[Rose76]

My doctor left primary care practice. The clinic where I go for care assigned me to a physician's assistant. I recently saw her for only the second time. I've decided that I don't like her. I don't think I want my primary care provider to not be a doctor . . . a real doctor whose name is followed by MD.

I'm afraid that, if I ask to be reassigned to a doctor, they might refuse and that I might be labeled a difficult person. I am very depressed.

Yesterday, I messaged my sister that I'm getting down. She called me at 4:15 a.m. drunk. She would talk over me, if I tried to talk. She kept saying things repeatedly. It was like she was talking to herself and letting me listen. I ended up telling her I had to go back to bed and thanking her for the call. I wish I hadn't picked up the phone. I should have known she would probably have been drunk.

I'm very depressed. What those two things above have to do with each other is hard to say. I feel like I have no one.

[Fuzzybear]

I'm so sorry you miss your doctor...

I kinda wish I'd ever had a "good enough" doctor that I would miss them

I'm sorry, I'm not intending to minimise your pain, "they" (irl) have done that to me too many times (impotence of empathy )

Actually I do miss one doctor a bit.. I trusted them compared to the others

I think if they label you or anyone as a "difficult patient" ... well that reflects completely on them and it's very sad.. for us "patients"

I'm sorry about your sister . An aunt was an alcoholic . She was a very cruel woman to me anyway..

[Rose76]

I've been breaking down crying past couple of days. I'm crying now just to see a response to my thread. I'm not eating much. I haven't even brushed my teeth today.

Maybe if I took an extra dose of my antidepressant. Maybe if I had some wine with food. Maybe if I took a pain pill. I just want to change how I feel.

My boyfriend is having a harder time walking. I don't get to go home because he is needing more snd more help. The two programs that were supposed to provide care for him aren't working out as they should have, so I'm not getting away for breaks like was supposed to happen.

My sister used to light up my life when she would call. Her life has gotten hard, and now it's depressing sometimes to listen to her. She's trying harder than I am.

I'm spending too much time in a rut. I keep rallying and doing good for short intervals, but can't sustain that. Keep slipping down.

[Misterpain]

Requesting a different provider is your choice, you or your insurance is hiring them to advise you , just like any other service you pay for, if you called a plumber and his high school age son who just took a shop class that taught him how to unclog a pipe would you pay for that ? , same thing at the doctors office with an advanced practice nurse , unfortunately many places are hiring these nurses because people don't complain and let them get away with it , you are paying for a physician don't accept anything less , I if they want to label you as a "difficult patient" that is indictment on them being less than ethical , in most states you also have the right to look at your entire record now including the formerly "private" doctors notes and to have a copy of your complete record , anytime you have a doctor change or leave a practice it's always a good idea to request a copy , any errors or ommisions found within or any personally conflicts that are noted in your chart can be combated by simply writing a letter of the facts and requesting that it be added to your record , under law they have to do it . So damn the torpedoes full speed ahead , if you are not your best advocate no one else can be , I have fired almost ever doctor in the town I live in for crossing a line , that I told them on day one not to go near and got the difficult patient label and to be honest it's a badge I am proud of , because when I go to out of town specialist for my care , they often don't understand at all what the label is about , because the doctor I fired was justified ,even last year when I had a stroke one of the nurses asked me why I go out of town for the majority of my care ? I told her don't get me started , it's a long story ,she leaned closer to the bed and said "I think I know what it is , I work with them day in and day out , I take myself and family out of town also , because these people are borderline incompetent and have a god complex" , I said that sums it up nicely .

I had a really good primary care doctor many years ago, primary care was not her first love in medicine , and there is no room to grow in this town ,so after being her patient for close to ten years she was offered a very prestigious position in geriatrics ( her first love) in another state , but she feared I would not get the care I needed from the guy that was taking her practice , she spent over 4 hours with this guy just on what a unique and special patient I am , and the care I need , he swore he would understood and would give me care equal or better then she had given me , he lied , she was not even out of town yet when he fired me from the practice , so I went to the chief of the physicians at the hospital to get what I needed this pissed said doctor off immensely, at that time hospitals still protected physicians who were a problem , so eventually I was asked to not return as patient to the entire network of hospitals , as I left I told them "if I do return , don't be here!" , the doctors I hired at another hospital network understood that I got a raw deal because of a jerk doctor , and have taken great care of me since, and anytime somebody does screw up I have no problem firing them and escalating the matter to a complaint about them to the medical board of there specialty as well as the Joint commission.

I know it's hard to make waves , but sometimes we have to do it , if you won't do it for yourself , do it for the patients who don't know they have choices !

Sorry to get on the soap box .

Also I don't know wear you are ,but all states have provisions for "respite" care to help caretakers not burn out , some places also have CIL, Center for Independent Living to provide aides to people with temporary or permanent disabilities , you can look into that for assistance with your boyfriends needs ,we cripples have away of finding things , if I can offer any help or more info feel free to ask .

Misterpain

[Rose76]

I get Vicodin for pain. Right now, my paramount concern is protecting my access to that. It hugely increases the quality of my life. Federal authorities are leaning on doctors to prescribe less narcotic pain medication. It may be only a matter of time before we get like Europe, where people can't get things like Vicodin. I've had a serious GI bleed, so I can't turn to anti-inflammatory medication. Doctors and all providers have a certain amount of latitude in deciding whether or not to prescribe pain killers. Alienating a provider is a good way - I believe - to find oneself cut off from getting a med like Vicodin.

