Showing posts with label primary care physician. Show all posts
Showing posts with label primary care physician. Show all posts

Tuesday, November 8, 2011

Medical Bait and Switch

Just a few weeks ago, I used my medical group's walk-in service because of a nasty bout of bronchitis.

Little did I know the appointment would feel like a rollercoaster derailing, thanks to medical staff's unwillingness inability to communicate to their patients effectively.

As I was checking in, a receptionist said coldly and matter-of-factly, "Oh, and here's a sheet to read while you're waiting."

I simply couldn't believe my eyes.

The letter started off, "We are sorry to inform you that XYZ Partners has decided to terminate its contract with our physicians...You will end up being assigned to a new (different) [primary care] physician." The letter went on to say all I had to do was to contact my HMO and change my group number, and I would continue to have my primary care physician lickety split.

Oh, and I would also be assigned to a new hospital. Which means -- with the exception of my primary care physician -- all new doctors. All new specialists.

Now if I were a run-of-the-mill person with excellent health, I might not have had too much of a problem with this. But all I could think of was this: I would have to make a horrible choice: Get a new primary care physician and keep my gazillion terrific specialists, including my oncologist, or keep my wonderful PCP and venture out to a new hospital and all new specialists.

So I did the only thing I could do at that moment.

I panicked.

When I questioned an unhappy-looking staffmember -- who was not at all concerned about my interests, of course -- she raised her shrill unpleasant voice to me, telling me that it was not the office's fault that my hospital was dropping my medical group as a provider.

And then I raised my voice, blaming the medical office's staff for breaking the news this impersonal way. 

In a shaky voice, I then poured out my heart. I told them that I have had breast cancer and I couldn't just go pick another medical group, thereby ditching my specialists and interrupting my continuation of care. And the meanie plus her medical cronies looked at each other, then at me, and the unhappy staffmember had the nerve to say:

"We understand this is an inconvenience and continuation of care is important, but if you select the new group 123, you will have the same primary care physician."

An inconvenience?

And I continued, "What about my oncologist, my breast surgeon, my gynecologist? Do I get to keep them!?"

The staffmembers all said, no, but if I selected the new group 123, I would be so lucky to keep the same primary care physician and get a new hospital to boot. 

I could see the writing on the wall: I would have to make a choice between my primary care physician, who took great care of me for 14 years, or my terrific oncologist, gynecologist, et al.

So while I sat in the examination room stunned as a fly who had just been swatted, in comes a physician I didn't know. The first thing he said to me was, "Looks like you're sick of being sick." Yes, I was sick, alright -- but my bronchitis was the furthest thing from my mind.

He started examining me and -- I've never had this happen to me before -- he said, "Ooops, I am not sure if I am supposed to be examining you because we are changing hospitals. You might have to pay a lot of money for this exam. Let me check."

And with that, he exited the examining room and then came back saying the office manager was allowing me to just pay the co-payment due to my unique circumstances. He could proceed with the examination.

Oh lucky me.

That exam being done and prescriptions being filled, I sobbed on the way to my car. I already made the tough decision: I will have to say goodbye to my primary care physician and keep my wide array of specialists and my hospital. I cried with anger that nobody told me about this change in person or via phone. Instead, I felt as if I were regarded as an afterthought with that impersonal letter.

A few days later....

To add insult to injury, I received the same "Dear John" letter in the mail.

A few days later....

I got a letter now saying that my primary care physician "resigned" from the medical group.

A week later....

I made an appointment to see my primary care physician just to achieve closure. I wanted to tell her -- without crying -- how much she meant to me. I wanted to tell her -- without crying -- how I didn't want another primary care physician and start over with a general doctor who didn't know me. I wanted to see her one last time -- without crying.

Well, I didn't cry, but I told her all those things and how very upset I was with the situation. She said she was upset about it, too. She said, "You know, I consider myself a pretty good physician. But you have many specialists, such as your oncologist, and it is easier to replace a primary care physician than it is an oncologist. You have specialized needs, so if I were you, I would search for a new PCP."

I didn't have the heart to tell her that was what I decided to do -- even before our appointment. In fact, I felt better because I was able to lie to convince myself that she made the decision for me.

Now that I'm no longer reeling from the shock of it all, I will call my oncologist and ask for a recommendation for a stellar PCP. It is difficult to start over with any doctor, but that's life. Change is inevitable. Doctors retire, move to other parts of the country, are also victims of changing healthcare policies, and they pass away.

They are human like everyone else.

Achieving closure with my PCP was one of the best things I could've done. I had an excellent doctor, and speaking with her in person about my concerns and fears was a great move.

I can go forward. I am still scared of the prospects of a new doctor, but I am going forward.

I'm writing a book titled Calling the Shots: Coaching Your Way Through the Medical System. Please feel free to subscribe to this blog by clicking the orange subscribe button. I am a professional writer and have published numerous academic and magazine articles, as well as an essay on my breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. I can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

Friday, April 17, 2009

Top Five Quick Tips on Choosing Doctors

In a previous blog, I covered Litmus tests for how to assess whether a doctor is right for you. Here, in a nutshell, are the top five things to keep in mind when considering a doctor -- from gateway doctor (primary care physician/internist/family doctor) to specialist:

1. Bring a notebook to your first appointment with questions written in advance. Leave ample space under each question for you to write notes.

