Wednesday, January 05, 2011

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?

17 comments:

  1. He's trying to make money off of you and using you for a guinea pig! My GP is like that... always with one more test that will cost me more money. When I tell her this to her face, she says, "Don't worry about the out of pocket. We'll take whatever blue cross pays and that'll be it." That to me says shyster!

    And the dang republicans think we don't need to do something about health care!

    But I will say be very careful with your bones! I know of some women on those bone pills who are just walking and the big thigh bone breaks!

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  2. I have little faith in the medical system. About 3 years ago my Mother almost died due to her long time Dr. (who was an absolute idiot), telling her that the headaches, loss of memory, and general ability to function was all in her head. She had functioned fine for years and then over the course of a few months showed signs that "something" was wrong. She kept making appointments with the Dr. telling him that something was wrong and every time he would prescribe her a pain medication and anti depressants. Finally me, my sisters and Aunt insisted that she needed to see someone else and found an Internist who would diagnose all of her symptoms. Needless to say the day she saw the Internist, they wouldn't let her go home and scheduled surgery for the next day for a subdural hematoma.

    Had it been me I would have sued the Dr. for malpractice, but my Mom is far too nice for that. However she did change Dr.s after that.

    There is no doubt that our medical system is broken, and far to many Dr's are practicing for the wrong reasons.

    I think it's time for you to find a new Dr. I am surly as cynical as you are, maybe even a bit more.

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  3. Holly, I think it's about money, too. I wouldn't mind if he recommended a certain treatment, but to push it so hard makes me wonder what's in it for him.

    Char, that's a shocking story! Thank goodness you were able to get your mother to see another doctor in time to do her some good.

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  4. I'm a retired RN who's cynical, sadly with a very good reason, I should add. Get another opinion, Linda. Maybe from an orthopod or a GYN doc, not a GP. Something is not right here.

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  5. I agree, get another doctor. If you need to, get another bone scan and start all over. This doctor doesn't seem to know what he talking about and doesn't even know YOU!

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  6. Oh wow....all the red flags, bells and whistles went off in my mind. I don't feel that this doctor knows what he's talking about....either that or he's getting one hell of a kick back on the meds. If I were you, I would definitely get a second opinion. It wasn't that long ago we heard about that one popular med for osteoporosis actually being harmful and causing breaks! And they wonder why we don't trust the medical profession! It wouldn't hurt to do a little research into the homeopathy line and see if there is anything there that might be beneficial to you. Good Luck and hold off treatment until you get different professional opinions.....IMHO.

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  7. Kybeadmaker, I bet you have seen a lot as an RN. As far as doctors go, I respect the medical profession, but I also realize that not every practicing physician was in the top half of his or her class at med school.

    Nan16, I think Medicare pays for bone density scans every two years, so I'll have to wait until November to get another scan. I think I'd like to do that anyway, just to see if the bone loss has progressed or if some of he things I'm doing now to take better care of myself have stopped the bone loss.

    Val, you and I are thinking along the same lines. In fact, he pushed for the first medication near the beginning of my first visit, saying, "Do you have heartburn? Because Medicare will pay for this if you have heartburn." It seemed to me he was pushing that particular treatment and trying to solicit information from me that would justify that particular choice.

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  8. Wow, do I know this one all too well, recently with a dentist, whose practice I had to leave as I feared he would "create" work on my teeth. Sadly, he was an EXCELLENT dentist, and then went through one of those dental boot camps and is now greedy, impatient and demeaning when he can't sell expensive, high-maintenance treatments to his patients. My clue was when I realized I was horrified at the idea of going back there. I think that's pretty much what you have to go by. Medical professionals do get benefits and perks from pharmaceutical companies for peddling their pills. If it isn't ringing up true for you, then you have your answer.

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  9. SDC, now that you mention dentists, I switched last year from one I've been seeing since 1985 in Baton Rouge to one who's right around the corner for me. I switched to avoid the traffic-laden commute, but the new dentist is all about crowns, veneers, implants, etc. I'm 68 years old and have no need to take gleaming-white, movie-star teeth to the grave with me. I just want my teeth cleaned every six months.

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  10. More so....all of us Sisters!

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  11. For peace of mind, I suggest getting a second opinion from a recommended doctor. Maybe ask some friends about their doctors so someone you trust can give you the recommendation. I am lucky in that I have a deep trust with my two main doctors. We've all kind of grown together, meaning I was a young patient when these two were young Doctors.

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  12. Oh my goodness! I have had doctors pushing meds/tests on me. I had one internist I trusted with my life, but had to leave him because he went to a concierge service and I couldn't justify paying thousands extra. The next internist I went to was very aggressive when it came to treatment. One visit they put me in the exam room and I immediately noticed the check off pad he had there for a new heart test facility and thought to myself hmmm. Of course he wanted me to go in for a special heart test, not covered by insurance. This was AFTER a cardiologist had finished running several very expensive tests and cleared me, saying "nothing to be worried about, see you in 6 mos." Seriously, when it comes to my heart, who am I going to listen to - the cardiologist or the internist?

    Needless to say, found myself another internist. If they prescribe lots of tests for no apparent reason, or lots of drugs, especially new ones - they better have a darn good explanation!

    Then we have what doctors did to my dad. No one should have to go through a death like my dad did. You do not spend 13 minutes trying to resuscitate an 84 yo man who has a DNR, and with dementia, cancer and other severe health issues - only to put him, unconscious, on a feeding tube and ventilator. I suspect so they could bill Medicare for ICU for a week, until we asked that extraordinary measures be stopped.

    I am not in the medical profession, but am pretty cynical about it. I do have some doctors I trust 100%, but they are few and far between.

    Sunflower Optimism

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  13. I'd be suspicious if my doctor and her office pushed me to take some medication I didn't know about and don't know how much Medicare pays for it. Good for you for standing your ground!

    I want to say to Sunflower that her experience with her dad is a good reason to fill out one of those living wills. I keep forgetting to do mine, but I'm bumping it up my list. I can't believe those doctors ignored a DNR order! I'd sue.

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  14. Holly-I just saw the last sentence of your post, that's pretty much what happened to my mom, but she wasn't taking any pills, just Citracal. My younger brother mentioned that he'd heard about those bone pills making bones brittle instead of strengthening them. It's scary!

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  15. 4th Sister, well, I KNOW the four of you are cynical. That's one of the things I like about you.

    Duly Inspired, I have a GP that I trust that way, and I'm very grateful for her.

    Sunflower Optimism, the stories of what happened to you and your dad are quite scary. On a positive note, let me say how DELIGHTED I am to hear from you again. Please post something or email me sometime soon and let me know how you're doing. I miss you.

    Janet, I do have a living will, though I've told my daughters, "Let 'em try once or twice to resuscitate me, then you can tell 'em you found the paper."

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  16. When I moved, I had to leave my doctor and dentist, who I'd been with for most of my adult years, behind. I was very surprised to find how different dental, and to a degree medical, practices are here.

    I can't handle dentists who push all these implants, whitening procedures, unneeded x-rays, etc. on me. I can get quite surly! I'm surprised, as well, as this didn't happen to me in my hometown. The reason, I've been told, is that most people here have dental insurance.

    I'd leave your doctor, if there was someone else available. Up here, there are few doctors and they have a monopoly. It's not easy to change doctors. Good luck, Linda!

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  17. Marion, I told my GP I didn't plan to go back to that endocrinologist ever again. She'll monitor the blood tests from time to time, and if something gets out of whack, we'll discuss what to do next. That works for me.

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