Join 3,512 readers in helping fund MetaFilter (Hide)


I don't want it, I just need it.
April 28, 2014 8:19 AM   Subscribe

Please help me mitigate/cope with my feelings about doctors/insurance and have the best visit with a general practitioner that I can after 10 years of being uninsured. This way lies snowflakes.

As mentioned above, I aged off of my parents' health insurance about a decade ago. After that point, I paid cash to keep seeing doctors for a while, but being unemployed for months at a time made even this impossible. My adult doctor's visits have been marked by difficulty communicating, feeling disrespected by doctors (being kept waiting 30 minutes or more, interrupted while explaining things, concerns and questions about medications shrugged off) and feeling stuck in a cycle of ass-covering testing that never revealed the source of chronic issues I've always seemed to have. ("Have you had your thyroid checked?" "Yes, they didn't find anything." "Well, we'll check it again." Test taken, no abnormalities found, lather rinse repeat.) This includes an incident where I feel I was probed too aggressively during an exam and ignored when I said "that really hurts." So I'd become less than enthusiastic about seeing doctors even while I had the means to see them. A major turning point also came when I went to an in-store clinic fearing that I had an ear infection and burned an entire paycheck just for the doctor to look in my ears and nose and say "no, it's just a bad cold". Over $350 for 10-15 minutes, for nothing.

In addition to my own issues, I've watched my parents and grandparents struggle greatly with their own medical care and paying for it, though they have never been without insurance themselves. There have been years where not a week has gone by that my mother wasn't on the phone with multiple organizations asking for leniency with some bill. My father had a GP that he respected, but that person abruptly left the practice where my father saw him with no forwarding information and it has been next to impossible for my father to develop the same rapport with another GP. Some doctors have attempted to get my father to change bad habits that he has by trying to intimidate him or get in his face and raise their voices, which is a guaranteed non-starter. There have been medication mistakes that could have been very serious had my mother not noticed and raised a stink to the doctor about getting the prescription reexamined. A doctor brought a dog into an examination with for my mother without regard for if my mother was comfortable with this, had allergies, or anything like that. My parents frequently go without or attempt to stretch needed medications further by taking less than the required dose due to financial issues (which then cause arguments with me because they won't take my money, when I have it, to get more medicine). My grandparents are now in a nursing home in part because my grandfather's doctors failed to see damage being done to his heart which eventually landed him in the hospital. My grandmother has a chronic condition that none of the nursing home staff seem to be able to control and allegedly cannot find anyone to assist them with. They are more mentally intact than many persons they live with, and complain bitterly about how they are not allowed to even play cards with residents living in other parts of the home who might be similarly conversant. It's hard to see them declining and not be able to do anything about it.

I'm sure you have heard most of these things before in some way: my point is that I have come to feel that most doctors don't care about doing right by their patients - certainly all of the doctors that my family have been able to afford. I'm not confident that doctors really know what the right thing to do is when it comes to things like weight loss, so for them to reject my questions and concerns and insist that something like the BMI explains all that needs to be known about what's going on in my body is insulting. Doctors also don't care or know about the end costs of testing and visits. I've had more than one give me a blank look when I asked how much a procedure or test might cost, as though it shouldn't matter what I spend in the name of my health- when it absolutely does.

Now, thanks to the ACA and what is likely an extension of my state's Medicaid, I have my own health insurance. (Thanks Obama.) My health isn't great, but it isn't awful either. I have been preparing for a future GP visit by gathering data, like researching doctors covered by my insurance, keeping a journal of what I eat from day to day, and making a list of specific issues I want to make sure are discussed, but to be sure, I envision my next doctor's visit to be me arriving on time, being shown (late) to an exam room, waiting 20 minutes more for someone to see me and almost walking out before someone arrives, having an argument with the GP, and finally walking out without any "work" being done, feeling minimized and disrespected. Alternately, I will find out that I've developed something terrible since my last examination, touching off my very own years of confusion, fear, frustration, crushing medical debt (despite the insurance), being hounded by collections agencies and/or worse. It's enough to make me not want to bother seeing the doctor. But I don't know for sure what will happen, do I?

So, what do I do to make the most of an examination in light of everything that my family and I have experienced?

Thank you for your time.
posted by koucha to Health & Fitness (39 answers total) 4 users marked this as a favorite
 
Ask around among your friends to see who has a doctor that they really like. I'm very enthusiastic about my doctor, he has Aspergers, but he's really personable and awesome if you can get over the awkward stuff.

Go for smaller practices, there are only two docs in ours. Also, chat up the office staff for a few minutes when making your appointment. The staff is a reflection of the docs, I've found. Our awesome doc has an awesome staff. Friendly, helpful and very willing to go the extra mile, especially with billing stuff.

As for testing, your doctor will do it. Just because your thyroid was okay last year, it doesn't mean we shouldn't look at it today.

Adjust your expectations. Why would you get into a fight with your GP? On one hand, you say you have issues, and on another you don't want to do testing. That's how doctors work, they test and rule things out until they figure out what your health problem is. Some are easier to figure out than others.

You very well be shown late into the exam room, doctors may try to work in a patient who is seriously ill and it disrupts their schedules. You'll be happy they do it, when you're seriously ill, or suddenly break out in hives from an alergic reaction.

As for waiting in the exam room, they do their best to insure that you don't do that, but sometimes the previous patient asks a lot of questions, or needs further testing, or something happens and the doctor will get delayed. It's not disrespect for you, it's respect for patients in the practice.

