Quick question: Are your doctors on speaking terms?

Dr Gary
By Dr GaryCA Latest Reply 2012-03-09 12:22:54 -0600
Started 2012-02-21 16:14:10 -0600

HI!

I have a good friend who is facing multiple diagnoses at the moment and is, consequently, working with more than one doctor. She is concerned about whether her medications are all working together, and if there is any overlap between medications. She also thinks that, at times, her doctors do some finger-pointing, saying "this is her/his problem, and not mine" or avoid her questions that might be in another doctor's "territory."

She is also worried that one diagnosis may be part of another diagnosis, or even a side effect, and not a separate condition at all. And she's concerned as to whether her doctors are listening to her, if she is making her concerns clear to them, since they don't seem to be speaking to each other.

My friend asked me is she should be "appointing" one of her doctors as the coordinator of her care, and if that is even possible. And she is wondering about what her responsibility is, and how she what she might do better.

I know some of you here on Diabetic Connect are dealing with multiple diagnoses, and you have had some of your own concerns in regard to working with multiple doctors.

Any approaches to this issue that have worked for you? Any techniques to suggest?

Thanks!


59 replies

pixsidust
pixsidust 2012-02-27 14:30:09 -0600 Report

my grandmother was a medical mess.
He heart doctor was her primary.
He was a smart and intelligent man and knew where he needed to arrange consultations for my grandmother to have other medical professionals look her over. He then would then implement their advise into one care plan.
She had him as her one doctor with other specialists weighing in but did not become a new patient for each one. I worked 7 years at a top ten medical facility and I can say this approach is the best. It all starts with a proactive hands on Primary. Thats what must be found first.

Dr Gary
Dr GaryCA 2012-03-09 12:22:54 -0600 Report

Hi!

Sorry I missed this before. You grandmother was really fortunate to have a cardiologist who was willing to take responsibility for managing the team. That's great. You're right, that should be the standard.

Thanks a lot!

Gary

Linda2
Linda2 2012-02-25 16:34:49 -0600 Report

I have a PCP who gets copies from both my heart doctor and diabetic specialist
(he refered me to them) so hopefully right hand knows what the left hand is doing. I see the PCP on a regular schedule every three to four months to touch base, my biggest complaint is I think he sometimes forgets that i am a diabetic and prescribes a medication that raises the blood sugar levels to a scary point. I was sick recently for the second time in as many months with a cold congestion etc and after the second round of antibiotics and finally prednazone and still feeling bad and coughing he suggested taking robituson for my continous cough, like a dummy that I am and not reading the label before taking a dose, when I checked my blood sugar before dinner it was over 500. Needless to say will be having a discussion with him at my next appointment. The first ingredient was high frutcose corn syrup, ouch. He should have known and I'll take my portion of the blame for not checking myself. I guess the bottom line is you need to check yourself allways, know the side effects and talk to your pharmacist about each new medication. My cardiologist ask me to bring my medications (all of them including supplements) each time I have a visit so he can check them also you should carry a copy of all medications with you in your purse or wallet. Also make sure you check each renewed medication when you pick them up at the pharmacy. Recently mine made a mistake giving me the wrong type of potassium. It caused sever heart burn and indigestion I was afraid I was having heart problems again. I really miss my small pharmacy which was bought out by walgreens - will be looking for another pharmacy soon.

Dr Gary
Dr GaryCA 2012-02-27 08:23:42 -0600 Report

Hi Linda!

Wow, this is a fantastic post. You gave us a lot of great information here. I hope this gets a lot of readers.

Yet another example of how important it is for patients to be their own advocates in this stressed out medical system that we are in. That is a very scary story you told about your PCP. So often, doctors are trying to see too many patients in one day, I guess in response to the dictates of managed care and the low reimbursement rates for individual appointments. I worry that they are sometimes moving too fast, not reading the charts adequately, and unable to remember the important details about each patient.

I totally agree that it is important for patients to stay on top of their medications, to carry a list with them, and to ask their pharmacist questions (along with double checking your pharmacist).

Another good reason to be mindful!

Thanks a lot for taking the time to share your experiences! I really appreciate it.

And have a great day!

