So what would you do with this medical care experience?

Parent Cafe
61

<p>nem,
GT alum’s post did a very good job of explaining/summarizing the gist of how many medical practices are run. I thought it was well written and said so. Please don’t think anyone is trivializing what is going on for you, because I don’t hear/see anyone doing that. You are worried and want to get things moving forward, and that is understandable. But it sounds like it is all happening in a reasonable time frame, (assuming there isn’t something going on that is life threatening and requires emergency intervention). You got fit into a doctors schedule on Monday, and by today you have the follow-up appointments made. This usually involves scheduling, verifying insurance, may or may not require pre-authorization, etc. These take a little time, though none of us like to wait. Without knowing any of what is going on for you, it seems reasonable to surmise that the care you are getting is appropriate.</p>

<p>Good luck with your follow up tests.</p>

<p>That said, please understand that some of the statements made by some posters about never trusting anyone (referring to their doctors) is highly offensive.</p>

62

<p>I would take the comments about not trusting your doctor and move that to the next step, with our health, we are the first line experts, we know every little thing that is happening and only have 2-20 minutes, depending on the appt, to relate the portion we choose to our physician.</p>

<p>Most of us would do better if we did not view the doctor as the expert on our bodies, we are the expert on our own bodies. Doctors are expert on the treatment for illness. In my personal experience, unless they can cut it our or medicate it, doctors haven’t always got much luck fixing things that affect quality of life and it is not really fair to expect them to do so.</p>

<p>That being said, a great doctor can have a poorly run office and vice versa! And administration is a huge part of the experience medically, sad to say.</p>

<p>I have watched my parents with that old fashioned view of the doctor as God, and others with the opposite view point. Somewhere in the middle, recognising ourselves as the true expert, doing a bit of research on our issues (perhaps a forum for a known ailment rather than Google for random symptoms!), presenting a well thought out paragraph summing up a problem rather than a rambling page of info, we can help our doctor to act as our “body coach”</p>

<p>Once you need surgery, then yeah, you do have to turn yourself over to them a bit more, but I had surgery with a renowned oncologist this summer and he was incredible in his attitude about just how I wanted things done depending on what he found. i really appreciated the respect, as I am the one who lives with the outcome.</p>

<p>I experienced unreasonable delays in test results from one local doctor and considered replacing him in his category, but gave it until after my post op check up. His staff is improved, the person with the worst attitude has not been there in any of my visits or calls since my unpleasant experience, so I am going to give that office a try for another year and just be watchful and not expect them to be as efficient as other offices. It was bad enough to complain, yet not quite bad enough to switch! I will need check ups for the next 5 years, so if I am not happy by this time next year, I will switch.</p>

63

<p>somemom, so glad that you had a great outcome!</p>

<p>Ellebud, thanks for your advice and compassion.</p>

<p>jym, I was seen on Monday, not because they wanted to fit me in. Initially I was turned away. It was only because I told them that if they do not see me that I would need to go to the ER, lol. I really needed some immediate medical care, so I would have had to go to the ER. I have been put on some medication by the doctor that I saw on Monday, until I get all of my tests done. Had I gone to the ER, guess who would have gotten a call to deal with me from there anyway? LOl! Now, I am being seen next week, because that is when I MUST MEDICALLY BE SEEN. There are not any choices in my situation. Look, the doctor came through, but waiting for my lab tests was just a bit too long, IMO.</p>

64

<p>Just as I chose my friends carefully, I try to be as picky about physicians. Along the way, I’ve met wonderful people/MDs, and others I cannot wait to get away from. I worked in a Boston hospital for more than a decade, helped train medical students, and saw wide range of styles. Some people give you their full attention when you are with them, go the extra distance and call another doctor to coordinate meds, and even call to check on progress. </p>

<p>For whatever reason, I found it harder to find specialists for my son when he was young. After futile efforts with the doctor in nearby town, switched to someone near Miami. On first visit, she ordered MRI for son, lab work, path work, and when we left there at 6 PM, we had a diagnosis and treatment scheduled. She gained our trust so much, that every 3 months for a dozen years we went back to see her. We waited a minimum of an hour to see her, but we understood her style.</p>

