How can I find a competent doctor in MD/DC area?

January 12, 2009 10:38 AM

I need a new doctor (internist or a general practitioner) who knows what he's doing. I've spent over $500 in doctor visits, meds and testings and I am still sick after 4 weeks. Can you make any doctor recommendations in DC suburbs? (Maryland).

For about a month now, I have had a swelling/lump right below my right chin. It's hard and hurts like it's bruised. Along with this, I've been having a fever of 102 on and off, worse at nights.

I went to see a doctor, who I found on a list somewhere cause I didn't have a GP that I go to and he was the only one available the week before Christmas. He said it's some sort of infection and prescribed two meds because the first prescription gave me an allergic reaction, and the second prescription ($150) stopped working after 4 doses out of 10 and my lump has been hurting and is still swollen.

I need to see a different doctor who is able to accommodate those that have to pay out of their own pocket without insurance, and is knowledgeable about their field. I live in Bethesda/Rockville area. I found some postings of doctor recommendations, but they are all not available for at least a week and a half and some are located far from where I am.

In addition, is there anything I can do with the previous doctor? He did offer my second visit for free, but I am really disappointed and annoyed that I am still sick after having spent all the money that he made me run around to take tests for.

posted by anonymous to health & fitness (10 comments total)

I'm concerned that you say the second medication stopped working out after "4 doses out of 10", because you are talking about an infection, and if this is an antibiotic you are taking, you do know you need to take ALL 10 doses for it to be effective right?

In answer to what to do about the current M.D.: If he offered your second visit for free, I say why not take him up on that before writing him off? He's already done the tests, and maybe you can use the second visit to collect all the details, get copies of your medical records, and save yourself having to go through all that again with a new doctor.
posted by misha at 10:48 AM on January 12

Sorry, should've been more clear. I just finished all 10 doses as of yesterday. What I noticed, is that after day 4, the lump stopped decreasing and started hurting.
posted by icollectpurses at 11:05 AM on January 12

I agree with misha.

I can recommend a good doctor. The problems - he is in downtown DC (though the office is close to the Foggy Bottom Metro), and he is *not* cheap. However, if you wind up thinking your current MD is not doing the trick, and can't come up with a better option, then he might be worth consulting. He is Dr. David H. Jacobs 202-296-3339, and his specialties are internal medicine, and allergy/immunology.
posted by gudrun at 11:36 AM on January 12 [1 favorite]

My first thought (not a doctor) about your neck lump, is that it is a swollen lymph node, and hence more of a symptom of something else (infection is common) and not the actual problem itself. For example, you could be having some variety of a viral infection, for which antibiotics won't help.

I would also go for that free appointment offered. The allergic reaction isn't anybody's fault, and drugs can be expensive without insurance. See if the doctor will work with you to make sure that any treatment plans are affordable for you, and ask about generics when you get prescriptions, and don't be afraid to ask the pharmacists about any suggestions they may have (I was prescribed prilosec, and was told from the pharmacy to buy it OTC because it was cheaper than via prescription).

Ask the doctor about the tests. What did he check for, and what were the results? Did you clearly communicate your symptoms to the doctor? Are you having any other symptoms apart from your fever and neck lump? Sniffliness, fatigue, appetite, etc? Telling your doctor these things can mean more than tests and test results, as there is no one disease oracle test.
posted by that girl at 11:41 AM on January 12

Just because the first doctor didn't cure you, doesn't mean he's incompetent. A prescription once induced Stevens-Johnson in me, but I would hardly blame the doctor.

I would take the doc up on the second visit. If it's unbearable, why not go to the emergency room? Before you do, find out exactly what tests the first doc did on you and get a copy of the results, if possible.
posted by anniecat at 12:09 PM on January 12

Also, why not go to a dermatologist, assuming that's not the kind of doc you went to before...
posted by anniecat at 12:10 PM on January 12

OP, I'm sorry to hear you're going through this. I know it's bad enough to deal with your symptoms and uncertainty as to what's going on, but to have to deal with it in the absence of insurance is quite daunting. I wish I could refer you to someone but I'm on the other side of the country and can't help you with that. But a few observations and recommendations I hope you take to heart:

Persistent fevers are interestingly one of the more challenging diagnostic dilemmas in medicine (unfortunately) because they can be caused by a wide variety of diseases, both infectious and not so. It's important to understand this because your frustration with a single visit to a doctor is easy to sense. The truth is, perhaps your expectations of someone giving you a miraculous diagnosis on a quick eyeballing need to be adjusted to make sure that those expectations don't make matters worse. In my experience symptoms such as yours often (though not always) require multiple visits and tests to get a handle on, along with even some trial and error. When you're paying out-of-pocket, I know that's the last thing you want to hear but you can imagine how getting too many different opinions from multiple doctors or putting doctors in the position of having to start from scratch and not have the benefit of longitudinal assessments over time may not serve your best interests. In this regard I think it's crucial that you at least take the first doctor up on their offer for a follow-up visit. A second opinion may be helpful but I'd at least get the follow-up appointment in first.

Also. This is not the purview of a dermatologist. Please see someone trained in internal medicine. You may need the help of someone also trained in a sub-specialty of IM (like Infectious Diseases), but it may be counterproductive at this early stage to see a specialist directly.
posted by drpynchon at 12:52 PM on January 12 [1 favorite]

For free/low-cost health care, you could try the Arlington Free Clinic, the Witman-Walker Clinic or your local Planned Parenthood. You could also see if your local Med School has a free clinic. All of these organizations exist to help patients regardless of their ability to pay, and the physicians see a lot of infectious diseases. The waiting rooms probably aren't glamorous, and since these clinics are geared towards sexually transmitted infections, the physicians may ask about your sex life and be more likely to consider an STD as the cause of the lump. Just be honest with them, and give them as much information as possible. Also, since they usually work with uninsured patients, they may be able to hook you up with free drugs or prescribe lower cost antibiotics as a first choice to try to minimize your out of pocket costs. (If not, you can always remind them that you are paying for drugs out of pocket.)

Also, I second taking up your physician on his offer of a free follow up.
posted by abirae at 12:55 PM on January 12 [1 favorite]

Mary Callsen in Chevy Chase/Friendship Heights. 301.656.4545
posted by zadiecharbon at 1:47 PM on January 13

How's your lump doing these days? Any updates would be appreciated.
posted by abirae at 7:41 AM on January 19