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    Finding a neurologist

    It seems to me that if you need to see a neurologist about a possible MS dx that you would be seeing the Doc. I have been seeing a good neurologist who wanted to have another neuro take a look at my case and get his opinion. Their office set me up with another neurology office who called and told me who I would be seeing. It wasn't the Doctor my primary neuro had told me he wanted me to see, but another person in that practice. Before my appointment I checked their credentials and found out they had just finished school last month. I went back to my primary who then set me up an appt with another doc. When I got there though I didn't see the doc I was set up for and when I got home and checked the persons credentials I found out she was a nurse practitioner. Is this normal?

    #2
    Sometimes you will see the MS specialists' nurse practitioner/PA first, just for history, exam, basic stuff like that, then if the NP/PA suspects a neurological problem they will get the neurologist to come in and do an exam themselves. The neurologist will then decide if they think you have MS or not. It is a move to save time. The NP/PA is qualified to do a neurological exam, history, and treat you, they just can't make a diagnosis-that goes to the neurologist.

    It is often better to go to the NP/PA. They have more time to spend with you. Take advantage of this opportunity, you will see the neurologist the same day as well for a diagnostic evaluation.

    Good luck!

    Lisa
    Moderation Team
    Disabled RN with MS for 14 years
    SPMS EDSS 7.5 Wheelchair (but a racing one)
    Tysabri

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      #3
      I wouldn't say it's normal but it isn't uncommon. It depends on where you go.

      In a teaching clinic it's standard procedure for the doctor training under the neurologist to do the workup as part of their learning and then take their results to the neurologist to discuss your case. Then the neurologist comes in and goes over things with the resident/fellow and with the patient.

      Some neurologists have nurse practitioners or physician's assistants do some tests first. But the neurologist comes in and finishes the exam.

      It's not normal to have an appointment with a neurologist and then never see that neurologist or any neurologist at all.

      There's some information missing here... When your neurologist referred you to the other neuro, did you specify with the second office that you were to see that specific doctor? Did you call your neuro and tell him that the second office made you an appointment with a different doctor in spite of his referral? Is your neuro still waiting for the results of an exam that never happened?

      Is there some reason you went to your primary for the appointment with the third neuro instead of to your original neuro? Did you specify with that office that your primary wanted you to see a particular doctor? Did you call your primary to say that you never saw the neurologist you were referred to or that you never saw a neurologist at all?

      I think both your first neuro and your primary doctor should know that their referrals weren't respected by the other neurology offices. For you to not see the neurologist you were referred to isn't normal.

      Comment


        #4
        My MS Specialist typically spends 45 mins to an hour on my clinical exam, not including time in the office discussing any changes, new sx's, meds., etc.

        I have seen his NP, who specializes in MS, but the diagnostic god in the practice is my MS doc. When my sx's are more active, changes in clinical exam, he takes over my care.

        For a 2nd opinion, I'd expect to be examined by the most qualified individual to provide that opinion. I would expect to see the NP only after a diagnosis has been established by a doc, treatment plans in effect, etc, and only after a doc/patient relationship has been established.

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          #5
          I would ask the office.
          Tell them that you want to be under the care of Dr. A, and does this Dr. B, work and learn under Dr. A? Will you be seeing both doctors?

          I go to a major teaching hospital for my Transverse Myelitis.
          At first everyone thought that I might have MS.

          Who knows at this point.

          Well anyway, I ended but seeing TWO MS neurologists at the same time. One that was the experienced MS specialist, and another one that was called a "fellow." He was learning and working under the main MS neurologist with 30 years of experience.

          They were both very, very, good.

          Comment


            #6
            The hierarchy of physicians in a teaching hospital is:

            1.Attending: Doc who has finished residency and fellowship and has started practicing their specialty.

            2. Fellow: An attending who is going for a specialty.

            3. Resident: A MD who is still learning, but is in charge of the interns. Residency is 1-3 years depending on the program.

            4. Intern: An MD who is still learning, but is in charge of the medical students. Internship is 1 year.

            5. Medical students: An MS who is just learning and is in charge of nobody but themselves. Medical school is 4 years.

            You may see each of these people or a combination of them. Sometimes you will see them all at one time.

            You can tell who is who by the length of coat they wear. The longer the coat, the higher up they are. Attending wears the long coat, and fellow.

            Lisa
            Moderation Team
            Disabled RN with MS for 14 years
            SPMS EDSS 7.5 Wheelchair (but a racing one)
            Tysabri

            Comment


              #7
              Very interesting comments. The first neuro ran lots of blood work that didn't show any conditions. I was going thru a period where I was extremely tired (to the point of having to get my wife to pick me up at work and drive me home).

              When I told him I was really tired he asked me if I slept well. I should have told him it was not the kind of tired where I didn't get a good nights sleep - it was just a feeling of no energy or strength. I told him I usually woke up around 3:00 in the morning and stayed up or lay in the bed cat napping until morning.

              He then thought my problem was just a lack of sleep and prescribed Cymbalta. He said it would help me sleep and make the tingling and numbness go away. I was excited that I finally had something to try, but looking back I think he just wanted to shut me up. I stayed on it for about 4 months when the tingling and numbness started coming back.

              I checked more into the Cymbalta which said it would just mask the symptoms of tingling temporarily and there are other side effects that aren't very appealing. I didn't appreciate the neuro at that point and made the change. The one I have now is great - suspects I have primary progress ms, but I don't have any lesions to support it at this time - hence the referral to the second.

              On my first visit with him I spent most of my visit with the Nurse Practitioner and about 10 minutes with the neuro I was sent to. Most of that time he talked about his kids. My second visit I never saw him and I'm still having more tests done.

              My symptoms seem to be getting more intense, tingling and numbness all the time in my legs and arms and now some flashing lights from the sides of my eyes. I stay dizzy all day long and just don't feel right. The NP didn't seem interested in any of the changes on my second visit, but maybe she is making note of it and I just don't see it. Going back tomorrow.

              ** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **

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