I’m confused and frustrated about my medical team. I have a psychiatrst, MD; a PA for medical care, a nutritionist, a diabetic educator, a dermatologist, an orthopedic PA; that’s pretty much the team. One of the group suggested I might want to get an internist or MD for my medical care. This would be fine, except the last time I tried to switch docs, the MD I had wanted to TELL my Psychiatrist (whom I have been with for 20 years) what meds I should be on…that just wasn’t going to happen. Now I have had the PA for 15 years, she is very good, thorough, and has MD’s at a second’s notice. There has never been a big problem she hasn’t sent me to a doc for. So my question is, what would you do, switch medical people a PA for an MD or internist…or stay with the person who knows me best? Just asking, Background: I live in a rural area, no endocrinologist within 220 miles; insurance doesn’t pay for both; been pushed around the system too often to put up with not knowing.
If you are receiving good care and are happy with it (and the results), then my take would be, it ain’t broke so don’t fix it.
I have to admit that I found your post kind of confusing. Starting with the title, you list 3 choices: a PA (Physician’s Assistant), an MD (Medical Doctor) or an internist. An internist IS an MD (or a DO [Doctor of Osteopathy]) who specializes in Internal Medicine. If you’re looking for an opinion on whether you should see a Physician’s Assistant versus a Physician (MD or DO), I’d say why see the Assistant if you can see the Physician? This is, of course, a biased opinion, as I am an MD. Don’t get me wrong; there is nothing inherently inferior about PAs. I just saw an Orthopedic PA after “rolling” my ankle. And I’d venture a guess that this excellent PA could teach me more than a thing or two about orthopedic injuries even though I have advanced training compared to the PA. Which makes sense because I specialize in another area of medicine. I think there are inferior MDs along with inferior PAs. And I’d rather see an excellent PA than a crappy MD any day.
There is a principle known as “Sturgeon’s Law”. It’s named after Theodore Sturgeon, a writer from the golden age of science fiction. Sturgeon was once walking through the crowded lobby of a hotel hosting a science fiction convention when a pugnacious would-be literary critic buttonholed him and announced, very combatively, “Ninety percent of science fiction is crap!”
Sturgeon smiled and calmly replied, “Of course. Ninety percent of everything is crap.”
You can debate the percentages, but the point is that the competent, quality 10% is where you find it, whether we are talking about auto mechanics, hairdressers, lawyers—or doctors. When you find a good one, hang on for dear life.
i’m studying to be, PA (Physician’s Assistant). & @rgcainmd wait till i’m done with med school, & i be a excellent PA, but there is a Problem, do you mind seeing one who is a diabetic, & not a good one ?.
Sdkate,
If the sole rationale for posting the “what would you do” scenario is as you state “one of the group suggested I might want to get an interest or MD for my medical care” then I would want to know what qualifies “one of the group” to make that suggestion.
What are the credentials of “one of the group”
I would also take into consideration whether or not I have been successful in managing my condition under the care of my current health care team. If the answer is yes that you are successful, then I wouldn’t reinvent the wheel. Your current team has an intimate knowledge of who you are. What value-added benefit at this stage in managing your diabetes would an interest add if you are already successfully managing your diabetes.
I hope this is helpful to you.
Best,
Jo
If the PA is meeting your needs and your team is working, then I would not change anything. I wonder who in the group made the suggestion as others have asked. 15 years is a long time to have someone having your back, your history, and is sort of trained in how you manage. I’d hang on to her.
Guess I need to be more specific, if only to answer questions that were raised.
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It wasn’t someone in THIS group that suggested the change. It was a Diabetic Educator who suggested it, she is on my team…and I asked her opinion after my PA has been on vacation. It’s been on my mind for awhile.
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I am well aware that an Endo, and Ortho’s are docs, however, as I said we live 220 miles from an Endo; and my ortho had misdiagnosed my knees saying they were a complete mess and needed to be replaced; when in reality they were riddled with arthritis and gout…thank God I didn’t go through two surgeries for nothing.
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Being an 18 year veteran of Diabetes, I know just about as much about MY diabetes as anyone. I take very good care of myself, and really only need them or any of my docs for major things, and a script okay every three months. I saw MD’s (family practice) and OB’s when I had my children 33 and 29 years ago…other than that I have had excellent PA’s…the one MD I did see was awful and I left her practice without even batting an eye
I think my whole question was to confirm what I wanted to do, because in a small town once you burn a bridge at one of our two small clinics, there is no building it back up with a medical person in the same clinic. Wanted to make sure I wasn’t being totally biased by my dislike for that doc.
Thanks for your in put.
Sdkate,
I really don’t need to know, however, as a certified diabetes educator (CDE), I am curious to know why the CDE on your team believes the inclusion of an internist is necessary. From the way you describe your circumstance, they seem great.
It would appear (at least from my limited perspective) that if your health care team felt that you had challenges they couldn’t handle your MD or PA would make the referral to the internist and not the RN (or is she an NP). It makes more sense if she is an NP but she would still need to speak with your PCP
As a certified diabetes seems that she’s stepping outside of her professional boundaries.
Sdkate, it does appear that you have everything together and understand the consequences of “burning bridges” within your community.
I wish you well.
Best,
Jo
I totally get where you are coming from sdkate! I believe it is a beautiful thing when you find a fit and as said 15 years is a long time. Trust is very important. I am glad you found confirmation in your what you wanted to do. I’d have made the same choice.
I’d be far more concerned with the quality of the care you’re getting than with the letters behind their name. My wife is a specialized nurse practitioner and all of the local physicians refer patients to her that are outside their expertise but within hers, which coincidentally include orthopedics and wound care (the latter gives her a pretty gruesome first hand view of the consequences of poorly controlled diabetes…)
As rgcainmd said, an internist is a medical doctor, whether MD or DO
My thought is if everything is working well and there is trust and understanding between you and your PA, stick with her. You are the one in charge and you are the one who picks. Over my 45 years with diabetes, I’ve had my fair share of bad and good doctors. For about 7 of those years I didn’t see a doctor eat all. For awhile I saw a NP/CDE and than a PA. Both were great and both listened and discussed everything we were thinking about doing. The key for me is always can you work together and are you getting good advice. Happy? Stay where you are. It is so very hard to find someone who is willing to listening to someone who has to deal with something 24/7 and understand that your life is not just your disease.