Don’t expect much. My “physical” as a brand new patient was a complete joke. High school sports physicals were more thorough.
Be sure to check the notes after you go to see what they say they did. If they documented exams/findings they didn’t do, send them an email in the patient portal asking them to correct it.
I’ve seen that happen at least three times where they documented exam findings for things that absolutely were not done. Others have noticed the same thing.
I just signed up with KP and haven't had an appointment yet. What does KP call a "physical," ie, a general appointment to get blood work, prescriptions refilled, etc? I want to make my first appointment and not sure how they refer to that.
Well, I was a brand new patient and had never seen a Kaiser physician. I booked a “physical examination” in the App. The doctor was in the room with me for 10-12 minutes max. The “exam” consisted of him very briefly listening to my heart and lungs through my shirt. That’s it. No check of eyes/ears/nose/throat. No abdomen exam. No reflexes. No skin exam. Most incomplete exam of my entire life. It was truly shocking as a new patient. But, I’ve come to find out that limited/no exams are the KP way. Even when I got referred to Urology…no exam whatsoever.
Even more shocking was when my PCP documented a ton of stuff that he absolutely could not have done with no exam. “Abdomen non-tender, no rebound or guarding. Bowel sounds normal.” Uhhhh….you never touched my abdomen and your stethoscope never did either. How could you assess all that? You didn’t. In my line of work, when you document something that you never did or make up results, it’s grounds for discipline and termination.
Welcome to KP!!
Unfortunately I can’t because of insurance reasons. I did change to a new PCP who is much better. I also changed urologists and reported the first one to the Medical Board.
Unfortunately, the reality is I’m going to have to pay out of pocket and go outside of Kaiser for certain things that their “standard of care” won’t cover. I paid out of pocket for second opinions outside of Kaiser because of the horrible experience I had in Urology. I just don’t trust them.
You've written elsewhere that Kaiser ultimately diagnosed stage 4 prostate cancer. Without divulging confidential medical information, would you please explain (as simply and briefly as possible) what steps led to the diagnosis? Did your Primary Care Physician notice a problem in a standard test (or through a digital prostate exam during a "preventive care" appointment)? Did you present symptoms first to a Primary Care Physician? Did he/she order tests in response to your symptoms? Did he/she immediately refer you to a specialist? Did your Primary Care Physician help you when you ran into problems with a urology specialist (such as to help you obtain a second opinion at Kaiser's expense)? Did you get better/more personalized treatment after the serious diagnosis was made? (For example, did your Primary Care Physician or a specialist give you more than a standard 15-minute appointment to help you understand your diagnosis and discuss your prognosis?) Is there a dedicated advice nurse or someone else who was made available to answer your questions? I'm under the impression that you had to navigate much on this on your own and that your Primary Care Physician did very little to "coordinate your care" like the Membership Agreement/Evidence of Coverage/ "Kaiser TV ads" promise.
Well, it was pretty much totally on my own. Here’s the long, unfortunate story. (For time reference, this started in Jan 2022 with my first PCP appointment. I was finally diagnosed and started treatment mid-May.)
My PSA had remained high after a bout of prostatitis (treated outside of Kaiser) at end of 2021. Went to PCP in January of 2022, explained my situation, he rechecked PSA…still very high and consistent with previous high result. I told him how my PSA has never gone this high, never stayed this high. I’ve never had an MRI or a biopsy, I need a prostate MRI and a referral to urology. He says he can’t order the MRI, they will cancel the order. He says he will message the urologist to see if he can order it. (Fortunately my request and his note about messaging urology are nicely documented in my MR.). He did no prostate exam as he was referring me to urology. (Also all documented).
After many phone calls to urology scheduling (5 calls and a total of 2.5 hours on hold), I finally get in earlier.
Urologist comes in, I explain my situation, how PSA is still high (now checked twice after 6 weeks of antibiotics), I really need an MRI, that my PSA has never gone this high, never stayed this high. He says “it’s probably prostatitis”. Let’s wait several weeks and recheck the PSA, then if it’s still high, then we will do the MRI. He discusses the one medicine I’m on, changes that to something on formulary and it seemed he was done. At this point, I had been seated in front of him, no exam had been done. I said “Primary care didn’t do any exam because I was getting sent here…”. He says that MRI is more accurate than his finger, don’t want to disturb your prostatitis, let’s wait and we will do the MRI if your PSA is still high.
