What can I ask my new primary care doctor at an intake appointment?
January 5, 2023 5:33 AM Subscribe
What, if anything, can I ask about whether he is anti-sexist? About his "second chance" medical school? About anything else beyond the basics?
I'm about to have a new primary care physician. Available PCPs are scarce in my area now, so I'm going with him despite some preliminary concerns -- namely, he's male (I'm female, in my 50s, and have had female PCPs for my entire adult life), and he went to a "second chance" med school in the Caribbean. I'll have a new patient intake visit with him before my first physical.
If I don't check my natural tendencies, I'm much more direct (read: unintentionally rude) than most people. I've learned to dial it back, though I still mess up sometimes. In a world that communicated just like me, here's what I would love to ask about my concerns:
- Do you believe healthcare is biased against women? How so? How about the healthcare you yourself provide? Do you do anything to combat that bias? What?
- Why did you go to St. George's for med school? If less-than-exemplary undergrad performance was a factor, what limited that performance? Has that changed since then? How? Or if it hasn't changed, what makes you a great doctor regardless?
- Oh and one more: I once sent my prior PCP a medical question through the patient portal, and I really hated her reply. So, I'd like to show him that question and ask, How would you reply to this?
I understand, though, that these aren't the kind of convivial, relationship-building, or otherwise expected questions I can actually ask in this kind of appointment. Google shows me the relatively bland questions that are typical. Last time I had one of these intakes, I asked something much tamer than the above, and I still managed to offend, I think. (I asked about her attitudes towards alternative medicine, because this is a very earthy-crunchy area in a way that can tip over into crystals etc., and I prefer care that adheres to peer-reviewed science.) And frankly, unless I hate the guy, he's my PCP for now because beggars can't be choosers.
But in the future, maybe I'll have more choice again, and if I'm ever going to ask probing questions for that eventuality, this seems like the time. So, is there any softened version of the above questions that I could ask without getting us off on the wrong foot? And how about any other beyond-the-basics questions that you recommend asking in an intake?
(As a bonus, if you have a hunch about the neuroatypicality, personality disorder, or other factor that this post suggests, I'm minorly obsessed with figuring that out about myself. I've never been diagnosed, haven't found a match using self-diagnosis questionnaires I've tried out online for various things, and I'm not ready to try for a professional diagnosis --- but very ready for speculation that I can follow up on.)
I'm about to have a new primary care physician. Available PCPs are scarce in my area now, so I'm going with him despite some preliminary concerns -- namely, he's male (I'm female, in my 50s, and have had female PCPs for my entire adult life), and he went to a "second chance" med school in the Caribbean. I'll have a new patient intake visit with him before my first physical.
If I don't check my natural tendencies, I'm much more direct (read: unintentionally rude) than most people. I've learned to dial it back, though I still mess up sometimes. In a world that communicated just like me, here's what I would love to ask about my concerns:
- Do you believe healthcare is biased against women? How so? How about the healthcare you yourself provide? Do you do anything to combat that bias? What?
- Why did you go to St. George's for med school? If less-than-exemplary undergrad performance was a factor, what limited that performance? Has that changed since then? How? Or if it hasn't changed, what makes you a great doctor regardless?
- Oh and one more: I once sent my prior PCP a medical question through the patient portal, and I really hated her reply. So, I'd like to show him that question and ask, How would you reply to this?
I understand, though, that these aren't the kind of convivial, relationship-building, or otherwise expected questions I can actually ask in this kind of appointment. Google shows me the relatively bland questions that are typical. Last time I had one of these intakes, I asked something much tamer than the above, and I still managed to offend, I think. (I asked about her attitudes towards alternative medicine, because this is a very earthy-crunchy area in a way that can tip over into crystals etc., and I prefer care that adheres to peer-reviewed science.) And frankly, unless I hate the guy, he's my PCP for now because beggars can't be choosers.
But in the future, maybe I'll have more choice again, and if I'm ever going to ask probing questions for that eventuality, this seems like the time. So, is there any softened version of the above questions that I could ask without getting us off on the wrong foot? And how about any other beyond-the-basics questions that you recommend asking in an intake?
(As a bonus, if you have a hunch about the neuroatypicality, personality disorder, or other factor that this post suggests, I'm minorly obsessed with figuring that out about myself. I've never been diagnosed, haven't found a match using self-diagnosis questionnaires I've tried out online for various things, and I'm not ready to try for a professional diagnosis --- but very ready for speculation that I can follow up on.)
He is a licensed physician in your state. He's competent to practice medicine. Where did he do his residency? That matters much more for terms of practical training.
posted by notjustthefish at 5:58 AM on January 5, 2023 [15 favorites]
posted by notjustthefish at 5:58 AM on January 5, 2023 [15 favorites]
Response by poster: Ok, so I'm realizing that asking the questions so bluntly here is making people bristle the same way it would make him bristle in the intake. I knew the latter, but thought I could be completely direct here.
I know he may be a great doctor. I also know he may not be, and I'd like to feel more confident in him. Getting good answers to my main worries would be the best way to do that, but I don't know if there's any way to raise those worries tactfully -- not as worded here, but some other way. That's the main thing I'm asking.
posted by daisyace at 6:04 AM on January 5, 2023 [3 favorites]
I know he may be a great doctor. I also know he may not be, and I'd like to feel more confident in him. Getting good answers to my main worries would be the best way to do that, but I don't know if there's any way to raise those worries tactfully -- not as worded here, but some other way. That's the main thing I'm asking.
posted by daisyace at 6:04 AM on January 5, 2023 [3 favorites]
I don't think you get to have this kind of conversation with your medical provider at all. You're not there to ask questions about their life or their worldview and they don't have to answer them (and in my understanding they probably shouldn't). It's a pretty hierarchical relationship and you're in the submissive role. Doubly so if you don't have an alternative, which is how it sounds from your description.
posted by eirias at 6:12 AM on January 5, 2023 [40 favorites]
posted by eirias at 6:12 AM on January 5, 2023 [40 favorites]
I do not find these questions appropriate for a clinical relationship, especially a new clinical relationship where you need a doctor. This doctor does not need to impress you. The question about a Caribbean med school is honestly rude - he is boarded and practicing in the US, and he is just as qualified as anyone else. The question about women is also not super appropriate for a clinical relationship - this is more nebulous, but it feels like a weird college essay question or candidate statement.
Even things like portal communication - doctors have different styles, caseloads, and billing structures. All of those will determine if you are able to get the answers you want from the portal - the doctor is under no specific obligation to communicate with you in a way you want via the portal.
You can - and should - ask questions that are concretely relevant to your care. But since you do not have an alternative provider, I would caution you against the questions - they would set up a very uncomfortable relationship.
I think if you are concerned about specific experiences and abilities, you can ask about those. Here's a suggested, potential script:
Even things like portal communication - doctors have different styles, caseloads, and billing structures. All of those will determine if you are able to get the answers you want from the portal - the doctor is under no specific obligation to communicate with you in a way you want via the portal.
You can - and should - ask questions that are concretely relevant to your care. But since you do not have an alternative provider, I would caution you against the questions - they would set up a very uncomfortable relationship.
I think if you are concerned about specific experiences and abilities, you can ask about those. Here's a suggested, potential script:
Hi Dr. X, it's so nice to meet you. I'm daisyace. I generally come to the doctor for issues related to Y and Z. I had some questions as a new patient - is this an okay time to ask you?posted by quadrilaterals at 6:23 AM on January 5, 2023 [68 favorites]
With previous doctors, I've communicated via the portal for questions on [billing, bloodwork, rx]. How does your office use the portal?
