On cnn.com today, author Dr. Jerome Groopman gives five key reasons to "fire" a current doctor and search for a new, better one. They include problems in fundamental aspects of the doctor-patient relationship: being able to ask questions, feel listened to, understand what the doctor is saying, and feel like you "click" with the doctor.
This topic really resonates with me, because, in the past year, I have completely reconstructed my health care team... new primary care doc, new neurosurgeon, new dentist, new eye doctor, new rheumatologist, new ENT, new pain specialist, new PT, new OB/GYN. I'm not kidding. I was dealing with several major crises at once, and various individuals in my existing cadre of docs failed me in countless ways:
1. By not being well connected. My primary care physician was a lovely, charming family doctor who listened well, cared about my situation, but was woefully unconnected with the right kinds of specialists. He belongs to a managed care group based around St. Agnes hospital in SW Baltimore that refers everyone "internally" to other docs in SW Baltimore who are managed by the same group. I needed to get into Johns Hopkins for serious neck surgery, and his efforts to get someone to take my case failed because he only had relationships with people in his little group.
2. By being heartless and unobservant. I was in so much pain at one point that I was afraid to sleep... when I did sleep, my muscles froze up so bad I could barely get myself out of bed in the morning. (Literally.) I had a pain specialist tell me that it was her "philosophy" that pain patients need to keep working. She refused to fill out short-term disability paperwork for me, even though I could barely eat, sleep, walk, or dress. Heartless witch!
3. By not seeing the whole picture. I had been seeing a rheumatologist for Sjogren's Syndrome, an autoimmune disorder. Then I was diagnosed with Marfan Syndrome, which can cause joint-related problems. Rheumatologists treat joint-related problems, so I went to my rheumatologist and explained that I wanted her to keep an eye on my Marfan Syndrome, too. She did not get it and insisted that she could not treat both.
4. By having surly office staff. At one point I was in so much pain that I could barely speak, so my husband was going to doctor's appointments with me and explaining things for the doc. At one office, a surly desk clerk refused to let my husband come into the exam room with me. She basically said, "He has to wait out here or the doctor won't see you." Jerk!
5. By running way behind schedule, every single day. I saw an infectious diseases specialist a few times, and every time, he was running a full hour or more behind schedule. Once in a while, I can understand how a doctor's schedule would get backed up. But if it happens every single day, something is just not right.
6. By being a one-trick pony. I saw a "pain specialist" who simply did spinal injections for nerve pain. It was all she was good at, so once I had the injections, it was time to move on.
7. By not explaining things well. I saw a neurosurgeon who literally told me that neck pain like mine generally cleared up with two weeks' bed rest and some pain pills. Later on, I requested a copy of my file from him, and to my surprise, it mentioned possible surgery. What? Why didn't he tell me that?!?
8. By not being attentive enough. I had a physical therapist who would work on me (hands-on bodywork) for about 10 minutes out of an hour-long appointment. And during those 10 minutes, he was also talking on the phone, monitoring other patients, and supervising other staff. I started to feel like I wasn't getting enough real care, so I did a quick phone survey of other PT offices in my area. All of them offered a minimum of 30 minutes of one-on-one time with the physical therapist during each one-hour appointment. I decided I really wanted to get that individualized attention, and left Mr. Distraction behind.
9. By not being available enough for appointments. This can be a heart breaker, when you think you have a great doc, but can't get appointments in a timely manner. My newest primary care physician has a two-week waiting list for appointments! What am I supposed to do if I have an infection that needs immediate care? Also, I was referred recently to a dermatologist with a six-month wait list for appointments. My rash will be long gone by then! And I used to see a rheumatologist who had office hours only on Tuesday afternoons. What on earth?!?! How useful is a doctor if you can't get in to see them when you have a problem?
10. By mis-billing me, repeatedly. I had a dentist triple-bill me for a single cleaning. And then their billing person took numerous tries at correcting the problem... without much success. I can't afford those kinds of problems!
11. By not staying up to date on medical advances. 'Nuff said.
12. By openly holding a political position that could undermine the quality of my care. I saw a hematologist/primary care doc who I later learned is openly pro-life and will not discuss birth control, the day after pill, etc. with patients. That just rubs me the wrong way... what if I need those things? I was going to use her as my primary care doc, but forget it.
There are more, I'm sure. Place a comment to add yours to the list!
Of course, changing docs is a major decision, and your ability to move from doc to doc is often restricted by insurance options (the doc you want may not be "in network" for your plan). Also, finding a really, really good doctor is very, very hard. I will write more about that later on!
I'm always hesistent to admit that I need to switch doctors. Recently I finally went to see a gynocologist for period problems and the doctor was fine but the receptionist/nurse was terrible. I told her I wanted the office to use my cell phone number to contact me and watched her make a note of it on my file. The next day she called me at my home number!
Then yesterday I went for a test required by my gynocologist that had been booked a week and a half in advance and the same receptionist/nurse hadn't sent in the requistion form yet. Fortunately my GP and her office is fantastic, so they sent in a requistion for the test for me.
My sister says I should complain, but I hate doing that because I'm afraid it will compromise my care.
I like your site by the way. I have Glycogen Storage Disease type 3a as well as cardiomyopathy and have been dealing with doctors since I was born. I also have my own web site called The Phoenix Zine. Would you mind if I provided a link to your site in my next blog?
Keep up the good work,
Amy
Posted by: Amy | August 23, 2007 at 02:47 PM
Amy - Thanks for the comment on my site. I hate trying to find a new doctor, too... there are so many ways the relationship can go wrong, and it's not always about the doctor (it can be the nurse, the desk staff, etc.). Sometimes you have to decide what sort of undesirable behaviors you are willing to accept, and which ones would make you want to end the relationship... basically, is what you're getting from the doc worth whatever nonsense is involved. Good luck and hang in there!
Posted by: Valerie Riedel | August 23, 2007 at 03:22 PM