Gary

Dev
Dev 2012-02-24 16:04:32 -0600 Report

I insisted that my husband join a diabetes center instead of going to a particular doctor. The idea was influenced by the Naomi Berri Diabetes center attached to Columbia University medical campus that portrayed itself as 'comprehensive, multidisciplinary diabetes care' something called a 'diabetes home' I think where all kinds of doctors are at one place. I felt like that was a good idea to go to a place like that where all doctors know and communicate with each other about you as a whole and not parts of your body or ailment. The Endo was supposed to be the point person.

Unfortunately, just putting all the doctors in one place doesn't help. The doctors also need to have an attitude to look at a patient as a whole person and not body parts. So when my husband used to complain about something or the other like aching muscles, the endo would say, it is nothing related to what I am looking at or what I am prescribing to you or not because of diabetes. What kind of answer is that?

When he moved to Massachusetts we thought that he should have a primary as a central person and specialists that can weigh in. It hasn't been much long for me to comment on how it works, but I am hoping it would work better than the so called 'comprehensive care'. The health records are also kept centrally by the insurance provider so everybody in the network can access the records and there is no need for requesting one doctor to share the records with other doctor. that was a pain before.

In India where I grew up we always had a family doctor that knows all about you, your family history and you as a person. It has been a struggle for us to find similar health care person here in US. I am hoping the primary as a central person would work like that. hopefully.

I am hopeful that there is somebody in this health system who looks at you as a person and not body parts.

Just Joyce
Just Joyce 2012-02-24 21:33:43 -0600 Report

Dev, I learned that you don't ask your podiatrist about chest pains. They really can't help you. A primary care physician who has read your records should be able to answer most of your questions and if he cares, he will follow up with any specialist he or she refers you to see. You still have to do your research and learn as much about your diagnosis as possible and ask questions for clarification. You have to follow up and make sure all of the physicians you see under your primary communicate with each other and with you.

Dr Gary
Dr GaryCA 2012-02-24 21:01:13 -0600 Report

Hi Dev,

Nice to see you! It's been awhile since we have been in touch. I have heard of the diabetes center you are referring to, I also live in NYC. Bud I didn't know anything about it.

Your experience is really interesting. It sounds like what you are seeing is the territorial attitude that specialists can sometimes have. I don't know if this is related to ego or defensiveness, or if they are acting within the guidelines of their institution. Or if this a problem due to lack of overall management. Certainly this approach contradicts the idea of comprehensive care.

I can understand why you would be frustrated. More work, more worry for the patients.

I agree, the system should revolve around a primary care physician who is willing and able to oversee the whole patient, and treat the patient like a whole person.

Thanks a lot for checking in. Wishing you the best.

Gary

Just Joyce
Just Joyce 2012-02-24 21:29:05 -0600 Report

Dr. Gary, unfortunately, it can be ego, arrogance, territorial and institutional guidelines. I worked in a hospital for 11 years. The worse doctors are the young interns who think they know it all and the doctors who are specialist who also think they know it all. I have had doctors who thought they were on a ladder far above me and talked to me in that manner.

I am a trained Emergency Medical Technician (no longer certified) When a doctor starts talking to me as though I am the most stupid person on the planet, I start asking questions using medical terms and definitions then tell them of my training.

When I go to the doctor the same way I go to a mechanic. I know whats wrong I want to know what you as my mechanic or doctor is going to do to fix it. I spent summers pumping gas at my uncle's full service gas station so I know something about cars also.

Dr Gary
Dr GaryCA 2012-02-25 09:07:48 -0600 Report

Hi Joyce,

I am sorry to say that I have seen the same thing in doctors. So often, it seems to go with the profession, with doctors being trained to behave this way. I have occasionally had medical students as clients and they have said that they feel alienated by that attitude. It's a shame that that attitude is continuously perpetuated.

I don't paint all doctors with that broad brush, but again, that attitude is out there.

It's great that you are also trained and can hold your own with a physician, and not be patronized. That certainly gives you an edge in these conversations.

And you're right. Doctors are professionals who perform a specific service, and patients are consumers who are purchasing that service. It really should come down to a professional, service-oriented relationship.

Thanks a lot for replying here!

