For my 16th birthday, my reluctant mother finally agreed to let me get my ears pierced. Back then, it was a procedure performed at a doctor's office, not at the nearest strip mall. I remember waiting in the doctor's exam room with my mom as she paced nervously and scrutinized his framed medical degrees on the wall. When he entered in his crisp white medical jacket, she pointed to the degrees and hit him with "How do I know these are real?" She wasn't, after all, about to just let some quack pierce her daughter's precious ears.
Perhaps I've inherited her healthy skepticism about medical practitioners. Through the years, I have encountered some wonderful doctors (like those who repaired my husband's heart) and some not-so-wonderful ones (like those who overlooked the conditions that led to his heart attack in the first place). I've been misdiagnosed, had procedures and tests I believe were unnecessary, and every time I look in the medicine cabinet, I see prescriptions that proved to me that the cure is sometimes worse than the disease.
Here's what I've come to know about doctors, now that I'm in my 60s:
1. Doctors are human, not gods.
Years ago, we empowered them way beyond what their skills and education justified. We deferred to them as "The Doctor" and hung on their every word as gospel. A second opinion meant you went to see their golfing buddy who reassured you that the first doctor was absolutely correct.
Truth is, doctors make mistakes; they have the malpractice insurance premiums to prove it. I'm not anti-doctor, mind you. But I am against the mind-set that they have all the answers and that you always need to take their advice.
2. Managed care changed a lot, but the Internet changed everything.
The Internet has allowed patients to arm themselves with questions. Information is power. We google our symptoms and self-diagnose what could be wrong with us before we see the doctor. We educate ourselves about treatments and come to the office visit better prepared.
While some doctors say they like the new informed citizenry, some clearly think that a little knowledge is a dangerous thing and wish we'd sign off WebMD. I say drop those guys and find ones who don't mind answering your questions.
3. I want my doctors to work for me, not my insurance company.
Managed care -- HMOs -- altered the face of health care delivery. In an HMO like Kaiser, doctors work for the insurance company. They are paid a salary, and just like any good employee, they want to keep the bosses happy -- which means not wasting the company's money. While some people swear by HMOs, they scare me silly. The idea that my doctor would be encouraged to practice minimalist medicine -- do the barest amount of medical testing, making treatment decisions based on their cost instead of my best interests -- destroys my core of trust in them. If your doctor's boss gives him a bonus for staying under budget, is he really the best doctor for you?
4. Every patient needs an advocate.
We live in an health care environment where doctors stack appointments and spend all of 10 minutes with you after you've been kept waiting an hour. They give your chart a cursory glance and hear what's ailing you while already preparing to move on to the patient in the next room. The situations in hospitals are worse, primarily because the stakes are higher.
A friend recently had to remind her doctor that she was a diabetic -- something that could have been the cause of the symptoms that brought her to the appointment. The importance of being able to speak up for your health can't be overstated, especially for elderly patients, who shouldn't go to medical appointments alone.
5. The quality of the office staff is as important as the quality of the doctor.
I've had medical office staff renew the wrong prescription when the drugstore called, forget to send me test results and screw up a lab order -- requiring a second trip to the lab, a second blood draw and a second billing sent to my insurance company who justifiably didn't want to pay it.
A medical practice is only as good as the person who answers the phone. Decades ago, the doctor's wife ran the front desk. Vested in her husband's business, she was the bookkeeper and the front line of customer relations.
Those days are long gone. Medical offices are as understaffed as every place else; the result is more time spent on hold and more mistakes being made.
6. You have to demand good service, just like you do with the cable company.
I switched doctors when I was told that the new office policy was to contact you only if your Pap smear was abnormal. "If you hear nothing, it means the test results were normal," the staff told me. Given how much paperwork I'd seen them lose, I wasn't about to trust them. I asked them to send me the results regardless of the test outcome, and they refused. Why? The cost of postage or the time it took for them to call me was "too much." Seriously. I still wonder how many women are walking around with untreated cervical cancer because the staff made a mistake and the doctor didn't want to spring for a stamp.
