Ever been kicked out of Doctor's practice?
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? :(
Replies to This Discussion
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Permalink Reply by Gerri on -
After going to one more endo (very few where I live), I now only go to my PCP. His young son was diagnosed T1, so he's current.
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Permalink Reply by Mayumi on -
Not that it does any good now, but I would have reported second Endo to the medical board of the area in which you live. Denying a diabetic medical care in the form of insulin is morally reprehensible. That said, I am afraid the same thing will happen to me as I'm still waiting for a response to refill my insulin Rx from said doctor's office (where the one nurse thinks that insulin comes in 1 or 4 mg strength :(
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Permalink Reply by Gerri on
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You're right. I really should have reported him.
Insulin in 1 or 4 mg. Rolling my eyes at that. Hope your Rx is renewed with no problems. No grounds for it not to be since you just had an appointment. My doctor sets mine to expire every 4 months so I'll make an appointment ($$$), but it gets renewed it anyway.
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Permalink Reply by Leo2 on -
I stand corrected! I guess Endos do have more than enough patients and so can get away with inappropriate tactics.
IMHO that means we need someone to write an article in the NYT about the badgering that can occur.
About diabetics being given 3-4 month prescriptions with early expiration dates. About some of these tactics that very wrongly still label people non-compliant. About tactics that leave a diabetic without an appointment for several months when close mentoring is needed.We could start a page on everything a journalist might include.
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Permalink Reply by Betty J on
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Take the test, I have the same problem with statins but I still take the tests when they want me to..I know it's you Kat.
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Permalink Reply by Tim on -
A couple of points...
The nurse is on a mission: get patients to show up ready for lab tests. This is not a bad thing, in fact a lot of patients will hardly lift a finger to show up for a lab test much less test their bg's at home.
The nurse doesn't want to waste the patients or doctors time by not having the patient show up as appropriate (fasting) for the test.
And the nurse's strategy is constructed around a balance of persuasion and threats.
The OP might feel bullied on the issue of statins, but lots of other ordinary people who need persuasion on issues of home bg testing, or on issues of taking a metformin pill, or on issues of taking insulin. Those here on tudiabetes are pretty gung ho about doing things right but in the larger world, the typical person-who-happens-to-be-diabetic might have a hard time doing home bg tests, or might have a hard time taking that pill, or have a hard time taking a shot. Maybe bullying is the right strategy. If you had a dear friend who was diabetic but not doing any home bg testing, would you lean on them to shape up and do it right? I think that's all the nurse was trying to do.
Would it be wrong for a front-line nurse to make strongly-worded-pursuasion (maybe interpreted as threats) against a T1, that they should take their insulin if they were showing some doubts on whether it was right or not? Well then, why not use the same strategy for T2's who won't test their bg's at home, or for T1's or T2's who sound like they don't want to show up fasting for a cholesterol test?
When I was a kid, education of a newly diagnosed juvenile diabetic consisted (and I kid you not) of showing them pictures of gangrenous and/or amputated limbs as a way of making them take their insulin. No, it wasn't pretty. It probably didn't help educate much either. But that's what the "education" was. That was the persuasion to be compliant back then. And I'm pretty sure that lots of folks on the receiving end of that education, viewed it as a threat rather than education. I sure as hell did. And I'm pretty sure that at least the older-school nurses were educated in methods like this (who knows, maybe the younger nurses are taught methods like this as well, maybe sometimes they hear a key word and slip into Nurse Ratched mode.)
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Permalink Reply by Clare on -
Wow Tim, that makes perfect sense to me. PWD are perceived to be "non-compliant" pretty much as they walk in the door. And I guess it may be up to us to dispel that myth. But you're right, there are a ton of PWD who just don't care and as a result those of us who do actually care are lumped together with them.
At the same time a nurse who admonishes a D for an A1C of 6.1% shouldn't be in an endocrinologists office. And certainly shouldn't be advising a PWD.
I was diagnosed in 1975 and thankfully the education you described must have been changed by then because my nurses taught me how to inject myself, what to eat and how to test my urine - not that I did that very often. I didn't see any gruesome pictures and I doubt that would have changed either my attitude or how I treated myself as a teenager.
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Permalink Reply by christy on -
I have to say as a health care professional we are NOT the norm. More patients than not ARE non-compliant for whatever reasons. Lack of education, lack of resources, or just DONT CARE. I was diagnosed in 1985 and my education actually consisted of learning to inject myself, test myself, etc. It was thought this is YOUR disease YOU need to learn about it, Yes we'll educate your parents but YOU need to take responsibility. But I think today, education wise, people are diagnosed and left to figure it out on their own. Maybe the education of show pictures of gangrene limbs is a bit drastic, BUT I think too the reality of what uncontrolled diabetes can do needs to be stressed as well.
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Permalink Reply by Mayumi on
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I heard the same thing as you've mentioned in your post Christy and I heard it from my Endo who has a very large practice in another state. He told me that someone like me who cares about their diabetes management results is in a minority. It is my GP that is raising h--- because she is after all the "Gatekeeper". My latest chol results are back finally and I am certain to receive at the very least a stern lecture and a script for a statin drug.
One good thing though......my A1C was down from 6.1 to 5.8 :)
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Permalink Reply by acidrock23 on -
Nice job on the A1C! I had moved to "borderline" LDL of 110 the summer before last and switched from (mostly) ham & eggs for breakfast and pretzels for snacks/ munchies @ work to spinach & broccoli w/ the eggs and carrots and broccoli for snacks. It seemed to help as my LDL has gone back down to 74.
Maybe the GP RN has worked out her script in dealing with other, less successful patients and doesn't have enough of them to understand what she's dealing with.
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Permalink Reply by Tim on
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110 is borderline? Wow, my doc is pushing me to keep my LDL below 70. With a combination of statins and diet I can sometimes make it below 70. But it's a hard goal for me.
Seems like they keep on moving the goalpost. Bernstein says our A1C's should be in the 4's, perhaps below the non-diabetic population. Doc says cholesterol for me should be lower than the goal for a non-diabetic. Wow, it is a lot of work. Used to be all we had to do was to show up in the ER with DKA symptoms and an astronomical amount of sugar in urine to get treated. Now to get treated sometimes it feels like we need numbers better than the average non-diabetic.
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Permalink Reply by Clare on
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Congrats on the lowered A1C good for you. I admit if it were my GP raising hell about how I treat my D and if it were her nurse giving me crap about an A1C of 6.1% I would find another GP. GP's are supposed to yes be the "gatekeeper" but at the same time they need to know their patients. If you have had issues for years with statins that should be noted in your chart. My new endo actually put down that I am allergic to simvastatin. Because I complained that I had really bad muscles aches and cramps when I took it. So it is now actually in my charts allergic to simvastatin, where previously it had always read NKA (no known allergies). Problem is today the average Primary Care Physician has about 2300 patients, and about an average of 15 minutes time to spend on each appointment. You can't go over even the most cursory information in 15 minutes, never mind actually listen to your patients and process the information. But with managed care and cut backs in every kind of reimbursement,doctors need to see more patients just to stay afloat. I do not condone the kind of treatment you received at the doctor's office but it is unfortunately what you can expect these days when there is very little time and so many patients to see.
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