[Stitcher]

Do you consider yourself a "consumer" with rights when you visit a physician's office? If not, you should.

Know when it's time to fire your doctor

• Story Highlights
• Leaving your physician can be a difficult decision
• It's OK to consider leaving if your doctor doesn't like questions, doesn't listen
• Before bolting, try to express your dissatisfaction, using "we," not "you"

By Elizabeth Cohen
CNN
http://www.cnn.com/2007/HEALTH/08/16...ref=rss_health

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.

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.'"

Elizabeth Cohen is a correspondent with CNN Medical News.

[Todd]

This certainly touched a nerve with me. I recently had to do this - fire my doctor - actually, doctors! The doctors in my health plan coverage have all been great - except for neurology. The entire department is brutal. They are simply mean and arrogant towards patients. Even the nurses are not nice. It's a very negative environment, and when you count on these people to be part of your care team, that's simply not good.

So, not only did I leave, but I filed an official complaint with my health care provider. In addition to the complaint, I also requested to see a MDS out-of-network since my provider doesn't have one within reasonable time and distance. Of course, my complaint was rejected ("our physicians are more than qualified to take care of your needs" - gag!) and the request to see the MDS was also denied. So I appealed, and that was denied as well.

Next step? I filed an official complaint with my state's Department of Managed Health Care department, who are now investigating. I also requested, through my state, an Independent Medical Review. And I'll soon be firing off yet another letter to the head of neurology and his boss as well. They may simply toss it in the trash, which wouldn't surprise me at all, but I'll feel better knowing I've had my say. It's sad that a patient has to fight so hard to get proper treatment.

Here's the kicker. While this is all in progress, my prescriptions are running out. So I found out who the pharmaceutical reps were in my area, then talked to them about which doctors they found easiest to work with. I found a neurologist within my healthcare plan that is about a 1/2 hour farther than where I usually go and went to see her. I was scared because if she was anything like the other department I've filed complaints against, I would be screwed.

Luckily, that wasn't the case. She did everything a good doctor is supposed to do. She listened to my concerns, allowed me to ask questions, offered her advice and feedback, and was willing to work with me as part of my team. What a relief!

The bottom line is, this is our health we're talking about, so it's worth fighting for. It will be stressful and may take a while to get resolved, but just keep telling yourself that you're worth it, because you are. You deserve the best healthcare that's available to you, so roll up your sleeves and fight for it!

[K.Ibsen]

I figure that, ultimately, when all is said and done, only one person is responsible for my health. That person is me. As long as I can still think, the decisions are mine and mine alone.

[mamafigure]

I may not have fired my neurologist, but he is out on disciplinary action. lol

Everytime I visit him alone he ignores me. If my husband comes, he fawns over me, telling me how he will get to the bottom of things.

but even that isn't enough any more.

After ordering blood tests, but telling me that it was time that we all realized that this has been going on too long for a medical dx, and that a psych dx seems to be the only solution...and after he rescinded his dx of parkinsonsim....my blood tests (from him and my gp ordered simultaneously) came back frightening.

AFter trying to contact his office and waiting days for a return call with no avail, I stopped in to discuss the results (which I already had obtained from my gp and who had instructed me to contact the neuro). I was told that he was too busy to see me (I just wanted anybody to talk with me). The nurse was very rude, said that they didn't have the tests. so I let her have a copy of my results. She said that she would leave them on his desk, but that he was much too busy to see me.

I left and went to see my gp. We are working on the problem ourselves.

I will say that he did have the nurse call and have some labs for me to do as a follow-up. I returned the call, saying thanks, but that I had already done the labs for the gp.

So, he is out for now, but since he is about the only game in town, I don't know how long it will last. There is one other neuro in town that isn't part of his office.

So, thanks for giving me the gumption to at least sort of do what I should have done nearly 7 years ago.

By the way, some of the follow-up labs have come back. Still bad liver function tests, but the cerulo whatever (the other copper test) is within limits (the serum copper came back elevated,, nearly double).

Kathy

[K.Ibsen]

Yes, I did. It was about four months ago. I had reasons, but I felt bad about it for months. I still sometimes question the decision.

Why did I decided it was time for a new doctor?

The biggest problem was communication. It just didn't seem like he was listening to me. He also seemed forgetful. He would often ask me questions that should have been in the records right in front of him. One time, he started to complain about how hard it is to be a doctor these days and our roles reversed as I consoled him about how complex our world has become. I think he had too many patients.

I also think that doctors don't know how to say to a patient that there may be a doctor out there who may be a better fit for the patient--it seems only patients can do that. Even though human relationships change often, we seem to elevate the doctor-patient and/or patient-doctor relationship above the status a of all other human relationships.

My thinking at the time was simply that this wasn't working as well as it could or should. It was nothing personal. Some people we get along with just fine and others we don't.

So I scheduled an appointment with my former doctor and sent him a note about putting a sort of closure on our relationship. I thought it would be a good idea to make an opportunity to part on a positive note. Well, he canceled the appointment and refused to see me. I haven't seen him since.

Choosing a new doctor isn't exactly easy. I read online biographies of just about all of the doctors in town--it's a small town. I checked their affiliations. I talked to people. I even found that many doctors offices have "meet the doctor" appointments that are usually free, so I interviewed three doctors after I read about them on their web sites.

It has taken months to build a new relationship with my new doctor. The first thing he wanted to do was talk to my previous doctor and just continue doing what he had been doing. This was in spite of the fact that during my meet-the-doctor interview, I told the new doctor that I wanted a fresh (i.e. unbiased) opinion. Lately, though, the new doctor seems to be living up to his promise to make up his own mind.

In the end, I believe I did the right thing. I still regret hurting the feelings of my previous doctor. It didn't have to be that way, but in my opinion, it was his choice.

Karl