“William Osler, often called the father of modern medicine, famously advised his students: “Just listen to your patient; he is telling you the diagnosis.” A century later, clinicians and health system leaders started tuning out the patient’s voice, turning instead to electronic health records and the latest care protocols to manage their most complicated and high-need patients. We believe it’s time for an urgent and strategic reset. The factors that lead people to become our nation’s costliest are complex. But they call for, at the start, the simplest intervention: listening.” (A)
“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 said. “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 “says 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 said. “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.” “ (B)
“I always liked my primary care doctor personally. He routinely welcomed me to his office with a cheery hello and a smile. We asked about each other’s children. We often discussed our respective exercise regimens, running in his case and pickup basketball in mine. For more than 20 years, we even confided about our ambitions as writers.
But I often questioned his judgment in medical matters.
Take, for example, the time my neck bothered me. I complained to him about frequent soreness and stiffness – probably a result of spending hours planted in front of a computer. He suggested I obtain a neck brace to wear while working. “Is that necessary?” I asked him. No, he said.
At no point did he ask me where my neck hurt, or how much, or how often. He never physically examined my neck, nor instructed me to turn my head in order to observe my range of motion. He neglected to propose I do specific exercises to rehabilitate my neck or get a new chair or just take frequent breaks from sitting at a keyboard.
Rather, he advised me to see an orthopedist or physiatrist. He also printed out some medical journal articles about neck problems for me to read, all well over my head. (C)
“Moving on from your physician could open you up to certain challenges, so it’s important that the situation is dealt with carefully. No one wants to be without care, or to spend a lot of time looking around for a physician. In some cases you may be able to switch between physicians in the same practice, but some groups frown on that. If there’s not a lot of choice in physicians in your local area, it’s important not to burn any bridges. The best-case scenario is for both you and your physician to agree that you’ve gone as far as you can together, and that it’s time for a change.
Before you decide to fire your doc, you should try to first repair the relationship. You’ll need to put your finger on the cause of the problem: is it the doctor or is it you (and let’s be honest!)? If the problem is something that you feel the two of you can work on, you’ll want to take steps to smooth things over and try to establish a better working relationship. If it’s impossible to work out your differences, you’ll want to consider if it’s time to fire your doctor and switch to a new one… (D)
“The last time I saw my gynecologist, she glossed over the issue I’d come in for and gave me a test I didn’t want — without even discussing it with me first. In my previous visit, she ordered me a mammogram and brushed off my attempts to discuss the exam’s harms and benefits. It’s clear we have a communication problem, and frankly I’m ready to fire her — but how? Am I obligated to tell her I’m switching doctors? (I’d feel badly if she found out by reading it in this column.) And what obligations does she have to me?….
Once you have decided to leave, be sure to request a copy of your medical records. You can have them sent either to you or directly to your new doctor. Ask that they include lab results and such things as MRIs, X-rays, EKGs and recent hospital records, Blackwelder says. If your doctor has sent you to a specialist, it’s a good idea to ask for copies of the consultation notes from these visits too, he says. Legally, the records belong to your doctor, but as a patient you have a right to a copy, says Rachel Seeger of the Office for Civil Rights at the Department of Health and Human Services. “ (E)
“Regardless of how many years you have been with the same doctor, there may come a time when you need to find a new one. Perhaps you are not comfortable with your current physician, or maybe the doctor that you have loved for years has died or retired. In some cases, your life may depend on firing and replacing your doctor…
Many people are somewhat intimidated by their doctors. You might consciously or subconsciously feel that the
“There are many things your doctor could do or not do, or say or not say, that may make you want to find a new doctor. These things may be different for each person and situation. Here are a few things you can look out for. You do not feel that your doctor is listening to you.You do not feel that your doctor believes you.Your doctor cuts you off when you are speaking. You feel rushed when you are with your doctor. You feel that your doctor acts superior to you. Your doctor insults you, instead of treating you.
