If you could write your own Rx's, would you visit your doctor?

I've been at this diabetes business for 31 years now. I've mostly visited an endocrinologist four times each year. The appointments lasted anywhere from 15-45 minutes. The doc would review my numbers and make suggestions about my insulin program. They never made any suggestions that revolutionized my treatment plan like low carb eating.

I kind of feel like an athlete competing in day-long event and the coach (doctor) only showed up for the last two minutes. And with such little awareness of the ebb and flow of the contest, they would then offer some meaningless advice! They would, however, always work in their seemingly required hypo warning.

Looking back over the years, I see that time as mostly wasted. The docs I worked with, about seven, were definitely not experts on insulin management. Nutrition was not their strong suit either. My attitude about them degraded to seeing them as merely a medical transcriptionist documenting my path into diabetes complications.

To a person, their expectations were low. And if you avoided hypos they didn't seem to care if your A1c climbed into the 7%+ range.

The biggest reason I keep a relationship with a doctor is for the scripts. If I could write my own scripts, I would probably limit my exposure to a once per year visit. I do value their ability to watch my blood test and also provide referrals to other specialties but for the most part I find it a "smile and nod charade!"

What do you think? Would you visit the endo four times per year if you could write your own scripts?

There's a rather large segment of the population that can write their own prescriptions-- doctors, nurse practitioners, and physicians assistants. And generally when they have a health issue, they go to a doctor themselves....

I don't visit the endo 4 times / year. I generally go twice, which seems like more than enough, I actually think once would be plenty for me... but I go twice because that's what they tell me to do...

Most of my sensibility on this issue, Sam, comes from my interactions with doctors in the context of a chronic disease, diabetes. When it comes to a new diagnosis, I think the need for a doctor is more understandable. If I received a diagnosis of, for example, MS, I would probably want to talk with a doctor.

Like you, I lost patience with seeing an endocrinologist years ago. They never told me anything I didn’t already know. I’d take a whole day off from work to go to the city for a 15 minute appointment only to have them look at my log sheet and never lay a hand on me. I could have faxed them the information and saved a sick day for a time when I was really sick. They can’t charge you for their time unless you actually go there.

I just see my regular MD four times a year. He orders my blood work and calls me with the results and phones in my prescriptions for me. If my A1c starts to creep up (only once in the time I have been seeing him) then we know I need to eat less, exercise more, or increase my dose by a few units. I get everything I need out of my GP.

I did, however, work intensively with a nutritionist for about a year. I paid for it myself as insurance didn’t cover it. The nutritionist did more for me than any other doctor ever has in terms of helping me manage diabetes for the long haul. Because I worked with her so long, weekly for a year, she really got to know ME and MY life style. It was money well spent.

Interesting that you took an a-la-carte option toward your medical care. You opted for the less specialized GP and added a nutritionist on the side.

How often would you visit a doctor for diabetes care each year if you could write your own prescriptions? The same amount or less?

I can see where you are coming from, Terry. My short answer is no. The bit longer answer is I haven't done a lot of 4 visits/year in my 41+ years as a diabetic.

I have had really only two endos since the late 1990s. My first one, after I was established on the pump, was able to recognize that 4 visits/year was about 3 too many. It also allowed her to spend more time with patients who really needed her expertise. I actually think she would have seen me even less, if her malpractice insurance would have allowed it.

My current endo, whom I have seen for just over a year, is getting there, we have moved from 4X to 3x/year.

I try to always have a written agenda for my endo visits.

I would still go to my GP four times a year because I want the blood tests. I want to know where my A1c stands, plus I have other stuff I’m watching like cholesterol, kidney function and a vitamin D deficiency. I think once a year is too long to go without the blood tests.

Have you mentioned to our diabetes doctor that you would like to decrease your frequency?

I had just gotten my visit schedule with my doctor down to twice per year but then became eligible for Medicare and Medicare requires one visit every three months.

