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Specialist Referral Questions - updated again in November... ;) p2.


Jerry

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**I know this is a stupid question that could be answered by ringing the doctor office, but what is EB for if not to ask stupid questions sometimes?**

 

We went to doctor for another specialist referral for a second opinion on DD's (15) chronic hip pain.

 

Apart from the GP saying it is probably all psychological and DD will have to learn to live with it (great way to say things to DD - not), he gave us a referral to a partner specialist of the original specialist.

I had told him a few names I had looked up of specialists that appealed to me (based on their website and reviews). But the GP said he would refer me to a good one. It was only later that I noted that it is the specialist next door to original specialist. Sure, he has a high level of skills according to the internet and his qualifications, but I am concerned that the next door buddies will just back each other up without investigating further.

The GP cautioned us against getting a second opinion to get the answer we want, rather than the right answer.

 

Anyway, this is a long winded way of asking - can I use the referral with a different specialist (same type - orthopaedic)? Or will I have to find a new nicer GP who listens and gives us new referral?

Edited by Jerry
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Yes you should be able to use the referral with any specialist of that type. I'm pretty sure the specific one you're seeing doesn't have to be named on the referral, and even if there is one named on it you can use it to see someone different. Obviously you'd need to check with the specialist of your choice. I think some get a bit weird about it and might insist on you getting a referral with their specific name on it.


Your poor DD - so she's still having issues with her hip?

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Yes [mention]Paddlepop[/mention] , she is still in pain. :(


We've been seeing a great physio for nearly 6 months now and she's been doing exercises with little gain.

The Physio stated last time "DD presents clinically as a patient with FAI (hip impingement)." This is something that has been on my radar for a bit.

Unfortunately the MRI she had mid last year didn't show too much. The first specialist saw us for about 5 minutes, barely listened, looked at the MRI and said it looked clear except for some minor gluteal minimum muscle inflammation. When I asked why muscle would cause 3 years of pain, even after rested and after physio, he laughed and said "The body is a funny thing". My "research" tells me that for FAI and hip dysplasia you need mri and X-rays in different positions. I asked about more X-rays and he said not necessary.

Hence the request for second opinion.

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It's really gets my goat when the absence of a cause is put down to psychosomatic issues.


I first had that at 13, six months later ended up in the RCH for six weeks by which time I could barely stand up and was fainting regularly. (My mother was mostly to blame for that one - doctors know everything apparently.)


Second time it was pain and two specialists (one I'd known for nearly 20 years with zero general health issues) decided it was psychosomatic. I lost 20 years of decent exercise to that when it turned out to be caused by an (eventually diagnosed) adrenal tumour.


No one tells me something's psychosomatic.


"So you haven't found the cause of the pain, yet." would be my response when they say they can't see a problem.


There's so much still to be known about the human body, the best doctors will recognise that it can be a real challenge.


Funnily enough, my first and second conditions were always considered to be unrelated. In 2016 it found that people with the first condition were 20 x times more likely to get the second.

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Jerry: I'm going to PM you the name of a specialist who might be able to help steer you in the right direction. He's a distant relative of mine and apparently he's a brilliant surgeon. Sounds like that first specialist was a dismissive dickhead. Surely thorough radiology investigations would be a good start. Can the GP at least refer DD for them or do they need to be ordered by a specialist to be eligible for Medicare rebates?


The skill of the radiologist is also important. I've had hip bursitis issues on and off for about 7 years now, and get cortisone injections about once a year for the past 4 or 5 years. This time I went to a different radiology place for it because the usual place was going to charge an out of pocket cost but the different one fully bulk billed me. The sonographer who did the ultrasound on my hip asked me to do a particular movement with my heel during the scan. I've never been asked to do that before. Turns out it reveals the hip bursa nicely by moving some tendons out of the way. Just little things like that can make a difference to the quality of the images and results. The doctor who injected the cortisone wasn't as good as the usual guy who does it but hopefully it does the trick for my pain.


Also, you might remember that my DH has been battling ill health for a few years now with no results from any doctors. One of them said that he would refer DH to a pain management specialist and to increase his dose of Lyrica. That seemed like giving up to us. We weren't ready to give up. DH has now been able to go off Lyrica completely and no longer needs it. Turns out a simple blood pressure medication he was on was giving him horrendous pain and swelling. Nobody ever questioned it despite it being well documented as causing pain and swelling for some patients. He ran out of it at Easter and didn't get a new script because of the Brisbane Covid lockdown/mask thingy. He improved amazingly without it. He's still ill but no longer needs compression stockings and can actually play and roughhouse with DD again. He also has back pain that turns out seems to be very closely linked to two hernias he has. He tried a support belt for them and his back pain and leg pain vastly decreased. Again, no doctor bothered to look into his hernias and non-surgical treatment of them. It was basically just meh, you're fat, you have hernias, deal with it. We still have no idea what's happening with his skin but that's much more bearable with so much less pain in his body now.


Sorry, didn't mean to take over your thread. I'll PM you.

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I think you can use it with any specialist (same specialty obviously).


In year 7 I developed a very sore foot. I saw the GP 6 times over 10 weeks before he mentioned “is everything ok at home” and started asking if it was in my head, x-rays showed nothing. Eventually convinced him that I was psychologically fine but really starting to struggle because my foot was so sore. He agreed, under sufferance, to a bone scan, which revealed a stress fracture. It took 9 months to heal in the end. Not so much as an apology, and it must have cost my parents a fortune.


Doctors who stand in the way of progress towards a solution do my head in!

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"So you haven't found the cause of the pain, yet." would be my response when they say they can't see a problem.

 

Agree. That's my attitude to my DH's health issues when specialists try to say there's nothing wrong with him. There's something wrong - they just haven't worked it out yet.

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"So you haven't found the cause of the pain, yet." would be my response when they say they can't see a problem.

 

Agree. That's my attitude to my DH's health issues when specialists try to say there's nothing wrong with him. There's something wrong - they just haven't worked it out yet.

Agree - but it is so hard to keep going back and being believed. I believe DD - I have seen her pain with my own eyes. Unfortunately she does have a long term diagnosis of Generalised Anxiety Disorder, so they jump straight to that. But I know she's in pain - it is very obvious and comes on suddenly at times.

I will keep investigating for DD. The doctor saying it is in her mind just made her so upset.


[mention]Paddlepop[/mention] - Yes I remember about your DH"s undiagnosed issues. Glad there is some improvement.


Glad to hear others have had undiagnosed issues resolved, though wish it was quicker.

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Kiwi Bicycle

I am going to go against what everyone saying it's Ok to use the referral anywhere and say I have been told that yes you can switch doctors, but only at the same practise. That Medicare want addresses to match the refferal letter.

Happened when I was looking for a behavioral pead. The one the GP referred us to has her book full but the clinic said I could use the refferal for a collegue, when I asked if I needed an updated referral as the addresses match.

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Jerry: We've encountered the same sort of discriminatory bullshit due to DH's ASD, ADHD and depression. Must be in his head because of those conditions. No, if it was in his head his psychiatrist would have worked that out and be "fixing" it. They get kind of shitty when I point out that DH sees a psychiatrist regularly and has since before he became unwell, and that he's on top of DH's mental and psychiatric health. They need to stick to their own field of speciality and not dabble in psychology and psychiatry.


One suggestion I have is to get her GAD diagnosis removed from her referral. Ask the GP to exclude it. We did that for one specialist DH saw. My goodness, the difference in attitude towards DH. We disclosed his diagnoses at the end of the initial appointment prior to any prescribing of any medications. The specialist admitted that had he known at the start about them that he too would have assumed it was all in DH's head like other specialists have.

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One (mildly sneaky) possibility would be to call the GP’s reception and say that the specialist referred to didn’t have any available appointments, so could the referral please be updated to Dr XYZ as you called their office and they were able to fit you in. I’ve been able to get the referrals just reissued (when the relevant specialist legitimately wasn’t taking new patients) without having to go back in.

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Yes you can use it anywhere. We just had this with my sons paed. We were referred to one then a friend recommended a different one, GP receptionist said we could use it anywhere within 12 months. The second paed accepted it no questions asked.


Hope you get some answers soon!

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There is nothing wrong with being referred to a Pain Management Specialist...nothing at all. Sometimes there is pain that is not due to an abnormal disease process and that does not mean you are making it up nor does it necessarily mean you are being referred because they think you are imagining it. The brain often responds to a previous pain by 'remembering' it so the pain stays long after the injury or illness has healed. It is real pain.

Sometimes the best approach to treating pain is not with with exercise, surgery or medication,


eta.. sorry Jerry, I didn't really address your query.

Good luck.

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There is nothing wrong with being referred to a Pain Management Specialist...nothing at all. Sometimes there is pain that is not due to an abnormal disease process and that does not mean you are making it up nor does it necessarily mean you are being referred because they think you are imagining it. The brain often responds to a previous pain by 'remembering' it so the pain stays long after the injury or illness has healed. It is real pain.

