If you don't like the care or the attitude you get from your physician, why not change to another one?

Sometimes "a pill" can be the solution. Offering it may be expedient and also effective but not always and not a sign of a comprehensive or satisfying assessment in the patient's eyes, understandably so.

Medical training and practices are highly specialized these days. Knowledge is compartmentalized. You know and I know that joint pain can be the domain of an orthopedist, or a rheumatologist, as a starting point. Pick one. Do you need a primary care doc's referral to go see one? That may be where you need to go, I think some forms of arthritis can be diagnosed with an Xray of the painful joint. .

Good luck.

I agree with Elmer and I disagree. When your ankle is bothering you and you go to an orthopedist and they give you PT, because they're looking at it with an orthopedist's eyes, it's because that's all they know what to do.

But what if you're actually hurting because you have gout?

A specialist can only look with their specialist point of view. It's tough for them to see outside of it. There are organizations that have round tables for very hard to diagnose diseases. And there are some things that have a satellite of symptoms. I wish they could do that for a "smaller" disorders.

I'm having a similar struggle in my life. I was sent to a gastroenterologist, because my esophagus was bothering me. Well it does make sense! But the diagnosis is eosinophilic esophagitis. Now we're talking an inflamed esophagus because of allergies. So what I really needed was an allergist. Currently, I'm stuck with the gastroenterologist who wants to give me heartburn medication, but what I really need is an allergy medication.

And I work in medicine! It's really hard for lay people to get across what is going on well enough to medical personnel, sometimes. And the medical people have a very narrow view, because they're stuck in their specialty.

So there's my agreeing and disagreeing.

rob, if you work in patient healthcare (which can be different from "medicine"), you should know that there are many conditions and issues that don't fit neatly into one box. You need to start somewhere.

Knowing nothing about your condition and being the first to challenge others who think that internet search hits convey "knowledge", I'll simply share that my search using the words of your condition says that it is diagnosed by gastroenterologists via an endoscopic exam and, often, a biopsy. Gastroenterologists do exams via scopes on humans entering both ends of the digestive system, that's normal. Allergists don't do the invasive procedure that my search suggests is needed for the diagnosis.

Why are you "stuck" with what you think is the wrong kind of doctor? Maybe you're where you need to be or the right answer now that you know the issue is to see a second doctor? Ask the question. Good Luck.

My search result:

Cleveland Clinic discussion on rob's suspected problem

I don't work in patient care!It was diagnosed by the gastroenterologist. But it needs to be treated by an allergist. It's an unusual condition and there aren't a lot of people who can actually treat it. I'm on the search for one who specializes in EoE. I'll get there. But I've got to keep the condition in check until I find that person. Does that make sense?

I think my point was there are many conditions that present in a myriad of ways and it's hard for either party to communicate well enough to get to the bottom of the problem. There are so many interfering factors. 😉

Heavily edited: Dr Cho has a published method for treatment is online (when she was in New York) and her treatment is one that my "other allergist" refers to. I've been prescribed medication through this other allergist, but I need a special specialist. I did this treatment, and it cleared everything up, as verified by my gastroenterologist. I had an EoE specialist, but with the current conditions of funding in the US, he went back to practice in the Midwest, rather than staying in research.

You said " I'm having a similar struggle in my life "

but then you said:

" I did this treatment, and it cleared everything up, "

I'm missing the struggle. It seems like the diagnosis and the treatment of your condition that seems to fall on the border between two specialisms got resolved.

The Stanford website says about it " While EoE is still a rare disease..... ". I understand that it can be frustrating and maddening to have to deal with something like that but on the other hand, not everyone in a relevant specialty is going to "specialize" in what ultimately turns out to be the rare condition you need to deal with. Fair is fair, finding people with the narrow focus you needed (apparently past tense) has nothing to do with the things that are both good and bad in the US healthcare world.

Rob, it soundslike a very uncomfortable condition. I hope you get good care and comfort soon.

I’ve never heard ot that condition. Are you Llergic to a group of things? How is it treated?

Best wishes for you, rob333.

