What's reasonable to expect from your GP (Canada)?
January 29, 2015 9:36 AM Subscribe
My doctor covers the basics well and is caring, but isn't a great communicator. Is that a dealbreaker?
If something's wrong with me that's easily identifiable or fixable with a standard treatment, she'll take care of it or refer me on if I ask her to. (I do have to ask, usually - she doesn't love that, she prefers to manage things herself, but she'll do it.)
With more complex things (hormonal/gyno issues, mental health), she likes to stick to standard treatment as well, and to want to manage things herself. She's very practical, overall. This may be a good thing, because I'm prone to Google-itis, and a grounded approach might be what's called for.
On the other hand, there isn't a lot of discussion or explanation of the diagnosis or treatment (which makes me uncomfortable, because I'm a PITA and need to know why why why and "what can I expect" and "no really, give me the fine print on the potential risks of this medicine, please") and my preferences wrt treatment aren't always taken into account.
No big deal for a lot of issues, I guess; the main thing right now is she's recommending SSRIs for anxiety. I don't want them, I just don't. I tried another drug of the same class in the past and had just a miserable experience with it, during and after. I am not up for putting myself through that trial and error process. I know there are a few other pharma approaches to anxiety management (have had experience with one) and mentioned these, and she said, "hmm, maybe, but let's try X first". She's generally not keen on the research I bring up and think is relevant. (This is only an example of what I mean about communication; I'd be grateful if answerers focused on that and not on persuading me to get on board the SSRI train.)
Similar exchanges take place wrt a few other issues. E.g., arthritis: "You have arthritis". "What kind?" "Wear and tear. Take these NSAIDs". E.g., chronic pain and tingling in the ankle after running: "Don't run. Take these NSAIDs". "There's nothing I can do? Physio won't help?" "Oh, okay, sure. See a physio. Ok let me thing of who's good, ok, go here." (She's not being rude or anything, she's friendly - that's just how she talks.)
So I wind up going to Google anyway and freaking myself out. I usually discover that she's right in the end, that NSAIDs really are the answer to most of my problems, but only after a good bit of stress thinking I maybe have compartment syndrome. (Also, the ankle thing is just not getting better, years out. Also, I have a schwack of tendon problems, and I'm curious about why that is, and she's not, so much. My desktop full of pdfs suggests there aren't any easy answers, anyway, but still.)
I have to remember to follow up on tests for ongoing issues and physicals, but I think that's a normal and expected part of a patient's responsibility (right?).
She's missed one or two things that walk-in doctors have caught, but those are just odds, right? Or maybe it's because I usually see her for particular things, and there's only so much time in any given appointment.
Overall, I like her, I'm mostly well-covered for the things that have answers, I've been with her for a long time, and I'm grateful to even have a regular doctor. I appreciate that I may well be a hypochondriac and that my communication needs might be higher than the average bear's.
(Secondary question: if you think I should try to find another doctor, how should I go about it? What are reasonable questions/expectations?)
I live in Ontario, Canada. Thanks!
If something's wrong with me that's easily identifiable or fixable with a standard treatment, she'll take care of it or refer me on if I ask her to. (I do have to ask, usually - she doesn't love that, she prefers to manage things herself, but she'll do it.)
With more complex things (hormonal/gyno issues, mental health), she likes to stick to standard treatment as well, and to want to manage things herself. She's very practical, overall. This may be a good thing, because I'm prone to Google-itis, and a grounded approach might be what's called for.
On the other hand, there isn't a lot of discussion or explanation of the diagnosis or treatment (which makes me uncomfortable, because I'm a PITA and need to know why why why and "what can I expect" and "no really, give me the fine print on the potential risks of this medicine, please") and my preferences wrt treatment aren't always taken into account.
No big deal for a lot of issues, I guess; the main thing right now is she's recommending SSRIs for anxiety. I don't want them, I just don't. I tried another drug of the same class in the past and had just a miserable experience with it, during and after. I am not up for putting myself through that trial and error process. I know there are a few other pharma approaches to anxiety management (have had experience with one) and mentioned these, and she said, "hmm, maybe, but let's try X first". She's generally not keen on the research I bring up and think is relevant. (This is only an example of what I mean about communication; I'd be grateful if answerers focused on that and not on persuading me to get on board the SSRI train.)
Similar exchanges take place wrt a few other issues. E.g., arthritis: "You have arthritis". "What kind?" "Wear and tear. Take these NSAIDs". E.g., chronic pain and tingling in the ankle after running: "Don't run. Take these NSAIDs". "There's nothing I can do? Physio won't help?" "Oh, okay, sure. See a physio. Ok let me thing of who's good, ok, go here." (She's not being rude or anything, she's friendly - that's just how she talks.)