<p>For the record, I feel the same way about accountants and lawyers.</p>

65

<p>I don’t mind waiting an hour to see my doctor. Do I like it? No. But what I know is that he/she is in with patients, perhaps with an emergency, perhaps putting someone at ease, perhaps helping them through a difficult time. And yes, sometimes celebrating a good result. And sometimes, yes the doctor and patient are bonding over baseball. I know that, if needed, the doctor will spend extra time with me.</p>

66

<p>

</p>

<p>I think it’s so true that if it’s something concrete that the doctors recognize and know what to do with, they are on it like flies on bat guano. If you have something vague and ill-defined that has a lot of possible causes they are more likely to order a lot of tests and send you home hoping it clears up before they have to get any more involved. DS was born with a sacral dimple and they had him x-rayed within minutes, and a sonogram in front of a class of med students within the first week. Thankfully, it was closed and not an issue, but it was fascinating to see them jump all over that.</p>

67

<p>I don’t want to hijack this thread, but this sort of ties in with the “waiting forever for a callback” issue, albeit in a different context.</p>

<p>My pharmacy called my doctor’s office a week ago tomorrow to get authorization to refill my prescription for the anti-depressant/anti-anxiety medication I take (cymbalta). In the past, in the 8 years I’ve been seeing this doctor, getting a refill authorization has never taken more than a day or two.</p>

<p>Despite three messages left by the pharmacy, and another one by me, during the week (all on voicemail in the “prescription refill” department, since it’s hard to get a live person to talk to at that clinic), they still haven’t gotten authorization. And I ran out on Thursday, so I’ve had to go without for three days. As some of you may know from experience, going off an anti-depressant cold turkey can be a very unpleasant experience. Which I told the pharmacy as I was begging them to give me a few to tide me over (which my old pharmacy in New Jersey was always willing to do), but they said sorry, ma’am, we can’t do it.</p>

<p>So I’m really pretty annoyed. I don’t know if it’s my doctor’s fault, or the fault of the people in charge of refills (it’s a large clinic, certainly the largest LGBT-oriented medical clinic in NYC and probably the largest East of the Mississsippi), but this shouldn’t happen. I’m seeing my doctor on Tuesday anyway (as if that isn’t enough to be concerned about, as I posted about in a different thread), but in the meantime I have not been a happy camper, and without the medication I’ve been really on edge all weekend, with that undefinable feeling of anxiety gnawing at me that I haven’t missed – at all – since the days when it was always there and thought that was what life had to be like. Plus some really unpleasant physical sensations (hard to describe, but they’re breathing/heartbeat related – it feels like my heart is beating too fast, and I can hear it inside my ears, and I’m slightly short of breath) that have to be withdrawal symptoms. Oy. And I have <em>not</em> been able to get any of the work I brought home this weekend done, either.</p>

<p>It could be worse; the last time something like this happened, months ago – I simply forgot to refill it, and didn’t make the connection for a couple of days with how I was feeling – I had some really serious suicidal ideation until I finally put two and two together (nobody ever said I was smart) and got the refill. That doesn’t seem to be a problem this time, but it’s still both unfun and unpleasant. All because somebody couldn’t be bothered to call back with a refill authorization for a week.</p>

<p>I think I’m going to go take half a klonipin; maybe that’ll help a little.</p>

<p>I do dislike this sort of experience.</p>

68

<p>^^Sorry that you had to go through this problem. I can tell you that a small (non-chain) pharmacy near my home can tell me which doc will call back right away, and which medical office will take many phone calls on the part of the pharmacist to get the RX for the refill.</p>

<p>I have one medication that I take regularly. What I have done is built up a little bit extra each month by filling it on the FIRST day allowed by insurance company. This gives me something like 6+ days of medication so if I take a trip and can’t refill it, have a problem like the one you describe, Donna, I have some cushion on time.</p>

