Breaking It Off With Your Doc

Being with the wrong doctor can have grave consequences -- literally. As a practicing physician, I'm the first to admit that no doctor is perfect, especially me. I'm in a field that is eternally humbling, with my next mistake potentially hiding just around the corner. The stakes are enormous and the number of tasks I must juggle often daunting. From my point of view, I'm trying my best. But from the patient's point of view, that may not be enough. So how do you know when it's time to call it quits with your doctor? Here are ten reasons to make you think twice about continuing with the status quo:

1) You feel your doctor isn't listening to you.
Listening isn't waiting to speak. One of my favorite and most beloved teachers, Dr. Alfred Markowitz, once told me, "If you let patients talk long enough, they'll actually tell you what's the matter." Studies show that, on average, doctors let patients talk for 18-23 seconds before interrupting. Patients are allowed to finish their opening statement of concerns about 25 percent of the time.

You want a physician who not only is willing to hear what you're saying but who's intrigued by interpreting nuances of words and body language, who notices when you hesitate a millisecond before answering a question that's hit a hidden sore spot. Don't be shy about confronting a doctor who isn't listening. And leave if your concerns aren't addressed.

2) Your doctor can't communicate effectively with you.
Your doctor not only needs to be a great listener but has to be able to explain things to you in a way that you can understand. You'll know it when you don't hear it.

3) The doctor isn't taking you seriously.
This is a deal breaker. It may happen if your doctor jumps to a conclusion about the cause of your symptoms before considering other possibilities. Even if you're a hypochondriac, your hypochondria needs to be seriously addressed. And even hypochondriacs get real illnesses.

4) You have a problem with the office staff.
Office personnel represent the doctor. If they're unfriendly or unkind then you're starting off on the wrong foot. And it gets worse if they're inefficient. Messages must be given to the doctor, insurance forms filed, tests properly scheduled and results reported. Last week, a survey of primary care practices found that patients were not told of abnormal results an average of 7 percent of the time.

5) You're kept waiting too long.
Doctors can be delayed by unpredictable medical emergencies. But if it happens consistently then the doctor is probably scheduling inefficiently. A clue you've been in the waiting room too long: if you pass completely through menopause while waiting to discuss your hot flashes.

6) It takes too long to get an appointment.
Routine annual visits can be scheduled months in advance but new problems and ongoing medical complaints need to be addressed in a timely fashion.

7) The doctor's too busy.
This may develop over time, as the practice grows. If messages are going unreturned, insist on talking to the doctor. If the problem continues or the doctor always seems to be in a hurry then you may need to find somebody else.

8) Your doctor gets annoyed by questions.
This may be a reflection of other problems listed above such as the doctor being too busy or not taking you seriously. Whatever the cause, it's unacceptable. Not only are patients entitled to careful consideration of questions, those questions may provide doctors with important clues. "Why do I get a stomach ache every time I eat a slice of toast?" may lead to the diagnosis of celiac disease, a condition in which gluten -- a component of wheat, rye, and barley -- is toxic to the body. If a doctor doesn't immediately know the answer, a perfectly good response is, "I don't know but I'll research it and get back to you."

9) Your doctor is too arrogant.
God save us from the brilliant doctors. You probably need to be a B+ student to be smart enough to learn everything you need to be a great doctor. But you also need to be A+ in empathy, listening, carefulness, keeping an open mind, logic, and common sense. Doctors who think they are brilliant scare the heck out of me. I've seen them make huge mistakes as they take short cuts or rely on their instincts without seeking help from others or adequately listening to their patients.

10) It just doesn't feel right.
As with any relationship, sometimes you can't put it into words but you just know it's wrong. Don't fight your instincts.

For this week's episode of CBS Doc Dot Com, I visit the Mount Sinai School of Medicine in New York City and speak to Erica Friedman, the director of the Morchand Center, where budding doctors are schooled on bedside manner by treating actors pretending to be patients.

