Newly
Diagnosed? Referred To A ‘Specialist’?
Some Things You NEED To Know To Help You Find The Best Provider For The
Best Care Possible!”
09/16/12
To my very, very dearest friends, and as ever, kind,
and loyal readers,
Earlier—today—I happened to chance-upon, read, and
respond to a discussion thread by a new member to MDJunction, ‘JJ351’, who
inquired how to find a specific Primary for treatment.
My response—as is now, quite typical, was long…perhaps,
even overly so. But in thinking about my response, I thought, subsequently, to
use it as today’s diary entry, for all of us have often had to find Providers,
or, ‘Specialists’ for our beginning, or, continued care.
And, how many times have we had to seek such care-givers
and such care, with scarcely a clue as to who might be out there, how will we ‘feel’
about them, and whether they are readily available, and able to administer to
us the very best of care?
For those who have insurance besides Medicare,
and/or Medicaid, frequently, one is forced to choose a Provider from a list of
Plan Providers, which are listed County, by County, often, accordingly to
specialties. And after looking over what
may be a very short list (as one—for example—does not have to want to drive
three hours, out of one’s home County, just to see a Provider whose specialty
is on the plan’s list, one is then forced to make a decision—really—based not
on quality, but on location!
But then, out of those who remain, how can one
choose the best Provider to receive the best care possible?
While it should never become a ‘guessing game’, all
too often, it is made to be, when one seeks a Provider for the very first time,
or needs specialized care.
In replying to ‘JJ351’s’ query, I hope that—in presenting
it to you, my dearest friends—my response may prove to be ever of some, small
help to you!
Dear new
friend,'JJ351',
Welcome to 'MDJ'!
I agree with both, 'redhairali',
and, 'mumeva', and also regret that--as I live in Florida--I cannot come up
with any possible referrals for a 'Rheumy' where you live.
Perhaps you might try calling a
couple of hospitals near you, to see if they offer a free, physician's referral
line, or directory.
I suggest this (rather than blindly
poking-through a telephone book), as you might be able to obtain much, valued information
about a particular Provider that I feel is vitally important, even before
setting up your first visit.
Where possible:
1)
Where is the doctor's office located? While this sounds stupid, a live person at a
directory can often tell you--based on miles, or landmarks--where the office is
in relation to where you live.
This will first give you an idea how many Providers there
are, and how far or near they are to you. Depending upon your source of
transportation and/or your toleration of possibly heavy traffic, this
information may help narrow-down your search.
2) How old is this doctor? Sometimes
your level of care may be influenced by how experienced a Provider might be or,
possibly, how knowledgeable or familiar they are with current treatment
modalities.
3) How long has this Provider been
in practice? You want stability, and reliability; someone who has been
practicing (in the same location/the same STATE) for a while; they are more
likely to have an established patient base, thus being more familiar with a
wide array of patients, stages of illness, treatment methods.
4) Does the Provider in question
have admitting privileges to particular hospital near you, OR, to any other,
local hospital, say, within County? Should you have to be admitted to hospital,
you'll want your Provider to be able to see you, evaluate you there, and possibly
work with the admitting physician (who may only be an internist, or a
hospitalist, only vaguely familiar with your diagnosis, and how it may impact
the reason for your hospital admission.
5) Very, very important: is your
potential Provider 'Board Certified' in his or her chosen field of treatment?
Ignore terms such as 'Diplomat’ of, as that tells you nothing.
Personally, I insist that my
potential Provider has 1) Passed his or her State boards to be able to practice
medicine in my State, and 2) they have to be Board Certified in their field of
treatment. For example, I once rejected out of hand, a possible Pain Management
Provider, who was only Board Certified in Urology!!!!!!!!
'JJ351', since the evaluation of,
and treatment of such conditions as Lupus (or, SLE), fibromyalgia, or any of
the autoimmune conditions such as rheumatoid arthritis, connective tissue disorder,
etc., is still so highly specialized, you'll want a Provider very much
experienced in your condition so as to be able to treat you more effectively
with specific target medications, and how these medications might interact with
other medication you may be taking, ESPECIALLY, signs and symptoms of possible
adverse reactions or allergies.
