March 20th, 2013

more doctor bad service

Two years ago I was diagnosed with bipolar and put on Lamictal. It can have some really nasty side effects, but most are pretty standard. However, it has a black box warning for a rash. I was told by the LPN who prescribed it that if I had a rash, I needed to immediately stop taking the medication and come in to see her, or go to my GP if she wasn't available. The FDA's website says the same thing, and also lists "uncontrolled eye movements" as a stop-medication-immediately side effect, and the paperwork I got with the meds again said the same. This is important.

Last February, my dizziness got worse, and then I had an episode where I was sitting down but got really dizzy, and then my eyes wouldn't focus. They kept sliding to the left and then jumping back to the right, like I was watching something scroll by. It was quick and terrifying, and over in about two minutes, but that's a long time for something like that to be happening. And then the next morning I discovered a rash all over my inner thighs. I called the doctor immediately and made an appointment for two days later, and didn't take any more medication.

My lovely LPN had actually moved out-of-state, so they had randomly assigned me to another LPN. She was HORRIBLE. She lectured me for stopping the meds, dismissed my dizziness and eye movements as MS symptoms (ignoring that even though my mom has it, I haven't yet been screened for MS, and it isn't even directly hereditary), and got really snotty about the rash, saying "we only worry about a rash if it's above the neck", which isn't true. The rash is worrying any time, especially if it's near soft tissue, and hey, the vagina is soft tissue. The rash was only about two inches away from soft tissue, that's not good. That all took about fifteen minutes and then she told me that I could go get a physical if it would make me feel better, and that I should do that if I was going off meds, then she spent the remainder of the appointment on the phone with the county mental health services, trying to pass me off to them because I don't have insurance. After two or three appointments with the county, I learned that I'm not enough of a risk to qualify, so I'm currently without care for my mental illness, but that's a different story.

It turned out that everything was a fairly benign (if uncomfortable) allergic reaction. I was confused as to why I'd suddenly have an allergic reaction after 9 months on that same medication, but it turned out the pharmacy had started using a different generic. But it still fit all the sky-is-falling warnings that I'd gotten from three different sources.
Fire Rose

Doctor's office suck

My doctor is pretty awesome. She's on board with alternative remedies and balancing life with medical care. For example, she doesn't harp on me that I'm apparently incapable of taking my asthma meds every day, she simply stresses that my medication won't be nearly as effective and helps me try to find other ways of managing my asthma. She also suggests home treatments, such as the fact that she could prescribe a pharmaceutical but it has some nasty side effects and the active ingredient is also in black tea, so if I'd rather drink a couple cups of black tea a day I can skip taking a pill (plus, you know, warmth & fluids are good for asthma, and no nasty side effects).

Her staff, however, are worse than useless. I was in on March 5th, and the doctor ordered a second round of physical therapy for me, this time for my neck/shoulders/upper back instead of my knee. I WATCHED her mark the referral as "urgent" and "requires prior authorization" on my electronic chart. She wrote in the description that it needed to be done urgently, as I have only 3 sessions left of physical therapy, and if my additional sessions are not approved by my health plan, then my PT treatment plan needs to change immediately--as in, this is Tuesday, and my next visit is Monday.

Since the doctor's office was having issues with their computers and electronic charting the day I was in, I called Wednesday late in the day to see if my health plan had received the request yet, and was told they had not. The re said that my physical therapist could fill out the authorization request instead of my doctor. The PT's office says they can't. My doctor's office says they have sent the PA request, but health plan still has no record of it two weeks later. I keep calling people and checking on this, trying to get the PT's office to fill out the form, but they refuse because they're "not a doctor's office." My doctor's office says they've sent the referral, but the can't seem to figure out that I want them to fill out the form they were told to fill out: the prior authorization request.

In the meantime while waiting for all this, I have received four different referrals from the doctor's office, sending me to PT--for my knee. Finally I got another one, this time for my neck. They also apparently "keep faxing it to the PT's office but it keeps not going through." Even though the PT's office has been calling the referral dept and asking why they're sending additional identical referrals, and trying so very hard to get a prior auth form sent for me.

I'm going in for my last PT visit next week, and according to two different service reps at the heath plan, the longer I go between the last session and the health plan getting the prior auth request for more, the less likely they are to approve it--because in their minds I will have been falling behind in vital treatment and therefore getting less out of subsequent treatments, even though it's supposed to be for a different part of me.

At this point, I think my only option is to print off the form myself, take it into my doctor's office, have her fill it out, and fax it to the health plan myself. I told my PT's office that the referral dept doesn't know their ass from their elbow, and they offered that if I can get my doctor to fill out the form and give it back directly to me then they will fax it for me so we can skip the staff entirely.

PT has been going great, BTW, I can walk like a normal person a lot more now, and I even have used stairs for the first time in ages. I'm starting to have an easier time breathing, since my neck and back issues have really aggravated my asthma. I have a long way to go and with my medical maladies I may never be completely well, but I'm starting to have hope that I may be a mostly-functional human being again! So that's nice :)