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The dreaded 'your doctor is out, you'll have to deal with his covering physician'

LionsPrideLionsPrideMember
I call in today because I'm going 'home for the holidays' back on the east coast to spend 2 weeks with our families. I'm heading towards what i think is a little bacterial overgrowth issue and I always like to travel with something just in case. Turns out my Dr. is out till February which is wonderful for him, but not so much for me.

I talk to the nurse, i explain as simply as possible my issues. Can't take flagyl anymore, cipro doesn't work that well and I took it last bout. I would like augmentin, works great and I discussed it with my doctor at my last appointment as the next med to take.

Get a call back from the nurse. Dr. X says that won't be effective, he wants to give you xifaxan. I calmly explain that I've tried that once and my insurance doesn't cover it. It cost me close to $300 dollars and didn't even work. She says ok and she'll speak to the doctor.

She calls me back and says good news, the doctor switched it to metronidazole. I, trying to stay calm, point out that I can't take that anymore because I experienced peripheral neuropathy. She goes 'oh right you did tell me that, well I think the Dr. has left for the day but I'll see what i can do. He said Augmentin wasn't appropriate for pouchitis' Now i know damn well from this board that it's worked before for many people, that it's popular with pregnant women with pouchitis and that my own Dr. has it queued up as my next drug, but this covering physician just flat out refuses to give it to me. I mean, i'm not asking for narcotics here. Is there a big blackmarket trade in antibiotics I'm unaware of?

This stuff just kills me, and of course it's always around the holidays. At least it's given me the last push I needed to find another GI in the area. Thankfully living in Chicago I have a wealth of options.

This happened once before around another holiday. My doctor was out and I had full blown pouchitis sneak up on me. His coverage's initial reaction was to tell me to followup with my regular doctor in a week and go to an urgent care center if I needed it. The concern for my wellbeing was overwhelming...(sarcasm). I put the breaks on that spiffy plan, but man oh man oh man do I hate dealing with 'coverage' physicians.
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RM Randi MMember
Lionspride-I see you had your surgeries awhile ago. Can you still call your surgeon for the script? I see you're from Chicago? Did you have your surgeries done there? I'm rather new as I had my last surgery 6 months ago but I thought I'd be calling my surgeon if I ever needed scripts for pouch issues. And yes in Chicago you have lots of options. Good luck
LionsPrideLionsPrideMember
Conditions - Hemorrhoids, Hepatitis B, Hepatitis C

Expertise - General Gastroenterology, Liver Disease, IRC Hemorrhoid Treatment

Glad this is the guy my Christmas welling being is in the hands of...

Hi Randi. No the surgeon isn't an option anymore, in fact he's probably retired by now. Living in Chicago you'll probably dump over to a GI full time after 6 months to a year. It's really up to you and your surgeon. The merits of seeing a surgeon or a GI is a hot topic on here. Personally if you have the option I'm of mind that surgeons cut and GI treats, but for many the surgeon is the most knowledgeable on the procedure and complications in their area.

Still haven't heard back from the doctor. I'm guessing by defying his authority I've gone into the 'problem' patient pile in his head. We'll see if I actually get anything before I leave on Thursday night. Nothing like a 14 hour car ride with bacterial overgrowth/pouchitis.
Scott FScott FMember
It's a dreadful nuisance to try to explain a complicated situation to a covering physician through an intermediary. I'd suggest a couple of things: 1) Perhaps your doc wrote down the augmentin plan in your chart. In that case the covering doc could review it, especially if prompted by you. 2) The covering doc may be reachable after hours, if the practice uses an answering service rather than the dreaded-but-cheaper answering machine/voice mail. 3) You may be better off asking for a call back rather than further miscommunication. Good luck having the conversation you need to have. I once went and camped out in a optometrist's waiting room when I couldn't get a brief but critical question answered any other way. Not always recommended, but it worked for me once.

FWIW, you'll probably get this resolved in the morning, but it's still frustrating.
J JillMMember
If you can, find a new GI who is part of a large practice group, preferably one that is affiliated with a hospital. My GI is part of a 9 doctor group. Over the course of my active issues, most of the drs had spoken to me at least once, and even if they hadn't, they could easily access my drs notes from meetings and had probably heard about my case at some point. It makes things much easier. Plus, it means that there is always a dr on call who I can feel comfortable with...
CTBarristerCTBarristerMember
quote:
He said Augmentin wasn't appropriate for pouchitis'


This statement is not correct. No seasoned doctor who is experienced with treating pouchitis would make such a statement.

My pouch expert has an assistant who knows what his orders are and she handles all my prescriptions. Therefore his non presence in the office is an irrelevant issue. However if I am leaving on a vacation I always call well in advance to make sure I am stocked with what I need.

My Doctor's practice group is a large group of digestive disease specialists affiliated with a hospital (Yale New Haven). I think Jill's suggestion is a good one because I would never have an issue like this with that group.
Last edited by CTBarrister
LionsPrideLionsPrideMember
So good advice by all, thanks. After trying several things I ascertained my regular GI is 'out of touch' and my internal medicine doctor is on vacation already. He's another issue I won't get into, other than to say he no longer prescribes general maintenance meds for longer than 3 months so he can get you in and bill an office visit. He has many other tricks like that I've spotted. He's on his way out too. Anyway, I didn't hear anything so I called my pharmacy around 7 to discover I had a shiny new prescription ready in my name....for xifaxan...sigh.

So i bit the bullet. I had the last bit of the HSA to spend anyway which eased the pain, i just hope it works.

This particular provider is actually part of a large healthcare group out here, northshore university health systems. I think, or at least hope, that the hospital I deal with for them is the issue. I'll be switching everything over to another better known hospital in their network in the coming months. Hopefully I won't have to deal with this again. I can honestly say after 20 years of having physicians in a university health setting this whole process was boggling. It's a shame too because their office staff and all the procedures I've had there have been nothing but smooth sailing.

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