F*ck my doctor, all he is is a bloodsucking idiot

[Kitsune]

One more example of the doctors not checking our charts: My best friend goes to the same center I do. Well, about two months ago, she landed in the nursing home with two broken hips. The idiot nursing home doctor never saw her once and prescribed her some pills. One of them was a diabetic pill. My friend is not diabetic, so she called our doctor to tell him these had prescribed, and do you all know what our doctor said, "Oh, keep taking them, they are good for you.", which is a lie because taking medicine is not for your condition can make things worse. So, now we are leery of taking any medicines this quack says are good for us. 

But then, why the hell should these doctors care? If they make us sicker, that means we have to stay there at their dialysis center longer because we will not be healthy enough for transplantation. That's more money for them. Whatever happened to the "Oath To Do No Harm." Oh, right, I forgot, that would be an oath to do harm to their bottom line. The more dialysis patients they lose, the more money they have to spend to put an a dog and pony show to get patients to come their center. It's funny that our doctor has money to spend on cruises and going on picture-taking safaris, but yet there's no money for tissues and crushed ice. Either, he's just paying for basics that the law requires and taking the rest of our blood money, oops insurance reimbursement for his own use or tissues and ice machines have gotten REALLY REALLY expensive.

I say it's the first option, but hey what do I know? To them, I should be just a simple, mentally deficient little dialysis patient who reads those godforsaken Captain Binder comics they put in the Fresenius newsletters (that they leave out for people to read, only to throw them all away a month later because no one likes them), who thinks that even one of those people actually gives a f*ck about me ,and gets inspiration from those people who have been at the center forever and will never get a kidney no matter what they do but keep hanging on even though they get sicker and sicker each day and says, "Gee, if only I could be like that happy,sedated old lady over there who lies in her own blood as her needles come out. She's lived on dialysis 35 years!! Never mind she can't even sit up long enough to use a wheelchair, let alone leave her bed except to come here on a stretcher! She's alive and that's all that matters!", as I smile sweetly and let whoever wants to take a crack at it that day stick me, since "trainees have to practice on SOMEONE!". Well, guess what, those newsletters are full of outdated information, no one gives a crap, that old lady is basically a zombie, who wants to be that?, and you all can go practice on someone else, I ain't your pincushion, pally.

Man, oh man, I will jump for joy when I get my kidney because that means I'll have a nephrologist who actually listens to me. I've met the one I'm going to have already, and he really seems to give a damn. When I do, it'll be bye bye quack, hello freedom.

[Hawkeye]

Not that I disagree with anything else you said I just wanted to clarify that the Neph's have absolutely no control over the supplies used or provided at a clinic unless it's a privately owned one.  The Neph's at your Fresenius clinic perscribe the parameters for your treatment and the medications you should be on and thats about it. The only items used during your treatment they have control over are your dialyzer and bath which have to be perscribed to be used. They are more or less a consultant of Fresenius.

[okarol]

It might be my own misconception, but it seems that some Neph's who are associated with dialysis clinics do not have much of a private practice, so they are available to be hired by a dialysis chain.

[flip]

they also usually have a piece of the action too

[Robby712]

None of my dialysis Nephs haven been as outstanding as the docs I had when I pre and post (my first) transplant.   They just seem to show up once or twice a month, shift your dry weight, ask if you have any problems and then move on.  God forbid you have something actually wrong with you.  

I actually shifted to a dialysis unit outside of the one that was run by my particular hospital 9 months ago (15 minutes away, but 15 minutes closer to home) and my neph was supposed to come out once a month.  In 9 months he's been there twice.  (He actually complained about the drive the first time---uhhh...hello, I drove 30 minutes 3 times a week for 2 years.  You can drive 15 minutes once a month)

I'd also pay $100 bucks to the first dialysis neph that I actually saw give a "physical" exam to someone.  

I think the problem for most of them is this:  75-90% of their patients will NOT get better.  All they can do is maintain a certain level of health and in the mean time use dialysis as a form of life-support.  I get the feeling once you're on, and established...then they can't do much for you.  Also, the number of people that just refuse to follow the fluid, diet, medical restrictions, etc...has to be frustrating.

