WHEN TO FIRE YOUR DOCTOR . . . AND HOW TO FIND ANOTHER
A 60-year-old attorney, a patient of mine for the past 15 years, sat across the desk from me and told me he was leaving my care. “It’s not you,” he said. “It’s just that I can’t be kept waiting. My time is just as valuable as yours.”
I had good reason to be late that day, but further discussion was useless. This man had apparently been kept waiting one time too many. He had made up his mind.
And he was right. Patients shouldn’t tolerate what they see as high-handed or inconsiderate behavior on the part of a physician—long waits, rushed consultations, perfunctory examinations, brusque or evasive answers to questions. Nor should they tolerate a condescending or authoritarian attitude, or a doctor who blames them when treatment fails. Patients needn’t endure office staff who are rude or inattentive or who consider it their job to shield the doctor from the patient.
Don’t fire your physician in a moment of anger over an isolated incident, especially if the relationship has been a long and trusting one. Try discussing your grievances. Your doctor may not even know a problem exists. If the problem still can’t be resolved, it’s time to leave. Certain misdeeds, of course, shouldn’t be forgiven even if they occur only once. Don’t return to a doctor who misdiagnoses a significant problem or who fails to follow up an important abnormal laboratory result, for example.
Finding a doctor
There’s no sure way to find a new personal physician who will meet all your needs. But a few steps can help you avoid a poorly qualified physician—and just might lead you to the right person.
First you’ll need some names. Many people simply ask a satisfied friend or relative. A better approach, in my view, is to ask a health-care professional—a physician, nurse, therapist, technician, or social worker—who has seen many doctors in action. Almost anyone who works in a hospital can tell you which doctors are regarded highly by their patients and colleagues.
If you don’t know an insider, call the local hospital and ask the medical staff secretary for the names of several family practitioners or internists on the roster who have agreed to take referrals for new patients. The county medical society can also provide names. Never rely on a paid advertisement in the newspaper or Yellow Pages.
Once you have a short list of candidates, investigate their qualifications. (If you have managed-care health insurance, see if your candidates are all “participating providers.”) Look into these areas:
• Education. Residency training is more important than the medical school attended. Residency programs at big, typically urban university medical centers tend to provide a wider variety of cases and more hands-on experience than do those at smaller hospitals. If a physician holds a faculty position at a medical school, so much the better.
• Board certification. Medical specialty boards certify doctors who have completed an approved residency program and passed a test. A “board-eligible” doctor has finished his or her residency but has either failed or not yet taken the certifying exam. Your choice should be board-certified in internal medicine or family practice. An internist may also be certified in a subspecialty, such as cardiology or gastroenterology, which may be important if you have a particular health problem.
• Hospital affiliation. University and community hospitals, which themselves are evaluated by the Joint Commission on Accreditation of Healthcare Organizations, routinely check the qualifications and performance of theừ staff physicians. Your new doctor should be affiliated with a JCAHO-accredited hospital.
• Professional affiliations, specialty societies, such as the American Academy of Family Physicians or, for internists, the American College of Physicians, exist mainly to offer continuing education to their members. Fellowship suggests the doctor has some interest in keeping up with the latest research.
Hiring a doctor
How do you check for all those qualifications? There are several sources, none of them foolproof. It’s probably best to consult one or more directories that you can find in a public library. Note, however, that none of those sources verifies all information provided by physicians, and some entries may be out of date.
Ultimately, you’ll need to meet the finalists. Many physicians will see you for a brief introduction without charge. You’re not looking for a best buddy, but you do want to avoid a personality clash. Once you’ve found someone you’re happy with, schedule a checkup. That lets you check up on the doctor more closely, too. Does the doctor conduct a careful interview and a thorough physical exam? Explain all tests and procedures? Answer your questions fully and clearly?
Be sure to have your records sent to your new physician. Your former physician must honor your written request to forward your records. You needn’t feel embarrassed about this. In fact, you might even let your former doctor know why you decided to leave.
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