Gary

Caroltoo
Caroltoo 2012-02-24 16:31:22 -0600 Report

Dev, this is sad. I, too, grew up with a family doctor. About 5 years ago I was lucky and found a PCP who acts like a caring "family doctor"; it has made so much difference in my care. Previously, I had felt like I was in an almost adversarial role with my PCP. Be hopeful: caring docs do still exist.

Dev
Dev 2012-02-24 17:48:04 -0600 Report

Thanks Carol.

I hear you about the adversarial role with the doctor. I felt that way with my husband's endo. Once I went with him for the appointment because he was too frustrated with her. But whenever I asked questions or clarifications she reacted as if I was questioning her expertise. Wouldn't give me straight answers about the course of medication or side effects or risk of damage if not taken. Those are obvious questions and a doctor should give a complete picture without asking in the first place. Especially, not get angry if a patient asks the questions to make sure what they are doing to their own body and decide for themselves which risks they want to take.

I hate doctors who expect the patients to take whatever they say as if the patient is too dumb to allow to have control over their own bodies or life.

Sigh. I am in a ranting mood today. sorry for that :(

Dr Gary
Dr GaryCA 2012-02-24 21:03:33 -0600 Report

Just wanted to add that it seems that patients who are being good advocates for themselves, and their caregivers, are inevitably going to find themselves in adversarial roles with doctors. That's a shame. When a doctor becomes defensive, communication suffers. But patients still have to make sure that they get what they need.

You are expressing some honest opinions here, and I am sure we all appreciate it. Don't worry about ranting.

Just Joyce
Just Joyce 2012-02-24 14:10:27 -0600 Report

Hi Dr. Gary, yes I was in a grant funded health car program, my primary was the lead and he talked to every Dr. I had to see. When one doctor told me I had cancer but would wait for the results of my biopsy, he said I will send you the results. I told him send them to my doctor. After not hearing anything for 3 weeks I contacted my doctor. He had to call the doctor to get the results. I didn't have cancer and refused to see this man again in life.

If you are seeing multiple physicians and have a primary care physician, have those doctors send all information to the primary. You also have to follow up yourself. If one doctor says he will have results in 5 days and is suppose to send those results to the primary, call the office to see if the results are in. If not let the office staff know so your primary can get the results.

Keep in mind that the doctor is working for you and you have to let him know that he has to communicate with physicians he is referring you to see. If not change doctors (some medical plans will allow this as long as the doctor is in their system) and request that the new doctor gets your medical records from the previous doctor even if you have to sign a release to get them.

Finally, don't be a bump on a log when you get a diagnosis. Do your research and make a list of questions prior to seeing the primary or the specialist again. Then become a prosecutor and question the doctor. This is your life he has in his hands and if he can't answer your questions, find someone who can answer them for you.

Dr Gary
Dr GaryCA 2012-02-24 20:52:15 -0600 Report

Joyce,

This is fantastic! Thanks a lot for taking the time to share your wisdom with everybody.

Wow, what an experience you had. That is such a careless way for a doctor to treat a patient. It sounds like you learned from this experience and decided not to let it happen again.

You hit the nail on the head here in terms of what patients have to do to partner with their doctors. Get the records sent, but don't assume anybody is doing their job. And then communicate with the doctor in terms of your expectations for their performance. Yes, your doctor is working for you.

And keeping that list of questions is key. Always come to the appointment prepared to do ask questions and get answers, based on your own research.

Thanks again. Great to see you!

Gary

Just Joyce
Just Joyce 2012-02-24 21:18:18 -0600 Report

Thanks, my primary care physician taught medicine and had this doctor as a student. Needless to say he was none to happy with what a former student had done to his patient.

granniesophie
granniesophie 2012-02-24 06:06:34 -0600 Report

I only have one doctor for everything, and he barely speaks to ME (for lack of time!)! If I need a referel for a specialist,(rarely) that doctor is chosen for me based on where I live, and it doesn't matter if I like them or not. I've had some really awful specialists, who I wouldn't go to normally more than once and then find a new one! That specialist only knows about the problem I am refered for, nothing else, and when it is over, or not, the report goes back to my doctor and into my records and I seldom know what the results are. I usually have to demand the results!
For example, I thought I had something with my stomach, diagnosed by a gastro doctor, and when I mentioned it to my doctor he said that wasn't what was in the report at all! And the gastro hadn't wanted to see me again anyway, just sent me back to the regular doctor.
And I can't file complaints. As I have mentioned before-this is a military doctor and you get what you get. So having a team of doctors who talk to each other is a dream of mine, actually having a team of doctors for different issues, period!! :)

