Thursday Health Thoughts: Doctors out of State/Country Series-Part Six- Communicating with a Doctor Out of State/Country

August 7, 2014

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Happy Thursday y'all!! I am so excited to continue this six part series on Thursdays dealing with topics related to seeing doctors out of state or country. Here is the list of the topics for the series and the coming weeks:

Happy Thursday y'all! Today I wanted to conclude this series on dealing with doctors out of state or country by discussing an important topic: communication. I hope that some of the things that I have learned the last couple of years (sometimes the hard way!) might help someone and also I am excited to hear from y'all who have experience with this! (Side note: No offense to any of my doctors but since NONE of them have ever looked like this guy or I think all of the ladies would have no problem with communication! Right? Hahaha! *smiles* This single gal can dream right? *smiles*)

As a little background I have dealt (in deep communication - not talking about hospitals around the country that I have been seen at) with three out of state doctors offices. Two of them have been wonderful but sadly one was a little bit of a nightmare to deal with. Some of these things that I am sharing were a hard lesson to learn and other things are just general tips! I hope that this is of help to any of you who may be traveling out of state or country to see a doctor!

General Thoughts

(one) Understand that your doctor is out of state or country. I know that this sounds silly to state but it a true fact. Having a doctor out of state or country requires the acknowledgement that things are going to operate differently then if they were in your same town. You will need to understand time zone differences, the way to communicate with your doctor if there is a serious or important issue, phone consultations (which may or may not be covered by your insurance), how many times you will need to go back and see this doctor for "in office visits" throughout a calendar year, have patience with communication between in state doctors and your specialist, and a variety of other things that you would never have to think about if they weren't out of state or country. Sometimes it is a bit overwhelming so my encouragement to you is to try to take a deep breath and patiently walk through the maze before you.

(two) The key to success is CLEAR communication (from both parties). I am going to say this numerous times in this post but it is true: I love my current doctors who are out of state. They communicate clearly, are delightful and helpful each time that I interact with them, and are extremely professional. I am honestly so grateful for their compassion and the way that they respect me as a patient and give such clear instructions and help. 

While I have had this happen with two of the doctors offices that I have dealt with out of state, one of the offices that I dealt with was the complete opposite and it was a bit of a nightmare. It was incredibly difficult to get a hold of my doctor (or her nurse), the phone consultations appointments would be scheduled for a certain time and then I wouldn't get a phone call until hours later, often times I had been trying to get a hold of this doctor and since I wouldn't hear a response (for days or weeks) I would follow the course of my GP's thoughts only to receive "a lecture" (unfortunately true), and finally I would just not hear back. One time I waited for over five days for her response on a serious stomach infection I had only to have to wait two more days for the prescription to be filled (and this was only after I finally allowed my father to get involved) and ended up in the hospital because I was so sick. Unfortunately at that point I knew that it was time to part ways. I don't believe this was the way the entire practice was run (and am currently under the care of a different doctor at this practice for something other than Lyme Disease) but it was extremely frustrating, discouraging, and scary. Scary because my health was in such a precarious situation and I couldn't even speak to my doctor get a response and frustrating because we had paid a lot of money to the practice. 

I share that story to say that it is extremely important to have clear communication on your expectations and the doctors commitment and your commitment to working with someone out of state. It will take some navigating but I do promise that it can be done! One of the best ways to accomplish this is to understand the following four things:

Things to Understand
(one) Understand your doctors policies on office visits. Having an out of state/country doctor means that you will be scheduling appointments in advance. Unlike a doctor who is in your hometown you won't just call up and say that you would like to "drop in" for an appointment. Due to this you will need to understand in depth the doctors policies on office visits: (1) How far in advance do you need to schedule them? (2)What is the time frame for a cancellation appointment? (3) Is there a penalty of any kind (financial or other) for missing an appointment? (4) Is it easy to reschedule the appointments if they need to be cancelled? Finding out as much detail as you can will save you both time and frustration. As I mentioned above the key to success is clear communication. Ask as many questions as you need to to understand the policies on office visits. Do not assume that it is the same as your GP (general practitioner) at home. 

(two) Understand your doctors policy on emergency situations before they occur. This one really is critical, especially for those that are seriously ill. In all likelihood you will experience a medical crisis while under the care of your doctor who is out of state/country so understand what the protocol is before the situation occurs. For example, understand if they want you to call after you have called 911 and are on the way to the ER or if they want you to call once you are released from the hospital. Do they want to have the final say over a prescription that might be administered while you are under the care of another doctor or do you need to understand that you will need to be air-lifted to their hospital? All of these things are really important to understand. 

**NOTE: MANY out of state doctors can't (legally) recommend whether or not you should go to the hospital without seeing you in person, so most of the time if you call up and ask - "should I go to the hospital" they are going to recommend that you do so. Don't get frustrated with this, unfortunately it is just the nature of the beast that they can't see you so they want to make sure that you are safe. 

(three) Understand the cost of telephone consultations before your first phone appointment. This was discussed in the post about insurance in this series but make sure that you understand if you will need to pay for your phone appointment (and how much this is per billable minute!) or if they are submitting it to insurance. 

I LOVE LOVE LOVE my current Lyme Doctors office. They are COMPLETELY up front with every single item, and this is one of them. I know exactly what I am being charged for and how many minutes that I have per phone conversation. Unfortunately I have experienced the opposite and have heard from many others the same thing. My best advice is to have something in writing that shows exactly how much each minute costs for a phone appointment and find out who will be timing the call. One friend shared that she dealt with an office that said that they would "watch" the minutes for her and the next thing she knew she was paying double the amount she should have. Yikes!

(four) Understand your the offices policy on medication refills. Different doctors offices have different policies on medication refills. Some require that you have the pharmacy fax a refill request, some request that you call in and ask, some require that you write or fax an email with your signature, etc. It is really important to understand the refill system before you need your medication. 

My current Lyme Doctor's office (and my hometown GP's office) are AMAZING with medication refill requests. SO much so that I feel that I am completely spoiled. They are prompt with their actions (completing the request within an hour) and are quick to help answer questions and help me in anyway that they can. Unfortunately this was not the case with one doctors office out of state that I dealt with. It was a nightmare. I would call in the refill request and it would take up to two weeks (!!) with no answer, numerous phone calls, emails, and eventually having to involve the patient advocate each time. I NEVER experienced such frustration in my life as I did with that office over medication refills. Compounding the frustration was that certain states (mine is one of them) does not legally allow their pharmacists to call in refill requests (which was this doctors office policy). I had explained that at the time, been assured that things would be fine, and it turned out it was anything but fine. Also, I had to time things "perfectly" because I couldn't request the medications to early or my insurance wouldn't pay for it (because they saw that I had just refilled it!) and I couldn't wait too long because I never knew when I would get a response. It caused a lot of stress and a few tears and eventually became one of the reasons that I left that particular doctor. I share all of that to say that I would encourage you to understand the process as best as you can and be up front about your insurance needs or your states requirements so that there is no confusion. 

I hope that this helps y'all! It's hard to believe that this is the last post in this series! (Where has the summer gone??) I am excited to share though an exciting new project that I have been working on for months and months next Thursday!!! I am so giddy about this!!
 Happy Thursday y'all!!

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