69

<p>Some prescription plans (Caremark, Medco, etc) will try to push the Drs into prescribing a cheaper or generic drug (and there is no generic for Cymbalta yet). Even if you have already had this med prescribed in the past, the prescription plans may be requiring written documentation from the MD as to why you need the more expensive med. So, its possible that they could be waiting to hear back from the prescription plan to see if they will deign to let you stay on the med that the Dr feels is the right (not the cheapest) one for you.</p>

70

<p>I guess anything’s possible, jym626 and jordansmom, but pre-authorization issues seem like the least likely explanation. My firm switched from Healthnet to Oxford back in May, and I’ve refilled this prescription five or six times already through Oxford without any problem. Right now, I just happen to be out of refills. Besides, the pharmacist, not the doctor, would be the one who would find out about any issue like this from the insurance company in the first instance; it’s the pharmacist who would then inform the doctor about the need for pre-authorization. And this pharmacist hasn’t dealt yet with the insurance company about this refill, because the doctor hasn’t called back yet to give it the OK.</p>

<p>So I’m pretty sure someone at the doctor’s office just screwed up, whether because they’re overworked and understaffed, or for some other reason. I don’t think the insurance company can be blamed for this one. </p>

<p>In the future, I’ll try to order the refill even further in advance, although that’s kind of a catch 22, because if you order it too soon, the insurance company won’t pay for a refill.</p>

71

<p>Jordansmomn posted a PHENOMENAL post of explanation which I now do not see. Jordansmom-- can you kindly repost? It was WONDERFULLY written and very informative.</p>

72

<p>PS: I just checked the Oxford precertification list, and cymbalta isn’t on it. So that definitely isn’t the issue here. </p>

<p>I guess what bothers me the most is that when I left my voicemail message with the clinic mid-week, I made very clear what the problem was, and asked them if they could please, please, please try to call the pharmacy back before the end of the week so I wouldn’t have this problem. They didn’t. I think it’s some kind of office failure, because, having known this doctor for 8 years, I find it impossible to believe that she wouldn’t have given the OK for the refill if she’d known about it.</p>

<p>Jym626, I don’t know what happened for you, but I see jordansmom’s post just fine. You’re right, it’s very informative, even if it almost certainly has nothing to do with my situation.</p>

73

<p>oops, now I don’t see jordansmom’s post anymore either!</p>

74

<p>Monthly prescriptions can typically be refilled after day 21 of the previous refill. Many now offer 90 day supplies (and they are often cheaper, and many are available by mail order). Several pediatricians here require 10 days advanced notice to refill prescriptions (this may apply to the ones that have to be mailed because they cannot be called in, such as class II drugs like ADHD meds). As Jordansmom so eloquently explained, and as she has before, these things take staff, time and patience. I am guessing she is weary of explaining this, and tired of hearing that everything is always the doctors fault, and I totally understand how she feels.</p>

<p>As an aside, this past Thursday was a holiday, and some offices were closed.</p>

75

<p>Not this one. It isn’t a holiday in New York, certainly not for this clinic.</p>

<p>And I couldn’t have called in the refill 9 days ago, because I was between pharmacies at that point. And it’s never taken more than two days to get authorization before anyway.</p>

<p>Look, is this really necessary? Is it impossible for you to accept that SOMETIMES doctors’ offices screw up? As I said, maybe they are understaffed and overworked. But I’ll bet almost anything that in the space of five days, either they never forwarded any one of the four messages to my doctor’s attention (even though they were made aware – by me – that this was important), or she did give them the OK and they didn’t get around to making a 10-second call to the pharmacy. </p>

<p>As I said, she’s been my doctor for eight years. I know her. She wouldn’t just ignore a message like that.</p>

<p>Not that doctors don’t screw up sometimes, just like everybody else. I’ve been a rather frequent consumer of medical services for the last 33 years or so, and I ought to know. Not to mention that my mother died as much as a result of medical malpractice as of the car accident that injured her in the first place.</p>

