Priscilla[/font][/size]Hi,

I had my VSG done in Mexico 7 weeks ago. My surgeon suggests an Upper GI and certain blood work be done at 3 months. I saw my PCP last week and she agreed to order the tests. However, today she called me and said after speaking with her administrator, she would not be able to order the tests because she is not familiar with bariatrics. She said I would need to self refer myself to someone who would follow me in that aspect. The best she could do would be to have their referral coordinator send me a letter with a list of possible Dr's that might follow me and I could make the necessary contacts myself. She said I could also look on the internet to see if I could find someone since I found my surgeon that way. She said she would still follow me for my high cholesterol, HPB, and pre-diabetes and order those blood tests. I have other co-morbidities too.

I would really like someone to follow me because I also have severe GERD for which I'm taking medication but has been worse since surgery.

Has anyone else run into this problem? What did you do?

Thanks,

Priscilla

I just had my surgery in Mexico last weekend but I fully anticipate my PCP treating me the same way. I say find a new Primary. Why stay with someone with such an attiture. Mine has always had an attitude and I didn't really care because I don't have any regular issues. I only go with the flu or cold. I asked the nurse last time I was in there if she felt the Dr would fire me and she said probably. So I'm going to start making some calls this week to have a new primary lined up.

Hi Priscilla!

I'd get a new doctor, too. "I'm not familiar with bariatrics" doesn't cut it. We're having an upper GI to look for a late leak or stricture and a radiologist reads the films and sends the PCP a report. As for the bloodwork, if she can't tell good values from bad ones, (the lab report will point out levels that are too high or too low) she probably isn't someone you want to go to anyway.

I'd tell her why I was leaving, too, and also say that you will be spreading the word through these forums that the practice is not bariatric-friendly.

It really makes me angry that we are treated poorly in this country when we take charge of our own medical care. My own PCP is a doll but the Kaiser bariatric center treated me like dirt since I had surgery out of the program.

Write an angry letter to her administrator. I did that after this one doc at the clinic I go to gave me a bunch of shit and now everybody tiptoes around me and I only see the medical director, not any other doctors.

I would find another doctor, specifically one that specializes in bariatrics. you can keep both doctors, and just find a bariatric doc to handle your bariatric needs.

This isn't that uncommon for a doctor to refer a patient to another doctor to handle a case. The doctor simply may not be familiar with such a specialty there for they would not be appropriate to handle the case. It's not only a safety issue for yourself and your health, but it's also protection of the doctor and their licensure/practice. So don't think of it as something nasty, but simply having your PCP/the practice wanting quality care for you and your health and of course no liability upon themselves for things they may not be familiar with.

I would find another doctor, specifically one that specializes in bariatrics. you can keep both doctors, and just find a bariatric doc to handle your bariatric needs.

This isn't that uncommon for a doctor to refer a patient to another doctor to handle a case. The doctor simply may not be familiar with such a specialty there for they would not be appropriate to handle the case. It's not only a safety issue for yourself and your health, but it's also protection of the doctor and their licensure/practice. So don't think of it as something nasty, but simply having your PCP/the practice wanting quality care for you and your health and of course no liability upon themselves for things they may not be familiar with.

I have to disagree, I don't think her doc is being cooperative. The tests Dr. Aceves requires are very basic bloodwork - the stuff any PCP orders if you come in with pretty much any complaint (CBC, Iron, B12, etc). There's no reason for her to refuse to do these basic tests that a first year medical student can interpret. The X-ray is read by a radiologist, so he or she does the report. My report, for one, said "Stomach has been reduced to a small tubular structure consistent with the vertical sleeve gastrectomy procedure, no leakage of contrast was observed." You don't need to be some sort of bariatric specialist to interpret this information. Now, if her tests came back with positive results, then sure, refer to a specialist. But it sounds like her doc is just trying to cause her roadblocks for no reason.

Thank you for all your replies. I'm going to find a Gastroenterologist to follow me and I'm also going to start looking around for a new PCP.

Priscilla

Priscilla[/font][/size]Hi,

I had my VSG done in Mexico 7 weeks ago. My surgeon suggests an Upper GI and certain blood work be done at 3 months. I saw my PCP last week and she agreed to order the tests. However, today she called me and said after speaking with her administrator, she would not be able to order the tests because she is not familiar with bariatrics. She said I would need to self refer myself to someone who would follow me in that aspect. The best she could do would be to have their referral coordinator send me a letter with a list of possible Dr's that might follow me and I could make the necessary contacts myself. She said I could also look on the internet to see if I could find someone since I found my surgeon that way. She said she would still follow me for my high cholesterol, HPB, and pre-diabetes and order those blood tests. I have other co-morbidities too.

I would really like someone to follow me because I also have severe GERD for which I'm taking medication but has been worse since surgery.

Has anyone else run into this problem? What did you do?

Thanks,

Priscilla

Hi Everyone,

Just wondering, do you really need to have the upper GI three months after?

I have my doctor-ordered upper GI next week but am afraid my insurance will not cover it as I did have it in Mexico. I am also wondering if one is not having any side-effects if it's necessary?

My PCP recommended a couple of GI docs to go to in order to have my reflux investigated. The one I went to ordered an upper GI scope (EGD). No probs with insurance, since I have reflux.

PCP did order all my followup bloodwork and was super excited by my weight loss.

My surgeon has never mentioned anything about an upper GI at 3 months. If I'm not having any issues, I don't see it happening.

I would find another doctor, specifically one that specializes in bariatrics. you can keep both doctors, and just find a bariatric doc to handle your bariatric needs.

This isn't that uncommon for a doctor to refer a patient to another doctor to handle a case. The doctor simply may not be familiar with such a specialty there for they would not be appropriate to handle the case. It's not only a safety issue for yourself and your health, but it's also protection of the doctor and their licensure/practice. So don't think of it as something nasty, but simply having your PCP/the practice wanting quality care for you and your health and of course no liability upon themselves for things they may not be familiar with.

I think this is an excellent answer. I work in the medical field and see how uncomfortable physicians can be when patients push them to practice outside their training and comfort. What if your PCP fails to recognize some early indication of a rising bariatric complication? You would most likely be very angry, and for good cause. Referral is just good common sense.

As far as writing letters that end up with you only being seen by the medical director, well, that is just shooting yourself in the foot. You may feel like you are being taken seriously as everyone 'tiptoes' around you, but the truth of the matter is you often end up with slower response times to your concerns because no other physician is allowed to help. The 'high maintenance' patients often end up with testing and procedures that really aren't necessary but end up being done because no one likes to be sued over missing something, even if the chances are really small. I see it all the time. And keep in mind, all those tests come with their own risks of complications.

Totally with FOXBINS on this one...time for new PCP

BTW...if you have medical tests from a different doc outside of your insurances coverage, take the tests to your PP and ask him/her to sign the order. I was told by my doc that if she signs the order, then it becomes PRIMARY to her and secondary to the other doc. We did it this way for all of my pre-testing and it was covered. Ask your PCP to make sure.

Thank you for all your replies. I'm going to find a Gastroenterologist to follow me and I'm also going to start looking around for a new PCP.

Priscilla

Good girl. . .you have to look out for number 1 and that is you. . .I don't think writing nasty letters solves anything especially getting you care. . . I'm glad you're going to a gastroentrologist and finding a new PCP. . . good for you! Now hopefully you'll get the right care you deserve. . .

Hi Everyone,

Just wondering, do you really need to have the upper GI three months after?

Maybe that is a Mexico doctor protocol because I didn't have to have one either. Just my ordinary labs to make sure everything was ok.