Greetings,
My pdoc/neuro was concerned that I see PAs at my other doctors' offices.
He said he works on a committee involved with malpractice and sees a lot of badly handled cases due to PAs.

I recently saw a PA for my first appoinment/new patient at the nephrologist's. According to the pdoc, that is against standard protocol. The mdoc should have seen me for my first appointment.

I told the pdoc that for GP and GYN wellness exams I also see a PA. And that the first PA referred me to the nephrologist based on blood work results from a yearly check up. And a physician should have spoken to me before I got sent out of the office.
He said that using PAs was bad medical practice. MDs hire them in order to make more profit -- at no benefit to the patients.

I trust the pdoc with my life so I am going to switch mdoc's offices for my GP and find someone else for GYN stuff.
This conversation disturbed me -- probably because I dislike having to make changes.
I've been annoyed since the appointment.

Mari

I agree, and every so many visit I see the real doc, If I am not having a flare and need treatment PA can take a follow up although I am not thrilled with them. Every other visit at neuro, every third at Physiatrist, I always will see the doc at gyn unless in delivery and decide not to reschedule.

I agree it is a way to double and triple amount of patients, not fair for us to be charged a doc visit either the price should reflect a charge of short viist not doctor, a PA.

Di
PS change is tough; perhaps you can be firm about the needs to see the doc, not PA. Also have them get you back in for doctor to review the test. Who wants double test a they want a different facility used or something else. I agree a first visit would never warrant a PA.., always a doc…complain!
Di

Hi,

In the fall 06, I got blood work back at the GP's office with one flag for kidneys and another marker in high normal range. The PA at the GP's office said I had to see a kidney specialist.

I didn't get into see the kidney guy until last week. And I didn't get to see him. I saw the PA and she annoyed me. She wants to rerun the blood work because it is borderline, send me for a sonogram in case the kidneys are in the wrong place or something. If the sono is fine and the blood work is the same (borderline), she wants to put me on a heart med called Altace.

The logic is that kidney problems cause hypertension.
I pointed to my chart and told her I already take a heart med off label for a mood stabilzer. She said that I could take her med too, not a problem to be on two heart meds.

EXCUSE ME. IT IS A PROBLEM.
I hate the side effects of the Verapamil that I am on. I am always tired and draggy and slightly depressed. It has a low side effect profile compared to the other official mood stabilzers, but geeze already, the side effects from Verapamil are bad enough. And what person would put me on another heart med when my blood pressue is fine -- around 117/78 ?????

The side effects of the Altace would effect my mood too. This is my issue.

Heart meds have side effects. Don't BS me. The side effects of the Verapamil are strong enough to wipe out the mixed moods and horrible anxiety I used to get.

I'm not going to agree to take a new heart med.
And, well, she was very annoying.

I'm going to call her office and ask to see the physician at my next appointment.

And I have been seeing my dr of chinese med so that the blood work will be within range next time.


My pdoc/neuro checked my blood pressure in his office today and said I am not hypertensive (the Verapamil works, no kidding). He also told me that the klonopin I take gets processed in the liver, not the kidney.

He was pretty sure that I don't have kidney problems. When he said it, I felt like he was being cute and supportive. But afterwards, I was annoyed. He is diagnosising me without looking at my kidney bloodwork -- at least the PA had a chart in front of her. Still, I can hope that he has some kind of intuition or somthing and that I am fine. That is what I pray for.

Mari

Dear Di,
We posted at the same time.
Thanks for being supportive.


Yes, this what the pdoc said is supposed to happen.


At the GP's I knew to ask for a physician when I had something a little complicated like weirdo neuro symptoms one time (he told me to go to the pdoc/neuro), and another time for chest pain. I knew that that was beyond the routine yearly that the PA does. That much I knew.

Of course the MD wasn't much help with the chest pain. He gave me an EKG, said it was fine, and then said to go to the hosptial. The hospital admitted me for 24 hours.
I should have switched dr's offices then (2004) but didn't get around to it.