Doctors are humans who heal, it's as much an art as a science. Some are great at diagnosing stuff, but have shitty bed-side manners. Others are very nice and personable, but not very good about thinking outside the box. My doctor loves his meds, as he is also a pharmacist, so he enjoys long conversations and musings about drugs, side-effects and interactions.

There are some hacks. Try to get the first appointment of the day. That way, they're not already off schedule by the time you come in. Arrive a bit early, especially on your first visit, so that you can do the paperwork and they can get the insurance stuff done ahead of time. Schedule a full physical for your first visit. They allocate extra time for blood draws, getting an accurate history etc. Expect to give your history to the nurse and to the doctor. That's normal.

Don't go in with a chip on your shoulder, good attitudes and friendliness are contageous. if you're dour, and snappish, your doctor may pick up on it. If you smile and are friendly, and completely open, your doctor will respond in kind.
posted by Ruthless Bunny at 8:33 AM on April 28 [12 favorites]


So, what do I do to make the most of an examination in light of everything that my family and I have experienced?

A bit of perspective alteration might be appropriate here: It sounds like you and your family have had bad luck with doctors in the US. I can't do anything to change that. However, your experiences are not representative of the whole. The human body is really, really, really complicated. Sometimes things happen to it, and nobody knows why. A doctor that does not know what to do with your case do is not necessarily failing as a doctor - it might just be that they really don't know what to do. The solution to this that I've found is to ask a doctor what they'd do in your scenario. For some reason, they always seem a bit surprised when asked this, but it definitely humanizes the experience. You might find that they think there's a better doctor you could be going to, that there are alternative treatments they wouldn't otherwise mention, or that you really are one of those pernicious cases that we haven't yet figured out what to do with.
posted by saeculorum at 8:36 AM on April 28 [2 favorites]


I just memailed you a doctor recommendation since I see that we're both in MPLS.
posted by Frowner at 8:39 AM on April 28


On preview, all of the above advise from Ruthless Bunny is very good. I came in specifically to mention this part:

You very well be shown late into the exam room, doctors may try to work in a patient who is seriously ill and it disrupts their schedules. You'll be happy they do it, when you're seriously ill, or suddenly break out in hives from an allergic reaction.

I had doctors who I didn't really like to see in the past because I felt that they rushed through appointments with me or kept me waiting far too long. Then, I had the unfortunate experience of actually being seriously ill. Suddenly my doctors were spending a lot of time with me, and every single one whom I had had trouble getting appointments with in the past was saying, "I want you to come in today, just come whenever you can and tell the receptionist I said I need to see you."

I'm now healthy again and waiting for appointments and sometimes feeling rushed, but I'm much more zen about it. My doctor might be keeping me waiting because she's playing Angry Birds (who's to say), but I know from experience that sometimes it's because she's busy taking care of someone who is far sicker than I am. I wish there were enough resources for everyone regardless of health status to get lots and lots of individual attention, but that is just a wish and simply not reality.

The truth is that if you've managed to go this long without seeing a doctor, it's because you are most likely pretty darn healthy, in the grand scheme of things. A side effect of that is not being doted upon (and believe me, it's a good tradeoff).
posted by telegraph at 8:39 AM on April 28 [11 favorites]


Most doctors in the US really don't know how much procedures cost. That's not because they don't care, or because they think it shouldn't matter how much you spend. It's because procedure costs and what insurance covers for a given procedure can vary wildly amongst practitioners, facilities, and insurers. Before my friend had major surgery on her spine, her doctor's assistant had to spend several days talking to the hospital, anesthesiologist, and insurance company to find out all the costs. It wasn't easy, and unfortunately the US healthcare system is like that. It is frustrating, but it is not happening because the doctor doesn't care.

If you get frustrated waiting, I definitely agree with the suggestions above to get an appointment early in the day. Those delays are caused by spending time with patients, and if you are the first or second patient to be seen, you will be far less likely to experience a delay. Schedule a full physical and ask them if you need to fast for it (sometimes they will want you to come in on an empty stomach for blood sugar testing). During your exam, tell the doctor the list of concerns and issues you'd like to discuss. The doctor should ask you questions about symptoms and may refer you to specialists, which is a good thing. Most GPs have general knowledge, but refer people to specialists for specific health concerns. You want a specialist because you want the most knowledgeable person on that health topic.

Try to approach this with an open mind and try to envision a more positive experience. Not all doctors are shitty. In fact, many are good. It can just take some time to find the right one.
posted by bedhead at 8:52 AM on April 28 [1 favorite]


Most doctors I've had have been hurried in meetings (and late to them). It's the nature of insurance and not anything personal.

However, one or two offices were exceptional at making patients feel comfortable, with docs were particularly good at listening and projecting calm.

You might search review sites for practices where they make an extra effort to listen. In my anecdata of one or two, these were practices that focused on women or also had some Chinese medicine practioners in the same office as the western medicine docs.

But yes, waiting in the exam room for the doc is a symptom of the system, and not usually the doctor themself being disrespectful. Bring a book, try to breathe deep, and the time may go faster.
posted by zippy at 8:57 AM on April 28


If you have a chronic condition that needs to be managed, you should really go under the care of a specialist who handles that class of conditions. Your primary care doctor is very good for diagnosing those chronic conditions and handling acute conditions as-needed, but if you are the sort of person who needs to be visiting a doctor regularly to help manage an issue, you should find a specialist who deals with that.

