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Doc: With medical providers, patients still have choice

Keith Roach
To Your Health

Dear Dr. Roach: I have a question regarding medical providers. In the past, when I have made an appointment to see my physician, I have seen the physician. Lately, when I make an appointment to see my physician, I am seen by a physician assistant. The problem for me is that I have built up a relationship with my physician. I have no relationship at all with the physician assistant.

The other problem I am having is that I pay a lot of money for health insurance to be able to see my physician, not the physician assistant. I have told them before that I prefer to see the physician, but I am still seen by the physician assistant.

Am I being overly sensitive on this issue, or should I start looking for another physician?


Dear C.J.: In my experience, physician assistants provide excellent care, and I note that you are not dissatisfied with the quality of the care you are receiving. Several studies confirm that both PAs and nurse practitioners provide a quality of care comparable to physicians. To me, your concerns are similar to seeing a different physician in your physician’s group when you want to see the provider who knows you and with whom you have built a relationship (hopefully) based on trust.

There are many reasons that a physician or other provider might not be available on a given day, such as medical emergencies and personal issues. The reason I am concerned is that you have asked to see your physician and your wishes have not been respected. It is entirely reasonable for you to want to see your own doctor. If that’s not possible, then I would recommend you find a new practice where it is.

Dear Dr. Roach: I am an 80-year-old woman. I have been seeing a neurologist for blockages in my carotid arteries. I have had MRIs and MRAs. My most recent test showed a 50 percent blockage on the left side and a 70 percent on the right. I am being treated with aspirin.

The past several months, I feel and hear a pulsing in the left ear, especially at bedtime, when it’s quiet. When I told the neurologist about it, he didn’t seem to be concerned. I saw an ENT, and although he removed some ear wax and a hearing test showed some hearing loss, he gave me no reason for the pulsating. It’s very bothersome. I have no pain or headaches. Can you tell me what causes this, and what I can do?


Dear V.S.: A pulsing noise in the ear is called pulsatile tinnitus, and always deserves an evaluation, since it often represents an abnormality of the blood vessels of the head and neck. These include arteriovenous shunts (abnormal connections directly between an artery and vein), vascular tumors near the ear and blockages in the arteries.

Since you have had what sounds like a pretty extensive evaluation (both the magnetic resonance scan and its related test, a magnetic resonance angiogram, are very sensitive) and have a known cause (a blockage in the carotid), I think it’s very likely that the blockage in the left carotid artery is causing the noise and sensation. It isn’t the degree of stenosis — the narrowing of the artery — but where the blockage is that makes it more likely to be noticed. It’s also more likely to be noticed at night, when as you said, all is quiet.

Sometimes knowing what the cause is can make the noise bearable. In other people, “masking” the tinnitus with other noises is effective. This might mean using a white-noise machine or tuning a radio between stations to deliberately hear static.

Email questions to ToYourGoodHealth@med.cornell.edu.