I've had some issues about [gender-related health issue]. Have you treated patients with this before? What is your approach?
I empathize with your desire to screen out all sorts of bullshit - but no, you really can't query your medical provider about their personal backstory for why they went the education route they did. That's a level of prying into their personal business that just isn't generally acceptable in this relationship.
Their attitude toward how they practice medicine now, however, very much is your business. I think you're on more solid ground asking about their views on how gender impacts medical care. I'd ask it almost exactly like that, what are their views and experiences with the impacts of gender on medical care? Keep it broad and see where they go with it, don't feed them the answer you want to hear back.
posted by Stacey at 6:24 AM on January 5, 2023 [14 favorites]
Their attitude toward how they practice medicine now, however, very much is your business. I think you're on more solid ground asking about their views on how gender impacts medical care. I'd ask it almost exactly like that, what are their views and experiences with the impacts of gender on medical care? Keep it broad and see where they go with it, don't feed them the answer you want to hear back.
posted by Stacey at 6:24 AM on January 5, 2023 [14 favorites]
I would suggest that you are using his med school background as a proxy for how good a doctor he will be for you, and having some anxiety that you would like him to reassure you about. As those things (med school and how good he will be for you) are not actually highly correlated, I think you need to let it go. You can infer a lot about how your experience will be gathering other, more relevant data. What is his approach to treating people with the same medical concerns you have? How does he like to communicate?
posted by studioaudience at 6:25 AM on January 5, 2023 [12 favorites]
posted by studioaudience at 6:25 AM on January 5, 2023 [12 favorites]
Your questions make it sound as if you're assuming he's an incompetent, sexist, bigot who loves woo and distrusts science.
Then your fantasy answers seems like the kind of info that I would never expect a professional to give out, nor would I as a (non-medical) professional give out to anyone I didn't know really well.
Politely, you're not being direct, you are genuinely being rude and prying. Please don't ask these questions.
posted by underclocked at 6:27 AM on January 5, 2023 [61 favorites]
Then your fantasy answers seems like the kind of info that I would never expect a professional to give out, nor would I as a (non-medical) professional give out to anyone I didn't know really well.
Politely, you're not being direct, you are genuinely being rude and prying. Please don't ask these questions.
posted by underclocked at 6:27 AM on January 5, 2023 [61 favorites]
There is a very old joke: Q: What do you call the person who graduated at the bottom of their medical school class? A: Doctor.
If he had gone to UT you would not be asking, and wouldn't even know he'd graduated last in his class. Asking is not appropriate and also not informative. (Where he did his residency is a much better indicator of, well, everything, as well as what certifications he holds. )
You can ask him if he's read any journal articles on gender bias in clinical practice and what his thoughts are about the emerging data.
posted by DarlingBri at 6:37 AM on January 5, 2023 [12 favorites]
If he had gone to UT you would not be asking, and wouldn't even know he'd graduated last in his class. Asking is not appropriate and also not informative. (Where he did his residency is a much better indicator of, well, everything, as well as what certifications he holds. )
You can ask him if he's read any journal articles on gender bias in clinical practice and what his thoughts are about the emerging data.
posted by DarlingBri at 6:37 AM on January 5, 2023 [12 favorites]
First and foremost, you need to be heard by the guy, and it sounds like you are self-aware about people sometimes getting defensive with your communication style. Tell him about you! Tell him you will sometimes ask questions that will focus on being female because you, like him, want to make sure that women are getting excellent medical care. Lead with the shared goal of the medical community, as it’s bigger than both of you. Both of you, with each appointment, are working to make this better.
He can’t change where he went to medical school, and by focusing on the past, you might create awkwardness for discussing where he is now. As a practicing professional he could be doing mentoring, research, committees, volunteer work, or even speaking at the local elementary school on career day, which might say a whole lot more about today. He may also be so overbooked that a question like that might be exasperating.
On the flip side, you have spent decades supporting the careers of female health professionals, and it sounds like, when you have a choice, that will resume. I’m not seeing a whole lot of red flags here, so you might need to make some peace with this brief stint with an OK male PCP. He may find candor refreshing and I truly hope it works out.
posted by childofTethys at 6:45 AM on January 5, 2023 [8 favorites]
He can’t change where he went to medical school, and by focusing on the past, you might create awkwardness for discussing where he is now. As a practicing professional he could be doing mentoring, research, committees, volunteer work, or even speaking at the local elementary school on career day, which might say a whole lot more about today. He may also be so overbooked that a question like that might be exasperating.
On the flip side, you have spent decades supporting the careers of female health professionals, and it sounds like, when you have a choice, that will resume. I’m not seeing a whole lot of red flags here, so you might need to make some peace with this brief stint with an OK male PCP. He may find candor refreshing and I truly hope it works out.
posted by childofTethys at 6:45 AM on January 5, 2023 [8 favorites]
Response by poster: notjustthefish,DarlingBri, and others who know about residencies and certifications -- I don't know enough about those to know: what could my questions about those be, and what should I make of potential answers?
(Everyone, what you've told me is helpful, and I'm hearing it -- I'm rushing out the door and will say more later!)
posted by daisyace at 6:50 AM on January 5, 2023
(Everyone, what you've told me is helpful, and I'm hearing it -- I'm rushing out the door and will say more later!)
posted by daisyace at 6:50 AM on January 5, 2023
Echoing the above. I think when trying to figure out if a PCP is a good fit for you picking out 2 or 3 top concerns and asking questions about that on your first appointment.
In general, my top priority is accessibility bc I have asthma and I can go from ok to need a hospital in a day, and there are small windows of opportunity to get things that can ensure I don't need hospitalization. So im pretty upfront about that. "I have asthma and sometimes I need care quickly. How can your practice accommodate that need? How can I communicate with you if I'm thinking im having a serious attack, what are your response times? "
I've literally had practices tell me that they can't handle that, and so I don't use them.
Its okay to ask something like how do you ensure your patients have been heard and respected?
Also it's okay to say something brief like "I felt my last physician was dismissive of xyz, it's important to me. Is that something we can focus on?"
You can ask one question about bias but it should be broad and give lots of room for answers. Another good question is if I feel dismissed something isn't being resolved, how can
we communicate about that?
As a warning, time in these appointments is short, and there physicians will focus on health history and current health because that is their job. The more you talk about them, the less room there is to talk about you, and it's just how primary care operates these days. They really don't have wiggle room to adjust the length of the appointment on the fly unless absolutely necessary.
posted by AlexiaSky at 6:50 AM on January 5, 2023 [14 favorites]
In general, my top priority is accessibility bc I have asthma and I can go from ok to need a hospital in a day, and there are small windows of opportunity to get things that can ensure I don't need hospitalization. So im pretty upfront about that. "I have asthma and sometimes I need care quickly. How can your practice accommodate that need? How can I communicate with you if I'm thinking im having a serious attack, what are your response times? "
I've literally had practices tell me that they can't handle that, and so I don't use them.
Its okay to ask something like how do you ensure your patients have been heard and respected?
Also it's okay to say something brief like "I felt my last physician was dismissive of xyz, it's important to me. Is that something we can focus on?"
You can ask one question about bias but it should be broad and give lots of room for answers. Another good question is if I feel dismissed something isn't being resolved, how can
we communicate about that?