The struggle is finding somebody who is a specialist in the area, and prescribing the right medication. You are devolving the thread, Elmer. It's well in hand, even if it's not solved. (I'm trying to tell health for the person who was the specialist for it at my locale, who has moved to pediatrics in the Midwest).

Thank you petal! It is a condition where the esophagus is inflamed due to some allergen. A good portion of the time it's ingested from food. My particular case is just from allergens in the air. It's treated by swallowing the particular medication rather than inhaling it.

Biomedical research efforts and funding these days are a complicated picture and has been for a long time. Events of the past few months are on everyone's mind but it's not like the state of play in years and decades past has been always rosy.

One term used to describe MDs who also do research is "physician-scientists". It's also called "translational research", bridging what's long been a gap between bioscience research and the clinical treatment of patients. Many so involved have both MD and PhD degrees and split their time between seeing patients and doing research work. Some of the NIH and other grant providing organizations explicitly provide a portion of their funding to train and sponsor such people.

Translational research at educational/medical institutions has always been a revolving door of people in and people out. The reasons are many- hitting research dead-ends, fatigue from dealing with the politics of faculty positions and getting tenure, limited success with attracting funding for the work the person wants to do, family or personal needs to have income more at the level of fellow docs who work only with patients instead of at the lower pay of faculty jobs, and more.

I believe more biomedical research is conducted in the US (mostly because of available NIH funding levels) than anywhere else in the world. Researchers from abroad take jobs here for that reason. Is all of the money well spent? Of course not. But nor is it spent willy/nilly.

It's a complex situation with newly arisen complexities. All of that to say - rob, it's not uncommon now or in the past for researchers with secondary credentials (ie, MDs) to leave research in favor of jobs working exclusively treating patients, or to leave one institution and go to work at another one across the country where they find a greater appreciation ($$$) for their presence on the faculty than their current job provides. Sorry it happened to a doc you'd found.

" You are devolving the thread, Elmer. "

I thought some of your comments were inconsistent/misleading and I explained why it seemed so. You often say this, "shifting a thread" is when someone disagrees with you or has something to add.

good luck pere and rob. I also have a medical issue that has not been resolved after over 20 years. I feel your pain. It's frustrating and can take a stupid long time. But the medical problem that is currently an issue with me is the lack of internal medicine MDs. The ones that were practicing in my community have retired, and no one is taking their place. They either steer towards specialties that offer much more $$. (I get it, they have $$$$ of medical school bills to pay, and internal med MD's treat senior citizens, who are on medicare with pathetic reimbursements, on and on.) also, they aren't coming out to my town, as they prefer the more metropolitan area 40-50 miles away. Even the local hospital has a huge amount of empty beds due to no other reason but they lack the medical and nursing staff. I know I can make the drive and all, if need be, and I realize I have been spoiled. What we now have nearby are mainly family practitioners, and although they are fine for general type stuff and pediatrics, I miss the more comprehensive care as given by the MD's I had and trusted years ago.

" you have absolutely no idea what's going on in the world of research!!! "

I know at least 5 individuals personally, including a relative, who are working on NIH funded projects. If I thought more than a second about it, there are more.

You know, rob, the kind of NIH funding with Application and Grant numbers that are in the public domain and can be searched for? The kind where historically follow-on support could be expected with reasonable results and which now are up in the air.

I also know the first salvo happened right after the inauguration when it was announced arbitrarily that there would be a reduction and a cap on the inclusion of indirect or so-called overhead costs. This portion of historical funding has been essential to allow the resident institutions to properly support the work being done. And may very well be what pays your salary, eh?

rob, take it easy. Your frequent method of demeaning comments you dislike is to attack them. Claiming only you have knowledge on the subject. Sorry, it's usually not been the case and isn't this time.

And a reminder - leave out the personal insults, who they reflect on is you, not me.

And PS - these individuals I know can always revert to patient work, haven't yet decided what they'll do. They're located from sea to shining sea, Far West to North East, so no point in trying to guess where.

To save you some time, rob, knowing that you seem to like to muck around on the internet looking for things....