While there are many reasons for wanting a new doctor, you do not need a specific reason for changing doctors. You may not be able to pinpoint why you want to switch to a new physician, but if you feel like you want to make a change, the reason does not matter.”” (F)
“… Patients ask me frequently, “Can my doctor dismiss me?” The answer is — yes it is legal and fair for a doctor to fire a patient under any circumstances. But there are also circumstances under which a doctor may not dismiss a patient….
The American Medical Association has established guidelines regarding when a doctor may fire a patient, based on its Code of Ethics. In addition, many states have laws about the circumstances under which a doctor may terminate a patient relationship.
The reasons a doctor may dismiss his or her patient are:Patient non-compliance (non-adherence). A patient’s rude or obnoxious behavior. Non-payment of bills. A relatively new reason for dismissal seems to be based on the type of insurance a patient has…
When a Doctor Cannot Legally Dismiss a Patient…Doctors may not discriminate based on race, color, religion, national origin, sexual orientation, gender identity or any other attribute that is nationally recognized as discrimination. The courts have ruled that a patient cannot be dismissed because he or she is HIV-positive…
Doctors may not dismiss a patient in the midst of ongoing medical care, called “continuity of care.” For example, a pregnant woman cannot be dismissed by her doctor within a few weeks of delivery. A cancer patient cannot be fired before his chemo or radiation treatments are completed. However, a patient who has been on a primary care doctor’s roster, but hasn’t visited that doctor in a year or two might be dismissed. That is not considered ongoing care. (G)
“Being old and sick in America frequently means a doctor won’t ask you about troublesome concerns you deal with day to day difficulty walking, dizziness, a leaky bladder, sleep disturbances memory lapses, and more.
It means that if you’re hospitalized, you have a good chance of being treated by a physician you’ve never met and undergoing questionable tests and treatments that might end up compromising your health. It means that if you subsequently seek rehabilitation at a skilled nursing facility, you’ll encounter another medical team that doesn’t know you or understand your at-home circumstances. Typically, a doctor won’t see you very often…
A complex set of forces is responsible. Some examples: Medical training doesn’t make geriatric expertise a priority. Care at bottom-line-oriented hospitals is driven by the availability of sophisticated technology. Drug companies and medical device manufacturers want to see their products adopted widely and offer incentives to ensure this happens. Medicare, the government’s influential health program for seniors, pays more for procedures than for the intensive counseling that older adults and caregivers need.” (H)
(A) Listening Is a Lost Art in Medicine. Here’s How to Rediscover It, Prabhjot Singh, MDNiyum Gandhi, https://hbr.org/2017/11/listening-is-a-lost-art-in-medicine-heres-how-to-rediscover-it
(B) Know when it’s time to fire your doctor, by Elizabeth Cohen, http://www.cnn.com/2016/10/07/health/fire-your-doctor/index.html
(C) Why I Almost Fired My Doctor, by BOB BRODY, https://www.nytimes.com/2017/10/12/well/live/why-i-almost-fired-my-doctor.html
(D) How to Fire Your Doctor, by Amber J. Tresca, https://www.verywell.com/how-to-fire-your-doctor-1942906
(E) How to fire your doctor. Rule One: Make sure you have another one lined up first, by Christie Aschwanden, https://www.washingtonpost.com/national/health-science/how-to-fire-your-doctor-rule-one-make-sure-you-have-another-one-lined-up-first/2014/01/13/44778c2e-76fb-11e3-af7f-13bf0e9965f6_story.html?utm_term=.3cb5b7baada3
(F) When, Why and How to Fire Your Doctor, by Michal Vilímovský, https://medlicker.com/1199-how-to-fire-your-doctor
(G) Can My Doctor Fire or Dismiss Me as a Patient? By Trisha Torrey, https://www.verywell.com/can-my-doctor-fire-or-dismiss-me-as-a-patient-2615017
(H) How older patients can dodge pitfalls entrenched in health care system, by Judith Graham, How older patients can dodge pitfalls entrenched in health care system, by Judith Graham, http://www.chicagotribune.com/lifestyles/health/ct-older-patients-pitfalls-health-care-20171128-story.html