Dr Gary
Dr GaryCA 2012-02-24 20:47:37 -0600 Report

Hi,

Oh my gosh, you are working in a difficult system. I didn't realize the military system offered so few options. And with so little communications among these doctors, I can see why you would be frustrated. Not to mention concerned that you are getting the best treatment as a result. This really places you in the position of having to constantly speak up for yourself, I would guess, and that has to be hard work.

Thanks for sharing your experience. Anything you are doing that helps you to overcome this challenge? Just wondering.

Take care!

Gary

MoeGig
MoeGig 2012-02-24 05:06:17 -0600 Report

This is why I like Kaiser Permanente. It should be the structure under which medical care is delivered. All doctors, primary care physicians and specialist are employees of Kaiser. The pharmacy is there and everyone (including the patients) have an integrated web site where you can email your doctor(s), see all your meds, and order them, get all your tests from their lab, see the results, etc. It's a great system. IMHO.

Dr Gary
Dr GaryCA 2012-02-24 15:23:04 -0600 Report

Hey MoeGig,

Thanks for checking in! I have heard great things about Kaiser for year. I am surprised that more health organizations haven't adopted that model. It makes a lot lot of sense to me. It would seem to be efficient but comprehensive at the same time.

Gary

LizSpring113
LizSpring113 2012-02-23 22:39:13 -0600 Report

It might be helpful too for your friend to make a list of her meds and the contraindications of each of these meds. So for example recently she has become dizzy or nauseated every day. Look at her list and see if any has a side effect of dizziness or becomimg nauseated. If it's nausea, try eating something before she tajes the medicine. If it is dizziness that she can stand, just don't drive, be very careful around stairs, etc. Some people don't think about the side effects if medicine and assume it is part of a disease. Also,when she asks questions of one Dr, just ask the question. Try not to say, Dr. So and so said…this can immediately put the Dr on the defensive and you have lost before you even started. Buu when you pose it as your question, that can make them few more open and talkative. If she knows any good nurses, they can be the best resource for information, questions to ask Drs, etc. They can also be very helpful on who are the best Dr's to go to…and who to stay away from.

Dr Gary
Dr GaryCA 2012-02-24 14:44:12 -0600 Report

Hey Liz,

Thanks a lot. This is a great idea! Once you get going with a list, it is a simple thing to keep it updated. This can also be pulled from a journal, for people who would rather record the information that way. And I really love your advice about not putting doctors on the defensive. You are absolutely right. Saying that one doctor said something can automatically place the other doctor on the defensive, though you certainly don't mean it that way. Questions are always a good way to start a conversation.

I have also asked nurses for advice on doctors. They watch them in action and they hear stories, so they can be a wealth of knowledge.

Great to hear from you. Thank you!!!

Gary

Set apart
Set apart 2012-02-23 07:58:54 -0600 Report

Hi Dr. Gary, Its always nice to hear from you. I live in a rural community my initial diagnosis came from an ER Dr. As a T2, well after changing Drs. To a new Dr. Who ran addtl. Tests and came up with T1. I was educating myself reading everything from ADA, to Diabetes for Dummies, where was my dream team? You know the one you read about this new Dr. And her team had diagnosed me so where were my resources? I had to seek out my own Endo, thank goodness my insurance allows me to see specialists without referrals. My Dr. Came to a halt diagnosed me, placed me on insulin, and then said see you every 3 months. I now drive 1 1/2 hrs. To my Endo, My Dr. Also seemed upset cuz my husband took me to the Mayo Clinic. I have had so many problems, this is me for crying out loud, I needed to know things and everything I was learning was from books and thank God from this site! My hypothyroid when checked by PCP said I had 2 cysts had an ultrasound and biopsy, a bruise that made me lookmlike Inhad been beaten which lasted 1 month, at the Mayo Clinic no cysts, turns out I have enlarged lymph nodes, yet theybwere considering removing the cysts, there were none! with all of this said I have found out thAt I will have ton advocate for myself and what I am entitled to. My new Endo is working out, D EducTor is awesome! I am still looking for a PCP! thanks

Dr Gary
Dr GaryCA 2012-02-23 22:25:41 -0600 Report

Hi!

