Challenges to Hormone Replacement Therapy that Impact Treatment

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Dr. Kathy Maupin and Brett Newcomb discuss different challenges to hormone replacement therapy that they face and how those challenges impact patient care.

“That woman will kill you. If you insist on going to see her, I won’t see you any more” was the message that one of my patients heard recently from her physician when she told him she was going to come to me for treatment of hormone loss.

This kind of message really frustrates me because it is so reactionary and uninformed. This physician does not know me, the training I have had, or the work I do. He has formed an opinion regarding hormone replacement therapy from somewhere else. And, from what he said to her, he is extremely misinformed. This is a challenge that I encounter periodically. What I practice is new and cutting-edge medicine based on new—but validated—research. Doctors who don not keep up with the newer treatment options are responding based on their training from long ago. In the past, hormone therapy was suspect primarily because of the WHI study that warned women and their doctors off of hormone replacement therapy, due to a perceived correlation with breast cancer.

That WHI study, however, has been repeatedly and thoroughly discredited, although many doctors have not accepted this.

Another challenge I regularly encounter is when insurance companies try to get involved in what I do. I do not work with insurance companies and do not accept payments from them. My clients are told that they probably will not receive reimbursement for the work that I do. Recently, I received a letter from an insurance company informing that my prescription of thyroid medicine for a 67 year old male patient of mine was not “standard of care for the elderly male” and that I should cease giving him that prescription. Remember, this patient was not asking his insurance to pay for his care and I was not billing them. Neither of us had experienced any communication or contact with this insurance company. Somewhere they had obtained data that informed them my patient was receiving this prescription from me and they inserted themselves unilaterally into the treatment by requesting that it be discontinued. They sent both of us a letter saying it was not the standard of care for elderly males. Again, the upsetting part is that they do not know the unique condition of this male patient, nor any other aspects or facts regarding his treatment. He had not asked to utilize his coverage and they have no right to insert themselves into our relationship, but they did. That is extremely frustrating.

I practice medicine by looking at the norms, the labs, the patient history; all the common and standard concerns of the ethical and trained physician. What I do—that I am coming to believe may be nearly unique—is spend time with my patient. I want to know what symptoms they are experiencing and I want to alleviate those experiences. I do not want to do check-list medicine: “What is the norm? Have I done it? Has my bill been paid?” What I want to do is heal the sick, improve the health of the suffering, and alleviate or remediate their symptoms so that they feel better. I encounter challenges because this is my focus and not some protocol that is determined by some insurance agency, some government bureaucracy, or some hospital. I want to treat my sick patients and make them better. I do what that takes when I can even if these other entities do not like that.

I practice individualized, personalized, relationship-based medicine. I am not a machine and I am not a robot. I do not work from a check list or a common core standard. Hopefully you will be open to finding more doctors like me and demand the right to have a physician with this approach.