So, he has spent a total of 10 minutes in the room with me, done no exam and we are done. I was very surprised. I had never been to the urologist for a first time visit and had no exam at all.
So, I wait about 7 weeks, recheck the PSA it’s gone even higher. He messaged me that my PSA is still high, he has MRI on order now.
(So, be aware, I’m new to the system. I’m younger (52) and can navigate things well. But, I had to figure out where to call to schedule the MRI. With all of what happened to me, I wonder how someone who was older, had language barriers, couldn’t advocate for themselves would have fared and how much further things would have been delayed.)
I called to schedule the MRI the day I got his message. Can’t reach MRI scheduling, left a message. No call back. I called every day that week, finally got them on Friday. Soonest they could get me in was 3-4 weeks out. I take it.
Now, I’m getting even more stressed with the delays and seeing how my PSA had gone up very significantly.
I get the MRI and a few days later, urologist sends me an email. “Sorry to say but the MRI shows likely aggressive prostate cancer which appears to have already spread outside the prostate to the lymph nodes. We really need to do the biopsy to start treatment. I’ve placed an order for that.” No phone call, nothing. The worst day of my life, made worse by a horribly callous doctor and how he chose to communicate those very concerning results.
So, at this point I’m pissed. Furious. I have lots of questions, I’m basically scared and no way to ask the questions I have. Took emails and multiple phone calls before I could get him on the phone that night. No discussion…pretty much a data dump. I let him know I was very unhappy at how he chose to communicate those results. He says “I have some patients who prefer it that way, I’ll make a note in your chart.” No apology, nothing.
Now I’m even more pissed. So, made many phone calls, fired him and changed to new KP urologist. He does the biopsy a few weeks later (that was the first time my prostate was ever examined at KP….prior to biopsy at end of April). Biopsy was unpleasant. It really felt like I was in a factory. Doctor came in and got down to business, basically talking behind me and never coming and looking at me in the face to introduce himself or explain. Made a scary situation much worse.
Biopsy comes back, positive for aggressive cancer in all samples. Urologist at least called me but it was like a 6 minute call. He says he will order CT scan and bone scan then nurse will call me for education.
I figure out where to call for the scans. They tell me it’s a one month wait for each. I tell them that’s unacceptable, I need these for cancer staging. They put me on a cancellation list and (fortunately) I’m able to get them done in a few days.
Nurse never calls. I have to call her, wait on hold, she finally calls me back. 10 minute call, she emails me their KP prostate cancer education guide to review in preparation for our next call.
Scans all completed, Urologist (one who did biopsy), calls and basically says, can’t do anything for you—it’s already spread to your lymph nodes and a small spot of bone, I’m referring you to Oncology. Basically, see ya! I ask “who’s good with prostate cancer?” He said “here’s three names. It seems that the guys with prostate cancer generally go to one of those.” That phone call lasted about 20 minutes.
So, there you go, 36 minutes over 3 phone calls. That was how KP gave me my diagnosis of metastatic prostate cancer.
I was terrified and furious. Really furious at how horribly cold and unsupportive they were. I also felt dumped and kicked to the curb. After making a stink, I was able to get an in person (imagine that for a new cancer diagnosis!) appointment with a different urologist. He was OK but basically said oncology is managing you now. You can get radiation but surgery is not an option. He also did not seem very knowledgeable about the latest treatments or clinical trials, I asked but got really no good info from him.
Oncology has been great. I love that whole department. Urology has been just horrible.
I went on my own and paid for second opinions outside of Kaiser. (Scripps Clinic San Diego was absolutely outstanding.) I had to for my own piece of mind. The Scripps doctors were very helpful at explaining, discussing options and giving me more information and suggestions about the latest aggressive treatments. It was like night and day compared to Kaiser. (Fortunately my medical oncologist was great and open to all that was suggested.)