I would also try to acclimate yourself to the reality of "brutal efficiency" during your doctors' visits. An old doctor of mine would come into the office with his laptop, type in my description of symptoms, do a brief physical exam based on my description, then make a conclusion and type up a prescription which I would pick up on my way out. All done in 15-20 minutes. Not very nurturing, but it got the job done.

As far as tests, the thing is that doctors have no incentive NOT to do tests. For one, the status of your thyroid could have changed. For two, your description of symptoms allowed the doctor to do a thyroid test, which he could bill for, increasing the value of your visit.

As far as a doctor trying to get a patient to change their habits, if you want to have better health, look at it from the doctor's perspective: there are known habits that lifestyle changes that patients need to adopt to become healthier. These are well known and uncontroversial. A patient who doesn't do them is, from the doctor's perspective, being lazy/ignorant/obstinate about not changing and yet keeps visiting the doctor's office with ongoing health problems that aren't improving. This is a "you can lead a horse to water, but you can't make him drink" situation. Accept the fact that doctors are not trained to be horse whisperers-- they are trained to connect symptoms to illnesses and implement treatment.
posted by deanc at 9:01 AM on April 28 [4 favorites]


My grandparents are now in a nursing home in part because my grandfather's doctors failed to see damage being done to his heart which eventually landed him in the hospital. My grandmother has a chronic condition that none of the nursing home staff seem to be able to control and allegedly cannot find anyone to assist them with. They are more mentally intact than many persons they live with, and complain bitterly about how they are not allowed to even play cards with residents living in other parts of the home who might be similarly conversant. It's hard to see them declining and not be able to do anything about it.

Getting old stinks, everyone I know who is elderly hates it. If there was a doctor out there who had a magical cure for it, they'd be a billionaire. Until then, we trudge along the best we can. Ultimately, medicine fails us all- we all get sick, we all get older, and we all die. I think that's something we all have to keep in mind while we seek medical care for our ailments. Like Ruthless Bunny said, in some ways it's as much an art as a science.

In terms of finances, how much do you understand about your new health plan? Do you know what your benefits are in terms of in-network/out-of-network coverage, and how much your deductible and out-of-pocket maximums are? You mentioned Medicaid, so I'm not sure if you're on a Medicaid or commercial exchange plan. Either way, you might be comforted to research those details so you're totally clear on what your total responsibility could be in a worst-case situation. You might feel better about the little bills rolling in here and there if you know, hey, my out-of-pocket max for the year is $7k and after that, I'm 100% covered (or if you're on Medicaid, there might not be any out-of-pocket cost to you).
posted by ThePinkSuperhero at 9:01 AM on April 28


You may want to look at finding a Doctor of Osteopathy as your GP (assuming it is permitted by your insurance). Like any branch of medicine, there are good docs and bad docs. Some D.O.'s are more focused on the "skeletal manipulation" thing as a cure, and that is not necessarily effective. But, not all are into that type of treatment and I've found that doctors trained in osteopathy are more willing to sit down for a long time with you, hear your concerns, and treat the patient, not just the symptoms. I've also had success with an MD that had training in eastern medicine (e.g., acupuncture).
posted by melissasaurus at 9:11 AM on April 28


If you want a warm, friendly practitioner who will listen at length to every symptom, and encourage behavioral change gently and persuasively, and give you a clear menu of treatments and prices, I really think you'll have better luck with an alternative or holistic practitioner.

That's what I do for quality-of-life issues (I'll put up with a little woo), but for anything potentially life-or-death I use western medicine (and put up with a lot of pain, cost, and disrespect).
posted by Bentobox Humperdinck at 9:19 AM on April 28


I wanted to nth that you should only go to your doctor when there's actually something wrong with you. If you're going in to see what they can suggest in general, or with vague "make me feel even better" demands, you won't get any helpful advice because really, beyond "eat healthily and get plenty of exercise", there isn't much to say (thyroid function, kidney and anaemia screens are the standard "tired all the time" blood tests, so if that's what you're complaining of, that's what they'll do).

You went to see a doctor to see if you had an ear infection, and you didn't. There isn't much they can do for a cold. We don't generally give antibiotics for uncomplicated ear infections either these days because it doesn't shorten the duration of symptoms. That isn't the doctor's fault. I'm sorry that cost $350, but that's the US medical system (I agree it's crap, GPs in the UK get less than half that per patient per year in exchange for unlimited access, by way of comparison).

This may sound like snark coming from a medical doctor, but it isn't: If you are in your thirties and otherwise healthy, homeopathy/osteopathy may suit you better if what you are basically looking for is somebody to listen to you and take time explaining things in nice surroundings (I do not recommend them for actual medical problems because it's all placebo effect, but hopefully you can tell the difference between a self-limiting viral illness and a heart attack yourself). As an example, a lot of patients with chronic pain, or with medically-unexplained symptoms, get a lot of relief from homeopathy with no side effects or risks of over-investigation. I have no problem with people using the placebo effect for conditions for which there is no effective medical treatment available, or alongside traditional medical treatments.

On preview - what everyone else said, apparently.
posted by tinkletown at 9:37 AM on April 28 [2 favorites]


I envision my next doctor's visit to be me arriving on time, being shown (late) to an exam room, waiting 20 minutes more for someone to see me and almost walking out before someone arrives,

Appointments with GPs involve waiting. This is not usually because they are trying to get in a few more holes after their leisurely lunch of bonbons. They get backed up because someone arrives with a cough but turns out to have lung cancer. That patient needs more than 20 minutes, and your doctor will therefore be late for your appointment.
posted by DarlingBri at 10:39 AM on April 28 [9 favorites]


Some of what you are experiencing qualifies as anxiety, I think, presenting as offense or pessimism.