2. See if the doctor answers your questions to your satisfaction and thoroughly -- in a way you can understand it.

3. Observe the doctor's body language. See if the doctor maintains excellent eye contact, and when you bring up your concern, whether he/she seems in a rush or simply sits down and talks with you. In addition, see if the doctor is distant from you emotionally and physically. If the doctor is comfortable being physically close to you while answering questions, that's a good sign.

4. Give the doctor an emotional prompt on a topic that really concerns you, such as: "I'm really worried about my cholesterol levels." If the doctor is empathetic and great at putting you at ease, that's a great sign.

5. Call the doctor back the day after your appointment to bring up another real concern. If he or she calls you back promptly and reassures you/answers your questions, that's a sign that the doctor is vested in your emotional and physical well-being and respects you.

These methods aren't foolproof, but they really are crucial in your quest to find the doctor who's right for you.
Photobucket

Thursday, April 9, 2009

The Gateway Doctor

My grandmother always told me, "If you have your health, you have everything." As a child, I didn't understand the truth in these words. I didn't heed these words as a healthy young adult: I came from very genetically healthy stock -- people in my family die of old age for goodness sakes, even the ones exposed to asbestos, lead, and various other toxins!

I didn't heed my grandma's words until I was diagnosed with breast cancer. Because let's face it: I, as so many people, took my health for granted -- until I didn't have it.

Now I'm going to spin my grandma's words to suit my medical-advocacy purpose: "If you have a great gateway doctor, you have everything."

Besides you, the most important person managing your health care is the "gateway doctor," also known as the primary care physician, internist, general family doctor, etc. Whether or not you are healthy, whether or not your family has had the same physician they have felt comfortable with for decades, whether or not your doctor is well-versed in all of the new medical technologies, whether or not your doctor has had an established practice with a good reputation, it all boils down to this:

Do you trust your family doctor with your life?

If the answer is anything but a resounding, enthusiastic "YES!," find another doctor immediately. Your life is too precious to take a chance with incompetence and mediocrity.

I measure competent doctors by their medical and emotional know-how. They must be medically competent (sounds like I'm stating the obvious, but it needs to be stated) and they must have your best interest at heart. The latter point means more than just bedside manner: I have had doctors be pleasant to me during an examination, but mere pleasantries are not enough.

You must LOVE your doctor.

As is the case with specialists, the ideal gateway doctor cares about you as a patient and will work as hard as possible to advocate for you. Another perk is that a great family-practice physician tends to keep company with other excellent doctors -- and that opens the gateway to outstanding medical care.

I was lucky to have an outstanding gateway doctor in place before I got diagnosed with breast cancer. She was my physician for years because we had great patient-doctor chemistry.

Let me tell you what she did for me during my breast cancer journey:

She called me often, coaching me through the diagnosis and prognosis. She listened to me, and validated my concerns. She encouraged questions and provided prompt answers. She returned my phone calls, often on the same day that I left her a message. And she was working behind the scenes and putting an excellent team in place for me. She landed a great surgeon, steered me toward a fantastic medical oncologist and radiation oncologist. These top-level professionals all worked tirelessly to save my life, but they didn't treat me as if I were a mere patient.

They treated me like family.

And they were all HMO doctors.

(In a future blog, I will dispel the myth that all HMO doctors are bad.)

And even though I had a medical team of specialists who were unbelievably outstanding and kind -- like off-the-charts brilliant and sweet people -- I probably wouldn't have crossed paths with them, had it not been for my gateway doctor, whom I have called my guardian angel.

So now that I've waxed poetic about my gateway doctor, here are some litmus tests that can help you find the doctor that's right for you. These tests also apply to specialists, but you need a great PCP in place before you can even consider a specialist.

You'll need to set up a routine exam, perhaps with several doctors, to find the right one so please be patient.

Litmus test one: During your meeting, give an emotional prompt, like: “I’m afraid of blood tests.” Observe the doctor’s reactions. Is he/she emotionally vested in you? Reassuring? If not, find another doctor.

Litmus test two: Sometime in the week following your exam, call the doctor to ask a question. Does the doctor call you back promptly? Does he or she communicate with you clearly and patiently? Does he or she take your concerns seriously? If the answer to any of these is “no,” find another doctor.

Litmus test three: Based on litmus tests one and two, do you LOVE your doctor? If you are feeling badly about him/her or just so-so, find another doctor. Don’t settle for mediocrity because if there were a medical crisis, a doctor you love and who cares deeply about your welfare will be the one who fights for you.

Litmus test four: Does the doctor play “ring around the patient,” where he/she continuously throws statistics to impress you with his or her know-how? Does he/she come with print-outs of pages from the Internet to illustrate these statistics? Do you feel confused during and/or after the session?

Run – do not walk – away from this doctor.

Litmus test five: Does the doctor use scare tactics, telling you all the terrible things that can happen to you? Is he/she dismissive of your emotional and physical needs? Does he or she sound like a doctor who has watched too many ER or Grey's Anatomy episodes? If so, this is not the doctor for you.

All in all, trust your instincts and be persistent in your goals to find a great doctor. You will know whether a doctor is a good fit for you. Also, if you suspect something is wrong and a doctor does not give you a satisfactory answer or solution, then continue advocating for yourself. Don’t accept answers like, “You are too young to get cancer.”

Demand to be treated with respect and, if need be, be difficult to those who treat you unfairly. You have an amazing power to demand to be treated with respect – whether from doctors, nurses, and office personnel. If someone treats you with disrespect, such as rudeness, talk back.

You are nobody’s doormat, and they need to know it.

Photobucket