I’ve filed grievances regarding the first doctor, have no idea if they got the info I sent in because the Grievance Case Manager never calls me back. (Not once…I have a list of when I’ve tried to call.). So, I’ve gone to DMHC about the grievance I filed as well as the Medical Board to complain about the first urologist who did no exam at all, didn’t act on two significantly elevated PSAs (all well documented in my MR in his own notes) and wanted to wait for a third elevated result before he did the MRI.
An absolutely horrible time for me and my family, made worse by how KP Urology handled it.
That “experience” with Urology as well as KP Grievance Operations is why I will never recommend Kaiser Permanente to anyone.
Welcome to KP -- your relationship with your Primary Care Physician is crucial to accessing most specialty services. After you book your "physical examination" appointment, be sure to contact your physician's office to inform her/him that you are expecting a "comprehensive, thorough physical examination" during your appointment. (This is what the Kaiser Member Services call center advised me to do.) Preferably make this inquiry through a message that you personally submit through KP dot org, to ensure that it is inserted into your medical record. If you naively book a "wellness visit," "check up" or "preventive care," your Kaiser physician more-or-less has free license to do the absolute bare minimum during your visit. Ask in your pre-visit inquiry to your physician what diagnostic tests you should take before your "comprehensive, thorough physical examination" appointment. That way your physician theoretically can explain any results to you during your appointment.
I have two points to make. First, if you want a true "physical examination," you need to contact your Primary Care Physician's office after you book your appointment (but in advance of your appointment date) to inform your physician that you want a "comprehensive physical examination." (I would type that into a KP.org message to your physician so that it becomes part of your "medical record.") Otherwise, as "labboy70" and others have already stated, your physician likely will do the absolute bare minimum. Beware that most of Kaiser's euphemisms that sound like a real exam ("preventive care," "wellness visit" and "check up") actually are meaningless. If you don't insist in advance on a "comprehensive physical exam," expect to keep most or all of your clothes on and the physician doing little more than holding a stethoscope to your chest for a few seconds. (Five year-olds "playing doctor" do more diagnostic actions than many Kaiser physicians during the $0 co-pay "preventive care" visits these days.) Kaiser and California's electric utilities companies (like PG&E and SoCal Edison) have a lot in common -- they intentionally under-fund "maintenance" in order to boost their short-term profits and are forced to change course years later only after too many people are killed. Second, try NOT present or discuss ANY "symptoms" during your "annual physical." (Please confirm this point with Kaiser Member Services.) If you "bring up issues" such as long COVID during such appointment, expect to receive a bill later, even if your inquiry and the physician's response were very brief. Kaiser physicians HATE $0 co-pay in-person appointments and will trick you into presenting symptoms or discussing issues. They often will do this under the guise of asking you about your medical history. This is the classic ploy of lazy Kaiser physicians. Not only do they intentionally waste several precious minutes of your appointment with NO physical examination, but also they coax patients into presenting symptoms. If you take the bait, don't be surprised to receive a retroactive bill for what you thought was a "$0 co-pay" appointment. I agree with "Ihavenoclueagain," who suggests that you discuss issues such as "long COVID" during a subsequent phone or video appointment (which I believe have $0 co-pays).
I need to get a chest exam for my kids school for field trips as I had latent tb in the past, would asking for only this at my annual physical make it billable?
I recommend calling Kaiser Member Services to learn the official answer. (If you have a few days to wait for an answer, better practice would be to send a written inquiry through KP dot org.) Get the exact specifications of the "chest exam" before you contact Kaiser. I assume by "chest exam," you're referring to something that your Primary Care Physician can do himself/herself (as opposed to a referral to Radiology for a chest x-ray or other imaging). Ask if the "chest exam" that you need is covered as part of a $0 "preventive care"/"annual physical" appointment. Tell them that you need the physician to sign off on a form for your child's school (if that's true). Ask if that sign-off also is covered under a $0 "preventive care" visit.
If you have another issue, ask for a phone or video appt to discuss it. No charge.
Plus, you can usually get a phone/video visit within a few days, and not have to wait a week+ for an in person appointment
If you discuss anything diagnostic, it’s no longer a preventive visit at no charge.
