Everyone fantasizes about finding the perfect doctor. The one who will remember every single thing about you, year after year; who will be completely up-to-date on the latest medical discoveries and research; who will listen to everything you need to talk about without rushing you out the door so she can see the next managed care patient. (Helpful hint: Not all doctors accept Medicare. Before you get too attached to your primary care physician, make sure she accepts Medicare, so when you reach 65 you can continue as a patient.)
Your primary care physician must have the ability to listen to your concerns, show empathy and work with you to understand your symptoms and address the problem. If you're not getting this from your PCP, find another.
Your PCP should be well connected to other doctors and able to refer you to the best specialists. Ideally, your PCP will be "networked" to other doctors, allowing each physician to pull up your information at the touch of a button. My doctors are all within the New York University Medical Center system, which means they can see what's going on with me from all perspectives, at any time, quickly and easily.
We expect a lot from our doctors, but it's a two-way street. I asked a few physicians to tell me which behaviors they see in patients that impede their ability to provide the best care. In addition to the obvious, such as being late for appointments, keeping your cell phone on during appointments (or worse: answering the calls), or not calling a day before to cancel, there were a few things all the doctors listed as especially frustrating. Are you guilty of any of these common complaints?
- The patient brings friends or family into the checkup room who take over the conversation. While I don't yet bring anyone into my doctor's appointments, I do accompany both my mother and mother-in-law to theirs. They are 75 and 83, respectively, and a second set of ears and eyes is always a good thing, especially when the doctor is discussing procedures, medicine and follow-up recommendations. In this case, I believe physicians welcome my presence, as long as I don't completely take over. I always take notes and ask the doctor to repeat or review something if I don't understand.
- The patient doesn't reveal the entire truth about her lifestyle. Don't hold anything back, and never lie about what you do and don't do. Your doctor is not there to judge you, but to help. If you feel judged, get a new doctor. There are things in your genetic history or your past or present lifestyle that can affect your health, and your doctor can't know about them if you don't tell. Be prepared to discuss everything you know about your parents' and siblings' health histories, too. For women, a key predictor of long-term health is your mother's health history, specifically her experiences with pregnancy and menopause.
- The patient stops taking medications without consulting the doctor. My mother has been guilty of this many times, and in fact recently revealed that she hadn't had her Coumadin (a blood thinner) level checked in her blood for a few months, even though she's supposed to go every other week. Why? She felt fine and didn't see the need. People stop taking medications all the time, usually because they feel better or can't afford the cost. It's a chronic situation, especially as Americans get older. I have now been dubbed the "General" in my family for staying on top of both my mother and mother-in-law regarding their medicines and doctor visits.
- The patient believes in the "magic pill" approach to better health, instead of lifestyle adjustments. Most doctors I interviewed strongly urged patients to take the "lifestyle changes first, meds second" view, which entails doing and not doing certain things -- smoking, fitness, eating better and so on -- to address their health issues. But, since there is a pill for just about everything that ails us, many people just continue doing what they're doing, believing they are protecting their health with meds.
- The patient is a "serial screener". We're fortunate to be living in an age where there are screening tests for almost every potential disease or illness. However, there is such a thing as overdoing it, especially when it comes to medical testing. There are patients who want screening tests performed even when they don't need them, which can cause complications, false positive results and unnecessary procedures.
- The patient just doesn't listen. This is probably the most frustrating concern of all. The doctor will explain what the patient needs to do in order to prevent disease or improve their health, but the patient will walk out of the office and never look back. Our doctor can only assess and recommend. It's up to us to take control and follow the advice.
If you don't yet have the right doctor, ask for recommendations from friends and family. Your insurance plan may limit your pool of possible doctors, so start with those that are in your network. Whoever your doctor is, and no matter how much you respect her, remember: It's your body and your life. You can find the ideal PCP who, in turn, can refer you to the best specialists in the country. She can listen, empathize and advise... but that doesn't mean you should ever just hand your life over. Pay attention to medical information, ask questions about anything you don't understand and get second or even third opinions when warranted. According to a recent article in the Wall Street Journal, "Evidence is mounting that second opinions -- particularly on radiology images and pathology slides from biopsies -- can lead to significant changes in a patient's diagnosis or in recommendations for treating a disease." But, if you do seek another opinion, it's best to let your doctor know.
We all deserve to have doctors who respect, encourage and support our desire to be vigilant about our own health. But, doctors deserve good patients who are willing to work with them in partnership to improve the health and well-being of their patients.
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