Breaking Up is Hard to Do: medical system edition

November 21, 2013 7:12 PM

I think I need to dump my primary care doctor under bad circumstances. He's abrasive, no longer coordinating my healthcare and has been suddenly unwilling to perform the services I pay for as part of a $3k+ yearly concierge program. After being a real boon to my healthcare as somebody with a rare disease for years, his treatment of me changed on a dime this fall. I blamed myself initially -- or thought he was just having a difficult day/week/month. It turns out he's being disciplined for severe incompetence (like, jaw dropping) and the practice will be monitored for many years. He has been so angry and abusive just to my husband picking up paper that I don't feel safe in the room alone with him. How can I tell new doctors why I'm leaving? How should I wrap things up? *blizzard*

I had the best internal medicine doctor in the world until this fall, when his behavior became aggressive, erratic and negligent. For the first couple interactions we had, I chalked it up to everybody having their bad days. Then it became clear he'd really changed - not returning pages, slacking on referrals, needing dozens of reminders for mundane prescriptions like a special kind of folate and then blowing up at me for calling too much, telling me to go to urgent care for a minor injury because he had no time to see me --when I pay in excess of $3k a year for a "concierge" doctor package, guaranteed same day access! He yelled at my husband.

This is a complete 180. This is the doctor whose care changed my whole quality of life and who supported me through a near fatal hospital stay. Who finally got me answers and recovery. Who kept me out of the ER and actually recovering because we finally got to the root of my problems. Before when I needed a referral, he'd pick up the phone and talk to the other doc, get me in quick. If things weren't going well or I didn't understand my treatment or needed insurance help, he'd run interference. Now he just shrugs. He won't even give me names for referrals! I pay over $200 a month for access to a private office number, cell phone, email, same day appointments, extended appointments, etc. My contact is not returned. Because he's supposed to be so connected, he doesn't have a backup person on call -- it is worse than having a plain old doctor! And i've been paying for it all this time.

The first thing he threw a fit about was pain meds, so I accepted the stigma -- though it was insane. I'm on really low dose chronic pain meds for failed back surgery and I needed the pain meds for shingles! Shingles! But he soon slacked and then blew up about ... prescription folate. He screamed at my husband about ... a bladder spasm drug. He's nuts now. He's never gone back to normal.

We speculated about what had happened and joked that he must have gotten in trouble for something. It turned out that was right. When I was searching for a new specialist, I was introduced to how to check doctors' disciplinary records. Turned out the first day my doc screamed was the day of his medical board punishment.

Being on chronic pain meds and having a complex medical history (and especially having had a recent clash in September with my doc over pain meds with the shingles), I feel like leaving my primary care doctor is going to look suspect. Though -- the pain doctor I visited told me that he thought I was undertreated for pain and my primary doctor should be doing more. Anyway, I have the chronic pain meds stigma. The sources say you shouldn't say anything negative about your doctor when switching. But... there's no other reason. Doctor Before He Got In Trouble used to have everything on lock -- it was an immense relief. He was really coordinating my care. I got better because of it. My chart reflected that. Now my chart is going to be full of tons of contacts and make me seem really needy (because he doesn't do anything until I've reminded him eleventy times -- and often not even then). I'm looking up how I can file a medical board complaint.

Doctors seem to close ranks, though, and don't like it when you criticize them. (As well as being skeptical of people in chronic pain.) What can I say to justify leaving my long term doctor? My health and life are at stake. And I'm really nervous -- I have just been treated really badly by a doctor who is like a family member. Can I tell them? It's public record. Should I? What if I file a complaint?

posted by anonymous to Health & Fitness (25 answers total)

