Upcoming interrogation

I have an upcoming interrogation my first 3 mo. At the 2 week my doctor was there. They said he won’t be there this time. Before the tech confered with him when he made an adjustment. I wouldn’t want the tech making an adjustment on his own.  I absolutely refuse to see a PA. When that’s the case I refuse to pay my specialist copay because I didn’t see a specialist. So if I do need an adjustment first my EP has to read the report first (which they promised me he would do) so then what I have to be brought back in when the tech is there to make an adjustment?


It's a little more complicated than that

by crustyg - 2020-01-19 04:33:01

I am sure that your assessment of the legal/financial arrangements is entirely correct, AgentX86.

However, as an another physician, I can empathise at the thought of my box being adjusted by another group of non-quite-doctors.  Over here in the UK we're arguably still behind the USA's use of wannabe-doctors who work as doctors, notionally supervised by a licensed physician who is somewhere around.  Your use of anaesthetic assistants was much more widespread 20-30years ago compared to the UK.  But we're catching up and it doesn't always go so well.

I've had several experiences at the hands of non-quite doctors, and the majority, so far, have not been good, with real doctors having to step in and save the day.

I used to date a nurse back in the 1980s - she became so dissatisfied with the role, that she did the honourable thing and went to med-school and qualified for full registration and practiced for the rest of her career.

There's a whole flame-war waiting to erupt at this post, but the reality is that we expect our physicians to study and suffer for years, accruing vast debts and then we resent paying them a salary that would enable them to service that debt and recognise that they have sweated blood to achieve their licences.  And because society recognises that we simply don't have enough (the UK has one of the worst patient:doctor ratios of any developed country) we emply wannabe-docs on tiny salaries and expect everyone to be happy.

Only in fairy tales.  And the results and patient frustrations turn up here in this forum, anger with our health care systems and litigation.  Lots and lots of litigation.  Which makes the doctors even more unhappy.  Nicely encapsulated near the end of 'Love and Other Drugs' where the doctor (not the hero) explains how his altruistic motivation has been replaced with cynicism.

@Mallya: charm and persuasion is always more effective than confrontation (as I know to my own personal cost).  Try and get your EP doc on side, and then you can be sure that any changes made by the EP tech (which *will* have been approved by your EP physician) are the ones that *you* have negotiated.


by Gemita - 2020-01-19 06:16:08

Mallya, I would ring your EPs secretary and ask whether you could arrange to be seen by your EP in the PM clinic on the same day as your PM interrogation is due, especially if you are having symptoms and you want to discuss these with your EP first prior to having any adjustments made to your PM settings.  I am in the UK but when I attend my PM interrogation checks I usually have a follow up appointment made with my EP on the same day, so that any adjustments (after discussion with EP) can then be made.  As it is still early days it is quite natural for you to feel you want to discuss your treatment with your main consultant first and I can fully understand this, but maybe a little more diplomacy would help.

Let us not forget, there are some very good junior doctors/technicians out there, with a lot of patience and up-to-date knowledge, sometimes equalling or, dare I say it, surpassing that of a consultant who doesn’t always have the time to spend with his patients, or the time to keep up with the latest research.  I have often come away from an appointment feeling more reassured and empowered after speaking to a junior member of my EPs team, straight out of medical school so you might be surprised just how much you will learn from your PA.

Of course we all want to deal with the most knowledgeable, experienced doctor or PM technician, but everyone has a role to play and most decent medical professionals really try to do their best for us, so perhaps a little more respect and humility might go a long long way.  You are a paediatrician I believe ?  I hope you were given opportunities when you were learning and you were made to feel that you were a valued member of your team as you developed your skills.  I always find that when I treat others with kindness, respect and encouragement, they usually respond in kind. Good luck and I hope you get the best possible care whoever sees you



PAs and other professionals

by AgentX86 - 2020-01-19 12:00:50

Another thing to remember with PAs and NPs is that you have a much higher probability of spending some real time with them.  They'll usually be much more likely to have the time to educate you about your condition and alternatives. I had an appointment with my neurologist's NP at the end of last year.  She spent a half hour with me and the doctor came in for about 1/3 of the time, probably because it's a new and unexplained.  I have an annual appointment with me vascular doctor but never see the doctor.  I have a sonogram of the carotids and the NP essentially says, "see you next year".  There is no reason to get the doctor involved.  As Crusty points out, there simply aren't enough doctors to hold the hands of everyone who is healthy.  People thing the health care system is expensive now!

PAs and NPs have a lot more education than two years.  A PA is a doctor that hasn't taken his residency.

Am I Missing Something ?

by IAN MC - 2020-01-19 13:48:03

I cannot understand this desire to be seen by a senior doctor unless it is absolutely necessary.

I had my pacemaker fitted 10 yrs ago and have not seen the EP since  ( I have almost forgotten what he looks like )

With considerable input from myself, my tech has made all decisions regarding settings and carried out all PM adjustments . He has arranged and conducted treadmill tests when I have asked for them.

I firmly believe that UK pacemaker technicians usually have more training and experience of different pacemakers and the rationale for adjustments than do the Drs who implant them.

I am not at all bothered by their lower status and surely all we need from  technicians, junior Drs or GPs is the certainty that they will refer us upwards to a consultant when it is absolutely necessary.

I am certain that , if I asked,  I would get an appointment with the EP if I had good reason to do so , but  it goes without saying , that it helps to use  " charm and persuasion "   ( as Crusty so wisely recommends )



reschedule or change docs

by dwelch - 2020-01-21 11:51:59

I would reschedule and if required double book the interrogation and an office visit with the EP.

Or I would find a new EP/practice.

After 32 years of pacers and about ummm 13 years with this EP, I found out the tech made a change to my pacer this last visit, talked to the EP about it and it was fine it was directed by the cardiologists, a procedure that they take a measurement add a factor and adjust one of the settings.  So it really wasnt an on her own thing.

But, despite that, I always see the EP and if that changes will have to start insisting or scheduling.  and I may have to start asking the tech every visit now if any changes were made, the report I get from the boston sci box does not show a before/after that I am used to from what I was used to from the medtronic boxes.


BostonSci *does* have a changes report

by crustyg - 2020-01-22 07:38:21

@dwelch: I get *all* of the reports from each interrogation, and I'm looking at the ViewChangesReport from my last go: shows Before and After values.

I count six reports (not including the MarkerLegend report which is just a list of abbreviations used on the graphs).

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