7. Not every ache or pain needs to be addressed by a doctor or a drug.
Years studying ballet taught me that ice is nature's anesthesia. Sometimes all you need is a good ice pack or heating pad to feel better. A good night's rest can knock out a flu bug. Hot soup and tea make a sore throat feel better. Soaking in hot salt water fixes the pain of most ingrown toenails, and a hot soak will make pretty much everything feel good again. Getting a nice massage reduces my blood pressure, and talking to a friend on the phone chases the blues away.
Yes, some conditions absolutely need medical intervention. But I do think that we sometimes use a bazooka to shoot the mosquito. When we go to the doctor with our ails, we are in essence asking them for treatment. If they don't give us something, we feel cheated out of what we paid for. It's why so many super-strength antibiotics are prescribed for the common cold. We'd get over the cold just as fast if we just stayed in bed and drank hot liquids.
8. Be open to alternative medical treatments.
Western medicine isn't without imperfections, yet many people dismiss alternative treatments as quackery. Acupuncture and Chinese herbs have been around for a very long time. They shouldn't be seen as the treatment of last resort or a sign that the patient is desperate. That said, the Internet has fueled a wave of medicinal scams. Proceed with caution.
9. Know that every drug -- every drug -- has some kind of side effect that could hurt you while it heals you.
Our bodies are programmed to heal themselves. Sometimes, you just have to let our bodies do their job.
10. When you find a doctor who you like, let the world know.
I adore my gastroenterologist. I rarely wait more than 10 minutes to see him, his office staff runs efficiently and I love that he not only stays current in his field, but also asks me about how life in general is going (stress aggravates a condition he treats me for, so he's not just being nosy).
He personally speaks to every patient after a colonoscopy and then calls that evening to see how they are feeling. When he gets biopsy results, he calls to deliver the news immediately. When I told him I would be traveling to China this summer, he gave me a just-in-case prescription to fill and take with me, as well as his email and phone numbers with the invitation to "call any time at the first sign of a problem." I sing his praises on Yelp and whenever I hear anyone in need of a great gastroenterologist in Los Angeles.
Before Your Appointment
Gathering your health information and getting organized before your appointment are the key steps to ensuring a productive meeting with your doctor. This is especially important if you're seeing multiple doctors or are meeting with a new physician for the first time.
Get Your Test Results
Make sure the doctor you're seeing has copies of your latest X-ray, MRI or any other test or lab results, including reports from other doctors that you've seen. In most cases, you'll need to do the legwork yourself, which may only require a phone call to your previous doctor's administrative staff, asking for it to be sent, or you may need to go pick it up and bring it to the new office yourself.
List Your Medications
Make a list of all the medications you're taking (prescription drugs, over-the-counter medications, vitamins, minerals and herbal supplements) along with the dosages, and take it with you to your appointment. Or, just gather up all your pill bottles in a bag and bring them with you.
Gather Your Health History
Your doctor also needs to know about any previous hospitalizations, as well as any current or past medical problems, even if they are not the reason you are going to the doctor this time. Genetics matter too, so having your family's health history can be helpful. The U.S. Surgeon General offers a free web-based tool called <a href="http://familyhistory.hhs.gov" target="_hplink">"My Family Health Portrait"</a> that can help you put one together.
Prepare A List Of Questions
Make a written list of the top three or four issues you want to discuss with your doctor. Since most appointments last between 10 and 15 minutes, this can help you stay on track and ensure you address your most pressing concerns first. If you're in for a diagnostic visit, you should prepare a detailed description of your symptoms.
During Your Appointment
The best advice when you meet with your doctor is to speak up. Don't wait to be asked. Be direct, honest and as specific as possible when recounting your symptoms or expressing your concerns. Many patients are reluctant or embarrassed to talk about their symptoms, which makes the doctor's job a lot harder to do. It's also a good idea to bring along a family member or friend to your appointment. They can help you ask questions, listen to what the doctor is telling you and give you support.