When I read what I write, I realize I sound like an idiot. I know enough to keep up with my appointments but not enough to care about who is seeing me???

I'm going to try to calm my self down my imagining that there are very good drs in this world and that many of them practice good medicine.

Mari

you are right..there are good doctors out there and they are practicing. one of the secrets I found is find just one very good doctor and he/she/it can refer you to others.
I am sorry you are going through another difficult time.
Bobby

I am sorry you are going through this too.

When I go to my PCP, I see the FNP or PA whatever she is.

But, my Dr. is in the same office. They have meetings and he knows everything that is going on with me, if something was to happen, he would be the one to see me in the hospital.

If she is not in, then he takes my calls on meds, or whatever. It's fine with me, because she is great.

Where I live, a lot of Dr's do NOT go to hospitals anymore, they let the attending Dr's at the hospitals do it all and send reports, which I think sucks. I was lucky to find one that does go to hospitals.

My mom's Dr doesn't go to the hospitals, that is why him and I butt heads on so many issues, because he is clueless most of the time, I have to TELL him what she needs or has or whatever. Makes me angry.

Hugs, Nikko

I usually see a PA at my dermo office only. But the doc will see me for few minutes after to check what she did. Other places PA's were, like ortho, the doc came in for a few minutes or so.

Edit:
I can see why adding a med warrants a doc's opinion, always. at least I think.

Nikko-I have the same problem, my shrink is not the attending at the hospital I have been to twice now. Its another guy, then I get out, have to explain everything to my shrink. And my shrink and him have a convo about two minutes long. This last time the attending shrink just asked my husband what I was on.

hi Mari,
It is very hard finding a good doctor.
My pdoc cares more about my overall well being than my general practioner doc.
Even so...
The truth of the matter is that no one is perfect.

My current pdoc is terrific but she is not perfect either.

3 years ago she allowed me to take trileptal as my mood stabilizer...
she never ordered yearly labs to check levels....which it clearly states
(in the refernce guide) the need to be monitored...I was having all kinds of side effects, low sodium, anemia, low white blood count...I could not donate blood for three years and never figured that out.....all quickly identified with a simple blood test....
I should have caught that...it was my fault.
She switched me to lamictal which I am very thankful for...
but this last time for me when I became manic she ordered my geodon to be taken at night, once a day.....when the medication guide clearly states the medication is to be taken twice a day...I doubled up on it and got in trouble for it...Was I supposed to tell her that the literature says to take it twice a day????
again is this my fault?

I say all of this not to trample on your thread just to say that it really does take work to stay on top of our meds, we do have to use our brains ......
she is not perfect and neither am I.

But I do know that:
We know ourselves best.

I wish you well Mari.
(((HUGS)))
bizi

Hi, Friends,
Thanks.
I wonder how we are supposed to keep up with all the dr appointments.
I finally got my dental insurance straightened out AND I got the new insurance card in the mail today.

I have an appointment Thursday for the new dentist who can fit me for the NTI device that sits in the front teeth and is supposed to stop the grinding. I can hope.

My pdoc said that the klonopin can be causing the grinding -- isn't that nice???

http://www.headachedocs.com

'Didn't really mean to be complaining but I am.

Mari

That's interesting Mari, about the Klonapin causeing the grinding, I grind in my sleep all the time and wake up with a clenched jaw sometimes and a headache.

Yet, this has been happening way before I ever started on Klonapin.

I would think the Klonapin would relax us more so we wouldn't grind.

I do wake up several times a night again, I don't think it is from grinding, just say old STRESS.

I tried one of those night guards, well 2 different ones, even one the Dentist made me, and other I bought at the drug store. I would wake up and find it under my pillow, in the bed someplace, on the floor, I guess, I know I must of taken it out while in my sleep.

Hugs. Nikko