Doctor Shopping

According to Wikipedia “Dr Shopping” is done by patients trying to get prescriptions for pain killers or the like, from multiple Dr’s.  Dr’s believe this is also the only reason.

But it’s also a term used patients when they are dissatisfied with the care their current PCP/GP is giving them and they want either a Single Second Opinion, or you want a complete change of Dr, and they try several before they settle on one.

I recently heard about a Seinfeld episode (I didn’t watch it myself) where someone had been labeled “a difficult patient” and then “fired” by their Dr and tried to steal their medical records to change the “difficult patient” label because it was being seen by every Dr they went to.

When you Dr Shop for a better standard of care, what it is assumed is that you are looking for drugs, because, well, what else could it be?  Heaven forbid you might actually just want to get your life back on track, and have a better Quality of Life.

And once something negative is put on your medical file, anyone that reads it, will believe it, because it was written by a Dr, or Nurse, and they know you better then you do.  After all, they have seen you for at least 10 minutes.

Many patients with chronic illness have this problem.  One I heard of recently had the term “malingerer” put on their file, even though during that particular ER visit, they were admitted to hospital seriously ill for several days in adrenal crisis.

The process to have that single word removed from their file was going to be long and arduous.  And it was not guaranteed it would be removed.

These days people are realising that we all have a right to a certain standard of care, and to get that you sometimes have to shop for the right Dr for you.

Have YOU ever gone Dr shopping?

We have.  Our Dr, who we liked, retired and we had to find someone who could look after Derek’s complex situation.  We wanted someone who was willing to acknowledge what they didn’t know, and be willing to learn what they needed to, to help Derek live the most “normal” life he could.

We needed someone who would order tests if we asked, who would acknowledge tests that were not within Derek’s “normal” range, and who would suggest options, referrals, medications, to help, not hinder him.

That was hard.  Our Dr had gone on a 3 month sabbatical so we used the Locum, but found her to be a very basic, “if it’s not a cold, I don’t want to know” type Dr.  We then learned, because Derek needed to see a Dr, that ours was not coming back but had decided to retire.  We were offered the opportunity to stick with the temporary Dr in his practice or go to another Dr in the practice.  Neither of these was an option as we knew both and had found them lacking in both People skills, and willingness to work with the patient.  They would rather talk AT you than WITH you.  There was no way I would entrust Derek to their care.

We had also learned not to trust Doctors completely so finding one I was willing to trust was going to be hard.

I started thinking about this recently because of a news article I read about a new Dr’s practice opening up in a town which was suffering an extreme shortage of Dr’s.  The problem was, the Head Dr in the town said patients should NOT Dr shop.  She insisted you should stick with the Dr you had good or bad, and learn to work with them.  But there was no mention of the Dr learning to work with the patient.

When you have a chronic illness it is more important than ever that you have a Dr you trust, but also a Dr that knows the correct way to treat you.

In the social media groups, you are not supposed to Criticize doctors.  The reason for that became obvious to someone one day when their specialist told them he no longer wanted to treat them because they had heard what this particular patient had said in a closed group, about how she felt his care was.  It was also originally not allowed to recommend or “rate” your Dr.  Because of issues around recommending Medical Practitioners and litigation in some countries, it is also good practice to avoid support groups advising one Dr over another.

Now however, there a several “Recommended” lists for people to find the right specialist.  This works to a point, but you have to be able to get in to them.  You also still need a General Practitioner or Primary Care Practitioner.

This is where Dr shopping IS a good idea.  And this is what Derek and I proceeded to do.

A couple of years previous the local Medical Centre had been taken over, and renovated.  We were hearing good things about the new owner.

Since we were looking for a new GP, and the Medical Centre was, within walking distance for when Derek was feeling well, it was decided that we would check out the Doctors there.  Only I didn’t want just any Doctor.  I wanted one I could click with.

I had already been Dr shopping when looking for a family Dr years ago, when I found the one that is now retiring.  I had been to a number of Drs after we moved town, but hadn’t yet met one I “clicked” with, until that particular Dr.

This time I was doing it deliberately.  So I went in with a list of questions, and informed her immediately that I was there to see if I felt she was the right Dr for us.  Her books were closed, she was the 2nd in charge in the practice of 10 Doctors and it would be hard to get on to her books.

Some of the questions were:
1.  Are you willing to allow me full access to all test results?
2.  Are you willing to have patient led care?
3.  Are you happy being interviewed by a patient?

Derek is lucky.  The Doctor was very happy we were interviewing her.  And once we explained Derek’s medical conditions, and history, she understood that we were being careful about who we chose.

Once you find your Dr

Whoever you decide on, once you start to work together it needs to be a partnership.  It can’t be one sided, from either side.

A friend of mine has written a document for working with your Dr which is well worth a read.

Talking to your Doctor

by Des Rolph

When going to appointments be prepared. Take your medical history with you. If it is extensive, type it up making dot points, not long paragraphs. It is easier for them to read. Keeping your notes concise and to the point is key, no rambling on.

  1. Tell them that you would like to work with them in treating your problem and that you need to fully understand reasons behind treatment and what the expected outcomes should be.
  2. Ask if they have any documentation/information around their proposed treatment and your condition, or can they point you to websites that explain the condition.
  3. Initially go in with a list of symptoms and general questions rather than with your own thoughts on diagnosis. You can always do a bit of steering if they aren’t connecting with you, but things get missed if you try to lead too early. If you are not sure about anything, ask questions.
  4. Have a list of questions! Do not throw them together at the last minute, but jot them down in the weeks leading up to the appointment. Take two copies, one for the doctor, one for you to make notes. I have found some doctors write on your notes and hand them back to you.
  5. It is helpful to take someone with you to the appointment, so that they can take notes so you don’t miss anything. For some reason, having someone with you who can validate your symptoms can have a positive impact. It might be useful to have an extra copy of your list of questions for them as well.
  6. Keep a symptom diary. Jot down BP on waking and going to bed at minimum. It is helpful to have a glucose metre, and take note of your blood sugars before meals. Jot down any symptoms you experience and record your cortisone dose if you have updosed for the day. If you have pain, indicate out of 10 what level it was.
  7. Medication list – also break it down by time of day and dosages for each
  8. If you have multiple doctors and/or multiple conditions, be sure to note who prescribes each medication and/or what condition it is for.
  9. Include in your medication list, any supplements, over the counter medications and as-needed tablets, solutions, powders or remedies.

You have many things to weigh up, and make decisions about. If you have multiple issues, often one treatment can inversely affect something else, and we have to decide which is the most at risk.

Remember that they are working for you, and that the ideal relationship between you and your doctor should be open, honest, and equal. They should respect that you need to understand their decisions and why they are making them. Without understanding treatment, we can become anxious and not feel confident.

 

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