While Yelp and similar - if you're good at reading between the lines - can help you find less anxiety-producing environments, there is a certain amount of this process that simply works the way it works and wanting it to work differently is always going to result in disappointment.

Your arrival at a doctor's office is the beginning of a workflow, it is not an exclusive engagement with a physician, and can take several hours for even a simple engagement. That's just how it is. I don't know what in-store clinic is charging $350 for an exam, that's certainly a very unfortunate experience compared to parts of the country I have lived in, but wanting them to diagnose you with something you didn't have just to provide you with customer satisfaction is not a productive perspective or safe methodology. At some point you have to give them credit for their education, which at least in terms of medicine is more comprehensive than yours.

Some studies (and anecdata) suggest that you may experience better doctor-patient communication if you arrive with notes and take notes during the interaction, and going forward keep bringing and taking those notes so you're building a more comprehensive narrative. Sticking with a single doctor - even if they aren't your most favorite personality - will pay off in more comprehensive care. When they ask if someone else has done a thyroid panel and then do their own, it's because they need to see the results. Either bring yours or accept that they can't just work off a verbal report that it was "fine". Thyroid is a lot more relative than used to be believed. You want your physician to use data, that's a good thing.

You may also want to let them know up front that you experience anxiety in medical environments. But you will also have a better experience if you have practical expectations and patience and don't go in already angry and ready to be offended.
posted by Lyn Never at 10:43 AM on April 28 [3 favorites]


"I don't want it, I just need it."

Except from what I can tell from what you have written, you don't, actually, need it. You don't have a chronic condition that needs managing, you don't have a complaint--why would you see a doctor? Drop the idea of going because you're "supposed to,"---what do you WANT?

If you do not, in fact, feel well, then perhaps if you elaborate on your symptoms we can tell you what sort of care you should seek.
posted by Violet Hour at 10:43 AM on April 28 [3 favorites]


You might like working with a doctor who has an Ideal Medical Practice.
posted by evoque at 10:47 AM on April 28


Many of your complaints are actually about the insurance and the structure of our healthcare system, but you're attributing the problem to doctors. In other cases, you're assuming the worst, but you don't know the full story. I'm a doctor myself (so - disclaimer, of course), so I often get to hear people's complaints about other doctors. To hear their side of the story it often sounds like the doctor they're referring to has done something truly puzzling or even heinous. But then I often get the opportunity to speak to the doctor in question or read through the chart, and find out that the problem is that the patient misunderstood or misinterpreted the situation, and there was no error or no malignant intention on the physician's part. So what I'm saying is - it's possible that every doctor your family members have run into is a jerk who doesn't care about their patients, but it's also possible that the things you describe are misunderstandings that you are hearing through the grapevine and interpreting through your own lens of dislike towards the medical profession. Or honest mistakes, doctors are human and they do not always get things right - this can happen even to people who care deeply about their patients, ask me how I know…

You're right, I don't know about the cost of the tests that I order. They're different for every insurance plan. Also, I don't want to order tests based on how much they cost, I want to order them based on whether they are the right thing to do for my patient.

Remember to communicate clearly - doctors have to do physical exam things that hurt patients sometimes, like press on the abdomen of people having abdominal pain. It is part of what we need to do to help us find out what's wrong. If you want someone to stop or be more gentle, tell them to stop or be more gentle.

Final thing, this is a pet peeve of mine - you did not pay for nothing when you went to the urgent care. You paid for what you got, a history, physical exam, assessment and plan by a professional who trained for many years to be able to provide that service. Why is it that if an ear infection was found, you would feel like you got more for your money? Someone who would prescribe you antibiotics for a viral upper respiratory infection/cold is doing you a disservice and is practicing poor medicine. I see patients almost every day who are having the worst abdominal pain, the worst headache, the worst chest pain of their lives. After I perform a full workup and am able to discharge them, either with a temporary diagnosis that requires further outpatient evaluation or with a final diagnosis that is benign, I have many times heard the complaint that "I came here for nothing!" That is extremely frustrating to hear to a person who did 4 years of post-medical-school training in emergency medicine so that I could gain the skills to rule out life threatening conditions in the vast majority of patients and send them home safely. If my assessment is worth nothing to you, feel free to diagnose yourself at home using WebMD. I am sorry that you've had bad experiences with medical professionals, but it would be unfortunate if that caused you to come to the conclusion that doctors' skills have no value.

Re the comment above, I agree that you don't have to go to a doctor if you don't want to, but as I suspect the asker is aware, a number of health problems have no overt symptoms until late in the game (like high blood pressure and cholesterol), and certain health maintenance/preventative services are likely needed. At the least, if it's been 10 years, you're overdue on a tetanus vaccine.
posted by treehorn+bunny at 10:48 AM on April 28 [30 favorites]


I also meant to add that I can see from your comments about "developing something terrible" that you are scared. Good for you for facing your anxieties and getting checked out. Too many people stick their heads in the sand and just decide to avoid doctors for the rest of their lives (and die of preventable medical problems) because they can't handle the idea of getting a diagnosis. That always makes me very sad. Hope you find someone great and get a clean bill of health!
posted by treehorn+bunny at 10:53 AM on April 28 [2 favorites]


Everyone above has done a good job explaining the reasons that it's normal to wait in a doctor's office. I can't add anything of value there, but I also think you need to work on being your own advocate at an exam.