6) Whenever possible, I also want to
know, 1) where the Provider attended medical school, and, 2) where did the
Provider do his or her internship. I find THIS to be of importance as if a
potential provider went to medical school in say, the Bahamas, or Grenada, and
then, may have interned in some back-water hospital no one has ever heard of.
For my 'money', and for the
much-hoped for successful treatment of my conditions (please review my 'profile',
here at MDJunction, to see what my illnesses are), personally, I feel better if
a Provider has attended a better-known medical school, and has interned at a
hospital, whose name I can recognize.
'JJ351', after you have all that,
before you attend your first, ever visit with a Provider, I suggest you telephone
his or her office first. This will give you an idea of, 1) which insurances are
accepted, and which are not; does the Provider accept Medicare (and, Medicaid),
if appropriate, and if so, do they accept a Medicare assignment for services
rendered?
This is very important, as if they
do accept assignment, you will generally pay nothing, otherwise--on
Medicare--you will be responsible for paying 20% of any charges accrued. And,
believe me, this 20%'s worth can often add up to a LOT of cash YOU will have to
pay, at once, or--as agreed to be repaid--over time.
And once you have set up a repayment plan, you
pretty much have to stick with it. Ignoring the Provider's bills will get you
turned over to a collection agency, and--trust me--they can be brutal, AND,
doing so will wreck your credit!
In calling the office, I would also
ask what the basic office visit fee is. That way, you'll pretty much know what
the initial charges will be, and whether you may need to bring your checkbook
along, or cash.
7) Lastly, before you actually see
anyone, I urge to find out and call your State's Office Of Medical Quality
Assurance. Look in the telephone directory, or, perhaps go on-line for their
phone#, where you will want to speak with an actual, human person!
By calling, you'll be able to find out if your
potential Provider has ever been brought before the A.M.A. for accidents,
serious errors in judgment, malpractice suits ( either in the past, or
on-going), sanctions by the A.M.A. or the State version of same. This last
would make or break it for me. And should there have been any complaints,
or--for example--has the Provider in question been moving from State to State
to practice: if so, maybe a Google search will uncover the reason why.
And--frankly--'JJ351', I would not
ever see this Provider, even if they were the only one in town for my
complaint; I'd arrange--somehow--to go to the next town, or a larger
metropolitan area, where there would be more choices, regarding your illness.
Then, 'JJ351', your tasks are not
quite completed, yet.
Say, everything has checked out
O.K., and you've set up an appointment to see a Provider. Be sure to bring
along:
1) Your driver's license, or State
I.D.
2) Where applicable, your insurance
card, or your Medicare card. And, if you have one, your Medicaid card. All
should be current.
3) By all means, bring along a typed
or carefully printed copy of the COMPLETE list of any medications that you are
currently on, listing the amount you are taking, how often, and why, as well as
who prescribed it, and, for what reason. Vital to list are all allergies to
medications, food, antibiotics, everything, and to what degree you are
allergic.
List all previous hospitalizations,
surgeries, emergency room visits, when and why.
Also list--separately--all Providers
you are currently seeing, why, and for how long.
And, 'JJ351', when you've made up
this list, it is always wise to keep copies of it:
A) Several, to give to each
Provider, revising as necessary.
Always dispose of medication you
have, but are no longer using; DON'T keep them near your regular meds. And
NEVER flush unused medications down the toilet!
As I was most curious, I telephoned a local pharmacist on medication
disposal. She told me to wrap the medications separately, and then place them
in a bag with ‘undesirables’, such as kitty litter, or coffee grounds.
C) Keep a copy in an envelope in the
glove box of your car. Should an accident occur, your medication list will be
ready.
D) Keep a copy of your med. list in
your wallet at ALL TIMES! For all of the above reasons.
E) Finally, just in case, I would
give a copy to a very trusted friend; again, an event may occur where you will
not be able to speak for yourself.