Thanks for taking the time to let us know what's going on with you. This is an amazing story, and a good example of what patients often have to deal with. I am glad that you took matters into your own hands, found a specialist who could help you, and got your treatment underway. Very good news, and a great example of being an empowered patient.

It amazes me when doctors don't give their patients the care they need and then get mad when their patients seek expert care on their own. There are fortunately a lot of great doctors out there, we just have to find our way to them when we need them.

It's great that you have at least most of your team in place. I hope you find your way to a great PCP, too.

Thanks again. Glad to be in touch!

Gary

jigsaw
jigsaw 2012-02-23 08:23:56 -0600 Report

Good job of taking care of yourself! The situation with your cysts that didn't exist is quite scary and makes a very valid and valuable point. I have had some amazingly careless, thoughtless if not downright stupid things said to me by doctors. Of course I moved on to other doctors that I believe to be very helpful. I hope you find a decent PCP.

harry1
harry1 2012-02-23 04:25:42 -0600 Report

mines not pcp put me on naproxen gastro said i should not be on it because of stomach problems ask gastro to change it the she told me she would not since another dr prescirbed it but if its going to cause problems with my stomach she could have called my pcp and see if it was all right to change it. i see a pcp, endo, gastro, cardio, and a psycho i wish i could find one person who would look at all my health conditions and have all these drs work with that one person to make sure meds and treatments are right and i'm not going through any unnessary tests.

TraceyLin
TraceyLin 2012-02-24 14:55:52 -0600 Report

btw, won't to trade list? I have IBS, GERD, Diabetes 2, osteoarthritis in my neck, shoulders, spine. degenerative spine disease, plantar faciitis carpal tunnel syndrome, tachycardia, fibermyalgia, PTSD, frozen right shoulder with bone spurs on clavicle, bone spurs on heels, diabetic neuropathy of the nerves whereby all my mylanin sheaths have degenerated, cataracts, I think that's all, I always manage to forget a few,lol. My body may be falling apart but I sure look good doing it!

TraceyLin
TraceyLin 2012-02-24 14:51:57 -0600 Report

Harry, I know it's difficult to have a positive outlook about your situation. I might suggest that rather than resent the additional test, you look at them from the point of view that they are merely doing them to make sure that you don't have a particular problem and I am sure your mind will rest much easier when you can scratch that problem off of your list of possibilities. Good luck and great fortune to you.

Dr Gary
Dr GaryCA 2012-02-23 22:20:49 -0600 Report

Hi Harry,

Thanks for sharing what you are experiencing and for saying it so well. You are absolutely right. There should be one person coordinating your care for you. This would result in better care for you, including protecting you from unnecessary tests and treatments, and medications that don't work well together.

I hope that you can get one of your healthcare professionals to step into this role.

Gary

sheriden
sheriden 2012-02-22 21:40:34 -0600 Report

I have been trying to get my doctors to work together with little luck. I passed out cold had a ax, and went to ER. They checked my BG it was fine. and they checked other things. The ER docs were great but said I need to check into other Primary care giver. At the time my friends mom was in the hospital due to a heart att. I have her doc and we had been trying to get her help because she was not eating or able to drink for throwing up. The ER doc could not come out and say but hinted strongly that we should both find a new doc. In this small com, that is hard. I went to Casper and my daughter took care of me for ten days till i could move around without being dizzy and sick. But I am afraid that things will get worse as they have for Sylvia and I will just be out there w/o a doctor. I hope your friend finds what she needs if she dose I would like to know what she did to make it come together as we are all stumped.

Dr Gary
Dr GaryCA 2012-02-23 21:18:12 -0600 Report

Hi Sheriden,

This is certainly a common complaint. But wow, when a doctor subtly recommends that you replace another doctor, you know that is something you want to think about. Just amazing. But maybe that ER doctor was doing you a big favor. I hope you get connected with a new one soon.

