Monday, October 21, 2013

Under New Management - Part 2

I didn't mean to leave you hanging all Empire-Strikes-Back-style, but I realize the last post of why I decided to switch RE practices was getting very lengthy. Here's how it all shook out...

After the disappointing conversation with Dr. F's nurse, I decided to contact UH the next day. I talked to the front desk staff and the financial counselor. I asked a lot of questions about how their process worked and what the costs were. The process was very similar to CC with a few distinct differences. First, they have only one sonographer, which I think it great because personally I think this slightly more of an art than a science and it's good to consistency in the interpretation. Second, when they have their meeting in early afternoon to review all the data, ALL of the Drs meet together, meaning that my actual Dr will be in on all of these meetings (assuming he's not off work) and making the decisions himself. Pricing was comparable between both practices. The front desk worker said that she'd give my folder to the nurse and he/she would call me back to get some more history and all the updates since my initial consultation in late spring.

Instead what happened was that Dr. P call, the actual Dr! He left a message because I was with my own patients and couldn't answer the phone but called both my work and home numbers and left messages on both! (Have I mentioned that I haven't actually spoken to Dr. F since the initial consultation, only talking through him to the nurses since this time) Then, the next day, he called again... at 7:20 in the morning! C mentioned that this was likely a professional curtesy because he knows I work professionally, which I agreed with after my initial shock in the lack of typical social etiquette. Or maybe this is just because I am not a morning person; even though I was already close to work at that point.

C and happened to be carpooling in the day, so he got to hear most of the conversation as well. I briefly explained what has happened since last meeting with him. He told me about some brand new research presented at the recent professional conference of a huge study that showed Femera was significantly more effective in patients with PCOS than Clomid. I appreciated that he discussed the actual research studies with me and thought this was very respectful. He then gave me a similar talk as our initial consultation by listing out the several options that I could choose from! These included a "step-wise" approach to Femera, going straight to injectables, or going straight to IVF. I explained my hesitancy towards spending a lot of time on oral medications, but also my desire to given this a shot since it is much less expensive and time consuming. He clarified what he meant by "step-wise", saying that we would start with 5mg (not the 2.5 B.S. Dr. F was insisting on) and monitor me from ~12-13. If I haven't responded to this by ~20-22, I would begin taking 7.5mg immediately so that the whole cycle would take a maximum of roughly six weeks. This way we could give it a shot and say we tried, but not waste too much time and be able to move on injectables (if we need) maybe even by the end of the year. I am thrilled about this plan. It feels like the best of both worlds. Then, he recommended I come in for a baseline ultrasound to see if we could start this right away (if my lining is thin enough) or if they would give me some more medicine to induce a period. Sweet! Let's get this show on the road!

After hanging up, C mentioned that he sounded really nice and felt good about the plan. I agreed and so we officially made the switch.

At one point, we had discussed emailing or setting up a meeting with Dr. F to give him one more shot to explain his rationale and help him to understand my frustration. I haven't done this yet and am not sure it's necessary. I also haven't let the CC practice know that I'm switching teams, but aren't sure this is necessary either. I think this is the loyalty in me that feels bad about breaking up with my employer's practice and doing it by abandoning them in the middle of the night without an explanation rather than having a big-girl conversation. But alas, this is not a romantic relationship, maybe this analogy doesn't really apply at all.

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