"Know when it's time to fire your doctor"

This is an older article however it brings up some good points. And it seems that every now and then people are not happy with their doctors so it is a good read.

Sandi I wasn't sure where to post this so if you want to move it that's ok - I just didn't think it should go in the Social section because a lot do not go there.




www.cnn.com/2007/HEALTH/08/16/ep.fire.your.doc/index.html


By Elizabeth Cohen
CNN

Empowered Patient is a regular feature from CNN Medical News correspondent Elizabeth Cohen that helps put you in the driver's seat when it comes to health care.

ATLANTA, Georgia (CNN) -- Dr. Jerome Groopman knew he needed to break up with his doctor.


Dr. Jerome Groopman says sometimes the doctor-patient relationship comes down to chemistry.

Five years ago, when he started seeing his internist, everything was fine. But Groopman says that in time, the internist became more popular -- and hence more busy and harried -- right when Groopman needed him most.

"I have a strong family history of high cholesterol and heart disease. Every male in my family has had a [heart attack] in his 50s and 60s," he says. "I was moving into middle age, and I just didn't feel that my doctor was looking at me as an individual, and taking those factors into account."

But Groopman -- a physician and author of four books about doctors and patients -- found it difficult to leave his internist of five years. "It sounds strange, but I didn't want to insult him."

Groopman is not alone. "I really think it's a fear of the unknown," says Robin DiMatteo, a researcher at the University of California at Riverside who's studied doctor-patient communication. "But if the doctor isn't supporting your healing or health, you should go."

Here are five ways to know when it's time to think about leaving your doctor, and the best way to do it.

1. When your doctor doesn't like it when you ask questions

Groopman says after the publication of his book "How Doctors Think," a reader contacted him with her story. "She was seeing an orthopedic surgeon for back pain, and when she asked a question, his response was 'Since when did you get an M.D.?'" Groopman says. "That kind of response is just about a deal breaker."

2. When your doctor doesn't listen to you

Debra Roter, a behavioral scientist at Johns Hopkins and co-author of "Doctors Talking with Patients," says it's a red flag when your doctor doesn't pay attention to what you have to say. "A doctor suggested my friend take a certain drug, but she'd taken it before and she told him it hadn't worked for her," she says. "But her doctor wanted her to try it anyway. He didn't give her any credibility."

3. If your doctor can't explain your illness to you in terms you understand

"It's really important that a physician be able to communicate in plain speak and plain language," Roter says. "A doctor has to be able to explain things so you can put the information to use to take good care of yourself."

4. If you feel bad when you leave your doctor's office

DiMatteo says sometimes you just have to go with your gut. "For example, if a patient says, 'My pain is still there,' and the doctor says, 'It shouldn't be -- this treatment works for other people,' and you walk out of the office feeling badly, I don't think you should stay."

5. If you feel your doctor just doesn't like you -- or if you don't like him or her

"Sometimes there's chemistry and people click right away, and there are some people you don't click with," Roter says. "If your gut says you're not crazy about your doctor, they probably aren't crazy about you, and that's not good."

Groopman agrees. He says a doctor who doesn't like a patient often stereotypes him or her. "I was terribly guilty of this as a young doctor. One of my patients said she had indigestion, and I got very irritated with her, and thought she was a whiner and a complainer," he says. "It was catastrophic because she actually had a torn aorta."

The woman died. "I have never forgiven myself for failing to diagnose it," he writes in "How Doctors Think." "There was a chance she could have been saved."

So once you've decided it might be time to divorce your doctor, how do you do it? First of all, make sure whatever's bothering you isn't just a one-time thing. "Make sure it's not just a quirk of the doctor's day," Groopman says. "Maybe they're just having a bad day."

If the problems continue, Groopman, Roter, and DiMatteo agree it's best to try to express your dissatisfaction instead of just bolting. "Use the first person plural, such as 'We're not communicating well' as opposed to 'You seem distracted or irritable with me,'" suggests Groopman. "That may cause cause the physician to stop and reflect and shift gears."

When it doesn't, you can be sure it's time to get another doctor, Roter says. She described two friends who wrote letters to their doctor saying they were unhappy with some of the treatments they'd received. "The both got back letters saying, 'Good luck with your new doctor.'"

It's fine where it is, Melinda. The section rules are not that strict. It's a good article that may be helpful. Too many people are intimidated by their doctors, so hopefully it is read!

I think this article is something everyone should read!

A few months ago, we were unhappy with the way my husband's cardiologist communicated with us. We are with a big HMO. Finally, we asked for a "second opinion." We didn't say bad things about the first doctor to the second, but explained that we had had trouble understanding the advice (much of which was written--through email) of the first. The "second opinion" doctor took us on, and things improved immediately.