Have you mentioned this to your doctor himself yet or any of his nurses? You could be direct: "Doctor, I feel that your attitude towards and treatment of me and my husband has declined dramatically over the past few months. This is a real problem for me, and I want you to know that I am considering getting a new doctor because I no longer feel safe coming to your office for visit. Has something happened that I should know about? I would like to be able to continue coming to you but your behavior and bedside manner is unacceptable and I need to feel safe in your care in order to continue being your patient." And then if he blows up at you after that, stay calm and let him know that you appreciate what he's done for you and that you hope he is able to return to the professionalism and care he once showed you and his other patients. Then file a report and find another doctor.
posted by These Birds of a Feather at 7:18 PM on November 21, 2013 [1 favorite]

Odds are good that the new doctor won't ask why you are switching doctors. They get new patients all the time and don't typically make you explain why you're a new patient. Have your medical records sent to the new office before the appointment and then just introduce yourself and give your medical history. They will ask about your medical needs, not about your previous doctor.
posted by third rail at 7:18 PM on November 21, 2013 [14 favorites]

Even if some future doctor was really curious/suspicious about why you switched doctors, wouldn't they have access to the same disciplinary information that you saw?
posted by acidic at 7:28 PM on November 21, 2013 [2 favorites]

Do not worry about switching. If you can find a physician that will take you on, switch. If that one doesn't work out, switch again. You don't owe this guy anything. In exchange for helping you, he got several thousand dollars. He's no longer helping you, the deal doesn't need to continue.
posted by DigDoug at 7:33 PM on November 21, 2013 [10 favorites]

The doctor was disciplined for misconduct. He himself provided you with the best reason for moving on, and none of it comes back to you or the stigma of chronic pain medication. If anyone asks, and I don't know that they will, inform them that he was disciplined for inappropriate medical behavior (if you feel it to be clearly inappropriate to the jawdropping level you mention above, I think you can mention that too) and you no longer felt comfortable accepting care from him.
posted by c'mon sea legs at 7:56 PM on November 21, 2013 [1 favorite]

You're overthinking this. Find a new doc. Switch. End of story. Your new doc won't care.
posted by BlahLaLa at 7:57 PM on November 21, 2013 [4 favorites]

Why would you be asked why you are switching??

I don't think this is an issue. Your old doctor can find out you've left his care when the new office phones him for your records, which by law, he must and will forward to your new doctor. You never have to speak to your old doctor ever again, no worries.

There is no "stigma" for pain meds if you have a legitimate issue, which you do.

You're really blowing this out of proportion. I know you really really liked this guy, but sometimes these relationships fall apart, and you must move on.

Drop the drama. It's not healthy.

Good luck & I hope your new doctor is AWESOME!!
posted by jbenben at 8:00 PM on November 21, 2013 [3 favorites]

Why are you still paying for services you're not receiving? I'd talk to a legal professional about the fees you've paid for care (I.e. same day service) that you've not been provided.

You should also report this behaviour to his governing body- there's a good chance that a refusal to provide referrals, as well as some of his other behaviour, is actionable.

As for why you're switching, they probably won't ask, but you can just say you weren't happy with him or that he's no longer giving you the care you need.
posted by windykites at 8:02 PM on November 21, 2013 [2 favorites]

I've switched doctors before, and I don't think I've ever been asked why by the new doc. (I've certainly never been expected to "justify" it.) Doctors get new patients all the time, for a variety of reasons; it's just part of practicing medicine. Make the switch, have your records transferred, and don't get yourself wound up over a scenario that almost certainly won't ever come to pass.
posted by scody at 8:03 PM on November 21, 2013 [1 favorite]

I just wanted to add one suggestion about your health records....(IANYD)

Under the circumstances, I would request the records from your current doctor and take receipt of them yourself. Under HIPPA laws you may request your records and the office can charge a "reasonable" fee for making copies. You may also receive them in any format you request (this allows for digital imaging on disks, etc.).

I say this because if the doctor is becoming as unstable as you say, it would be best if you had the opportunity to see what your new primary care physician will see. They are your records. You can choose what you want your new pcp to see - or not see. Sometimes, there is actually benefits to starting over with a new doc who will not just assume all the records from the prior doctor are true and accurate. Maybe, say, there has been a misdiagnosis. All kinds of examples.

