Firing a sleep medicine doc...how do YOU do it?

The BEST doctor I ever had was a family doctor I picked out of the yellow pages when we moved to where we are now because his office was conveniently located regardless which of the two routes we used to go "into town". My entire family LOVED him. The dirty bird died on me right at the height of my Crohn's disease initial flare but he's the one who convinced me to go to Mayo. Fortunately I had a 20 year remission after the surgery at Mayo.

The next best family doctor we had we went to just because she was located only 5 minutes away. SHE died on me right at the height of my problems after the whiplash and return of Crohn's disease activity. *sigh* I didn't need her much during those 20 years but my family liked her and she was one of the few who was able to convince my husband to take better care of himself - or she got on his back but good!!!!

Medical practices changed DRASTICALLY in those intervening years but we were sheltered from all that by this famly doctor. Imagine going from $35 office calls for anything and everything to $150 initial office calls (had never heard of such a thing!) and office calls billed in time increments!!!!

SleepingUgly wrote:

mstevens wrote:Folks this is easy. I'm a physician. I just "fired" my own doctor, who is a colleague I see several times per week in meetings yet can't seem to get an appointment with. I called went to her office and signed a release to forward my records to a different doctor. No drama necessary.

You couldn't get an appointment with her via her secretary, or you couldn't get an appointment with her by asking her directly for one? (and I assume you mean that you can't get an appointment as soon as you want one, not that you can't get one ever.) I have a hard time believing that a physician who knows you personally would not get you in for an appointment. Fair or not, a physician patient that is willing to use his/her "I'm a physician" card can no doubt get better service from another physician than the average non-physician patient.

The only time I ever used the "I'm a physician card" was when my daughter was dying. Here, there's no need - everyone knows who I am.

I tried to make an appointment for an overdue physical and to address some minor issues and was offered a time a year from now. It's not appropriate for her to cancel another patient to see me. It's also inappropriate for her to see me outside of her usual office hours (and to ask her staff to work outside of their usual hours). If she's that busy, she won't miss me as a patient and I'm running the risk of getting poor care.

mstevens wrote:The only time I ever used the "I'm a physician card" was when my daughter was dying.

I hope she is well now.

I tried to make an appointment for an overdue physical and to address some minor issues and was offered a time a year from now.

A YEAR?!! Who has a wait list of a year? She either is so fantastic that people are lining up to see her, or she's so incredibly slow that she can only see very few patients a day (or she may be part-time?).

It's not appropriate for her to cancel another patient to see me. It's also inappropriate for her to see me outside of her usual office hours (and to ask her staff to work outside of their usual hours).

I've never heard of a physician that doesn't "squeeze" patients in. Patients get sick, and physicians have to squeeze more urgent cases in around the patients that are already scheduled.

If she's that busy, she won't miss me as a patient and I'm running the risk of getting poor care.

Maybe she told her office staff, "If Dr. Stevens calls for an appointment, offer him a slot a year from now so he won't come back. Last time he was here, I felt like he was analyzing me."

mstevens wrote:... I called went to her office and signed a release to forward my records to a different doctor. No drama necessary.

Wulfman wrote:... finding "good" doctors is a real crap-shoot.

That pretty much sums it up.

"Ain't" no doctor w/a one year wait for an appointments. Hail, the scheduling software can't even advance beyond six months!

And "ain't" no doctor WORTH a one year wait for an appointment.

The message was pretty clear YOU were NOT wanted as a patient - either by the scheduling staff or the doctor herself. Probably for fear you would recognize how good a doctor she isn't.

She's probably better at snowing patients than at Dx'ing and Tx'ing them.

SleepingUgly wrote: I've never heard of a physician that doesn't "squeeze" patients in. Patients get sick, and physicians have to squeeze more urgent cases in around the patients that are already scheduled

I am with you on this one.
I used to work for orthopedic surgeon. We always found time for either emergency or simply another physician or their family member with a problem. It was a given. No question about doing it. Whether we stayed late or whatever. The doctor would have had my head on a platter if we had put off a colleague or family member just because no spot on the appointment calendar. I once went in to assist with a surgery in the office on a Saturday for the doctor's family friend. The friend had no insurance or money for the surgery to be done in the hospital.

I've switched doctors with no fanfare a few times through the years, simply had the new doc send for my records. Twice I've left in a blaze of ... uh, something not very glorious.