This particular relative is my wife's married niece with whom we're quite close. She chose to use her husband's last name as her own too starting back when they got married in medical school. And has used only that ever since. So there's no back tracing to me possible in the most unlikely event you found the needle in a very, very large haystack.

There, there, little ladies, don't worry your pretty little heads over this stuff that you cannot possibly understand....he knows someone who knows someone which makes him an expert in every possible situation.

" But the medical problem that is currently an issue with me is the lack of internal medicine MDs. The ones that were practicing in my community have retired, and no one is taking their place. They either steer towards specialties that offer much more $$."

This is precisely what I was talking about, and trying to figure out which specialty is impossible to get right for us lay folks. I guess the good news is, it looks as though more MDs might be coming back to medical practices since research is being attacked. That could help? I'm going to hope so!

" also, they aren't coming out to my town, as they prefer the more metropolitan area 40-50 miles away. "

Isn't that also true of shopping options, HVAC contractors, plumbers, dentists and health clubs and so many other things unavailable or available only in limited choices in small towns and more rural areas? Of course it is.

Judging from the aspiring physicians, the med school students, I've known, there's an added choice factor in assessing what residencies they want to apply for that wasn't common among docs of my generation. That is, the factor of life style. Life style to them isn't just earnings potential. It's whether they want a career during which they could be on call evenings or weekends. Whether they have regular hours or irregular hours (especially true for docs wanting to have children and needing some regularity to deal with child care.). Whether the opportunities of a particular specialty will allow them to live where they want to live. And more.

There's a particular issue with internal medicine along with it being one of the less lucrative specialties. The economics of group practices and insurance reimbursement practices have turned primary care patient interactions into days of 25 or more patient appointments. Some don't want that. Indeed, many docs boarded in internal medicine don't see patients in traditional primary care practices but instead work as hospitalists. The pay is usually much better, the hours are regular, and (I'm told) the professional satisfaction of working in this way can be more personally interesting and fulfilling.

When one decides to live "out of town", somewhere where desired goods and services are less available and less convenient to get than when living in a more populated area, the outcome is an option - either to accept it and make do with the limited choices or drive.

I live in the Puget Sound area and we get what is called the PS bump. We can get seriously fantastic doctors who move here for the Pacific North West environment even though my county is rural. Still you have to access those amazing doctors and the only way is a referral from someone with pull. When I was diagnosed with cancer the first time I was referred to an Oncologist so amazing that when I told my latest Oncologist who my first one was years ago he almost fell out of his chair. The fabulous Gynecologist who referred me was here because he liked to drop off his dock in his kayak and paddle around Puget Sound at dawn most days. This is great when you can access it but it doesn't help that you cant if your primary is also ran. I know this area has a fabulous Endocrinologist who I could really use but she doesn't take new patients. You cant just chop and change. That is reality. Having Medicare puts a further rock in the gear.

patriciae

" the only way is a referral from someone with pull. "

The opposite is true where I live. When a referral is needed, it's because of the requirements of the terms of a specific insurance plan.

I can pick up the phone and call any doc of any specialty I want to have an appointment with. Including, within the faculty practice of the nearby medical school. No referrals required and no "pulls" involved.

My partner and I chose a DO rather than an MD for our family care. She is exceptional and truly tries to figure out the root cause of an issue, and allow time for lifestyle changes to remedy certain issues. She doesn't like to "throw a pill" at every little thing, which we both appreciate.

Example: my partner has elevated cholesterol. She gave him six months to make lifestyle changes to bring it down, rather than immediately putting him on statins. He also has hypertension, and lifestyle changes did not help that - it's apparently a familial trait, so he does take a daily pill to keep his BP in the healthy range.

Elmer, you amaze me. How do you access the best of care in an area chock a block with other people who want what you want.

You do continue to say this sort of thing but I am here on earth to tell you that most of us cant live where you live nor access what you say you can access. There is not enough room.

patriciae

" How do you access the best of care in an area chock a block with other people who want what you want. "

What do you expect me to say? My comments are always truthful. When I say what my own experiences are and you tell me "No, that's not how it is", I'm a dumbfounded how to respond.

