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Things change...
Things change over time. That's pretty much a
given concept. Attitudes change over time, some more quickly than others. When I
was growing up, doctors were... well, revered is probably a pretty good word.
Everyone respected doctors. It was pretty much unheard of for anyone to question
them. When the doctor told you to "take your medicine," you did it, without ever
even thinking about why. We would never have dreamed that a doctor might have
been mistaken about anything, ever.
It's not cliché to say that things were simpler
then; it's just a fact. There were far fewer medications, fewer specialists.
What we're finding now is that it's also true that many illnesses and diseases
went undiagnosed and untreated. Migraine disease and many headache disorders are
among those.
With advancements in medical science and
technology has come a proliferation of tests, medications, and specialties. Our
family doctors have more and more to learn, yet medical school and internships
only last so long. The same is true of specialists, and we're now seeing the
development of more subspecialties, which makes a great deal of sense.
Patients have changed...
What else has changed? The patient has changed
in many cases. We're bombarded with health stories in the media -- television,
radio, magazines, newspapers, the Internet. When it's not news stores, it's
advertisements. Much of this is positive; we're shown how we can make changes in
how we live that will have a positive impact on our health. We're learning that
the answers aren't always our doctors' responsibility. Patients today have more
information available to us than ever before, at least in part because of the
Internet. We're able to learn about illnesses and diseases, medications, and
much more.
As we strive to manage our health, it behooves
us to match ourselves with doctors whose personalities and the way they work
with their patients fit our needs.
Patients are consumers, customers...
So, who has the patient become? The patient has
become a consumer, a customer of health care services. The Merriam-Webster
Collegiate Dictionary defines a consumer as, "one that utilizes economic goods,"
and a customer as, "one that purchases a commodity or service." The
Merriam-Webster Medical Dictionary defines a patient as, "a client for medical
service." This makes a great deal of sense, especially given the rising
cost and percentage of income associated with health care.
This new role of the patient and some of the
issues with doctors that people bring to me lead me to ask a question. When you
go shopping, would you continue to shop in a store where you're dissatisfied
with the product or the attitude of the sales associates? I think not. Why?
Because we don't spend our hard earned dollars on unsatisfactory products or bad
customer service. Thus, when we consider that a patient is a consumer, a
customer of health care services, I would propose that if we aren't receiving
the medical care we feel we need, it's time to purchase those health care
services elsewhere.
Patients as employers...
In a way, as consumers of health care, we are also employers. We employ our
doctors and other health care professionals to help us manage our health in the
best ways possible. If you're an employer, you'll be following this thought
easily. If not, let's take the example of hiring a housekeeper. We may look in
the phone book and hire a housekeeper in that fashion. We're entrusting a
housekeeper with the precious possessions in our homes, so we probably check
references. The housekeeper is accountable to us, not the other way around. If
he or she isn't doing the job we expect them to do, we fire them. Why should it
be any different with health care providers? It's not our precious possessions
we're placing their hands, but our lives, literally. It's not just our
prerogative, but our responsibility to hire the doctor we feel most qualified to
handle our care and fire him or her if our expectations aren't met. Obviously,
that's not to say that we have any right to be demanding, unreasonable or
disrespectful. The point is this:
"Optimal health care can be achieved only
when patients are educated about their health and patients and physicians
work together as treatment partners in an atmosphere of mutual respect."1
Why we don't change doctors...
Some of us are reluctant to change doctors. We feel that it indicates failure,
either on our part of the doctor's. We don't like confrontation, don't want to
hurt the doctor's feelings, or just don't feel up to any conflict when we're
already not feeling well. When a doctor/patient relationship doesn't work, it's
not necessarily a sign of anyone's failure. Regardless of it being a
professional relationship, personalities are involved. Purely and simply, no
matter how wonderful a doctor is, he or she is not the right doctor for every
patient. Don't think of doctors as higher beings. They're not; they're only
human. Certainly, if a doctor just doesn't have the experience and training to
handle a particular case, they're not the right doctor for that patient. But
there are other circumstances under which excellent doctors may not be the right
doctor for us. Here are some examples:
- When the doctor's practice is very large,
and there isn't much time to spend with individual patients to answer
questions, etc.