Once was over his degrading and condescending remarks when I wanted a data capable CPAP, even though in 5 months I'd gone straight downhill and he was unable to help me. (In 2 days on here I was on track with my treatment.) Wrote a detailed letter afterward so he'd know exactly what he said that was offensive and what my solutions ended up being (that he couldn't figure out). I wasn't mean to him during the visit (not my style), but I was tearful from a combo of desperation, frustration, and anger, and remained adamant about what I wanted and neither of us would budge. I didn't write the letter to "get him told". I felt a responsibility to address a wrong.

The other time I reported a doctor to the medical director of the multi-site facility, and met with the director to tell him in person of the inexcusably cruel and irresponsible behavior of the doctor. I knew if he treated me like that, he had to be doing the same to others, and I wanted him put in check.

I think some relationships can be salvaged with a good talk and a better understanding. Others, for whatever reason, are best left in the past. Sadly, I realize that doctors like the two I mentioned, who had already shown me they didn't have my well being as a priority, won't care what I said in the letters. They'd already justified their conduct in their minds. Oh well. Just grateful to have had mostly good doctors so as to keep me from becomiing jaded.

A lot of these "kinder, gentler" replies about how you fired a doctor dont exactly jibe with my experiences. Ive had so much trouble with doctors, I think much of it has to do with managed care group health insurance Ive had for all but about three years since the late nineties when I first became ill. I honestly believe if there is not much financial incentive in it for them, many of them truly do not care.

That has been my experience and it has made me very angry in the past because it caused me to become disabled for a while. And put a huge financial and emotional strain on both my family and myself. And I believed strongly it could have been prevented had I gotten access to quality care.

Ive had some docs who were OK, never had a doctor I honestly thought was wonderful. Again, I think the patients who do the best are the ones who can afford to cut out the middleman (health insurance) and pay direct out of pocket to the doctor. Doctors like that a lot I have figured out. And it creates a much more cozy, tighter patient/physician relationship. Throw health insurance into it all and it just becomes a huge mess...at least with managed care health insurance.


Eric

SleepingUgly wrote:I hope she is well now.

She had a malignant brain tumor and died at 16 months.

SleepingUgly wrote:A YEAR?!! Who has a wait list of a year? She either is so fantastic that people are lining up to see her, or she's so incredibly slow that she can only see very few patients a day (or she may be part-time?).

Part-time and slow. The biggest issue is that she doesn't have many slots for physicals to begin with.

SleepingUgly wrote:I've never heard of a physician that doesn't "squeeze" patients in. Patients get sick, and physicians have to squeeze more urgent cases in around the patients that are already scheduled.

I'm sure if I were acutely ill she would have squeezed me in, possibly to see the nurse practitioner. Physicals are different, though. For one thing, they take an hour. Nobody has an extra hour in their schedule.

SleepingUgly wrote:Maybe she told her office staff, "If Dr. Stevens calls for an appointment, offer him a slot a year from now so he won't come back. Last time he was here, I felt like he was analyzing me."

I can still analyze her at all the stupid meetings we have to attend together.

mstevens wrote:

SleepingUgly wrote:I hope she is well now.

She had a malignant brain tumor and died at 16 months.

I am so sorry. I can't even imagine how one copes with such a tragedy.

Part-time and slow.

I never know what to make of the slow ones... Are they so thorough that it really behooves me to have someone so comprehensive, or are they so bad that they don't know what's important and what's not?!

I can still analyze her at all the stupid meetings we have to attend together.

time is out

Again, I think the patients who do the best are the ones who can afford to cut out the middleman (health insurance) and pay direct out of pocket to the doctor.

That's exactly what ruined a relationship with one of my doctors. When my husband was between jobs I saw a doctor only to find out AFTERWARDS he was not a preferred provider and since we hadn't met our $500 out of network deductible for the year the entire visit was out of pocket. The rotten thing was that this doctor contracted with a lot of insurers who would pay him about $80 for the visit. But he wanted every penny of $350 from me and refused to work with me on any compromise. And we didn't have it--COBRA payments alone were 1 1/2 times our house payment--and didn't pay for this visit. We could barely put food on the table, two small kids to feed and I was working two jobs just to barely make ends meet. If I had realized that we had the deductible (my mistake, I admit, I'd always used network providers before) I would NOT have gone to see this doctor, knowing I could not afford it. It was clear he was all about the money, had no compassion for our position, but gladly took so much less from insurers because they promised volume.