Corporate medicine in the USA must go both ways. I say get your records (which belong to you) and then pass them on to your new doctor with as little explanation as possible. Or, come up with an elevator-version of your post here and tell it like it is.

Best of luck to you!
posted by Gerard Sorme at 8:11 PM on November 21, 2013 [8 favorites]

Doctors gossip. Your new doctor will most likely have heard about the investigation of your old doctor. The old doctor will most likely never mention it to you.

You don't need to mention it either, even if the new doctor does not know.

In a perfect world you would have known to request a photocopy of every report/office visit note as each lab/imaging/office visit happened. If you have those papers, then you have most of your medical record. But, that is not necessary, because your doctor is required by law to forward that information to your new doctor. There may be a "reasonable" copying fee allowable by law. If you are told that you need to pay $.50 or $1 per page, please do not be caught off guard by that. Look into the laws in your area.
posted by bilabial at 8:13 PM on November 21, 2013

Gerard Sorme has given you great advice. Simply call up the front desk staff and ask for a complete copy of your records. Under law they can charge you a reasonable per page fee however they cannot charge you an archiving fee or a retrieval fee. You don't even have to tell them why. Good Luck.
posted by PorcineWithMe at 8:17 PM on November 21, 2013

(By the way, the law we are all referencing is the Federal HIPAA act)
posted by PorcineWithMe at 8:19 PM on November 21, 2013 [1 favorite]

I would guess that in addition to being disciplined for incompetence, he had become dependent on drugs-- probably opiates-- that he was prescribing for himself, and that his changed behavior reflects the effects of the internal imbalance such addictions leave in their wake.

Don't worry about it; everyone will understand why you're leaving.
posted by jamjam at 9:01 PM on November 21, 2013 [3 favorites]

You can say whatever you like. Chances are, a new doctor will have heard about this jaw-dropping incompetence and know why you're really switching.

I am a medical transcriptionist and when patients change doctors, these are things I have heard dictated:

Too far from their house.
Did not like the waiting room.
Did not like the parking lot.
Did not like the intersection to get to the parking lot.
Did not like being kept waiting for 2 hours past appointment time.
Felt like a number instead of a person.
Felt like they were too busy/noisy/quiet/calm in the office.
Did not like the decor of the office.

Say whatever you feel comfortable with or nothing at all.

Maybe just make an appointment elsewhere as a new patient and sign the records release form. Then tell the old place, perhaps by phone message after hours ;), that you are ending your service there and wanted to let them know to expect a records request from your new provider. That's probably all you need to tell them.

And Gerard Sorme (sp? not visible from the edit window) is right about the records. Just pleasantly ask for a copy for your personal records, to keep them up to date, and then carry them with you to the new physician.
posted by AllieTessKipp at 9:22 PM on November 21, 2013 [4 favorites]

I switched to a new doctor who worked for the same practice as the one I'd seen previously. All I had to say to the receptionist was: "I didn't have a good experience with Dr. X" and no one batted an eyelash.
posted by brujita at 10:53 PM on November 21, 2013

Don't worry about this making you seem like a med seeker: you didn't invent his medical conduct (and you're not switching your pain doc) so it doesn't come off that way at all.

Don't be negative, especially since you don't have to. You can just repeat what your pain doc told you, if you want to go that far.
posted by RainyJay at 11:21 PM on November 21, 2013

You absolutely do not have to justify changing health care providers. You will be able to have your records transferred. You deserve excellent medical care.
posted by theora55 at 11:33 PM on November 21, 2013

Send a request to get a copy of all your medical records ASAP. Never see this doctor again.
posted by bananafish at 11:36 PM on November 21, 2013

I have had this issue, although not to nearly such a horrific degree. Mostly I've just done a workaround so that I see many specialists and rarely see my gp. But changing my GP is on my list of things to do, because to not do it wouldn't be taking good care of myself. If you think of it that way -- that you have to do it to take care of yourself (and so your husband won't be abused) -- maybe you'll get away from the fearing the breakup to a (completely justified) resentment of your GP, and it will be easier to find a new doctor.