As a warning, time in these appointments is short, and there physicians will focus on health history and current health because that is their job. The more you talk about them, the less room there is to talk about you, and it's just how primary care operates these days. They really don't have wiggle room to adjust the length of the appointment on the fly unless absolutely necessary.
posted by AlexiaSky at 6:50 AM on January 5, 2023 [14 favorites]
I strongly agree with @quadrilaterals and their suggested approach. One thing I wanted to add, specific to woo, is that you could ask about the COVID vaccine and vaccines generally -- what is his approach to vaccines and what does he recommend about the COVID vaccine. If he harbors the worst of the woo, you'll hear it in response to that question. Given your limited options, screening out anything other than the worst does not seem viable.
posted by OrangeDisk at 6:52 AM on January 5, 2023 [5 favorites]
posted by OrangeDisk at 6:52 AM on January 5, 2023 [5 favorites]
Given PCP scarcity in your area, you could ask if, after this introductory visit and physical, your care will be coordinated by a nurse practitioner or a physician's assistant -- there may be an opportunity to request a female provider within the practice.
posted by Iris Gambol at 7:07 AM on January 5, 2023 [7 favorites]
posted by Iris Gambol at 7:07 AM on January 5, 2023 [7 favorites]
I am a nurse and interact with many doctors all day long, for the last 11 years or so. I do not think which medical school someone went to has any relationship to their medical or interpersonal skills. If anything, I would avoid the doc who went to the most prestigious school as that indicates someone who prioritizes striving and how they are perceived by elites over bedside manner or technical competence. I would not recommend focusing on this as I'm not sure any answer, to any phrasing of a question about this, would provide you with any useful information.
If it is really important to you to know more about his educational background, you can ask something like, "Why did you pick x location for your residency?", but keep in mind, doctors have had years of experience giving bullshit answers to these types of questions. Imagine someone with over a decade of experience with high-stakes interviews about their own motivations. You have to develop a set of answers that you think will make people admire and like you. This is not the same as an honest and heartfelt answer that incorporates realities like, "I couldn't afford to live in NY" or "I had an anxiety disorder and had to give up my dream of trying to get a residency in LA" or whatever.
posted by latkes at 7:09 AM on January 5, 2023 [27 favorites]
If it is really important to you to know more about his educational background, you can ask something like, "Why did you pick x location for your residency?", but keep in mind, doctors have had years of experience giving bullshit answers to these types of questions. Imagine someone with over a decade of experience with high-stakes interviews about their own motivations. You have to develop a set of answers that you think will make people admire and like you. This is not the same as an honest and heartfelt answer that incorporates realities like, "I couldn't afford to live in NY" or "I had an anxiety disorder and had to give up my dream of trying to get a residency in LA" or whatever.
posted by latkes at 7:09 AM on January 5, 2023 [27 favorites]
I mean you have the control here and you can fire your doctor for whatever reason you want.
How old are they? At some point where you went to school becomes not nearly that important. If you cared about where I went to school now that I'm a professional with decades of experience, that would be odd to me. If I were just coming out of school or my first job, sure care about that. But if I have 20 years or experience in my field, most of what I know is from that experience at this point and not what I learned in a room in the 90's.
Generally for a primary care doc their residency is where they really learned practical medicine. Like others have said, a lot of people are forced to go to caribbean medical schools because they have no other avenue available to them. If they got into a US residency, that means they interviewed and matched and spent 3 years there working as a doctor. A residency program intensely interviewed them and decided they will be an asset to their program and will pass their step 2 and step 3 exams (otherwise the residency program gets dinged) and hired them. That is where their medical school experience was most relevant.
The bluntness stuff is fine, but insinuating they are second class because of where they went to school is silly. Ask if they are board certified. If they are, I think you should be satisfied with their training and judge them individually based on the actual experience of your doctor-patient relationship that you are just now starting.
The whole he's a male and you're a female is a reasonable and common concern. But the concern there is most likely with you and your comfort, not whether he is trained properly. Asking if the medical system is inherently biased against women sounds like a conversation for a bar and a couple of beers, not your new patient visit. Men are actually rarer in primary care...
posted by cmm at 7:12 AM on January 5, 2023 [1 favorite]
How old are they? At some point where you went to school becomes not nearly that important. If you cared about where I went to school now that I'm a professional with decades of experience, that would be odd to me. If I were just coming out of school or my first job, sure care about that. But if I have 20 years or experience in my field, most of what I know is from that experience at this point and not what I learned in a room in the 90's.
Generally for a primary care doc their residency is where they really learned practical medicine. Like others have said, a lot of people are forced to go to caribbean medical schools because they have no other avenue available to them. If they got into a US residency, that means they interviewed and matched and spent 3 years there working as a doctor. A residency program intensely interviewed them and decided they will be an asset to their program and will pass their step 2 and step 3 exams (otherwise the residency program gets dinged) and hired them. That is where their medical school experience was most relevant.
The bluntness stuff is fine, but insinuating they are second class because of where they went to school is silly. Ask if they are board certified. If they are, I think you should be satisfied with their training and judge them individually based on the actual experience of your doctor-patient relationship that you are just now starting.
The whole he's a male and you're a female is a reasonable and common concern. But the concern there is most likely with you and your comfort, not whether he is trained properly. Asking if the medical system is inherently biased against women sounds like a conversation for a bar and a couple of beers, not your new patient visit. Men are actually rarer in primary care...
posted by cmm at 7:12 AM on January 5, 2023 [1 favorite]
None of these questions are appropriate for a doctor/patient relationship. It’s not because you’re in a “submissive” role as another answer said—I think that’s a harmful way to think about medicine—but because you’re not here to evaluate your doctor’s competency level or personal beliefs, you’re here to get care.
In my opinion the best way to get answers for these questions is just to self-advocate as a patient and see how the doctor reacts. Some examples of how I’ve self-advocated:
-“That [medication/treatment/recovery plan/alternative medicine] won’t work for me because [reason]. Is there another option?”
-“I did some research on my own and I’m curious about whether this could be [diagnosis]. Can we test for that?”
-“I did some research and I’m curious about trying [drug/treatment/referral to specialist]. Do you think that would work for me?”
-“My previous doctor tried [treatment/diagnosis/referral] and it didn’t work because [reason]. Is that normal? Can we rule that out now?”
A good doctor will respect your preferences, explain their reasoning if they disagree with you, believe you immediately if you say “this hurts” or “I had this side effect”, and never push you into doing anything you’re uncomfortable with. A REALLY good doctor will explain all the options they considered, walk you through the science behind them, and lay out how they came to their conclusion…but REALLY good is rare and just good is okay.
posted by capricorn at 7:12 AM on January 5, 2023 [24 favorites]
In my opinion the best way to get answers for these questions is just to self-advocate as a patient and see how the doctor reacts. Some examples of how I’ve self-advocated:
-“That [medication/treatment/recovery plan/alternative medicine] won’t work for me because [reason]. Is there another option?”
-“I did some research on my own and I’m curious about whether this could be [diagnosis]. Can we test for that?”
-“I did some research and I’m curious about trying [drug/treatment/referral to specialist]. Do you think that would work for me?”
-“My previous doctor tried [treatment/diagnosis/referral] and it didn’t work because [reason]. Is that normal? Can we rule that out now?”