If my deductible had been met, he would have gotten only a fraction of the $350 (I offered him more than he would have gotten in compromise). I asked him if he would accept that and he refused. His office manager called every week asking when they could expect the money we did not have. It took me months to pay this off, and I would NEVER show my face in his office again, even though he was literally the only specialist left in our county for the medical issue he was treating (tons of doctors fled our county in the 80's because of the managed care stranglehold on a majority of insured patients here including the very wonderful specialist I was seeing before this creep). Some doctors will cut a break for patients paying cash--they still make more money not having to do the insurance claim paperwork.

That experience was not exactly a relationship builder!

It's illegal for a doctor to charge a cash-paying patient less than what they bill insurance--it's insurance fraud. The only way around this would be to have not billed you or your insurance in the first place and done it pro bono. But it sounds like it was billed by the time you realized this problem. So at that point the only option would be to have come up with a payment plan that you could have afforded, even if it was a mere $5 a month or whatever.

mstevens wrote:I know quite a few psychiatrists who completed Internal Medicine or Neurology training before doing Psychiatry. I even know a few former surgeons and a former anesthesiologist. All psychiatrist have to do primary care training if they do an integrated residency or an internship in Internal Medicine, Family Medicine, or Pediatrics if they don't.

I agree - many psychiatrists - not all - are well-rounded. They have to be MD's before they can be psychiatrists. I know one that has a degree in physical chemistry and is certified in nutrition.

Most of us don't really need to 'fire' our sleep doctors. Many of us never actually get to even meet the sleep doctor who scored our sleep labs. If you actually met a sleep doctor, chances are, he doesn't know as much about your machine as you do or the scoring software as his techs do.

If you feel you need closure with a professional like a doctor, the best course of action is simply not to go there again. You're fed up. Hey, I know from personal experience exactly what you're going through. Yelling at the doc isn't going to help. Find another sleep doc. If you're asked, say you're getting a 'second opinion'. Chances are after one opinion or another, you'll find a sleep doc that works for you.

Janknitz wrote:

Again, I think the patients who do the best are the ones who can afford to cut out the middleman (health insurance) and pay direct out of pocket to the doctor.

That's exactly what ruined a relationship with one of my doctors. When my husband was between jobs I saw a doctor only to find out AFTERWARDS he was not a preferred provider and since we hadn't met our $500 out of network deductible for the year the entire visit was out of pocket. The rotten thing was that this doctor contracted with a lot of insurers who would pay him about $80 for the visit. But he wanted every penny of $350 from me and refused to work with me on any compromise. And we didn't have it--COBRA payments alone were 1 1/2 times our house payment--and didn't pay for this visit. We could barely put food on the table, two small kids to feed and I was working two jobs just to barely make ends meet. If I had realized that we had the deductible (my mistake, I admit, I'd always used network providers before) I would NOT have gone to see this doctor, knowing I could not afford it. It was clear he was all about the money, had no compassion for our position, but gladly took so much less from insurers because they promised volume.

If my deductible had been met, he would have gotten only a fraction of the $350 (I offered him more than he would have gotten in compromise). I asked him if he would accept that and he refused. His office manager called every week asking when they could expect the money we did not have. It took me months to pay this off, and I would NEVER show my face in his office again, even though he was literally the only specialist left in our county for the medical issue he was treating (tons of doctors fled our county in the 80's because of the managed care stranglehold on a majority of insured patients here including the very wonderful specialist I was seeing before this creep). Some doctors will cut a break for patients paying cash--they still make more money not having to do the insurance claim paperwork.

That experience was not exactly a relationship builder!

Yeah, Ive had several doctor relationships destroyed because of health insurance meddling. Basically what it comes down to is you need certain care, the insurance wont pay for it but you dont know it. The doctor does not tell you or care to tell you. And you get mad at your doctor because you just went in, gave him your copay and all he did was take your BP and pulse, temp and spend ten at most fifteen minutes with you. And nothing of any substance comes out of it. And you go on sick.

I have wondered how many chronically ill people have actually been killed by the way managed care health insurance operates? I used to have an Internal medicine doctor as a personal friend. He used to tell me that privately, a lot of his doctor friends would discuss how insurance would rather let diabetics die than pay for good quality gear they need to keep them alive or at least a decent passable standard of living. I bet its in the hundreds of thousands have been either killed or damaged further thru shoddy insurance practices and frictional doctor/patient relationships that begin with insurance issues.

Eric