As with your saying that you need to have a referral and apparently have to beg to get an appointment to see a particular provider and I respond "I don't". I said that because, I don't.

Where I live, it's state law that I can see any doctor/specialist without a referral. I just pick up the phone and call, or book online through the doctor's/hospital's website.

I live in a city with three teaching hospitals and two world-renowned cancer treatment centers. I had zero problems choosing my own oncologist.

Well you live in a city with three teaching hospitals and two renown cancer treatments centers. It might surprise you that is not the norm Chartreuse.

Elmer, we don't beg for a referral. We do need a referral to some doctors though as this is a rural area and really good doctors are not lying about with free time. As I said and you always ignore, if we all lived where you live you might have to live under a rock or in a tree. Around 300 million people do not live anywhere near where you do. It is fairly simple math and a very big country.

Now it can work otherwise. When I broke my leg a couple of years ago I got sent to Seattle to the super specialists at Harborview and I was top on their treatment list because my break was so challenging and interesting. They are a major teaching hospital. My little local hospital simply sent me down but my case was sufficiently fun and informative that I got top care. A more pedestrian though serious case would not have gotten that reaction. Frankly I would prefer to not be so interesting.

patriciae

" the only way is a referral from someone with pull. "

If I misunderstood this comment of yours, please help me understand.

The term "teaching hospital" is overused and sometimes misunderstood. The majority of hospitals offering primary care residencies are not affiliated with medical schools and many do not have the same caliber of instruction or breadth of exposure to specialty docs that medical school residents have. Why do community hospitals offer residency training slots and become "teaching hospitals"? Simple - the costs of employing residents are funded by Medicare and Medicaid. So what, you might ask? Offering residency training provides essentially free labor to the hospital. Some of the community hospitals do get attending physician support from nearby medical schools but not all do.

Obtaining residency slots is very competitive, in several desirable specialties in particular. Community hospital slots are in less demand and many go unfilled or take in graduates of foreign medical schools (like those in the Caribbean) who some programs view as less desirable candidates.

Chartreuse - Which state do you live in? I'm not aware of any state with a law that specifies you can see any specialist without a referral. I would be interested in knowing - I tried to find it online but didn't have any success.

Thanks

Elmer - DH's former partner moved to CA and has another hematology/oncology practice. They require referrals from another physician - not necessarily a matter of insurance although some insurance policies do require a referral first - but because they prefer to know that a prospective patient has been screened by a primary or another specialist first to ascertain that the patient is seeing the right specialist. It also helps to coordinate care between the PCP and the specialist and to utilize medical resources in an optimal manner. Simply put - it's more efficient and effective.

When I was diagnosed with breast cancer a few years ago I found out that I have a genetic mutation that increases my risk of breast and ovarian cancer. It was recommended that I consult with a gynecological oncologist to have my ovaries removed.

However, there was no gyn onc at the facility where I was treated for breast cancer and she was not able to refer me to someone outside that system. In calling oncologists for an appointment I found that a doctor's referral was required by the oncologist although my health insurance did not require it. Two years ago I moved to a new PCP in a different system. I asked if she could refer me to a gyn onc in her system. She ignored my request twice.

I finally found a gyn onc at a teaching hospital that would accept my self referral after begging his receptionist to check with the doctor or nurse to see if they would take me as a patient. The doctor agreed to see me and a prophylactic surgery was scheduled. Unfortunately it was too late as pathology indicated I had ovarian cancer. The care has been excellent.

While it is not a doctor's fault that I have cancer, had I been able to get care sooner I likely could have had my ovaries removed prior to cancer developing.

heritagehd - I am so sorry. Reading your story makes me furious for you.

I've seen similar situations happen to others. Most often what I've seen is the problems occur when different providers are in different networks and things fall between the cracks. Your story feels even worse to me though, because your own provider/s apparently failed you, very badly.

So glad to read you're now getting excellent care!

