Had an awful neurologist appt,, now what?
February 6, 2016 5:03 PM   Subscribe

I recently saw a neurologist for my chronic cough, which has been diagnosed as neurogenic by a cough specialist. The appt was one of the worst medical experiences I've had. While I don't know if he did anything illegal, I'd like to report him somewhere. I'm also wondering if there's a way to get out of paying him. More inside.

I spent over a year trying to diagnose a very persistent cough, went through all kinds of tests, before I found an ENT that had a cough specialist who realized my cough was neurogenic. Unfortunately, I moved away before we could really get started on treatment. In my new location (Virginia) I started all over with a GP who couldn't help referring me to an ENT who couldn't help who finally offered a neurologist referral.

I went to the appointment and started to describe my symptoms and such to him, as well as tell him about all the diagnostic testing I'd already undergone. He interrupts me right away and says he doesn't believe I have a neurogenic cough and is not going to prescribe any of the usual medications for it. I asked him what my problem was, then, and he said it was environmental factors. I asked for more specifics and he refused to give any.

He gave me a brief, odd exam. I was there for my cough, yet he didn't hear me cough or listen to my lungs. He did have me take off my shoes so he could examine my feet.

The general tone was him not listening to me and then not explaining anything he said. Then I went to check out, and the receptionist told me he had ordered me an MRI and a lot of blood work. He didn't mention either of those to me, so I have no idea what they are about. (I canceled both.)

A week or so later, I got an after-visit summary in the mail. Under "Diagnoses," he had written "Chronic cough" but had also written "Demyelination of central nervous system." Which is not something he mentioned to me at all. Plus, since that diagnosis can include things like MS, explanation is usually warranted.

So then I got a bill. I have Medicare so can end up with hefty copays for specialists. This guy wants $170 for that visit. I have no idea if you can appeal a medical bill on the grounds the doctor was wtf, but I'd like to.

In conclusion, I don't feel that this doctor is very professional, and I'd like to voice that to someone. I think he is in charge of the clinic, so I can't complain to an immediate supervisor. Who can I complain to? Again, I am in southwest VA. Also, are there ways to avoid paying the bill aside from just not paying it?
posted by mermaidcafe to Health & Fitness (26 answers total) 1 user marked this as a favorite
 
Best answer: Is he a member of the AMA? If so, you can report him to that organization.

Legally, I don't know that you have much recourse. It's kind of a he-said-she-said situation.
posted by deathpanels at 5:13 PM on February 6, 2016 [2 favorites]


Maybe he noticed something very indicative that triggered a gestalt diagnostic insight. Maybe he read your file before you arrived and put two and two together. It is awful that he didn't communicate this (or much at all) to you... I don't think it's great practice, but I've had doctors order tests and not really explain why until the results came back. MS is a heavy diagnosis to deliver, and there's probably more than one condition that fit what he saw, that he wanted to rule out. He may not have wanted to say much without confirmation (or had the skills to). Absolutely terrible communication, I'm not apologizing on his behalf for that, but I would not throw out his expertise altogether.
posted by cotton dress sock at 5:25 PM on February 6, 2016 [3 favorites]


Do you owe this guy your annual Medicare deductible ($170 is about what that is)? The thing about your deductible is that you have to pay it every year- to him or to somebody else. So should you end up not having the bill forgiven, you could mentally file it as, this is part of my overall healthcare costs, not necessarily just a payment to this one guy.
posted by ThePinkSuperhero at 5:27 PM on February 6, 2016 [1 favorite]


Use yelp and other social rating sites to calmly and factually recount your experience. Highly recommended. This is a great way to handle this - and help others looking for a good neurologist.
posted by arnicae at 5:35 PM on February 6, 2016 [4 favorites]


what did he do with your feet? (i have ms and am wondering if it's anything i have experienced at a neurologist, in which case it may help explain things a little (i do agree it all sounds very odd)).
posted by andrewcooke at 5:57 PM on February 6, 2016


Best answer: See another neurologist. You don't want to have to keep wondering if you have some kind of awful disease.

Neurogenic coughs are pretty treatable. I have a cough that they started to treat as neurogenic before figuring out that it was caused by acid reflux/other underlying issues. If you haven't yet, you can get a referral to a speech pathologist who can work on the relevant cough suppression exercises with you. It's strange that he wouldn't at least try you on a nerve medication like gabepentin. Going to a speech pathologist and subsequently ruling out a neurogenic cause was a huge part in figuring out the cause of my cough.

Anyway, I digress. Writing terrible reviews is incredibly gratifying. Word of mouth is powerful. In my experience, a lot of doctors who are actually good doctors and people have pretty shit social skills, likely a side effect of being really damn smart. Try writing him a letter. Explain why you don't want to pay, and why you shouldn't HAVE to pay, but also just try to explain in general why you were so unhappy. It will likely have no bearing on your life (I.e. he'll still want his money), but you can wake him up to how he speaks to the next patient.
posted by Amy93 at 6:07 PM on February 6, 2016 [2 favorites]


Is the neurologist part of a larger health/hospital system (rather than an independent solo or small group practice)? If so, there may be a 'patient relations' that you could contact. They could help with the billing situation, and could also send your concerns to the clinic.

The AMA is more of a political lobbying group, so it's less likely to be helpful here.

In addition to above, definitely let your referring primary care physician know of your negative experience - he/she could then know to keep from referring patients to the neurologist in the future, which is a big deal for specialists that depend on referrals. Also, with knowing your experience your primary care provider could also find a more suitable specialist for you.

This does not directly answer your question, but if there is an unanswered part of the diagnosis I would recommend contacting the clinic to ask what the diagnosis of 'Demyelination of central nervous system' means for you, including your prognosis and future management - more specifically what needs to be monitored in the future (any red flags to keep an eye out for?) and does anything need to be done now?

I second Amy93's recommendation for a speech specialist to help reduce coughing symptoms.
posted by slomodinkens at 6:17 PM on February 6, 2016 [3 favorites]


You could google them and leave a bad review for any online listings you find - google, yelp, etc.
posted by zug at 6:40 PM on February 6, 2016


Could you possibly call and ask for clarification? Just say what you told us - "hey, this seemed kinda strange; would you mind explaining the tests you did and why you ordered ____?" If you don't feel comfortable asking the doctor, or if he doesn't answer your questions, could you ask the doctor who referred you?
posted by kevinbelt at 7:00 PM on February 6, 2016 [1 favorite]


When he examined your feet, could he have been checking for the Babinski sign? It's a normal thing for babies, but in adults it can suggest the presence of a nervous system disorder.
posted by pullayup at 7:03 PM on February 6, 2016 [1 favorite]


It's too late now, but maybe this will help you and others in the future.

Before the current health care system in the US, a HMO nurse told me one of their problems was a patient who knew that if he mentioned a symptom, it had to go in his medical record, which made it lawsuit bait. Don't let a doc or nurse shut you up. Drown him out saying something like 'take note of this' then simply list your symptoms. They hated it when they had to spend more time and money on a patient then they had too.
posted by Homer42 at 8:25 PM on February 6, 2016 [1 favorite]


I have a regular neuro I see for various issues, and one of the first thing he checks every appointment is my feet. Other neuros have as well in the past. I too thought is was very odd. Apparently it's part of checking your neurological vital signs. I really wish I could remember what they were checking for specifically -- I did ask about it once. Unfortunately all I remember about the answer was me thinking 'huh, ok, I guess that makes sense.' So I don't think that particular part for your experience is too unusual at least. The rest tho, I don't know about, but it sounds very frustrating and in sorry your going through it.
posted by cgg at 8:46 PM on February 6, 2016


If he thinks you have a demyelinating disease of the CNS, then ordering the MRI and a ton of bloodwork make perfect sense. The MRI is to look for lesions on your brain and spinal cord, and the bloodwork is to eliminate all the other possible diseases that present similarly to MS. If the MRI finds demyelination, and the bloodwork all comes back negative, then you would wind up with a diagnosis of MS more or less by process of elimination.

The guy sounds like a pretty lousy doctor, at least in terms of communication, but the lab orders are consistent with his diagnostic notes.
posted by McCoy Pauley at 8:53 PM on February 6, 2016 [8 favorites]


Thirding the foot exam.
posted by Room 641-A at 8:55 PM on February 6, 2016


Also, this is anecdotal, of course, but I'm not sure that neurologists have the best bedside manner.
posted by Room 641-A at 8:57 PM on February 6, 2016 [2 favorites]


Response by poster: He did not have any of my files to look at beforehand, just to clarify.
posted by mermaidcafe at 9:14 PM on February 6, 2016


For some reason I hear terrible things about the bedside manner of neurologists a lot. Hopefully someone in the office is knowledgeable and patient enough to go over his notes. I'd call the office and see if there is a nurse who works with him that you can talk to.
posted by pattern juggler at 1:07 AM on February 7, 2016 [1 favorite]


just want to add to the chorus saying go see someone else. my neurologist rocks, so there are good people out there. and for something like MS you want to catch things as soon as possible (there's no "fix", but they can slow things down, so the sooner you know, the better, and there are lots of treatment options these days, so for many people it's quite a manageable problem).
posted by andrewcooke at 3:36 AM on February 7, 2016 [1 favorite]


You can also file a complaint with Medicare.
posted by dogmom at 5:37 AM on February 7, 2016 [3 favorites]


First, I'm sorry you had such a lousy and distressing experience. I agree with those above that you might do well both to find a different neurologist and share your experiences of this one in a suitable venue.

On a practical note, you still have $170 out of pocket invested in this visit, and you probably are stuck with that. But that might not necessarily mean that you can't extract more value from that visit to help inform your next steps. Two specific ideas come to mind:

First, doctors who suck at communication with patients usually can manage to muster it with other doctors. It would not hurt to discuss with your GP this visit's outcomes, your confusion over the diagnosis and follow up tests, how you feel you were not able to get a clear picture from the neuro, and how as a result you are hesitant to follow up in the ways the neuro prescribed. Your GP shares responsibility for your care, and it's possible they will be willing to help bridge the gap - either by reaching out to the neuro for a doctor-to-doctor conversation/email exchange or by requesting the chart records from the visit and reviewing the notes.

