|Length of time for appointments needs to be longer||D27: Time is a constraint. I would love to have 30 min for every problem a patient comes in and then I think this wouldn’t be an issue.|
|Lack of continuity of care||
D3: Well, I would actually wonder how many of those people were not getting regular care like with the same physician, like continuous care. So, you know a lot of say younger people who go to an urgent care center are like you know … “Oh, I’m here and I’ve got low back pain” and for the doctor it’s like, let me give them a shot of Toradol and send them on their way, “Here’s some anti-inflammatory meds, follow up with your primary care.”|
D32: They [patients] get kind of used to the pain, and they’ve kind of seen doctors who have examined them and said, hey, everything looks fine. You don’t need to keep coming in.
|Costs of tests expensive||
D24: I see so many people with back pain, a subset of those I test for autoimmune diseases, but even when I’m doing that, if I’m going to test or something like B27, I can’t really use it as a screening test because insurance doesn’t pay for those sort of tests just for a diagnosis of back pain … Uveitis, I think it will get covered, but, I mean, people get upset when they get a big bill; why did you do all these blood tests on me?|
D12: Once I see, yes, it’s heading in that direction, I’ll probably do blood work and their clear blood work, ANA, HLA-B27, which I kind of wait, because it might be an expensive.
|Lack of back pain clinics||
D11: Chronic back pain, no one wants to see them, no one wants to own them.|
D29: Yeah, so our orthopedists don’t see back, so only our neurologist will see our back patients, if we have anybody. I don’t think rheum sees back.
D28: Oh, yeah; it’s the most difficult thing to -- the single worst referral is the referral for the rheumatologist.
|Shortage of available rheumatologists||
D31: The issue is we don’t have many rheumatologists at all. There’s a shortage. … the nearest rheumatologist, I think, is probably going to be at least an hour drive away or maybe like 45–50 miles.|
D24: We don’t have rheumatology in our county, so that’s an out of county referral and much harder to get an appointment.