On Fri, 1 Sep 2006 19:33:52 -0400, d'huit wrote
(in message <IdWdnT0EBOr1XmXZnZ2dnUVZ_sudnZ2d@comcast.com>):

I'm glad you're back is getting such comprehensive attention, but surely
wish
things didn't appear to be deteriorating more.

Interesting comments, but it seems to me that one shouldn't necessarily make
this a blanket policy.  Overall, you are the best consumer by going to
doctors who take appropriately good and thorough care of you and you are the
best judge of that.  You may find them in large clinics or small practices.

***true.  in my defense, i was waaay too tired and too hurtin' last night to
be coherent about anything (shouldn't have tried) and/or elaborate further.
he did say there were other considerations, like the quality of care,
expertise, communication/listening, availability, competence, thoroughness,
carefulness, personal manner, taking enough time with a patient,
prevention/self-help advice, and such. . .

i know i haven't been getting the kind of care, from my pcp and my rd, that
i need and they are both in the same medical health care
organization/system, which is a regional monopoly in south puget sound.
this particular health care system/org. is into rationing health care--he
didn't tell me that, a nurse did, not his nurse.  i suspected that, because
i've often felt my care was being rationed out to me in tiny increments,
when i knew i needed a more comprehensive approach.  they were making me
have to come back often, for things that could/should have been taken care
of in the prior appmt. when i first mentioned them.

he said what he said to me, because he was astonished that i could function
at all, without good pain management.

this doctor is a pain management specialist, that my neurologist sent me to
this time.  and my neuro didn't want me to see anybody else, except this
particular doctor (at the time, i had no idea who he was sending me to); and
my neuro told him to do anything and everything he could for me--very lucky
me!  my neuro told him he's not required to clear anything, he feels he
needs to do, with my neuro.

this doctor is no longer limited by the health care organization/company, he
used to work for, that limited him to strictly treatment (kind of like
selling product--i surmise.), and did not allow him to do comprehensive
treatment plans, diagnosing or prognosing.  i last saw this same doctor for
my epidurals, the last time i had them, at that company's clinic.

now, he has his own pain management practice/office.  he is, and was, the
doctor with the very "expensive wallpaper" (M.D. degrees from just about
every ivy league medical school i can name), that i told all of you about.
i knew he was a very special doctor the first time i saw him, because he
took his time with me and was very thorough (despite the constraints imposed
upon him).  i feel very blest that he is now my permanent pain management
doctor.  he told me he likes challenges (LOL!) and is happy to be able to
help me.

sidenote:  did you know--- the majority of medical schools don't even spend
3% of *any* medical course of study (specialties included) on pain managment
and end of life palliative care is just as bad.  what a shock that was to
hear coming out in a doctor's symposium, when i watched it.  geesh, no
wonder so many people spend their lives suffering, even though they are
regularly going to doctors!  in otherwords, most doctors don't know sh.t 
about managing pain!  "because they are taught next to nothing about pain
management" (according to the symposium), most doctors are winging it when
it comes to pain managment in their medical practices.  can you believe
that?!  that's sooo shocking to me.

kate

We have a friend who is getting very inadequate care from a doctor in a solo
practice (but she's been going to him for decades and yada-yada....).
Meanwhile, we are happy with our doc who is in a multi-specialty practice of
about 15 docs.  Of course, issues are different here, with the consolidation
of resources in a rural area, but blanket statements are still tricky.

i LOVE this guy!  had him before and loved him then, too.  am very unhappy
with the health care rationing of the organization of which my pcp and rd
are members.

i wish we could meet, kelly.  i'm certain we'd get along famously!  or
infamously, knowing me.LOL

kate

A good workup is good.  Do you like this guy?  Hopefully you have someone
who can be with you Kate.  i would come down but I would be next to useless
in the condition I am in and even if I get my rituxan won't be allowed to
travel to the states until we know for sure no lingering side effects.
Please take care of yourself and get some help!

As for the smaller practice - if you like your doctor stay with him/her.  So
long as the practice works well it seems to me that is where you should be.
If however you have a different person each time and they never seem to have
"communication" whether by chart or whatever that is a good reason to go
seek someone else.

Take care of yourself,
Kelly