It is great to hear from you, sheriden. It's been awhile.

Stay in touch!

Gary

sheriden
sheriden 2012-02-24 06:08:43 -0600 Report

Thanks I will try and stay in touch. Just been so sick can't stand to do mutch. Yes I belive knowing Rays mom was in the hospital because after many trips to same doc and told to go home and try to drink eat ect and than me he the ER doc was ready to hint that one should seek another doc. Lol.

June Tademy
June Tademy 2012-02-22 16:45:13 -0600 Report

Hi there Dr Gary, I have stated my case on this many times on this site. I had many problems, it took only two weeks before I was fed up with these Doctors, I told myprimary Doctor that I wanted to see an Endo, she tried to dismiss my request and I fought her on that, when I saw the Endo I met face to face with him and he sat down and listened to every word I said and also listened to my complaints, I was in the office and lab for 3hours. Of course I guess I was fortunate because this was an older Doctor and the best in the department. He referred me to another primary Doctor and told me about him and how good he was and he also referred me to the kidney specialist. Each Doctor I asked at the very beginning of the conversation"do you have time to listen to me and if you do are you going to give me your best" if not refer me to another Doctor and they said yes and I have been great every since. I have a Case Manager,A pharmacist, Kidney Specialist, Bone specialist., and if I need anything else I will ask for it. This took a lot of work and a lot of talking and complaining but it worked and I am well taken care of and I am very blessed. Conclusion: You have to take responsibility for your own body and you have to ask questions and get the right answers. Report them to the medical board if you are not satisfied and search,search and search until you get the right one. This is our body and we have to take care of it and we must have the right team to help us, fight for your body and the right to live a nice live without worrying about your life. Blessings to you!!!!!

P.S. If you cannot do it yourself get a caregiver to help you, with this venture, I know we had to fight for our Mom before she died, but she had the best of the best because we had to fight for it, they wanted her to just die, they do not really care, you have to fight for your right to have good Dodctors. Not like it use to be too many people and too many overworked Doctors…It is worth it.

Dr Gary
Dr GaryCA 2012-02-23 14:17:23 -0600 Report

Hi June,

Great to hear from you and thanks SO much for your honest, and helpful reply. I hope that it gets a lot of eyes!

You really should be commended for taking care of yourself. You are a great example of what it means to be an empowered medical consumer. You found a great doctor and I suspect that your doctor recognized that you are taking your healthcare seriously. You are a good team.

I totally agree. You really have to be your own advocate, and take your healthcare into your own hands. Or find a caregiver who is willing and able to step up to the plate for you. I went through the same thing with my mom as you did. My siblings and I had to constantly jump in and make sure that she was taken care of. It meant a lot of time on the phone, a lot of conferences. But it was worth it.

And you're right, lots of people, lots of overworked doctors. Lots of pressure on everyone.

Thanks again. I hope you are having a great week!

Gary

jigsaw
jigsaw 2012-02-22 18:53:00 -0600 Report

Beautifully said June! I did much of the same. I went through quite a few doctors before I found some that I was comfortable with. I make sure that all my doctors have a current list of the meds that I take. If they don't have time for my questions, they lose a patient. If I am being treated by a few doctors for the same condition, then I make sure that they exchange my med records. At the very least, I get copies of my records to deliver myself. I am currently being treated by specialists at Duke Hospital and it's 150 miles from my home. My primary care physician, and endo which are local are all aware and working in unison with each other.
As of recently, some of my doctors are now part of the same large health organization locally. As a result, they all have access to my computerized med records. I have found that doctors that practice within a medical organization are usually better equipped to handle a large volume of patients.

