I'm gonna need a new PCP

[Clematis]

I warn in advance that this post is a bit of a pointless frustrated whine. If you’re short on time, move along, not much to see here.

My annual physical was last week. I’ve been going to this PCP for 3 years but never cared for her as I always felt she harbored a contempt for the obese. Because of this, I have refused to ever step foot on her scale and give her ammunition. Besides, the scale is in the middle of a busy hall where anyone can see, for crissakes. I’m sensitive about my weight. I’d rather have a public pelvic than a public weigh-in. I left the PCP I had before this one for much the same reason — that one found a way to blame everything on weight, even scary, life-threatening side effects from statins.

So back to my physical. I led with my plan to get self-pay WLS, specifically the duodenal switch. I don’t know what I was hoping, maybe that with her disdain for my weight, when I said WLS she’d say, “That’s terrific! I’m so glad you’re taking charge.” or something encouraging. Instead she said, "in my experience, WLS is only successful 32% of the time. I don’t recommend it to anyone.” I could tell she was unfamiliar with DS and asked her if these unsuccessful patients she was referencing were RNY. “I haven’t had many patients who have had WLS, never had a RNY patient,” she said, "but the surgeries are all about the same.“ [I suppressed the urge to guffaw.] “You need to figure out why you’re overeating and make your mind up to stick to a healthy diet,” she continued, "The weight loss drug Belviq has helped my patients take off some weight.” I told her I had been dieting since before she was born, had “successfully” taken off 80-100 pounds several times but it doesn;t stay off. With my co-morbidities of borderline diabetes, high blood pressure and high cholesterol, I said I believed the duodenal switch was best for me. I declined her Belviq prescription.

If you’re still with me on this wandering whine, let me recap: I have a PCP who could try to block my DS. If I use a surgeon who does not require PCP approval (ie, Mexico), my PCP could refuse to manage the aftercare. Here I am agonizing on whether to go out of state or perhaps even to Mexicali for a DS, and I’m at a standstill without a PCP who will pick up the ball after surgery.

I know I know, you’re thinking, damn girl, why not just go get a new PCP? But that’s not so easy to do. Almost all doctors around here are employees of the two major hospital systems. Gone are the days of the independent docs in a small office who can admit to several hospitals. You kinda have to pick the hospital system and then pick a doc within that system. The doctors’ offices are attached to hospitals (so they can bill insurance a $95 facilities fee in addition to the sky-high medical care costs) and within these are specialty departments with a floor of PCPs (internists or family care). If I leave my PCP, I’d end up with a PCP in the same office which could be awkward, if they'd even take me on. Also awkward is making a chat-only appointment with a prospective PCP at probably $300 a pop, and the possibility of having to interview several docs. (Insurance wouldn't cover something like this — I just had my physical. And just walking in the door incurs a $95 facility fee.) There are docs outside these two major systems but they only admit to charity-type hospitals — not somewhere I would want to be a patient. They do not perform the DS in these hospitals so having an ER visit for a DS complication would be unwise.

The PCP I have now was referred by a close friend who, astonishingly, likes her. My friend is thin so she doesn’t get the reptilian half-lidded look from a doc with fat disgust. Every one else I know has little respect for their own PCP. (Side note: There is something really disturbing about the decay in the quality of PCPs in the last decade or so. I don’t think the field attracts the sharpest scalpels in the drawer any more.) So if I can’t depend on nonexistent referrals from friends, how do I find a new PCP? How can I do the first round of vetting a PCP and find one amenable to WLS without dumping hundreds or thousands of dollars in meet-n-greet appointments?

No easy answers.

I return you now to your regularly scheduled forum...

 

[DianaCox]

Have you seen the PCP letter?
http://bariatricfacts.org/threads/talking-to-your-pcp-about-the-ds.9/

 

[Clematis]

Thanks, Diana. Yes, I had seen that and printed it out for future use. Once I get in front of a PCP who doesn't categorically say no to WLS, I will discuss all those points.

BTW, yesterday I joined OH for the specific purpose of contacting a member who has had DS at the Cleveland Clinic and lives somewhat near me to ask if he would recommend his PCP. I think I'll check out the boards looking for other DSers in my metropolitan area.

