Should I find a new Doctor?

I think I've lost faith in my primary care physician. I don't know whether I'm being unfair, overthinking things, or if I'm legitimate in wanting to switch to a different doctor. I've got my annual physical coming up in a few weeks, and now would be the time to get a new Dr.

Short Version - Dr. told me completely spuriously to go to an ER, which has hurt my trust in him. I don't know if maybe I'm being too hard on him.

Situation was - I got bitten by a mouse back in October. I figured this was a non-issue, but wild animals can carry diseases so I sent an online message basically saying, "I'm not worried about this, but should I be?"

No response from my Dr. directly, but his office calls me a couple times, and eventually tells me that I *need* to go to an Emergency Room for a tetanus booster and rabies vaccine. Went to urgent care, and they could do tetanus, but not rabies.

Go to ER... and they were like, "Rodents don't carry rabies. Checking your records, you're current on your tetanus. Here are some antibiotics. That'll be a $750 co-pay, and you'll almost certainly get billed for more later by your insurance."

So... my Dr. should have known that rodents don't carry rabies and that I was current on my tetanus. I see this as either, he had a major gap in his knowledge, or he wasn't really paying attention and just gave a blanket CYA answer that has ended up costing me over $1,000. Both of these hurt my trust in the quality of care I'll get from him.

Or am I being too hard on physicians who are overwhelmed with stuff right now? That any primary care Dr. is going to be overwhelmed with stuff right now, and would not devote time or energy to someone saying, "I was bit by an animal." That any Dr. would just have the office staff give the most CYA directions possible?

Try to get a new primary care Dr.? Or suck it up and just be glad that I'm good enough financially to handle the money that the healthcare industry is bleeding me for?

Firstly, rodents most definitely can carry rabies.  Very unlikely, but possible.  Most of the smaller mammals like rabbits, squirrels, chipmunks, and mice rarely get it.  But, considering the death rate if you contract symptoms (effectively 100%), it certainly can't hurt.  Put it this way, there has been exactly one person known who survived a rabies infection and that was in 2004.

The ER is incorrect.  Rodents can carry rabies and can transmit it.  It's just that its very rare.  For my taste, I don't care how rare it is when the death rate is 100% and the success rate of the vaccine is effectively 100%.

As far as finding a new doctor?  I wouldn't be too hard on him.  He sees 4-6 patients an hour, so between your last visit and this one he has seen about 2000 different people.  It's impossible to remember everything.  Mine is super good at remembering (and likely reading through his notes/chart before an appointment) and even he trips up sometimes, like forgetting that I just had a colonoscopy a couple months ago.

If I were bitten by a mouse, I would get a rabies vaccine.  That's just my opinion.

In reply to Curtis73 (Forum Supporter) :

Per the CDC "Small rodents (like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs (including rabbits and hares) are almost never found to be infected with rabies and have not been known to transmit rabies to humans."

I don't think I've ever had a conversation with a phone-a-nurse or a doctor's office that didn't end with either "come in right away" or "you should go to the ER".  Personally, I think it's just a lot of CYA.  You're pissed off at the expense, but their malpractice insurance premiums go up if anything bad happens and they didn't "do something".

That's my cynical view, anyway....

Beer Baron said:

In reply to Curtis73 (Forum Supporter) :

Per the CDC "Small rodents (like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs (including rabbits and hares) are almost never found to be infected with rabies and have not been known to transmit rabies to humans."

Yup.  Read that too.  I don't want to be one of the "known" ones who did get it.  I was bitten by a squirrel as a kid.  Doc said "nah, you don't need the shot."  I got it anyway.

In reply to Curtis73 (Forum Supporter) :

I'm pissed at the situation. But the biggest problem is our healthcare system and the problem of, "Your only option is the ER, and we're not going to tell you how much that's going to cost."

The situation was broken.

I'm not sure how much of the situation being broken was my doctor and how much is the system. (I'm also having a generally E36 M3ty day, and got reminded of this when I received my THIRD bill for the ER visit.)

In reply to Beer Baron :

We definitely agree on that.  Completely broken.

So you're mad about the bill?  Or mad that the urgent care couldn't give you the rabies vaccine?  Or mad that the Dr did the right thing and advised you to seek treatment?  BTW, I very much doubt it was the Doc that responded to your message, most likely it was a PA or some other mid level provider at their office.

