaccines caught up, sometimes it's cheaper/easier to get them at a pharmacy but you'd have to check your insurance. The nurses at my doc's office are slightly better than the pharmacists at it

        2 votes
  3. PepperJackson
    Link
    There is little data to suggest that running a lot of blood tests on young healthy people is actually beneficial. I would have to look at the USPSTF recommendations again. I think that primary...

    There is little data to suggest that running a lot of blood tests on young healthy people is actually beneficial. I would have to look at the USPSTF recommendations again.

    I think that primary care is critical to maintain, however, if you do not have any specific complaints, there is little utility in getting extra tests done. When you have a low suspicion for pathology, they actually can be more harmful than beneficial. (Read about the Bayesian trap if you are interested, Veritasium's video is pretty good too https://www.youtube.com/watch?v=R13BD8qKeTg)

    Ultimately, I would recommend going to a primary care physician and say that you are interested in "establishing care". This will get you plugged into their system with regular visits and give you someone to ask about any issues that arise in the meantime. Your provider should be happy to discuss your concerns about ADD and seasonal affective disorder and potentially refer you to the appropriate specialists.

    11 votes
  4. knocklessmonster
    Link
    Let them know you want a standard physical. You're actually "supposed" to do one a year so it's not some sort of strange ask. Some doctors bake in additional tests like blood panels, EKGs, for...

    Let them know you want a standard physical. You're actually "supposed" to do one a year so it's not some sort of strange ask. Some doctors bake in additional tests like blood panels, EKGs, for more thorough examinations as well, but they aren't required typically. I had a doctor give me an EKG and do a blood panel within the next two weeks after not being seen for a few years, all covered by insurance as part of the physical.

    11 votes
  5. [2]
    tanglisha
    Link
    I always bring a list of concerns with me to the doctor. I can never seem to remember anything in the moment, plus I can hand it over to the person who takes notes before I see the doctor. When a...

    I always bring a list of concerns with me to the doctor. I can never seem to remember anything in the moment, plus I can hand it over to the person who takes notes before I see the doctor.

    When a doctor asks, “How are you doing?”, I always answer, “I’m okay, how are you?” out of habit. I’ve done this in the emergency room, it’s really not helpful.

    7 votes
    1. doctor_avoider
      Link Parent
      I'm similar to you. To copy another comment I just left,

      I'm similar to you. To copy another comment I just left,

      If my mood tracking is anything like my physical health, I can distinctly remember being at a -3 (on a -3 to +3 scale) at noon, yet my overall mood for the day is ±0.25. Similarly, unless a problem bothers me on the day of my appointment, there's a good chance I'll report that my physical health is “fine” or “good enough.”

      3 votes
  6. moocow1452
    Link
    Explain the situation and ask for a physical? You're probably not the first person they ever had to deal with in this situation. If you're asking for mental health stuff, they'll probably refer...

    Explain the situation and ask for a physical? You're probably not the first person they ever had to deal with in this situation. If you're asking for mental health stuff, they'll probably refer you to a psychiatrist, and other medical stuff will be dealt with as needed.

    6 votes
  7. Akir
    Link
    You don't need to do anything special - just ask for it. Granted, medicaid is a crazy system in which every state is different, but in any case, every healthcare plan actively wants you to have an...

    You don't need to do anything special - just ask for it.

    Granted, medicaid is a crazy system in which every state is different, but in any case, every healthcare plan actively wants you to have an annual physical because preventative healthcare is cheaper than reactive healthcare. Mental health is also covered by medicaid so all you need to do is to ask to see a psychologist. But because every state is different, you might need to ask your local medicaid office to see exactly how to use your benefits.

    Your health is really important, so please go and get yourself checked out.

    6 votes
  8. cloud_loud
    Link
    I guess it depends on where you’re at. But at my doctors a general checkup/physical includes a basic blood test. It’s not comprehensive but should cover any major issues.

    I guess it depends on where you’re at. But at my doctors a general checkup/physical includes a basic blood test. It’s not comprehensive but should cover any major issues.

