Opinion?? GI in private practice or hospital clinic

[Tesscorm]

My son is currently a patient at with an IBD clinic in a children's hospital. However, he is turning 18 this year and must be transferred to an adult GI. The hospital will refer him to any GI we request (I suppose as long as the GI is accepting new patients??).

Just wondering, does anyone have an opinion re a GI in a private practice vs. a GI based in a hospital clinic?

I'm wondering if a private practice GI will have more room for independent thought and treatment, may be more open to a variety of treatments, including alternative treatments such as LDN. But, do they have the same support system and resources as a GI based in a large IBD clinic in a hospital?

I know that diagnosis/treatments at my son's clinic are discussed amoungst the GI team and the decision is based on team opinion rather than just one individual's (GI's) opinion, however, would a GI in a hospital clinic be more constrained and expected to follow 'clinic' rules for treatment, have more limitations with regards to liability, reputation, etc.?

Our children's hospital has a very extensive IBD clinic and is associated with another large hospital with another extensive IBD clinic. That is where they generally transfer their patients and where I will probably move to, but just wondering what other people's experiences are...

 

[Trysha]

My preference would be for a hospital based Gastroenterologist since there is immediate support from colleagues and ready access to equipment and necessary procedures.
Peer support and review is very valuable with a Gi team at hand.
Hospital based Gastro's do have room for independent thought and support.There is also room for research and meetings at the national and international level.This allows the GI to keep up to speed with current thought and treatments.
Most specialists whether in private practice or hospital based have an attachment to
hospitals.
Trysha

 

[DustyKat]

I think Trysha may have just answered my question.

Here most specialists have private practices but are also affiliated with public hospitals. So it makes no real difference whether you see them in their private rooms or in an outpatients clinic, except in an outpatients clinic you don't pay to see them but the waiting list is longer.

When Matt was diagnosed we saw the GI privately. The GP rang on Friday afternoon and we saw the GI the following Tuesday, had an endoscopy and colonoscopy Wednesday, a CT Enterogram Thursday and an appointment with the GI on the Friday again. It wouldn't have been that speedy through an outpatient clinic.

When Sarah moved to Sydney she hooked with a GI that sees patients in his private rooms but he also practices in the large public hospital across the road. I think this gives her the best of both worlds. She doesn't pay to see him because she is a university student and the hospital is affiliated with the university. Is there a set up like that for Stephen?

Dusty. xxx

 

[Tesscorm]

As far as cost, we don't pay to see any GI, regardless of clinic type.

Right now, Stephen's GI is part of the hospital where he was diagnosed. For the most part, I really like the clinic and the many services it offers (emergency number for a 24-hour on-call GI, I can email the GI nurse at any time with questions, dietitien also reachable by email, both usually respond by the next day, etc.). They are a well regarded IBD team and have written and worked on studies re EN (and others as well) and I like that, if necessary, the GI has a team behind him should issues arise. From my understanding, the clinic Stephen will be transferred to (unless I request alternative arrangements) is similar (perhaps not as many of the 'reassurance'-type services as they are not dealing with concerned parents). The IBD clinics at the two hospitals are associated and share expertise, etc. (they are directly across the street from one another and are even connected underground...).

I definitely leaning towards a transfer to this new hospital, I'm only asking the question because I've never had to deal with any specialist (in or out of a hospital clinic) for an extended time period and the transfer to this new hospital is what we were told would happen almost as soon as Stephen was diagnosed. So, I just wasn't sure if there were any considerations that I was missing...

 

[lowone]

While not gi related... I saw a private practice surgeon for my knee when I hurt it so bad I couldn't sleep at night. The diffrence was amazing over anything I have had done at my regular doctor.

Regular doctor for different things in the past...
Normal X-ray for broken elbow, 30 minutes.
CT scan for broken elbow, 5 hour wait... At hospital.
MRI for left knee pain in other knee years earlier, 2 weeks wait, then 4 hours wait after my appointment time. At different hospital 90 miles away cause local one was booked up.
Week wait for MRI results.

Private practice surgeon for right knee
X-rays done as soon as I explained my problem. No wait.
X-rays inconclusive, surgeon said it was the probably soft tissue and asked if I wanted a MRI. Said yes do it (worried it would be a long wait like last time)
MRI, done 30 second walk from exam room to private practice MRI, no wait!!!
Initial results 5 minutes after MRI, scheduled for orthoscopic knee surgery 3 days later. (Though the MRI images sent out for review which took a day to verify)
Best decision I ever made, knee has been awesome ever since.

----

Gi related, my gp referred me to a specialist group. Sure took a long time to actually get in to see them. But once in and they heard my story, they booked me for a colonoscopy 4 days later, fastest their prep diet yuck drink stuff allowed for! They started me on lialda the next day, which has turned out to work well for me!

----

I like my gp so will keep going to him. But for anything that requires someone more then a generalist gp... Private practice sure seems like the way to go where I live.

 

[Tesscorm]

Thanks for all the info Lowone!

 

[moogie]

Some are better than others. I think that a private doc might be better because he or she won't be so swamp with work and wikll eb able to give all the time your son might need.

 

[Crohn's 35]

My personal thoughts a private or hospital clinic would not matter to me, it is the GI...trust me I have had lots both private and clinic (but not in a hospital but did have a second opinion in Mount Sinai. I would research what you can about the doctor you are seeking. If you have a choice. Most Gi's even though they have a private practice usually belong to the hospital nearest them because if you end up in the hospital they come to visit or release you. I have had 2 really good Gi's out of 4 or 5. One was private (but near Peel Memorial) and the other here in Thunder Bay but he is retiring and he is sending me to a new and experienced Gi rather than one who was just recruited. I see him Thurs for my scope and pending the outcome he will send me to someone who will lookafter me.


Hope this helps.

 

[Emily]

I love my hopsital GI, and I guess I can't really imagine seeing someone in private practice, I think I'd be uncomfortable. It's just that I know that my GI has the advice & support of his whole team, works close with the surgical people, and kind of has the whole hospital in front of him. Maybe it makes me trust him so much.
Also just the fact that having my GI in my hospital kind of makes anything else at my hospital easier. For example, I went to the ER last summer, where he was quickly contacted, and the emergency team was able to take good care of me, having my records already in the computer and having my doctor on call. One of the gastro guys in the ER knew him well and I guess it was just comforting to be able to be in the same place I go for checkups, with people who know and trust my doctor.

Sorry, that was a bit of a ramble. I guess for me, a private practice guy seems inaccessible and maybe too independent. If I had a private GI, that ER trip would have gone less smoothly and I doubt the GI would even know about it until he got to his office the next morning.

 

[Tesscorm]

Thanks everyone.

Pen - hope your scope goes well!

Emily - I'm am leaning to the GI in the hospital setting for all the reasons you state:thumright:. Hopefully, the clinic isn't so large that we/he (my son) gets lost amoungst everyone...:thumbdown: