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Thursday, May 9, 2013

Goodbye Family Practice, after 30 years

I have now transitioned from primary/care to a Lyme consultative practice.

I don't get to diagnose patients in the "general population."

The chief complaint of patients visiting a primary doctor is musculoskeletal in nature about 30% of the time. For some reason, the incidence of peripheral neuropathy is on the rise; I was surprised to read that "idiopathic." unknown cause, is found more often than diabetes. ( old joke: idiopathic means the patient is pathological and the the doctor is an idiot). OK, so how many of these patients and others have Lyme disease?

Then there is the growing population diagnosed with fibromyalgia:  many treated with drugs that are supposed to help but only make things worse.

The really sick patients might see 40 doctors before visiting with an "LLMD" if they are lucky.

Many patients will be left disabled with "mystery diagnoses."

Of course if I am not there to diagnose a few,  my former patients will suffer the fate of so many others. Perhaps when patients hear I have left primary care to treat Lyme disease it might communicate something.

HMOs and managed care allows for 6-8 minute visits with a primary care doctor and focused evaluations by specialists who never see the bigger picture. Even the more open minded physicians operate in a system which deprives them of the energy or time to look elsewhere.

This is all rather depressing so I will turn my attention elsewhere.


JT said...

Sad to hear you've closed your practice but fully understand.

I am one of the many fibromyalgia/CFS patients that "may" have Lyme,Babesia,Anaplasmosis, and other co-infections.

The doctor that ordered tests through IGenex wants me to see an LLMD but I haven't selected one yet. I live in Massachusetts within 35 miles of Boston yet I'm not jumping to see the LLMD's.

One at MGH, I'm not sure I can trust since he is one of the authors of the IDSA guidelines. The other two do not take insurance at all. Trust is very difficult these days.

It is truly overwhelming trying to make wise medical decisions when there is so much disputed. Even family members want to know if I have Lyme or do I not.

Good luck with your new LLMD practice! I only hope I'm one who will find healing after so many years.

Marie said...

Hello, I live 35 miles South of Boston and I see a wonderful Infectious Disease Dr who has been treating me for Lyme the past 10 months. Prior to getting Lyme last Summer, Ive been seeing him for years for CFS/Fibro.

He is not a LLMD, but knowledgeable, great listener, and thinks outside the box.

I don't know if I can leave a name here or not. If you're interested you can email me

I've enjoyed this blog very much doctor, good luck w your new Lyme needed.

Seibertneurolyme said...

Congratulations and Good Luck!!!!!

I think this transition will enable you to help your tickborne patients better if you have longer patient appointments. These illnesses are so complex that the standard 10 or 15 minute appointment as allowed by insurance just doesn't fit the bill.

LYMEMJ said...

As a Lyme sufferer and being one of the special ones diagnosed by you, I applaud and thank you for this sift towards treating Lyme Disease patients because our Lyme community is desperate of help and as you well know and said, we pass by 10 to 40 physicians until finding a compassionate knowledgeable Doctor who dares to treat us and help us. Unfortunately there are very few Drs like you and most of us live far away. We need you Dr J, and we have signed letters and will continue to support you in response as you care and dedication to all of us. We've seen you grow as a physician and this shift is more a response to our huge call! Thank you deeply!
(About me as an update, after you dgx in 2009 I came back to Florida and have survived thanks to reading your blog and taking Ivermectin once a week, low dose oral. I told you when I met you, back then, that there had to be a parasitic infection in Lyme and thanks to that theory, that I got from a phone call to a Dr in South America, I'm still here giving this battle. Also made a blog and now doing videos and itnerviews to Integrative and traditional Drs who dare to treat lyme, when would you give me one interview? Here is my new VLOG:

Unknown said...

I've followed your posts a long time and real happy with your move. We need thousands more like you. Not necessarily the lyme experience, but the overall outlook that medicine is a combo of art and detective, a duty of intuition guided by experience, it is a patient-doctor partnership, it is not an establishment-patient relationship. Your posts have helped to guide the direction of my visits with clinicians not up to speed, and your info was enough to convince them to write the prescriptions I wanted. Now I've got an LLMD taking over the steering and I like that. Improvement is gradual. Mine is probably a 20 year infection. Of interest to you may be this: I was predominantly a depression/psych victim, not much physical symptoms, and it was Rifampin/Cipro combo that wiped out pscyh symptoms in 3 months. Thus....Bartonella is prime suspect when psychiatric symptoms are prominent. Interesting, none of a backpack full of psych meds...all antidepressants except nardil, all mood stabilizers, all antipsychotics, and other stuff...all caused worsening or no improvement. Helpful on an as-needed emergency basis were Ritalin or vicadin or ultra low dose savella. Thus...suspect infection when a patient does poorly with psych meds. Anyway, cheers and God bless what you do! You have shared your gifts with me, let me share mine with you. On youtube type in channel 'jlafolle1' and click on the song Moon Candles. This Lymie is back on stage. You played a part in that.

Unknown said...

You have shared your gift with me. I want to share mine with you. I am real happy with your move. We need many more like you. There are plenty of family docs. We need more of you, not them. Beyond your lyme experience, I especially like your approach to medicine as a combo of art and detective, guided by intuition and experience, not by establishment. Too many stay sick and die due to establishment medical policies. I have a good LLMD now, but prior to that it was your blogs guiding me and my NP! My gift to you....please go to youtube, type in channel jlafolle1, click on song Moon Candles. This Lymie is back on stage after 20 years of death! And you played a part in that! thank you sir

Unknown said...

Of interest to you, since you seem to be such a sharp detective....

My symptoms were mostly depression and psychiatric, not physical. A backpack full of all psych meds worsened my mood or did not help much, including all antidepressants except nardil, all mood stabilizers, all antipsychotics. The only ones helpful, on an as-needed irregular basis, were Ritalin or Vicadin (both for mood) and sometimes ultra low dose Savella (6mg). Even ECT failed. Guess what worked? Rifampin/Cipro combo. Thus, my journeys tell me psychiatric symptoms are mostly Bartonella. I also have seen that when a patient does poorly with psychiatric meds, especially the ssri's, that is a loud clue that stealth infection is suspect.

R.L.M. Tipton said...

On behalf of those chronic Lyme sufferers who have no insurance, no options, a lot of problems that get blindly ignored via what may be a case of blatant stupidity among certain of the 'medical INDUSTRY'...or profitable behavior in terms of long-term illness being worth a lot of money to them... thank you. Thank you for listening to your patients. Thank you for trying to help. Bless you.