" It also helps to coordinate care between the PCP and the specialist and to utilize medical resources in an optimal manner "

maire-cate, maybe it's different with hem-onc but my observation with various specialists I've seen over the years is that there is little or no "coordination" that takes place. Sometimes a courtesy "we have seen your patient X and provided care for ABC condition". Sometimes with details, sometimes not. I know because an update on my health is always discussed in my annual sessions with my primary care doc. I typically ask if she received information from the others. It's sometimes yes, sometimes no, but usually a discussion with me and a notation in the chart is all that's done. Sometimes my consultations are with docs inside the medical school faculty practice (in which case all details are easily seen in my electronic "chart"), sometimes not.

My primary doc likes to be updated, whether from me or from a formal notice. I know she doesn't pay attention to notifications when they arrive because she's told me she reviews such things only just before seeing me.

I had a medical issue a few years ago that sent me to urgent care and then my primary care doc. The diagnosis was easy because of the symptoms, the causes I learned are of many possible types. My doc set me on a course of treatment that she said "should" be effective. When it wasn't, she told me that I needed to see a particular sub-specialist of a particular specialty. In essence, a double-boarded doc whose training involved two different specialties so as to focus on one medical condition.

The medical school I usually use had one such specialist, who was about to go on maternity leave and had no appointments available sooner than 9 months away. I called a second school, they had two docs, soonest appointment was in 6 months. I booked one.

Some weeks later, I was in Southern California where there are several medical schools near where I stay. I called one, they had one such focused specialist, soonest appointment was in 4 months. I booked it. I also said I would be in the area for several weeks and would be happy to fill a cancelled appointment slot if one came up. Son of a gun, I got a call a few days later for a same day appointment. I was examined, tested, and successfully treated by that doc over a period of 6 months.

I don't know if all docs with such double credentials and very focused practices are at medical schools but that was how my doc directed me and that was all I found in my search. Medical schools, with but a few exceptions, are in populated urban areas (for obvious reasons). I doubt someone living in a smaller town or rural area would have much chance of having easy access to a doc with appropriate capabilities.

Another example for you, patricia, of getting access to a rare type of specialist in a very populated area in just a few days (with some luck, but in just a few months otherwise). But for the large population, such specialists wouldn't even be there. And, no referral was needed. They didn't even ask for my insurance info (which is of type not requiring a referral) until I was standing at the reception desk checking in for my appointment.

Heritagehd. Wow that is a grim story with a happy ending. I also had Ovarian cancer though not known to be genetic. I was young and had been misdiagnosed probably because of that. My chances of survival were practically nonexistant but I did as I said luck out and get a super specialist. The Gynecologist I was sent to was a close friend of the gastroenterologist I consulted finally so that is how I got him. Luck. I am so glad to hear things are going well with you. The treatments for that terrible disease have improved massively since I had it.

That our system is so fractured and profit based is just outrageous. When you cant get a doctor because they dont take any more Medicare or worse Medicaid patients which to Americans is mingy pay while to the rest of the world it is likely still more than a doctor elsewhere would get paid for the same procedures we are really in a poor place. In system out of system. It is a nightmare. We all have stories.

patriciae

I agree there are problems and issues with our system but I have yet to see or hear a comprehensive proposal that would fix it.

Do you have any suggestions that are practical and do-able?

study other countries who are doing a better job and do what they are doing

patriciae

Of the ones I know, most have limitations and shortcomings.

Pick one, call it Hypothetical country A. How can the system be changed from what it is now to what A does? How to put it in place (what means can be used), what is the transition, how to balance the effect on gainers and losers?

I think that's a possibly insurmountable obstacle. That was my question, what is practical and do-able? Not what to change to, how to make the change.

Throw in the towel, Elmer says we cant fix anything because they have limitations and shortcomings. Oh dear. Our system on the other hand is perfection? Expensive, limited, bizarre perfection for those who have really good health insurance except the areas where they wont cover because you are not in network.

patriciae

If you don't have ideas to offer, all that's left is to attack me?

My questions and comments to you have been polite and respectful. Why must you always be so rude?

I had an idea to offer and you didnt like it.

