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Old 08-16-2011, 10:10 AM   #1
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How can I get the doc to give dad a referral for a neurologist?

I have attempted to get a referral from dad's doc to get him to a neurologist.
The doc just responded that they (the neurologist) are "just going to tell you the same thing." I got nowhere. Basically, he's telling me it's unnecessary.

Dad is on Medicare/Secure Horizons HMO.

The doc has never really flat out told him dad's diagnosis. When an MRI was done, doc told dad it was "normal aging". He's prescribed the Exelon patch and Namenda. (Among other meds for type2 diabetes, etc.)

Dad's walking is getting so bad. I think it's because of a head/brain thing (not so much physical).

I would just like to get a neurologist's opinion and have them review dad's meds. I don't think I could get dad to do another MRI.

Other than getting down on my knees pleading (which I refuse ), what could I say to the doc to influence him to give me a referral? I hate HMOs.

gogo

 
Old 08-16-2011, 12:52 PM   #2
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Re: How can I get the doc to give dad a referral for a neurologist?

Hi Gogo,

How about asking for a memory test? My FIL was diagnosed with Alzheimer's in late 2006. He was wondering if he could drive, so he asked the GP to send him to a place for memory test. He went to a behavior center to get tested in the office with 3 hours verbal test. He came out with Alzheimer's. Not very accurate in terms of stage because he lied to the psychologist that he took a shower at night but he refused to take a shower at that time and looked dirty. He was in moderate stage. (The test came out with early stage.)

Just ask for a memory test so you know his level.
There is MMSE test also and a nurse can do it too. It depends on the GP. Is he supportive with dementia or he thinks dementia is just old aging??? A good GP should know that the diagnosis for dementia is important. It helps pinpoints the issues and stages. It also helps how you handle the caregiving.

Good luck,
Nina

 
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Old 08-16-2011, 01:24 PM   #3
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Re: How can I get the doc to give dad a referral for a neurologist?

The doc did his own Memory Test over a year ago. After that he ordered the MRI, and proceeded to tell my dad it was normal aging.

Fast forward a year, the nurse had written down "Alzheimer's" on his application for AL. So, I guess it's in his file???? However, I had to ask her to change what she wrote or they wouldn't accept him at the facility. (changed it to memory issues or something like that) He's now been living at the IL/AL place since Nov'10. I do not doubt that he has dementia. I am not convinced it's AZ. I don't know if it even matters. I just want to make sure he's on the right meds/right dosages.

I'd rather not switch docs. (Dad likes him.) I just get the "he's old" it's expected attitude...which is true, but, he hasn't known my dad long and I wonder if he's taking too many meds. I would just feel better getting some advice from a neurologist. Or, am I way out of line? Do people with AZ need to go to neurologists? am I going overboard?

I was just wondering if there was something I could say to the doc to get him to give us the referral? Like he's hallucinating or something?? It's almost like the doc doesn't want him to go elsewhere cause he'll lose out on $?? or, does it hurt doctors to give referrals?? like with Medicare/insurance I don't know...

gogo

 
Old 08-16-2011, 01:55 PM   #4
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Re: How can I get the doc to give dad a referral for a neurologist?

I think both neurologist and/or psychiatrist can do the diagnosis. Usually GP is not that good at it so often they refer to someone else. Not sure about this GP.

However, I do believe that when it is sort of early stage, it would be hard to detect it. He needs to have another test. My FIL did it around moderate stage when it was quite visible that he was crazy like being dirty and could get lost and all that...

Frankly, it matters if it is vascular dementia or Alzheimer's. ALZ is the most common one but vascular dementia is the second common one.

Yes, it does matter what type of dementia he has. ALZ is just one type. Vascular dementia is another type. The GP just does not know which type and he claimed it was normal aging...
I believe HMO does some harm but it depends on the GP also.

You know, why don't you try the AL - does the AL have their own test? Maybe the nurse there did their own test and came out with Alzheimer's.

The type is important because this decides what kind of med and prognosis.
ALZ is very clear in terms of 7 clinical stages, but other types may have different stages or meds.