Set apart
Set apart 2012-02-23 20:34:37 -0600 Report

This is great Jigsaw, I also carry a walking record of my medical documents since my diagnosis, if I have bloodwork ordered I now make sure I have a copy of the order and will get a copy of my results, as they're shared. If it's about me and my health I make sure I ask, like you I have a history of doctors I've said Goodbye to, if they don't have time for me, it'll be our last visit. If I feel rushed it'll be goodbye, it seems harsh, but life with D can also be harsh without our dream team! blessings, Louise

jigsaw
jigsaw 2012-02-24 09:18:28 -0600 Report

Awareness specifically with self preservation is the key. I believe we are definitely having a positive effect in this area. I'm sure the sharing that you and I, as well as other members here, are doing, is having substantial impact on others! Thanks

Dr Gary
Dr GaryCA 2012-02-23 14:22:29 -0600 Report

Hey jigsaw,

Thank you. Some great information here! I really think its great how you are taking responsibility for managing your own information, keeping files and records, not assuming anything, even delivering them yourself. This keeps everybody informed, and everybody on there toes.

I also wonder if health organizations aren't more and more in our future. As you say, they are well equipped to handle large volumes of patients and paperwork.

Thanks again. Have a great day!

Gary

jigsaw
jigsaw 2012-02-24 05:59:38 -0600 Report

Dr Gary,

I see this Discussion as being outstanding! The info here can help many deal more constructively with their health matters relative to their doctors care. Your care and thought put into this discussion and others as well, is appreciated. I hope many read this Discussion…Thanks

Dr Gary
Dr GaryCA 2012-02-24 14:34:42 -0600 Report

Jigsaw, thanks a lot! I really appreciate your kind words. The real experts are the members here on Diabetic Connect, and it is fantastic when everybody jumps int. I hope you have a good weekend!

jayabee52
jayabee52 2012-02-23 15:08:20 -0600 Report

I was in the Kaiser Permanente org. when living in CA and my experience there was fantastic as was my medical care. I'd still be with them if they had a branch here in Las Vegas, but since I've moved I have had to make do with other med insurance.

June Tademy
June Tademy 2012-02-23 21:54:44 -0600 Report

Hi James, I am with Kaiser andhave been for a long time. It has so improved over the years, now they call you,send letters,send people to your house, it is great. It was not like this when I was first diagnosed with diabetes, I had only one Doctor who worked with me and he retired so then my project began to find a good doctor. I have no complaints now they are the best, I will probably have to go through this again when I relocate to my hometown which does not have Kaiser branch, but I have already looked into a great Diabetes Center there and checked out the Doctors and e-mailed them. So far all is good, but if not I will fight again to find the right team. Fortunately my hometown is good for seniors and take very good care of them . Always good to hear from you

jayabee52
jayabee52 2012-02-24 09:30:51 -0600 Report

great to hear from you too June. I was only a member of kaiser from Apr 2009 to Dec 2010.

My bride "Jem" had been with them for about 20 yrs. In fact that they had kept her alive for those 20 yrs (with heart problems) was why I moved to the SF bay area. I didn't want to take her away from the wonderful care she was getting, so I moved there to be with her.

I didn't know how good it could be but I am glad I experienced it! Too bad they don't have a KP facility here in LVNV area or I'd still be a member. The closest facility is 3 hrs away in Victorville CA. a bit far to go for medical care.

So where is your hometown?

June Tademy
June Tademy 2012-02-22 20:32:30 -0600 Report

Hey jigsaw: Great post, I am so glad that your Doctors are working together and as you said if they do not they loose a patient. Keep taking good care of yourself. It is true about Doctors that practice in a medical organization being better equipped. When my Mom was ill we had to fight every single individual Doctor and even the nurses, we did eventually find good Doctors for her. But this is the life we are in now and we want to live it in peace and able to enjoy the flowers:) Blessings to you and thanks for your response. Stay on them:)

Type1Lou
Type1Lou 2012-02-22 17:00:31 -0600 Report

Amen June! I so agree with all you've said!

June Tademy
June Tademy 2012-02-22 18:06:28 -0600 Report

Thank You Type1Lou, I was a little winded:) got carried away, just makes me sad when some of the Doctors treat patients badly-and I want everyone to know we have a choice - we do not have to take it, this is our life to live. Blessings to you.

Caroltoo
Caroltoo 2012-02-21 22:28:58 -0600 Report

Be sure they all have written consents to give AND receive information from each other and let them know you EXPECT that they will consult. They can't speak without your written consent.

