How do you get good medical care?
July 13, 2016 8:27 AM Subscribe
Need ideas, experiences and resources re questions to ask at a first appointment, steps to take before even making that appointment, being a good self-advocate, managing anxiety, and setting reasonable expectations.
Feel free to ignore all that's below and just answer the top-level question/s. I'm in Canada, so that might matter for some things.
I think I need a new GP. May also need a new physio*.
****
1) How do you find a good doctor or other healthcare practitioner? What are good questions to ask at a first appointment? Other than a good fit, what should be thought about? (E.g., I've heard that it's not silly to figure out which hospital GPs have got privileges at, as part of the calculus.) Canada-specific - what practical steps do you take?
2) What is the best way to be a patient? (As a woman?) How should you present your concerns, especially when they are many (but not life-threatening)? Here, you have to make appointments for each issue. I have several, and none of them are particularly dangerous - or clear-cut. (Gyno-related things, thyroid things, digestive things, a schwack of MSK things, mostly soft-tissue stuff...) To monitor them all properly means about a visit a month. I feel like I'm always in there, asking for something... it's embarrassing, for some reason. I worry it damages my credibility as a patient :/
I also worry about how the syndromey, apparently nebulous nature of most of these issues complicates things - a) because I worry I'll come across as a kook, and b) because I think I do need a doc who's a good pattern matcher and up-to-date on syndromey things, and able to navigate them in a way that's comprehensive, but doesn't without exacerbate my anxiety.
(My doc's advice for IBS is "eat more fiber". I asked about how I should incorporate soluble vs insoluble, which I know from my own experience (logging!) and reading makes a HUGE difference, and she was like, "yeah, I don't know about that. Just eat more fiber". )
Lots of doctors seem to hate when patients read about issues and bring those up - will it be more effective to just not do that?
3) How do you overcome anxiety and cynicism about the possibility of getting good care?
I personally have experienced a number of not wonderful experiences. More than a few errors have happened, in my own care and in that of loved ones. (I'm at the point where with imaging, for example, I no longer trust techs to take the images properly, with the right machines, or doctors to order the right views, etc. There is a backstory, too long to get into.)
I already felt like this, when I fell upon a Reddit sub for professionals of a particular group, and my worst fears about lack of professionalism and conscientiousness seemed to be confirmed :/ People admitted making mistakes (fine, happens) - and not actually giving a shit (much less fine! From a member of one group of so-called "mid-level" professionals - "if a doctor's going to talk to me that way, I'm not going to bend over backwards for him". To me this attitude is just, wow. Surely it's about the patient?
I think one thing is that I grew up with healthcare professionals, and although I didn't work with them, obviously didn't see everything they did, surely they weren't perfect, it was *always* about the patient. I saw them take emergencies nights and weekends, consult with colleagues when they didn't have an answer, just *not stop* working or thinking or researching until an issue was either dealt with or couldn't be. And it was clear that patients appreciated it - Christmasses, we were inundated with chocolates, wine, cards; people travelled hours to see them, etc. Maybe my expectations are unreasonable?
I mean that attitude doesn't represent everyone's; people have bad days, sometimes they get caught up in wonky systems; not everything is going to happen the way you think it should, and maybe there are legit reasons for that that I'm not positioned to understand (because I'm not a medical professional, I mean really, what do I know); just because standard N exists in place Q doesn't mean it's going to happen within the reality of the system you're in...
I know all this, and it's sort of fine to me, in theory, but when it's your body, you sometimes feel less than generous about human foibles, etc.
***
* only because travelling to see her was sort of getting to be onerous, but mostly because, I need to see someone for a particular injury now, and she's on mat leave. Finding one as good as she is is daunting... it took a long time to find her. She was just very smart about diagnostics, and thoughtful. (E.g., for a peroneal injury - other physios had me doing cookie-cutter band work. She was like, "you don't actually have enough strength in your foot to generate the required eccentric force, so we're going to do this other thing". She didn't just rely on reports, she did extensive clinical tests... I have just not found this everywhere.) We have a good relationship. I trust her judgement, totally. She saw me through three years of unlikely injuries, as they happened; they all need to be touched on now and again. (I fear that recapping everything with someone new is going to be a challenge, for a few reasons...)