In terms of caregiving, it may not matter what type, but it helps to know.
The real issue is, if he really has dementia of any type, he would need to be in the locked memory unit some day soon.

Good luck,
Nina

Last edited by ninamarc; 08-16-2011 at 02:03 PM.

 
Old 08-16-2011, 10:13 PM   #5
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Re: How can I get the doc to give dad a referral for a neurologist?

Gogo...I do believe it is unfair to you to put Alzheimer's on his medical records and not give you the appropriate testing and information so you can make appropriate decisions for and with your Dad. This is so very typical of general practitioners. They just don't get it... unless they have been personally touched by this disease in a loved one. The type of cognitive problems created by the various types are dementia are NOT natural aging. If Dad forgets where his keys are occasionally that's normal. If he forgets he had keys or what they are for that's a problem. Nope... you local family doctor just doesn't get it. Even with a MMSE score that indicates a problem they think it will all be ok. They may do an MRI but that doesn't show Alzheimer's. There may be some shrinkage when the disease is further along but it is not a diagnostic tool at this time. So I do believe you should get a referral. I would ask.... I have concerns and for my own peace of mind could we please have a referral?

Yes, there is a difference between the various kinds of dementia. Each has it's own symptoms and time line. A proper diagnosis and information about that particular dementia will give you some guidance as to what to expect. Mom has Alzheimer's and Dad had Vascular Dementia and they were very different. Knowing the difference has helped to know what to expect and how to help them both

So be persistent in requesting your Dad a referral. You are his advocate and things get done when you insist. Yes, you can demand what you want. You are not at the mercy of the doctor and whatever he decides in the moment. I would pester until I got a yes, please get off my phone, answer

Love, deb

 
Old 08-17-2011, 09:48 AM   #6
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Re: How can I get the doc to give dad a referral for a neurologist?

Gogo,

Sometimes some GPs have the old school or traditional idea that dementia is normal aging or that there is no certain test to do that.
The fact is nowadays there are more tools available to find out about Alzheimer's and vascular dementia. I don't know if you can ask for a second opinion from another doctor in HMO? If the AL has its own doctor, ask the doctor to get him another memory test.
No doctors can hold the patient hostage and you are always entitled to a second opinion.

I never like the stuff that the doctor has our medical records and we have to pay to get the copy and all that. It is our own medical records and it is our health. A doctor should not hold that much power over us, esp. the GP.

There are a few times when my GP have different opinions from the walk-in GPs.
So one doctor is not an expert for all.

Good luck,
Nina

Last edited by ninamarc; 08-17-2011 at 09:50 AM.

 
Old 08-17-2011, 12:00 PM   #7
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Re: How can I get the doc to give dad a referral for a neurologist?

Thanks guys,

Dad is in the independent part of AL. He gets his meals in the dining room and I have peace of mind that he is not all alone. He could not get his license renewed beginning of this year TG (but believe me, he TRIED and TRIED).

I really donít want to have to start over with a new GP. I am worn down. My mom passed away 12/09, so that is part of the whole equation too.

When I asked the GP about NPH, he said the MRI didnít show anything. Poof! end of discussion. I then went on and on about dadís walking. Of course, dad walked nicely in front of the doc. But, GP went ahead and sent him for a walking evaluation. PT said he needed therapy. PT never heard of NPH. Go back to GP and was told no, heís fine, doesnít need PT. Honestly, I was not going to be able to take him NOR would he have gone.

I had sent dadís MRI results to a contact at the Hydrocephalus Foundation and she forwarded the results to the head of the medical advisory board. This is what he said, ď"It sounds like an atrophic brain, but yes it could be nph. The pt should see a neurologist to have a workup, as the ct diagnosis cannot be conclusive about dementia or nph." This doc was referred to as an N/S?? neurosurgeon??

I am so overwhelmed and frustrated. Did I mention I work and have a husband and 6 year old? Why is it so difficult to get a referral? Is it seen as failure? My guess is that it is about ego?? I mean what does the GP have to lose by giving dad a referral? MONEY??

