Wednesday, March 6, 2019

A Conversation With My Dog About Doctors

The dog and I had a deep conversation recently.

OK, fine. I'll be honest: It was mostly me ranting, with her just watching and listening. Every so often, she'd wag her tail, raise her ears or tilt her head inquisitively. Mostly, the dog was there to listen and offer moral support.

You see, I had a doctor's office visit recently. We've been back for nearly four years now and have had the same Michigan-based HMO policy during that time. It's great insurance coverage and I am very thankful for it, but it's a bit frustrating as to the headaches I must endure as a part of the process.

For instance, the endocrinologist that I've seen for 3+ years now is one of the best. And while he's cool with unofficially being a point-person for my healthcare since 99.9% of it relates to my T1D, it's not official and my insurance requires a Primary Care Physician. That means in order to see my endo or any other doctor who's basically a "specialist," I must have a referral. And they only last a year.

So annually, I must go through the task of going in to see a new PCP to basically recap my general health picture to get these referrals. And per usual, I decline to do anything more like blood-work, lab tests or medication changes because that's all handled by my endo's office. I prefer that everything go through his office, since his name or clinicians are the ones signing my Rx's.

Of course, these Primary Care Physicians aren't pleased with my brushing them off.

I also happen to go to a family clinic about a mile from my home/remote work office, out of convenience; and this particular place is in the same hospital-affiliated network that my endo is. Unfortunately for me in several ways, it's a "teaching facility" which means I typically see 2nd or 3rd year residents who are just going through the motions; I've never once seen the actual doctor whose considered faculty, and I refuse to wait several months for an appointment that I don't take too seriously to start with.

As such, the last time I was at this office to see anyone in person was in late 2017. Last year, I lucked out that the referral specialist agreed to just renew my referrals for my endo and other docs, so I was able to skip seeing a doctor there.

Not so much in 2019, and the in-person appointment was required before anything else. So I sucked it up and made the appointment.

Since I've now just turned 40, I also figured it was time to check off some non-diabetes related health tasks that materialize as you age. Among them, a physical.

After seeing a very nice nurse who went through the check-in health measurements and online chart checks, I was left alone to wait for the never-seen-before doctor. I waited an hour, and in doing so was already missing out on an important work call that had started just before my appointment time.

The doctor finally entered and ignored my extended hand as he studied a paper chart, and this put me in an even-more grumbly mood.

"Wow, you haven't here since 2017? And you have diabetes!"

My response: "Correct. I see an endocrinologist at least a few times a year and work with him directly on my diabetes and most other things. But my referral is expiring soon and my insurance requires that I see a primary care physician, something he isn't able to do officially. So that's why I am hear. To get my referrals."

After dealing with this young doctor's disbelief that I even needed a referral, which is straight up fact for me since 2015 when beginning on this Michigan insurance plan, he moved on.

He started asking about my medications, without looking at the online screen where they had been entered by the nurse an hour earlier. I reminded him of that. While also handing him a written sheet listing the med names and doses. And noting that I didn't need any Rx fills, because my endo handles that all.

[[ The dog, meanwhile in real time, is just looking at me. I can't tell if she even cares about my story, but at least she's listening. ]]

"What's Tresiba?" he asked, and I explained.

"What's Afrezza?" he asked, and I explained.

"You also take Novolog... why are you on so many insulins?" he asked, and I politely brushed him off by reminding him that it's something my endo and I have determined is best.

He then mentioned my endo and wanting to see those records, to which I suggested he give my endo's office a call. Or simply look at the screen since both facilities are in the same hospital network system... and last I knew, the records were being shared. He did that and found the records, from my last visit in November.

[[ At this point in my story-telling the dog hopped up onto the couch and gave a look of concern, before putting her head down and sighing... clearly, we were on the same page here ]]

And this is where it elevated to the next level.

