I am struggling to understand how this practice looks so good "on paper" (their website and marketing materials), and yet the in-person patient experience can be so bad.
I've had two annual physicals at Avance care now (believing in second chances), sadly with the same poor experience.
First, "convenience" is emphasized all over the website. Yet, an annual physical exam, quite inconveniently, requires two visits - one for labs and a second for the actual exam. My previous, less "convenient" provider (in fact, every previous doctor I've had), had always been able to accomplish these two tasks in one convenient visit: Draw blood, perform physical exam, follow-up phone call if there's anything to talk about in the lab results.
The second thing that throws me is the word "comprehensive" used to describe the physical exam. I've never had a LESS comprehensive than the two I experienced at two different locations. And this includes one-off "employment" physicals by providers I'd never see again, let alone one that is supposed to be my "partner" in maintaining my overall long-term health. Each exam (seemingly cookie-cutter in how identical they were), consisted of: shining a light in my ears and mouth, listening to my heart and lungs (which was done over my shirt - more on this later), asking (not looking) if I am having any abdominal problems and having me push and pull against the provider's hands with my hands, arms and legs. 5-minutes, maximum, and that's being generous.
Along with the first exam, my bloodwork revealed a minor issue that the NP suggested an over-the-counter supplement for. The next day, a medical assistant called to say the NP had decided an Rx would be a better approach, and called it in to my pharmacy. About 2-weeks after that, the NP called with a "courtesy follow up" to ask if I'd been able to find the OTC supplement she recommended, and seemed surprised when I told her about the call from the assistant suggesting it be an Rx (supposedly ordered by her) instead.
This year, the discussion of my completed lab work (at the second location) led to this NP suggesting that a few additional tests be run, because of last year's identification of this same issue. So -- my chart showed that (a) there was an abnormality in last year's blood work, (b) I was taking a supplement (or maybe an Rx) to address it, and still this year's lab order didn't include the test to measure for this. Did anyone read my chart before ordering the labs or setting this appointment?
From the Avance Care website, FAQ page (https://www.avancecare.com/for-patients/faqs/):
Q) Do you perform skin checks and do skin biopsies?
A) Yes. Typically, a total body skin check is part of your comprehensive medical exam. If we detect a worrisome skin lesion or mole, we will often recommend a skin biopsy. We
routinely perform these skin biopsies in our office.
Back to that comprehensive medical exam... Over the years, I've had multiple 'abnormal' moles removed (this fact was mentioned in the "patient history" (electronic) paperwork I completed). While I do see a dermatologist for annual skin exams, I intentionally see a primary care doctor 6-months in-between (effectively, to get two skin exams each year, since my insurance only covers one). It's hard to do a total body skin exam when only the face, neck and arms (elbows down) are exposed. To my point earlier, these have also been the only two physical exams I can ever recall having where, at the very least, I wasn't even asked to remove my shirt. So, a TBSE is supposed to be part of a 'typical' comprehensive exam, and my history specifically mentions previous abnormal moles, and no skin exam was performed, even though it's supposedly typically done during the CPE. Needless to say, neither was a genital exam, hernia, or testicular cancer screening (and, reviewing my visit summary online mentions "testicular self exam was discussed with patient" - it was not.)
I'm sure many patients would feel "relieved" that their annual physical was so easy. Most men don't like to be examined by any doctor. I'm sure some would be entirely uncomfortable with a young lady NP. "Getting away easy" by not even having to remove their shirt, let alone "turn and cough" might be perfect for some. I was asked when I made the appointment, if I had a provider preference, and could have easily requested a male provider if it would have been an issue for me to be seen by a female. I don't know if this was part of the reason for the lack of "thoroughness" (I'd like to think not). Personally, as someone who's already had moles removed (one from a pretty "private" place) and family members who have experienced several forms of cancers and various other issues that a TRUE comprehensive physical exam uncovered, 30-seconds of embarrassment to identify something that could potentially shorten my life is a fair price to pay, and the primary reason why I will not be returning to this practice. read more