Need Help With Asking PCP Again for a Referral to a Specialist

Posted by fiesty76 @fiesty76, Feb 1, 2021

I am struggling to find a way to bring up again my request and need for a referral to an endocrinologist for help during this year of being off of Reclast for my osteoporosis. When I made the request in our brief phone visit, she brushed me off saying there were only 2-3 meds I've not been given and to just continue the yr off until I can resume taking Reclast.

I was truly shocked that she wouldn't provide a referral because when I'd asked for a referral to a nephrologist, she provided one. When I said I'd read of additional supplements to add during this interim, she said: "You take a multi-vitamin and it contains the supplements you mentioned". Mine doesn't and those it includes are tiny amts. I'm wondering if she just wanted to keep the phone visit brief and while I don't want to offend her, I could profit from additional help from an endocrinologist. Any ideas about how to approach this diplomatically and obtain the referral?

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What is so difficult about this pandemic is the isolation and not having people around to walk with , to talk with, to motivate us. To have dinner with, to debate ideas and to share projects. The only time I like to rest and do nothing is when I am watching the birds out my window, because I never seemed to have time for it when I was younger. My home is a lot of work, but I have room to roam around, and on the bad days, I can sit in different places. We can encourage each other by computer and be grateful for the opportunity to reach out to each other. It's not perfect, but it's a start. Dorisena

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@susu2 Since I have no personal knowledge about you (age, physical limitations, whatever), I can only speak in the most general terms. My first choice for exercise is physical therapy, which will be geared to your particular problems and help you to avoid doing any damage. If you have something you really enjoy doing, I.e., swimming, biking, dancing, you should make it part of your program. Third is just plain 'ol self-discipline. Tomorrow, walk around your house for TWO MINUTES; next day, THREE MINUTES. Keep going until you hit 30 minutes. There are, of course, other places to walk, but even if you have only one room, YOU CAN DO IT!

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@dorisena. You're statement is absolutely correct. I will do anything to stay out of a facility, whatever. While our lives are certainly different, I admire your determination. Therefore, I've a "what would you do" question. Seems I have a mass on my ovary and everyone is bound and determined that I shall have a hysterectomy. I am caregiver for my husband, who has Alzheimer's. I take care of us and our home. I am the last surviving member of my family and all of my husband's family are dealing with large problems such as dementia. I contend that at 82, the idea that post surgery, I can return to our home and resume my life is highly improbable, and so I am refusing surgery. Have no symptoms. Do you think I'm wrong? I cannot see having surgery so that we can move to a nursing home. My husband is doing okay and we hopefully have some more of our life to share together yet. Your comments would be appreciated.

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@fiesty76

@contentandwell, Yes, JK, having a good relationship with the doc does make a decision to change much harder...especially for one who dreads change anyway. smiles Thanks to the confidence building suggestions from you, @johnbishop, @merpreb, @sunnyflower,@sueinmn, @colleenyoung, I am happy to report that my pcp approved my second request for an endo. referral! Started with 1 Big Thk U and 1 Big Request, I read to doc my "Plea statement/reasons for referral request" lol and she said "yes" to the referral! BIG relief and you guys get the credit.

No reference to her earlier denial and the fact that she had a young intern shadowing her may have contributed. I also said another opinion might not change anything during my yr off from Reclast but it would help "the worry wart's" peace of mind to know I'd tried all I could to add to my bone tool box. I wonder if she realized how stressful her first denial was and if reading out my family history and reasons for wanting another opinion made the difference.

Had placed 2 direct calls to Endo. offices about requiring referrals and accepting new patients and both required referrals and had closed practices.

A good friend suggested that the denials might be due to the fact that I was in a "managed care system". That sent me for more info. on "managed health care" and I learned more from: https://www.fool.com/investing/general/2015/10/06/what-is-managed-care.aspx.

My state retired teachers plan started at retirement with Aetna, moved to Humana, and recently changed to United Health. The last two are Medicare Advantaged Plans. I'm still not sure if it is just a local decision to require doc referrals to specialists or my particular ins plans but neither of the 2 endo offices asked about my ins. just my name and birthdate.