So I wind up going to Google anyway and freaking myself out. I usually discover that she's right in the end, that NSAIDs really are the answer to most of my problems, but only after a good bit of stress thinking I maybe have compartment syndrome. (Also, the ankle thing is just not getting better, years out. Also, I have a schwack of tendon problems, and I'm curious about why that is, and she's not, so much. My desktop full of pdfs suggests there aren't any easy answers, anyway, but still.)
I have to remember to follow up on tests for ongoing issues and physicals, but I think that's a normal and expected part of a patient's responsibility (right?).
She's missed one or two things that walk-in doctors have caught, but those are just odds, right? Or maybe it's because I usually see her for particular things, and there's only so much time in any given appointment.
Overall, I like her, I'm mostly well-covered for the things that have answers, I've been with her for a long time, and I'm grateful to even have a regular doctor. I appreciate that I may well be a hypochondriac and that my communication needs might be higher than the average bear's.
(Secondary question: if you think I should try to find another doctor, how should I go about it? What are reasonable questions/expectations?)
I live in Ontario, Canada. Thanks!
Best answer: It doesn't sound like she's the doctor for you. I'd look for a new doctor, only because you're not happy (and I can tell this by the fact you wrote a pretty significant wall of text). Since it isn't a big deal, just switch to another doctor and see if you find one that fits better.
posted by arnicae at 9:42 AM on January 29, 2015 [5 favorites]
posted by arnicae at 9:42 AM on January 29, 2015 [5 favorites]
If your doctor won't actively work with you to maintain your ability to exercise you need to GTFO. That is not a good doctor.
posted by srboisvert at 9:47 AM on January 29, 2015 [2 favorites]
posted by srboisvert at 9:47 AM on January 29, 2015 [2 favorites]
Best answer: I think it is perfectly fine to seek out another doctor if you aren't happy, for whatever the reasons. That said, I don't think excessive Googling is going to disappear just because you get a different doctor. It sounds like in the majority of these cases, the doctor was actually correct, and you just freaked yourself out. I am prone to this myself, so I get it! But, I would just keep in mind that no doctor can prevent you from looking up weird symptoms on the web and deciding you have compartment syndrome. :) I would also keep in mind that a lot of health stuff actually is legitimately complicated and we don't have great medical solutions (especially things like chronic pain, etc.) This isn't to say there isn't a doc out there who can serve you better, but I wouldn't see finding a new doctor as a magic pill that will solve all of these ongoing problems. As long as you are realistic about what you want out of a new doctor, I think it could be fine to look for someone new. Perhaps call around a few places or ask for reccs from friends, and specify that you're looking for someone who is a big communicator.
I would continue to push for referrals in areas where the doctor is not an expert. I wouldn't want to try new psychiatric medications with a general doc -- can be fine for upkeep/maintenance once you're all figured out, but I would want to see a psychiatrist for this, especially if you want to experiment with a slightly-different-than-standard treatment. My general experience has been that my primary care is fabulous for everyday ailments and checkups, but when I have a more specific problem, it pretty much always pays for me to see the more specialized person.
posted by rainbowbrite at 9:51 AM on January 29, 2015 [2 favorites]
I would continue to push for referrals in areas where the doctor is not an expert. I wouldn't want to try new psychiatric medications with a general doc -- can be fine for upkeep/maintenance once you're all figured out, but I would want to see a psychiatrist for this, especially if you want to experiment with a slightly-different-than-standard treatment. My general experience has been that my primary care is fabulous for everyday ailments and checkups, but when I have a more specific problem, it pretty much always pays for me to see the more specialized person.
posted by rainbowbrite at 9:51 AM on January 29, 2015 [2 favorites]
Best answer: IME in Ontario, GPs are almost the worst choice to go to for sports-related injuries. They don't seem to understand causes or solutions, and will mostly recommend pills, as has happened in your case.
I have had good luck with going to specialty sports medicine people and to occupational therapists. I'd ask for a referral.
posted by bonehead at 9:51 AM on January 29, 2015 [2 favorites]
I have had good luck with going to specialty sports medicine people and to occupational therapists. I'd ask for a referral.
posted by bonehead at 9:51 AM on January 29, 2015 [2 favorites]
Best answer: Depending where you are in Ontario, it may be very difficult to find a family doctor who's accepting new patients. It's a major problem in my city. Finding a female doctor in particular is nearly impossible - I eventually gave up and went to a male doctor.
Sure, if you're not happy it's always worth seeking out alternatives. If you can find a better one, fantastic. Don't burn any bridges though, or assume that you can easily replace a female family doctor at all, let alone one who seems halfway competent at her actual job. Seriously, I would be thrilled to have your doctor...any chance you're in Ottawa? She sounds a lot less dismissive than any doctor I've been to.
