Has anyone here ever been kicked out of a Doctor's practice for non compliance by refusing a statin drug?
I got a phone call today from the nurse at my doctor's office telling me that my lab appointment for tomorrow has been changed to a fasting appointment. The GP has ordered a diabetic labs including A1C and fasting cholesterol.
I asked why the cholesterol test when I am intolerant of statin drugs because of some side effects? The nurse reminded me of the fact that my LDL level was out of control and my A1C at 6.1 wasn't very good either.
She then insuinuated that when a patient's levels are out of control that it makes the doctor and the practice look bad. I was told that 'they' (whomever they are) are putting the pressure on the doctor for all patients, especially diabetic patients, to be under control, and perhaps if I wasn't under control that I would be kicked out of the practice.
So.......now in addition to worrying about managing my diabetes, blood pressure and cholesterol - I have to worry whether I will be kicked out of the doctor's practice too? I thought this was America, where we have freedom to choose what medicine we want to take? :(
These cholesterol medications are not without some serious potential side effects. Yes I know being diabetic can put you at an increased risk, BUT I'm not taking potentially dangerous medication,,,JUST BECAUSE. Luckily I do not have cholesterol issues, Same with an Ace-inhibitor, when I have no blood pressure problems, my diabetes is WELL managed, I have really no significant risk factors. Luckily my endo supports that as long as there is no significant risk factor, taking meds just to take them isn't really necessary, and my PCP after talking to my endo respected that decision too.
Amen. Me too.
When my previous doc first prescribed me a statin (I'm not even 30 yrs old yet) I was not about to take it. My cholesterol was only slightly above where it "should" be (has anyone else noticed that where cholesterol "should" be keeps getting lower and lower and people aren't getting healthier??). Then at a follow up appointment, he noticed that my cholesterol had gotten better and asked if I was taking the statins. He was quite surprised when I said no. Long story short, I don't go to him anymore. I drive over 30 miles to another, better, more advanced endocrinologist office.
This doc wants me on them, but not for a while. Too bad. I won't take them then either. That's a fight for another day, especially since I believe and new research shows that cholesterol is good for your body--it's plaque that isn't and causes blockages.
High dose of Lipitor can also affect your liver. Sometimes u have to outweigh the pro's with the con's. However, like my situation, if your cholesterol was already fine then why double the dosage? That is where I am with my Endo n his nurse.
Without knowing your doctor, my guess is you have an uneducated nurse talking to you (as others have stated).
I would request a separate, longer appointment with your endo to specifically discuss YOUR goals and how to best work with the practice to achieve YOUR goals. I would state up front that if the practice is NOT interested in achieving the positive outcomes that YOU want, that perhaps the doctor will want to pursue a different career.
At this meeting, I would first ask if the doctor is aware that the nurse is beating you up for what are pretty outstanding A1C results.
I woud next ask if the doctor supports having you take statin medications that you are having a severe reaction to just so the doctor can place a check mark on your medical history. Further, is the doctor aware that the FDA is now concerned about using statins to reduce cholesterol, especially in diabetic patients? Could the doctor help you reduce your cholesterol count by using alternative methods?
etc, etc ...
The answers to your questions, beginning with the desire to meet with you to discuss YOUR objectives will tell you a lot about whether to continue with this doctor/practice.
Really sorry about the aggravation. Horrible to be threatened & blackmailed! And, that's what I'd tell the doctor.
I've had the statin argument with my doctor at most every visit. I refuse to take them as prevention & told him why. Too bad that he's not going to win a trip to London for writing enough statin scripts. A couple of times I took the Rx & tossed it because I wasn't in the mood for another discussion.
No doubt non-compliant is stamped in red on my records.
I read a few articles about lipid ranges being lowered specifically to sell more statins. Big Pharma push behind that.
I was but it was sort of that I'd withdrawn, as I hadn't seen the doc for a pretty long time, maybe 5-10 years, they'd sent letters, I'd reschedule, Walgreens would refill the RX, I'd mozy back in, etc. but the whole process moved very slowly, perhaps a gesture of support, until they cancelled my RX's. So I got a new doc. That was right about the time I decided to take things more seriously-ish, although it still took a while before they really started to click for me.
