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  #11  
Old 02-09-2019, 06:40 PM
queasy27 queasy27 is offline
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Thanks for the explanation, Brandigirl. That makes sense. This is a newish doctor; my old one accepted that statins didn't work well for me and didn't push it.

To be honest, I miss the days when I'd go to the doctor if I was sick and otherwise we left each other alone. Now it's nag, nag, nag. I'm happy to put some of the blame on insurance company policies.

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Originally Posted by Living a Fantasy View Post
I argued with three different MD's when I refused to take statins. One of those MD's is my son-in law. Finally, my primary care declared me statin intolerant.
Oy. I feel you. I showed this doctor a research article from JAMA about myopathy being highly associated with a particular DNA variant* that I have according to my raw data from 23 and Me. He brushed it off. Most MDs tend not to appreciate it when patients roll in with research off the Internet. ;-)


* C variant SNP rs4363657 within SLCO1B1, if interested.
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  #12  
Old 02-09-2019, 07:19 PM
Brandigirl Brandigirl is offline
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To Retired Guy. You are right, it is not the doctor's fault at all if the patient does not want to follow the advice the doctor gives. I am not sure how specifically it works, but they have people who just gather data. That chart would be audited and it would just show that the patient is not on cholesterol medications and has a diagnosis of high cholesterol. What the ramifications are for not meeting the guidelines ....I don't know. I am also not sure if they just audit the chart and only are looking for a diagnosis of high cholesterol AND if they are/are not on cholesterol medication OR if they look for documentation that the patient refused. If is all complicated but I don't know the finer details. For instance, if you are on a medication for low thyroid level, you have to see your doctor 1x/year in order to continue to get your thyroid medication renewed even if the lab test shows it is in the normal range. As for the weight, for instance, there may have to be documentation that the patient was counseled on weight loss or anyone over a certain BMI would have to have certain other criteria documented in the chart.
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  #13  
Old 02-09-2019, 07:55 PM
JoMar JoMar is offline
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My view is that you have the right to fire the doctory if you don't feel he is doing what is in your personal view, what's best for you. He also has the right to fire you if he doesn't feel you are doing what is in his personal view, what's best for you. I also know that families have a tenendency to sue doctors do so I assume there might be some liabillity but most likely, he doesn't want to treat someone that doesn't want to be treated and self diagnoses. Your solution is easy, go find a doctor that meets your treatment criteria.
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  #14  
Old 02-09-2019, 08:56 PM
mills3186 mills3186 is offline
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It is a sad fact that health care providers these days must have "best practices" they must follow, the health care corporation dictates that they must have their diabetic patients under certain control, those with high cholesterol must get their #'s down, etc. At the HMO I worked at, we were given benchmarks to meet and part of our pay was docked if not. So was it my fault my patients chose to continue to be morbidly obese? No, I can't really change their lifetime of bad habits or the fact they have bad genetics. It was a nightmare to inherit another train wreck. Some practitioners resort to doing what yours did in order to make it look as if they had their patients well managed. This is part of the burn out issue you keep hearing about. I've had plenty of patients who either couldn't tolerate statins or didn't work, if they simply didn't want to take them it was my job to explain the benefits and consequence of not doing it. I would never discharge a patient though. If they were blatantly non-compliant, I would mark that on their chart on multiple occasions to protect myself. In your case, I would have written that you have hypercholesteremia that did not respond well to statins and were non-tolerated. To discharge you from his practice is just wrong in my opinion. Unethical? Hard to say.
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  #15  
Old 02-09-2019, 10:26 PM
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Taltarzac725 Taltarzac725 is offline
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Quote:
Originally Posted by queasy27 View Post
Without getting too specific, one of my doctors said they would have to discharge me as a patient if I wasn't wiling to take a cholesterol medication. My objection was that I had taken them for 15+ years but had developed side effects that I am no long willing to tolerate. During that time, my cholesterol was never reduced to recommended levels, anyway.

I confess I don't really understand the doctor's position. Am I not allowed as a patient to refuse treatment? Should doctors have the right to only treat obedient patients who do everything they say?

I don't know the answers. I'm not trying to be stubborn or willfully noncompliant but do feel strongly about this particular issue. I'm curious to hear other opinions from both sides.
Just wondering if there are a number of these kind of medications one of which might be OK for you to use?
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  #16  
Old 02-09-2019, 10:39 PM
queasy27 queasy27 is offline
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Quote:
Originally Posted by JoMar View Post
My view is that you have the right to fire the doctor if you don't feel he is doing what is in your personal view, what's best for you. He also has the right to fire you if he doesn't feel you are doing what is in his personal view, what's best for you.
I truly do sympathize with the doctor's side of things, but I'd also expect a bit of forebearance on their part.