Also, depending on your location, I think many of them are overwhelmed with the number of patients they are responsible for.  When I was going to in-center in the city (St. Louis)  the place was always packed.  They had 2 nephs responsible for 300 or so patients.   Being a teacher in charge of 150 a year myself I understand how EVERYONE wants you to remember their particular issues, and EVERYONE wants special attention, and EVERYONE wants a chunk of your time.  It just cannot be done.  One person cannot remember specialized info for 150 people.  You start to generalize problems that many have and apply general "fixes"...and sometimes it works and sometimes it doesn't.  The difference is in high school ceramics they stakes are much higher.

I think one solution is finding a GOOD primary care doc that is aware of your medical issues that will communicate with your neph if and when you need something that falls outside of the range of the typical dialysis related problem.  Even if it does, if your neph igores you...go see the PC Doc.

Glad to see I'm not the only one...

[monrein]

I know this is quite easy to say and not at all easy to do especially when feeling sick but I feel I need to say it anyway because it is how I've tried for about 30 years now to manage this whole ESRD thing.
I am my own case manager.  I need to know and fully understand (of course this takes time to do and should be seen as a process or a steep learning curve) all of the interconnecting issues that affect me as a renal patient and I need to push and advocate on my behalf to have my needs met.  My neph is a member of my team and I try to be respectful of his time by doing my research ahead of time so that my questions are clear, by making a list  so that I don't forget any of them and if necessary I take notes about his answers so that I can research it more afterwards and be sure I FULLY UNDERSTAND what the answer means and how it fits into my overall health picture.  If I don't have a clue what a doc is talking about, I say something like "Could you break that down a bit for me, I'm not clear on how that works". Then I have to take responsibility for  doing everything in my power to keep my quite abnormal system in the best possible shape I can.  I have had really good success with this approach at building good relationships with the nurses and doctors.  They are my consultants as I see it.  I would also not hesitate to let one of my team know if I felt dismissed, infantilized or treated with disrespect.  These are just people, human, fallible people and they WILL make mistakes.  I expect them to and my job is to understand how all these pieces fit together because then I have a chance of catching the mistake myself.   When a medication change is suggested I say that I need a little time to research it and let them know if I have questions or if it seems like a good idea.  Recently a BP meds change was suggested but the neph wanted to cut different ones than I thought he should , so I said so, told him why I thought what I did and he agreed that my idea made better sense for me.  I also told him I'd monitor the BP at home and if I was wrong I'd let him know and we'd try another route.

Doctors receive medical training but that training does NOT include any specifics about my make and model of the infinitely variable human body.  They are the experts on the human system in general, I am the expert on my system in particular and my responsibility is to provide further training to each member of my team on the the quirks, the idiosyncrasies , the weaknesses as well as the  triumphs of THIS PARTICULAR BODY.  To do that I have to be willing and ready to learn from them and run with it and I expect them to do the same.

If someone told me a med was good for me he'd need to be a lot more specific about why. 

[Stacy Without An E]

This brings up the issue of when was the last time any major disease or malady was cured?  Polio?  Smallpox?  That was back in the first half of the 20th Century.  I imagine there will never be a cure for any major disease ever again because those who supply the care and the drugs are making gobs of money off of our suffering.  I'm on seven different medications related to my Dialysis treatment.  Seven!  Each one costs anywhere from $10 to $45 co-pay.  Is it any wonder I don't own a house?

One of the three nephs in our clinic comes by maybe once a month.  If I bring up anything that I'm having trouble with they hem and haw and try to end the conversation as quickly as possible.  Then when I get my insurance statement, they charge $450 for two minutes of time!

That's $225 a minute. 

It's a scam, a ruse, a swindle.  And every Dialysis patient is worse off for it.

[monrein]

A system in need of major surgery I'd say.

[pelagia]

This brings up the issue of when was the last time any major disease or malady was cured?  Polio?  Smallpox?  That was back in the first half of the 20th Century. 