I have had good doctors and I have had bad doctors. I had one doctor who rushed at my face to inject it with a needle, without asking. The asshat doctor didn't know that I have a phobia of needles. I pushed her away, told her she didn't not have my consent and started to cry and walked out of the office, refusing any payment, while explaining that I have a fear of needles and would not be seeing her again. But even with the good doctors, you should stand up for yourself and your own medical care. I know it's hard because doctors are such "experts" in our culture, but you can do this.

So I recently went in for a scan. My doctor said I only needed one kind of scan, but the clinic doing the scan said they insisted on two types of scans. I was upset because the second scan hurts (and my primary doctor said I didn't need it). The medical aide checking me in, insisted I get the second, painful scan. I asked why. She said, "that's how we always do it." At this point, I could have sit down, sulked, feeling vulnerable and violated. Instead, I just said: "Okay, can I please talk to a doctor?" They put me in the waiting room and I spent the time Googling the scan differences on my smartphone. I was ready to call my primary doctor. The doctor eventually came and we met in her office. She said I was right, I could just start with the first scan and we'd look at it and THEN decide about the second scan. I felt proud that I advocated for myself and listened to, and had some information to back up my concerns. My point is, you have some ability to shape the conversation with your doctor.

When you go in for your appointment, say:

* I've had a couple of bad experiences with doctors in the past. I felt rushed and like I wasn't listened to. I would imagine you're not like that but I wanted to say that upfront so you know that I'm nervous, and that I really appreciate not feeling rushed, so thanks in advance.

* My thyroid has been tested many times before, and it's always come back normal. Is it normal to have it tested again, or are you seeing some external sign that signals I might need another test?

* I am really concerned about unnecessary costs for care, it brings me great stress and anxiety, can you talk me through my options with this specific visit?

Or, really, anything else you're concerned about. You should just talk to the doctor. If the doctor is an asshat, walk away. There are lots of good doctors out there but you can't be afraid to talk to them, tell them what you need, and leave if they're not treating you right.
posted by amoeba at 11:05 AM on April 28 [6 favorites]


I hate having to wait for a doctor to the point where I feel like bursting into tears over it. I know it's irrational, but I feel like they think their time is more important than my time and it makes me angry. I mitigate these feelings by calling 15-30 minutes before my appointment to ask if they are running late.

Secondly, I hate feeling brushed aside by doctors. I mitigated this by searching for the oldest doctor I could find in my vicinity. I figured an old doctor, who started practicing before managed care, would be more likely to spend more time on patients. I was correct in my case and found an older doctor who only schedules patients in 45 minute time slots.

Lastly, you might want to look into a boutique practice where you pay a yearly fee and you are guaranteed an on-time appointment and the ability to schedule an appointment at your convenience.
posted by parakeetdog at 11:11 AM on April 28


Although it of course depends on the specific individual, you may have better luck with a nurse practitioner than with an MD.
posted by Mr.Know-it-some at 11:42 AM on April 28 [3 favorites]


As far as tests, the thing is that doctors have no incentive NOT to do tests. For one, the status of your thyroid could have changed.

This. Just because you've tested normal in the past doesn't mean you'll test normal this time. My thyroid always tested normal... until it didn't. Now the numbers are off the charts and I'm having all kinds of problems with it. Don't think that the doctors are ignoring you or brushing you off because you tell them that you've tested normal in the past. The past has no bearing on your present symptoms.

I mean, if you didn't have a cold yesterday, does that mean you won't have a cold today? That just doesn't make sense.

And I also agree with this: Final thing, this is a pet peeve of mine - you did not pay for nothing when you went to the urgent care. You paid for what you got, a history, physical exam, assessment and plan by a professional who trained for many years to be able to provide that service. Why is it that if an ear infection was found, you would feel like you got more for your money? Someone who would prescribe you antibiotics for a viral upper respiratory infection/cold is doing you a disservice and is practicing poor medicine.

Just because doctors don't find anything wrong with you does not mean that they aren't doing their jobs. Trust me, I know the frustration of hearing, "Well, everything is normal, we're gonna send you home." How can everything be normal when I feel so awful? But you cannot blame the staff for your test results. If the tests are normal, they're normal. Doctors cannot treat you for something they cannot find.

In the end though, the people who posted before me are right. Doctors are human and they have their own ups and downs. It's when people expect miracles from them that they get disappointed. I love my current GP. She listens to me and we're working together to figure out what's wrong with me. We tend to disagree on some things, but we are working together on it. Ask around, get references. Check online reference sources. Do your homework. Good doctors are out there, and they really are not that scarce.
posted by patheral at 11:53 AM on April 28 [2 favorites]


Since no one has touched on this yet:

I'm not confident that doctors really know what the right thing to do is when it comes to things like weight loss, so for them to reject my questions and concerns and insist that something like the BMI explains all that needs to be known about what's going on in my body is insulting.

Some of the worst advice I've received about weight loss has come from general practitioners who I felt were otherwise capable. If this is an ongoing concern you have, and you feel that way about your new GP, it may be worth asking for a referral to an endocrinologist and/or a nutritionist.
posted by gnomeloaf at 12:09 PM on April 28 [1 favorite]


I'm not sure how helpful this will be - but I have a lot of doctors. A lot.

Some doctors suck. In a million different ways. It's unbelievable and unbearable.

But not all of them. And just like any relationship, keep looking until you find one that fits.