I think I could live with the 4x/year blood draw schedule and fewer face-to-face doctor visits.

Wow that’s lame. No way around it? What a waste… Those resources could be going where they’re needed instead of to someone who doesn’t even want or need them

I guess it's a relative and subjective value judgement. If you feel you're getting valuable interaction from the doctor then I understand how you see it's worth it for you. Many of my visits in the past I didn't feel like I was learning much.

It was nice that your past doctor recognized that you didn't need as much face time. I usually carry a list of questions when I see the doctor, too, but these are not burning issue immediate kind of treatment questions. It's more like, "Did you see this research study results?"

What would happen with Medicare if you just flat out insisted you would only go once or twice a year? How could they twist your arm to going 4x?

I've read that they require the 4x/year doctor visits to be eligible for a pump. I'd like to get a new pump in 2016/17. I don't want to risk having to argue with a giant bureaucracy when I want to upgrade my technology.

I agree with you, Sam, about the Medicare bureaucracy and its policies. I actually can run my own show most of the time. Newly diagnosed diabetics need more care than I do. Then I remind myself that I am not typical in my diabetes care. The Medicare policies are written for a much larger demographic. I just wish they could be a bit more flexible to accommodate people like me.

They should require you to keep the appointment schedule developed by you and your physician and approved by the physician… That would actually make sense. I get so frustrated by this kind of nonsense wherever I encounter it in life—

FYI - Medicare does NOT require one visit every three months for diabetes or an A1c test. This may very well be be required by your doctor or clinic but it's not a "rule" of Medicare. Here's the real rules: Medicare coverage of Diabetes Supplies and Services at a glance: http://www.medicare.gov/Pubs/pdf/11022.pdf

On the HbA1c - http://www.medicare.gov/coverage/diabetes-screenings.html

On Insulin Pumps - http://www.medicare.gov/coverage/infusion-pumps.html

On test strips - http://www.medicare.gov/coverage/blood-sugar-test-strips.html

I don't know where folks are reading otherwise, but the truth is out there and Medicare has never said 4 times a year doctor visit is a requirement. They have offered to pay for more strips if the doc deems it necessary and writes the prescription to have more. Medicare is not the one making anyone follow non existent bureaucracy and its policies that are not real. If your doc is requiring all that then you are lucky that it is covered at all.

We should be the ones setting our own requirements. I see my diabetes specialist once a year and my RX(s) are written for a one year period. BOOM!! And if I should call then I get right in, she knows something is wrong!

I believe it is if you want a pump, Karen, that Medicare requires three times a year visits.

And no, I wouldn't visit if not required. When I lived in Guatemala I could get labs done without a doctor's order and also get any medications without prescription. I only went to the doctor if I had something new or needed help or advice

I cannot do my own blood work and if something changes I want it caught. Over the years though I have discovered my knack for firing professionals who do not listen to me or seem to care.
I have an awesome Endocrinologist and Nurse practitioner for my primary care. There have been others though I cannot be so kind in description.
I see me as a team member...of which doctors and health providers are part of.

If I could get all the supplies I need for free, and not require a prescription or a doctor's visit, I would be almost as happy as having a cure for diabetes. Or better yet, never getting it in the 1st place. My last visit I had to leave work early, wait more than an hour and a half in the waiting room, another half hour in the back room, only to spend 5 minutes with the endo. The nurse never introduced herself, the fellow was rude and ignorant, and it was not pleasant until my endo entered the room. Never a word about diet or eating, didn't seem to care that I was doing well with LCHF diet, just mildly interested to placate me. Luckily I am self taught and doing well, for now. :(

The every three month requirement is set forth in the Medicare NCD Manual 280.14 (formerly CIM 60-14) Section A.5 that can be found at the link below (after the main body of the memo). Specifically, the Manual states:

Continued coverage of the insulin pump would require that the patient has been seen and evaluated by the treating physician at least every three months.