Skittish physician

Help Support ValveReplacement.org:

Protimenow

Well-known member
Joined
Aug 10, 2010
Messages
3,580
Location
California
There are other, similar, threads all over this forum, but I am adding one more.

My new HMO required that I pick one of the doctors in a medical group that I'm stuck in.

My new PCP isn't too bad, but yesterday he told me that he has a problem with prescribing Warfarin. I told him that I've been self-testing and self-managing for more than ten years.

This didn't matter to him. He wants me to go to an anticoagulation clinic about five or six miles from my home. He doesn't want to have anything to do with Warfarin. My history of testing and managing didn't matter to him.

I may get refills from my former physician (if his office staff will call them in) and plan to get as many refills of those that haven't expired, so I can continue to self-manage.

I wiil probably be contacted by this 'clinic' and may go there to assess how they do it. If they use a CoaguChek, maybe I can talk them out of some strips so I can test at home. Maybe they'll give me a meter and strips, so I can self-test at home. It'll be interesting to hear their advice and their recommendations on frequency of testing. I'll have to remember to show up, acting ignorant about testing and management (probably hard for me to remember to do) until I see how their system works.

But it's annoying that this doctor is uncomfortable prescribing Warfarin. (Yeah, I sort of get it, because he doesn't want to accept liability if something happens - he'd rather transfer that liability to a clinic, and doesn't want to worry about how I self-test and self-manage). As long as they don't want blood draws, I'll probably put up with occasional trips to a clinic.
 

tom in MO

Well-known member
Joined
Jan 17, 2012
Messages
1,372
Location
MO USA
To me it's a revenue stream for the clinics. If you test at home and self dose, they can't charge for anything other than your yearly checkup. If you use the clinic, and you are on Medicare, they can charge Medicare a monthly fee for managing your warfarin.

Medicare allowed routine charges for warfarin therapy a couple of years ago and I suspect recently they started allowing a monthly flat fee. I am not on Medicare, but when my clinic started routine charges, the head nurse told me they changed their policies because Medicare allows them to charge and they treat all patients the same. Recently my clinic changed billing practices again and wants to charge me $30/month whether or not I call in once a week or once a month. I still pay for my own home testing supplies.
 

MrsBray

VR.org Supporter
VR.org Supporter
Joined
Nov 2, 2013
Messages
287
Location
Clearwater/Tampa FL area
I choose to NOT let my PCP take care of my warfarin. They could do it for free - but it would be a blood draw, no nurse to talk with, and a delay in the results. And I don't want to self-test. So I self-pay at my cardiologist's coumidin clinic (it's just a nurse in the office). Costs me about $28 a visit, and I get a finger stick, instant results, and a chat with the nurse. I go every 6ish weeks. It's worth it to me.
 

Protimenow

Well-known member
Joined
Aug 10, 2010
Messages
3,580
Location
California
EVERY SIX WEEKS? That's dangerous and foolish. Is it worth it to you to risk having a stroke because you wait six weeks for a retest? If THEY recommend every six weeks - they haven't kept up with standards for anticoagulation testing.

Personally, I'd have serious problems with anticoagulation clinic that recommends testing every six weeks.

I can understand that you don't want to self-test. Some people can't do it themselves. I understand not wanting your PCP to manage the warfarin dosage, but I have real issues with the gap between tests. It's unsafe.
 

AnnieP

Member
Joined
Feb 14, 2017
Messages
21
Location
I have noticed increased SOB last 12 months and ai
There are other, similar, threads all over this forum, but I am adding one more.

My new HMO required that I pick one of the doctors in a medical group that I'm stuck in.

My new PCP isn't too bad, but yesterday he told me that he has a problem with prescribing Warfarin. I told him that I've been self-testing and self-managing for more than ten years.

This didn't matter to him. He wants me to go to an anticoagulation clinic about five or six miles from my home. He doesn't want to have anything to do with Warfarin. My history of testing and managing didn't matter to him.

I may get refills from my former physician (if his office staff will call them in) and plan to get as many refills of those that haven't expired, so I can continue to self-manage.

I wiil probably be contacted by this 'clinic' and may go there to assess how they do it. If they use a CoaguChek, maybe I can talk them out of some strips so I can test at home. Maybe they'll give me a meter and strips, so I can self-test at home. It'll be interesting to hear their advice and their recommendations on frequency of testing. I'll have to remember to show up, acting ignorant about testing and management (probably hard for me to remember to do) until I see how their system works.

But it's annoying that this doctor is uncomfortable prescribing Warfarin. (Yeah, I sort of get it, because he doesn't want to accept liability if something happens - he'd rather transfer that liability to a clinic, and doesn't want to worry about how I self-test and self-manage). As long as they don't want blood draws, I'll probably put up with occasional trips to a clinic.
Ask to either change doctors and or sign a disclaimer for self testing it is your body and your choice
 

mecretired

Well-known member
VR.org Supporter
Joined
Apr 28, 2010
Messages
222
Location
Southeast Missouri, USA
Just FYI to those who don’t know—-I have Medicare and a Medicare supplement. Medicare covers the Coaguchek xs, all strips for weekly testing and the single use t-shaped lancets. They also cover a $20 monthly charge by my cardiologist. My supplement picks up deductible and copay. I can’t imagine doing anything other than weekly testing.
 

Protimenow

Well-known member
Joined
Aug 10, 2010
Messages
3,580
Location
California
I had seen the item about Medicare covering the cost of a meter and strips. My doctors didn't seem aware of this.

Now, I may take AnnieP's advice - I've been self-testing for more than a decade.

I'll see what my HMO's clinic has to offer. Maybe they'll set me up with a meter. I have a CoaguChek XS, but a new meter and supplies wouldn't hurt (I can't afford the strips right now). I will be able to occasionally compare results to my Coag-Sense, if I get a supply of CoaguChek strips.
 

Protimenow

Well-known member
Joined
Aug 10, 2010
Messages
3,580
Location
California
AnnieP - is there a basic disclaimer form that you're aware of, or do I just write something and give it to him?

My body, my choice - but MDs are gods who know it all....
 
Top