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Caribbean-trained Doctors - Any cause for concern?

Reformed1RReformed1 Posts: 257
edited 06/11/2012 - 8:46 AM in Pain Management
I've posted this under Pain Management because that is where the concern came up.

I'm very conflicted because I just met with a Pain Management practice which I really liked, but I just learned that at least half of the doctors obtained their MD's from schools somewhere in the Caribbean. My NS told me to stay away from this practice, that it was a "black box" -- they do mysterious procedures. I consider my NS to be a little grumpy, but I never doubted his professionalism, so the fact that he would say that causes great concern in and of itself.

I don't know the facts about this subject. I have read plenty of innuendo, though, and I'm nervous about someone who has an MD, but may not be properly trained to do invasive PM procedures.

Any insights into this?



  • I'm not sure what you mean by Black Box. I've read your other thread and you seemed quite excited about this practice. Not everyone gets to go to Johns Hopkins or Hardvard. It doesn't mean they're not good doctors. Maybe its just a bunch of guys who went to college together and started a practice together. Why not give it some time and see where everything goes. I believe someone made the suggestion of checking with the state to see if they had any complaints filed against them. If there are none, give it some time.

    Stop beating yourself up.

  • Are their MDs AND their fellowships in the carribean? A lot of times people with MDs from elsewhere come and get internships and fellowships here. That's where they learn to do the invasive procedures, the MD is just where they learn anatomy and stuff ;)
  • dilaurodilauro ConnecticutPosts: 9,877
    If they successfully graduate from medical school and did their internship and residency, they should be qualified doctors.

    It gets harder and harder to go to Medical schools in USA and move on.

    As long at the doctor follows the proper code of ethic and adheres to their Hippocratic oath, there shouldn't be any problems
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • My wife is a nurse, and she is telling me NOT to let a doctor who was not US-educated to do any kind of invasive procedure. In other words, it's fine if they prescribe meds, partly because the nurses are double-checking the dosages and interactions, but would you take the risk of having a catheter with a sharp needle threaded up your spinal canal in order to make incisions in scar tissue adjacent to the sciatic nerve root? I'm inclined to stick with my Georgetown-trained doctor to do that procedure.

    I feel badly saying all this because it may be an unfounded fear. Again, I would simply ask that beyond the theory that they should be okay, would you allow them to do very sensitive and critical procedures?

  • I was talking to one of my neighbors a few weeks ago and found out that there's more and more Americans going overseas to attend nursing school and medical school. What's crazy is that although there's a high demand and shortage of qualified nurses and some physician positions due to a few things, more and more Americans are going abroad to go to school. There are 21 different medical schools accepting application in the Caribbean alone!

    The AMA has set quotas on how many school slots are available. While there may be 30 qualified applicants, with only 1 or 2 slots available, the other 28 applicants either wait another 2 to 3 years or they choose another profession to go in to.

    Unfortunately I think the problem is going to get worse before it gets better. We need to build more schools or increase the class size limits. When someone can live in the Caribbean while going to school versus waiting and taking a dead end job in the interim, the beaches and fresh ocean air will win out most every time.

    It's hard to know why your NS would caution you about this place. Maybe they have some philosophical disagreements. If your first impression was a good one, what have you got to lose by giving them a chance? Any procedure that they recommend, you are going to have the final say on it anyway. So if it doesn't sound right, then by all means bail out. You never know though, this just might be one of the best clinics around.

  • I did, in fact, have a great first meeting with this PM practice, and I do intend to stick with them to manage my overall care. Interestingly, though, I'm not meeting with the doctor until after my next set of injections and Lysis procedure which is being done by original Interventional PM doc. The new PM doctor who went to Ross University (fully accredited) did her residency/internship at a couple of very good US hospitals, so she is probably very capable. I'm sure she will be fine. However, if I need another round of Epidural Lysis procedures, I will most likely just tell her very tactfully that I would like to have the procedure done by the doctor who I have already been seeing. If she has an issue with that, then it might raise a question in my mind about her intentions, but again, I believe that she will be fine with it.