Watch CBS Videos Online

Comments

[STARDUST101]

Hey! A Prescription Drug Pushing Hierarchy ( I have researched the adversary culture behind the hierarchy ) that pushes its meds on the public, and our free press media, and makes a seriously indifferent and agressive advertising campaign out of it----and makes us all have to pay for it---as well as a no holds barred pricing---- for all the commericials and the rising drug costs....Why all this for "keeeping the masses drugged up", "dummies up" and "over medicated" for a cruel and indifferent corporate few? And who wants the world as well!? We need better social moral auditing of this adversary cutlure with due process rights to continue to battle for our moral justice in our medicine, and democratic "free choice" freedom in our social medical concerns----and not the socialization of our medical hierarchy of policy makers "that look to mock the meat they feed upon" ....

[SamKnause]

I had the same Dr. for ten years. I was late for an appointment. I let the receptionist know, before I signed in and paid, that I was ten minutes late. I explained that a semi was blocking two lanes of traffic, and I couldn't get around the truck. I sat in the waiting room for 20 minutes. A nurse came out to tell me that the Dr. would not see me because I was late for my appointment. I explained to her the reason I was late. She came back 25 minutes later and said the Dr. said he would not see me. I fired him on the spot. I went to the main office and filed a complaint. I lost all respect and confidence in my Dr. when I was treated this way, and felt he cared nothing about me and that I was just a number to him. The next day, adding insult to injury, I received a letter from his office stating he would no longer see me or anyone in my family. The letter was unnecessary, because I had already let the receptionist and nurse know I would never be seeing the Dr. again. He didn't even have the courtesy to come out and tell me his self or call me to a back room and tell me, all of this transpired in the waiting room in front of all the other patients.

[amhcw]

Come on-n-n, doctor! I've been to 19 different specialists trying to find a doctor who fits your above criteria. The last one smirks sarcastically at me at every visit probably because she knows due to the record keeping I had shown her that I had been to others first . I only stay because I have exhausted the supply in this metropolitan area. My insurance has paid but I gather most wouldn't. I have a record of the (very good) reasons I moved on from each of these doctors.

I am an LPN and have an MA in Health Education. Obviously there is something wrong with physician training. I think it may stem from their basic training being in the techniques of hospital emergency care rather than in what the general public needs during an office visit. That and the risks that doctors take; their psychies must need protection and they use us patients for that protection!

[cinemaven]

Most of these are reasons to have a frank discussion with your doctor.. when I don't feel like my MD (who is generally amazing and wonderful) is listening, I call her on it. The few times it happened, my visit came just after a visit by a patient she's extremely worried about.

The two doctors I did leave, I left for the same reason. Both were unrepentant pill pushers. Every ailment was a reason for pills and they both were into pain and antidepression drugs with such enthusiasm that there was no room for a patient like myself who would rather treat the real causes than just mask them with drugs. My current doctor who has been our family physician for 21 years uses meds as a last resort rather than a first and she loses a lot of patients because of it. (they don't die *lol*... they just go to a pill pushing dr.) She was the first doctor to refuse antibiotics unless they were actually necessary so no one in my family has exhausted the antibiotic drug list the way many of my friends and their children have.

[1differentdrummer]

We had a doc for ten years and dumped him later than we should have. MD may mean very little.

[MonkeyDaddy]

My doctor is technically very competent, but I am dumping him because he took two seconds to try to put me on statins for the rest of my life when my cholesterol came up high. He completely rebuffed any discussion of diet, exercise and other lifestyle changes to address the issue first. Doctors are trained to address the technical issue with the magic bullet of the day, not work with the patient to achieve optimum health.

[itolduso]

My husband's doc. did the same thing, based on one blood test (which the nurse botched- she missed the vein twice, left a HUGE bruise) He also insisted that the statins were COMPLETELY safe, that diet & exercise were not effective ways to keep cholesterol in check (my husband's very active, lifts weight, loves vegetables-the blood test was done right after Christmas, the one time of year he indulges in fatty foods, livers, cheesecakes, ect.) When I asked about reports of side-effects of statins- he got angry, yelling that "uneducated" people on the internet were spreading "dangerous" misinformation, that he prescribes them all the time and " NOT ONE PERSON has had an adverse reaction". We've never gone back to him.

[WindmillSlayer]

My doc did the same thing (immediately wanted to put me on statins), but it was her staff who delivered that info, not the doc herself. And her staff scoffed at the idea of alternatives.

My new doc called me personally after getting my blood test results, as well as the results of an MRI. They don't want to put me on drugs, but instead sent me literature about lifestyle changes.

