My first term of naturopathic medical school is coming to an end, and I have spent a lot of the past twelve weeks thinking about what it means to be a good doctor, both for my own development as a physician and as a patient. I recently worked with a health coaching client who - in my personal and soon-to-be professional opinion - had a decidedly bad doctor and it made me think about how difficult it is for us as patients to feel we have a choice and a voice in our own providers and care.
Insurance, time, distance, and many other factors can make finding a great doctor more complicated, but I am writing this post to try to convince you that it is worth investing that effort, and to give you some ideas about how to qualitatively judge someone who has more professional knowledge than you do. (Doctors can be intimidating!)
If you are healthy "doctor shopping" can be hard enough, but if you are chronically ill it is even worse. You may have been under the care of many doctors who have not been able to help you. It may be because you are still working towards a diagnosis, or the treatments had difficult side effects, or the doctors have not taken the time to listen or explain things to you, or perhaps you have lost hope that anything can be done to make you feel better. The idea of explaining your story to yet another physician may feel exhausting, but it is worth it to find someone who fits well for you.
It is your RIGHT to have a doctor who listens, understands, cares, and helps as best they can.
If your doctor is not someone you can trust, or is not doing her job, it is entirely your prerogative to move on. If you hired a highly trained chef for your party and he served pop tarts and frozen pizza, you would fire him. The same principle applies to healthcare, but understandably it can feel more difficult.
*Please note this post is subjective and focused on primary care physicians. What makes a neurosurgeon great at what he or she does is very different from the qualities that are essential in your primary care doctor. Also, what I think is important may be different from what you find important, so please keep your own needs in mind as you read on for ideas about how to assess a physician and how to know when it is time to move on.
A NEGATIVE PRIMARY CARE EXPERIENCE
You felt anxious and stressed out as soon as you walked into the office. Staff were disorganized and could be rude, and you had to wait over an hour, as usual.
In the appointment room, the doctor was distracted and rushed. There was hardly enough time to go over your primary issue, much less discuss secondary concerns. You felt like all she did was interrupt you, write another prescription and send you out the door.
You do not feel comfortable with or trust your doctor, so you were hesitant to discuss issues you needed to, including digestion, sex, personal safety, and mental health.
When you mentioned a study you had heard about that said saturated fat does not cause heart disease, your doctor seemed irritated, like you "knew better." In fact, your doctor has not updated his advice in decades.
Lifestyle is never part of the conversation with your doctor. If you have a symptom, you get a diagnosis and a prescription. There is never any time dedicated to discussing how to implement a healthy diet, exercise, good quality sleep, or mental health.
Your doctor's goal is to make the symptom that brought you into the office go away, and so rarely takes the time to seek out a root cause for your issue.
The doctor did not bother to tell you anything more than a medical term for your diagnosis which you did not understand. You do not really know what the medicine is going to do other than "treat it."
If something serious comes up, your doctor is reluctant to refer to a specialist because "he knows best." He orders excessive expensive tests and tries to handle issues outside his scope of practice.
When do you have several specialists in addition to your primary care physician, your doctor does not help you manage this complicated healthcare. He is out of touch with the protocols other doctors have given you, and does not keep track of your records.
Your doctor speaks with you in a way that makes you feel childish, uncomfortable, and anxious. She may be condescending about your questions, or harsh when delivering difficult news.
When you need to speak to your doctor, you cannot reach her. If you leave a message you will not hear back, and if you do it will be days later.
When you leave the office, you are discouraged and possibly confused. You do not think you will feel better or get well.
A POSITIVE PRIMARY CARE EXPERIENCE
You felt taken care of as soon as you walked into the office. The staff was pleasant and professional, the space reasonably inviting, and you did not have to wait long.
In the appointment room, the doctor took the time to really listen to your concerns. Some doctors spend only 15 minutes with a patient, some over an hour, but no matter how long you were in the room together you felt there was plenty of time to address everything you needed to.
You felt comfortable bringing up all relevant issues with your doctor no matter how personal they were, including digestion, sex, personal safety and mental health.
When you mentioned a study you had heard about that said saturated fat does not cause heart disease, your doctor knew about it. In fact, your doctor always seems to be on top of current medical research.
Lifestyle is always a part of your conversation with your doctor. If you have a symptom that can be addressed by modifying your diet, exercise, good quality sleep, or mental health support, alternatives to medication are always discussed.
Your doctor's goal is always to understand what is the root cause of your health concern and treat it directly, rather than suppress symptoms.
The doctor explained everything in a way that you could easily understand. You leave your appointment knowing what is happening in your body/with your condition and how any medicine you are taking may affect you.
If something serious comes up, your doctor does not hesitate to refer to a specialist who is better qualified. That said, he never orders unnecessary tests or sends you to a specialist when a routine office visit will suffice.
When you do have several specialists in addition to your primary care physician, your doctor feels like home base. You know he stays in touch with your other doctors, knows what medications they have prescribed for you, and keeps your records in order.
Your doctor speaks with you in a way that makes you feel supported, safe, and taken care of. For some people this may mean a soft-spoken, empathetic physician; for others it may mean direct professionalism.
When you need to speak to your doctor, you can get in touch with her. She is available by email and always gets back to you quickly when it is important.
When you walk out of the office, you feel confidant that your health is in good hands and that you are on the right track.
If your primary care physician sounds like the doctor on the left, that's amazing! You have a great primary care doctor (tell your friends!). If, however, your primary care experiences have been more like the column on the right, you deserve better.
Sometimes even a good doctor is not the right doctor for you. If you like your doctor but feel she has run out of ideas to improve your health, especially if you are managing a chronic condition, it is time to move on. Have a conversation with your provider; she will likely agree it makes sense to try someone new, and may even be able to recommend someone.
Another important consideration is, of course, your doctor's medical training. A board certified physician has to maintain a current license, including continuing education hours every year. This is usually very important, but keep in mind there are some exceptions. Naturopathic physicians (NDs), while exceptionally well trained primary care doctors, cannot be licensed in all states, but they may still be a valuable resource for you. Osteopathic physicians (DOs) are licensed across America, as are allopathic physicians (MDs). Traditionally, DOs spend more time with their primary care patients than MDs and know some manual therapy, but that is not always the case. Many MDs now have integrative practices and recognize the importance of the patient-doctor relationship, including dedicating more time to appointments. In the end, it comes down to your personal interaction. It is your doctor, after all.
If you have decided to find someone new, you will want to request a copy of your medical records from your physician to bring to the new office (or they can often fax them over). This is your right, and it should be free or less than $20 to do so. If you are taking any prescription medications, be sure to get refills before switching doctors, as it can take some time to get into your first appointment.
There are lots of wonderful doctors out there. One of them should be yours! You deserve it.