Good article! In my opinion and experience its okay to "just bolt". You don't have to work it out with a doctor or explain anything or write letters. If you want to do all those things fine, but its okay to just leave.

My first hemo (assigned to me by the ER) was intense, domineering and not a good listener. I was intimidated by him and stressing out before and after each visit. After 4 mos of trying to work with him I finally got the courage to leave. I simply made an appt with another hemo and canceled the appt with the Intimidator. It was such a great move and a relief- my second hemo was a dream.

Thank you for sharing! I knew I grew up thinking that doctors were like gods and we just did everything we said. I've realized that doctors are people who may or may not know about itp. I would like to add in, you should fire a doctor if he is not willing to read the latest research on the illness. Also, if you and he can not agree in a treatment plan.

My boyfriend had a professor who was an ophthalmologist. His firsts words were I'm a great doctor. However, there are amazing doctors as well. Feel free to get a second opinion.

I'm with Poseymint, I just 'bolt'. Did so with my GP who said to me that if the hospital didn't care about my red blood cell size then she didn't care either. I'd mentioned it in the hope that she would explain some things to me. I just left and signed up with another GP practice which has turned out great. I've seen a few doctors in the new practice and they are all really caring and supportive.

I also told my first haematolgoist that I didn't want to see her locum any more. I told her I didn't need someone scaring me about ITP and bleeding to death. The next time he was there I saw him pick up my notes and move them to the other doctor.. LOL.. she'd either said something to him or he didn't want to see me as much as I didn't want to see him. Either way it worked out. We really do have to stand up for ourselves.

It's so often a delicate dance of personalities, taking the good and tolerating the bad.
My hema hates my questions, usually shrugs them off with very little response. After 5 years, I know nothing about him as a person and vice versa. He's terse... Checks the count, adjusts the dose, out the door. Hand over the co-pay. It's all business.
But, although he's firm about the treatment he believes is needed, he allows me to say no. By the look on his face, he always seems peeved about it, but he isn't pushy. I'd unapologetically go elsewhere, but I'm afraid of finding worse at the next stop. If that happened, I would feel I'd burned the bridge and couldn't go back.

When a doctor and I don't see eye to eye, I leave without explanation. It's the same as if a favorite local restaurant changed the menu or hired a bad cook. I'd just eat someplace else. No excuse needed, unless it would appreciably change something. Almost always, it won't.

I've also just left certain doctors. I don't feel that I owe them an explanation. I figure they know I've left when I request my records forwarded to someone else's office. I did write a complaint letter to a Rheumatologist once who blew me off, and he did respond. His response made no sense as far as the issue was concerned. It was a CYA letter but did not address my complaints at all.

Janet, your doctor sounds like a jerk. He allows you to say no? How could he not allow you?
Erica

Erica, I know by my participation in various health forums over the years that there are doctors out there who would fire a patient who refuses to go along with their agenda.

I can't say I like the guy, but at least he's better than some MDs my family and I have had over the years. Like I said, I'm afraid to move on to someone else who could be a whole other kind of horror show.

Something else I forgot to mention... This guy's office staff is awesome. Having once had an office assistant literally scream at me over the phone about a mistake she had made regarding a serious dosing error, I vowed never again to patronize a doctor who has any rotten apple staff members.

My daughter was once terminated as a patient by her Endo for saying 'no'. She refused to take birth control forced on her by the doctor. She was on a thyroid medication that caused birth defects and she fully knew the risks. She'd been on the medication for a few years by that point. One day out of the blue that doctor decided that Holli should get an intrauterine birth control implant or she would stop prescribing the thyroid meds.

Holli was totally out of pills and had no refills. It was a Friday and she was stuck. Since when can a doctor force birth control on a patient?

Wow Sandi, thats awful! To me doctors are supposed to help you decide the best course of action for something like birth control, not force something and give ultimatums. To leave her without the thyroid meds seems unethical.

My former PCP once told me that I was the only person who ever had side effects from prednisone!

A good doctor can help so much and It makes me sad to read about all these people who have to put up with doctors who dont communicate well. Over the years I got to know my Hema as she would tell me things about her children, husband, books she liked, and trips. She just retired, at age 50, because her teenage children needed more parenting as she put it. I was so sad when she retired and her replacement is finishing up her fellowship. She is young, but hopefully i will like her. Meantime i like the office staff and nurse practionioners, and the dr who is covering until the new one comes.

I thought it was unethical too. Holli is wise and knew what she was doing. Her Endo after that told her that he had gray hair from three patients who did get pregnant while on that medication. He also said that the babies were fine...the mothers were on a low dose (as Holli was) and the risk was low. As for being stuck without meds, I called her GP and explained the situation. He prescribed the pills for one month until she found a new doctor. He was a lifesaver!