He saw my higher A1C. He noted how my labwork was overdue, for many things including thyroid and kidney function tests. And he connected that all back to what he'd already observed about my lack of primary care doc visits, a higher blood pressure reading despite my current endo-prescribed ACE inhibitor... and generally, my lack of enthusiasm for talking to him in particular.

"I'll be right back," he said, and left the room.

Oh, boy. Now I'd done it. He was only gone a few minutes, during which time I put my socks and shoes back on. He re-entered and didn't sit.

Clearly, the tension had risen.

"You need to change medications," he declared.

Um, no. Even if that's the case, I'm not comfortable with that here. It's a conversation for my endo and I to have, once I can get the referral.

The 2nd-year resident explained the role of a primary care physician to me, noting how important that job is and that he can help explain things to me that other "specialists" may not.

"Listen, I appreciate your job and understand that I'm being difficult here. But I don't need you to explain that to me. While some may, I don't want that from you. It's not why I am here."

He glared at me, dumb-founded.

"You're basically asking us to be a referral mill, something that I'm not comfortable with..."

Then I guess I will be taking my business elsewhere, I stated. Paraphrasing what I told him next: I'm essentially checking off a box here, for insurance purposes. I'll get to managing my health with the appropriate people who know my history and I trust to work with me in that decision-making. Sorry, bud, that's not you. Chances are, I'm never going to see or hear from you again after this visit -- just as it's been every single time I have come here since mid-2015.

What happens if you go to see another doctor and that person tells you to change something, and you need help understanding it?" he asked.

"Then I'll ask that doctor and work it out with him or her. And then let my endo know."

I was actually a bit insulted that this particular young doctor didn't think other doctors, especially those who've been practicing MUCH LONGER than he has, would not be able to make simple recommendations or explain care. That I would need him or this office in particular to explain it to me.

[[ The dog was again perked up, sensing my rising blood pressure,  and inched closer to me and put her head on my leg. That was nice. ]]

After two hours in the office, I was finally able to leave after the young doctor all but threw up his hands and gave me the paper referrals needed to get into my "specialist" physicians. I checked out and left.

Granted, I know that I am being difficult here. That really, I need to put more care into my own health and diabetes management and that -- in the context of this primary care office -- that I should respect their role more. I'm basically gaming to work the system to get what I want.

Still, I didn't feel listened to at this office or by this doctor. And that maddens me. It's also a similar experience I had the last time I was there, and why I hadn't returned in so long.

Maybe now that I'm 40, I can do better on my healthcare. And take it more seriously than I have, to improve my D-management as well as my A1Cs and general health.

I just don't think a primary care physician is what I need for that, and it'll add more headache and stress and push me toward not wanting to take care of myself. I'd like my insurance company to know this, too.

Again, I know it's complaining just to complain here. And that in the end, I've got great insurance coverage that just requires me to jump through hoops. Necessary hoops.

[[ It's a damn shame my dog can't be my primary care physician... she already does more for me than any PCP has in the past three years. Maybe I can teach her to write referrals.... ]]

Oh well. We can dream, right??


RIck Phillips said...

Hey my dog Samantha ghost wrote part of my dissertation.

I can say that now that I have graduated. But if I become the nominee to be Secretary of Housing and Urban Development or maybe Attorney General (they seem to be in short supply these days), and you send this note to the Senators during my confirmation process, I will say someone impersonated me. Likely a dog. Just saying.

Oh and as for your your Endo, I grew up in Kokomo, I know people. If you want their names give me a call. Just Saying.

TheSavvyDiabetic said...

Oh, I could just move my lips and your words would come out! And I love Riley for understanding! I used to bring a teddy bear with my to my pcp office visits because I would get so upset and I wasn't allowed to bring my certified therapy dogs to the office.

I wonder if there is any way we could have impact at the medical school level to deal with communications and medical arrogance. I just did a blog post that included a suggestion that we stop addressing our physicians as Dr. ... sets a distance which easily lets superiority sneak in.

Oh, and let me say again, I love Riley!!!

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