- When the doctor is in a clinic setting,
and we don't always get to see the same doctor.
- When the doctors personality is "all
business," and the patient needs the comfort of a better "bedside manner."
- When the doctor has "run out of ideas." It
happens. In any problem-solving situation, a "fresh set of eyes" can
sometimes bring a new perspective that changes the dynamics.
"Hiring" and "firing" doctors...
I've honestly known people who put more effort into hiring an excellent hair
stylist than choosing their doctor. (Imagine me shaking my head here. That's the
least of my reactions.) That, however, seems to be changing. More and more,
we're asking questions about doctors before we make that first appointment.
We're also asking our doctors more questions than before. Many doctors
appreciate the educated patient. Studies have shown that educated patients are
more compliant with their treatment regimens.2 Dr. William Young of
the Jefferson Headache Center told me, "An educated patient is a better patient.
I'd rather have a treatment partner than a dishrag." We need to do a bit of
homework before making an appointment with a new doctor. Talk to friends, nurses
you may know, your pharmacist. You can also call the doctor's office and ask
about their office hours. If you have a certain day off work every week, it's
good to find out in advance if the doctor has office hours that day. Once at
that first appointment, there are questions we can ask to help us know if the
doctor and the rules and routines of his or her practice match up with our
needs. Here are some questions to ask a new doctor:
- If it's a group practice or clinic: "Will
you be the doctor I see at every appointment?"
- "I know I need to take responsibility for
taking care of myself. Will you work with me as a treatment partner, with
the two of us as a team?
- How do you feel about patients who ask
questions?
- What do you have your patients do if they
need help after hours or on weekends?
- When you're on vacation, does someone
cover your practice?
If you have to "fire" a doctor, don't let it
become personal. You don't have to say anything at all to the doctor. You can
just go to a new doctor and ask them to get your medical records transferred. If
you do want to say something to the doctor, it can be something as simple as,
"This just isn't working out well. Thank you for your time." If you leave a
doctor, and you want a copy of your records, you should know that a federal law
requires that a copy be provided to you within 30 days of your written request.
Most offices have a release form they will want you to fill out and sign. They
may charge you a "reasonable" fee for the copies. If you are told that they
cannot be released to you, ask whomever tells you that to please refer to HIPAA
(The Health Information Portability and Accountability Act).
Summary...
Ultimately, we are each responsible for our own health. We can't just go to
the doctor and expect him or her to make it all better. It simply doesn't work
that way. In a good doctor/patient relationship, the doctor doesn't make
decisions for us, the doctor makes decisions with
us. For this to work, that relationship has to be a sound one of mutual respect.
We don't pay out our hard earned dollars for substandard products or services,
and health care services should not be an exception. Even with insurance
coverage, we do indeed pay for the services because, in one way or another,
we've paid for that insurance. Find a doctor whom you can respect and who will
respect you. We deserve nothing less.
_____________
Sources:
1 Robert, Teri. "Living Well With
Migraine Disease and Headaches: What Your Doctor Doesn't Tell You... That You
Need To Know." page 95. New York. HarperCollins. 2005.
2 Rothrock, John Farr, Parada,
Victoria A., Sims, Cheryl, Key, Kristin, Walters, Naomi S. & Zweifler, Richard
M. (2006) "The Impact of Intensive Patient Education on Clinical Outcome in a
Clinic-Based Migraine Population." Headache: The Journal of Head and Face
Pain 46 (5), 726-731. doi: 10.1111/j.1526-4610.2006.00428.x
Merriam-Webster
Collegiate Dictionary, Online Edition.
Merriam-Webster Medical Dictionary, Online Edition.
Published May 16, 2006
© Teri Robert
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