And I want to say - I don't stress about seeing my physio, or anything I see her for. Because I don't question her judgement. I trust her professionalism, knowledge, and conscientiousness. I don't read more than I have to, because I know it's just going to be handled.
(I actually hate doing the tons of research I do for other things, it's just that I have little faith that they'll be dealt with appropriately, and I feel like I need to be equipped in that case...)
Feel free to ignore all that's below and just answer the top-level question/s. I'm in Canada, so that might matter for some things.
I think I need a new GP. May also need a new physio*.
****
1) How do you find a good doctor or other healthcare practitioner? What are good questions to ask at a first appointment? Other than a good fit, what should be thought about? (E.g., I've heard that it's not silly to figure out which hospital GPs have got privileges at, as part of the calculus.) Canada-specific - what practical steps do you take?
2) What is the best way to be a patient? (As a woman?) How should you present your concerns, especially when they are many (but not life-threatening)? Here, you have to make appointments for each issue. I have several, and none of them are particularly dangerous - or clear-cut. (Gyno-related things, thyroid things, digestive things, a schwack of MSK things, mostly soft-tissue stuff...) To monitor them all properly means about a visit a month. I feel like I'm always in there, asking for something... it's embarrassing, for some reason. I worry it damages my credibility as a patient :/
I also worry about how the syndromey, apparently nebulous nature of most of these issues complicates things - a) because I worry I'll come across as a kook, and b) because I think I do need a doc who's a good pattern matcher and up-to-date on syndromey things, and able to navigate them in a way that's comprehensive, but doesn't without exacerbate my anxiety.
(My doc's advice for IBS is "eat more fiber". I asked about how I should incorporate soluble vs insoluble, which I know from my own experience (logging!) and reading makes a HUGE difference, and she was like, "yeah, I don't know about that. Just eat more fiber". )
Lots of doctors seem to hate when patients read about issues and bring those up - will it be more effective to just not do that?
3) How do you overcome anxiety and cynicism about the possibility of getting good care?
I personally have experienced a number of not wonderful experiences. More than a few errors have happened, in my own care and in that of loved ones. (I'm at the point where with imaging, for example, I no longer trust techs to take the images properly, with the right machines, or doctors to order the right views, etc. There is a backstory, too long to get into.)
I already felt like this, when I fell upon a Reddit sub for professionals of a particular group, and my worst fears about lack of professionalism and conscientiousness seemed to be confirmed :/ People admitted making mistakes (fine, happens) - and not actually giving a shit (much less fine! From a member of one group of so-called "mid-level" professionals - "if a doctor's going to talk to me that way, I'm not going to bend over backwards for him". To me this attitude is just, wow. Surely it's about the patient?
I think one thing is that I grew up with healthcare professionals, and although I didn't work with them, obviously didn't see everything they did, surely they weren't perfect, it was *always* about the patient. I saw them take emergencies nights and weekends, consult with colleagues when they didn't have an answer, just *not stop* working or thinking or researching until an issue was either dealt with or couldn't be. And it was clear that patients appreciated it - Christmasses, we were inundated with chocolates, wine, cards; people travelled hours to see them, etc. Maybe my expectations are unreasonable?
I mean that attitude doesn't represent everyone's; people have bad days, sometimes they get caught up in wonky systems; not everything is going to happen the way you think it should, and maybe there are legit reasons for that that I'm not positioned to understand (because I'm not a medical professional, I mean really, what do I know); just because standard N exists in place Q doesn't mean it's going to happen within the reality of the system you're in...
I know all this, and it's sort of fine to me, in theory, but when it's your body, you sometimes feel less than generous about human foibles, etc.
