"Treat the disease, you win some, you lose some. Treat the patient, you always win."
~Patch Adams~

Saturday, April 21, 2012

The Doctor Will See You-If You're Quick

In my communications with patients who are seeking bioidentical hormone care, I too often hear horror stories about how they have tried to get their primary care physician or gynocologist to listen to them about their menopausal symptoms. They are exhausted, gaining weight, "addled" (cognitively impaired, often worrying about early onset dementia), have insomnia (which makes the exhaustion during the day even worse), have no interest in sex, and have hot flashes/night sweats that are absolutely debilitating. Half the time patients can't even get the entire list of symptoms out of their mouths before the doctor reaches for the prescription pad to write out an order for either Premarin/Prempro (horse urine---drug not a hormone) or an antidepressant. They are then told that to lose weight they must simply eat less and exercise more (never mind that you are exhausted, exercise anyway), hot flashes are "normal", as is loss of libido and memory loss. Check the side effects list for antidepressants----they mirror the symptoms of menopause---insomnia, loss of libido, weight gain, etc----but I guess the idea is that if you take the antidepressant you may still have the symptoms but you at least won't care any more. These exchanges in a doctor's office generally take about 10-15 minutes, then the doctor is out the door to see another patient. I know this is true because I have been though the mainstream medical mill.

I frequently hear patients complain that most of the doctors (including my own) who specialize in bioidentical hormone balance will not take insurance. I have done a number of posts about the myriad of reasons that BHRT practices do not take insurance, and one of the many reasons is that a physician cannot spend adequate time with a patient, getting a history, an exam, and discussing with the patient their concerns/symptoms in a 10-15 minute appointment, the time allotted for an appointment by practices that take insurance. It simply isn't possible, bioidentical hormone optimization is both a science and an art! Dr. Carr takes more time than that to just go over my semi-annual blood work with me, because it's important that I understand what my lab values mean and how they relate to my hormone dosing, my symptoms, etc. ------- and I am an established patient! I know he spends at least an hour with a new patient in his office. I was absolutely astounded when at my first visit with him he spent so much time going over my health history, asking me the reason I was taking each medication I was taking (he is huge into patient education, as are most doctors who practice holistic medicine), discussing stress level, and asking me what were my most pressing concerns. No other doctor had even come close to making me feel that "cared for", and my experience is very similar to many patients who seek care from a BHRT specialist.

The Daily Beast ran a rather lengthy article earlier this week on the subject of the doctor/patient relationship, and I think it's important reading, it will help those of you who are feeling very rushed and harried by your practitioner know that you are not alone. I know that now a 10 minute appointment with my former primary care physician, who wasn't listening to me, who ordered blood work an never discussed it with me (his stock answer was "normal", and only many years later did I discover I was severely hypothyroid) and did little more than add more medications to an ever growing list of pharmaceuticals I was taking) is no longer acceptable medical care, and I am far healthier because of it.

Have a great weekend, everyone, this is my first blog post from my new iPad (it's taken me a while to learn how to use this new app that will allow me to post directly from the iPad). It is taking me a little practice to figure out how all this works, but that's ok, it's a good "brain exercise" and helping to keep me cognitively sharp!