Office Policies

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  YOUR MEDICATIONS

Please bring with you all your medications and non-prescription remedies in their original bottles so we can accurately review your regimen. At the end of each visit you will be able to access through the portal of your Electronic Health Record, an “End of Visit Summary” which will, among other things, have your updated medication list as we understand it. If there are inaccuracies on this please let us know. At subsequent visits please bring in writing any additions, corrections, or changes to this list. In addition, we often suggest over the counter supplements and many patients are taking very many supplements. Please bring to each visit an accurate up-to-date list of your supplements. This will often necessitate that you bring in the actual pill bottles as, for instance, “B complex” could have a great variety of actual ingredients. An accurate listing of all your medications and supplements is vital to allow the delivery of safe and effective care.

LOCAL PHYSICIANS

Our practice does not perform any primary care functions and cannot and will not take on any of your primary care needs. Therefore, you must have a primary care physician in your own local area, which you continue to see on a regular basis. This is a strict requirement, for we cater to specialty needs, and will not perform primary care responsibilities. We will not refill or prescribe medications not originally prescribed by us or not related to the special problems that we are treating. For example, for our Lyme disease patients, we will not refill birth control pills, medications for high blood pressure, diabetes, etc. In the event that an emergency arises and you are not able to see us immediately for an issue related to your chronic tick borne illness, you should see your primary caregiver, who can then call us if our input is needed. Because we do not fill or refill any controlled drugs, you will need to see your primary for this.

AFTER HOURS CALLS AND QUESTIONS

Dr. Durand is continuing the practice of the management of tick borne diseases after his retirement from his lifelong practice of primary care. There are no physicians or other health care providers with whom Dr. Durand is sharing on-call responsibilities. Therefore, although Dr. Durand will attempt to be available as much as possible, Dr. Durand cannot be available at all times for everyone’s after hours questions. If possible, please try to call us during our routine office hours which are Tuesdays and Thursdays. We ask that you recognize that questions for  the office will be addressed during our next office hours. In the case of an emergency, you should call 911 and/ or proceed to an Emergency Room or Urgent Care facility. 

You may have questions or concerns about your care and your response to treatment. Generally these should be addressed during a routine office visit. We will be providing telehealth care via telephone or a video-chat platform. Most questions will be scheduled to be addressed in this fashion and in the form of a brief office visit. 

ROUTINE LAB TESTING

In many cases we request that you obtain lab work prior to your office visit. Usually this consists of a CBC (complete blood count) and a Comprehensive Metabolic Profile which includes kidney and liver function tests. You should be able to access an order form for this in the Electronic Health Record via the patient portal and usually it is a “standard order” which will be operative for six months. Please print out this order and bring it with you to the lab drawing station. Please get the blood drawn in adequate time that we will have the results at the time of the visit. Our Electronic Medical Record has a functionality with Quest Diagnostic Services so that labs drawn at Quest Diagnostic will automatically upload to your office electronic medical record. If you use other laboratories, there may be some delay as we obtain those results, so please keep that in mind in regards to getting your labs drawn about a week prior to your office visit. Please do not call us for the lab results; we will discuss these at your next office visit. 

LYME DISEASE SPECIALTY TESTING

We feel that the most accurate tick borne disease testing is through the Igenex Lab in Pala Alto, California. Most of our Lyme Disease and Tick-Borne Illness testing will be through this lab. Please note that the Igenex lab does not participate with commercial insurance. They do participate with conventional Medicare, although many Medicare Advantage plans do not cover Igenex labs. For testing through the Igenex Lab, we will either give you a kit for the testing when you are in the office, or we will contact the Igenex Lab and have them ship the kit to you. In any event, you will need to take the kit to a blood drawing station where your blood with be drawn, processed, then shipped to the Igenex Lab. Unfortunately neither Lab Corps or Quest Diagnostic Lab will do this service. The best location for this blood draw is at the Concord Hospital Memorial Building lab drawing site. The results with be discussed with you at your next office visit. At this point, Igenex Lab does not have a patient portal for you to view your results on-line. Please be aware that interpretation of these tests is sometimes quite complicated and you will need to discuss the results with Dr. Durand at your next office visit to try to understand their significance. 

MEDICATION AND TREATMENT QUESTIONS

Occasionally there are questions or problems with your treatment that cannot wait until your next scheduled visit. We ask that you do not decide to change the treatment on your own in these situations but rather to contact our office with the question or problem. For instance, in many situations if you are having a medication side effect, we may be able to help you in ways such that the medication could be made more tolerable. All antibiotics will be more tolerable if they are taken on a full stomach. This is especially true with doxycycline. However, often there is a note on the doxycycline pill bottle that states “take on an empty stomach.” Please actually take on a full stomach but in the case of doxycycline and minocycline you need to avoid high amounts of calcium in the food within one hour of taking the pill (milk, yogurt, and cheese).

PROBIOTICS

It is Vital that you take probiotics while you are on antibiotics and for many months after discontinuing antibiotics. This is for many reasons. One is that it will decrease the Gastrointestinal side effects of the antibiotics. It will decrease the risk of antibiotic associated diarrhea and,, in particular, it will decrease your risk of developing diarrhea caused by c. diff (clostridium difficile), a severe antibiotic related diarrheal illness. If you do develop severe very frequent watery, bloody diarrhea associated with severe abdominal cramping, please be sure to call us, or your Primary Care Doctor or go to an emergency room or urgent care center We may need to stop the antibiotics and have you tested for this potential complication.

CALLS AND FAXES AND EMAILS TO THE OFFICE

The preferred method of contacting us is through the patient portal of the Electronic Health Record. 

NO PRESCRIPTIONS RENEWALS BY PHONE

We will not refill prescriptions by phone. At each office visit, be prepared to tell us what you need to prevent you from running out.

Please silence cell phones inside the office building.

This document could not possibly cover all of the details of our practice and only serves as a general guide. Because circumstances change, updates will no doubt be made. We will keep you informed!