The controversy over widespread use of Physician Assistants versus Medical Doctors came to a head for me yesterday. Quite frankly, having to go to my PCP for refills every three months is a virtual money racket in my opinion but, having to deal with a PA that has an attitude has now forced me to find a new doctor. What happened? Buckle up kids because it’s a bumpy ride.

For over a year now, my anxiety has been at an all time high due to three family members consistently being involuntarily committed over and over. 

Fifteen years ago, I was hospitalized for a heart attack that turned out to be a panic attack. Because of this ER visit, I was prescribed anxiety medication. I rarely took my anxiety medication unless I was dealing with my demanding family. 

Needless to say, for fifteen years now, I’ve had anxiety medication on hand in the event I need it as prescribed by my PCP. After a year of Psych Ward Visits to three different family members, it would be apparent that I not only need my anxiety prescription but also, my thyroid medications which are the only reasons I bother going to my PCP since I now go to Parker County ER for ear or sinus infections. 

By the way, I don’t see a PA at Parker County. I see an actual doctor. I don’t see a PA at my gynecologist or dentist either. Widespread use of PA’s by doctors is controversial.

Let’s examine the “PA Problem.” First, they aren’t doctors but, at my PCP’s office, I haven’t had an appointment with my actual doctor in over 12 years. Why? It’s too difficult to get in with him. 

The rotating cycle of PA’s are the only option left to patients. By the way, PA’s are hit and miss at my doctors office. They are either friendly and listen or have an attitude about your visit. 

Your insurance company is billed over $300 for a “visit with a PA.” You are paying for a service but the quality of service is questionable. 

Last month, my husband saw the same PA that I saw yesterday. He had told me his visit was awkward and uncomfortable and had decided to find another doctor because of it. I should add that my husband has used my Dr and dentist for 14 years now and like me, hates change. 

What happened? The usual three month visit for refills happened. The PA walked in and announced “you obviously don’t want to be here. I think you should stop taking your anxiety medication and start taking antidepressants.” 

My Husband suffers with high anxiety after losing his daughter a few months ago as well as his job overseeing 13-18 developments and five contractors is stressful as well was instantly LIT. 

Changes to medication he’s taken for years by a PA rather than a psychologist or physician are just the tip of the iceberg. 

Four years ago, a PA refused to refill my husband’s testosterone prescription due to his high cholesterol. “Well, I can’t refill that prescription unless you start taking Fenofibrate to control your cholesterol.” 

Four years later, my husband still cannot get his testosterone prescription although he went along with taking the expensive prescription for Fenofibrate. 

My husband for years has suggested finding a new doctor and although we both have very busy schedules, it’s time. 

PA’s at our PCP’s office are rude and confrontational but, let’s go over what happened at my visit yesterday to dig deeper. 

I arrived and paid my copay after waiting nearly an hour for my appointment. 

My visit was for an ear infection and refills but, my ears were never checked and my refills would be in question. Why? The PA had decided that I no longer needed my T3 medication, Cytomel. 

Let’s go over how difficult it was for me to even get a T3 prescription to accompany the widely overprescribed T4, Synthroid. 

Seven years ago, I had consistently had problems swallowing. My PA at my PCP diagnosed me with Dysphagia although I had never had problems swallowing before. 

For two years, I asked for a referral to an ENT. For two years, I didn’t get one. I finally called my insurance company and learned that my policy allowed me to choose my own doctor and found an ENT that diagnosed me as having thyroid cancer to the left thyroid. 

Was I upset for two years that a PA at my my PCP’s office didn’t believe there was an issue? Absolutely. The trust I had in my PCP went out the window for anything serious after the thyroid cancer. 

The Thyroid specialist sent to surgeon who convinced me “if you have problems with the left, you will eventually have problems with the right. We should remove both.” I’m going to go out on a limb here and admit that I had no idea what a full thyroidectomy would do to my health and went along with this “doctor.” 

As usual, Cindy was with me at the appointment to schedule surgery and like me, didn’t want me to have thyroid cancer twice. Fear drove me to this decision. 

My sister is my best friend and my support. Neither of us could imagine our life without the other in it.  The fear of going through thyroid cancer twice if I didn’t remove the right and left was the primary reason for my decision “to go along with a full thyroidectomy.” 