My Hemo asks me about my kids too and tells me about his. I only see him once a year now, but he always remembers.

dru wrote: My former PCP once told me that I was the only person who ever had side effects from prednisone!

Oh my gosh - didn't that just make you want to take a bottle of prednisone and dump it down his/her throat!! I can see why this is your "former" PCP.

I'm glad you all like the article - I think we just need to remember it is our body, and if we do not like the doctor or feel comfortable with the doctor or doubt the doctor or anything else we do need to move on. Some of the stuff I hear I wouldn't take from my kids pediatrician muchless my cat's vet - but we do seem to let some things slip when it is us who is the patient.

My doctor's office also told me "none of our other patients have those problems on Prednisone". I knew better from listening to everyone here.

I didn't have "here" when I was on prednisone - I do recall my MD saying prednisone would bring my count up and it would be normal by the time we moved to Tokyo [and donkeys fly!]. None of my doctors ever told me prednisone didn't cause side effects - they were all honest & up front about it. I've even had doctors tell me how nasty prednisone is.

Question for you experts:

I've had very few obvious symptoms during the two 8-month stints I've had with Prednisone, but the highest my dose has been is only 20 mgs. Is that why I'm not having a very hard time with it?

Janet,
Not everyone has obvious problems with prednisone; weight gain, moon face, insomnia, mood swings etc.
While i dont have many problems when on 5mg, I certainly do on 20mg. Since it works for you, its is great that prednisone doesnt affect you so badly.

Midwest- I've gotten more and more sensitive to prednisone side effects as time goes on. In the beginning 40mg wasn't too bad, now if I go up to 10mg I have serious high blood pressure, anxiety weight gain- all my body weight seems to go to my neck! and terrible acid reflux that has burned my esophagus enough to give me a persistant cough. I really can't tolerate 10mg now. Not sure if every one gets more sensitive with time.?

back to firing doctors: My primary care physician suggested several times that when I get CBCs for my hemo I should have the results also sent over to them. I avoided doing that, until finally I said okay and asked them not to call my hemo about the results because hes really busy. They promised they wouldn't call him.

Next time I got labs my count was 17K- good count for me. So I get a frantic call from my PCP nurse saying my platelets are "dangerously low" and "your hemotologist doesn't seem at all concerned!"

Next time at Lab Corp I took them right off the order- with a note that only my hemo can receive the results.

Unfortunately in the UK you do not really have a choice when it comes to specialist departments. A lot depends on if your local Hospital has that service.

Whilst we can change local GP (I just have as my old ones were beyond awful) you are kind of stuck with who ever you get as a Hemo.

For example If I did not like my Hemo my only option would be to go to another hospital which is approx 50 miles away and that is if they have a Haematology department.

As I have CVID I have to travel 50 miles to the other hospital(massive pain)as my local hospital does not have a specialist immunology department. Luckily at the moment it is once every 6 months.

I have just had a heated chat with my immunologist trying to explain to her how difficult it is for me to get to her. She wants to start me on a treatment due to low levels of immunoglobulins but I have expressly told her that I will take anything until it is cleared with my Hemo as I want nothing to interfere with my current treatment. She was not happy but I stood my ground. I haven't gone though 6 weeks treatment just to have it all ruined with a "I think it will be okay"

She is not in good books as it is as when I asked her is there anything I can do lifestyle wise to help increase my immunoglobulins I got a flat out "No only drugs with help"

I went through three hematologists before I found my current doctor. I am glad that I decided to push each one until I found someone who is willing to dive into this disease and search out potential triggers, if not the cause. I also feel more comfortable with him in discussing my treatment options and the next steps. I encourage everyone who feels uncomfortable to look somewhere else. A second or third opinion never hurt!

GhostRider, what treatment does the immunologist want to give you? The treatment for CVID is IVIG (or subQ IG) which as you know is also a treatment for ITP so I wouldn't see a problem. Apart from that there's antibiotics which I take daily and I don't imagine that they will have any untoward effect. Actually, I'm far more concerned about my immune disorder than I am the ITP and it is the immune disorder that I would primarily treat.

Have you seen the list of ITP specialists, patients are encouraged to choose from the list.

itpsupport.org.uk/itpforum/centres.htm

I'm lucky as I have several hospitals near me on that list. I chose one that isn't actually the nearest to me but a 15 minute tube journey away.

That's what I was told treatment for CVID was - IVIg.

Ghost:

There really aren't any tried and true lifestyle changes to help with the CVID. If it were that easy, no one would be treating with IVIG. You can try different things on your own such as exercise, mediation, diet changes, no alcohol, etc....but no one can guarantee that those things will help. Anything that you do to help your overall health will make a difference in the long run though, so nothing you try would hurt.

