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



We can do that here in PA w/our HMO--called HealthGuard (What a Joke!!!). 
But, specialists are not supposed to be able to refer to other specialists,
so I don't know how it actually works.

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>From: Ruth Elowitz <email @ redacted>
>To: email @ redacted
>Subject: Re: [IP] Do DMers need primary care doctors?
>Date: Mon, Jun 19, 2000, 1:37 AM
>

> 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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>
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