When Trusted Doctors Leave Town...
March 2, 2010 3:09 PM   Subscribe

Should I find a new doctor, and if so, must I start from scratch? My long-time rheumatologist has moved out of state and I have an appointment this week to see her successor. I have "iffy" feelings about him based on one phone conversation. Long backstory inside. I know YANMD, but I'd appreciate opinions from both medical professionals and consumers.

Both Mr. Adams and I have auto-immune diseases (me Lupus, him Ankylosing Spondylitis) and have both been seeing the same rheumatologist since the mid-1990s. Dr. J was also an internist, and as such she diagnosed and treated some of our collateral illnesses (Mr. Adams was subsequently diagnosed over the years with both hyperthyroidism and Type II Diabetes, and she monitored those conditions and prescribed accordingly.) Last October she contacted us to let us know that due to family circumstances she was moving to Indiana. She referred us....well, not exactly referred; she said that if we wanted to remain with the same practice, Dr. B was another rheumatologist/internist on staff. She then quickly (this was all left in our voicemail, as we weren't home when she phoned) listed some other specialists she knew that we could call if necessary...an endocrinologist, an internist and a neurologist (for another possible health problem that came up in our last batch of tests). When I called to make an appointment with Dr. B, I was told that even though he's also an internist, he would only handle our rheumatology issues. Apparently it is some sort of new policy within the practice, the doctors can't "share" specialties....? Something like that. I was told we'd have to also make an appointment with Dr. M the internist if we wanted to keep refilling our Synthroid and Metformin prescriptions in the meantime.

As I said, that was last October, and since we'd just had our bloodwork done, I scheduled March appointments with both Dr. B (rheumy) and Dr. M (internist). Mr. Adams has had a prescription for Hydrocodone for several years, and back in April 2009 Dr. J upped the dosage from 660 to 750. When the drug store called Dr. B's office for a refill in Jan 2010, he prescribed the 660 dosage. I phoned him and told him that Dr. J had been prescribing 750 and he said "No, she hasn't." "I've got the bottle from the pharmacy in my hand, it says 750." "I've got his file in my hand, and it doesn't say 750 anywhere." I protested that since Hydrocodone is so controlled the pharmacy would not have given us a stronger dose without authorization. He just got more agitated and kept repeating that he didn't know how we got the 750, the file showed....blah blah. The next day I was able to reach the medical tech at the practice who I sorta knew from my visits over the years and who'd worked with Dr. J. She pulled the file and said "It's right here, he just doesn't know how to read Dr. J's notes." Sure enough, later that day the pharmacy called to say they'd gotten an updated script from Dr. B. What bothers me is how adamant Dr. B had been that he was right, that there was no possibility of an error. That just raises a red flag in my mind. Am I being unnecessarily critical? Maybe it's bad to judge on the basis of one phone conversation, but he's giving me the impression that he's omniscient, which could mean that in the future he might discount any symptoms/complaints.

I also wonder about the new rule about having to see a separate internist. Is this just a ploy to collect more co-pays? If I do keep my appointment with Dr. M (the new internist; that appointment isn't 'til the end of the month), just how much does a traditional internist handle? Will she refill Mr. Adams' diabetes meds and his thyroid meds? Or will we have to find an endocrinologist for that area of his illness?

We'll keep this week's appointment with Dr. B, but if I ultimately don't like him, what happens if I choose to go with a different specialist? This will sound terribly naive, but I don't know what all is involved - if I find another rheumy/internist will Dr. B's practice transfer all our records and X-rays? Or will we have to start from ground zero with all the basic testing (X-rays, breathing tests, blood work, etc)? I'm not worried about cost so much, since we have pretty good Blue Cross, but time is a factor. Mr. Adams and I both freelance from home and hours spent at the doctor's office undergoing tests we've just had six months ago are hours of lost income.
posted by Oriole Adams to Health & Fitness (9 answers total)
Sometimes you can fill out a release form at the new practice and they'll handle it for you and get the records sent straight over to the new doctor. Otherwise, you may have to request copies of your records, but your current doctor's office should give you a copy of your records. However, the new practice may still decide they need some tests done again - too old, too illegible, not done with whatever standard the new doc prefers, etc.
posted by dilettante at 3:23 PM on March 2, 2010

Changing doctors is always difficult, and most doctors tend to be a little, um, careful when prescribing narcotics. That said, it sounds like it was a very negative interaction for you, and you sound ready to change. Just want to warn you that you may get similar reactions from your new rheumatologist as well - being prepared with old prescription bottles/doctors notes is helpful.

As for your records, it is your right to receive a copy of your records. As dilettante says, whether your new doctor wants to repeat some testing is individual.

I cannot speak for all internists, but most are comfortable caring for diabetes and thyroid conditions, esp if they are stable.

Hope this is helpful, sounds like you're going through a pretty stressful time.
posted by deliquescent at 3:57 PM on March 2, 2010

Best answer: Please check your MeFiMail.
posted by Drasher at 4:03 PM on March 2, 2010

It's amazing the number of people who call a doctor to pill shop. That's why the doctor was adamant. People call with all types of stories to get more pills/increase dosage. No one knocks their cholesterol Rx or birth control pills into the toilet, but those slippery narcotics are always falling down the drain, into the toilet and accidentally getting tossed in the trash. You were a patient who is unknown to him, telling him the chart is wrong and you need a higher pain med. In that situation, most docs are going to think you're pill shopping. (In this instance, it was his mistake and should apologize for the mix up.)

You should ask about the policy regarding shared specialties - is it the doctor's policy or the practice's policy? Is it specific to your insurance carrier? It's worth getting to the bottom of what that policy is and why it exists.