Treating CVID could actually help your platelet counts. It shouldn't lower them.

My immunologist mention some kind of prophylaxis antibiotics. She also mentioned that I would need a ECG before I could take it. She then mentioned that they can give me something not very nice side effects like diarrhoea.

She did mention IVG which I have had before a few years ago when my platelets crashed but we are not there yet.

My worry is that my immunologist is based at one hospital and my Hemo at another, so I do not want to get in the situation where they are giving me medication that might clash with each other.

This is why I have told my immunologist that what ever she wants to give me she must clear it first with my Hemo.

I suppose it only natural when you have 2 doctors located at 2 different locations in 2 different departments that the risk of things being missed, things not being communicated increases so I am doing what I can to make sure that doesn't happen.

For example she wants me to have yearly flu injections and other inoculations, when I queried her about them possibly reducing my platelet count and are they worth the risk I got stone wall silence and then a "I don't know" Well that is not good enough for me lol. I am not going to take something which can have adverse effect if the risk is not worth it. It doesn't inspire confidence.

I am aware that with something like CVID you do require medication, I was just upset with the way she completely dismissed everything else.

I know there are other things such as food intolerances and vitamins levels which can effect your immune system, something which I would of thought would be important in your overall general health, especially if you have CVID.

My view is whilst it might not effect your Ig counts themselves, anything that would improve your overall health and lower the risks of infection and bolster your immune system would be a good thing.

The fact she would not even discuss the matter and just completely dismissed even the notion that there are things which I could do and look into to improve my overall heath and bolster my immune system is what annoyed me.

The ironic thing is that over the last six month my heath hasn't been this good (platelet to one side) for the last couple for years.

Bottom line, we are paying our doctors and not the other way around. They need to keep this foremost in their minds as should the rest of us.

Ghost - I have about six different doctors who treat me for different things and they are all in different places. When one of them suggests something, I go home and look it up before making a decision.

The problem with all of this is that I have seen people here with two different health issues. One doctor wants to treat a potentially serious illness, and the other doctor will not agree to it because it might conflict with his treatment ideas. The other illness is clearly more serious, but doesn't get the proper treatment because the patient gets confused and says no to the treatment plan. The thing is, you have to decide which is the more serious of the two and focus on that one a bit more. It's a bit of a juggling act sometimes. There are people here who have low counts but also have to use blood thinners. Now that's a tough one!

The discussion of the flu vaccine comes up a lot. Yes, it could cause counts to drop, but so could the flu. It comes down to a personal choice. Some doctors recommend it and some do not. There is no guarantee that counts won't drop, it happens sometimes. However, counts usually rebound, especially if a patient is undergoing treatment. People here who use N-Plate or Promacta sometimes have counts tank periodically for no apparent reason....it happens, but they can usually get it under control within a few weeks. I actually think it's a good thing when a doctor says "I don't know". It's better than having them take a guess and give you incorrect information that might backfire. As far as ITP goes, everything is mostly trial and error. You never know what will work and what will not. You also never know what will cause counts to drop. Some antibiotics can cause drops, but they can also cause counts to go up. Depends on the person.

If you want to improve your diet, you could do some research online or see a dietician. There are not that many medical specialists who are knowledgeable about foods and vitamins.

With my low IgG I was told not to have any immunizations - I did get the flu shot and will continue to get it because I have young germ carrying grandchildren
Thankfully I am not at the treatable stage yet!

The discussion of the flu vaccine comes up a lot. Yes, it could cause counts to drop, but so could the flu.
And the flu can also cause death and/or serious complications. Yep the discussion comes up a lot and we all have our opinions and never the twain shall meet. I've been getting a flu shot yearly since 1992 and have been ok - however I did get a tetanus booster and my count tanked, didn't come back up so had to treat. When you come right down to it - the majority do not know what triggered their ITP and we don't know what will trigger a relapse. You just do what you have to do.

I would make sure my hematologist and immunologist are talking to each other. And seriously, if you don't like this immunologist it would be worth a long ride to see another one that you did like and trust.

You have good points Ghost and you have to do what you feel is best/right for you - that's all that matters, period!

Great feedback as always

At the moment due to my health being pretty damn good my ITP is my primary concern. Also I trust me Hemo and to be honest it makes me feel happier if she has the final say whilst I am under her primary care.

I am seeing her in a couple of days so will have a good chat with her.

I think my immunologist doesn't think I take the CVID seriously enough, I do, rightly or wrongly, I treat it like I treat my ITP, whilst the numbers do matter to some extent, I prefer to concrete on my symptoms and as I have said, I feel good so ITP comes first.

Also being a man I find it difficult to juggle more then one ting at a time :silly:

I most likely will get flu shots and just hope all is okay.. like I said, I am a man and we all know that man flu is the worst type of flu