***
* only because travelling to see her was sort of getting to be onerous, but mostly because, I need to see someone for a particular injury now, and she's on mat leave. Finding one as good as she is is daunting... it took a long time to find her. She was just very smart about diagnostics, and thoughtful. (E.g., for a peroneal injury - other physios had me doing cookie-cutter band work. She was like, "you don't actually have enough strength in your foot to generate the required eccentric force, so we're going to do this other thing". She didn't just rely on reports, she did extensive clinical tests... I have just not found this everywhere.) We have a good relationship. I trust her judgement, totally. She saw me through three years of unlikely injuries, as they happened; they all need to be touched on now and again. (I fear that recapping everything with someone new is going to be a challenge, for a few reasons...)
And I want to say - I don't stress about seeing my physio, or anything I see her for. Because I don't question her judgement. I trust her professionalism, knowledge, and conscientiousness. I don't read more than I have to, because I know it's just going to be handled.
(I actually hate doing the tons of research I do for other things, it's just that I have little faith that they'll be dealt with appropriately, and I feel like I need to be equipped in that case...)
Response by poster: She has a new grad subbing for her. A friend of mine saw this person, was not impressed :/
posted by cotton dress sock at 8:35 AM on July 13, 2016
posted by cotton dress sock at 8:35 AM on July 13, 2016
Best answer: 1) The one question my GP -- who is super old school and has virtually no quality of life because of the high level of care he provides to a large practice -- has taught me to always ask new providers is: "If I call you, will I hear back from you within 48 hours?" Nowadays you might update this to, "If I have a question in between appointments, how should I contact you, and when can I expect to hear back?" I would add, "If I have a question in between appointments and I contact you, should I expect to hear back from you or from your PA/NP/RN?" I have very rarely encountered a physician who didn't provide adequate care for me in person, but trying to get ask a question in between appointments really separates the wheat from the chaff.
2) Bring your questions written down and run through the list during the appointment. I let the physician see that I have a list so they understand that I have thought about my questions in advance and roughly how many there are. Some doctors (surgeons especially) prefer to take the list and read it themselves and then answer en bloc, which is also fine.
2a) Try to temper your expectations, especially around dietary advice. Most GPs just don't have a lot of training in this area, and it's bigger than a training problem because mostly the knowledge just isn't out there. People who are willing to make very specific recommendations are primarily flying by the seat of their pants, guesswork, small studies, and anecdote. I think your GP failed more here at tact than anything else -- it sounds like she meant to say, "The different types affect people differently and it's very individual, so you should use whatever makes you feel best." You've done diarying in the past so I doubt this is a new concept for you.
3) This one is tougher. You know, doctors and medical professionals are just people, too. To your Reddit story, the important point there for me is that you saw a lack of professionalism and conscientiousness... on Reddit. Not in the OR. Not in the exam room. In these zany times in which we live I think Reddit (or places like it) is for many people the one context where they blow off steam and act a little unprofessionally and a little casually. I'm not going so far as to say doctors have to blow off steam and act like goons in order to be good doctors, especially because it sounds like in your personal life you've known doctors who were 24/7 saints, but I don't think it says anything at all about whether they provide good patient care or not.
posted by telegraph at 9:36 AM on July 13, 2016 [4 favorites]
2) Bring your questions written down and run through the list during the appointment. I let the physician see that I have a list so they understand that I have thought about my questions in advance and roughly how many there are. Some doctors (surgeons especially) prefer to take the list and read it themselves and then answer en bloc, which is also fine.
2a) Try to temper your expectations, especially around dietary advice. Most GPs just don't have a lot of training in this area, and it's bigger than a training problem because mostly the knowledge just isn't out there. People who are willing to make very specific recommendations are primarily flying by the seat of their pants, guesswork, small studies, and anecdote. I think your GP failed more here at tact than anything else -- it sounds like she meant to say, "The different types affect people differently and it's very individual, so you should use whatever makes you feel best." You've done diarying in the past so I doubt this is a new concept for you.