 

[Larra]

On the other hand...
While this is obviously a far less than perfect approach, if this ignorant and prejudiced pcp is willing to order post-op labs for you despite her ignorance and prejudice (and disdain and other negative qualities) she's better than nothing. And while it is NOT your personal responsibility to educate her, she might actually learn a thing or two from seeing your success, of which I have absolutely no doubt.
Pretty sad though when the best thing we can say about a pcp is that she's better than nothing.

 

[Settledownnow]

You might also trying going to one of the support group meetings through Cleveland Clinic and meet others and ask about their PCP.
I would also have an honest conversation with the doctor about the need for privacy when getting weighed. At the same time, you need to realize that the scale just gives a number and work toward getting past feelings of shame related to your weight.

You may not like this answer, but also consider everything your doc had to say about WLS very carefully with regard to healthy eating and figuring out why you are eating. If you are not already done so, work on improving your eating habits by reducing any emotional or binge eating, tracking your food intake, and exercising. You will need to change your eating habits with WLS anyway so you might do that as a way to appease your doctor and strengthen your case for WLS.

 

[Nosh Spice]

@Clematis, I'm in a similar situation. My PCP is generally biased against bariatric surgery, so when I brought in diagrams and Diana's letter, he felt broadsided. It sucks to have to find a new PCP because of building a new relationship, most can't see me until next year, etc. Call your closest DS surgeon's office and as mentioned, find support group members nearby and ask for their PCPs. Neither of those tactics worked for me though.

In my case, I have a great dietician who knows something about the DS. She referred me to a physician in the area who specializes in weight management and supports bariatric patients, including other DS patients. I met with him yesterday and the plan of attack we can up with is to go back to my PCP and request a consultation to the new Dr as a specialist. That way I have another professional in my court to help me persuade my PCP, and can keep my PCP for all the other stuff I have going on.

 

[Kassandra]

@Clematis - Have you done a basic Google search for your hospital name + bariatric PCP or some such combo of terms? Hospital name + weight loss surgery referral, Hospital name + duodenal switch surgeon, etc.? It might pull up some links that include a Dr's name, or even a message board somewhere that can at least give you a starting point for others in your area. At least as a start. You might just also call that Cleveland clinic and ask if they can suggest a Dr. at your hospital that they often get referrals from.

 

[Clematis]

You might also trying going to one of the support group meetings through Cleveland Clinic and meet others and ask about their PCP.

Great idea.

You may not like this answer, but also consider everything your doc had to say about WLS very carefully with regard to healthy eating and figuring out why you are eating. If you are not already done so, work on improving your eating habits by reducing any emotional or binge eating, tracking your food intake, and exercising. You will need to change your eating habits with WLS anyway so you might do that as a way to appease your doctor and strengthen your case for WLS.

Her point wasn't that I had to prove I could eat healthy before she'd approve WLS, rather that WLS doesn't work so she will never approve it and that only diet and exercise achieves weight loss.

@Clematis, I'm in a similar situation. My PCP is generally biased against bariatric surgery, so when I brought in diagrams and Diana's letter, he felt broadsided. It sucks to have to find a new PCP because of building a new relationship, most can't see me until next year, etc. Call your closest DS surgeon's office and as mentioned, find support group members nearby and ask for their PCPs. Neither of those tactics worked for me though.

In my case, I have a great dietician who knows something about the DS. She referred me to a physician in the area who specializes in weight management and supports bariatric patients, including other DS patients. I met with him yesterday and the plan of attack we can up with is to go back to my PCP and request a consultation to the new Dr as a specialist. That way I have another professional in my court to help me persuade my PCP, and can keep my PCP for all the other stuff I have going on.

I'm the type who often shows up with reams of research reports despite the fact that every doctor has declined to look at it. This doctor would be no different.

The funny thing is, the Cleveland Clinic is a huge proponent of WLS and even suggests and pays for it for their own employees, so my PCPs stance is tantamount to insubordination.

@Clematis - You might just also call that Cleveland clinic and ask if they can suggest a Dr. at your hospital that they often get referrals from.

The clinic moves s-l-o-w-l-y. In the time since I called and have been waiting for them to send me their welcome materials (still hasn't arrived and I have called back twice), I called and was seen by a bariatric surgeon at another hospital system (but they don't do DS.)

 

[Charris]

I am so happy to have gotten my pcp. She knew zilch about wls. She took the stand that she was willing to try and learn. She set my chart up so that anytime anything went in it it Sent dr. K a copy. She was like and whatever he needs me to do have him just shoot me a message.