You are your own best advocate. Ask friends who they like and read online reviews if available. Just like finding a hairstylist or SO, it can be a numbers game. It's taken me a year to put my team together, down from four years - so I'm getting better at it.

If a friend can go with you, all the better. I keep a running list of everything I want to talk to the doctor about. Sometimes a doctor will be dismissive about something, but I note that in my list for future reference.

A couple of times I haven't liked someone but had to tough it out for some reason or another, and they found HUGE problems others had missed. You have to let them get to know you too. It can take more than one appointment.

It's a relationship.

(Also, I had a doctor who had three-hour wait times. 30 minutes is nothing. If you needed a little extra time, you'd be glad your doctor stayed a little longer to explain something. Extend other patients the same courtesy.)
posted by crankyrogalsky at 12:24 PM on April 28 [1 favorite]


Except from what I can tell from what you have written, you don't, actually, need it. You don't have a chronic condition that needs managing, you don't have a complaint--why would you see a doctor? Drop the idea of going because you're "supposed to,"---what do you WANT?

If you do not, in fact, feel well, then perhaps if you elaborate on your symptoms we can tell you what sort of care you should seek.


I do have issues that I am concerned about, and naturally I don't know what is causing them, because it seems to me the only way to even get close to knowing what's actually going on is to see a trained professional - which, as I mentioned, I have been unable to do for the better part of ten years. Googling one's symptoms is only so helpful. What do they always tell people in AskMes who say, "this, this and this are happening, the internet says X; what do you think?" Go to a doctor.

I chose not to go into the details of my current health because I thought it would obfuscate the actual question, which is how to make the most of my next visit in light of the things I have experienced personally and through my family and the beliefs about doctors and health care that I have developed as a result. No, I haven't collapsed and been hauled off in an ambulance ever, but that doesn't mean that nothing's wrong, is there?

The repeated testing is like square one to me. Year after year, the doctor always redoes square one, and nothing new is learned from that test, but we still do it, year after year, and my symptoms don't improve, and I tell the doctor so, but every year- square one. The test takes relatively little of the doctor's time, but I live in this body every day, 24 hours a day, and the responsibility to pay for the test that did nothing to help me understand or learn anything my symptoms is also my responsibility. "We are doing this test because I am the doctor and I said so" doesn't help me to understand or do anything about what is happening to me. Or am I misunderstanding something?

Final thing, this is a pet peeve of mine - you did not pay for nothing when you went to the urgent care. You paid for what you got, a history, physical exam, assessment and plan by a professional who trained for many years to be able to provide that service. Why is it that if an ear infection was found, you would feel like you got more for your money?

I'm not sure where you got this from. The doctor did not take a history or do much more than look in my ears and nose and listen to my chest. It's true that I was able to come away from the experience at least knowing that I did not have an infection, but it was a significant expenditure for me at that time, as I stated, and left me with nothing to show for it other than knowing it was just a cold. Spending more than $350 on a cold is not normal or good stewardship of limited financial resources. I don't know anyone who can do it. The point of going to the doctor at all was to be able to get access via prescription to needed medication if I did have the infection I thought I had. That incident was a mistake that I can't make again on what I earn. I don't blame the doctor.
posted by koucha at 1:06 PM on April 28


...see a trained professional - which, as I mentioned, I have been unable to do for the better part of ten years...

...Year after year, the doctor always redoes square one, and nothing new is learned from that test, but we still do it, year after year, and my symptoms don't improve, and I tell the doctor so, but every year- square one...


I'm having trouble following. Have you been seeing a doctor for tests every year, or has it been ten years since the last time you saw a doctor and had a test done?
posted by Bentobox Humperdinck at 1:20 PM on April 28 [1 favorite]


I'm having trouble following. Have you been seeing a doctor for tests every year, or has it been ten years since the last time you saw a doctor and had a test done?

The latter. Prior to that point, when I was still on my parents' insurance, it was as I described. I regret the confusion.
posted by koucha at 1:26 PM on April 28


Lower your expectations. Doctor's offices don't much worry about wasting your time. Take a book, or computer game or friend.
posted by SemiSalt at 1:45 PM on April 28


So when did you ever call up and say "yo, this is bullshit, you need to figure out whats going on" or more politely "When this test comes back, when should I schedule a follow up with these results?"

You need to be an advocate for yourself. You should do some of your own research too. I'm not saying come to the doctor with your own list of internet diagnosis, but figure out what test was being done, what it measures, why it was ordered, what it hopes to rule out.

And also, be open to the possibility that whatever weird symptoms you're having could sub-clinical. Meaning not really worth treating, because whatever treatment isn't going to work, is too expensive, has too many side effects for not much reward because you're not suffering very much. They've already ruled out the things that could kill you, the things that can disable you, and the things that require specialized treatment. The things that are somewhat annoying? Who the hell knows what it could be.

And so so many digestive issues are psychology linked. It's not an answer patients like to hear so doctors often don't tell it.

You want there to be some nice definitive diagnosis that wraps up all your mystery symptoms in a nice red bow. Reality is much more messy. Doctors aren't magicians. Be your own advocate.

You seem to have carried around this idea that you are Mysteriously Sick your whole life. Will you be able to accept the idea that you aren't?
posted by fontophilic at 1:45 PM on April 28 [3 favorites]


If you feel mysteriously sick, then you are mysteriously sick, until you get a definitive diagnosis.
posted by serena15221 at 1:51 PM on April 28


My adult doctor's visits have been marked by difficulty communicating, feeling disrespected by doctors (being kept waiting 30 minutes or more...)

