Barb, I am sorry that they sent in a student neuro for your appointment. It happened to us on our last appointment, too. Only we did not even get a student neuro; we got a nurse practitioner. It was the same as your appointment?no warning. She came in, introduced herself and sat down and started an interview. After a couple of minutes I realized that we were not going to see Dr. D. I stopped her and asked when the doctor would be in. She explained that they were very busy and that new patients had to wait three months for an appointment. She would be taking over some of the established cases. She was trying to make me feel guilty but it did not work. The clinic should hire more doctors.

I reminded her that Tony had Huntington?s and said that he needed to see a neurologist to supervise his care. She bristled and told me firmly that she had a Master?s degree. I still did not raise my voice, but I told her that I had a large accumulation of college hours myself but that it did not make me a neurologist. I asked her what experience she had with HD. She said that she had been working with Dr. D?s HD patients. Well, that was not true. I had never seen her before. The truth is he probably briefed her.

It was clear that she was not going to get the doctor. I told her that we would have to make other arrangements. With that she left the room and the doctor came in. He blamed the receptionists and said it was a mix up and we would see him for the appointments. I lost a lot of respect for him at that point. The truth is that if they hire nurses at less money who see patients they can double the number of people seen and increase their income.

Barb, same thing happened to us at the last Neurologist appt. Nurse practitioner came in for the appt. We "cooperated" with her at that appt. but when we left I told the receptionist that we expected to see the Neurologist at the next visit and she said "yes" she understood.
In the future we may not have a problem seeing the nurse practitioner as she is the one involved in and organizing the Memantine study with the psychologist and seems to have a real interest in the studies.

HI

Here in the Virginia clinic we see the doctor and/or a nurse practitioner and at times a student. Either the student will come in first followed by the doctor or they come together. I have no problem with that as it is best for the HD community to have as many doctors as possible familiar with HD. For each student we see it may mean a world of help to many down the road. I do however want to also see the doctor at some point that visit. We always do without having to ask. As for nurse practitioner, we sometimes see him instead of the doctor. At our clinic he has been with them long term, is extremely knowlegeble, kind and understanding and very helpful. Our clinic is very busy, our doctor does research and the clinic travels to W. Virginia to see patients. It is busy. Our practitioner has worked closely with the doctor and I have never felt any doubt with him. When I call for refills he is so prompt it shocks you. Answers to questions are covered as quickly. He is fully capable.

Another point that may help you is that I always type up a report of how we are doing, any questions or problems I have and anything else I feel is important to them or to us. I fax this to the clinic prior to our visit so they can review them. I think this may also help in deciding who we will see. If things have not changed and there are no great problems and the doctor is swamped, we don't really need to see her when we have such a capable nurse practitioner. In your notes you could request the doctor be present for your appointment. Another thing this report does is help to address problems that you want to bring up but don't want to appear to be "complaining" about in from of your loved one. Our doctor reads the report and at times asks my husband "do you experience such and such, a lot of our patients do." Then the discussion opens itself up to help. By saying other patients experience it it helps to relax him about it. Sometimes I also put in the report that I want to speak to the doctor alone which always helps for the doctor and I to have a one on one consultation without upsetting my husband. It is a process that has worked very well for me with not only the clinic but in other situations also. It helps to notify them in advance of my concerns and keeps our visits calm and less upsetting for all. The first time I did it I simply got the fax number and headed the report: "Points of concern for our upcoming visit with Doctor XXX on May 19th @ 4:00 PM. Please see the doctor receives this prior to our visit. Thank you for your help." That is the approximate wording and it has worked ever since. Now in fact, I believe they request this of all patients, asking about what concerns you have. It works great.

I hope this report suggestion can help everyone and that you give your nurse practitioner a fair chance. Just like with any doctor, you get a real quick feel for how much they know and how well you will be able to work with them. I have a nurse practitioner for my general doctor who I would not trade for the world. She understands and I feel is more sympathetic to my life circumstances and stresses that any doctor I have had so far. I had always felt put off and less that happy without a full fledge doctor. This was a GREAT misunderstanding on my part. I was so unhappy with one doctor and his lack of smarts that I got up, got dressed and left. He looked stunned. If you ever are unhappy or concerned with a doctor or nurse practitioner please exert yourself and state your feelings. You are paying a great deal and have a lot at risk. Follow your gut instinct. But, in the other sense, please do not write off a nurse practitioner. They can be a world of help to you.

Lecture over! Everyone, good luck in finding help that you can rely on and feel comfortable with.

Good points, Phyllis. I see a nurse practitioner at our family doctor?s and have no problem with that. When I make the appointment they give me a choice. I usually have to wait longer for an appointment with the doctor so if I have a concern that I feel she can handle, I choose the nurse.

In the case of the neurologist, I was not given a choice or told in advance. The NP told us that our case had been ?turned over? to her because the waiting time for new patients was too long. Sounds like your doctor does it right. He at least sees you for part of the visit. I don?t think our doctor had such a plan. He has always had student doctors in the clinic and like you I like that idea.

Another problem I had was that the NP was very young. I would bet this was her first job. We were the first HD patients she had seen.

I send our doctor emails and call them ?Tony Updates?. I agree that is a very good thing to do. I can be completely honest and blunt without having to say it in front of Tony when it might upset him. The doctor sends emails to me when he finds articles, a new drug or some other thing he thinks will interest me. That works well.

I have always liked our neuro a lot, but I am disappointed in him because he did not plan better and just ?dumped? patients. I am still wondering if he were planning to have more involvement in Tony?s case than the NP lead us to believe. He has always been so attentive and actually ?hovered? when Tony was in the hospital with the surgery. We?ll see, but I don't want Tony written off!

NP's are fine if you have the flu. But we don't choose a dr. for their great NP. Especially when not just the patient needs to see the doctor but a family member may also... if just to unload a little bit. You want the assurances of the doctor who is supposed have a certain understanding of things...even if it's not fixable. Our COE is at a teaching hospital. I don't, and Teresa didn't, mind the med students sitting in and do some of the tests..heal toe and so forth. The next great HD doc has to come from somewhere. We still wanted our one on one time with the doctor though. One time I took my son to the appt. so he could talk to the doctor if he wanted. Three med students were there for that appt. so they could see a family. I would love to know if one of those med students is treating one of you now somewhere. I would also like to know if someone who may have been thinking of doing so, but chose otherwise, got weeded out because they were not suitable for that sort of specialty. Either way, it seems a good thing to let them participate.

One of the most enjoyable visits that we ever had with the neuro was one in which he brought in three students. He introduced them and asked if they had ever known anyone with HD. They had not. One student admitted that she hardly knew what it was because there had only been one short chapter in her classes. I told them to ask any questions that they wanted to ask. They asked Tony a lot of questions about HD that would never be covered in a book. His reactions etc. to things around him. It was an extra long session with a million questions. I think they went away with a better understanding of what it is like to have HD and Tony had enjoyed helping the young students to understand the disease.

But then, there is nothing funnier than watchin the doc and Tony walk around on their heels. (Tony was better than the doc at first, but now can no longer do it)
Maggie

I do see student doctors at my COE first and then the doctor at the end of the appointment. I think the students need to practice interviewing patients so the questions get a bit repetitious after a while. They always ask me about hobbies,etc. Next time just to shake things up, I am thinking about telling them "I am training to be a cage fighter" to see if they believe me and write it down.



Margie



Edited 1 time(s). Last edit at 10/06/2008 12:19PM by maahearna.