I was wondering what everyone thinks in regards to what makes a good LLMD?
I know a primary care Dr. who is considering becoming an LLMD and they want to know what most folks are looking for?
Now of course the things we want from our LLMD's needs to be with in reason. Most do not accept medical insurance and are not available 24 hrs a day.
I appreciate any comments as I think we can always use another LLMD to help us. The fact that this Dr. actually is concerned and wants to know what most people are looking for is a plus in itself.
Thanks in advance.
Posted by dmc (Member # 5102) on :
an ILADS education doesn't necessarily need to be a member, just ILADS education
Posted by sixgoofykids (Member # 11141) on :
Trained in treating Lyme & co., willing to treat until it's gone .... those two things would make an LLMD, IMO.
Posted by randibear (Member # 11290) on :
ability to listen and not make the patient feel like they're an idiot...
Posted by maureen2174 (Member # 11471) on :
willingness to think "outside the box". no patients are the same. what works for some, will not work for others.
willingness to learn about other issues patient may be having and to help address those issues, as they are probably key in getting well from lyme and co.
Posted by tick battler (Member # 21113) on :
A good LLMD will do the following:
- make a clinical diagnosis of coinfections - treat as aggressively as the patient can handle - treat lyme and coinfections at the same time if possible - test for heavy metals and adrenal function issues - incorporate detox in protocol - use appropriate supplements - recommend good probiotics - use the best testing labs and keep up on the latest news in this area to stay ahead of the curve - attend conferences to stay on the cutting edge - be open minded and willing to think outside the box with new or alternative treatments - require monthly CBC and liver function tests -do trials of abx to see if symptoms change - treat patients with respect and let them have a part in the decision making about protocols -return phone calls within 24 hours or sooner if there is an urgent issue - have a good knowledge of the best and latest herbal treatments (Buhner, Zhang, Cowden) - treat until symptoms are gone, and then treat for 2 to 3 months after that -read Dr. B's guidelines several times and read every good lyme book out there
Where is this doc located? Please let us know if he/she decides to go for it. The more LLMD's the better!
tickbattler
Posted by purplemom (Member # 21064) on :
I personally value the medical insurance my LLMD takes. So many lyme patients are broke trying to get treated. I also value that I can call him and he will return my call and answer questions and I am not charged $200 for it.
I value that he slowly progresses my treatment so I am not totally incapacitated by too much at once.
Posted by canefan17 (Member # 22149) on :
Someone who has personal experience with Lyme (I'm guessing that's all of em though)
One who uses Dr B's guidelines as a basis
Posted by Stacyb (Member # 13084) on :
Thanks so much for all the responses everyone! Those were all really good! Many of those things that you all mentioned this doctor has! I will let you know if this doctor decides to become an LLMD.
Anyone else???
Posted by Stacyb (Member # 13084) on :
Hey gang,
One more question please for all of you... What was your initial charge, follow up charge and phone consult costs for your LLMD and what do you think is fair and reasonable?
This Dr. is trying to keep costs down as much as possible as they are well aware of the expense we have to go through with this illness.
Thanks in advance again!
Posted by Stacyb (Member # 13084) on :
up
Posted by Stacyb (Member # 13084) on :
Sorry gang but this Dr was trying to get some feed back on what most think is is a fair or decent costs for visits. They want to keep the cost to the pt. as low as possible.
Posted by tick battler (Member # 21113) on :
I know some of the most experienced LLMD's charge around $900 for a 2 hour first appt. I would hope she would charge something less than that for 2 hours. $500 to $600 would be more reasonable for the first appointment. Then $150 to $200 for half hour to hour long follow up appointments seems reasonable.
tickbattler
Posted by randibear (Member # 11290) on :
my doctor charges 175 per visit. unfortunately, he does NOT do any phone consults, period.
sometimes visits range an hour, sometimes less, but it's always the same price.
doesn't take any insurance, but tests are covered by mine.
Posted by METALLlC BLUE (Member # 6628) on :
Tick Battler covered almost every base. The best LLMD's also follow these patterns. I'm going to include Tick Battlers data within my own so it's all organized in one post.
willing to perform experimental therapies as long as the patient consents and all other evidence based therapies have been attempted. -
They'll also attempt to accommodate patients financially when possible. -
The best LLMD's are willing to put their license on the line and willing to persist and speak out politically and lecture so other physicians can learn more. -
They'll also test deficiency issues, or hormone irregularities. -
Treats each patient as an individual, and recognizes that they respond different to each drug used. -
They will also treat pain and other symptoms independent of trying to kill the infection. Such as using sleep medications, or pain therapies, whether alternative or drug therapies. -
They will read "all" of the studies demonstrating persistenc on Lyme Disease, as well as Seronegativity, Inadequate testing kits and laboratories, as well as understanding the legal implications, political, immunological, and infectious methodology of what makes Lyme Disease and associated co-infections so complex. -
They will spend as much time as is needed by a patient during an appointment and will listen without making assumptions that aren't supported by the case history, such as implying the patients "emotional problems" are causing the patient to stay sick. -
The best will also attempt to work with other LLMD's and constantly get updates to find out what the latest techniques are for cutting edge methods. -
They will also educate other physicians who wish to do internships or visitations to observe at the physicians office while the LLMD works.