Patriciae

That's more civil.

I thought I had expressed clearly in my earlier comment what I saw as the problem. To quote myself:

" Do you have any suggestions that are practical and do-able?

Meaning, how do we get from here to there?

This is going to shock your socks off Elmer but I am not a government official in charge of anything to do with changing medical care in America nor am I Almighty God. I really believe we have to start with we are not doing this right and build from there and I do think and have been saying for years lets look at places who are being more successful in getting the job done. If I cant get you to do anything, and I do tell this to my representation which is all I can legally do, then what? I am not on board with shooting CEO's of health insurance organizations. That rattles cages but violence is not a good thing.

patriciae

I've skipped down, read the beginning few posts so maybe this is off topic from where this went. I would say in my years for my medical care and my three offspring, go with your gut and FIGHT for your care. Doctors don't know it all. Second opinions are a good thing and when the diagnosis and fix is offered your gut knows it. The best doctor I had was one who knew her limitations and referred me to others. Once for my thyroid and once for my daughters milk allergy. In the end it's on you if you get the care you need. Squeaky wheels people squeaky wheels!!!

" I am not a government official in charge of anything to do with changing medical care "

Nor is anyone else. This isn't how a system that operates under enacted laws gets changed.

I hope you're not following the example of the senator from Vermont. 50 years of complaining and getting little done. He's failed to find common ground with others over his career, including members of the party his views are closest to but too extreme to fit in. As a result, he has a dismal record of originating bills concerning anything significant that get enacted into law.

What's needed in my opinion is not rhetoric and grousing but rather hard work to find bipartisan incremental steps that can be enacted to start to fix the problems. If your reps aren't doing what you want, don't reelect them.

Like Arcy, I have skipped down without reading most of this thread, but I do have something to add to the topic.

My latest problem has to do with information on "MyChart", and the current issue is that it is listing my legal gender as FEMALE instead of male. I do not know how this could have happened, unless it was recorded by someone who has only talked with me on the phone and had never seen me in person. I was able to put the gender that I identify with as "male" but I can only have a medical professional change my legal gender. I sent a message to my doctor on MyChart to have this corrected. I have a follow-up with him next Wednesday (April 30) to discuss the results of my blood tests from April 17.

I'm not thrilled with my current PCP, but it is difficult to find any who are taking new patients and also accepting my insurance, which is UHC Optum. It is admittedly the least expensive option for insurance for me, but this is what my insurance broker recommended, as well as my previous doctor in Los Angeles.

I was extremely happy and satisfied with the care that I got through UCLA while I was still in Los Angeles, but I have not found similar quality in the Palm Springs area - maybe if I had different insurance it would be better. Despite the population differences, there seemed to be a much better doctor to patient ratio in Los Angeles than in Coachella Valley.

I've had people confuse me for female on the phone before (perhaps through a bad connection), but not in person, at least not since I was 11 or 12.

I don't have anywhere near the brain power to discuss this intelligently, but I gather that patients in the Kaiser system seem to be pleased. (I dont have it.) And I have read some news about UHC buying up some medical clinics. So could one envision a future where the insurance companies (the purseholders) take control of the whole situation and buy up the hospitals and medical facilities? I don't know. It sounds horrid, but at least it's a thought outside the box for better minds to ponder.

Um, Kaiser? no.

And Elmer I am not a Senator so how can I act like a Senator. Lots of people actually are Senators. Like more or less a hundred of them and then there is the house to which I also do not belong. You are reaching.

patriciae

First, I am not being snarky. You seem to perceive snark where I am just stating an honest opinion. You are wrong there. Take my word for it.

Second, We live in a representative Republic and my role as a citizen is to state my opinion, try to vote for people who support my opinion and to keep reminding those who I voted for what my opinion is. I offered you my often stated opinion on Health care provision. I sincerely believe that the best thing our government can do is look to other countries who seem to be successful in providing appropriate health care to their citizens and take from that what they are doing right. I cant even make you do what I want so I dont see how you think I am going to make Congress where over half dont want most Americans to have health care listen to me.

patriciae