    Regarding my NS, it really bothers me that he made that statement so strongly, yet my observations so far seem to indicate that he is flat out wrong. I'm seeing him in mid-September after my CT Scan to see if I'm fused. I have a very good feeling that I am fused at this point (there were signs of fusion beginning at 6 weeks post op). Once I am fused, I think my NS will want to declare that he is done and that he was successful. The fact that I'm in more pain after surgery is not an issue to him -- I just need to be patient. Yeah.... r-r-i-i-g-g-h-h-t-t... /:-)

  • that seems to back up what everyone is saying. In fact, it's a study done on this very subject and is interesting.

  • Great article, Cath! It certainly changes the discussion from "Where did my doctor go to med school?" to "What are my doctor's qualifications?".

    I always thought of board certification to be like a driver's license -- it gives you the right to drive, but it doesn't make you a good driver. I suppose that is not an accurate viewpoint. Board Certification would be more like a rigorous driving test that could only be passed by going through a rigorous driver education program.

    Another point in the article that surprised me was the correlation of mortality with the time that has lapsed since certification. I think I have always looked for the more seasoned doctors. According to the study that was done, if a doctor hasn't maintained their training since certification, they may not be more seasoned, they may actually be more obsolete.

    Thanks for sharing this.

  • Yes, board certification is not easy to get! And there are a lot of doctors practicing who are not board certified.

    And once they get the board certification, maintaining it is hard.

    You know those doctors with those plaques up with all of those fellowships and board certs and such? They buy those expensive frames because they are proud as hell of their accomplishments ;) I will be too if either of my kids goes that route!

  • I know several people that went to Ross, quite frankly it was because they couldn't get accepted into US schools, not because they wanted to be near a beach. One girl I remember quite well was a very hard party-er, who was only going into medicine because her family expected her to become a doctor & was paying for it. Ross is known as an inferior med school for US applicant rejects, but honestly as long as they do a US internship & residency, I would have no worries (I am assuming those individuals "grew up" while in med school).
    Now, when it comes internal medicine, family practice, pediatrics I agree 100% with that article. Individuals at the top of the class in med schools here usually go into subspecialties, not primary care. Foreign doctors have to take a set of boards called the FMGEMS, which are much tougher than US boards and have only a 20% or so pass rate. The individuals that trained at places with less "sophisticated" equipment actually have to rely more on the art and skills of diagnostic medicine, instead of a million tests and imaging studies.
    The point is, if you feel comfortable with a doctor, give them a chance - they may surprise you.
  • Now if only the nursing staff would have filled my prescription yesterday as they had committed. Oops, they forgot, and now I have no pain meds for Sunday, Monday, and Tuesday morning (presuming I can actually get it filled on Tuesday).

    It's going to be a weekend of hell for me due to the incompetence, or should I say "gross negligence" of the office staff. Oh, and the answering service won't even allow me to speak to a doctor, because I'm obviously a drug-seeker????

    I'm angry, and at this point I don't think I have to worry about where the doctor went to med school. I'm finding a new PM practice (US-educated, at that). First, I have several formal complaints to write.

  • I can't believe you have to wait so long for your meds. The answering service should have to put you through as they aren't medically trained are they? What about withdrawals? I would go the the ER where your Dr. works out of and let them know what happened and maybe the ER Dr. could speak directly with your PM Dr? Best wishes and hope you get some pain relief. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Thanks for the suggestion, Charry, but my wife processes ER claims for our insurance company, so I already know that it wouldn't be covered.

    On a side note, I was reading another thread about pain management contracts. As far as I'm concerned, my pain contract is null and void since the doctor didn't fulfill their responsibility. I already talked to my pharmacist about the situation and said that I'm going back to my NS until I get a referral to a more professional PM practice. I just didn't want them raising any red flags about me going back and forth between doctors.

    Regarding the rest of this weekend, I still don't know what I'm going to do. I may try to get ahold of my PCP, but it's doubtful that he is on.
  • I would ask to speak to the Manager of the call service. I know ER doesn't give pain meds for chronic pain but if you're having acute pain or if pain meds doesn't relieve your pain ER may still be an option. Prayers somehow you find relief.
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Dave - when this happens and it has happened to me a couple of times, I have gone to the ER, with my bottles and my last 6 months of pharmacy scripts and asked them to just set me up with enough meds to get to the next time my Dr is suppose to be in.

