Can I find a different doctor?

[Desert Dancer]

I thoroughly despise my nephrologist. She's an incurious, lazy prescription jockey who doesn't want to hear anything from me unless it's directly related to dialysis. I'm sick and tired of going to her with things that are obviously kidney/dialysis related and her saying, "Oh, I don't think it's that" and "Oh, I don't think this has anything to do with it". Really? Then why don't you come up with some freakin' ideas of your own, beeyatch? All she's interested in is doing the least amount of work she can for what Medicare pays her; the only props I can give her is that when I come up with solutions she pooh-poohs them but does at least change her orders to match whatever it is I've decided to do. It's not enough. I really need to find a doctor who will help me dig for solutions and not just pawn me off on everyone else.

Am I stuck with the doctor that comes with the dialysis center? I really, really want to start searching for a new nephrologist but I'm not sure how it works as far as Medicare, DaVita rules, etc.

Does anyone know?

[cattlekid]

You are doing home hemo, correct?  I am on home hemo with DaVita.  I do not see the nephrologist who is the medical director of the center, I see my own personal nephrologist.  I had no problem with that, other than having two appointments each month, one with the clinic nurse and one with my nephrologist.  My clinic nurse sends a report to my nephrologist each month prior to my meeting with him, and she has to get signoff on any prescription changes from him as well. 

I find it's an ideal setup, as I get to continue to see a nephrologist that I love and who I can work with easily.  It's more work for the clinic nurse, but since she only has three home hemo patients at my center (!), it's no skin off my nose. 

[Desert Dancer]

Yes, I do home hemo; my clinic is a home training/self-care clinic, so almost all their patients are at home.

I have to see the clinic doctor once a month and my nurse once a month (two separate appointments, ugh). Are you saying that you see your own nephrologist once a month and that substitutes for seeing the clinic doc once a month?

You're with DaVita so I imagine it should be the same for my clinic. I forget, are you on Medicare? They like to throw out "Oh, those are Medicare rules" when in fact, most of the time they aren't.

[amanda100wilson]

could you switch to another doctor who has admitting privilages to your clinic.  when I switched clinics a while ago, I wanted to keep my doctor, so asked if he could get privilages at that unit, which he did.  maybe you could find another doc. and ask if he would do that?  it is a paperwork excercise.

[MooseMom]

I've been following your saga for ages, and I agree that you need to find a new neph.  Your current one is just a waste of space.  I have no idea of how you go about doing it, but you certainly have my support (as if that's worth very much, if anything at all).  Please keep us updated on your progress.   

[Desert Dancer]

could you switch to another doctor who has admitting privilages to your clinic.  when I switched clinics a while ago, I wanted to keep my doctor, so asked if he could get privilages at that unit, which he did.  maybe you could find another doc. and ask if he would do that?  it is a paperwork excercise.

That's the whole thing. First I have to find a neph who will take me on as a patient, THEN I have to figure out how to approach my clinic with it. I don't know whether they'll co-operate or not. I'm fairly certain the first thing they'll do is tell me it can't be done; they still haven't figured out that I'm not just going to swallow the BS they try to feed me. They act as though they don't even know the CMS website exists.

[cattlekid]

Yes, you are correct.  I've never seen the clinic doc.  Apparently, he is aware of my existence and has put in his two cents about my progress here or there but my own neph has the final say on all changes. 

Good point about Medicare.  I just picked up Medicare secondary because I am THISCLOSE to transplant.  I didn't want the extra expense of the Part B premium before when it wasn't cost effective.  Don't know if it's Medicare rules that you have to see the clinic nephrologist.  I will be highly incensed if I have to change nephrologists when Medicare becomes primary.  Hopefully, since that won't be until a year from now, dialysis will be a faint memory by then.

Yes, I do home hemo; my clinic is a home training/self-care clinic, so almost all their patients are at home.

I have to see the clinic doctor once a month and my nurse once a month (two separate appointments, ugh). Are you saying that you see your own nephrologist once a month and that substitutes for seeing the clinic doc once a month?

You're with DaVita so I imagine it should be the same for my clinic. I forget, are you on Medicare? They like to throw out "Oh, those are Medicare rules" when in fact, most of the time they aren't.

[amanda100wilson]

my experience is hat the clinic doesn't mind having another doctor sign up with them.  more potential patients,  more potential money.

[justjen321]

For some reason, I can't send a private message to you DD.

What's the biggest city near ya?

[Lillupie]

If you have to change, it is YOUR right to do so at a clinic that offers your modality. Dont let a clinic bully you into staying or not letting your transfer.

I dont know why it seems that dialysis patients they always wanto to give them a hard time for changing,a nd it is ONLY dialysis patients who have to deal with this.

Lisa

[malaka]

You've got to understand the doctor mentality.  It starts in grade school he/she is the kid who always has his/her hand up and revels in being called on and giving the correct answer.  In college its the kid who sits in the front row of a lecture hall class. 

Fine for them so far.  And fine for the majority of patients--the doctor still revels in the right answer -- i.e. the patient recovers.

For dialysis patients, we're the wrong answer, the failures. Kidney disease wasn't reversed for halted in its tracks.  We ended up in KF despite the doctor doing eveything he or she could. 

Each time you are seen, the doc is reminded of the time she gave the wrong answer in class, at least subconsciously.

So, you'll be lucky to find a nephrologist who really enjoys treating dialysis patients who, after all, failed treatment. 

I'm one of those patients, so don't think I'm knocking you. 

It takes a special type to be a nephrologist to dialysis patients, as it does to be an ocologist treating inoperable lung cancer, pancreatic cancer, etc.  Your "attyboys" are few and far between.

[Desert Dancer]

For some reason, I can't send a private message to you DD.

What's the biggest city near ya?

That's strange, my mailbox isn't full. You can email me at: a  n  d  y  s  g  r  l  AT g  m  a  i  l  DOT  c  o  m if you like. I'm smack in the middle of Phoenix.

If you have to change, it is YOUR right to do so at a clinic that offers your modality. Dont let a clinic bully you into staying or not letting your transfer.

I wish it were just a matter of changing clinics but it isn't. I can't change clinics. This is the only one in the state offering nocturnal. My problem is staying with the same clinic but changing doctors.

Malaka, you make great points but if they can't refrain from taking out their feelings of inadequacy on their patients maybe they're in the wrong business. Maybe I just expect too much.

[justjen321]

Damn, I was hoping to point you to a Wellbound.

I disagree with the above assessment of Nephrology. Kidney patients haven't failed. Nephrology is LARGELY centered around kidney disease, dialysis, etc. Nephrologists KNOW going in they will be dealing with patients in a variety of stages of kidney failure, and that many will be on or end up on dialysis.

Desert Dancer, I hope you do find one who will be a partner in your care with you. I started trying to research it on my own, but am struggling to do so for lack of correct search terms. I still plan to poke at it. SOMEONE out there has to be progressive and willing to partner with you.

As for them working with your clinic, I'm unsure HOW that works, but I plan to ask when WE go in for clinic.

[Schulthess]

  Sure you can find different doctor.If you are not satisfied or feel well the current dialysis.

                          Every where a lots of doctors / clinics are available.You are free to change physician as per your requirment.


Thanks