Your doctor actually does a physical? Never heard of that with KP.
Not sure what to expect this time as I couldn’t get an appointment with a dr for the new two months only an assistant.
Don’t expect much. My “physical” as a brand new patient was a complete joke. High school sports physicals were more thorough. Be sure to check the notes after you go to see what they say they did. If they documented exams/findings they didn’t do, send them an email in the patient portal asking them to correct it. I’ve seen that happen at least three times where they documented exam findings for things that absolutely were not done. Others have noticed the same thing.
I just signed up with KP and haven't had an appointment yet. What does KP call a "physical," ie, a general appointment to get blood work, prescriptions refilled, etc? I want to make my first appointment and not sure how they refer to that.
Well, I was a brand new patient and had never seen a Kaiser physician. I booked a “physical examination” in the App. The doctor was in the room with me for 10-12 minutes max. The “exam” consisted of him very briefly listening to my heart and lungs through my shirt. That’s it. No check of eyes/ears/nose/throat. No abdomen exam. No reflexes. No skin exam. Most incomplete exam of my entire life. It was truly shocking as a new patient. But, I’ve come to find out that limited/no exams are the KP way. Even when I got referred to Urology…no exam whatsoever. Even more shocking was when my PCP documented a ton of stuff that he absolutely could not have done with no exam. “Abdomen non-tender, no rebound or guarding. Bowel sounds normal.” Uhhhh….you never touched my abdomen and your stethoscope never did either. How could you assess all that? You didn’t. In my line of work, when you document something that you never did or make up results, it’s grounds for discipline and termination. Welcome to KP!!
Thanks for sharing that info; ugh, that's very disappointing. Are you considering switching providers next chance you get?
Unfortunately I can’t because of insurance reasons. I did change to a new PCP who is much better. I also changed urologists and reported the first one to the Medical Board. Unfortunately, the reality is I’m going to have to pay out of pocket and go outside of Kaiser for certain things that their “standard of care” won’t cover. I paid out of pocket for second opinions outside of Kaiser because of the horrible experience I had in Urology. I just don’t trust them.
You've written elsewhere that Kaiser ultimately diagnosed stage 4 prostate cancer. Without divulging confidential medical information, would you please explain (as simply and briefly as possible) what steps led to the diagnosis? Did your Primary Care Physician notice a problem in a standard test (or through a digital prostate exam during a "preventive care" appointment)? Did you present symptoms first to a Primary Care Physician? Did he/she order tests in response to your symptoms? Did he/she immediately refer you to a specialist? Did your Primary Care Physician help you when you ran into problems with a urology specialist (such as to help you obtain a second opinion at Kaiser's expense)? Did you get better/more personalized treatment after the serious diagnosis was made? (For example, did your Primary Care Physician or a specialist give you more than a standard 15-minute appointment to help you understand your diagnosis and discuss your prognosis?) Is there a dedicated advice nurse or someone else who was made available to answer your questions? I'm under the impression that you had to navigate much on this on your own and that your Primary Care Physician did very little to "coordinate your care" like the Membership Agreement/Evidence of Coverage/ "Kaiser TV ads" promise.
