Free medical advice?

[Phelonious Ponk]

Not really. I know there are quite a few physicians on the board and I'm looking for advice on how to find the right clinic. Let me start with the basics -- I have colitis (moderate) and arthritis (getting worse), and I'm completely unsatisfied with the care I'm getting from my doctors. My primary care physician is uninvolved in managing overall care, which I kinda think is the job. His office just does bloodwork periodically and refills my statins. My gastric doc is completely unengaged - he runs a machine that probably does a few dozen colonoscopys a day, but once you're tested and diagnosed, he's basically got nothing except to insist on an annual visit (I don't need another test for a few years) in which he says "how ya doin,'" I say "the same" he bills my insurance company a hundred bucks (and me $45) and refills my Balsalazide. The rheumatoid doc is fine, but I really don't need him. He recommended I take 4 - 6 Tylenol a day, and that helps. If the arthritis gets a lot worse, I'll call him and we'll talk. In the meantime, I'm grateful that I don't have to see him once a year just to be able to buy Tylenol.

I have two inflamatory, probably auto-immune related conditions, and none of these guys has even so much as asked a question about lifestyle or diet. And none of them seems to be interested in getting engaged in helping me manage the conditions, which are very slowly getting worse. I feel like I'm just sitting around waiting for them to get bad enough to need some serious intervention while my 3 docs are going..."oh, hi...nice to see you again. That'll be $100, here's a pass to get more pills."

I've thought about going the homeopathic or naturopathic route, but insurance won't cover anything. What I really want is someone who will get actively engaged in helping me manage this crap before it gets worse. Tell me I need to change my diet, tell me to stop drinking coffee (pleeeeeease don't tell me to give up bourbon ), put me in a leotard and send me to a frickin' yoga class...at least pretend to be trying! I feel like they're just giving me pills and passing me along to the next guy.

So how do I find something better? What do I look for?

Tim

 

[jazdoc]

I'll give it a go...

Firstly, and possibly most important advice you will receive, bourbon has medicinal qualities

More seriously...
Sadly, your story is not atypical. You've already determined you are unhappy and alluded to some of things that you are looking for. One of the things I always tell friends and patients; prepare a work-list before you go see the doctor. Everyone (physicians included) go blank when they are in the doctor's office. If you want to continue with your primary care physician, I would ask him if you could schedule two appointment slots to discuss your concerns regarding your physician-patient relationship and the direction of your care. Perhaps naively, I believe most physicians welcome patients' feedback and want to improve their interactive skills. You may have to pay for it, but if you are comfortable with your relationship, then it may be worthwhile.

If you have decided to move your care, my best advice is to seek input of your circle of family, friends and acquaintances. Our neighborhood keeps a list of physicians with whom residents have had good (and not so good) interactions. I'd be wary of online sources... One thing to consider is the so called concierge practice. For a fixed annual fee, you get fairly unlimited access to a small group of like minded physicians who limit the size of the practice to better serve their patients.

More than ever, patients need to be proactive. You've done the most important thing by recognizing you are not getting the results you want and are willing to consider changes. Good luck

 

[Steve Williams]

Tim

There are some autoimmune illnesses which involve the GI tract (colitis) and arthritis (not the osteoarthritis we all get as we age. As Mark says you can't beat word of mouth as the best source of referral however remember the "Three A's" which I always taught my med students as to how to be a good doctor is
Ability
Availability
Affability

The best is in the order I gave

Sadly all too often there are some of the busiest doctors who only possess "affability" and lack the other 2 so caveat emptor

The other pearl is to find out who the doctors themselves see as patients. They know

 

[Keith_W]

Re: your colitis. If you don't have active diarrhoea and pain it is probably quiescent. All you need is annual screening. However, if you are not satisfied with your colitis, talk to your gastro.

Re: your arthritis. If we are talking lifestyle modification, the most important is to lose weight and exercise. If you can not exercise because of the arthritis, find a type of exercise you can do - water aerobics, swimming, cycling, tai chi, and yoga are pretty low impact and gentle. I am not aware of any specific diet recommended for arthritis - just make sure your diet is balanced in the first place. Supplements like Chondroitin and Glucosamine are routinely recommended, but I am not aware of any evidence that supports their use (I am not a rheumatologist, however). One for the list of things to ask your rheumatologist.

You should also be aware that you are likely to have two types of arthritis - osteoarthritis and seronegative arthritis. The osteoarthritis is simply wear and tear of your joints. The seronegative arthritis might be an extra-intestinal manifestation of your colitis - in which case the question is whether there is active joint inflammation or not. If your rheumatologist thinks that there is, it might be time to upgrade you to a so-called DMARD (Disease Modifying Anti-Rheumatic Drug).

Ultimately, I think jazdoc has given you the right advice. Make sure you have an agenda when you go to see your doctor. As a start, here is a list for you:

1. "I think my arthritis is getting worse.", then insert some objective reasons why you think so - "I require more medication for pain relief, the medication does not last as long, and I am able to do less". Then say - "I would like to know whether I have active arthritis or not, or whether my symptoms are purely progression from osteoarthritis. If I have an active arthritis, what can be done about it?".

2. "I would like advice on whether diet or lifestyle factors can improve my colitis and arthritis. If you can not provide this advice, can you point me towards someone who can?"

Good luck.

 

[amirm]

That's really good advice. I always make a list and my Doctor then takes the time to answer them. If I ask nothing, then it is a short visit. Luckily he is very personable and never makes me feel like I am taking too much time.

Sadly I had the same experience with GI doctor that you did Tim. I had to go other paths as you are considering to get relief. While I am not sure how scientific their approach is, the result was very positive! If it is placebo, it is very good placebo .