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which doctor manages what?

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Chronic Pain
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Posted 7/29/2011 8:58 PM (GMT 0)
These days I'm getting pretty confused about which doctor I'm supposed to talk to about which concern. I see three main doctors - my PCP, a physiatrist, and a psychiatrist. My PCP prescribes meds for fibro and has prescribed some meds for my back pain, the physiatrist is now working on my back pain, and the psychiatrist prescribes my psych meds. But all these meds are so interrelated. I'm concerned about two meds the PCP is prescribing - naproxen and gabapentin. This seems like something I should discuss with her, but also relevant to discuss with the physiatrist. My PCP has talked about putting me on Cymbalta or amitriptyline for the fibro, but this of course has to be coordinated with my psychiatrist. And then in general, I'm concerned with how many meds I am taking. Who should I be talking to about these concerns? Who is in charge of resolving conflicts between meds, such as Cymbalta and my existing psych meds?
Posted 7/29/2011 9:32 PM (GMT 0)
In a perfect world, all of your doctors talk to each other. In the real world, I know that doesn't always happen. Just make sure that your PCP know every single med you take. No, make sure ALL of your drs know every single med you take. Write down your doses the morning you go to each appt and hand the paper over to the dr (not just the nurse).

My PCP takes care of my bp and migraine meds.
My PM takes care of my pain medication.
My endocrinologist takes care of my thyroid medication (still tinkering with that one).
My hematologist deals with the Coumadin for my DVT (short term, haven't had the same dose two visits in a row).

The specialists I have are GREAT about immediately cc-ing the PCP on labs, tests, and any changes in doses, but I still have my lists of meds that I print out and take to every appt w/ every doctor. With some of the changes they've had to do lately, it's important.

In your case, discuss with your PCP your concerns about drug interactions. PCPs are bettered versed in more meds, usually, even if they don't typically prescribe them.
Posted 7/29/2011 9:48 PM (GMT 0)
Basically both your PCP and the physiologist should be equally informed about any and all pain issues you are having as well as any problems you might have with movement, work, etc.

Your psychologist/psychiatrist should be kept informed of all mental health issues.

All you doctors need to be kept informed of all medications you are on and what they are being prescribed for.

In addition to the above your PCP needs to be kept up to date with your treatment plans from the other doctors on your health care team. Ideally the other doctors should be sending regular reports to your PCP but do not count on this. You need to make sure the PCP knows everything that is going on with you. Anytime groups of doctors treat a person it is the PCP that acts as the coordinator for the group. At least that is how it is suppose to work. Of course any general health issues you should address with your PCP.

As far as medication inquiries go, try talking with the doctor who is prescribing that medication and/or your PCP.
Posted 7/30/2011 12:52 AM (GMT 0)
Hi Heather...

I have as close to the 'perfect world' as we can have, I think.

My GP (the same as your PCP) acts as a central point - all my specialists send their letters through to him, and he relays anything through that needs to be done.

I also have something of a 'small world' situation too - my PM doctor knows my physio, my GP treats my physio's kids, my GI doctor initially referred me to my cardiologist, so they talk regularly.

Unless I'm starting a new medication that he's not familiar with, or not comfortable handling initially, my GP handles all my medications. He is always happy to prescribe my narcotic meds (oxycontin and oxcodone IR), but I do have a close relationship with him and he's known me for many years. He also likes to review at least once a month even if I'm quite well - just to make sure we're on top of things.

Laura
Posted 7/30/2011 2:07 AM (GMT 0)
I would never count on my drs talking to each other, in fact I know they never have. Its really the patients duty to make each dr aware of any and all medications they are taking. Especially when they want to start you on a new medication. By making it a point to tell the dr what you are currently taking that will help you from having a big conflict with your meds. I never rely on my dr to know what meds I take and I know he/she is not going to look at my list of 18 either. Heather it sounds like your drs are rxing some meds that are the same so make sure they are aware of what you take. Good luck.
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