Is the system broken?  Hmm.  In many ways, yes.  However people aren't willing to accept what it takes to have a European style type healthcare here and even that system has its definite drawbacks.

Curtis73 (Forum Supporter) said:

In reply to Beer Baron :

We definitely agree on that.  Completely broken.

I'm relatively healthy (blood pressure and cholesterol meds) and have my finances in order with a solid emergency fund.

I can't imagine dealing with this system if you actually have serious medical needs and/or don't have money.

docwyte said:

So you're mad about the bill?  Or mad that the urgent care couldn't give you the rabies vaccine?  Or mad that the Dr did the right thing and advised you to seek treatment?  BTW, I very much doubt it was the Doc that responded to your message, most likely it was a PA or some other mid level provider at their office.

I'm angry that if I send a message to my Dr., I don't know if I'm able to trust the response is anything more than a CYA blow-off.

The fees are frustrating, and the complete lack of transparency in the fees is infuriating.

You're right that it almost certainly wasn't the actual Dr., and so he probably doesn't deserve my ire. It's probably the communication system that's broken. But that also means that I'm stuck with this broken system.

With my previous Dr. using the online communication portal actually got me to her to answer questions about non-urgent issues I was concerned about. I don't know if she was more attentive, those issues weren't "emergencies" so she was comfortable taking time to give a correct answer rather than feeling pressured to give an immediate CYA answer, or if this is because the health care system is more strained now.

I also think most people underestimate how understaffed and overbooked normal PCP-style dr's offices are these days.  Hell, all medical facilities are, if I'm honest.  Your doctor was definitely in full-on CYA mode, and just recommended the bulletproof, '100% guarantee that you will be safe ant unharmed permanently from this' course of action.  I wouldn't hate on him for that...

Doctors can be busy.  I cut my finger recently and had to go to the ER to get stitches, but when it was time to remove them I figured I'd call my primary care physician.  It turned out he didn't have any openings until mid-January, and he told me to go back to the ER or to Urgent Help instead.

You need a good primary physician that isn't owned by a large conglomerate or the local hospital system. You also need a relationship with a decent urgent care system. 

You should never go to the ER unless the ambulance takes you. 

I use a locally owned primary care physician. He does decent work. I would not go to him for anything other than annual visits, keeping an eye on long term health, and for refills on meds. I also use a locally-owned urgent care that is awesome when it comes to sutures and other illnesses. Instead of $1000 ER visits, stitches are $100 each. You know the price before you walk in the door. Office visits are $75. It's not a fancy place in a brand-new building, but it's clean and they do a great job. They also do not file insurance. You have to do that yourself. But their total cost is less than the copay at the ER so it's well worth the trouble of filing. 

I don't have a PCP and doubt I ever will. No one wants new patients or says they will see you in 18 months. Urgent care and the ER is my PCP. I used to think that was a bad plan but hearing this story told over and over, it sounds like my only option.

In reply to Toyman! :

I'm surprised something like this exists anymore. 

My wife insists we need to be our own health advocates.  That means you gotta double check what the medical experts tell you which isn't easy not having the education they have. Then I'm on the internet seeing I have a lot of deadly diseases.

I'd be pissed about the bill too as my health insurance also charges crazy if you don't get admitted to the hospital when using the ER.

My joke is all our future medical procedures will be handled at that little medical room at Walgreens or Costco.

I wouldn't say he shotgunned too much healthcare at you. The tetanus was a totally valid concern, and since the mouse *bit* *you* I'm sure he didn't want to go down in history as the doctor who led to the first person ever dying from rabies from a mouse.

I would be pissed at the ER for billing you $1000 for some pills. I didn't know that rodents could almost never give you rabies, but that said, I watched an old black and white film in school years ago about rabies which showed people including children in the advanced stages of dying from rabies. (edit; they suffered horribly as it was eating out their brains.)

I would have also been heading to the ER, but that said, I rescued a feral cat I had been feeding all winter the day before she gave birth, putting her into a cage I built under the stairs without handling her. She was all lovey dovey after giving birth the next day until I tried to open the makeshift door to clean the litter box and she tried to kill me.

