Nicholas Myers said:Unfortunately, that workflow is becoming a thing of the past. You contact your primary care physician just to get a referral, while the specialist handles the thyroid management exclusively.
Essentially, for the diagnosis you're managing, issuing a standard specialist referral isn't typically justified. It isn't considered appropriate for an endocrinologist to write internal referrals for patients who already have an established diagnosis.
Checking thyroid hormone levels—which is pretty straightforward—can be done via a standard insurance referral before your scheduled specialist visit, and the endocrinologist can then review those results to decide if your medication needs adjusting.
Furthermore, the primary care doctor is supposed to determine the schedule for future check-ups. An endocrinologist shouldn't explicitly dictate the exact date of the next appointment, though they can suggest *when* a hormone check is necessary. You shouldn't be handed a printed appointment slip for your next visit.
However, I see that some colleagues at the hospital still recommend specific dates, and I hear rumors of patients receiving appointment slips for three or six months out based on certain types of insurance referrals, even though that isn't permitted.
In my view, the primary care physician acted correctly.
If additional tests are needed, such as a thyroid ultrasound, the endocrinologist can certainly provide a recommendation for them.
But for the comprehensive management of Hashimoto's, especially for patients already under a specialist's care, I don't see the justification for bypassing the GP. Primary care doctors need to remain involved in the process.
If their only role is signing paperwork, it begs the question: what purpose do they actually serve?
And if you feel uneasy about your primary doctor being involved in the management of this condition, then you'll simply have to find a new one—someone you actually trust.
Specialized referrals are being closely monitored, so primary care physicians will be writing them less and less frequently. This means they'll have to take a more active role in the diagnostic and treatment decisions for their patients. From what I can see, that was the entire point of this reform.
It’s all just incredibly complicated, and the patient is the one paying the price. At the end of the day, why are we even bothering with our family doctors if specialists are already available? It feels like they're just trying to lighten the load on the hospital at the expense of the medical associations... who should really be focusing on their specializations before moving into outpatient clinics. Just because I can't choose who treats me—especially when I'm seriously ill—and which medications I need to take, doesn't mean it isn't a way of restricting patient rights, the right to a second opinion, and so much more.
Being sick these days is a genuine luxury given all the nonsense we deal with—paying for supplemental insurance, copays, setting money aside for healthcare, only to end up not receiving the medication that actually works. Instead, you get the cheapest option in the group, and if for some reason it doesn't suit you, too bad; if you don't have the cash for the expensive version, that's your problem.
And don't even get me started on scheduling and "reducing the workload." I signed up for an MRI at the desk 15 days ago and got a notice at my house for an appointment on March 18th, 2014... I mean, 6 months isn't exactly a long wait, but still. Everything has boiled down to "take it or leave it"... sad, but true.☕