Would you go back?

Here's something I wrote this past August and decided not to post at that time:

August 2010:

Last week I had a follow-up visit with an endocrinologist I've seen four times previously. I went to see him originally because my general practitioner suspected I had hyperparathyroidism and might need surgery to remove the affected parathyroid gland(s). After many tests, the endocronologist said, “I can’t prove you have it,” so surgery is not on the table at this point. I’m fine with that.

Instead, the endocrinologist has focused on a bone density scan I had in November 2009, telling me on each of the first four visits that I have osteoporosis (not the less severe osteopenia that the technician who gave the test diagnosed) and pushed me to pursue a certain course of treatment that I've so far resisted due to reports of negative side effects.

On this visit, because I've been feeling exceptionally well and think I could now tolerate the side effects, I was ready to get on with it. But this visit was different. This time the doctor looked at the same November 2009 bone density scan results and said, "Oh, yes, I see that you have osteopenia." (Huh? My condition has improved from osteoporosis to osteopenia on a piece of paper that's been in your file for nine months? Great news!)

He asked if I had any other questions, and I said, "Well, you've mentioned [treatment plan I didn't like] in the past." He looked again at the test results, left to go to his office and do a risk assessment calculation on his computer, then came back and told me I don't need that treatment.

"It wouldn't hurt anything to do it as a preventive measure," he said, "but you can have another bone density scan, let's say next summer, and consider it again then."

What a waste of everybody's time and Medicare's money.

Back to the present:

I'm posting that earlier rant now because I went to see this doctor again yesterday. Yesterday's appointment was scheduled at the end of the one in August. At that time the doctor gave me lab test orders, told me to have the tests done in five months (which I did) and follow them with an office visit ten days later.

This time, after I waited alone in the exam room for more than an hour before he finally came in and rifled through my file to figure out who the hell I was and why I was there, he zeroed in again on that 2009 bone density test, the only one I've ever had, and what he is now calling my "borderline osteoporosis." He told me about a new treatment, one that "only came on the market about four months ago, and it's a really good medicine." It's an injection that's given every six months. He said it costs $700 or $800 and that I should check to see what my insurance will pay. I told him Medicare is the only coverage I have, and he said, "Well, if they need pre-approval, let me know." I said not one word to indicate to him whether I wanted this drug or not, but he hastily wrote a prescription and told me to get it filled at a pharmacy, then bring it with me to his office so his nurse could give me the injection.

He also told me to make another follow-up appointment for six months from yesterday, though he didn't give me any lab orders, so I don't know what he plans to follow up on. I took the prescription without further discussion, intending to find out more about the medication and my insurance coverage and then make a decision. As I started for the exit, a nurse motioned me to the front desk to make the follow-up appointment, but I kept going, saying I'd call back later for that.

Late in the afternoon, after I would have assumed his office would be closed, I got a phone call from someone there asking if I'd filled that prescription. I told her I had not, and she said, "Well, don't fill it; we've ordered it from here." I told her I didn't intend to take the injection until I got more information about how I was going to pay for it, and she said, "Medicare will pay for it."

"How much of it will they pay?" I asked.

"I don't know. Some of it."

I told her she needed to cancel their order for the medication, and she said they would "be in touch" with me.

I do not like to be pushed, and I do not like for someone to think he can make decisions for me, as long as I'm conscious and coherent, just because he has a stethoscope hanging around his neck. Both of the "must-have" treatments he has insisted I take involve extremely expensive medications purchased through his office. I have my own idea about why he's tried so hard to push me into these treatments, but I'd sure like to know what you think. Are you as cynical as I am?