I'm not shy about advocating for myself. But I know I can't browbeat a provider into caring about me. Getting into an adversarial stance isn't going to endear me to anyone. Having a decent reputation in the eyes of providers at my clinic is important to me.

I'm a retired nurse. I know that professionals tend to close ranks against anyone they see as hostile, so I'm trying to keep things friendly. If a health problem comes up that I feel is over my PA's head, I can ask to see an MD. Actually, the non-MDs can be pretty quick to order diagnostic tests because they are looking to validate their guesses.

Watching my S.O. gradually deteriorate is sad. I've been caring for him, since 2013, at least. I dread losing him. I'm plugged into every source of help there is. Home health aides that we've had have all been very nice, but they are limited in what they can or will do. These attendants need a lot of direction.

I'ld been with my doctor for over 5 years and gone through a lot over that period. It takes a while for a provider to know a patient. I'm old enough to have developed a number of significant health issues. I don't quite know why I'm feeling so insecure with this new provider. I'm picking up that she herself seems not real secure.

For a family practice office to have NPs and PAs is great IMO. They are effective "extenders" of attention to patients. When you suddenly need to see someone real soon, but the MD is booked up for the next two months, these auxilliary providers can be very adequate. I was using them from time to time, even when my doctor was still with this practice. Then my doctor would review their notes and he'ld know what went on, even when it wasn't him I'ld seen. As Misterpain points out, there is a vast difference in the training of a doctor and these other providers. In talking with her (my PA) the other day, I found myself doubting her competence. I flunked a urine drug screening test that came up "dirty" for benzodiazepines. (This is required to get Vicodin.) She seemed to think this was due to a nasal spray I was using for allergies. That's just nutty because those two types of meds aren't closely related. I had been on a benzo some months ago, and it's possible that it wasn't fully cleared out of my system. But she struck me as confused in her efforts to figure out how what could have happened. She wasn't being accusatory toward me, which I appreciated, but she seemed so flumoxed.

I think PAs do best as auxilliaries to MDs in specialty areas. They have a more limited territory to become familiar with. Though they are lower paid, general practitioner doctors have to have knowledge ranging over a vast area. In that respect, they almost have to be smarter than specialists. General practice, IMHO, is just too broad an arena for a non-physician to be wandering around in. They get familiar with what they see commonly. But they become like a deer looking into headlights, when something is not a routine problem. Medical schools and residency programs must have a system for weeding out candidates who aren't really geared toward independent critical thinking. Nursing programs, by contrast, tend to inculcate a follower mentality. You strive to do exactly what you're told. You are not rewarded for arguing. How PAs are trained I have no idea.

For 3 days I've cooked dinner, but haven't wanted to eat myself.

[Clara22]

I am so sorry. It is hard for my head to buy in that a PA could be your primary care provider. I cannot get how the system has degenerated in this way. When I was in the US for a short period of time I had a PA Leading my care and it was a bad experience. One day, after my visit to her I asked her to write a note for me to be hospitalized. She said no, and sent me home with a prescription. Then I asked the nurse and I was in such a condition that the nurse got the note for me. Then I asked the receptionist to call an ambulance for me . She said I could take a cab. I said the wheelchair cab would take 2 hours to arrive. So, I took the metro and then the bus. And I went to the emergency room. Then ER nurse was alarmed by my vital signs and hurried for me to be seen by the ER doctor. And the doctor asked me: is it true that you came by yourself by metro and bus? You are in septic shock!
I had been going to see the PA for a while and called 100 times. And in the last visit I said to her: i am not well at all, I think i need to go to the hospital, but she thought it was too early for that.
Before I had not satisfactory exchanges with PAs but that one was the worst one.
But, as you said, in the current system, it is not so easy to change and get an MD.
I really wish you can manage to get an MD.
Sending you a hug

[Misterpain]

Don't worry Clara Healthcare has gone to hell here , I got thrown out of my doctors office last February(2016) well having a stroke , it's all screwed up over here , things that you can't make up . And it's only going to get worse ,much worse with the new president , he want to cut almost all social care programs and destroy the environment, but build up the war machine , make more nuclear weapons and is turning our allies into enemies.

[Rose76]

My Lord, Clara, that story is horrifying. You know - you've got me thinking . . . and I'm starting to see real potential for weakness in the experience of a PA. Even an ordinary nurse, like me, spends a vast amount of time in the presence of very sick people. In that sense, a PA might have less real trench experience than the average nurse. Working in an office setting, most of the people you see are reasonably well . . . well enough to get to the office.

My boyfriend became septic once. It is horrifying. I slept outside the ICU for fear he wouldn't last the night.

I hope you will consider, Clara, that you yourself can call an ambulance anytime you feel you need one - in the U.S. But it is intimidating to be in an office setting and get told you don't need emergency transport to the E.R. Good that you had the sense to get yourself to an E.R.

Sometimes, it's surprising who has the most sense. Last time I was in the E.D. with a bad belly ache, it was a paramedic who advocated for me, as she thought that everyone, including myself, was minimizing the problem. She leaned on a doctor to send me for a CT scan. Turned out I had diverticulitis, which this paramedic was the only one to suspect. I bow before paramedics . . . and, even, EMTs. They spend so much time "in the trenches" so to speak. I fear that PAs are too dependent on book learning.

That's how this PA comes across to me. She seems to be trying to figure things out in her head, using logic, and I wonder what constitutes her experience.

I will wait a bit and see what develops relative to this drug test result. It occurred to me today that I had a benzodiazepine during an endoscopy some weeks ago.

If I am told I have to accept a PA, I might go to a different heslthcare system. But I'ld have to wait till Jan. 2018.