How do you fire a doctor?

That's a good question: it involves not just what your family doctor is able and willing to do, but what your insurance company is willing to accept. Would they reimburse the cost of expensive cancer drugs based on a prescription from a general practitioner (even if that doctor were allowed to prescribe them)?

I reside in Nevada but am being treated by Mayo Phoenix. I'm on daily 5mg tadalafil and the Mayo staff urologists I've seen at my 3 month checkups (a different one each time so far) always given me a pdf order for my next psa test and send/refill my prescription to my local pharmacy. But I have no idea if they'll do that for other states. As far as my local urologist, I had a different experience than you did. It was actually my local urologist who suggested I go to Mayo so I've been comfortable continuing to see my local urologist occasionally and keep him informed on my status. My thought was keeping that door open would be useful if I had some future urological need. In fact, since I had the surgery 06/2024 I do have ED which has been slowly improving. So I've already discussed with my local urologist where I'm at in my ED recovery with him and my experience with the daily tadalafil that Mayo has me on. We then discussed future options (eg. trimix shots) if my recovery progress stalls and/or I decide I need them. He doesn't seem bothered at all with my continuing relationship with Mayo and is fine with still being there for me going forward. Writing this it reminds me I'm lucky to have such a professional and objective care provider locally who isn't resistant to me getting care at Mayo while continuing as a patient of his. Of course, if I do start trimix shots with my local urologist I'd discuss that with Mayo before proceeding, but I doubt Mayo would object. Best wishes.

Thanks. I'll be checking in here now and then in search of good nuggets of advice.

I'm on Medicare, which should make things easier.

After I had my surgery, I didn’t really need to speak to my urologist for much of anything for years. I was given an oncologist to work with, and that’s who I discussed my treatment with. You found your oncologist at Mayo, So as far as cancer is concerned, you are all set.

At this point, there may not be any reason to have a urologist to work with. Sure if you have urinary track problems that’s the person to go to. Just find another urologist in your local area when you need one. If you have incontinent issues, a urologist may be the person to go to, but you want to make sure you get one that’s working specifically in the area of incontinence. My medical services are provided by Kaiser. When I needed to speak to someone about incontinence they had two different doctors that specialize in it and knew all about every technique that can be used. My regular urologist did not get involved with this, Other than to prescribe Myrbetriq when I requested similar medicine.

Thanks for all the helpful comments.

Maybe I'll make an appointment with my general practitioner for a "yearly checkup," then spring it on him: "Will you be my local facilitator for my Mayo cancer treatments?"

Be sure to stay up dated on Medicare changes to telehealth coverage requirements.
https://www.medicare.gov/coverage/telehealth#:~:text=Through%20September%2030%2C%202025%2C%20you,or%20after%20October%201%2C%20including:

My urologist literally said he was “passing the baton” to my Radiation oncologist. Like, don’t bother me kid.

My radiation oncologist I liked very much but he would only recommend IMRT and said he wouldn’t do SBRT. So I went to Mayo and am happy.

I need my original Rad. Onco, because of the hormones. I don’t think your GP will be able to get the buy-in as Mayo does. What I intend to say is:, that I’ve gotten a 2nd opinion and gotten other options and so will go to Mayo. This happens all the time. Just keep an eye on insurance. Mayo will prob (don’t know) will help you with any appeals.

Thanks. Very helpful link. I will make sure I get a Telehealth visit before the end of September!

As the Nike slogan goes, "just do it."

My primary care doctor can and does handle a number of medical things for me based on our consults. Some he can and dies his self, others he refers out,, as an example, I have a colonoscopy on Wednesday.

I have fired three doctors during my journey, when a urologist let his feelings, ego and wallet get in the way of providing the best treatment, I thanked him and said we're done. When a urologist failed to actively listen on a 2nd opinion consult, I thanked him and left. His PA knew I was pissed at the perfunctory care and let me know where the exit was vice scheduling desk. I also fired an oncologist, same thing, thanked him and left, didn't ask about any further appointments.

There may be issues depending on your insurance, I have Medicare and TRICARE For Life so no issues seeing who I want to see.

If your medical team isn't working for you, find some that do!

Kevin

Thanks for all the comments. Just today I had a learning experience involving Mayo and my local GP. Mayo faxed his office info on a urine test (I'll need to have it done before I drive back to Mayo next month). It turns out my local doctor can't do external lab requests, so I had to make arrangements at my local Quest office, Mayo re-sent the info to them, and hopefully we'll live happily ever after.

Actually, I'm still on Cloud 9 from my recent trip to Mayo, so I'm looking forward to driving 11 hours one way again in May and again in June. I'm so impressed by Mayo that if I didn't have cancer I'd make up some ailment just so I could drive up there and get treated by them.