A good doctor will respect your preferences, explain their reasoning if they disagree with you, believe you immediately if you say “this hurts” or “I had this side effect”, and never push you into doing anything you’re uncomfortable with. A REALLY good doctor will explain all the options they considered, walk you through the science behind them, and lay out how they came to their conclusion…but REALLY good is rare and just good is okay.
posted by capricorn at 7:12 AM on January 5, 2023 [24 favorites]
Asking about his med school seems to me to be inappropriate and actually kind of classist.
But it’s totally ok in my opinion to ask about his gender care. Here’s how I asked my birth team about medical racism:
I’ve been reading a lot about medical racism in the childbirth space and it’s made me feel rather anxious since it aligns with some treatment I’ve experienced in the past in medical settings. Did you read about Serena Williams’ story? I will email a couple of specific pieces I’m referring to, it’s really scary. Can we talk a bit about ways you’ve seen medical racism play out with your clients or those of your colleagues, and discuss how we can keep me safe?
Answers that I used to disqualify providers were:
- nervous laughter, blushing, and racing words
- ”kindness” or “everybody”
- nervousness or avoidance or stuttering about saying the words Black or racism
- dismissing my concern with blanket reassurance that they had never seen anything racist
- dismissive / condescending reassurance that it would never happen to me even though that couldn’t be guaranteed since there was a chance that an unknown OB might take over my care during birth
Answers I received and accepted were:
- staying calm, speaking calmly, using the right terms without avoidance
- yes medical racism is real
- I would also be worried in your shoes
- I’ve read a lot about it
- I will be extra vigilant about consent with you
- we will always err on the side of offering pain-relief medication to override any “feel no pain” bias
- I will watch your body language carefully especially when we’re working with another provider
- you can always tell me if you notice something I do that’s not working and I will be receptive to feedback
- do you have any other suggestions we could try
- thank you for bringing this up
Obviously midwives and doulas are some of the more progressive types in healthcare but I also talked to my PCP (female, progressive, downtown provider in a large city with a very mixed demographic population) about this stuff and felt validated and cared for.
posted by nouvelle-personne at 7:13 AM on January 5, 2023 [48 favorites]
But it’s totally ok in my opinion to ask about his gender care. Here’s how I asked my birth team about medical racism:
I’ve been reading a lot about medical racism in the childbirth space and it’s made me feel rather anxious since it aligns with some treatment I’ve experienced in the past in medical settings. Did you read about Serena Williams’ story? I will email a couple of specific pieces I’m referring to, it’s really scary. Can we talk a bit about ways you’ve seen medical racism play out with your clients or those of your colleagues, and discuss how we can keep me safe?
Answers that I used to disqualify providers were:
- nervous laughter, blushing, and racing words
- ”kindness” or “everybody”
- nervousness or avoidance or stuttering about saying the words Black or racism
- dismissing my concern with blanket reassurance that they had never seen anything racist
- dismissive / condescending reassurance that it would never happen to me even though that couldn’t be guaranteed since there was a chance that an unknown OB might take over my care during birth
Answers I received and accepted were:
- staying calm, speaking calmly, using the right terms without avoidance
- yes medical racism is real
- I would also be worried in your shoes
- I’ve read a lot about it
- I will be extra vigilant about consent with you
- we will always err on the side of offering pain-relief medication to override any “feel no pain” bias
- I will watch your body language carefully especially when we’re working with another provider
- you can always tell me if you notice something I do that’s not working and I will be receptive to feedback
- do you have any other suggestions we could try
- thank you for bringing this up
Obviously midwives and doulas are some of the more progressive types in healthcare but I also talked to my PCP (female, progressive, downtown provider in a large city with a very mixed demographic population) about this stuff and felt validated and cared for.
posted by nouvelle-personne at 7:13 AM on January 5, 2023 [48 favorites]
I think it's totally appropriate to express your concerns about sexism in terms of your own needs as a patient, i.e. as AlexiaSky provided above. I don't think a good male doctor who sees women patients should find that awkward or be offended by any perceived presumption.
I agree with others that the stuff about his med school background is pretty inappropriate and most of all not really useful.
posted by dusty potato at 7:16 AM on January 5, 2023 [5 favorites]
I agree with others that the stuff about his med school background is pretty inappropriate and most of all not really useful.
posted by dusty potato at 7:16 AM on January 5, 2023 [5 favorites]
notjustthefish,DarlingBri, and others who know about residencies and certifications -- I don't know enough about those to know: what could my questions about those be, and what should I make of potential answers?I again don't think this question will give you the answers you need. Honestly, it's very impressive for someone from a Caribbean school to match and complete residency in the US - the deck is stacked against them. (I know several Caribbean grads who were unable to match.) In primary care, I don't think residency location is as relevant as it would be for a specialty, and I'm also not sure how you adjudicate the "best" residency
Unless you are interviewing your doctor for a job, I would also not ask this unless it gives you information to make a different choice. If the doctor said "I did my residency at UVM," what would you make of that vs. "I did my residency at MGH"? Would you find another doctor? I am not asking these to be oppositional; I really don't know what I would do and why it would matter. The note about time practicing above is also relevant - programs change and unless you have very specific inside information, it would be hard to say anything about anything based on residency site. (That said - many doctors will have residency information available publicly.)
I understand your concerns about getting a good PCP, but I'm not sure you can get this information in a single visit and I am sure you cannot get this information by asking questions about his resume. I would focus any questions about specific practices, experiences with health conditions you have, and expectations on both ends.
posted by quadrilaterals at 7:16 AM on January 5, 2023 [16 favorites]
I think you’re smart to realize that if you may be stuck with this provider no matter what, that you be careful with risking offending them in the first visit and starting off on the wrong foot.
- focus your questions on your care. There are some great sample questions above about how the practice handles communication, who you will actually see, how to get a speedy response or a nurse line etc
- focus on your specific issues. The Dr could be really sexist. They may not. How does this play out for you- do you have any illnesses that you have or are worried about that present very differently in men than women? I’m guessing that in your 50’s your personal access to abortion is less of a concern, but maybe you want to know how they manage menopause? Do you need trauma informed care in physicals with express consent at each part of the exam? I think framing and considering questions these ways will help you focus on the type of care you need, and rather than making the doctor the subject of the questions, it’s really about refocusing to you. Maybe they are a “second rate” doctor, but if they have good communication and responses to emerging events, maybe that’s more important than a doctor whose office of impossible to make an appointment at. It may not be ideal for you but it may help with the practicalities.
posted by raccoon409 at 7:28 AM on January 5, 2023 [2 favorites]
- focus your questions on your care. There are some great sample questions above about how the practice handles communication, who you will actually see, how to get a speedy response or a nurse line etc
- focus on your specific issues. The Dr could be really sexist. They may not. How does this play out for you- do you have any illnesses that you have or are worried about that present very differently in men than women? I’m guessing that in your 50’s your personal access to abortion is less of a concern, but maybe you want to know how they manage menopause? Do you need trauma informed care in physicals with express consent at each part of the exam? I think framing and considering questions these ways will help you focus on the type of care you need, and rather than making the doctor the subject of the questions, it’s really about refocusing to you. Maybe they are a “second rate” doctor, but if they have good communication and responses to emerging events, maybe that’s more important than a doctor whose office of impossible to make an appointment at. It may not be ideal for you but it may help with the practicalities.
posted by raccoon409 at 7:28 AM on January 5, 2023 [2 favorites]
It's a pretty hierarchical relationship and you're in the submissive role. Doubly so if you don't have an alternative, which is how it sounds from your description.
YIKES. Seconding that this is an extremely harmful way to think about medicine. I applaud that you are advocating for yourself (we all should!) and agree that you should focus your questions on sexism, bias and your needs as a patient. Good luck
posted by bahama mama at 7:30 AM on January 5, 2023 [7 favorites]
YIKES. Seconding that this is an extremely harmful way to think about medicine. I applaud that you are advocating for yourself (we all should!) and agree that you should focus your questions on sexism, bias and your needs as a patient. Good luck
posted by bahama mama at 7:30 AM on January 5, 2023 [7 favorites]
I'm going to go for the bonus points and suggest listening to this 63-minute podcast interview with an autistic woman professional who kept getting slammed by people being offended by her direct communication style, in order to see if it resonates.
posted by heatherlogan at 7:33 AM on January 5, 2023 [9 favorites]
posted by heatherlogan at 7:33 AM on January 5, 2023 [9 favorites]
I appreciate you are really concerned about this, and of course you want confidence in your healthcare provider. But what do you need a PCP for? To prescribe the occasional antibiotic or some other bread and butter treatment. How much can they really screw up? And you are kind of stuck with this PCP for now.
Where he went to med school is a non-issue. I’ve interacting with MDs from Harvard and other top tier med schools—some have been great, some have not.
Bias in medicine against women (and medical racism) are systematic issues, but a female doc is not automatically immune to it. I have had some lousy, sexist female MDs.
In my experience, the best you can do is be aware of the issue and work on being your own health advocate, so if anything comes up, you can handle it. (One example from somewhere on Metafilter-you can decline to be weighed.) It is not clear if you have had issues where your care was negatively impacted by gender bias. If you have, you should definitely mention those.
Good luck.
posted by rhonzo at 7:51 AM on January 5, 2023 [1 favorite]
Where he went to med school is a non-issue. I’ve interacting with MDs from Harvard and other top tier med schools—some have been great, some have not.
Bias in medicine against women (and medical racism) are systematic issues, but a female doc is not automatically immune to it. I have had some lousy, sexist female MDs.
In my experience, the best you can do is be aware of the issue and work on being your own health advocate, so if anything comes up, you can handle it. (One example from somewhere on Metafilter-you can decline to be weighed.) It is not clear if you have had issues where your care was negatively impacted by gender bias. If you have, you should definitely mention those.
Good luck.
posted by rhonzo at 7:51 AM on January 5, 2023 [1 favorite]
Oh my god, don't ask him why he went to a "second choice" Caribbean medical school. You know the answer to that one. If it's a problem for you, find a different doctor.
I also cannot imagine that you'll receive a satisfactory answer to your questions regarding gender bias in medicine, particularly not if you ask during an appointment with no prelude. Those questions, however, are less jaw-droppingly entitled than the ones about his education.
As far as showing him your former provider's response via MyChart, in my experience, physicians are VERY reluctant to step on toes by commenting negatively on the work of a colleague, even if they aren't affiliated with the same hospital or practice. He probably won't give you a candid answer, and really, he couldn't do so because he doesn't have any context for the response or why you felt it unsatisfactory. Especially since you don't even know this doctor and would be asking at your very first appointment, I don't think you'll receive any useful information by asking, and indeed, it could backfire and lead him to conclude that you're difficult to work with.
posted by easy, lucky, free at 8:21 AM on January 5, 2023 [12 favorites]
I also cannot imagine that you'll receive a satisfactory answer to your questions regarding gender bias in medicine, particularly not if you ask during an appointment with no prelude. Those questions, however, are less jaw-droppingly entitled than the ones about his education.
As far as showing him your former provider's response via MyChart, in my experience, physicians are VERY reluctant to step on toes by commenting negatively on the work of a colleague, even if they aren't affiliated with the same hospital or practice. He probably won't give you a candid answer, and really, he couldn't do so because he doesn't have any context for the response or why you felt it unsatisfactory. Especially since you don't even know this doctor and would be asking at your very first appointment, I don't think you'll receive any useful information by asking, and indeed, it could backfire and lead him to conclude that you're difficult to work with.
posted by easy, lucky, free at 8:21 AM on January 5, 2023 [12 favorites]
Maybe this is too obvious, or you did already, but have you googled him?
i would do that and (if nothing totally super weird pops up) see him for a health check (where i live insurance pays for one annually). This way you get to interact and experience his approach.
Chat if possible with is receptionist when you are there (small talk, not about his credentials etc, to get an idea about the practice. Something like Looks like you are having a busy/quiet/stressful etc day?).
Personally, i would not ask him any of those questions, but i am generally not direct.
posted by 15L06 at 8:24 AM on January 5, 2023
i would do that and (if nothing totally super weird pops up) see him for a health check (where i live insurance pays for one annually). This way you get to interact and experience his approach.
Chat if possible with is receptionist when you are there (small talk, not about his credentials etc, to get an idea about the practice. Something like Looks like you are having a busy/quiet/stressful etc day?).
Personally, i would not ask him any of those questions, but i am generally not direct.
posted by 15L06 at 8:24 AM on January 5, 2023
direct (read: unintentionally rude) When men act this way, they are perceived as direct and assertive, women are perceived as bitches. Yes, we have to navigate the world as we find it, but your harshness towards yourself opens the door for others to be harsh. You are honest and straightforward. Take a short list of notes with you; it's super helpful for it to be clear that you have a checklist. They have one, too, the screen they'll be staring at. The screen stuff is good because it helps them be thorough, but it does not assist personalization.
There is absolutely a bias against 2nd chance medical schools, but St. George is an accredited medical school. It's probably better to have a doctor who was one of the best at their school than a doctor who was low-ranked at a fancier school. And better to have a doctor who listens, asks the right questions, trusts patients, stays informed.
In any case, the doctor passed the licensing exams. The next question is if the doctor is Board Certified, meaning they passed exams in their specialty. You can also check to see if the doctor has licensing complaints. Here is a site I found with some advice about checking a doctor's reputation. Also, sending you a link via MeMail.
Your questions are Are they sexist? and Is their education valid? A negative approach does raise hackles. Instead, try There's a lot of evidence that women's health is not as well studied, and that women have trouble being heard well. Can you tell me how you address this?
The question I'd ask about education is What are your particular interests in continuing medical education?
Being assertive at the beginning may not make you more popular, but it will probably get you better care. Being female and 50+ means you will need care through menopause, an aging body, and whatever else. This is your health; it's important.
posted by theora55 at 8:54 AM on January 5, 2023 [7 favorites]
There is absolutely a bias against 2nd chance medical schools, but St. George is an accredited medical school. It's probably better to have a doctor who was one of the best at their school than a doctor who was low-ranked at a fancier school. And better to have a doctor who listens, asks the right questions, trusts patients, stays informed.
In any case, the doctor passed the licensing exams. The next question is if the doctor is Board Certified, meaning they passed exams in their specialty. You can also check to see if the doctor has licensing complaints. Here is a site I found with some advice about checking a doctor's reputation. Also, sending you a link via MeMail.
Your questions are Are they sexist? and Is their education valid? A negative approach does raise hackles. Instead, try There's a lot of evidence that women's health is not as well studied, and that women have trouble being heard well. Can you tell me how you address this?
The question I'd ask about education is What are your particular interests in continuing medical education?
Being assertive at the beginning may not make you more popular, but it will probably get you better care. Being female and 50+ means you will need care through menopause, an aging body, and whatever else. This is your health; it's important.
posted by theora55 at 8:54 AM on January 5, 2023 [7 favorites]
You guys, why are you hearing, "I know this isn't the right way," and responding "No! You are wrong to do things the not-right way!" She _knows_ . This isn't the purpose here.