That said, I'd strongly recommend getting a referral to a psychiatrist for the mental health stuff. That's really not something GPs do well with. (ex: my family doctor likes to lecture me about my psych-prescribed ADD meds because he doesn't think it's a real thing....anyway)
posted by randomnity at 9:52 AM on January 29, 2015 [3 favorites]
Sure, if you're not happy it's always worth seeking out alternatives. If you can find a better one, fantastic. Don't burn any bridges though, or assume that you can easily replace a female family doctor at all, let alone one who seems halfway competent at her actual job. Seriously, I would be thrilled to have your doctor...any chance you're in Ottawa? She sounds a lot less dismissive than any doctor I've been to.
That said, I'd strongly recommend getting a referral to a psychiatrist for the mental health stuff. That's really not something GPs do well with. (ex: my family doctor likes to lecture me about my psych-prescribed ADD meds because he doesn't think it's a real thing....anyway)
posted by randomnity at 9:52 AM on January 29, 2015 [3 favorites]
Since it isn't a big deal, just switch to another doctor and see if you find one that fits better.
Switching doctors in Ontario is kind of a big deal. There are chronic shortages, leading to long wait times, as well as some contract-type paperwork to do.
posted by bonehead at 9:54 AM on January 29, 2015 [1 favorite]
Switching doctors in Ontario is kind of a big deal. There are chronic shortages, leading to long wait times, as well as some contract-type paperwork to do.
posted by bonehead at 9:54 AM on January 29, 2015 [1 favorite]
Best answer: Your doctor sounds a lot like my doctor. I like him as well and deal pretty well with his practical approach. That said, I do ask him for referrals to specialists and sometimes need to press a bit. I think you need to do more of that. You like her overall, you are a long-term patient and you're mostly well-covered for the things that have answers -- that all sounds pretty good and doctors in Ontario taking new patients are hard to find. Ask to see a psychiatrist and stop with Dr. Google if you can -- I know it's hard...believe me I know.
posted by Lescha at 10:05 AM on January 29, 2015 [2 favorites]
posted by Lescha at 10:05 AM on January 29, 2015 [2 favorites]
I'm pretty sure my doctor's office is accepting new patients. Downtown Toronto. Can't speak for other doctors in the practice, but mine has been very good about referrals.
posted by feckless fecal fear mongering at 10:22 AM on January 29, 2015 [1 favorite]
posted by feckless fecal fear mongering at 10:22 AM on January 29, 2015 [1 favorite]
(memail me if you want contact info)
Also, psych referrals take forever. Fair warning.
posted by feckless fecal fear mongering at 10:23 AM on January 29, 2015 [1 favorite]
Also, psych referrals take forever. Fair warning.
posted by feckless fecal fear mongering at 10:23 AM on January 29, 2015 [1 favorite]
Best answer: I would switch. It doesn't sound like your doctor is wrong necessarily, but if I googled something that was a bad idea, I would want my doctor to at least say "I don't think that's a good idea at this point, because..." not just keep barreling forward with their own way without explanation.
Yes, it can be hard to find a doctor taking new patients, but if you do, it's not a big deal to switch. I don't know what bonehead is talking about in terms of paperwork. It's not like you have to declare to anyone who your doctor is or anything like that (a la PCP thing with US health insurance). "Your doctor" is just whatever doctor you go to. Probably the doctor themselves will obviously want you to fill in some health history, like any time you see any new doctor. I believe with e-health, it might be pretty simple to get your records migrated over. I've never had any doctor ask me to sign a contract of any sort (what the hell would it say?)
posted by If only I had a penguin... at 10:42 AM on January 29, 2015 [1 favorite]
Yes, it can be hard to find a doctor taking new patients, but if you do, it's not a big deal to switch. I don't know what bonehead is talking about in terms of paperwork. It's not like you have to declare to anyone who your doctor is or anything like that (a la PCP thing with US health insurance). "Your doctor" is just whatever doctor you go to. Probably the doctor themselves will obviously want you to fill in some health history, like any time you see any new doctor. I believe with e-health, it might be pretty simple to get your records migrated over. I've never had any doctor ask me to sign a contract of any sort (what the hell would it say?)
posted by If only I had a penguin... at 10:42 AM on January 29, 2015 [1 favorite]
Some family practices have been caught cherry picking patients in the past few years with pre-screening interviews. They can't discriminate on human right categories, but GPs can refuse patients for workload and expertise reasons. In practice, this means people with greater risk of issues, i.e. past middle age, or pre-existing issues are getting turned away.