I called the vet and asked if there was a way to test a living animal for rabies and she said no so I decided to take my chances and did nothing. I didn't get rabies and the mother turned into the nicest cat ever, but that said, later on, I read a story in the news about a local pet shop that had kittens on display and for some reason, everybody that came into contact with them had to get rabies shots, so...

I have also read that rabies can take up to 2 years to show symptoms. 

You are absolutely right. The fees are ridiculous, and the transparency issue is obscene. 
 

But it's likely you will find this at the next provider too. 

Unfortunate circumstances, but I don't see it playing out any differently. 
All warm blooded animals are susceptible to rabies, the chance of you contracting it in this case was not zero. 

Don't underestimate the fact that you got antibiotics. As someone who has been scratched and bitten by animals far more times than I can count, I worry most about bacterial infections. 

It's not real uncommon to have an animal bite wound end up with permanent damage or an amputation just from the bacterial infection. 

I'd be pissed but resigned to reality. This is as good as you can get presently - aside from a "concierge program" doctor to whom you pay a fixed fee for their time.

Now for the real question.. how did you get bitten by a mouse?

Curtis73 (Forum Supporter) said:

Firstly, rodents most definitely can carry rabies.  Very unlikely, but possible.  Most of the smaller mammals like rabbits, squirrels, chipmunks, and mice rarely get it.  But, considering the death rate if you contract symptoms (effectively 100%), it certainly can't hurt.  Put it this way, there has been exactly one person known who survived a rabies infection and that was in 2004.

The ER is incorrect.  Rodents can carry rabies and can transmit it.  It's just that its very rare.  For my taste, I don't care how rare it is when the death rate is 100% and the success rate of the vaccine is effectively 100%.

Yup.  All of this.  I'm sure insurance feels otherwise.

I have heard some really berkeleying scary stores re: people struggling to get a vaccine because of bureacracy.  If I got bit by anything warm blooded that didn't have tags, or I couldn't capture for testing, I'd be on my way to the nearest ER/Urgent Care/Etc. immediately.

Regarding payment - in the future, depending on your scenario, just tell them you don't have insurance.  Thats what I did with my physical therapist, because after running the math there is no way I would have hit my OOP Max or Deductible this year (HDHP = I'm paying out of pocket anyway until I reach those thresholds), and going with the insurance rate would've bled me for a LOT more money over the past few months.

Yes, its stupid that we have to do such math.  But at least they could give me a number.  Trying to figure out how much a vasectomy would cost me required a significant number of face to face questions and phone calls.

The system is berkeleyed.  And having dated a doctor and seeing behind the curtain a bit... its extra berkeleyed.

Back on topic.  I would probably ask my doctor point blank about it, but I don't know that this one incident would make me run to a new doc.  I agree these issues are likely many places.  

I agree with Toyman to find a GP that isn't part of a big megacorp hospital - but I'm honeslty not sure how one goes about doing that, especially with some of the more major insurance plans.

Incoherent rambling over.

Beer Baron said:

In reply to Curtis73 (Forum Supporter) :

I'm pissed at the situation. But the biggest problem is our healthcare system and the problem of, "Your only option is the ER, and we're not going to tell you how much that's going to cost."

The situation was broken.

I'm not sure how much of the situation being broken was my doctor and how much is the system. (I'm also having a generally E36 M3ty day, and got reminded of this when I received my THIRD bill for the ER visit.)

As far as I know, the ER being the only option for rabies shots is accurate.  About a decade ago, we were woken in the middle of the night by bats, and the local health officials suggest getting the rabies shots for that risk.  

The rabies shots is a series of shots we had to get- 6 at the inital time, and then 2 more for two more visits.  But all of them had to be administered at an ER- no other location was an option.

Even if the finanical system of healthcare is fixed, I don't see that part as changing.

My first thought was with a $750 co-pay screw the doctor Id be looking to find new insurance.

Seeing as I couldn't tell you the name of "my" doctor I obviously have no relationship with them and if I had a situation which made me loose faith I'd switch.  But the fact that I lost faith in most medical professionals long ago is probably why I dont know the name of my doctor.  My doctor is whomever is available to see me when I need to see a doctor.