The surgeon was getting significantly more income by “doubling up” on the surgery and my health following the surgery and overly prescribed Synthroid Script would go downhill for over a year while I researched about weight gain, hair loss and other factors that included fatigue. The Synthroid alone was causing my issues. 

For nearly another two years, weight gain and depression were the “gift” my full thyroidectomy left me with. I researched everything I could find about thyroidectomy AND Synthroid. 

If I had any idea of how much a full thyroidectomy would affect my health, I can assure you that I would never have agreed to the life changing surgery. But, the surgeon never discussed the impact of a full thyroidectomy. 

Synthroid, a T4 drug causes massive weight gain. It’s also the most overly prescribed drug on the planet and most everyone taking it hates it. From “Synthroid sucks” forums to patients who have no idea why they continue to gain weight, feel sluggish or depressed to people who throw their meds in the trash and go on strike, I’ve found that Synthroid alone is the prescription that’s always written without any consideration of the side effects. 

I decided to research more in order to find a way to “get around” the side effects of Synthroid by adding a T3. The rarely prescribed and hard to get prescription? Cytomel. 

Finding a doctor to write this prescription to take in conjunction with Synthroid would take another year but, I finally did because I refused to give up. 

Yesterday, the PA announced “we’ve decided to stop filling Cytomel. You don’t need it.” I was instantly furious. Was the PA just having a bad day and taking it out on me or playing God? Your guess is as good as mine. Her attitude and demeanor were more than standoffish. 

My twin sister had joined me at my visit (as usual) and knew how hard I had fought to get this prescription in the first place. Cindy also knew that this Cytomel issue would be a deal breaker for me. 

I was so angry at a PA “deciding” to change a prescription that I could barely speak and much less look at her. I had nothing to say to this lady who had in minutes undone everything I had worked to accomplish. 

This is why you should see a Dr rather than a PA. Synthroid ruined my health and my life and getting around being grossly obese due to having no thyroid was a journey for me. It was a battle. 

Cindy knew how upset and angry I would be about this “decision.” Cindy also knew I would be forced to find another doctor and, the smart Alec PA didn’t. 

When I think of the thousands of dollars I’ve spent on Dr visits to my PCP spent for visits with the PA rather than the Dr and the billings to my health insurance company, my head swims. 

After all, it was the PA who didn’t think diagnosing me with Dysphagia without finding why I couldn’t swallow wasn’t a big deal. I quickly sent my husband a text from the chair. “Houston, we have a problem. The PA is cancelling my Cytomel. Find us another PCP quick, fast and, in a hurry.” 

A few moments later, the PA demanded I disrobe after tossing a gown at me. What I should have done was gotten up and walked out of this “appointment.” I was reminded of my husband and his warning about a miserable visit himself that had driven him to seek out another PCP. Now, it was my turn to be upset and angry. 

I tried to control my anxiety while realizing that I hadn’t taken my anxiety medication yesterday as I wasn’t going to visit any of relatives in a Psych Ward and therefore didn’t feel I would need my anxiety medication it but, that had been a mistake. 

My heart rate went up and the “PA with an attitude” decided to order an EKG. Was she forcing me to remove my clothing in order to retaliate for me questioning her decision? What do you think? 

I don’t have high blood pressure OR heart disease but this PA was forcing me to remove my clothing and pay 20% for an unnecessary EKG? What the? I was even more upset about getting sucker punched over the Cytomel that had saved my life after fighting so hard to get it and now being forced to disrobe by the same PA? I decided to see the nurse about all of this. 

After I demanded to see a nurse, I went ahead took off my blouse and bra while waiting. By the time the nurse arrived, I was not only controlling my anger and my breathing but was also questioning why for all of these years I had accepted seeing a PA rather than my doctor?! 

Are PA’s acting as physicians without proper training and education? The answer is yes. Recently, the New York Times published an article on excessive costs incurred by mid-level providers over-treating benign skin lesions. 

According to the piece, more than 15% of biopsies billed to Medicare in 2015 were done by unsupervised PA’s or Nurse Practitioners.

PA’s aren’t dermatologists and yet, they continue to perform medical procedures that should be conducted by an experienced physician. 

Yesterday, a PA not only changed my prescriptions without explaining why but also attempted to force me into an EKG. I was angry and agitated about being curved into removing my shirt and my bra but, I didn’t do the EKG after the PA announced “perhaps you, your husband, your niece, your brother in law and your sister should see Dr Richwine since you disagree with me and I’m not comfortable treating you.” 