Many of the clinic-based practices are also trying on all sorts of fees and "contracts", some legal some not. My provider made me sign a "sole provider" agreement when I joined her practice, for example, meaning that I have to pay her the cost of a consultation if I choose to go to a walk-in or somthing. It's not clear to me if this is actually enforceable, but they're trying it on.The Appletree clinics seem to be the worst.
posted by bonehead at 11:05 AM on January 29, 2015
Many of the clinic-based practices are also trying on all sorts of fees and "contracts", some legal some not. My provider made me sign a "sole provider" agreement when I joined her practice, for example, meaning that I have to pay her the cost of a consultation if I choose to go to a walk-in or somthing. It's not clear to me if this is actually enforceable, but they're trying it on.The Appletree clinics seem to be the worst.
posted by bonehead at 11:05 AM on January 29, 2015
IANAD, but your doctor sounds pretty reasonable - she does refer you when you need it. It sounds like you should go see a psychiatrist regarding your anxiety though, if that's the issue you're most concerned about getting addressed properly.
I have had awful experiences with SSRIs, and I don't think GPs should prescribe them willy-nilly and just send the patient off to fend for themselves. I was having long-time chronic ladyparts pain due to (long story) and couldn't see my regular doctor. Another doctor at the clinic said he thought it was persisting due to low endorphins because of my being depressed, and prescribed them to me. They made me feel so sick and disoriented. And yeah I guess I was pretty depressed, but merely elevating my mood didn't help me get over it, it just felt fake. I should have seen a psychiatrist while on them, to have it properly monitored.
posted by lizbunny at 11:12 AM on January 29, 2015 [1 favorite]
I have had awful experiences with SSRIs, and I don't think GPs should prescribe them willy-nilly and just send the patient off to fend for themselves. I was having long-time chronic ladyparts pain due to (long story) and couldn't see my regular doctor. Another doctor at the clinic said he thought it was persisting due to low endorphins because of my being depressed, and prescribed them to me. They made me feel so sick and disoriented. And yeah I guess I was pretty depressed, but merely elevating my mood didn't help me get over it, it just felt fake. I should have seen a psychiatrist while on them, to have it properly monitored.
posted by lizbunny at 11:12 AM on January 29, 2015 [1 favorite]
Best answer: To literally answer your first question: I've dumped a doctor who was a poor communicator (in a different way that I won't go into). So: yes, I think it's a valid deal breaker.
I think the real question is: how poor of a communicator do they have to be to push you into dealing with the inconvenience of finding a new, better doctor?
Based on what you've written, I think I would look for someone else. From your description, she does not sound at all proactive and maybe she's burnt-out or something. It is not too much to ask that a doctor explain things and answer questions. I don't know the extent to which you freak yourself out with Google, but I'm pretty sure that these days most doctors have some ability to discuss and respond when a patient says "I Googled it and ..." I lucked out and found a really good doctor who is very good at explaining his reasoning.
But for me, the deal breaker In your situation is the whole SSRI thing: she's not listening to you. Which was the crux of the communications issue I had with my previous doctor.
posted by doctor tough love at 11:20 AM on January 29, 2015 [1 favorite]
I think the real question is: how poor of a communicator do they have to be to push you into dealing with the inconvenience of finding a new, better doctor?
Based on what you've written, I think I would look for someone else. From your description, she does not sound at all proactive and maybe she's burnt-out or something. It is not too much to ask that a doctor explain things and answer questions. I don't know the extent to which you freak yourself out with Google, but I'm pretty sure that these days most doctors have some ability to discuss and respond when a patient says "I Googled it and ..." I lucked out and found a really good doctor who is very good at explaining his reasoning.
But for me, the deal breaker In your situation is the whole SSRI thing: she's not listening to you. Which was the crux of the communications issue I had with my previous doctor.
posted by doctor tough love at 11:20 AM on January 29, 2015 [1 favorite]
Response by poster: Lots of views on this, and lots to think about. Thank you. I really appreciate hearing that my fussiness might not be entirely kooky. Equally, I value the perspectives advising tempering expectations and taking a more directive approach in my communication with my (really very nice!) doctor, and asking for a specialist when required. I think I might do that for now, and see how I get on. The thing with that is, I feel like I have to do a lot of reading to be sure that what's supposed to happen (e.g. particular tests) is happening. Which I guess suits me in a way, because I'd be reading anyway, but may not be ideal wrt my anxiety. Then again, nothing's ideal. For crying out loud, I have a doctor who takes care of things. That's pretty amazing. Maybe a psych will help me work out the anxiety part of the equation.
Thanks again!
posted by cotton dress sock at 5:20 PM on January 29, 2015
Thanks again!
posted by cotton dress sock at 5:20 PM on January 29, 2015
Response by poster: And thanks, fffm, for the offer of a reccy :) I may take you up on it :)
posted by cotton dress sock at 5:22 PM on January 29, 2015
posted by cotton dress sock at 5:22 PM on January 29, 2015
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Otherwise, find a doctor you're 100% comfortable with. You shouldn't add stress to a relationship that's supposed to keep you happy.
posted by xingcat at 9:40 AM on January 29, 2015 [2 favorites]