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Thursday, May 24, 2012

Non-Specific Hormone Problems

I refer out to compounding pharmacist often. I am willing to try cutting edge approaches to help balance non-specific hormone problems. Some people call it Anti-aging Medicine (or Bio-identicals). I find those titles too limiting to describe the full-spectrum of what I do as I help teens with issues; preconception & lactation; and weight-loss, fatigue, and libido in all ages(both genders).

I should have been an Endocrinologist?
Maybe, but I like being a primary care physician who can work with open-minded specialist. There are like-minded endocrinologist, but they are hard to find.

Patients don't understand the relationship I have with the Pharmacist I consult with and patients often go to my nurses to ask if I will transfer the recommended prescription hormone to a different pharmacy. I wrote out a dialogue for my nurses to share with callers why I won't transfer locally. I decided to share my reasons with you. Pardon me for talking about myself in third person.


"Dr. Punger refers you to the best resources for  your circumstances. She uses the PharmD, Doctor in Pharmacy, (the compounding pharmacist) as her clinical extender which means you are getting expert team approach care. It is not likely she will call your hormones locally if she made a referral that you agreed to. The pharmacist is a part of your medical care team. She relies on him and his team to gather information about hormones and endocrine disorders not so always readily accepted by other MD's and drugstore pharmacists. The PharmD attends continuing education and meetings when she can not. She relies on him to make recommendations about dosage and delivery route (for example, SL, sublinguals are not available locally). The Pharmacist also is available to you for on-going opinions and adjustments in dosage often after hours. That will save you face-to-face visits. At the current time, Dr. Punger prefers to keep up with her primary care skills and she can extend you the specialized hormone balance by keeping the pharmacist on the team. It is rare to find a physician who continues primary care AND extends services to hormones to the extent she does. By using the same pharmacy team, medial errors are reduced, as compared to having different pharmacies and different protocols for her to keep up with. 

She has no disclosures. She does not receive kick-back from the pharmacy. Nor are PharmD's employed by the practice. She simply refers you to the best resource for your circumstances at the time. In the meantime you are not paying high fees for anti-aging or weight loss clinics. Most of the consult is handled by phone call after initial face-to-face appointment with Dr. Punger. The teamwork between the PharmD and the MD is a highly specialized one and patients come from all over seeking this kind of care.

Dr. Punger won't refer you to the Pharmacist if she doesn't think you need that approach. If you simply need straight forward Vit D, or Synthroid, you will be directed to the locally pharmacy from the get-go. She will send you to an ENT, GYN, thyroid specialist right-off if that is what she thinks is best. 

If you don't like the team approach Dr. Punger has with the PharmD you may seek on your own a GYN or endocrinologist (who will likely tell you that what Dr. Punger does doesn't work) and offer you other options. Understandably not all patients will respond to Dr. Punger's treatment and you are free to seek any opinions you want. At that point, you will be under the specialist care and Dr. Punger will no longer be responsible for your hormone balance/weight loss/bleeding etc.... 

Dr. Punger has had good results with her approach and thus she continues to use all the resources available to her."

1 comment:

Denise Punger MD IBCLC said...

I read this to one patient in particular wanting to switch to a local pharmacy. When I got done, he said Bellevue was higher quality. So why dis he fight and insist to keep changing the hormones???

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