Perhaps my Dr should question why he’s losing patients? 

Well, she was right about one thing, my entire family visit this clinic and my entire family have never even seen our doctor and yes, I was uncomfortable with a PA making my medical decisions too. Perhaps my entire family need a new PCP? After all, the PA “missed” my thyroid cancer. 

But, if you cannot get an appointment with your PCP, it’s time to change doctors in my opinion. I felt bullied by the PA. 

Embarrassed into being forced to disrobe and unable to say what I was really thinking certainly didn’t help matters for me either. 

The cocky and condescending attitude of the PA on top of having to take off my clothes was literally over the top. Healthcare in America is expensive. 

My health insurance costs due to endemetriosis and thyroid cancer are high. Insurance premiums on my husband and I are $15k a year. Yes, insurance is a hefty investment and for many older Americans, the quality of healthcare is going downhill. Let’s get back to the Dysphasia Diagnosis. A PA had “diagnosed” me with the issue but getting a referral while struggling with thyroid cancer was never questioned at my PCP’s office. No further tests or biopsies were ordered either. Suddenly, difficulty swallowing wasn’t a problem? 

Question your PA or find another doctor because your health is at stake. If I hadn’t finally found a specialist, I’d be dead by now. 

My husband has a small area near his lip that’s been bothersome. A PA suggested “burning it off for him” at our PCP’s office. My alarmed husband chose to go to a dermatologist as well he should have. 

My surgeon that suggested removing both my right and left thyroid changed my life forever by removing my right and left thyroid but, patients trust the decisions of physicians and, they shouldn’t.  

Unfortunately, there are doctors (or PA’s) out there who will talk over, bully, or coerce patients into medical decisions they don’t agree with. This is wrong. If this has happened to you, please know that it’s not your fault – the blame falls squarely on the provider engaging in unethical or unprofessional conduct.

When you’re dealing with a doctor with a bad bedside manner, know your rights. Know that you have the right to a full, understandable explanation of your medical condition and all of your treatment options. If you aren’t in a position to advocate for yourself, ask trusted family or friends to intercede. 

Insist on speaking to a different doctor, senior-level personnel, or a patient relations representative.

Don’t make the same mistake I did and just “go along with a life changing surgery.” I’ve had several people contact me regarding Cytomel. Cytomel is a thyroid medication which contains T3. … That means T3 directly stimulates increased energy production, increased fat burn and increased metabolism. Through these mechanisms, and many others, cytomel and T3 can actually help certain thyroid patients to lose weight and feel better. 

If you are taking Synthroid alone, you should have your levels check and ask to add Cytomel to Synthroid. It’s the single best decision that I’ve ever made after extensive research and I strongly suggest anyone who’s undergone a full thyroidectomy look into it. 

Why is it so difficult to get a Physician to add T3 to T4? I have no idea but I know this, it is. Finding a physician to prescribe Cytomel was the hardest thing I’ve ever accomplished and, it stopped the massive weight gain that Synthroid caused along with other side effects of Synthroid alone. 

Very few doctors recommend taking T3 (triiodothyronine) in addition to T4 for the treatment of hypothyroidism (that is, two separate pills). Liothyronine, known by the brand name Cytomel and Triostat, is the synthetic form of T3. 

The big picture for you or a loved one is to understand that, as of now, the standard treatment for hypothyroidism is a T4 drug alone. Though the addition of T3 continues to be a topic of “ongoing research and debate” within the thyroid community, for certain patients, it may be a sensible strategy. 

PA’s are not trained to have a bedside manner and they are taking over PCP’s offices in the US. They aren’t trained for specialty services either. The PA knew nothing about again or hormones regarding my husband’s situation. 

The same PA yesterday decided to discontinue Cytomel after I had fought so hard to get the prescription. For these reasons, we’ve decided to change doctors and find one that actually sees patients rather than diverting them to a PA. 

My gynecologist would never send a PA in to examine me but my PCP does so on a regular basis. My dentist would never send a PA in to examine or treat me either. 

Why PCP’s continue to put their patients care in the hands of a PA who isn’t qualified to either treat patients and in many cases to write prescriptions had become an  alarming issue to pharmacists who recognize the problem. Ask more questions and get more answers. In situations of surgery, you need a second opinion. I wish I had gotten one before undergoing a full thyroidectomy. 

If you cannot get the level of care you need at your PCP, it’s time to explore your options…