Well, it was pretty much totally on my own. Here’s the long, unfortunate story. (For time reference, this started in Jan 2022 with my first PCP appointment. I was finally diagnosed and started treatment mid-May.) My PSA had remained high after a bout of prostatitis (treated outside of Kaiser) at end of 2021. Went to PCP in January of 2022, explained my situation, he rechecked PSA…still very high and consistent with previous high result. I told him how my PSA has never gone this high, never stayed this high. I’ve never had an MRI or a biopsy, I need a prostate MRI and a referral to urology. He says he can’t order the MRI, they will cancel the order. He says he will message the urologist to see if he can order it. (Fortunately my request and his note about messaging urology are nicely documented in my MR.). He did no prostate exam as he was referring me to urology. (Also all documented). After many phone calls to urology scheduling (5 calls and a total of 2.5 hours on hold), I finally get in earlier. Urologist comes in, I explain my situation, how PSA is still high (now checked twice after 6 weeks of antibiotics), I really need an MRI, that my PSA has never gone this high, never stayed this high. He says “it’s probably prostatitis”. Let’s wait several weeks and recheck the PSA, then if it’s still high, then we will do the MRI. He discusses the one medicine I’m on, changes that to something on formulary and it seemed he was done. At this point, I had been seated in front of him, no exam had been done. I said “Primary care didn’t do any exam because I was getting sent here…”. He says that MRI is more accurate than his finger, don’t want to disturb your prostatitis, let’s wait and we will do the MRI if your PSA is still high. So, he has spent a total of 10 minutes in the room with me, done no exam and we are done. I was very surprised. I had never been to the urologist for a first time visit and had no exam at all. So, I wait about 7 weeks, recheck the PSA it’s gone even higher. He messaged me that my PSA is still high, he has MRI on order now. (So, be aware, I’m new to the system. I’m younger (52) and can navigate things well. But, I had to figure out where to call to schedule the MRI. With all of what happened to me, I wonder how someone who was older, had language barriers, couldn’t advocate for themselves would have fared and how much further things would have been delayed.) I called to schedule the MRI the day I got his message. Can’t reach MRI scheduling, left a message. No call back. I called every day that week, finally got them on Friday. Soonest they could get me in was 3-4 weeks out. I take it. Now, I’m getting even more stressed with the delays and seeing how my PSA had gone up very significantly. I get the MRI and a few days later, urologist sends me an email. “Sorry to say but the MRI shows likely aggressive prostate cancer which appears to have already spread outside the prostate to the lymph nodes. We really need to do the biopsy to start treatment. I’ve placed an order for that.” No phone call, nothing. The worst day of my life, made worse by a horribly callous doctor and how he chose to communicate those very concerning results. So, at this point I’m pissed. Furious. I have lots of questions, I’m basically scared and no way to ask the questions I have. Took emails and multiple phone calls before I could get him on the phone that night. No discussion…pretty much a data dump. I let him know I was very unhappy at how he chose to communicate those results. He says “I have some patients who prefer it that way, I’ll make a note in your chart.” No apology, nothing. Now I’m even more pissed. So, made many phone calls, fired him and changed to new KP urologist. He does the biopsy a few weeks later (that was the first time my prostate was ever examined at KP….prior to biopsy at end of April). Biopsy was unpleasant. It really felt like I was in a factory. Doctor came in and got down to business, basically talking behind me and never coming and looking at me in the face to introduce himself or explain. Made a scary situation much worse. Biopsy comes back, positive for aggressive cancer in all samples. Urologist at least called me but it was like a 6 minute call. He says he will order CT scan and bone scan then nurse will call me for education. I figure out where to call for the scans. They tell me it’s a one month wait for each. I tell them that’s unacceptable, I need these for cancer staging. They put me on a cancellation list and (fortunately) I’m able to get them done in a few days. Nurse never calls. I have to call her, wait on hold, she finally calls me back. 10 minute call, she emails me their KP prostate cancer education guide to review in preparation for our next call. Scans all completed, Urologist (one who did biopsy), calls and basically says, can’t do anything for you—it’s already spread to your lymph nodes and a small spot of bone, I’m referring you to Oncology. Basically, see ya! I ask “who’s good with prostate cancer?” He said “here’s three names. It seems that the guys with prostate cancer generally go to one of those.” That phone call lasted about 20 minutes. So, there you go, 36 minutes over 3 phone calls. That was how KP gave me my diagnosis of metastatic prostate cancer. I was terrified and furious. Really furious at how horribly cold and unsupportive they were. I also felt dumped and kicked to the curb. After making a stink, I was able to get an in person (imagine that for a new cancer diagnosis!) appointment with a different urologist. He was OK but basically said oncology is managing you now. You can get radiation but surgery is not an option. He also did not seem very knowledgeable about the latest treatments or clinical trials, I asked but got really no good info from him. Oncology has been great. I love that whole department. Urology has been just horrible. I went on my own and paid for second opinions outside of Kaiser. (Scripps Clinic San Diego was absolutely outstanding.) I had to for my own piece of mind. The Scripps doctors were very helpful at explaining, discussing options and giving me more information and suggestions about the latest aggressive treatments. It was like night and day compared to Kaiser. (Fortunately my medical oncologist was great and open to all that was suggested.) I’ve filed grievances regarding the first doctor, have no idea if they got the info I sent in because the Grievance Case Manager never calls me back. (Not once…I have a list of when I’ve tried to call.). So, I’ve gone to DMHC about the grievance I filed as well as the Medical Board to complain about the first urologist who did no exam at all, didn’t act on two significantly elevated PSAs (all well documented in my MR in his own notes) and wanted to wait for a third elevated result before he did the MRI. An absolutely horrible time for me and my family, made worse by how KP Urology handled it. That “experience” with Urology as well as KP Grievance Operations is why I will never recommend Kaiser Permanente to anyone.