Local friends with other ins and direct requests for other specialists have also been told referrals were needed. It seems odd that members in other locations have suggested that Medicare patients might not need a referral. Just happy that the doc agreed to the request and will now play a "wait & see" about how the next year goes. Sending cyber hugs to each of you for your help and reassurance. Fiesty

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Dear Fiesty, Yay!!!!!!!!!!!!! Sounds like you had a good and comical experience and achieved your goal!!!! I'm so happy for you!!! I will pray God gives you just the right Endocrinologist for you and clear direction regarding the best plan for you. Many blessings, Sunnyflower PS: I'm a Kaiser Permanente (Kaiser Permanente is recognized as one of America's leading health care providers and not-for-profit health plans.) They have pretty much everything under one roof; all kinds of doctors, pharmacy, Radiology, Lab, eyewear, physical therapy and the list goes on. Not every location has everything, but most have most. I have the Medicare Optimal plan so pay about $345/month but that includes dental. I don't have a yearly deductible. I don't pay for labs, most radiology such as mamograms and ultrasounds and when I have an MRI, CT and other radiographic diagnostics, I pay about $40. It's the Part D prescriptions that get me b/c I'm on so many! I can self refer to many specialties and none of my many docs over the years has ever denied my request for a referral when I need one from them. I pay $10 to see my PCP and $20 or $30 to see a specialist. Immunizations/vaccines are free too. $200 max for hospital. I think ER (non-admit) may have gone from $100 to $150 but I am not sure. Too bad Kaiser isn't located everywhere. Before it was Kaiser, it was Group Health Cooperative of Pugit Sound, non-profit health care coop. I worked for them for 20 years. I'm super happy with both of these organizations. Warmest wishes to all, Sunnyflower

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I always remember that they work for me. We have a tendency in this country to believe that people we pay to service our needs have a control over us, they don’t.. tell the Doctor what you want and the reason you want it. You can always find another PCP. Let the specialist decide what would most benefit you, not the PCP.

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@trishanna

@dorisena. You're statement is absolutely correct. I will do anything to stay out of a facility, whatever. While our lives are certainly different, I admire your determination. Therefore, I've a "what would you do" question. Seems I have a mass on my ovary and everyone is bound and determined that I shall have a hysterectomy. I am caregiver for my husband, who has Alzheimer's. I take care of us and our home. I am the last surviving member of my family and all of my husband's family are dealing with large problems such as dementia. I contend that at 82, the idea that post surgery, I can return to our home and resume my life is highly improbable, and so I am refusing surgery. Have no symptoms. Do you think I'm wrong? I cannot see having surgery so that we can move to a nursing home. My husband is doing okay and we hopefully have some more of our life to share together yet. Your comments would be appreciated.

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I had a 90'some year old neighbor who needed a historectomy and she let it go and died in a few months. She said to me "I should have my uterus removed, I don't really need it." I could barely keep from laughing at the explanation. She lived alone and used a cane. On the other hand, if the mass is cancerous you could deal with a lot of pain before the end of your life here. You are sharing your life now with your husband and that makes a lot of sense. A friend chose to do no surgery and died quietly without much trouble. I certainly wouldn't criticize your choices at this point. I am choosing no surgery for both my shoulders and so far I can manage alone. Therapy helps the pain and most days I have none if I don't reach high. It limits my exercise but that is O.K. I am not starving. Dorisena

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On the matter of removal of an ovary, I thought it was not a difficult thing to recover from having surgery. It could make your remaining life go much better.
I have always rebounded fast from surgery, except for my back surgery. That took a month in the nursing home and then I lived alone. The pain lasted many months after that. I have survived cancer twice. I would personally not wait if I found more cancer if it can be successful surgery. Dorisena

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@dorisena. Thanks for your input. Will let you know what happens. Meanwhile, take care of yourself - you're a good example for all of us!!!

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Thanks, I need to be on the team because I get lonely living alone and being cooped up by the weather and the pandemic. Dorisena

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@susu2

I saw an orthopedist yesterday because I have fallen twice and have little strength . He told me I need to exercise:”what is strong is what is used”. Where to start? All I want to do is sit and knit or read! But I can’t concentrate and certainly feel afraid to go out and try to walk. Where do you get your determination?

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Hi, @susu2, Like you, I'm not great about prodding myself to start some projects I know will help my health...especially exercising alone. So, last yr I set one goal for 2020 to walk 3 x's/week on specific days and to "reward" myself each week with some small treat for ea. week I "did the deed"...lol I found naming the specific days helped me stay on track.

Another tool I use frequently is setting a timer for "dreaded tasks", easily put off like paperwork prep for IRS, etc and then Stopping the task when the timer goes off. Otherwise I tend keep going and quickly face 'burn out'.

@becsbuddy, started a walking/exercise group and there are participants in the group at all stages and abilities. Have you checked out that group? Usually can get to it from the Daily Covid 19 group. P.S. I'm a "sitter, beginning knitter and avid reader" too but have to restrict time alotted to each otherwise, I would become a terminal "couch potato". Smiles.

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