3) This one is tougher. You know, doctors and medical professionals are just people, too. To your Reddit story, the important point there for me is that you saw a lack of professionalism and conscientiousness... on Reddit. Not in the OR. Not in the exam room. In these zany times in which we live I think Reddit (or places like it) is for many people the one context where they blow off steam and act a little unprofessionally and a little casually. I'm not going so far as to say doctors have to blow off steam and act like goons in order to be good doctors, especially because it sounds like in your personal life you've known doctors who were 24/7 saints, but I don't think it says anything at all about whether they provide good patient care or not.
posted by telegraph at 9:36 AM on July 13, 2016 [4 favorites]
Response by poster: Just to say (will not update after this) re the Reddit thing - I know what you mean about blowing off steam, it wasn't that, the particular thing was, this person admitted to particular inactions, which they justified with complaints around interpersonal issues/their work culture. Not everyone's like that, true. (Also the people I know are far from 24/7 saints, they were just very committed. Came with a cost, too :/ )
posted by cotton dress sock at 9:51 AM on July 13, 2016
posted by cotton dress sock at 9:51 AM on July 13, 2016
Best answer: Definitely writing down your questions ahead of time is really helpful. I also bring a list of current meds with doses, and a symptom history if I'm having a particular issue. I'm naturally rambly so sometimes I rehearse my symptom history so I can be more concise.
At the end I also verbally go through my notes and confirm with the doctor what I've written down.
posted by radioamy at 9:55 AM on July 13, 2016 [2 favorites]
At the end I also verbally go through my notes and confirm with the doctor what I've written down.
posted by radioamy at 9:55 AM on July 13, 2016 [2 favorites]
Best answer: Two years ago I moved and had to replace my much loved GP and my not so much loved Neurologist.
I consider my GP to be the most important person to have a good relationship with. What I did (Kaiser) was research the Doctors I was interested in contacting. I whittled it down to 4 women. I read as much about them as I could find on google, yelp, anywhere I could find info. All of them advertised their practices as closed to new patients. I called anyway and got an appointment with the second Dr on my list.
She is young, interested in skin issues and alternative medicine. All I can say is I love her. She listens, she communicates, she refers or at least calls a specialist and gets their take on an issue and then sends me an email or calls within 24 hours to share that update with me. She is a great advocate. I have had two issues with Kaiser and she has been instrumental in helping me find solutions. I need this from my GP - to be my go to person for problems, whether they are medical or access to medical care problems.
I have never said that directly to her. I just show up with my problem and ask her for help. So when I first met her I did not present a list of things I wanted from her. The Doctor Patient relationship develops over time just like any other relationships. I give them a year. If I am not happy a year later I move on.
As for presenting your long list of issues to a new Dr. I present my most worrisome issues at my first appointment and that usually results in a follow up appointment. At my once per year Wellness appointment is when I go over my list of concerns from head to toe. I ask all of my to embarrassed to ask and have read too much on the internet questions. Like what's up with my toe? My hips are making all kinds of noise? She answers them and then I can let my worries go.
I prefer women doctors for my GP, skin, and gyno. Any others can be male.
Good luck. There are great Docs everywhere. You just have to be able to find a way into their practice.
posted by cairnoflore at 11:52 AM on July 13, 2016 [1 favorite]
I consider my GP to be the most important person to have a good relationship with. What I did (Kaiser) was research the Doctors I was interested in contacting. I whittled it down to 4 women. I read as much about them as I could find on google, yelp, anywhere I could find info. All of them advertised their practices as closed to new patients. I called anyway and got an appointment with the second Dr on my list.
She is young, interested in skin issues and alternative medicine. All I can say is I love her. She listens, she communicates, she refers or at least calls a specialist and gets their take on an issue and then sends me an email or calls within 24 hours to share that update with me. She is a great advocate. I have had two issues with Kaiser and she has been instrumental in helping me find solutions. I need this from my GP - to be my go to person for problems, whether they are medical or access to medical care problems.
I have never said that directly to her. I just show up with my problem and ask her for help. So when I first met her I did not present a list of things I wanted from her. The Doctor Patient relationship develops over time just like any other relationships. I give them a year. If I am not happy a year later I move on.