    5 votes
  9. [2]
    Jordan117
    Link
    Make sure you're aware of exactly what your insurance covers. When I first got coverage through work I did the responsible thing and got a physical, confident that my post-ACA plan included both...

    Make sure you're aware of exactly what your insurance covers. When I first got coverage through work I did the responsible thing and got a physical, confident that my post-ACA plan included both blood work and an annual checkup 100%. Turns out that while it covers an annual checkup, and it covers blood work done "for cause", it doesn't cover blood work done as part of an annual checkup, and I got a bill (six months later) for $600. Oops.

    5 votes
    1. doctor_avoider
      Link Parent
      …and that's the reason I've avoided the medical system for the second half of that decade (the first half was due to being in my 20s with other priorities)

      …and that's the reason I've avoided the medical system for the second half of that decade (the first half was due to being in my 20s with other priorities)

      3 votes
  10. firedoll
    (edited )
    Link
    If I'm understanding correctly, it sounds like need to get established with a primary care doctor. You can probably tell them when scheduling the appointment that you haven't had a primary care...

    If I'm understanding correctly, it sounds like need to get established with a primary care doctor. You can probably tell them when scheduling the appointment that you haven't had a primary care for several years and you'd like a complete physical.

    My big pieces of advice are to think about anything that's bothering you and write it down ahead of time, then go over the notes with them in the physical. If you have a family history of a certain thing or are particularly worried about something like cholesterol or diabetes, make sure you mention that. They only have so much time for each patient, so you want to make sure concerns get addressed even if they are swamped.

    See if you can make sure you have your vaccine records from the state. Discuss if there are any you're due for a booster of. And, for issues related to mental health (or anything outside of general healthcare,) you could also ask for referrals to specialist.

    The aren't going to run you through every test or do something like a "full body scan," but they may want to run something like a Comprehensive Metabolic Panel, Complete Blood Count, a Lipid Panel, and/or a couple others. You could ask about those types of tests.

    That said, understand that tests have a margin of error. Unless there are symptom/signs that something is wrong, or you've reached an age where certain tests are normal (e.g. 45 year olds generally get a colonoscopy), they wouldn't run you through everything due to the possibility of false positives. Because, False positives can send you down an expensive path of unnecessary testing/treatment.

    4 votes
  11. rosco
    Link
    Popping in as someone with a similar history with medicine. I was on Medicaid for 3ish years from 2020 to halfway through 2023. I want to highlight that advice is probably going to be very...

    Popping in as someone with a similar history with medicine. I was on Medicaid for 3ish years from 2020 to halfway through 2023. I want to highlight that advice is probably going to be very location dependent. If you are in a major metro area you will likely have more options, but there might also be more impacted care in terms of availability and quality.

    The first major hurdle will be getting a primary care physician. I had a very hard time finding someone within 50 miles who took medicaid - or Medical in my case - and ended up going to urgent care for most of my injuries. Local urgent care facilities that did take Medical were pretty terrible, so I do not recommend that. I didn't end up finding a primary, but for anything you want a specialist for or continued care (which is pretty crucial in many cases so that it doesn't start fresh every time you go to the doctor) is kind of reliant on primary care. So look up who takes Medicaid in your area and find out if they are taking new patients. If none are, as was my case, you can try to get referred through urgent care.

    Once you do get an introductory appointment with a primary care physician find out how you bring up issues (i.e. can you just dump on your first visit or do you need to schedule an appointment for each). Everyone is different, but asking the person you're scheduling with will go a long way. If you're lucky you can address all your issues in the first visit, if not you should use the time to make a plan with them. Once you are a patient with the primary, it shouldn't take as long to schedule visits (like a few weeks vs a few months), so if they ask you to break it up it should be easier, even if that is annoying. If you can schedule it during your first visit you can get a full body physical. If you want them to extend the tests they give you, I've found that getting a physical for scientific scuba diving certification was by far and away the most intensive one I've ever had.