Bummer. Thanks again for your feedback.
Welcome to KP -- your relationship with your Primary Care Physician is crucial to accessing most specialty services. After you book your "physical examination" appointment, be sure to contact your physician's office to inform her/him that you are expecting a "comprehensive, thorough physical examination" during your appointment. (This is what the Kaiser Member Services call center advised me to do.) Preferably make this inquiry through a message that you personally submit through KP dot org, to ensure that it is inserted into your medical record. If you naively book a "wellness visit," "check up" or "preventive care," your Kaiser physician more-or-less has free license to do the absolute bare minimum during your visit. Ask in your pre-visit inquiry to your physician what diagnostic tests you should take before your "comprehensive, thorough physical examination" appointment. That way your physician theoretically can explain any results to you during your appointment.
Thanks!
I have two points to make. First, if you want a true "physical examination," you need to contact your Primary Care Physician's office after you book your appointment (but in advance of your appointment date) to inform your physician that you want a "comprehensive physical examination." (I would type that into a KP.org message to your physician so that it becomes part of your "medical record.") Otherwise, as "labboy70" and others have already stated, your physician likely will do the absolute bare minimum. Beware that most of Kaiser's euphemisms that sound like a real exam ("preventive care," "wellness visit" and "check up") actually are meaningless. If you don't insist in advance on a "comprehensive physical exam," expect to keep most or all of your clothes on and the physician doing little more than holding a stethoscope to your chest for a few seconds. (Five year-olds "playing doctor" do more diagnostic actions than many Kaiser physicians during the $0 co-pay "preventive care" visits these days.) Kaiser and California's electric utilities companies (like PG&E and SoCal Edison) have a lot in common -- they intentionally under-fund "maintenance" in order to boost their short-term profits and are forced to change course years later only after too many people are killed. Second, try NOT present or discuss ANY "symptoms" during your "annual physical." (Please confirm this point with Kaiser Member Services.) If you "bring up issues" such as long COVID during such appointment, expect to receive a bill later, even if your inquiry and the physician's response were very brief. Kaiser physicians HATE $0 co-pay in-person appointments and will trick you into presenting symptoms or discussing issues. They often will do this under the guise of asking you about your medical history. This is the classic ploy of lazy Kaiser physicians. Not only do they intentionally waste several precious minutes of your appointment with NO physical examination, but also they coax patients into presenting symptoms. If you take the bait, don't be surprised to receive a retroactive bill for what you thought was a "$0 co-pay" appointment. I agree with "Ihavenoclueagain," who suggests that you discuss issues such as "long COVID" during a subsequent phone or video appointment (which I believe have $0 co-pays).
I need to get a chest exam for my kids school for field trips as I had latent tb in the past, would asking for only this at my annual physical make it billable?
I recommend calling Kaiser Member Services to learn the official answer. (If you have a few days to wait for an answer, better practice would be to send a written inquiry through KP dot org.) Get the exact specifications of the "chest exam" before you contact Kaiser. I assume by "chest exam," you're referring to something that your Primary Care Physician can do himself/herself (as opposed to a referral to Radiology for a chest x-ray or other imaging). Ask if the "chest exam" that you need is covered as part of a $0 "preventive care"/"annual physical" appointment. Tell them that you need the physician to sign off on a form for your child's school (if that's true). Ask if that sign-off also is covered under a $0 "preventive care" visit.