I'm upset because this happens to me. Please hear the actual question:
They are at least equal partners, and ultimately the good or bad outcomes here affect her much much much more than they affect a doctor, so she should be in charge -- given that she's choosing to hire an expensive, highly-trained professional to help her, it would be foolish to not give that person the space and time and respect they need to work well, but this whole "submissive" idea is _not a good place to go_.
OP, I want you to know that I am 100% behind you in your desire to get in front of these issues. And even more supportive of the fact that you recognized your own lack of knowledge and sought to ameliorate that by _asking for more information here_.
To the question:
1) Educational background: what you're really trying to find out is if this person has whatever skill they would have at a "good" school. I believe this is what job interviews are trying to accomplish with questions like, "Tell me about a difficult problem you had to solve and how you solved it," or, "When was a time you were surprised to have your assumptions proven wrong." Unfortunately, these are also not a good fit for your office visit :)
Here's what I've done: when you need to call the office for some other reason, or during any other more casual/open-ended/low-focus interaction, ask the receptionist or nurse who they would go to if they had a real problem. Sometimes you get a vague "everybody's good" answer, but sometimes you can get a more open conversation, if you give signs that you are discreet and understanding.
You can also sometimes find interviews with the doctor in question, things they've written, etc.
However, your best bet is being astute during your time with that person, seeing how they handle complexities you bring up during the visit, and maybe asking what their particular interests are (and why) or some other easy-to-answer question that gives them a chance to show a little of their mind.
actual questions though
One approach that might be focused and interesting would be asking something like, "Since you graduated relatively recently, what do you think is newest in the education you got? What's changed in the way doctors are taught now vs. 10-20 years ago?".
Another possible approach: "What's the most surprisingly revelatory question or test you do with new patients?"
These are good conversational questions that give the doctor a chance to talk about something interesting to him, in an open-ended way, that also will show you something about the way his mind works.
Previously, people have evaluated doctors by how much or how well they seemed to listen to patients. This is important, but like anything people start caring about, it's been emphasized a bit. This is good! But I personally am a tiny bit wary of the emphasis on "bedside manner" I'm perceiving lately: doctors seem to be trained to listen in a way that makes people feel heard, which is great, but sometimes it seems performative and might occasionally prevent either of us (doctor and patient) from doing our best (I am not saying we should go backward to zero listening, though). Sometimes, I leave an appointment feeling that the doctor wasted a little bit of time just prompting me to talk about whatever, and making sure I 'felt heard', even though I didn't really have anything [that I thought was] relevant to say.
One issue that matters is handling complexity. Something I've been interested in is the idea of gerontology as a field, since complexity is part of what makes older patients challenging (I've heard). You can ask about this: "I know that caring for mature patients, which I'm becoming, can get complicated, since we tend to accumulate interacting conditions as we age. Does this practice [not putting all that on him personally] have any particular strategies for handling that, or do you personally? Do you think there's a specific age at which I should consider getting a gerontologist?"
One final idea: there has been some good information given in this thread about the phenomenon of 'alternative' medical schools. Now that you have that info, you could say something like, "I of course tried to learn as much about you as I could before this appointment, since one's doctor is so important. I asked around about St. George's, which I think is where you went to medical school, and it turns out it's really a rather impressive path. Did you like it?" Now, he can say why he liked it, including any outstanding features of the school's approach, and maybe how he thinks it compares to John's Hopkins or whatever -- but he gets to choose what he's comfortable with.
2) Medical sexism:
Avoid using the exact phrase "medical sexism" - the morpheme 'sex' just jumps out and makes everything more agitated, and the phrase is used by people when they are angry (justifiably so), so it takes conversations toward confrontation and away from real disclosure.
Instead, you can refer to things that are factual and/or have emotional weight for you, like X story in the New York times about Y event, which is just one instance of the kind of thing in the Z study that came out in 2018 that found that [something like women's health outcomes are on average X% worse than men's]. The study I'm thinking of was focused on emergency-room medicine, so (you can mention) it's a totally different situation than when you have a one-on-one relationship, built over time, with someone who knows you personally. Then, you can ask for advice, based on his knowing other doctors and also dealing with patients, on how to avoid having that kind of thing happen to you.
Then: you've given him an opportunity to blame women for the effects of bias. You can see how he handles that.
You can ask if this is addressed in his schooling; if his teachers, or he, have any thoughts about why this happens, or what can be (and is) done to avoid it or compensate for it. To make it less confrontational, you can open by being a little vulnerable and either mention a time it affected you or say that you know people (including me, actually) who have been affected by
You can also take a person-relating-to-person approach, and ask if he knows anyone or has any family members who have been affected by this. This is not an opening question, but rather a follow up if he seems open.
--
I've written a lot here. You obviously shouldn't try to ask every single question I wrote, but I hope the overall approach is helpful. Maybe there are one or two you can bring with you.
If you want to be strategic, think about when, during the appointment, you would ask them; what to do if everything seems rushed, or he is late -- do you ask later? Do you shoehorn in one quick question? Do you hang around the phlebotomy station, looking for gossipy assistants? Do you just stay calm, ask your questions in the middle of the appointment, and be OK with letting the next person wait as you had to wait? Do you plan for a follow-up appointment and ask then?
-- one more suggestion --
I've also had a _lot_ of success with compiling a document myself, before an initial appointment, listing all medications and concerns (and usually some questions). I try to keep the concerns, allergy and/or an overview of my health status on one page, and the medications on a separate page. My doctors seem to all ask about vitamin supplementation, so I include that. I also have a report of the frequency of my headaches, since that's a usual question. The nurses love having everything written down (nobody seems to know how to spell 'propylene glycol' or even my name), and, even if the doctor finds it odd, I at least know that they have _seen_ all relevant information right then.
posted by amtho at 8:56 AM on January 5, 2023 [19 favorites]
I'm upset because this happens to me. Please hear the actual question:
Given that I am a person who already has sensitivity enough to understand there _is_ a better way, but being a person who is tired, busy, and not infinitely educated in the myriad ways things can go wrong -- but grateful that I've learned from past experience that I cannot imagine every possible scenario and just pick the right one -- please help me, the person who is being open and vulnerable with you, by doing a little bit of creative thinking and proposing good alternatives for me. I am clearly very, very open to learning from positive suggestions, so please don't make me less open by scolding me for well-intentioned mistakes that I am already working hard to avoid and about which I am already embarrassed enough.Also, WTF? It's a pretty hierarchical relationship and you're in the submissive role. No, no she shouldn't be in a submissive role. It's not like just doing whatever people tell you to do and expecting them to take care of you will lead to a good outcome, and it's not like a person with an excellent education also can know everything about her history, her body, or her as a person.
They are at least equal partners, and ultimately the good or bad outcomes here affect her much much much more than they affect a doctor, so she should be in charge -- given that she's choosing to hire an expensive, highly-trained professional to help her, it would be foolish to not give that person the space and time and respect they need to work well, but this whole "submissive" idea is _not a good place to go_.
OP, I want you to know that I am 100% behind you in your desire to get in front of these issues. And even more supportive of the fact that you recognized your own lack of knowledge and sought to ameliorate that by _asking for more information here_.
