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[IP] Do DMers need primary care doctors?

Sat, 17 Jun 2000
Justine Gudenas asked:
Do DMers need primary care doctors?

> ..<snip>............................
> ................He (endo) treats ONLY DM. I must sign up with a primary
> physician. This person conducts physicals and advises on matters not
> to DM, such as infections, colds, etc.
>     Is he correct? Should I sign up with another physician even though I
> almost never sick? And shouldn't the diabetologist be involved in treating
> diabetic's colds, infections? What are other pumpers doing?

Most managed care plans require patients to have a primary care provider
(PCP), aka 'gatekeeper', who is an internist or family practitioner.  A
patient with diabetes must then have a referral to see an endo.  This
referral is too often too elusive.  When I needed to enlist with an HMO, as
a type 1 diabetic,  I first made an appointment with a prospective internist
(which I paid for out of pocket) specifically to discuss my intent to
continue seeing my endo of many years.   Would he, the PCP, have any
reservations about providing the necessary referrals.  He said I would
receive my referral and I would continue to see my endo on a regular basis.
Based on this I chose him as my PCP.  Nine months later, at my third visit,
I asked about the referral and was told that I was stable and under
excellent control and had no need to see an endo.  (Don't go away - this
gets better.)  A couple of visits later I said I wanted an insulin pump.  My
PCP said NO and offered several other options, such as glucophage, etc. as
an adjunct to my Regular, Ultralente, and NPH insulins.  When Humalog became
available he reluctantly, at my request, gave me the Rx.  When I told him
how well it worked he said he would not recommend to other patients.  He
preferred to let their bGs run high because "it keeps them out of trouble."
!?!  Now I am angry.  I remind him of our initial conversation about
referrals.  He gave me one and three weeks after seeing my endo I had a

This scenario is all too common and many patients with diabetes are
receiving inadequate care and no option to see someone who will provide the
appropriate care.  I have recently discussed with my endo the idea of
diabetics, at least type 1's, choosing an endo as a PCP (many managed care
plans allow women to pick an OB as their exclusive PCP, or as a second PCP
for whom no referrals are needed).  The diabetic can, when necessary, get a
referral from the endo to see an internist for other care.  My endo agrees
with this scheme, so I have been thinking about talking with my state
senator for his input and possible help in accomplishing this through
legislation.  Or should I write my HMO for their input?

What are the thoughts of the IP group?  Is this a reasonable expectation?
Does the idea seem to have merit?  Does it have a chance?  What are the

John Kinsley
email @ redacted
Type 1 since 1956
MM 507 since 6/9/98

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