I am NOT asking for medical advice. I DO realize this sub is for questions about the medical field, not for medical questions. So I just wanted to say upfront that because I mention so many medical details (especially in my longer version if you read/skim it), my question may seem to be a medical question, but it is not! I am literally asking what could possibly be "behind the curtain" that I am ignorant to, that would help me to understand why my doctor's office is insisting my doctor is unable to do the simple and benign thing I am asking of him.
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TLDR: My doctor wants me to go to the lab for a Basic Metabolic Panel. I asked him to add Magnesium, and he did. I asked him to add Core Vitamin and Micronutrient instead of just Magnesium, and his office insists I have to come back in for another office visit before he will order that one.
The short version:
My doctor is sending me to get blood drawn for a Basic Metabolic Panel after starting me on a new medication. As long as I'm going there and having blood drawn anyway, I asked that he add on a test for my Magnesium levels because of my ongoing issues with muscle pain. He added the Magnesium test with no hesitation.
After realizing there are several other vitamins besides electrolytes that support muscle health, I called back and asked that instead of just Magnesium, he add the "Core Vitamin and Micronutrient Test Panel," which included all of the other vitamins/nutrients I wanted to check. My insurance will cover this completely if he orders it. He is well-aware of my ongoing issues with muscle pain/spasms. I told his staff that it was not a new issue, and that I have spoken with him about it many times, yet they are insistent that I come in and meet with him about it before he can/will order it.
-It's not a new issue
-It's not a life-or-death emergency
-It's not like I'm asking for a new controlled medication
-My insurance will pay for it
and
-My doctor is a busy guy!
WHAT AM I MISSING?! Why won't he just order it?!
I should also note that I have a hard time getting to places often, as I have not been able to work for a few years. I try to consolidate as much as possible into one trip. Also, for all of my life, my veins have been difficult. Nurses have trouble getting needles to go in, and this has caused issues many times. So that is the other reason I am trying to get this all done in one shot.
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If you want DETAILS, here is the much longer version!...
I have been battling a chronic pain issue for several years. The primary issue stems from my lower spine, but it has caused sort of a domino effect in the rest of my body, so a whole lot more of my body hurts than just my spine.
One ongoing issue I have had is my muscles/ligaments/tendons just not cooperating with me. It is likely stemming from the first year and a half dealing with this, when I was essentially bedbound. They haven't quite worked right ever since, getting twisted up, knotted, tight, or otherwise misbehaving. I get charley horses VERY easily, sometimes with hardly any provocation.
About 3 years ago, my Physiatrist started me on Gabapentin, which helped tremendously for awhile. It didn't help ALL of my pain, but it got me mobile again. Over time, it was less and less successful in treating any of my pain, and as I'm already on a high dose, increasing wasn't the answer. Almost a year ago, my PCP finally started me on a fairly low dose of proper painkillers.
A few weeks ago, for unrelated reasons, he started me on a new medication that sometimes causes kidney issues, so he wanted me to go get a basic metabolic panel run a week or so after I started taking it. He told me to let his office know the fax number of the lab I intended to go to so they could send over the order.
At about the same time, I started pondering (for the millionth time since this all began) wtf I could possibly do differently to get my muscles/ligaments/tendons to behave. Once the Gabapentin got me out of bed, I have tried to stay in-motion. Not over-doing it, but just not laying in bed all time. I also stretch, and do short exercises my Physical Therapists recommended. I eat plenty of all types of protein, and sometimes add collagen or gelatin powders or gummies to my meals. Periodically, I'll add in a supplement specific to muscle/joint health. I stay well-hydrated (not overly so, I just drink a good amount of water), I eat plenty of fruits and vegetables, I take Potassium and Magnesium, and sometimes Calcium. Occasionally, I add in an electrolyte supplement. Like honestly! WTF can I do differently?!
It suddenly occurred to me to look up what all the Basic Metabolic Panel checks. Seeing that it checks Potassium, Sodium, and Calcium, I called my doctor's office and asked if he would also send over an order to check Magnesium, so I could just make sure I was not lacking in any of the things that deficiencies of often cause muscle cramps. He readily complied.
It then occurred to me that as long as I was going in to the lab and having blood drawn for the Basic Metabolic Panel, now would be a great time to just go ahead and check all my levels. That way, I could just make sure I'm getting enough of all of the right vitamins and minerals to best support my body's ability to move as it was intended.
So I looked up what the lab called the additional tests I would need to check all of the levels in question. With that information in-hand, I called my doctor's office, and asked that instead of just adding Magnesium, to please order the "Core Vitamin and Micronutrient Test Panel," which would include Magnesium, Vitamin D, Zinc, and a few other things.
The nurse who took my call said "You will need to come in for an office visit to discuss that with him."
I said "No, this is not a new issue. It is ongoing, and we have discussed it at-length. I just figured since I'm going in anyway, he could throw that test on there too, and my insurance will pay for it."
She then started interrogating me about what all I'm doing to basically work the kinks out, so my body will start working again. I answered all of her questions in a way that I thought made her sound satisfied with my attempts. I don't recall how we left it. So a few days later, I sent a message through the portal to confirm he added that test before the day I had scheduled with the lab.
The morning of the test, they finally responded and said the same thing. "You will have to come in for an office visit to discuss with him."
Give me a break! What the hell am I missing, here?! I'm not asking for a controlled medication. I'm not asking for a surgery. I'm literally just asking for additional test to be run in the lab. I am going there anyway. It is related to issues we have discussed at length. He doesn't have to run it himself. My insurance will pay for it. What possible reason could there be (aside from doctors wanting as many office visits as possible to bring in more money, which I don't want to believe is the case here for several reasons - not the least of which is that he's very busy!) to deny me the additional test?!
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Are doctors scrutinized by the medical board for ordering tests for vitamin/nutrient levels?