Sometimes the best approach to treating pain is not with with exercise, surgery or medication,


eta.. sorry Jerry, I didn't really address your query.

Good luck.

 

Yes, I do understand this. When it was perceived originally to be abdominal in nature the Gastro discussed Functional Abdominal pain syndrome, which definitely fits that explanation. Apparent a treatment for it is the use of Endep, which also blocks nerve transmission from abdominal pain, so helps break the cycle.

We've also considered using hypnotherapy to assist DD. Just at this stage I have to continue to try to find a physical cause (perhaps at the same time as trying pain management strategies).

I've also looked up pain specialists, ready in case.

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Fruitmincepies

[mention]Paddlepop[/mention] i don’t think I ever updated you - my family member’s medical mystery was finally sorted, or at least mostly sorted. Let me know if you want the story - it took some pretty dramatic symptoms to get a diagnosis.

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FMP: Yes please, I'd love to know. Please PM me. Glad that they've got it sorted.


STBG: Pain management specialists definitely have their place and are an important part of healthcare but it feels like more and more that specialists are referring to them instead of properly investigating why a patient is unwell.

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FMP: Yes please, I'd love to know. Please PM me. Glad that they've got it sorted.


STBG: Pain management specialists definitely have their place and are an important part of healthcare but it feels like more and more that specialists are referring to them instead of properly investigating why a patient is unwell.

My specialists could not have done a single more test on me. I drove them crazy as I wanted to know why and my medical brain told me that pain meant there was something that needed fixing. Sometimes you can exhaust every single option with invasive tests, surgeries and medications and still not get an answer that you want and it is not the fault of the specialists although I acknowledge that some are rubbish and would always recommend a couple of opinions.

At the end of the day I do not see a PMS as the default when there is no apparent answer but that they are part of the medical team.

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humblebumble

You don't need to see the specialist listed, the referral is for anyone in that area but be aware that no matter where you go you could run into the same issue of them all talking to each other. We have it here & it can be really frustrating, you see a new specialist & things are going great until they decide to chat to the previous one who you left because they weren't doing their job properly.

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**I know this is a stupid question that could be answered by ringing the doctor office, but what is EB for if not to ask stupid questions sometimes?**


The GP cautioned us against getting a second opinion to get the answer we want, rather than the right answer.

 

 

What on earth does this mean? So as an educated person, you have researched symptoms and have an idea of what it might be. Yet if you get a second opinion and they agree with your diagnosis, this only happened because you found someone willing to say it, rather than your child actually having the condition? I really don’t think specialists give diagnoses based on parent’s opinions!


Could be time for a new dr. When I was having trouble getting to the bottom of my DD’s medical condition, I saw plenty of GPs at our local clinic and had some dodgy responses. I eventually went back to the dr I liked the most, even though I had a big wait to see him. He did not treat me or my child like an idiot, listened and got us a diagnosis - well a referral to a specialist to get it.

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Oh your poor daughter, I remember so vividly twice as a teenager getting that sort of response. I was despondent. My orthopaedic specialist was seriously injured in a car accident. it makes him an excellent, non-up-yourself ortho and a rarity.

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@Paddlepop i don’t think I ever updated you - my family member’s medical mystery was finally sorted, or at least mostly sorted. Let me know if you want the story - it took some pretty dramatic symptoms to get a diagnosis.

 

[mention]Fruitmincepies[/mention] can you PM me too? Some similar issues here too.


[mention]Paddlepop[/mention] that's fantastic your DH is doing better.

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From the Medicare website

https://www.servicesaustralia.gov.au/organisations/health-professionals/subjects/referring-and-requesting-medicare-services#a2


"Referrals for specialist treatment

Patients can be referred to a specialist or consultant physician for treatment of their condition. The referral must include:


relevant clinical information about the patient’s condition for investigation, opinion, treatment and/or management

the date of the referral, and

the signature of the referring practitioner

Referrals don’t need to be made out to a certain specialist or consultant physician.


Referrers should let patients choose where to present the referral, this also applies to electronic referrals."


That said, not all doctors would know that so best call up the one you want to see and check they are ok with it. It's pretty disappointing that your GP is not listening to who you want to see :(

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  • 2 months later...

Jerry: That's great that the new specialist listened and believes that there is actually a physical problem. Fingers crossed that it can be fixed easily enough. How is DD feeling? I'm guessing she's relieved to be believed finally. Just curious: is this the specialist I suggested?

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