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April 10, 2001


Question from Roanoke, Virginia, USA:

My 16 year old daughter has had type 1 diabetes for two years and is being treated by a doctor at a teaching hospital two hours away. I was thinking about changing to another doctor who is local. I have talked to several parents lately who take their children to him. He seems to be a little more in favor of using the insulin pump.

I called the doctor’s office today and asked to make an appointment with this doctor. I didn’t want to take my daughter to this first visit because I just wanted to discusses certain issues about diabetes with him first. I wanted to get his general opinion on his current treatment, and how his treatment might be different. I just didn’t want to take my daughter until I was sure that this was going to be a positive move. I explained to the nurse on the phone that I didn’t expect him to treat her without seeing her first, but that I wanted to consult with him first as a parent. She acted like this was just a crazy idea and said that I could not see him unless I brought my daughter with me to the first visit. I didn’t think that this was an unusual request.

I asked her to explain why this was impossible, and she said that I had to understand that he was a specialist and would not talk with me unless he had seen my daughter. She went on to say that if I would like to make an appointment “with” my daughter it would be at least several months before they could see us. Is this the standard procedure?

Sometimes, I feel like I am hitting my head against a brick wall when it comes to treatment for diabetes. What is your opinion of this situation? I don’t know what to do next. I asked her if this was the doctor’s policy, and if he was aware of this. She said that it was office policy. Of course, I was not able to talk to the doctor. I have never come across this policy before.


From: DTeam Staff

Each doctor has his/her own practice and rules. My rules are my rules, and I don’t ask others if they approve. Likewise, I don’t have a say on this doctor’s rules. I wouldn’t do it this way, but that’s me. In addition, sub-specialists are few and far between. There are not enough pediatric endocrinologists in training to replace all in practice now. In 10 years, I fear there will be a severe shortage, but that’s a different problem.

Additional comments from Dr. David Schwartz:

We sure can understand your frustration! It sounds as if this doctor is an endocrinologist. The specialist at the teaching center will likely not discourage you or be offended that you are seeking possible alternatives, after all your daughter is 16 and would likely soon be “graduated” or transitioned to an adult endocrinologist. Perhaps, the staff at the teaching hospital can call your local doctor to explain your request, which is not at all unreasonable. Unfortunately, in today’s era of insurance payments, your local doctor may not be able to simply “charge for his time” if he sees you in consultation without your daughter present. Certainly, you would want to have him reimbursed for his time, but third party payors don’t always see it that way. If the patient isn’t examined, then the doctor has not contributed, at least in the insurance company’s eyes. Perhaps you can have a “pre- authorized counseling” visit approved by your insurance carrier.

Additional comments from Stephanie Schwartz, diabetes nurse specialist:
I agree with Dr. Deeb in that each doctor has an individual set of rules. It might help to have your daughter’s primary care physician call this specialist and discuss the situation “doctor to doctor”. If you trust him/her, you can then go from there.


[Editor’s comment: Several more thoughts:

It’s impossible for me to tell if the nurse indeed was accurately reflecting the physician’s policy or not. If somehow someday you do have the opportunity to talk to the physician, you might bring this issue up (not in anger, but in a spirit of frank discussion) and ask the physician himself if this were the office’s policy.
Depending on the size of the office and number of office staffers, there’s another approach that might work: call and ask to talk to the office manager, and double-check what you had heard.
I wholeheartedly agree with the thought to have your daughter’s primary-care physician, or her present endocrinologist, contact the doctor’s office.
Based on what you say in your question, I don’t think your request is illogical — but I’d also warn you that there is every likelihood that insurance companies will refuse to pay for such a consultation, and you should plan to pay the entire bill for your visit yourself at the time of the visit.