Many of the diseases for which we need cures today are far more complicated than those caused by infectious agents.  Research holds out the promise of genetic, cellular and immunological therapies in the future.  I remain optimistic.

[terry3004]

Geez...with all this slamming of doctors, I have to put my  in.

From what it sounds like I am in the minority.  My neph is awesome!!!

He has always taken the time to talk with me, check me out, do a "physical" check (lungs, heart, fistula).  He also makes sure that everything is working ok.  When I have a concern or question, he takes the time to answer in a way that I can understand.

Now, I can understand what everyone else is talking about, as I have had to deal with other nephs.  The clinic that my neph is with has a total of five nephs there.  When I was in-center the nephs are on clinic rotation and I would see a different one each week.  Each neph was different, and only two would really take the time to talk with me, a third one would somewhat talk with me, and the other two were simply "everything ok?  yes.  ok, bye."  Those nephs would be in and out within 30 min (about 10 patients). 

My neph would be there at least an hour, if not longer...he would bring a chair around with him at times to sit and talk with the patients.  Even the clinic staff at times would joke around with him, and he would joke back and the whole atmosphere at the center would be a lot brighter when he was around.  My neph actually would come in on Saturdays just so that his office wouldn't be bothering him so he could pay more attention to the patients at the dialysis clinic.  On top of that, he even showed up on July 4 last year!

Fortunately, now that I'm on NxStage, I only deal with my neph again and don't have to go through the "rotation" I was going through before.  His office does run behind at times, but normally not more than about 20 minutes and this is because he is so detailed with his patients and the person booking the appointments uses the same time block for all the nephs in the office.  I have no problems waiting because I have a neph that takes his time.

I know that there are a lot of doctors that don't pay that much attention, but there are some out there that do.  When you find one, hang on to them, and you will be the one that benefits the most.

[monrein]

My nephs are also amazing Terry and I've had several.  They are caring dedicated and knowledgeable.

[flip]

I like my neph too but I only see him about 3 minutes a month. He looks at my charts, listens to my lungs, and says " keep up the good work". The Nurse Practitioner makes rounds weekly and does a great job. I get all my meds and stuff through her.

[del]

Hubby and I are much like you monrein - we question things.  Any new meds they wanted to give in center we always researched. His bath got changed once when he was in center by mistake. It was changed for someone else not him but written in his chart. He noticed it the first day and asked why. When they checked they discovered the mistake. In December we found out that hubby's triglicerides were 5 times what they were supposed to be. First thing they wanted to do was put him on meds for it.  He made a big change in his diet and within 3 months the results were back to normal.  The dilaysis nurse said when I called to get the results that the pills really worked.  I started to laugh and confessed that he had not taken any of the medication.  Guess he didn't need it. 

[Jess21]

This brings up the issue of when was the last time any major disease or malady was cured?  Polio?  Smallpox?  That was back in the first half of the 20th Century.  I imagine there will never be a cure for any major disease ever again because those who supply the care and the drugs are making gobs of money off of our suffering.  I'm on seven different medications related to my Dialysis treatment.  Seven!  Each one costs anywhere from $10 to $45 co-pay.  Is it any wonder I don't own a house?

One of the three nephs in our clinic comes by maybe once a month.  If I bring up anything that I'm having trouble with they hem and haw and try to end the conversation as quickly as possible.  Then when I get my insurance statement, they charge $450 for two minutes of time!

That's $225 a minute. 

It's a scam, a ruse, a swindle.  And every Dialysis patient is worse off for it.

That's not too bad.  My insurance gets charged $686 a time for dialysis. ($3.05 a min it comes up to for my 3 hr 45 min session) My insurance just got charged $648 for the neph at my clinic for the month , and he just looks at my chart and says hi and bye 90% of the time.  If you're sleeping when he comes, he doesn't wake patients up.  Last week I slept through his visit.  That was one expensive nap.
At least because my mom and I both have had surgery this year/our meds/my dialysis and biopsies, we've paid enough to go on "catastrophic" so we don't pay co-pays or for any meds.  Thank God, cause I'm on Sensipar.