They will recognize that treating Lyme Disease Complex is a "specialty" not an elective to their practice. -
The best specialists also will not hesitate to refer the patient to other physicians who may be more competent at treating complex issues associated with the infections or complex issues the patient encounters. This includes chinese therapies, accupuncture, chiropractices, pain specialists, allergy specialists, and other people who have a more refined specialty over the LLMD. -
Will do phone consults as well as provide the patient with e-mail address or other contact information to help the patient cope with emergencies and to help keep the physician updated. -
Will not over book, leading to lower quality care. They will maintain high quality care by taking on new staff and N.P. or P.A's or other doctors to help continue to expand the practice if the patient load keeps expanding. -
Will be professional, compassionate, understanding, patient, yet daring and bold. - Tick Battler Writes:
make a clinical diagnosis of coinfections. -
treat as aggressively as the patient can handle but not beyond until the patient is capable. -
treat lyme and coinfections at the same time if possible. Candida infections should be taken seriously as well. -
The patients psychological state and history should also be monitored. The physician may have gently inform the patient that their mental health should be one part of their recovery, especially if the patient has comorbid illness. Trauma and other issues can be alarming to hear when the patient knows they have an infection, so the physician should be very sensitive to informing them it's a recommendation to help support them to improve their quality of life independent of the infection as well as contributing to decreasing stress. Meditative practices or other forms of exercise appropriate for the patient should be included, whether physical, mental or spiritual -- but also explained within appropriate context. -
test for heavy metals and adrenal function issues, as well as Thyroid, pituitary, and other endocrine glands. They will also beware of blood sugar issues as well. -
incorporate detox in protocol -
use appropriate supplements -
recommend good probiotics -
use the best testing labs and keep up on the latest news in this area to stay ahead of the curve. The best labs include Igenex, MDL, Specialty Labs, Clongen, and Fry Laboratories, as well as laboratories that specialize in testing for Viral infections. -
attend conferences to stay on the cutting edge. -
be open minded and willing to think outside the box with new or alternative treatments. -
require monthly CBC and liver function tests -
do trials of abx to see if symptoms change. -
treat patients with respect and let them have a part in the decision making about protocols
return phone calls within 24 hours or sooner if there is an urgent issue. -
have a good knowledge of the best and latest herbal treatments (Buhner, Zhang, Cowden). -
treat until symptoms are gone, and then treat for 2 to 3 months after that -
read Dr. B's guidelines several times and read every good lyme book out there
The appropriate cost for a patient, while still allowing the physician to profit, as well as pay rent, staff, insurance and other crucial & necessary costs is about [75$-500$.
Phone consults should cost anywhere between 75-150 dollars, and the duration should be based upon the patients need, while not extending beyond a time frame of 1hr for a follow-up. 15-30 minutes should cost about 75 dollars, 1 hr should cost 150$. -
Appointments in person should not increase in fee, though the physician should tell the patient up front if they have another appointment at a specific time, in order that the patient can communicate the information timely. On average appointments will run 30-1hr, with the occasional complex case requiring 1 1/2 hours. In-vist costs should be around 200$ (this is because testing, nurse preparation and cost of staff filling orders for supplements, or paperwork and scheduling. The first visit should cost around 350-500, depending on whether the patient needs 4hrs for their first visit, or only 2-3 hours.
Costs beyond this are excessive in my opinion and changes to the practice should be made if costs exceed 500$ for a first consultation. It is important the patient realize that costs of 1,000 to 1,500 are necessary if the physician requires testing which may not be covered, however the patient should be alerted upfront about these potential costs. Patients should be told by the physician which testing is crucial, and ask if the patient can endure initial test costs. Igenex testing is one example. The patient may only be able to afford the Western Blot, while another may be able to afford the Babesia testing, PCR testing, Western Blots and other Urine antigen test etc.
The physician should make all attempts to accept the patients insurance, however that may not be necessary depending on the aggressiveness of the therapy or the experimental nature of the therapy. Physicians are best served by providing documentation to warn the patient of the two different medical perspectives currently shrouded in controversy. The patient should be given the opportunity to sign the agreement with full knowledge to the extent that the physician practices.
Physicians should also attempt to keep costs down by sending out plenty of documentation for the patient or their family to fill out for patient histories. These histories should be complex, and not your typical "Does heart disease run in the family?" They should include questions involving exposure to ticks, vacations or travel the patient has taken in their lifetime, when symptoms began, the physicians the patient has seen, contact information of those physicians, medical records.
In other words, the patient should be encouraged to do their homework prior to coming to the appointment. This keeps cost down, while still gathering a great deal of information. The documentation should also include support so the patient can help fill out the forms if they can't do it themselves, such as providing tips to get family, friends or others to assist. If the patient has difficulty writing, the physicians office should also send a copy via E-mail that the patient can type out the answers and history, and then print it so it can be brought.
All of these factors should be considered.
[ 04-01-2010, 01:23 PM: Message edited by: METALLlC BLUE ]
Posted by Stacyb (Member # 13084) on :
Wow thanks to all of you for all that information! I am passing it along and it is much appreciated!