As for presenting your long list of issues to a new Dr. I present my most worrisome issues at my first appointment and that usually results in a follow up appointment. At my once per year Wellness appointment is when I go over my list of concerns from head to toe. I ask all of my to embarrassed to ask and have read too much on the internet questions. Like what's up with my toe? My hips are making all kinds of noise? She answers them and then I can let my worries go.
I prefer women doctors for my GP, skin, and gyno. Any others can be male.
Good luck. There are great Docs everywhere. You just have to be able to find a way into their practice.
posted by cairnoflore at 11:52 AM on July 13, 2016 [1 favorite]
Best answer: Like you, I'm a Canadian who has had some less than stellar experiences with individual physicians/specialists and also with the medical system in general. But I've also had some care that went above and beyond from some fantastic physicians and surgeons.
Unfortunately where I live you have to take who you get as your GP (if anyone will take you on as a patient at all), so I have no advice for how to choose a doctor. However, one of the things that has tipped me off about the level of care I'm going to receive from whoever I'm stuck with is: does this person ask questions about me as a whole person? My history, family life, employment situation, my emotional and mental health? I find it's a good sign if they are interested in the context of my experience as a whole human being, rather than just fixing the one thing I'm presenting with today.
posted by hurdy gurdy girl at 12:01 PM on July 13, 2016 [1 favorite]
Unfortunately where I live you have to take who you get as your GP (if anyone will take you on as a patient at all), so I have no advice for how to choose a doctor. However, one of the things that has tipped me off about the level of care I'm going to receive from whoever I'm stuck with is: does this person ask questions about me as a whole person? My history, family life, employment situation, my emotional and mental health? I find it's a good sign if they are interested in the context of my experience as a whole human being, rather than just fixing the one thing I'm presenting with today.
posted by hurdy gurdy girl at 12:01 PM on July 13, 2016 [1 favorite]
Best answer: I wonder if a stand alone GP is the right fit for you, or if you'd be happier with the level of care from a different provider? Wanting a different model for your health care is okay! Would a Nurse Practitioner who was able to spend more in depth time with you at each appointment and make appropriate referrals be good?
Or, have you thought about a clinic attached to a hospital? My doctor is part of a family practice at a major Toronto hospital and I really like the model. The clinic has evening and weekend hours, a resident who is on call 24 hours a day, social workers, dietitians etc. Being part of an academic centre means that she has access to all test results done at UHN, can refer easily and that the appointments aren't rushed. I also feel like the doctors stay on top of research and current practice since they are generally cross appointed with the medical school.
Each appointment generally starts with a checkin with the nurse practitioner, sometimes an assessment by a resident and then a meeting with her and a chance to ask questions. You can refuse any care or observation by the students, it doesn't bother me so I generally allow everything except bloodwork. She has called me about test results in the evenings and I haven't felt rushed. The clinic I'm at isn't taking new patients unfortunately but it looks like the St Mikes family practice is and it might broaden your search. Memail me if you have specific questions.
posted by five_cents at 3:42 PM on July 13, 2016 [1 favorite]
Or, have you thought about a clinic attached to a hospital? My doctor is part of a family practice at a major Toronto hospital and I really like the model. The clinic has evening and weekend hours, a resident who is on call 24 hours a day, social workers, dietitians etc. Being part of an academic centre means that she has access to all test results done at UHN, can refer easily and that the appointments aren't rushed. I also feel like the doctors stay on top of research and current practice since they are generally cross appointed with the medical school.
Each appointment generally starts with a checkin with the nurse practitioner, sometimes an assessment by a resident and then a meeting with her and a chance to ask questions. You can refuse any care or observation by the students, it doesn't bother me so I generally allow everything except bloodwork. She has called me about test results in the evenings and I haven't felt rushed. The clinic I'm at isn't taking new patients unfortunately but it looks like the St Mikes family practice is and it might broaden your search. Memail me if you have specific questions.
posted by five_cents at 3:42 PM on July 13, 2016 [1 favorite]
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