    I had my introductory appointment with a primary care physician for the first time in 7 years last Thursday, and it was freaking incredible!!! He addressed my on-going stomach issues by getting me a referral with a GI specialist, providing some suggested measures in the meantime and ordering blood tests; he also got me a referral for ADHD testing and a sports medicine referral for my Dupuytren's. Beyond that he set up a recurring annual physical. The experience was awesome, but it is by no means usual. So be prepared to figure out how to navigate getting what you want. It's ok to ask directly, but you might have to jump through hoops to get there.

    With all of this, be easy on yourself. The bureaucracy that surround healthcare in the US is staggering. As are the costs, even if you're insured. So, big congrats on getting back on the horse and getting set up!

    Lastly, for the ADHD diagnosis, I got one from my couples counselor. I told her at the beginning I thought I was and we did an assessment that came up that I didn't have it. However after having weekly sessions with her for 3 months about our relationship she asked for me to reassess. When we went through the questions together she asked why I had answered questions the way I had and told me 2 very important parts of the equation. 1. when a question asks you how difficult something is compared to the average person - compare yourself to an actual average person - not other neurodivergent folks, not high achievers - average people. 2. Assessments are effectively gatekeepers. If you answer conservatively or "incorrectly" they will keep you out of treatment. What you want to do is get yourself opted into treatment, what you choose to do or how your GP decides to treat after that is up to you. But if you get bounced from treatment you have no options. So to some degree you can treat it like a Harry Potter House Quiz. In the harry potter quizzes you can often tell what house the answers you're selecting are pushing you towards (i.e. Are you brave - Griffendor, Are you cunning - Slythern). The ADHD stuff is similar (i.e. Do you have trouble setting an agenda - ADHD). You can select the answers that reflect your experience but also be cognizant that if you want to see a specialist you want to get kicked into treatment, not out. So think about how your answers might impact that. When I took mine I said I was good at time management - and I kind of am - but through a series of off the wall coping mechanism and my subjective view of "good time management". But if I say I'm good at time management, it doesn't reflect that. So just be aware of that.

    3 votes
  12. hamefang
    (edited )
    Link
    Full urine and blood panel, as well as abdoment ultrasound should catch most troubles that might be brewing before they actually start manifesting any symptoms. Additionally, for ladies...

    Full urine and blood panel, as well as abdoment ultrasound should catch most troubles that might be brewing before they actually start manifesting any symptoms. Additionally, for ladies specifically, mammography / breast USG exam is a good idea, even if you aren't at a higher risk age yet. And since we are talking about prevention - get up to date on your vaccinations, at the very least flu and COVID.

    I compiled some tips below that help keep the results accurate / make the examination possible:

    Tips for the blood sample:

    • Withhold any supplements you might be taking for a few days beforehand. Do take your absolutely necessary meds, but check which tests they might potentially falsify.
    • Get a full night sleep beforehand.
    • Don't eat anything for 12h beforehand.
    • Drink a glass of water about 0.5h beforehand.
    • Sit down and chill for about 5-10min beforehand.
    • Go to take the sample in the morning.
    • Don't go to take a sample if you are under extreme stress.
    • Don't excercise before taking the sample.

    Tips for the urine sample:

    • Don't excercise before taking the sample.
    • Wash your genitals gently with a stream of water from the shower before taking the sample. Don't get your fingertips anywhere close to them, the smallest scratch from your fingernails can lead to contaminating the sample with blood.
    • Should be taken to a special plastic container - ask at a drug store, they should have them.
    • Should be taken in the morning - it's best if you don't pee during the night before taking the sample.
    • Get the sample to the testing center within an hour, after that it's not good.
    • Aim the pee into the toilet for a few seconds, then you aim for the container to fill it up to necessary volume, then aim back to the toilet.
    • The pee stream should be continous.

    Tips for ultrasound (to ensure they are able to check your intestines and bladder):

    • Don't eat anything the day before, make sure you have your bowel movement.
    • Take the special pills that prevent flatulence (explain that you'll be getting the USG exam at drug store, they'll get you some).
    • Your bladder should be full but you shouldn't be super desperate to pee. Drinking a tall glass of water about an hour before the exam should do it I reckon.