    Also - I have written him letters to explain how the lack of meds affects me. What it does to me, what I have to lose in order to get through a day, the fact that it affects my wife. And I point out the fact that it wastes resources to go to the ER and thier time, when I am on this stuff long term, using the same language that the Dr has used on me. I refer him back to HIS diagnosis and HIS recommendations. So I lay the blame back on him.

    And I never leave his office, without my next appointment being booked. The nurse will always look after me! And lets me know how and when I need to get stuff moved, so it works in my Dr's schedule.

    To me - it has been 4 years, but now it is a partnership.
  • I agree, ask to be put through to the manager of the call center. But they probably have orders not to call the doctor for any med refills. Most of them do :(

    The issue is to make it clear that it was not your error and that it will be a medical issue.
  • I think it was clear that this person had strict instructions to NOT call the doctor about medications. As soon as I said the word "prescription" she cut me off and wouldn't even let me address the medical issue around my health and safety if I abruptly stop taking narcotics after 16 months. I couldn't get there. She was more stubborn than me and would not let me talk. I'm sure she took my name and threw it in the garbage.

    I have spent a couple of hours today writing a rather lucid formal complaint that has already gone to my insurance company as a "quality of health care issue", to the senior management of the affiliated hospital as a "practice liability issue", and I faxed a copy to the doctor's office so that it will be there waiting for them when they come into the office Tuesday morning and it clearly quotes the nurse, verbatim, who told me that my prescription would be refilled by Friday. Oh, I had some choice comments about the answering service as well. So, I think I have adequately addressed the accountability issue.

    I may just try the supervisor route regarding the answering service. I have a feeling it's one person who works from home and gets paid less than minimum wage and she is her own boss.

    Oh, Centurion, I have to acknowledge that my poor wife who is a nurse and who was just trying to help me out, got the brunt of my frustration last night because she said something like "I wouldn't know what withdrawal is like because I have never taken a narcotic". That sounded condescending to me and I was not acting like a human being last night because I have a genuine fear of what's to come. (And I won't be much of a human being for the rest of the weekend). Of course, it's sunny and 75 degrees all weekend and I'll probably be in the bathroom the whole time (SORRY!).

  • Reformed,

    I am so sorry to hear this is going on. I have run into what you did, but with heart meds! What I've found is some offices, the office staff know most patients won't tell the doctor of their bad behavior, and as such continue. Before I drop a doctor, I verify with the doctor *if* this is the norm, or is he going to rectify the situation so it never happens again?

    Of course most of us know if the doctor really is going to do anything just by the reaction when we complain of how they behaved, or what they did. What I do when they say they "will call it in", I tell them point blank that I will check with my pharmacy in an hour or so, that way I can go get them... Tends to put a bug of 'action' in their ear, and they call it in. Works every time for me now!

    I so hope this can get worked out. My heart meds aren't suppose to be stopped suddenly either - can cause a heart attack. Gets ya nervous when the meds might run out; and potential withdrawal, heh, same deal there! *HUGZ* of support for ya darlin!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • If you make a trip to the ER due to severe withdrawal it's not a trip for chronic pain. You said you've been on narcotics for 16 months, and that is not something anyone in their right mind would say is okay to stop cold turkey.

    I know how frightening the thought of suddenly running out of meds is. I've been through opiate withdrawal and it isn't much fun. Depending on the person and whether or not there are any other health issues, it can be a serious matter.

    I hope that you are able to get things squared away before things get too far out of control.

  • The most ironic part of this is that I read my pain management contract again and it explicitly states that "If I find myself without medication, I am to call the emergency line.". So, I did so again this morning and I got the same person who was so rude on Friday. She was very calm this morning and I was able to at least explain the situation and the fact the contract said to call. She said that she passed my call request on to the doctor Friday night. So, I simply said, "so they are choosing not to call me back". Okay fine. In the meantime I found the formal complaint form to be filed with the Department of Public Health. They do follow-up with an investigation and either legal or disciplinary action. Of course, that doesn't make me feel any better other than I hope to protect others in the future.
  • I would also file a complaint with your state and/or county medical society. They do not take things like this lightly. Also (Ron please don't get mad at me) there are those sites that rate doctors. I don't see why honest info both good and bad shouldn't be reported.