Changing doctors is moderately inconvenient. Tests will likely need to be rerun which may be a financial hardship for you depending on your health coverage. It's also a hassle and a time suck. However, having a doctor you trust is worth the bother.
posted by 26.2 at 4:30 PM on March 2, 2010 [1 favorite]

Change is difficult. This applies to you and to your doctors. I feel that you have some positive relationships at the practice you are now seeing that might give you some comfort. I would suggest you keep your appointments and evaluate the experiences you have at that time. If you are really uncomfortable, then look around. If not, don't put yourself through the stress of possibly finding another doctor you don't care for and having to jump again. Step at a time.

When you see any new doctor, it doesn't hurt to explain your expectations in a non-confrontational way and to solicit an understanding of your doctor's comfort levels. My doctor has built up a trust in me to the point that he lets me suggest medications that he might not have thought about. This did not start on the first visit, but we did discuss at the time how we could work together, etc.
posted by Old Geezer at 5:04 PM on March 2, 2010

Best answer: Nthing that his reaction was more to do with the specific med in this case than you or your medical history. My mum's a medical receptionist, and you probably have no idea how hard many people try to get all kinds of meds, as much as possible.

I'm _not_ trying to insinuate that this is what you're doing at all - but doctors faced with multiple patients trying it on every day (and also colleagues who may be a bit more 'liberal' with prescriptions, for whatever reason), are apt to be a bit suspicious and defensive about stuff like this.

View it as an opportunity to establish a good relationship/rapport with your new doctor. If, after some consults, the rapport isn't forthcoming, start shopping around. If you know any docs that work in a hospital, ask them for a GP recommendation; you'll often get a good one from them.
posted by smoke at 6:32 PM on March 2, 2010

Best answer: Time for a new doctor and a new practice.

He didn't call you back to admit his mistake, and he was far to adamant in making the mistake in the first place; pain docs have to have courage these days in order to be able to assert their patients' best interests in the face of ever increasing and ever more heavy-handed regulation from state and federal governments and the insurance corporations, and this guy clearly lacks the gumption for that; and I agree with you, there would seem to be very little good reason to separate your internal medicine appointments from your rheumatology appointments other than increased billings.

But as someone from your neck of the woods had reason to write instead of what she did write, a good rheumatologist is hard to find, so don't sever your relationship with the current one until you're booked with someone else.
posted by jamjam at 8:48 PM on March 2, 2010

Oriole, I don't know if you are in another country where the standard operating procedures are different, but when I first read your question, I had the same response as your doctor, because hydrocodone does not come in 660 or 750 doses that I am aware of.

Typically, hydrocodone is dosed in milligrams (mg) and a typical dose would be 7.5 milligrams (so perhaps you could have been confused by one order of magnitude, or your bottle is strangely labeled in micrograms. Hydrocodone is typically paired with acetaminophen (can be noted on bottle as "APAP"), which is the generic name for Tylenol. When it is paired this way, it is called Vicodin. As far as I know, in the USA you cannot get hydrocodone alone, it must be hydrocodone with Tylenol or ibuprofen ("Vicoprofen").

Vicodin has 500mg of Tylenol in it, so there is also a possibility that you were reading the Tylenol dose, but it shouldn't be 660mg, that's not a typical Tylenol dose.

So, I can't comment on this guy or whether he's a good doctor or not, but just wanted to put forward the possibility that by calling and suggesting that you needed "750" of hydrocodone, you sounded to the doctor like the mythical drug addict in one of our medical urban legends who shows up at the office demanding "a pound of mo'fine".

p.s. yes, your records can be transferred from a previous physician to a new one as long as you fill out a form authorizing the release.
posted by treehorn+bunny at 5:13 AM on March 3, 2010 [1 favorite]

Response by poster: Treehorn, I was abbreviating what the prescription bottle labels said - "10-660" and "7.5-750" - just as a quick way of differentiating between the two.

Just as a follow-up, Mr. Adams and I saw Dr. B as scheduled. He was cordial and seemed to attempt to be thorough (constantly flipping through the 1/4" thick papers in each of our files). However, there were several things about him that rubbed me the wrong way. He answered five cell phone calls during our appointment. (I found it a bit ironic since there are signs all over the waiting room advising folks to turn off their cell phones.) He also asked me if I minded going over my history with Dr. F, a resident who was shadowing him. I'm all for helping out the doctors of tomorrow, but Dr. B left the room for a good 10 minutes and relied on Dr. F (whose name badge indicated that his specialty was podiatry) to get my all of my crucial information dating back some 20 years. When Dr. B returned to the room, he asked some perfunctory questions which Dr. F answered, but Dr. F didn't offer any additional information that he'd gathered from me but which Dr. B hadn't inquired. For example, I'd told Dr. F about my small stroke in 1997 and the subsequent diagnosis of antiphospholipid-antibody syndrome, but Dr. B didn't ask about the many collateral conditions that often go along with Lupus. He strictly asked about swollen joints, rashes, hair loss, things like that. His overall attitude was "well, you're not on steroids or immunosuppresants, so you might not have Lupus...." (My two previous rheumies had put me on steroids for short periods of time in the past; they were both always worried about the side-effects and prescribed it sparingly.) Anyway, I know that doctors are busy and probably don't have the time to review every page of every patient's folder prior to a first appointment, but while I'm in the examining room I expect him to give me his undivided attention, which he didn't.

Thanks very much to all who read and responded to this thread.
posted by Oriole Adams at 1:23 PM on March 8, 2010

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