Tuesday I took DH to a new geripsychiatrist because I feel the meds he's been on for the last 3.5 years are no longer as effective as they were. The psychiatrist we had been seeing (every 3 months) was not offering an alternatives to the meds DH is on, except to continue increasing the seroquel (at the highest it was 450 mgs/day).
We met with the new doctor, she didn't change the meds and told us she wants to see DH every month. When I advised her that the psychiatrist he usually sees only wants to see him every 3 months because there's not really anything he can do for him, she responded that she has to see him every month without an explanation as to why.
I think monthly visits are unnecessary, particularly if she's not going to change his meds. How frequently does your spouse see the geripsych or neurologist? If on a monthly basis, what is the medical necessity for such frequent visits?
That sounds like an awful lot of visits unless they are changing meds and need to monitor how well it is working. Even then once a month sounds like a lot.
L sees her psych 3 times a year. Used to be 4 times but since L was stable the psych suggested reducing the visits.
That's totally unneccesary - just a money maker for her. UNLESS you live in Florida and she is prescribing a controlled drug. Because Florida used to be the "drug capital" of the country, and everyone flocked here for oxy and all the other controlled substances, the legislature passed a VERY STRICT law. If it's a controlled substance:
1. You can only get one month supply at a time. No refills without seeing the doctor again. 2. You have to receive the prescription from the doctor personally and take it to the pharmacy in person- no phone ins; no faxes.
Sid's Risperdal, Percocet, and Fentanyl pain patch fall into those categories, which is why we have an apt. at the pain clinic every month.
The pain clinic we go to is an 80 mile round trip. (Long story - I hate the one in our city, and the one we go to is excellent and worth the trip). The first time we went, the doctor wrote the prescription for the wrong dose of pain patch. He wrote 12 mg. and it only comes in 12.5, 25, and 50. The pharmacist said his hands were tied. He could not fill it; could not take it from the doctor on the phone; could not take a fax; couldn't fix it himself. He said I had to go back and get a correct copy. I had just driven 80 miles. I could not do it again. I called the pain clinic, and they said not to worry. One of their nurses lives in my city, so she dropped off the new prescription to my pharmacy on her way home. :)
If you DON'T live in Florida, I would ask the doctor for an explanation.
the first red flag is when she gave no reason why. I am the type I need to know why or forget it. As mentioned, could be money. She definitely owes you an explanation as to why. If she refuses or is too busy, then I would look for another one.
Thanks all for your comments and confirming my suspicions that it's all based on $$$$$. But what was strange was she was willing to see DH on a "consulting" basis every 3 or 6 months provided DH see his regular geripsychiatrist on a monthly basis (which he has NEVER required). She also argued with me that Medicare woud NOT be the primary payer of her bill because DH has retiree medical coverage through UnitedHealthCare and they would be the primary (she's out of network so we wold have to pay the full fee out of pocket). I advised her that his geripsyc accepts and processes his bills through Medicare and as of this date we've never had a problem with payment.
Emily, the every 3 months visit is because he will not prescribe the seroquel, klonopin (controlled sunstance) and neurontin without seeing him.
Joan, we do not live in FL, we are in NJ (rural, not an oxymoron).
I fired my wife's neurologist after 3 visits. That was 4+ years ago. Since then she has been seen only by her PCP, a Family Physician, who sees her every 3 months. Also she (the PCP) comes once a month to the retirement Inn we live in, so I don't have to try to get my wife to the doctors office. The PCP she has will take care of any meds needed, so there is no need to go to any specialists. The nearest neurologist is an hour drive from us.
My husband sees his geri-psych about every 3-4 months if I feel it is necessary. The doctor says to make the appointment just so I have one if issues come up, but I can cancel it if things haven't changed. The geri-psych handles all his meds, which are mostly for behavior problems. He only sees the neurologist once a year.
We see our neuro every 6 months unless there is a change, then we can call and make an appt. Our doc is not one to put unnecessary visits upon us when what is going on is a progression of this disease. If something happen then call and get in earlier.
Our neuro is just like Mimi's once every 6 mos. I have called a couple of times and moved the appt. sooner because of something I was concerned about and he has moved it earlier if he chances his meds. to make sure everything is OK. When my dh was basically stable a year ago we hardly ever saw him...there is really no need...nothing they can do except change meds.
Was seeing neuro and PCP every 6 months. Since DH was only having minimal checks, no medication changes...coupled with his decreased mobility, have stopped going totally. In our case I am able to email both with any questions, which is rare. Agree that the doctor needs to give you an explanation for the frequency of the visits. DH only went monthly when part of a clinical trial.
LFL, I think this is a red flag that the new doctor wants monthly visits but did not adequately explain why. I know that you want good communication with any of the docs treating your husband and this doesn't sound like a promising start on that.
Steve was dx and treated for 6 years by the same neuropsychiatrist; the frequency of the visits was determined by his relative stability/instability as the disease progressed. Followup visits varied from 2 to 3, 4, or 6 months and the timeframes were driven by medication changes.
I think this doctor needs to explain to you specifically why she's asking for monthly visits.
For my husband every 3 months with his general neuro was the pattern for many years. However, this was combined with evaluations and visits to a specialist neuro, two neuropsychiatrists, and two neuropsychologists (and I think there is someone I am forgetting). The general neuro had recommended a cutback to every 6 months the last time my husband saw him. The only time I can remember a monthly follow up was after a hospitalization.
From Dx forward the only time we had monthly appointments was while making a difficult med change. After that it went to 3 month then 6, and finally once year and/or as needed. Unless there's a med change or problem not much can be done.
I agree. You notice that they schedule just beyond the three month or six month period - heaven forbid it should be BEFORE the anniversary of the last visit, because then they wouldn't get reimbursed. My husband's neuro saw him every 6 months once he was established.. and we'd see his GP every 6 months, until the mobility issue interfered.
Once you're certified for hospice, you go to their doctor, and once he's in a NH the same, although I don't know about ALFS.
Following his hospitalization, my husband went into an ALF that was palliative care based. That ALF had its own hospice certified physician. Almost immediatly husband was certified for hospice and so that physician worked with the hospice team.
Thank you all again for your comments/observations. I decided to consult this new geri-psych because she was well recommended for possible med change becase Rich continues to display difficult behaviors periodically. I get (sort of) why she may want to see him more frequently at first because they don't have a relationship, but what bewildered me was that she was willng to see him on a consulting basis if he saw his regular geripsych monthly. I am going back to previous gerpsych and will consult with her when necessary.