I really like my new doc, but his staff is horrible. However, I'd rather suffer through bad office managers than hunt for a doc I feel comfortable with, and who genuinely listens instead of automatically writing prescriptions.

[HST]

I seem to have the opposite problem with my doc. She is overly solicitous asking me if I think whatever she says is "all right" and if things she suggests are "ok" with me.. I think it may be due to the fact I am in the medical profession (not a MD), but it is annoying. I want a doctor who will tell me what they think should be or needs to be done and to lay out the options on the table. Being wishy-washy makes me nervous.

[euthman]

Re: "Doctors who think they are brilliant scare the heck out of me."

My observation, going all the way back to med school: Doctors who make spectacular diagnoses, which they advertise, also make spectacular errors, which they don't.

Medical diagnosis and management is more about plodding and persistence than flashy displays of brilliance.

[cmaukonen]

The arrogance is what get me. I had a doctor for a short while that would not treat you unless you were already healthy. Give me a break.

[yoshi]

After walking into our new Internist's office and being accosted by a big screen tv, with FOX News channel, we informed the new doctor that we would have to decline his services. We figured that it was "a relationship" that would never work out.

[stevemarvin]

I usually go with point # 10 , "It just doesn't feel right" because I have almost "never" had a doctor who did not violate all nine of the preceding. I did have one guy years ago who listened, was respectful, and was willing to tell me what he thought, but he was such a rare positive exception that he was in great demand and virtually unavailable. Plus he was a department head and had tons of administrative duties.
What's far more depressing than the doctors that I might have to see as patient, however, are the ones that I must collaborate with in my occupation. Yikes.

[roseau]

This entire post assumes I have any choice. Where I live there is such a dearth of primary physicians, I'm lucky to have one at all. Most practices within an hour are accepting no new patients. I pay $1200 a month to have an insurance plan that covers a practice that at least TRIES to re-hire each time they lose doctors. For a while my choice of doctors was between angry men about to retire, and young women overwhelmed and underprepared for the frantic nature of current family medicine. My doctor, who I'm lucky to have pounced on right after she moved to this area, is consistently forced to see more patients in a morning than most doctors saw in a week 25 years ago. She has had to change electronic medical records systems twice in two years, and she accepts a part time salary so she can work 45 hours per week, taking home records to finish every night.

And of course, if I want to get an appointment with her for a physical I still have to wait 3 months at least. Because then they have to schedule a 30 minute block, not 15 and they allot few of those per week to her.

There is no CHOICE for regular people. Rich people (and people rich in insurance) have the luxury of worrying about finding a good listener. Dear Out of Touch Network People, please report on topics relevant to the majority of Americans.

[Idytme]

Bravo

[AnotherMcIntosh]

All good points.

They should teach this in the medical schools.

[HumbleSage]

My doctor is pretty thorough once he gets to me but he's very busy. However, he will listen to and treat only one malady at a time. What if the conditions are related?

Just last week my dog nearly broke my index finger by pulling too fiercely on the leash. Dr. One Note examined it carefully, sent me to the x-ray tech in the same facility, and conferred with me within minutes that it wasn't broken and offered sympathy and advice about pain control. Thanks. OK, but the pain extended up my arm and into my neck and exacerbated neck pain that I have had for many years. I requested Physical Therapy, but he said I had to make another appointment to have that checked out. A regular appointment takes about 2 weeks.

SO is this guy being careful, or too focused on moving through his patient list? How do I know that seemingly unrelated symptoms might be related and lead to a different diagnosis?

My son, a healthcare worker, says drop him, but I want to know if he's just being careful or a bit too pushed.

[JuliaRain]

I would have gotten a second opinion, but I am Canadian. If it is chronic, then you would probably be referred to a specialist.
Please feel free to ask questions about Canada's health care here. There are many Canadian HP posters.

[KennethBowen]

I had a doctor like that. Billed me for a separate office visit for each ailment - even if treated at the same time. I went in for a sprained knee and a skin rash. Two co-pays, and billed insurance for two visits. Insurance company said that is allowed.(!!!) I don't see him anymore.

[kingcrimson2]

By these standards, I should have fired every doc or dentist I've ever scene.