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The same is true for "other" appointments such as any referrals to specialists, most commonly pulmonary and gastroenterology.
Remember, there are other patients on the schedule and squeezing one patient in would often necessitate cancelling another patient's appointment.
Why not schedule everything prior to visit?
1) What tests/procedures/appointments should be scheduled?
2) Who is going to order and than get insurance authorization for any tests/procedures? Our office can not do this without an office visit (same reason why medical offices can not prescribe any medications without an office visit first).
Although most patients who have travelled great distances for us to see have been grateful for the care we have provided that nobody locally was able to provide, many have also expressed some level of frustration (and perhaps even anger) due to the above-stated issues.
And this frustration often continues beyond the initial office visit if there's any follow-up required, especially if a health concern/question pops up. For example, globus is a condition where a person has a lump sensation in the throat. Sometimes, this sensation can get so bad, the patient can barely swallow. It is not uncommon that we get a panicked phone call from a patient suffering from severe globus stating they choked on some food and can barely eat anything now without coughing/gagging... except we are located in Virginia and the patient is located in Wisconsin. Any response we make in this situation will be met with some resentment because unfortunately there's not a whole lot we can do to treat/evaluate/manage this problem over a phone line.
1) Our normal response offering an appointment to see us is understandably not reasonable given the huge geographic distance separating us.
2) Go to the ER... Most patients have done this enough times before seeing us to know there's not much an ER can do for their specific problem.
3) Go see their local ENT... except they've already done that without results which is why they have come to see us in the first place.
4) We don't know what else to offer at this very moment over the phone beyond the above 3 options... which is the honest truth.
The typically unsatisfying response we end up making is to reassure that we need to complete the workup initiated at the last office visit to determine what is causing the symptoms and once a correct diagnosis is obtained, to than follow through on a treatment course to hopefully "cure" them.
After being on the receiving end of verbal tirades from angry, frustrated patients who spent hundreds if not thousands of dollars to see us because we literally and truly can't accommodate to get everything done while they are here... our office has decided to stop seeing patients who live more than a reasonable car drive's away.
Of course, our policy may change as circumstances change.
So why do we see spasmodic dysphonia and Zenker's, but not the other conditions? It's because these are conditions that we can potentially treat in one visit with minimal testing and minimal follow-up with near universal success.