    Other than that, get to a family doctor (general practicioner) and ask for a general exam. They should do some basic stuff like look into your throat and ears, listen to your lungs and heart, possibly do an EKG, etc. And of course you definitely need to see the psychiatrist for the ADHD / depression stuff, but I'd personally wait for all the other tests to be done first.

    2 votes
  13. Weldawadyathink
    Link
    People have answered your question pretty well. Most doctors know what they are doing. You (usually) don't need to play any word games just to get a checkup. As others mentioned, you are "supposed...

    People have answered your question pretty well. Most doctors know what they are doing. You (usually) don't need to play any word games just to get a checkup. As others mentioned, you are "supposed to" get a check up every year, but it's pretty normal for people to not do those for a long time, especially when young. So first you have to find a primary care physician. This will be your go-to contact for everything in the healthcare world. If you need, for example, an ADHD diagnosis, you will contact your primary care physician to get a referral to a psychiatrist.

    When looking for a doctor, you want to look for the keyword "family medicine". Despite what it sounds like, this is not family planning or anything like that. A family doctor is just a general doctor. You can either choose a specific doctor using a variety of websites or call a local hospital group and request a doctor. In my area, the doctors were extremely understaffed, so I had to call a hospital and take the doctor they assigned me. Then schedule a "wellness visit" or "new patient visit".

    For the visit, just give them all the info you have given in this post. Be honest about not seeing a doctor in the past. They will decide what, if any, tests they need to run. It is important to find a doctor you trust. If you don't fit well with the first doctor, you can always find a new one.

    For ADHD, I highly recommend seeking a diagnosis, even if you don't plan on any medication. I take medication, but the diagnosis itself was incredibly important to verify my feelings and start improving my life. You want to ask your primary care physician at your initial visit for a referral to a psychiatrist for an ADHD assessment. They may ask some pre-screening questions or ask about the symptoms you are experiencing. Just be honest. Then you need to see a Psychiatrist, not a Psychologist. You can look up the difference if you want, but for the initial diagnosis and possible medication, you need a Psychiatrist.

    Good luck in your health journey!

    2 votes
  14. [2]
    Earhart_Light
    Link
    Okay, so: some Medicaid plans are offered by better companies than others. I had United Healthcare, and they made everything a massive hassle; I moved to a different plan the next open season and...

    Okay, so: some Medicaid plans are offered by better companies than others. I had United Healthcare, and they made everything a massive hassle; I moved to a different plan the next open season and have been delighted. So, if your current Medicaid plan isn't working for you this year, do some investigation and see if there are any better ones for your area. (A lot will depend on your state, and how close you are to doctors.)

    When you call to make your appointment, tell them that you haven't seen a doctor in the last ten years and that you need a new patient appointment for an annual physical. The next available appointment will probably be a few months away (it's okay, you can use the time to your advantage), though you can ask to be put on a waiting list on case of cancellations. The new patient appointment is important because it's a larger time frame for a more detailed history.

    Ask them if they would like any lab tests (such as bloodwork) done before the exam. If so, ask them to send you the paperwork for the lab work. Call your insurance company and confirm that the lab work is covered under your policy, and that it doesn't require prior authorization. [Standard lab work should not require prior authorization, but I'm paranoid about checking these things first.] Whenever you contact your insurance company, keep a piece of paper with you. Write down the date and time, the name of the representative you're taking with, why you called, and what their answers were (again, my paranoia).

    Call the lab and schedule an appointment for 2-3 weeks before your doctor's appointment. That gives the lab plenty of time to run the tests and get the results to your doctor, and also makes sure that the test results are 'fresh' enough to still be relevant. For this and any other tests you ever have run, always ask the lab to send copies of the test results to you as well; I like having copies on hand in case I end up needing them for another doctor or if I want to look for patterns.

    If the doctor's office doesn't offer, ask them to mail/email you the new patient history forms to fill out. When they arrive, make a copy so that you're not working off the only original. Fill it out in as much detail as possible, ask relatives about family medical (and mental health) history for possible genetic risks. Thoroughly review the paper several times over the course of a couple weeks to make sure it's as complete as possible. You're deliberately making the list over a period of time (and on a 'test' copy of the form), because there will be things you think of or find out after you've initially filled it out. When you're finally done, re-write everything onto a fresh copy of the form, and make a copy of it for your records before you send it back to them.

    As you fill out your medical history form, and as you ask your family about the family history, keep a separate notepad available. As you go through the forms and history, write down every physical issue you've had in the last year, or any untreated major issues you've had since the last time you saw a doctor. Keep the notepad around for a couple weeks or a month and, every time you run into a new issue or remember an old issue, add it to the list.

    When you're done with the list, sit down with it and put it in some kind of order. I try to order the list with what I think are the most important issues at the top, with decreasing severity as you get farther down. This is so that, if there isn't enough time in the appointment to get through the entire list, the most important things are addressed first. Where appropriate, you can group issues together if you think they may be related in some way; like if you think a pair of symptoms are related to the same problem, or if you're having multiple problems with the same organ.

    Print out two copies of this record, one for you and one for your doctor, and bring them to your appointment. As you work your way down the list, write down any notes or comments on the paper; do not trust your memory.

    At the end of the appointment, I like to take a couple minutes to quickly read my notes back to the doctor. That gives them the chance to correct anything I may have misunderstood, and also the chance for them to offer further information on what they're suggesting and why.

    Your PCP will do basic care, and will likely refer up to specialists for everything else You are likely to leave the doctor's office with a bunch of referrals, for other tests and to see said specialists. Call your insurance company ask them what their process is for you to get prior authorization. Write their answer down so you have it for future reference. Then go over the list of referrals with them, and find out which ones require prior authorization. For each referral, you'll also want to ask them if the suggested doctor is in-network; if the doctor isn't, ask them for names of doctors with that specialty that are in-network and are in your area. [Most of this comment assumes that your referrals are to people and places that are in-network, but different doctors' offices and different insurance plans are better at making sure your referrals are actually made to in-network providers.]

    For the stuff that you don't need prior authorization for: call them up, confirm that they accept your insurance, confirm that they're accepting new patients, confirm that you do not need prior authorization, and make an appointment. [cont.]

    1 vote
    1. Earhart_Light
      Link Parent
      [cont.] For the stuff that you do need prior authorization for: go through the process to get the prior authorization. The exact details will vary depending on a lot of factors. I personally found...

      [cont.]

      For the stuff that you do need prior authorization for: go through the process to get the prior authorization. The exact details will vary depending on a lot of factors. I personally found it significantly easier once my PCP was part of a hospital's care network. I hate that I'm part of a corporate group, but getting and managing appointments was so much easier going through their network. The following is my process for handling a referral with my current insurance and hospital care network; yours will likely differ somehow, but I'd suggest writing down your process, plus whatever tips you find for making your life easier, so that Later!You has something you can refer to when you need to. My process:

      1. See or call PCP, describe problem, get referral.
      2. Call the place I was referred to, ask if they accept my insurance.
        2a. If they do not, call hospital care network and ask for a referral to an in-network doctor. [With my old insurance, this was a nightmare step, calling each office individually, trying to find someone in-network.]
      3. Once I have a referral to someplace in-network, call and make an appointment.
      4. Confirm with them whether I need prior authorization. If I don't, make the appointment and I'm done.
      5. If I need prior authorization, ask the appointment person for the doctor's NPI number.
      6. Call my PCP and ask for the referral department. Tell them I need prior authorization for the referral to this doctor, and give them the NPI number. They'll process it and give me a prior authorization number over the phone. Write that down on the referral sheet. [This was the other nightmare step under my old insurance.]
      7. Call the place I was referred to, give them the prior authorization number and make the appointment.

      Repeat steps 1-7 (or whatever your local process is) for every referral you have.