To the question:
1) Educational background: what you're really trying to find out is if this person has whatever skill they would have at a "good" school. I believe this is what job interviews are trying to accomplish with questions like, "Tell me about a difficult problem you had to solve and how you solved it," or, "When was a time you were surprised to have your assumptions proven wrong." Unfortunately, these are also not a good fit for your office visit :)
Here's what I've done: when you need to call the office for some other reason, or during any other more casual/open-ended/low-focus interaction, ask the receptionist or nurse who they would go to if they had a real problem. Sometimes you get a vague "everybody's good" answer, but sometimes you can get a more open conversation, if you give signs that you are discreet and understanding.
You can also sometimes find interviews with the doctor in question, things they've written, etc.
However, your best bet is being astute during your time with that person, seeing how they handle complexities you bring up during the visit, and maybe asking what their particular interests are (and why) or some other easy-to-answer question that gives them a chance to show a little of their mind.
actual questions though
One approach that might be focused and interesting would be asking something like, "Since you graduated relatively recently, what do you think is newest in the education you got? What's changed in the way doctors are taught now vs. 10-20 years ago?".
Another possible approach: "What's the most surprisingly revelatory question or test you do with new patients?"
These are good conversational questions that give the doctor a chance to talk about something interesting to him, in an open-ended way, that also will show you something about the way his mind works.
Previously, people have evaluated doctors by how much or how well they seemed to listen to patients. This is important, but like anything people start caring about, it's been emphasized a bit. This is good! But I personally am a tiny bit wary of the emphasis on "bedside manner" I'm perceiving lately: doctors seem to be trained to listen in a way that makes people feel heard, which is great, but sometimes it seems performative and might occasionally prevent either of us (doctor and patient) from doing our best (I am not saying we should go backward to zero listening, though). Sometimes, I leave an appointment feeling that the doctor wasted a little bit of time just prompting me to talk about whatever, and making sure I 'felt heard', even though I didn't really have anything [that I thought was] relevant to say.
One issue that matters is handling complexity. Something I've been interested in is the idea of gerontology as a field, since complexity is part of what makes older patients challenging (I've heard). You can ask about this: "I know that caring for mature patients, which I'm becoming, can get complicated, since we tend to accumulate interacting conditions as we age. Does this practice [not putting all that on him personally] have any particular strategies for handling that, or do you personally? Do you think there's a specific age at which I should consider getting a gerontologist?"
One final idea: there has been some good information given in this thread about the phenomenon of 'alternative' medical schools. Now that you have that info, you could say something like, "I of course tried to learn as much about you as I could before this appointment, since one's doctor is so important. I asked around about St. George's, which I think is where you went to medical school, and it turns out it's really a rather impressive path. Did you like it?" Now, he can say why he liked it, including any outstanding features of the school's approach, and maybe how he thinks it compares to John's Hopkins or whatever -- but he gets to choose what he's comfortable with.
2) Medical sexism:
Avoid using the exact phrase "medical sexism" - the morpheme 'sex' just jumps out and makes everything more agitated, and the phrase is used by people when they are angry (justifiably so), so it takes conversations toward confrontation and away from real disclosure.
Instead, you can refer to things that are factual and/or have emotional weight for you, like X story in the New York times about Y event, which is just one instance of the kind of thing in the Z study that came out in 2018 that found that [something like women's health outcomes are on average X% worse than men's]. The study I'm thinking of was focused on emergency-room medicine, so (you can mention) it's a totally different situation than when you have a one-on-one relationship, built over time, with someone who knows you personally. Then, you can ask for advice, based on his knowing other doctors and also dealing with patients, on how to avoid having that kind of thing happen to you.
Then: you've given him an opportunity to blame women for the effects of bias. You can see how he handles that.
You can ask if this is addressed in his schooling; if his teachers, or he, have any thoughts about why this happens, or what can be (and is) done to avoid it or compensate for it. To make it less confrontational, you can open by being a little vulnerable and either mention a time it affected you or say that you know people (including me, actually) who have been affected by
You can also take a person-relating-to-person approach, and ask if he knows anyone or has any family members who have been affected by this. This is not an opening question, but rather a follow up if he seems open.
--
I've written a lot here. You obviously shouldn't try to ask every single question I wrote, but I hope the overall approach is helpful. Maybe there are one or two you can bring with you.
If you want to be strategic, think about when, during the appointment, you would ask them; what to do if everything seems rushed, or he is late -- do you ask later? Do you shoehorn in one quick question? Do you hang around the phlebotomy station, looking for gossipy assistants? Do you just stay calm, ask your questions in the middle of the appointment, and be OK with letting the next person wait as you had to wait? Do you plan for a follow-up appointment and ask then?
-- one more suggestion --
I've also had a _lot_ of success with compiling a document myself, before an initial appointment, listing all medications and concerns (and usually some questions). I try to keep the concerns, allergy and/or an overview of my health status on one page, and the medications on a separate page. My doctors seem to all ask about vitamin supplementation, so I include that. I also have a report of the frequency of my headaches, since that's a usual question. The nurses love having everything written down (nobody seems to know how to spell 'propylene glycol' or even my name), and, even if the doctor finds it odd, I at least know that they have _seen_ all relevant information right then.
posted by amtho at 8:56 AM on January 5, 2023 [19 favorites]
I think your assumption here might be mistaken:
And frankly, unless I hate the guy, he's my PCP for now because beggars can't be choosers.
But in the future, maybe I'll have more choice again, and if I'm ever going to ask probing questions for that eventuality, this seems like the time.
I personally do not agree that now is the time or that earlier is better. Once you've received some care from him, you'll be in a much better position to gauge potential areas of weakness or bias - not to mention that Q&A isn't the only way to assess someone's treatment, as even someone who assures you they are perfectly aware of medical sexism in an early conversation is still capable of perpetuating it in their care. Plus, you'll have a stronger doctor-patient relationship built to inform those conversations. "Why did you suggest X for me?" is a much more appropriate - and useful - question than "How do you address medical sexism in your care?", even though they can both probe issues of bias.
If this is your doctor for now, and given that you have a limited amount of time in each visit, I'd focus on your medical needs first and then get a sense of their philosophy through how they respond to those needs.
posted by mosst at 8:56 AM on January 5, 2023 [14 favorites]
And frankly, unless I hate the guy, he's my PCP for now because beggars can't be choosers.
But in the future, maybe I'll have more choice again, and if I'm ever going to ask probing questions for that eventuality, this seems like the time.
I personally do not agree that now is the time or that earlier is better. Once you've received some care from him, you'll be in a much better position to gauge potential areas of weakness or bias - not to mention that Q&A isn't the only way to assess someone's treatment, as even someone who assures you they are perfectly aware of medical sexism in an early conversation is still capable of perpetuating it in their care. Plus, you'll have a stronger doctor-patient relationship built to inform those conversations. "Why did you suggest X for me?" is a much more appropriate - and useful - question than "How do you address medical sexism in your care?", even though they can both probe issues of bias.
If this is your doctor for now, and given that you have a limited amount of time in each visit, I'd focus on your medical needs first and then get a sense of their philosophy through how they respond to those needs.
posted by mosst at 8:56 AM on January 5, 2023 [14 favorites]
I like quadrilateral and theora55 and amtho's suggested approaches, and also the strategy of asking about Covid as something to use to evaluate this person's views.
