Perscription hell

Type 1 and LADA
1

Over the past couple of years I moved and stopped seeing my endo. In my new city, I picked up with a new primary care doctor who, upon first visit, told me that he's a diabetes expert too. So great, I thought, my one-stop shop.

Here's my grave mistake -- I didn't pay close enough attention to my prescriptions from my former endo, and they recently ran out. Dumb, dumb dumb. At first, I thought it would be no problem to transfer to my new doc. Now here's where I get confused.

They asked for the current prescription information. I call my pharmacy and they are extremely unhelpful (Safeway...ugh). The pharmacist just told me vaguely what they were, and couldn't send them anywhere.

My new doc tells me to get them from my endo. I have that done, and of course, it takes a few tries because apparently our health care industry is still stuck on fax machines. After they finally get it, my new doc breaks the news that they don't feel comfortable managing my prescriptions and I should get a new endo.

I book an appointment with this new endo for two months out.

They give me a temporary prescription after several more phone calls, and despite having the information, they didn't fill it correctly and I have to eat an extra $120 because it was filled for a supply period that was twice as long as it should have been. I had to take the supplies or I would have run out right then and there.

Now, I am just about out of test strips. I still have a month until I can get an endo to write my correct prescription. I call my doctor's office again to get a refill of test strips, and they fill it for what would last me halfway until my appointment.

Fantastic.

Does everyone here have an endo and a primary care physician? Is there such a thing as a one-stop shop? Is there some legal reason that my diabetes-trained PCP can't manage my prescriptions? Can I insist that he do? Should I look for another doctor and try this again?

And, I thought I knew my medication directions, but from this experience, I learned I also absolutely should know the quantity per days supply. Do you all just..know that? Does anyone have a recommendation as to exactly which information/format you should know about your prescriptions, just in case you need to tell a new doctor what they are?

2

I use my endo as my pcp. I really don't know why your pcp isn't providing you with the prescriptions that you need, though. There should be no reason that they can't? I'm suspecting your PCP is an internal meds doctor? They should be able to prescribe diabetes medication as well. I'd ask exactly why he does not feel comfortable filling your prescriptions?

3

I'm not a fan of HMOs because I want to be able to see the doctors I need to see. PCPs generally are too rushed to do diabetes management, rarely are knowledgeable enough, and are pressured by healthcare companies to keep costs down ("3-4 test strips are enough"). It's hard enough finding a good endo to manage my diabetes. In the meantime....you can generally get older insulins without a prescription from Walmart and their generic test strips are good enough.

4

I see. I don't get the impression they're particularly overloaded. But, I could be wrong. I've been eyeing cheaper, prescription-less supplies. Do you think it's financially viable to go completely prescription-less?

5

I like that direction. I'll ask my new endo about primary care, that could work really well. Yes, my doc is internal meds, I believe.

6

I'm afraid there just is no dependable rule of thumb where doctors are concerned. Doctors are like lawyers, mechanics, hairdressers, or any other profession: there are great ones, awful ones, and the great middle ground of mediocre ones. Your experience will depend on which kind you have (or are stuck with).

I don't have an endo. My PCP writes the prescriptions I ask for. We have a relationship of equals -- he treats me like a peer, not a wayward subordinate, and we solve problems together, as a team. But that is no accident. When I last changed doctors, I interviewed doctors until I found one who wanted to work with me, not on me. It took some time and effort but the results will last much longer than the amount of time I invested in doing it.

7

I've always been told that I would ideally have both an endo and a PCP, though for much of my life the only doctor I went to with any regularity was my endo. Diabetes aside, I've never really had a need for a PCP and my endos have always been ok with it, as long as I don't call them for an ear ache. As far as why the PCP wouldn't be comfortable, I've never been given a real answer, just told that they would not prescribe me diabetes meds long term as they just didn't feel comfortable.

8

It's possible you can get an endo that's also an internal medicine doctor, at least I think so...as this is what it says about mine on the website for my doctor:

Specialty Areas
Diabetes
Internal Medicine
Endocrinology
Primary Care

And he's also certified as an endocrinologist and an internal medicine doctor.

So I have the one stop shop. He'll deal with my GERD as well as my diabetes and when I have a cold he can help me and all. It's nice. I don't know exactly how common this is but he's been helpful and I'm glad. He's also a type 1 himself (diagnosed at the same age as me even, and his daughter was as well around the same age) so I feel less alone when I see him lol.