Type1Lou
Type1Lou 2012-02-21 17:51:12 -0600 Report

I have been dealing with the same concerns. I have a PCP, an endocrinologist, and recently saw a psychiatrist for my depression. The psychiatrist discovered that I had low B12 levels and also requested a thyroid test which came back in the low normal range. He directed me to my PCP for B12 shots which I'm now getting monthly. My endo hadn't ordered any blood work since I first saw him in December…this concerned me too. I finally drafted and delivered the same letter to my endo and my PCP outlining my diagnoses: Diabetes, hypothyroid, vitamin D and B12 deficiencies, hypertension and depression. While I went to the endo for my diabetes, I asked what I could expect each doctor to follow and what I was expected to do. The PCP's office called me back the same day. My endo will be following my diabetes and my thyroid, while my PCP will handle the vitamin deficiencies, lipid levels, and hypertension. The psychiatrist will help me with my depression. Now I know what to expect. I also make certain a copy of any bloodwork ordered goes to all of my doctors. I always summarize all of the medications I'm on when I first visit a doctor and update them with any changes in my medications, both RX and OTC, once again listing all of the meds and highlighting any changes. I've found I need to take an active role in my care and speak up when I have concerns.

jayabee52
jayabee52 2012-02-21 17:12:03 -0600 Report

Isn't a PCP/GP SUPPOSED to be a gatekeeper, a coordinator of her care? That is the way it was when I was with Jem in CA. Oh her Drs did their share of "that condition is not in my field" or were thinking it was due to another condition entirely. Jem was a tough one to treat sometimes as she had so many overlapping "medical challenges" (as she laughingly called them) that it WAS difficult to sort them out. For instance her diabetes, she told me, was due to her heart problem. Her cardiologist told her that. And when I first got there she was getting her diabetes care and dosing instructions from a nurse in the heart transplant clinic. But her BG numbers were so bad (due to meds she was taking for her Lupis and RA flares) that she needed the services of an endo. (her PGP referred Jem to him — acting as gatekeeper)

With my Drs now here in LV there was an incident where my gastro Dr wanted permission to do a endoscopy and colonoscopy. He saw my bloodwork and knew enough to understand that my kidney numbers were bad. Since it was an elective proceedure he put it off till he got the OK from my Renal specialist. The Renal Dr's office said they sent a fax to my Endo, but they said they never received it. So that is the way it is now. (I an none too excited about the colonoscopy prep, so I am not pressing the matter at this point. But since I have a bleeding ulcer (endoscope in Nov 2010) which seems to break open from time to time, and my kidney Dr tells me I have anemia, I'd better get this looked after soon.

Dr Gary
Dr GaryCA 2012-02-22 18:58:27 -0600 Report

Hi James,

Always great to hear from you. Thanks for sharing your experiences.

I think that ideally the PCP is the gatekeeper, and HMOs seem to be set up that way. Some patients have that experience and others don't. I am wondering if we are moving away from that model, for some reason.

It sounds like Jem was getting some good care coordination.

But it sounds like you haven't had such a good experience. Patients are more and more in the position of needing to be their own advocates, having to watch over their own care, follow up on faxes, get their doctors communicating. Some of us are more prepared for that than others.

I hope that you are staying on top of this. I agree, the colonoscopy is not a pleasant experience. The prep is awful, but it does provide you with a nice nap. And certainly something that you want to have do so that you know what's going on. And anemia is nothing to leave untreated.

(Just a gently push here.)

Thanks again. I hope you are having a good week!

Gary

Type1Lou
Type1Lou 2012-02-21 17:57:34 -0600 Report

Oftentimes, what is supposed to be just isn't. I've found I have to nudge the doctors sometimes and am not shy about asking questions. And I don't expect it will get any better as I age.

June Tademy
June Tademy 2012-02-22 18:09:28 -0600 Report

I like you, you are doing exactly what you are suppose to do, with age you only grow stronger and are even more demanding:) I started this when I was young and now I am "ripe" and I am stronger. Like your post take care.

Dr Gary
Dr GaryCA 2012-02-22 18:59:50 -0600 Report

Yes, demanding, and resolved to be your own advocate. Experience teaches us that. Nice to hear from you!