I hear that you are frustrated at not having gotten the level of healthcare service you felt you needed, but the truth is no one can make you feel disrespected without your permission, OP. It is a choice to view any delay in the worst light possible. It is a choice to think a 30-minute wait is too long and to not have planned accordingly by bringing some reading material or knitting (whatever may have been the case for you). It is a choice to blame it all on the mean doctor instead of choosing to see the bigger picture, as others here have suggested.

My advice? A little more empathy for what might be going on behind the other closed doors you see as you make your way down the doctor's office hallway. Horrible, sad, awful news is being delivered. "Your child has cancer."

The truth is there are MANY contributing factors to this foreseeable problem. The US Healthcare System is royally screwed up, for one. Insurance companies are an expensive and time-consuming middleman, that place a lot of extra demands not only on physicians but on the entire office staff. Documenting everything takes time. Complying with the vast array of changing regulations takes time. Reading and understanding a chart and test results takes more time. It is hard to predict what you're going to find - or not - on an exam. What started out as a 15-minute visit can suddenly turn serious and need several hours of your time Starting.Right.Now!

It's complicated. Things behind the scenes and out of our line of vision are not always as they seem. Being ferociously organized and flexible, and doing your own research, will go a long way to you having more positive healthcare experiences in the future. But at the end of the day, there are just things we cannot control.
posted by hush at 2:15 PM on April 28 [1 favorite]


If it helps, think of your doctor visit as a way to get information about options and take notes in preparation for the anonymous AskMe you can submit afterward: "this is happening; my doctor ordered X test that will cost $Y but when I pushed for an alternative, the doctor also gave me the option to try medication J that costs $K. I am on a tight budget. Has anyone had these test results come back in a problem range, and if so, what did your doctor recommend next? Has anyone tried the medication without having the test done first?"
posted by Bentobox Humperdinck at 2:33 PM on April 28


Nthing to schedule your appointment first thing in the morning, before they get behind. Doctors always get behind.

I understand your disgust and avoidance. I've had some bad experiences too. I was misdiagnosed with high blood pressure during a kidney stone attack, for example.

But, one of my closest friends is a doctor - she hates not being able to see patients for more than a few minutes, which is what her former employer demanded. You know what? Even she has trouble now and again, with a doctor whose advice she feels is iffy. That's why they talk about "second opinions". Doctors are human beings, and they vary like the rest of us.

I have also had some very good experiences with specialists in the last couple of years.
Talk to people and find a GP who has the time to talk to and with you. The Wall Street Journal guide to looking up health prices will help a lot.
posted by mitschlag at 3:24 PM on April 28


I have never waited less than 30 minutes to see a doctor, anywhere. Ever. I just take for granted that the appointment (getting there, waiting, being seen) will take up the whole morning or afternoon. And, it's fine, because I wouldn't want to see a doctor who'd zip through everyone like a machine; I've taken up my share of other people's time in the waiting room.

Everyone's spelled out the things I wanted to say. I will say that it's for sure frustrating to live intimately with pain - to have your life and the kinds of choices you make affected by it - and to not have any answers for it, or even a name. But it's not because of doctors, as treehorn+bunny said - it's because your pain's caught between the mysteries of the body, and the practical and economic limits of the system. And, a bit of luck - running into doctors who aren't great communicators can be demoralizing.

But, think about this - the kind of communication you would hope for might make you feel good and respected, but it doesn't have a lot of bearing on what your doctor can actually do for you. People are less likely to sue doctors for negligence if they dislike those doctors. That means, they will tolerate poor treatment outcomes if they like their doctors. So, is that the best criterion of good care?

If you feel you need better communication, I agree that a nurse practitioner might be the person to listen - they get a lot of training in communication. And I'd agree that every patient needs to take a proactive stance on their health. The systems in North America are not designed to promote optimal health. They're designed to catch things that obviously fail. I have no experience with the American system, but from the outside it's clear that the problem has to do with systems, and is of a large enough scale for your president to address. It's unfortunate that you've suffered through the problems that precipitated the recent changes. But, it's unfortunate - it's not individual doctors who've created the problem, they are only working within it.

Since that's the case, it really is up to us to try to advocate for ourselves. My doctor doesn't always remember every single thing I've got to deal with, but I've got a few minor things going on and a thick (paper) file - there's no software that's going to pop up to say it's time for my x test. So, sometimes I have to remind her. That's ok, because I keep track of what I need, and when I do remind her, she does a good job of what needs to be done. It's both of our jobs to keep me healthy.
posted by cotton dress sock at 3:25 PM on April 28 [2 favorites]


They are more mentally intact than many persons they live with, and complain bitterly about how they are not allowed to even play cards with residents living in other parts of the home who might be similarly conversant. It's hard to see them declining and not be able to do anything about it.

This also sounds unfortunate, but in a system dealing with a lot of people who need a lot of care, most of the resources are going to go to the majority. It's the unlucky outcome of the inertia of a system that's keeping itself going. Is there room to do something, though? Maybe getting in touch with those other few patients and their families, and working together to try to arrange something?
posted by cotton dress sock at 3:30 PM on April 28


*whoops - people are less likely to sue doctors they *like*.
posted by cotton dress sock at 3:50 PM on April 28


I chose not to go into the details of my current health because I thought it would obfuscate the actual question, which is how to make the most of my next visit in light of the things I have experienced personally and through my family and the beliefs about doctors and health care that I have developed as a result.