Re: having "non-compliant" on your file, the dx code should be on the itemized bill, 250.01/02/12/etc. ICD-9 coding. Here's the "trick for avoiding denials"which is sort of creepy-sounding, like many of these doctors seem to be, but is sort of an interesting article about the bizarro intersection of medical billing practices with clinical practicing. I think too that it may become more bizarre with nurses as they definitely seem to come across as nurse Ratchedy! I am not sure I could be "compliant" or "non-compliant" as my "plan" is "you know what you're doing so I can't really tell you anything except watch out for lows"
Folks, my guess is that we will be hearing more stories like this in the next few years as an unintended consequence of health law changes. Doctors and ACOs are going to be "scored" on their patient outcomes and a LOT of money will be riding on those scores. Better scores mean increased Medicare/Medicaid reimbursement. Combine that with a bunch of new patients in the health system without a substantial increase in doctors and you have a perfect opportunity to "game" the system. I have known my endo for twenty five years and but he is thinking about turning his practice into a "boutique." Non-compliant T2's would just be a bad memory for his staff.
I think I would feel worse than Mayumi, were I in that situation. Many, including me, expect more respect and when we don't get it from a medical professional, we are vulnerable.
another thought on this. If you have been warned about this non compliance mess I think its time to just go and get a new doctor before your insurance gets any information from them. Your new doctor does not have to know what happened with the previous doctor. When i had very bad side effects from the cholesterol medicines and the current doctor at the time decided to do nothing about it, I just went somewhere else and got a new doctor. I have one insurance company in my work but there are plenty of endos out there. Doctors are here to work for me not the other way around. My thought is no one dictates to me. I understand what they are trying to do but it does not work for everyone. So fire your doctor in my opinion and get a new one. I always tell them unless you sign a paper stating that you will pay for my emergency visits because of the statin issues then I am not taking them. I had 3 kidney stones from calcium build up from statins with bills of 3000 even with insurance paying. So statins are costing my insurance company more when I was taking them. So time to go shopping for a new endo for you in my opinion.
Blame the affordable care act! Doctors are expected to do everything to help patients get quality medicare! so If a patient comes up with a complication after the doctor sees and treats him he can get into trouble for it! If you see a doctor and he does not catch a problem and you go back again the doctor can be in trouble with the government and will NOT be Reimbursed for the second visit. They are trying to reduce repeat visits thus saving money.. The problem is that doctors DON"T have a crystal ball and they are not physic so they can not see in the future! Thats why the doctors are covering bases and pushing this type of practice!
First off lets not blame affordable care. It is going to keep a lot of us in insulin. I can deal with small repercussions. Second, there are alternatives to traditional Statins. Truly. I am neither a medical professional nor some one to offer medical advice but, my father needed statins and could not take them due to med reaction (he is not diabetic) and the doctor instead gave him Red Yeast Rice. I'd never heard of it. It actually is fairly respected in the medical community. That being said, please ask you doctor about alternatives. Tell him the statins make you sick and you want to see that that is noted in your charts for insurance purposes. If you really think he may kick you out ask to get copies of ALL your medical records from the practice to review them yourself. If he has written or noted something that is untrue about you it could affect you down the road with future doctors or insurance.
Red yeast rice works because it CONTAINS a statin. Lovastatin, to be precise. Here is an annotated paragraph from Wikipedia -- you can go to the article itself and look up the references.
"In the late 1970s, researchers in the United States and Japan were isolating lovastatin from Aspergillus and monacolins from Monascus, respectively, the latter being the same fungus used to make red yeast rice but cultured under carefully controlled conditions. Chemical analysis soon showed that lovastatin and monacolin K are identical. The article "The origin of statins" summarizes how the two isolations, documentations and patent applications were just months apart. Lovastatin became the patented, prescription drug Mevacor for Merck & Co. Red yeast rice went on to become a contentious non-prescription dietary supplement in the United States and other countries.
"Lovastatin and other prescription "statin" drugs inhibit cholesterol synthesis by blocking action of the enzyme HMG-CoA reductase. As a consequence, circulating total cholesterol and LDL-cholesterol are lowered. In a meta-analysis of 91 randomized clinical trial of ≥12 weeks duration, totaling 68,485 participants, LDL-cholesterol was lowered by 24-49% depending on the statin. Different strains of Monascus fungus will produce different amounts of monacolins. The 'Went' strain of Monascus purpureus (purpureus = dark red in Latin), when properly fermented and processed, will yield a dried red yeast rice powder that is approximately 0.4% monacolins, of which roughly half will be monacolin K (identical to lovastatin). Monacolin content of a red yeast rice product is described in a 2008 clinical trial report."
My take on the whole discussion is that if you react badly to one statin, you may be able to tolerate another, but if your cholesterol is good, you maybe shouldn't bother. But be aware that when a doc recommends a statin, he's just trying to protect you, because heart disease is the #1 killer of diabetics.