    And I agree that the hospital ER visit should be covered. If it isn't you can send the bill to the doctor and take him to small claims court if he doesn't pay :) Those contracts work both ways.
  • I'm so sorry about the situation with your PM doctor! So, starting today you don'g have any more meds until Tuesday? I'm sorry, but the call service should have the on call doctor call you back. No exceptions!!! Tell her it is urgent...b/c going thru w/d are urgent! You could land in the hospital. At the very least the doctor could do is call in some vicodin since gthey are still allowed to call it in...maybe thag would keep you from w/d??? I don't know what you take. Where do you live?
  • Thank goodness I stayed home, because the phone rang and caller ID said "private call", so I knew it was the doctor. It turned out to be the head of the practice and we had a calm, but very frank conversation about this incident and how angry and disappointed I am. He asked me a lot of questions. I suppose some of the questions were screening me to see if it was a legitimate need, but then he seemed to genuiunely care about how I perceived this whole problem and I think he was genuinely sorry and even a little angry that this happened.

    I asked him to give me enough meds until Tuesday, but told him that I am going back to my NS. To his credit, he still called in the prescription even knowing that I've left some pointed phone calls on their "prescription line" and their nursing line.

    To the nurses out there, Charry, Tarheelgirl, (is that right?), my own wife (who doesn't read these posts as far as I know), I want you to know that I don't necessarily blame the nurse. The breakdown could have been with the PA or even the doctor. I can't think of a bad experience that I have ever had with a nurse, so I guess I just wanted to say that.

    This was a learning experience for me. I realized that I was more afraid of the impending withdrawal than the increased pain level. I honestly felt like a little child who knew they had to go into battle against a monster from Lord of the Rings or something. I was terrified.

    Thanks for all of your support. Especially the small group of you (you know who you are) who are the backbone of this forum. Yes, pun intended.

    Take Care. I think I'll take a nap now!

  • I am so happy that a doctor calld you! That's how it should have been done. And I take no offense to how you feel or what you say or want to say about the nurses you have to work with.

    I couldn't stand the nurses that worked with my PM doctor practice.. They were all on a high horse and they made all the patients feel like drug seekers...almost like we didm't even have a diagnosis that make us have pain. Many nurses are absolutely relentless and without empathy. I can't tell you how many times I called that office and would get off the phone crying!! My husband could only watch that for so long before he went in the next appt I had. Often times the doctors are unaware of how their staff if treating their patients, I left her practice for a few reasons, but that was a big factor. We hurt so badly, then we feel guilty enough with the stigma attached to the meds we take and to have office staff make you feel belittled or like an addict...that's not what we need.

    However, For every bad one (nurse), there is a good one. I was very compassionate and enjoyed my patient's...that is what I miss. There are only a couple things I miss about it and that's one, lending an ear for an elderly person I believed helped in their healing process. Some had no family, some no visitors at all. Our unit had a high turnover rate...the patients had surgery today (for instance) and if everything goes well, would get off life support in the evening, and we'd wean them off any IV meds overnight and in the morning, they'd get up in a recliner for the first time and be wheeled upstairs that way and stay on this monitored 'step-dowm' unit until they were discharged home in a few days.

    Anyway, where am I going with my old job description? Well, on occassoin, we got what we called a "chronic" patient b/c they are staying with us from complications. And usually one complication led to another and another and they may end up staying with us 3 months or so. Every nurse had to take their turn with this patient b/c those working in this unit wanted to recover heart patients, not deal with med/surg ICU. And it was busy work...and their bowels were moving and such. But I always enjoyed these patients and would often volunteer my "turn". I enjoyed the interaction and what I could learn from them....they bring with them much wisdom.

    I'm not sure why I went off on this tangent...I think it's a medication induced one...I just took my pain med about 45 min ago and they make me talk more, which is good b/c I'm very shy and intraverted. I think my point to this whole tangent was to agree with you that many, many nurses are rude and crude and judgemental and non compassionate and makes you wonder why they chose this profession!? Then there are others who are just as good as the bad nurses are bad. I hope you are able to see this! I hope all of your encounters with nurses are not all bad ones. :)

    Again...I'm very happy that your situation turned out well this weekend!!
  • I'm really glad to read that the doc called you and you were able to voice your concerns. Of course the fact that you will have meds to get you through the weekend and up till you see your doc, well that's the way it should be in my opinion. Good for you for sticking to your guns and not letting them back you down.

