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Re: [IP] Do DMers need primary care doctors?

Great idea -yes!

John Kinsley wrote:

> 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
> care
> > physician. This person conducts physicals and advises on matters not
> related
> > to DM, such as infections, colds, etc.
> >     Is he correct? Should I sign up with another physician even though I
> am
> > almost never sick? And shouldn't the diabetologist be involved in treating
> a
> > 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
> pump.
> 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
> drawbacks?
> John Kinsley
> email @ redacted
> Type 1 since 1956
> MM 507 since 6/9/98
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