Before you go to your next doctor's appointment, write down everything you want him to know-- your symptoms, your history, etc. so you don't forget anything and read off that during your visit. It will be better for you, because you will have everything mapped out, and it will be better for the doctor because you will lay everything out on the table for him, making the most effective use of both your time and his time so you can figure out what the issue is.

Things like having to wait and going through tests you've had before are just part of the landscape.
posted by deanc at 8:27 PM on April 28


I do have issues that I am concerned about, and naturally I don't know what is causing them, because it seems to me the only way to even get close to knowing what's actually going on is to see a trained professional - which, as I mentioned, I have been unable to do for the better part of ten years.

Based on this update, I would suggest starting with a Physician's Assistant or Nurse Practitioner. They are (often, not always) more accessible, don't make you wait, and can take more time to explain things. Depending on your symptoms, I was also thinking you might be happier with a specialist than a GP (i.e., if you have digestive problems, go straight to a gastroenterologist), but of course if you have no idea what's wrong you don't know where to start with that.
posted by Violet Hour at 9:04 PM on April 28


I want to be kept waiting when I go to a doctor; in fact, if it's a new doctor and I get right in, I wonder why. I want the person who's in the office ahead of me to get every single minute of the doctor's time they need. I've had a couple of visits over the years in which the doctor popped his head in, asked what I needed, whipped out his prescription pad and wrote on it, handed me the script and then moved on. Busy doc, yes; happy patient? No.

I think you have a real misunderstanding of the way it works in a doctor's office in the world we're in today in that your insurance company is the one that dictates a good deal of what happens when you visit the doc. The doc has to come up with a reason for your visit, which had a code number attached to it for insurance purposes, then he has to order the right tests and no more, then decide treatment that fits within the parameters dictated by the insurance company. It's insane, if you want to know the truth, and I don't know how doctors can stand it. They'd better be quick, too - the time allotted for your visit is measured in 15-minute increments according to how "complex" your issues are. If you want a long visit and a thorough evaluation, you need to have something to tell the doctor for symptoms and you need to request the office reserve a long appointment for you, which will only be paid for if your insurance company agrees that you require a long appointment.

Today I was at my doctor's office (pulmonologist) and he was floored to learn that one of his patients wants to change oxygen providers due to the very poor service he's getting and it can't be done - because the patient's insurance company has a contract with his present oxygen provider to use that company and none other. So this patient is stuck with crappy service - all due to the insurance company. My doctor's MA assured him this was so - that's how it works - and my doctor was openly disgusted.

If you've experienced poor medical care, you're just like the rest of us - it's happened to everyone. Sometimes it's the doctor's fault - yes, there are real jackasses out there with medical degrees - but most often it's a lack of communication with your doctor that causes the problem. You need to express, courteously, your questions and concerns, and let the doc know that you've had some negative experiences but to expect him/her to just listen to an half-hour harangue about how lousy doctors have messed you up and other people you know, etc., is an outright waste of his time and won't be appreciated or be helpful to you in any way. Instead, express the idea that you wish to be fully informed about every little detail of your care because that will make you feel like your health is in your own hands.

If you're overweight and you've felt that everything you brought up to the doctor was dumped under the "obese" umbrella and therefore ignored, that's another thing that's happened to many people and it's a dealbreaker with a doctor to me. When I smoked, everything that happened to me was because I smoked; when I quit smoking and got fat, everything that happened to me was because I was fat. I have a dear friend who drinks too much and everything she has wrong with her is because of her drinking. That attitude is a big fail for both the doctor and patient - no one wins.

I finally got sick enough that all the usual blood tests reflected it and now all my doctors are much kinder and jump into action when I need help and, believe me, I appreciate it. I have walked away from two doctors in the last year - one of them for sheer rudeness (unbelievable) and the other for being so focused on trying to get me off pain pills that he flat-out ignored everything else I was dealing with, which included restless legs that kept me up and down all night to the point of serious sleep deprivation. Another doctor prescribed a medication that stopped the restless legs completely (!!) and, once I was able to sleep for a good, solid 8 or 9 hours, I found that I'd cut way back on my pain pills without even trying.

You must speak your wishes and your questions to your doctor and stop expecting him to read your mind. You must be patient and consider that you're only one of his patients and that many of the others are more likely sicker than you, so they get the priority service. You must understand that your insurance company is the God - not your doctor; he's operating within a much tighter box than you realize and you must give him something to work with - that means something more than "I'm tired a lot and have headaches sometimes."

I hope you can work all this out and hope you find a doctor who listens to the voice in the background and gives you a sense of being in safe hands. Good luck to you.
posted by aryma at 9:14 PM on April 28 [1 favorite]


And I second the idea of a Nurse Practitioner or even a Resident. In my experience, NPs are gentle and helpful and look at the big picture and they're not under the time and other constraints your doc is. They're really excellent at answering your questions. As for Residents, oooh - I like Residents; they're eager to "fix" their patient, whatever it takes. They're full of book knowledge - all the most up-to-date material there is is just bubbling in their brains - and when they get a chance to use all that education on a real person, they can have some remarkable ideas.

It was a Resident who taught my son how to control his breathing in order to halt a bad asthma attack; my son had been hospitalized many times and spent a week in the ICU with serious asthma in the past, but after his visit with this resident, he never was hospitalized for asthma again.
posted by aryma at 9:20 PM on April 28


« Older I work with a woman whose adul...   |  My mother's ~40-year-old Sears... Newer »

You are not logged in, either login or create an account to post comments