Second, you could try formulating your questions into a succinct letter to the neurologist and asking for answers to specific questions. We did this once after a highly dissatisfying specialist visit for my husband. It took weeks for a response, but finally a copy of the letter appeared in the mail one day with brief, scrawled answers in the margins. In our case, the answers confirmed that this particular doc was in no way the right one, but at least we had more specific reasons why and greater confidence in moving forward. In your case, the responses might reveal the doctor's specific concerns, or they might indicate that he just wants MRIs as a general precaution (which should be a big red flag).

Good luck to you.
posted by shelbaroo at 6:09 AM on February 7, 2016 [8 favorites]


The general tone was him not listening to me and then not explaining anything he said. Then I went to check out, and the receptionist told me he had ordered me an MRI and a lot of blood work. He didn't mention either of those to me, so I have no idea what they are about. (I canceled both.)

This guy sounds like an A1-level absolutely terrible communicator. To the comment above about neurologists in general, neurology is a very cerebral (haha), intellectual specialty and you can draw your own conclusions about how that might affect the interpersonal skills of the average neurologist.

That said, I think it's a really dangerous (though extraordinarily common) mistake to assume that a doctor who is rude, abrupt, and incommunicative also has poor clinical judgment. Just because this guy was a dick to you in the office visit does not, unfortunately, mean he also knows nothing about neurology. I see two possibilities here: a) he's such a poor clinician and inattentive guy that he has confused you with a different patient and ascribed their diagnostic codes, imaging, and labwork to you, or b) he's a very bad communicator, but he really thinks you need to be evaluated for a potential demyelinating disorder.

The best way I know of to figure out if the situation is A or B is to call the office and explain that you think the doctor might have made a mistake -- that he ordered tests and imaging studies that he didn't mention to you, and that the diagnosis code on your bill is not something you were made aware of -- so perhaps there was a mix up? Leave his bedside manner out of the discussion. The office staff should confirm with him or someone else in the clinic (e.g. a nurse or PA who has chart access) and let you know the situation. If it's A, you have a lot of leverage to ask that your visit be comped and the bill voided. If it's B, yes you had a bad experience, but just because the doctor is a jerk doesn't mean you shouldn't follow up with the blood tests and imaging studies. Once you get the results they can be taken to any neurologist or any other kind of doctor for follow up (this is the P for portability in HIPAA).
posted by telegraph at 6:43 AM on February 7, 2016 [10 favorites]


He did not have any of my files to look at beforehand, just to clarify... I went to the appointment and started to describe my symptoms and such to him, as well as tell him about all the diagnostic testing I'd already undergone. He interrupts me right away and says he doesn't believe I have a neurogenic cough and is not going to prescribe any of the usual medications for it. I was there for my cough, yet he didn't hear me cough or listen to my lungs. He did have me take off my shoes so he could examine my feet.

Don't complain to this doctor. Complain to the ENT who referred you to this doctor. You really don't need to write more than the above as those are the salient points.

Ask for a copy of the neurologist's report if there is one, and ask for a 2nd referral.
posted by DarlingBri at 8:04 AM on February 7, 2016


That said, I think it's a really dangerous (though extraordinarily common) mistake to assume that a doctor who is rude, abrupt, and incommunicative also has poor clinical judgment.

Oh, yes, that was my point! Apologies if it came out the wrong way. My message to the OP is that in searching for a new neurologist don't be surprised if they aren't very warm and fuzzy. They should, however, be able to communicate with you.
posted by Room 641-A at 8:21 AM on February 7, 2016


That sucks. A lot of specialists have very poor social and communication skills. He sounds among that group. One idea is to order your records. They are legally yours (well, legally, you have a right to copies). You may have to pay a moderate copy fee. I would also see another neurologist, with a short list of written questions, and maybe with a friend who can help advocate to make sure you get those questions answered. Finally, I would pass on the feedback to the ENT who referred you that you found this neurologist very difficult to communicate with, to the point that you questioned if he knew which patient you were.
posted by latkes at 7:44 PM on February 7, 2016


> I have a regular neuro I see for various issues, and one of the first thing he checks every appointment is my feet

Yup, I saw a neurologist recently about a concussion, and he examined at my feet. It is a Thing They Do. I believe he was testing to see if I had symptoms of a stroke, but I might be misremembering (see above re concussion).
posted by The corpse in the library at 11:52 AM on February 8, 2016


Ugh. This wont be very helpful, but as a person who has a degenerating peripheral neuropathy, I've spent a lot of time with neurologists. Let me tell you, they are a very weird bunch. I have yet to find one with any kind of bedside manner. If I presented with a brain problem, maybe they'd be interested.
posted by Gusaroo at 1:23 PM on February 29, 2016


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