The Difficult Doctor

Do you feel dismissed, deflated, and defensive after seeing your doctor? While doctor patient relationships can be difficult to navigate and you may be thinking that there is greener, softer and more malleable grass elsewhere, doctor hopping means starting from scratch. A new physician, new office, new portal requires energy and effort. You may want to expend some effort on your current physician relationship, particularly since physician shortages means new patient appointments can take months. In this world of fast food, virtual shopping and unlimited choices, that can be hard to adjust to. For most patients who do not have the funds for a concierge doctor, do not despair. There is good healthcare out there.  A continuous relationship with a provider is a cornerstone of good medical care and good health. So take a moment to think about cultivating  this.

There are lots of reasons for doctors to be cranky these days. Surviving long years of studying, test taking, competing and deferring life on the path to becoming a doctor takes a toll. After graduation, many doctors enter the workforce with hefty student loans. They go to work as employees of large corporations or hospital systems who dictate all kinds of responsibilities outside of patient care that require time and effort . Pharmacies pester physicians regarding their choice of medications, which may not follow formulary guidelines. Tests like MRIs are often declined without paperwork being filled out or  a telephone consultation with an insurance representative.  Billing and coding of visits requires a degree in itself. Doing this part of the job poorly carries consequences of audits and financial penalties.  Meanwhile, patient portals have become a direct link to doctors which is both helpful and maddening.   Spending up to an hour per day answering portal messages is burdensome, unpaid work that demands attention and takes precious time. The internet has created a cohort of people who are artificial doctors. They sometimes come to visits with lists of tests needed and diagnoses made. Beyond that, the patient has become a client in this process with the ability to “healthgrade” their doctor based on anything from  the condition of the waiting room, to the politeness of staff. Clients are catered to rather than cared for and that can be a problem for both parties.

The field of medicine is undergoing seismic shifts, trying to keep up with the goals of access and efficiency available in other industries.   Zocdoc has taken root in many health care systems, allowing patients to make their own appointments. Schedules have been adjusted to allow for earlier and later appointments, accommodating people who work and have limited availability. That has been successful in getting more patients visits when they want them but not necessarily with the same provider or at the same location. Not having to go through long phone trees at a doctor’s office with no human contact at the end of the call is definitely a plus.  At the same time, the no show rate for those appointments is high and a source of dissatisfaction for providers.   The pandemic brought immediate pressure to insurers to cover telehealth visits. We are never going back to a system without coverage for telehealth. That has been a huge benefit for people with transportation and time constraints. Meanwhile, industry disruptors like Walmart Health, Amazon One Medical, Pharmacy minute clinics and dozens of  Telehealth companies are vying for a piece of the healthcare pie with promises of quick and effective medical care. For many reasons, including the multitude of Electronic Health Records (EHRs) run by private industry as well as privacy concerns around medical records, EHR systems do not talk to each other. That means the provider seeing you in an urgent care setting may not have any details of your history and your usual doctor does not have easy access to the urgent care record. If you happen to need a hospital, you will most likely see a hospitalist rather than your primary care doctor. That can be scary when you are at your most vulnerable. Here we are back at disconnected communication and care.

What to do you may ask, to improve your experience in the disjointed, disconnected and disappointing landscape of American healthcare? After all, as a patient, you’re not responsible for the state of the healthcare system. You just need a provider to actually look at you, listen to you and give you good medical care. Is that asking for too much? It isn’t asking for too much. It is what each patient deserves especially considering Americans pay the most for healthcare in the entire world and do not have the best health to show for it.

To smooth the road in whatever medical journey you are taking, communication is key. Choose a healthcare system that shares your medical record across the continuum of care, from urgent care to  primary care and specialty offices, the hospital and home care arenas.  That way everyone can see what is happening on all fronts, On an individual level, good communication with your doctor comes from mutual respect and concern. Coming to a visit on time (or even a little early) with a clear concise description of your issues and goals is helpful. If the doctor is rushed, wait until he or she makes eye contact to speak. You are allowed to ask questions though bringing a list of more than 20 can be daunting. Try to answer questions and fill in pertinent details, especially life stressors: financial, familial and situational. Be willing to return for additional visits if you have a problem that is not straightforward.  Understand that a referral may be necessary to solve a problem, but constant specialty referrals are not usually a path to better health but a path to costlier care.  Good health primarily comes having a balanced life which includes living in a safe environment with access to clean air and water, eating  whole foods,  having regular physical activity, getting adequate sleep, nurturing supportive  relationships and avoiding high risk habits like drinking, smoking and using drugs.  Regular visits, when you are not acutely ill, are necessary to foster discussion about health promotion and to provide preventative care. Meanwhile, taking medications prescribed, having necessary tests and returning for follow up closes the loop of care.   Once the bond of trust is forged, you can feel more comfortable that you will be taken care of and your concerns will be addressed.    

Good luck out there