The difficulty is that "not forcing me to take medication" isn't a good way to find doctors. This is my 5th internist in 9 years -- three of them left TV and one I left because of excessive wait times and error-prone office staff. I'd hope to find something who's willing to work with me as I try to take back some control over my health care after a couple of stressful years on the medical merry go round. I'm tired of the paperwork and repeat testing and having to start over and explain everything again with someone new.

I absolutely dread going to the doctor these days and get quite anxious (blood pressure up!).

United Healthcare even contacted my danged pharmacy and had them call me to say I needed to take statins. Like, really?

Last edited by queasy27; 02-09-2019 at 10:44 PM.
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  #17  
Old 02-09-2019, 11:03 PM
queasy27 queasy27 is offline
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Quote:
Originally Posted by mills3186 View Post
At the HMO I worked at, we were given benchmarks to meet and part of our pay was docked if not. So was it my fault my patients chose to continue to be morbidly obese?
That's horrible!! I swear.

I appreciate the insight.

What's kind of ironic is that a couple of friends referred me to this doctor because they said this person doesn't nag. I didn't think it through, but the reason they don't get any pushback is because they're both fairly healthy and do what they're told. D'oh!
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  #18  
Old 02-10-2019, 05:57 AM
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graciegirl graciegirl is offline
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I believe that Statins are the number one reason we have had a huge drop in death from cardiovascular disease in the last thirty years. An ounce of prevention is worth a pound of cure. I have heard others say that statins caused pain in their arms and legs. I wonder what your side effects are? Sometimes the benefit outweighs the side effects, but that is for each to choose.
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Last edited by graciegirl; 02-10-2019 at 06:06 AM.
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Perhaps like anything else
  #19  
Old 02-10-2019, 09:02 AM
thetruth thetruth is offline
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Default Perhaps like anything else

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Originally Posted by retiredguy123 View Post
Huh??? This make no sense to me. If the doctor prescribes a drug and the patient doesn't take it, it is not the doctor's fault. Are you saying that someone who is 100 pounds overweight should not get medical treatment because they just eat too much? Is that the doctor's fault?
You choose a doctor because you believe they are qualified but perhaps more because you approve of their personality-bedside manner. Obviously, it is a two way street.

You mention 100 lbs overweight. If, that is your issue. If, it is getting worse. It is fairly easy to take weight off. The hard part, where most people fail is keeping it off. In any case, as frustrating as it is. it is also frustrating for a doctor. If, it is bad enough the doctor might well prefer you left.

Where we used to live-pre Villages. I, my sister and my niece all used the same doctor. I had used him for many years. He was sort of a friend and a bit of a gossip. I had serious issues with my sister due to my niece. The doctor knew as we would discuss it. Perhaps, inappropriately he once told me that my sister and my niece were his patients and that they had left.
His comment was he is glad they both left. My sister-I do not regularly talk to her. As a patient, as a human being, she is the type that refuses to listen to a different opinion than her own.
She is, or was several hundred pounds overweight. Her extra weight kept her from exercise so of course it got worse.

She has been going through chemo. I don't think her weight caused her cancer but I do know her weight makes her care, her options etc more difficult.
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  #20  
Old 02-10-2019, 09:17 AM
Brandigirl Brandigirl is offline
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Mills3186, great insight into how you actually experienced it. Doctors are under a lot of pressure to follow these guidelines. Who would want to have part of their pay taken away because they can't convince someone to follow the advice of the benchmarks and best practices! The patients should have the right to make an informed decision regarding their healthcare. The only thing the doctor should do is document the non-compliance with the " Benchmark or Best Practice" and that should be the end of it, but unfortunately it is not. To Queasy27: I know that with certain insurance companies, you are "flagged" by the insurance company by some circumstances. I am not sure what exactly sets off the flag but it could be something like multiple ER visits for high blood sugar or high blood pressure. The insurance company sees these claims when submitted and they feel you, for some reason, cannot keep your blood sugar or blood pressure under control. They will send you a letter stating that they recommend you start a medication or have a "Nurse Navigator" help you manage your health care. They work with you over the phone to try and prevent you from continually going to the ER. So when a medical practice sees that you have gone to the ER, they want you to come back for a follow up appt to try and educate you, review your medications and try and prevent it from happening again. ER visits are very expensive and some insurance companies give a medical practice a certain amount of money to manage a certain number of patients. So if the medical practice goes over that amount, it comes out of their pocket. That is where the "Best Practices" come into play.
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