<p>But I never said that everything was always the doctor’s fault, or the nurse’s fault, or the staff’s fault.</p>

<p>Sorry if I’m a bit irritable. I have every right to be.</p>

76

<p>Look-- As we have tried to explain, there are many variables that affect this. Frequently the new Rx carrier (Oxford) will give a grace period to your firm before they impose their own PIA rules. As you said, you are out of refills, so this requires a NEW prescription, and thus it is possible that now is when the insu co is making the provider jump through hoops to explain why you shouldnt be on a cheaper generic (even though you’ve been on Cymbalta already). It happened to me with Boniva/Actonel. Maybe your Drs office is a total slacker/screw-up, but maybe, just MAYBE they aren’t and there are other issues to consider. But I am tired of trying to explain, just to have it fall on deaf ears. No Mas.</p>

<ul>
<li>By the way-- have you checked with your OLD pharmacy to see if it was accidentally called in there? You just threw in that extra variable, and even if you left a new pharmacy/phone number on the VM, its possible that whoever is in charge of calling in the prescriptions pulled your chart (well, its probably an electronic medical record now) and called the pharmacy on file. That is quite possible. You made a change-- mistakes can happen under these circumstances. If you’ve used this Dr for years and the staff knows you, its possible that they didn’t catch that now, after umpteen years, you switched pharmacies. Even if this error did happen, surely it will be their fault for not triple checking every phone number. Got it. I understand why all the other healthcarel providers/staff have left this thread.</li>
</ul>

77

<p>I already said that cymbalta isn’t on their precertification list. I already said that even if it were, the provider wouldn’t know there was an issue unless the pharmacist told them about it. Which, by definition (since the pharmacist hasn’t spoken yet to the insurance company), the pharmacist hasn’t. I didn’t even mention that I’ve been out of refills before, and there have been “new prescriptions” for this already, since we switched to Oxford. OK? Any other ideas why it’s somebody else’s fault?</p>

<p>I’ve rarely seen such defensiveness. It’s totally uncalled for here. But thank you for graciously conceding, with great reluctance, the possibility that there was a screwup on this one occasion. (I did not, of course, suggest that they were total slackers/screw ups. Which is the main reason the defensiveness is inappropriate. The other one being that you seem to be taking out on me your annoyance – equally unjustified, I think – with the OP.)</p>

<p>I don’t need this, especially the way I’m feeling. So I’m very happy you’ve said “No Mas.”</p>

<p>PS: Lawyers get slammed all the time just as harshly, if not worse, than doctors. But I don’t act like this when someone says it seems that their lawyer screwed up.</p>

78

<p>Good grief donna. How do you like all the attorney bashing threads?? I am not being defensive-- we are trying to explain w how/why these things can happen, but again-- just get more cr*p. Even if a RX doesn’t require a “precertification” sometimes the companies will ask the Drs to explain why they didn’t write a cheaper/generic one. Its not technically a “precert”-- its the insu co trying to pressure the doc to write a Rx for a med that offers a generic.</p>

<p>Maybe its the withdrawl causing the moodiness. I totally get why the other posters left or pulled their posts. No one wants to hear any other possible issues to consider. The healthcare profession is a mess. Time to use shamans.</p>

79

<p>Yes-- maybe the drs office is totally screwing up, and maybe the Rx never got called in. But maybe, just maybe, they were being proactive if they know the insu co will require documentation (NOT precert) for the Rx BEFORE They call the pharmacy with the Rx. This is not unusual. And again, maybe your prescription is sitting at the wrong pharmacy. Lots of possibilities. Stuff happens. And thank you for acknowledging that your heightened level of irritibility may be chemically induced. Feel better, but take the anger elsewhere please.</p>

80

<p>I’m done arguing about this. It’s pointless. To be honest, I don’t even care that much why it happened, although no doubt I’ll find out soon enough. I’d just like my medicine, please, preferably tomorrow!</p>