I've had medical providers who were awesome, and a few who were real shits, and a few who were just maybe not that competent. You have the power here, so exercise it for the sake of your health.
posted by angrycat at 4:20 AM on November 22, 2013

Excellent advice here.

Do things in this order:

1. Find a new doctor.

2. Fill out the forms to have your records transferred prior to your initial appointment.

3. Call your doctor's office, speak to one of the staff members.

4. Request a hard copy of your records, expect that this will cost you nothing as part of the "concierge" services you were being provided.

5. Go to the office to pick up your records. It should be a quick in and out.

6. Once you have your records, call the administrator you were speaking to and tell him/her that you will no longer be enrolled in that program, and ask about a refund for the past X months, given that you have not been receiving the services you've been paying for.

7. If no refund is forthcoming, sue in small claims court. Or drop it. Whichever you prefer.

As for the "stigma of pain med seeking" don't worry about it. The next awesome doctor you pick will see your history and will be able to give you appropriate pain management.
posted by Ruthless Bunny at 5:49 AM on November 22, 2013

One thing to keep in mind is the many primary care providers do not prescribe narcotic pain medications to patients for extended periods of time. You referenced "the pain doctor I visited" in your question, is this someone you are currently seeing? If not, during your search for a new PCP, you should probably also go ahead and get established with a pain management clinic. Make sure you don't get into a situation where you are suddenly out of pain medicine and don't have anyone to prescribe it.

There is a lot of liability associated with maintaining a patient on chronic pain meds. Among providers I think it's not so much a stigmatizing thing as it is a cover-your-ass/avoid-liability thing. YMMV but my husband has chronic pain and this has been our experience. Good luck.
posted by little mouth at 5:51 AM on November 22, 2013

I think maybe part of your dilemma is that one reason to tell your new doctor about the old doctor is because it would give you a chance to say what you liked about the old doctor, before things took a turn.

It's okay to tell your new doctor what went well. "I'm a former patient of Dr. X. I received excellent care at some critical moments. He kept me alive, actually, when blah blah blah. Unfortunately, he's facing censure (ethics charges, etc.) and the last few times I've been in, I haven't received good care at all. I'm concerned about managing my disease and my pain on my own."

Now you've primed your next doctor to be your hero, and lead the discussion directly to your care. You haven't put New Doc on the spot, asking him or her to comment on Old Doc. Next sentence from New Doc is likely to be "tell me about your pain" or something like that.
posted by vitabellosi at 7:03 AM on November 22, 2013 [2 favorites]

I spotted another excellent doctor-changing reason in your question, if you would like another option: Because he's supposed to be so connected, he doesn't have a backup person on call -- it is worse than having a plain old doctor!

You could say "My doctor has been having some personal issues recently, and does not have a backup person on call. It's important to me to be able to reach someone promptly, at least a backup person." This also gives you an opening to discuss the backup arrangements of your potential new doctor. Personally, if I were in your shoes with chronic pain medication and other ongoing issues, it would be very important to me to have a doctor with a robust backup system. This should be a reasonable request, and any doctor who doesn't treat it as a reasonable request is not the right doctor for you.
posted by snorkmaiden at 9:59 AM on November 22, 2013 [1 favorite]

I have never been asked for a reason when switching to a different doctor, but if you are I would think it would be plenty to say: "I was paying a premium at the practice for access to same-day appointments, but then they were not available."

You do not need to give a reason to your old doctor. Just get a copy of the records - it's not as if the doctor himself will be dealing with this, and I would imagine the folks in his office are just as horrified by his behavior as you are if this guy used to be a great boss and then went crazy.
posted by rainbowbrite at 6:14 PM on November 22, 2013