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is it me?

  • 1.  is it me?

    Posted 08-30-2017 07:30
    Lovely patient  with a GI problem Sees specialist 2hrs away  Needs b 12   GI wants me to do    Ok  sure.Happy to help   I get the impersonal faxes which i  frankly resent but ok, with  "orders" .yes it ordered me to do X. I mean it  would be  nicer to say she needs X can  you do?
    But b 12 has gone to 164.00 on sale! So I send fax to GI saying not sure  what we can do I know you see her in two days, I left her a message Can we do PO( because hhe literature says most people can replete with po) and I get a call now on my  day off saying the specialists' staff told him I was unwilling to help. I say I am sad that he was told I am unwilling, I said I have spent an hr on this.   I will do anything to help and that  I left a msg for the patietn and have to ask her if she will buy it or try another route or something he says nice talking to  you and hangs up   . I think he p couldnt stand it when I said primary car e is just overwhelmed,But  how about  some collaboration or problem solving Who are these doctors that act like this?? I am not miss huggy or patient myslef  but really.and this business of staff saying Dr A is unwilling to do  I get this alot on the  phone "So you won;t.." and I say  I did not say that" Yesterday   it was neuro surg    Patient with  bad back trouble new symptoms  LAst mri 18 mo ago so not so old but had metal in back lots of artifact  Not clear to me if it is worth getting new one  will ct work or? I send all this to  a lovely neurosurgeon a thoughtful wonderful guy and his nurse calls me saying he will not see her without an MRI I say but that sis the dilemma not sure if it would help thats why I was asking him   how to go forward  She says well he made this protocol no visit  without mri    I say well I am not going to waste an mri we need to ask him  and on and on til I persuaded her that I  w as being thoughtful  yes I know the rules but the rules do not  always fit and we need to think about things    Noone  much cares.
     I get so  sad and lonely

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    Jean Antonucci
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  • 2.  RE: is it me?

    Posted 08-31-2017 09:18
    Jean,
    So sorry this is happening to you.??
    Often high dose oral B12 is effective.?? I didn't know injectable B12 had gotten so expensive but I know it was unavailable a short time ago.?? Amazing the diet centers can get it and afford it.?? Used to be you could get 3-30 Ml vials?? for about $10.??

    I did find that McKesson Medical Supply has affordable packaging.


    There is also nasal B12 which seems pretty affordable and effective, bypassing the stomach.??

    Shame on you for "not being willing to help".?? We all know you go above an beyond!
    --  Kathy Saradarian, MD Solo since 2003 Always Private, Small Group since 1990 Practice Partner since 2003 Branchville, NJ





  • 3.  RE: is it me?

    Posted 09-05-2017 18:29
    Jean,

    You can't fight city hall and some docs and their staff  will not change.

    Most of my b12 deficient patients are on PO Med's and a couple self inject.  None come in monthly.

    Don't lose sleep.   Do the right thing.   Bring patient in for visit and work out a plan (and get paid for your time).  Explain you would make more money if they come in for a zillion shots but not necessary.
    You can offer a few  shots ("to jump start treatment") if they want,  especially if very symptomatic, then encourage switch to PO Med's.

    If it truly is $164,  have patient purchase at pharmacy.  If they balk at the out of pocket cost, advise option of PO daily and recheck level in a month or two.

    Another option is at the first visit, write script for medication and syringes, and offer patient to return for second visit with medication and teach him / her to self inject.

    Most patients  will appreciate you for valuing their time and money and not requiring multiple ongoing office visits.


    Neurosurgeon insisting on MRI before visit is a whole other problem.  Wonderful and thoughtful????
    No great suggestion and I share your frustration with that one.  I too groan inside when I get those requests.  Each case is different.   The other big issue is they want you to get the prior author MRI.

    Sometimes I send letter to specialist and cc patient.   Explaining that is why you are consulting him i.e.- their "experienced opinion" if she needs another MRI, just PT, or surgery, etc. (how about adding desire to avoid pelvic radiation unless absolutely indicated :-)

    Most patients understand.

    Mike S.




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    Michael S. MD
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