      I'm going to be honest: I was in a similar situation as you a number of years ago, and making and getting to all the follow-up appointments is both exhausting and time-consuming. I do as much follow-up as I have time and energy for (trying to really hit the more critical issues), then I usually give up and leave the more minor items for the following year. It took a few years, but now most of my stuff is under control and we only go over the status of things at my yearly check-up.

      One side note, as well: be prepared that a significant percentage of your appointments, especially here in the beginning, will spawn follow-up appointments. You're having a foot issue, the doctor sends you out for X-rays, you have a follow-up appointment to go over the results - suddenly one appointment spawned into three! Like I said, it gets exhausting and time-consuming. Focus on the most important items first, and be able to accept that you may not follow up on everything.

      When you go in for a referral to a specialist: get a notepad and write down all relevant medical history, then write down your symptoms and your questions. Keep the notepad for a couple weeks, adding in symptoms and questions as they occur to you. Organize those, type them up (include the date and the doctor at the top of the page!), and bring two copies to your appointment, one for your doctor and one for you. Take notes, and take a couple minutes at the end of the appointment to repeat back to the doctor what you think they've said to you.

      For any follow-up appointments: I take my notes for the original doctor's appointment and update them as follows:

      1. These were my symptoms. You diagnosed <X> and told me to do <Y> and <Z>.
      2. I have done <Y>. I have not done / had trouble doing <Z> [I include this so their records are accurate] because of <reason> [this is useful because there may be alternative treatments].
      3. My issue is better in this way. I am still having problems in this other way.
      4. These are new problems that may possibly be related to earlier issues.
      5. These are new problems that I do not believe are related to my earlier issues, but which fall within your area of expertise.

      I bring in two copies to the doctor, etc, etc. I keep copies of all my notes and test results in a file; and I have a separate file for each calendar year. The files provide me with a detailed set of notes for any issues I may be having, including when things started, how things got better or worse over time, when things changed for the better or worse, and what things we did that helped or hindered.

      I acknowledge this is all tedious, but I can't rely on someone who sees me for half an hour once or twice a year to spot every little thing. The files give me a baseline to work with, to help manage my own health.

      1 vote
  15. first-must-burn
    Link
    I think there's already lots of good advice here, boiling down to establishing care with a family medicine practice by asking for an annual physical. They will do tests appropriate for age and...

    I think there's already lots of good advice here, boiling down to establishing care with a family medicine practice by asking for an annual physical. They will do tests appropriate for age and symptoms. The biggest thing is that it will give you someone to call when you aren't feeling well. Often if you just need something called in to the pharmacy, they can even do it over the phone without a visit once you're established care.

    I found a family medicine practice that has several doctors and PA's in it, which is good because it's likely you'll get seen quickly if you have an acute need. They also have walk-in hours every weekday morning from 7-9, so if I'm feeling poorly I can just show up the next day.

    Last piece of advice: find a psychiatrist who can help you manage your ADHD and depression symptoms. That needs specific training that a GP is not really qualified to give. Two examples:

    When I first hit the depression spiral about 15 years ago, my GP's method to treat was to just start trying things, six weeks at a time, and asking me if I felt better or worse. I eventually saw a psychiatrist, and she was able to do much more targeted diagnosis and had a better understanding of the medication landscape.

    Fast forward to a few years ago, I had lost my psychiatrist during COVID. She abruptly stopped practicing, and finding a replacement was very difficult, and I was stable, so I didn't try that hard.
    Then I had some major trauma and was deep in PTSD. My GP, who was fantastic for helping me process paperwork for FMLA leave and short-term disability coverage, had prescribed me Abilify. Fortunately, my talk therapist had referred me to a psychiatrist who fit me in on short notice. He put me on a higher-than-labelled dose of my antidepressant instead, and warned me the Abilify should really be a last resort, since it can have non-reversible physical side effects. He also commented that the drug reps heavily market to GPs, and they often don't have better information than what the drug reps tell them.

    1 vote