Last Friday, I spoke with a new patient who had a history of chronic abdominal pain, often worse upon awakening. Gabapentin did very little for him. Almost instantly, I recognized his symptoms as visceral hyperalgesia and prescribed him amitriptyline, 10 mg at bedtime.
Today, an “admin” day, I took a call from his wife. They switched insurance January 1 and could no longer use the medical supply company they had been dealing with for years. He was running out of colostomy supplies. I promised to try to find another supplier, knowing there are fewer and fewer companies that deal with that in Maine. I told her I would call her back when I located one.
45 minutes later I was able to call her back with the report that she would have to have them shipped from an out-of-state company operating nationally, and the three that I had found in my search had very mixed reviews by their customers.
This took a huge amount of time, but there was no way I could delegate this on a Friday afternoon. My own Health Advocate is out until Tuesday and the other two were doing home visits with and for their provider.
So my patient and his wife will research these companies and get a message back to me tomorrow, Saturday with their choice of vendor so I can put in the order.
I think I invented the term Metamedicine back in 2014. Here is that post. Note that the ICD 9 diagnostic codes have been replaced by ICD 10 since then.
https://acountrydoctorwrites.blog/2014/07/24/medicine-is-easy-but-metamedicine-is-hard/
They are so lucky to be your patients.
As inconvenient as it was for you to do the research, I can tell you from someone who had a temporary ileostomy, the discomfort and inconvenience was far worse for your patient than for you. It was over 20 years again for me and I still have PTSD.