9

It really depends. My endo prescribes 8-10 test strips and some strip manufacturers offer a copay card to bring the cost down further, so I need to go the prescription route. If I was only able to get a prescription for 3-5 strips a day then it might make sense to buy more generic test strips.

Moving was really rough for me as well. I badly needed to get on insulin (misdiagnosed at T2), but since I was going low carb (plus metformin and exercise), my A1C wasn't high enough for most doctors to prescribe insulin. I also didn't know about the Walmart insulin option at the time. I finally found an endo that I was happy with, but it took 2 years.

10

In my area, it takes 1-3 months to see a doctor as a new patient and my insurance limits who I can see. Is access easier when trying to interview them?

11

I have an endo and I basically use her as my PCP. I know exactly what my prescriptions are and I fill out the mail order forms , fax them to the endo and she signs and faxes them to Walgreens Mail Order. I get 90 days supply at a time so I only have to refill them 4 times a year. It's hard to find a one stop shop but I know if I need something my endo is a phone call away and she will generally do what I ask.
In general you should know how many test strips, insulin, pen needles, or pump supplies you use over a given period of time so you will be able to transition from one doctor to another, to be honest I have not found doctors to be that bright, or able to remember my prescription needs, so it is better that I have that information easily available for them.

12

I have had 3 different endos, due to moves, and none of them were PCPs. They only dealt with endo in general or diabetes specifically. Personally, I prefer a PCP plus an endo. I am older and have several chronic illnesses so I need an endo for diabetes specialty and a PCP for other ailments- reviews, tests, meds. My internist is board certified in gerontology, cardiology, and sports medicine. That covers a lot of the territory for an older adult! of course, he covers all internal medicine issues. And refers me to a specialist when needed.
I just don't think the typical internist has the time to be as knowledgeable as needed for serious diabetic persons. I understand that there can be exceptions. Exception means 'very hard to find.'

13

PS. Michael, please consider doing what I do. I have a list of all my medications, dosage, times taken, and reason for the med. The latter is most important! I take the list every time I go to any of my many docs (ophth, PCP, endo, podiatry, dentist, etc, etc) They always ask about your meds and it always impresses them when I hand them the page.

I also keep, in the same Word document, a history of my main health events, the year, and the dr. As one example, I had a major foot fracture in 2005 (they ask about surgeries too). I remember the year only because I have it written in my Health doc. I cannot recall what year I first got X or Y disease or high blood pressure unless I can check my med history.

You are young, and have a good memory now, but you will still find this useful.

I also have tried a number of meds over the years that did not work for me. I put the date that I stopped each of those so that I can tell any doc that "I tried that and it caused this condition so my dr took me off of it." That way I don't have to keep re-trying them!

This is a suggestion based on your experience with your meds. I hope it helps, in the future.

14

My PCP gives me all my scripts for everything. I tell him what I want, he generally just agrees and prescribes them. I haven't seen an Endo or CDE in at least eleven years, I do my own thing. All three of my pumps were even prescribed by my PCPs. Sometimes it depends on how knowledgeable you come off, if you seem to know what you're doing and know what you need, they tend to feel more comfortable dealing with the D.

15

Thanks. I'll consider keeping a better record.

16

That makes a lot of sense. I initially called to have him take over my meds, and I they just asked me to dictate the directions for each. I thought they wanted the exact directions to the T, so that tripped me up and I think they weren't reassured, lol.

17

Same for me, David, but it took several years for me to find a PCP who I can work with that way---partly because I wasn't brave enough to keep searching at first...Inbred duty/politeness/doc-as-god family history. Finally I learned enough to feel confident saying, ENOUGH! and take charge.....Blessings

18

Not necessarily easier nor harder -- as with most things, it just depends. One doctor's front office wouldn't even consider letting me meet with him without first becoming a patient. So I scratched him off the list. I doubt the doc ever even knew it happened. It's deplorable the walls people build around themselves, often without even knowing they do it. But that's his problem, not mine.

It's like life. Sometimes you get lucky right away, sometimes you have to keep working away for as long as it takes to get a good result. But we're not talking about a plumber here -- how important to you is your relationship with your medical team? The answer to that will determine how much time and effort you're willing to invest. For me, the stakes were high enough to warrant the effort -- whatever it took.