Saturday, September 12, 2009

When to Dump Your Doctor?

The following is an video and essay from CBS regarding when is it time to change physicians. Relationships of any type and kind are difficult to maintain but when we are considering the health and well being of our family, we need to watch the warning signs and take action. Remember, the life you save may be your own or that of your loved one.

Medical errors constitute the 6th leading cause of death in the United States. See, e.g.,

Hence, we should pay particular attention to how our physicians are dealing with our health issues and that of our children.

Watch CBS Videos Online

There are many reasons why people want to look for a new physician. It is a decision that might be harder than you think. Dr. Pamela Gallin speaks with Chris Wragge about when to dump your doc.

In relationships, sometimes you have to know when to call it quits. That's especially true when it comes to the relationship with your doctor.

Changing physicians could be the perfect prescription for your health; your life could even depend on it.

So how do you know when, or if, you should go that route?

Dr. Pamela Gallin, a surgeon at New York's Columbia Presbyterian Medical Center and author of the book, "How to Survive Your Doctor's Care," offered some insight on "The Early Show Saturday Edition."

Having the wrong doctor is a "huge" problem, Gallin says. "Many of my friends and patients sit with someone they dislike, thinking they aren't getting proper care, but are afraid to change their doctor. This is harmful to them: Their problem progresses, or they are taking unnecessary or wrong medications; all medications have side effects.

If you went to a restaurant and the food was cold, or they messed something up, the manager would know it. Why be complacent? Don't be.

How do you know you have the wrong doctor?

You don't have to "know." It is enough that you just feel uncomfortable or don't like him or her. As with friends: Some you like and others you don't, but later you find out what you were responding to. Your physician is an intimate and often embarrassing relationship. Don't compromise.


Can't get an appointment

Just because someone is a wonderful doctor doesn't help. They need to be accessible, and TAKE CARE of you. This means that you can see them in a reasonable period of time and that, if sick, they are responsive. I saw a baby from Canada yesterday. It took three months to get to the specialist and they were on a 10-month list to have surgery. I wasn't an emergency, but needed to be done shortly. Not being seen is not being cared for. Next doctor!

Rushes through the exam

We all know that the average visit is 15 minutes. It is our right and privilege to have a careful, thoughtful, considerate examination. And that our options get discussed. It is not about the overburdened physician. It is about taking care of you. While sympathetic, I am not interested that he or she has too many patients booked. If so, move on.

Doesn't answer questions

You are not supposed to have a Ph.D. in what ails you. That is the doctor's department. Medicine is not black and white. It is the obligation of the doctor to explain what you have and what the choices are in treating you. You are allowed, expected and required to voice your concerns about how the diagnosis or treatment will effect you and what choices you have to make. Some people can't take a medication in the middle of the day, and others cant take a pill with a once-a-day dose; the right answer is the best one for you. That requires discussion, and the doctor must be available to do so.

Treatment choices not discussed

Medicine is not one-size-fits-all, and the more complicated your problem, the more nuanced the care. There are frequently many ways to do the same thing. You must get the right one for you, and that requires choices. Sometimes surgery is an option, and sometimes it is the last thing you would want. Other times, you just want to fix the problem. This is complex and depends on the exact circumstances and your life; you must know what you are getting yourself into, and what the alternatives are, now and later.

Not up to date with latest treatments and procedures

No one knows everything about everything, and this is where sub-specialists and super-sub-specialists come in. But if you mention something about a treatment for what you have, it is fair to expect your doctor to know about it. The exception is if it is experimental, and even then maybe you want to go to someone doing the trial. Your doctor is supposed to know more than you. If you sense that is not the case, next doctor!

I have two friends, each of whom was told they needed emergency hysterectomies. In one, the diagnosis was wrong. In the other, there was a non-invasive procedure available through radiology. In the first case, the doctor botched the diagnosis. In the other, he didn't know (or wouldn't tell the patient) about the other.

You're just not getting better

Many medications are now for chronic use and take a while to work -- drugs such as hypertensive meds, diabetes, anti-inflammatory, anti-depressants. While you might be somewhat better, if you are not feeling the way you are supposed to, then it's time for another medication. But if your physician views this as a direct challenge, and won't discuss it, think of this as a maze with trial and error. Move on.

Do you find some people have a difficult time firing their doctor?

I like to talk about procuring the best care, but frankly, I was a coward personally, and have to laugh about it. I wanted to fire a sub-specialist and asked my internist for permission. Ludicrous! You could try out the new one before you burn bridges, but ... why be miserable? This is not the time to compromise

How hard is it to switch doctors, considering there are medical records, files, insurance etc. involved?

Surprisingly easy! Vote with your feet! The paperwork will catch up. Make an appointment with the new one, and request your records. If you have a complicated problem, collect your own file as you go, with letters of consultation and important lab values. Then you can take it along; more people are doing it now. It is not insulting, just industrious. I is your right and privilege under federal law to get your full file. You own it.


Get referrals from doctors you like

Doctors work in large, loose referral bases. It is good for the patient: If you are the ninth patient I sent to the other physician, they are responsible to me, and I want them to get it right. If they don't do right by my patients, they are fired, and I will send them elsewhere when I give a referral. You are getting the benefit of everyone who went before you, and if they don't treat you that way, I would them off my list. So find someone you like and ask who they like.

Check their credentials

There are extremely rigorous tests and evaluations of training that occur; the more complicated the sub-specialty, the more tests for the physician. Someone who has passed these is the one you want. It is a matter of record. Also, a doctor can't just get onto a hospital staff. You are carefully evaluated.and, if you don't do it right, then you are not renewed. So, go to the "best" hospital in your area, and get the best doctor.

Confirm insurance coverage

No one has unlimited funds; the coverage on the plans varies a lot, and doctors take different plans. It is not a reflection on their abilities, only on the new world we live in. So find out who is on your plan. If there is no one suitable, then see how much you have to pay.

Test 'em out!

In a perfect world, they can have a dry run. This is a good move with pediatricians, internists, and ob-gyns. Go for an initial exam; you will know if the office and physician are a good fit. If the doctor is good but the front office a disaster, maybe he or she is not for you. That is also true the other way around. If the hours don't fit your work schedule, it is unreasonable to take time off for each visit, and you don't want to explain it the others.

Do your homework. It really will save you time, and money. Most of all, it will help you take the best care of yourself.

CONTACT INFORMATION: If you or a family member have been injured or damaged due to the fault or responsibility of someone else, an industrial accident or by a dangerous or defective product, drug or toxic substance, contact Alan Morton for a no obligation, free consultation.

For additional information contact:

Alan L. Morton
1005 North Eighth Street
Post Office Box 420
Boise, ID 83701-0420
Telephone: 208.344.5555
Toll Free: 866.946.1669 [866.WIN.1.NOW]
Facsimile: 208.342.2509

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