And about the nurse putting Alzheimerís on the paperworkÖI really do believe she wrote that based upon the meds dad has been prescribed by GP. She did not know at all HOW to fill out the paperwork. She brought me back to the room to help her.

I just wish there was a key word I could throw at the GP to get him to assist me. Iím so annoyed. Yet, Iím running out of gas.

You're right. I feel like we're being held hostage. It sucks to be a senior and not have lots of money. I can only imagine what it would cost to see a neurologist for a visit out of pocket.

gogo

 
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Old 08-17-2011, 12:11 PM   #8
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Re: How can I get the doc to give dad a referral for a neurologist?

Maybe you should show that contact document to the GP.

I had to push my GP to give an MRI for my jaw. At frist she said I don't need it. I was told pretty bluntly that I needed no MRI when she wrote the order for me. Then she saw that MRI did show that I have dislocated left jaw and all that. What can she do? She suggested that I see a surgeon for opnion. Anyway, I go with the dental surgeon's advice and will see another guy.
it looks like I was so bad that I was telling my GP what to do.
People actually said she is very good...

The point here is the GP sometimes is wrong and then she can make correction later on without any apology at all...


Can you see another GP without transferring? I sure hope there is soomeone who can help out.
I think in the mean time, you just have to focus on caregiving. As long as he is happy, don't bother with the diagnosis. Soon, when he gets sicker, then you can ask for another test.
It looks like you need to have some episode so you can have the excuse to ask the GP for another evaluation.

Take care,
Nina

Last edited by ninamarc; 08-17-2011 at 12:16 PM.

 
Old 08-17-2011, 04:19 PM   #9
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Re: How can I get the doc to give dad a referral for a neurologist?

You know what I would have said? "Yes, I understand they may well tell me the same thing but the family would like to go ahead anyway. Whom do you think would be a good choice - or - I've heard good things about Dr. XYZ and he's in the network." And just sit there and stare back at him - firmly.

 
Old 08-17-2011, 09:36 PM   #10
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Re: How can I get the doc to give dad a referral for a neurologist?

GP's are bad about cutting you off when they don't know. It is an ego thing. N/S is probably neurosurgeon. Being in the position he is in he is definitely more qualified than the GP to make an assessment of the scan. Is there a way you can call the insurance company and request a referral on the basis of the information you have from the Hydrocephalus Foundation? It's worth a try!

Question... what medication is your Dad taking? Did the GP prescribe Excelon, Aricept, or Namenda? There had to be something there to lead the clerk to the Alzheimer's diagnosis. Why would the GP prescribe medication specific to dementia if there is none there?

Key word..... litigation! I hate to say it but that's the word they understand. A letter to the doctor, including the information from the Hydrocephalus Foundation, requesting a referral for diagnostic clarification is appropriate. A statement that it would be unfortunate if Dad had a disease that could be cured if it was diagnosed early and it went undiagnosed. I am not above putting the pressure back on the GP. Let him know, as a family, you need clarification to rule out potential diagnosis that were indicated on the scan.

It still amazes me how may doctor there are that don't understand Alzheimer's, NPH, and other diseases of the elderly. Old age is not a diagnosis! If you don't get what you need from this GP... it is better to change and get your Dad the medical care he needs than to stay because just because it is easier. Maybe a fresh set of eyes is what is needed to get your Dad an adequate diagnosis.

Mom's doctor was much as your Dad's GP. Her MMSE score was low but it was ok... she just needed to focus more, try harder. Everything was ok and there was a beautiful field of daisies out back... I called his office and told them I was talking Mom to the Memory Assessment Research Service for an evaluation. I would be coming by to pick up her records including her CT scan and I expected a referral to be included in the information. I went on to say if he had any questions please discuss them with my Dad's doctor who was his partner. I don't know if that exchange took place of not but Dad's doctor was aware that Mom had overdosed Dad with medication and then was unaware of what was going on. So yep, use what you get from one source to get what you need from another

Love, deb

 
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