With that list, 'JJ351', I would
include summaries of recent tests, lab work, and evaluations by other
Providers; you will first have to sign, ‘Release Of Information’ forms at each
Provider in question. This will help with your initial assessment with your new
Provider, and will also show them that you mean to stay on top of things!
And now, 'JJ351', you are at your
new Provider's for the first thing. The receptionist or nurse will ask you for
all your insurance information, and the list of your medications; you will also
have--on hand--copies of any prior treatment, lab results, information that
will help you and your Provider enormously in getting off on the right foot.
Expect no miracles on your very
first visit. You are there to hopefully establish a vitally important ethical,
responsible, and therapeutic dialogue with your new Primary; first impressions
DO matter. See if you can establish some sort of rapport with him or her. You
want to demonstrate that you are very 'proactive' (not, snotty or demanding)
about your own care, and you want your Provider to listen to you, and show
concern for your welfare, and for your dignity, and a hoped-for effectiveness
in treatment.
If you find you are being ignored,
or cut off, or spoken dismissingly to, or are treated not like a person, but as
a number, or as a 'disease', please Do keep the following in mind:
There are some Providers who are
charming, but who may be incompetent. Conversely, some Providers may be lacking
in people skills, but who are excellent therapists, and diagnosticians. Still, I
firmly believe that--especially for the duration of your care--some, successful
middle ground should be arrived at, wherein the Provider is friendly, kind,
concerned, AND an excellent care-giver!
Some slight signs to beware, and to
take note of:
1) An empty waiting room (does this
Provider see many clients?)
2) A jam-packed waiting room (does
this Provider double-book, or, triple-book patients?). That CAN indicate that
you're just a number, that your rights do not matter, or, that the care you get
may be insufficiently brief, rushed, inadequate, or pushed-along.
Note: I once went to a 'Specialist',
a Provider I had never seen before. I waited almost four hours in his crowded
waiting room, and then, an hour+ in the examination room.
When the doctor breezily entered the room, he
ignored me for the most part, and spent--perhaps 20 minutes--doing a routine
procedure. I was also not taken with his personality. And—frankly-- his nurse
seemed to be scared shitless of him!
While I was waiting to be 'shown the
door', I found him five feet away from me dictating his notes of my visit, into
a small, hand-held tape recorder. Mindless of my being there, he negligently
continued, speaking of a subject (possible cancer!), that he had not mentioned
to me about in the exam room.
At that point, I blew a major
gasket, and--frankly--told him off, loud, long, and to the point. Had I gotten
any more vociferous, I imagine he would have has his staff call the police.
(So, 'JJ351', you DO want to be careful in venting your feelings!)
Of course, I never, ever went back
to see him, AND, I told everyone I knew to not go!
And...it turns out that I was not
incorrect in my perception that he was a compete D***, as, when I happened to
be speaking of my visit to a dear, dear friend of mine (who is heavy), I found
out that she—too—had once gone to see him. But when he saw her in his waiting
room, he speculated (loudly) whether--upon her sitting down--she would not
break any chair in his waiting room. My friend left his office in tears, not
having even been seen by him for her complaint.
Anyway, 'JJ351', I know I have gone
on overlong, but as you are most recently diagnosed, these are things I feel
you need to know. That everyone needs to know!
And please always remember, my very
dearest friends, that, in addition to excellent care, availability, and success
of treatment, you want your care-giver to consider you as a person! Your needs. Your goals.
You want a Primary who goes a little
further, in consideration of your physical, mental, and spiritual needs as
well.
And while your care-giver need not
be a Mother Theresa, I would insist that they be human beings.
It can only make you a better, more
informed patient, able to seek, and receive the very best possible treatment
from your Provider.
And please always keep in mind that
your relationship is not a friendship, a marriage, or a lifetime commitment! If at any time your Primary ceases to be of
benefit to you, you have the ability, the justification, the right, and the
duty to look elsewhere.
With your most kind permission--I
would very much like to use this response in my diary, today.
I hope I may have proved to be of
some help!
Please do take care, "JJ351' !
And
to my very dear, and wonderful friends, and constant readers, please, please
always know that I love you dearly!
‘Zahc’/Charles