    Fear of withdrawal, to me, is way worse than fear of pain. I completely understand where you were coming from! Especially when you've been on the medication for such an extended period of time. No one knows for certain how much and how hard the withdrawal will be, and no one really wants to find out!

    Thanks for posting an update.

  • But why should we feel guilty about that? It's a medical fact, a side effect of the medications that we're on, and something known by the prescribing physicians. I don't understand why they put roadblocks in our way that make us feel like the fact that we have withdrawal symptoms is our fault, and we should just suck it up and take it like a man.

    Being fearful and upset and angry seem like perfectly natural emotions to me. We are in chronic pain already, taking away our pain relief and adding horrible illness symptoms to our pain is pure torture.

    I have never felt w/d symptoms. I don't wish to, especially not due to someone else's mistake.
  • You're all probably tired of me saying that my wife is a nurse. Anyhow, she said that the phones starting ringing off the hook at 5:05 PM on Fridays by all of the drug-seekers looking for a fix for the weekend and hoping to avoid the normal office staff. I called at about 5:15, so the answering service probably had already dealt with a stream of bogus calls. That's still no excuse in my opinion.

    I never felt guilty about the issue. What I absolutely resent, right to the core, is being treated in a demeaning manner as if I am doing something wrong. That's just bad business.

    I'm heartbroken that this practice screwed up like this. I was very hopeful about them. However, now that I know how they conduct their business, and that they have no better solution than my NS or current Interventional PM doc, plus this lingering question about their qualifications from Caribbean Med Schools, I think I may just see if my NS will stick with me until this is resolved. I'm going ask them if they have chronic pain patients. If not, I'll try to get yet another referral. (Ugh!)

    Have a nice Labor Day!

  • It is heartbreaking, Reformed! It is heartbreaking that any of us ever has to be treated that way because a medical establishment decides not to put the time or effort in to training people to tell the difference between a real patient emergency and a drug seeker.

    The guilt I was talking about was more that you seemed to feel sheepish that you were panicking over the withdrawal symptoms. I don't think you should feel sheepish, I think anyone would panic. But maybe I just read your emotions incorrectly.
  • I sort of had to laugh at myself because I lived in Iowa for over 10 years and went to college at Iowa State, yet I don't really even know what the word "sheepish" means. Okay, no IOWA JOKES (and no sheep jokes, either!)! :)

    I received a phone call yesterday from a program director at the hospital who is responsible for managing the relationship with the PM practice that I had an issue with. At first, I wondered if they were just trying to gauge whether or not I was going to pursue damages, but we had a good discussion about the need to improve upon their methods when it comes to having patients call the on-call doctor due to a legitimate error on the part of the practice, and he seemed sincerely interested in rectifying the problem. So far, I have heard apologies from three people in positions of authority at the hospital, but no apology from the practice itself. My wife (RN) said that the first thing they teach you about healthcare liability is to never apologize because it is an admission of guilt. Given that, I relish the apologies that I did receive because it shows that this hospital is taking responsibility for the issue! More importantly, though, is that they follow-through on this.

    At the end of the conversation, this gentleman offered to have me come back and be treated by the practice, but my case would be handled by the doctor who leads the practice (another Caribbean-trained doctor for whom my NS refused to give me a referral!). I thought that was interesting because I hadn't even met with the originally assigned doctor and I never complained about her. I'm a little curious as to why they offered to switch doctors. Is it in the spirit of offering me their best?

    They claim to be the only practice in the region that manages the whole picture. I don't know about that. I did learn of a Physiatrist through my NS who may be very good. Also, my PCP mentioned the possibility of a Psychiatrist since they are well-trained in the use of the medications that are often prescribed for pain. Based upon what Ron has said in numerous threads, I'm leaning toward the Physiatrist since I think there is something physically wrong with my back and/or SI joint. I would prefer to try some treatments that go beyond medication.

  • I just posted on another thread about my physiatrist. My physiatrist has gotten me to the point where I am functioning much better than I was before I started the treatment plan. I think that it would be great for you to find one, because they tend to look at you as a whole person, and also have a lot of knowledge about medications.
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