As an older woman, I did want to call out specifically what people are mentioning about that. In addition to sexism/paternalism in doctors, as I have gotten older I have experienced some ageism in doctors, including some who have great credentials on paper and even great reviews. The issues as you get older, and especially with women, call for different thinking/approaches/treatment sometimes from medical providers, and I would want to know that the person is paying some attention to that.
posted by gudrun at 8:59 AM on January 5, 2023 [2 favorites]
As an older woman, I did want to call out specifically what people are mentioning about that. In addition to sexism/paternalism in doctors, as I have gotten older I have experienced some ageism in doctors, including some who have great credentials on paper and even great reviews. The issues as you get older, and especially with women, call for different thinking/approaches/treatment sometimes from medical providers, and I would want to know that the person is paying some attention to that.
posted by gudrun at 8:59 AM on January 5, 2023 [2 favorites]
asking the questions so bluntly here is making people bristle
It's not the bluntness of the questions that's making people bristle; it's the assumptions behind them. Namely, that he's a bad doctor because he went to a certain medical school, and that you're the intrepid detective who's going to unmask him as a sexist fraud.
Personally, I wouldn't ask him these kinds of questions. They're... not the kind of questions that would elicit a sincere response. "Do you believe the care you provide is biased against women?" Do you seriously expect him to answer that question affirmatively? To a woman? Of course not. Even if he is extremely misogynistic, he'll bullshit the answer and tell you what you want to hear. You may think you have a finely-tuned bullshit detector, but if you truly do, it would have already gone off before you asked him such an asinine question.
If it were me, I'd approach it more obliquely. My preferred approach, if I knew other doctors in the area, would be to ask them. Do you see other doctors (i.e., specialists)? Do you have any doctor friends? Professionals love assessing the qualifications of other professionals. If you don't know any other doctors, do you have any friends or acquaintances who could answer your questions for you? If I were worried about sexism, I would find it a lot more reassuring to hear from another woman who had a positive experience with this guy than to have him give some BS spiel about how of course he believes in equality. Worst case scenario, ask on Facebook. There's probably a local group, and you can be as direct or indirect as you'd like there. FB randos are more hit-or-miss than people you already know and trust, but you're still hearing from real people who have had real interactions with this person.
posted by kevinbelt at 9:04 AM on January 5, 2023 [25 favorites]
It's not the bluntness of the questions that's making people bristle; it's the assumptions behind them. Namely, that he's a bad doctor because he went to a certain medical school, and that you're the intrepid detective who's going to unmask him as a sexist fraud.
Personally, I wouldn't ask him these kinds of questions. They're... not the kind of questions that would elicit a sincere response. "Do you believe the care you provide is biased against women?" Do you seriously expect him to answer that question affirmatively? To a woman? Of course not. Even if he is extremely misogynistic, he'll bullshit the answer and tell you what you want to hear. You may think you have a finely-tuned bullshit detector, but if you truly do, it would have already gone off before you asked him such an asinine question.
If it were me, I'd approach it more obliquely. My preferred approach, if I knew other doctors in the area, would be to ask them. Do you see other doctors (i.e., specialists)? Do you have any doctor friends? Professionals love assessing the qualifications of other professionals. If you don't know any other doctors, do you have any friends or acquaintances who could answer your questions for you? If I were worried about sexism, I would find it a lot more reassuring to hear from another woman who had a positive experience with this guy than to have him give some BS spiel about how of course he believes in equality. Worst case scenario, ask on Facebook. There's probably a local group, and you can be as direct or indirect as you'd like there. FB randos are more hit-or-miss than people you already know and trust, but you're still hearing from real people who have had real interactions with this person.
posted by kevinbelt at 9:04 AM on January 5, 2023 [25 favorites]
the only useful way to find out how a doctor treats women patients is to go in there appearing to be a woman and find out how he talks to you.
there are doctors who are not sexist but may appear to be the first time you meet them because they talk to all patients like slow children, not just women, and you have no way of knowing. but if you wouldn't want to be their patient anyway, it doesn't matter if you guess wrong about why they're like that. you would still know you don't want to deal with them.
in the u.s., you can and should look up the various unofficial ratings/review sites that practically all doctors show up on. almost all doctors of all types will have a four or five star average, with most people saying they're great and a solid minority saying they're monsters. this means nothing. UNLESS there is a very specific pattern among the patients who have bad things to say about him. sometimes there is. sometimes all the people who say a specific bad thing about a doctor are women. when there is a clear pattern, trust and believe it.
the very rare exception who has a very low average rating is either very unlucky or super fucked up. once I went to a primary care doc with nothing but one-star reviews out of sheer curiosity and contrarianism (she was a young-ish woman, had a real medical degree, and I thought How bad could she really be. real bad, it turned out.)
all this is good self-protective practice. however, challenging a doctor to prove he's not sexist will go about as well as treating a non-doctor that way (not well.)
posted by queenofbithynia at 9:06 AM on January 5, 2023 [3 favorites]
there are doctors who are not sexist but may appear to be the first time you meet them because they talk to all patients like slow children, not just women, and you have no way of knowing. but if you wouldn't want to be their patient anyway, it doesn't matter if you guess wrong about why they're like that. you would still know you don't want to deal with them.
in the u.s., you can and should look up the various unofficial ratings/review sites that practically all doctors show up on. almost all doctors of all types will have a four or five star average, with most people saying they're great and a solid minority saying they're monsters. this means nothing. UNLESS there is a very specific pattern among the patients who have bad things to say about him. sometimes there is. sometimes all the people who say a specific bad thing about a doctor are women. when there is a clear pattern, trust and believe it.
the very rare exception who has a very low average rating is either very unlucky or super fucked up. once I went to a primary care doc with nothing but one-star reviews out of sheer curiosity and contrarianism (she was a young-ish woman, had a real medical degree, and I thought How bad could she really be. real bad, it turned out.)
all this is good self-protective practice. however, challenging a doctor to prove he's not sexist will go about as well as treating a non-doctor that way (not well.)
posted by queenofbithynia at 9:06 AM on January 5, 2023 [3 favorites]
Maybe you don't need to approach this by asking questions. You could just tell this doc what your concerns are and if he doesn't listen, you know he's not for you. Don't bring up the medical school thing, though. One of the first responses to your question was from a doctor, I think, and it was perfect imo.
posted by BibiRose at 9:21 AM on January 5, 2023 [2 favorites]
posted by BibiRose at 9:21 AM on January 5, 2023 [2 favorites]
Nah, I think calling it a "second chance school" illustrates that there are some assumptions present.
posted by sagc at 9:28 AM on January 5, 2023 [28 favorites]
posted by sagc at 9:28 AM on January 5, 2023 [28 favorites]
If you are going to bring up online research start the conversation with symptoms, then possible diagnosis and ask what tilts toward it for your situation, or away from it.
The metaphorical language is horses and zebras, well, sometimes you have to pay attention to Specific Kinds of Horses, because a Shetland mare is not the same as an Arabian gelding that is trained for steeplechase events.
There are a thousand dismissals that sound like Dr Google, sometimes it’s helpful to bring up a specific context like CHADD (specific horse group) or the Muscular Dystrophy Association (that’s a herd of zebras)
posted by childofTethys at 9:32 AM on January 5, 2023
The metaphorical language is horses and zebras, well, sometimes you have to pay attention to Specific Kinds of Horses, because a Shetland mare is not the same as an Arabian gelding that is trained for steeplechase events.
There are a thousand dismissals that sound like Dr Google, sometimes it’s helpful to bring up a specific context like CHADD (specific horse group) or the Muscular Dystrophy Association (that’s a herd of zebras)
posted by childofTethys at 9:32 AM on January 5, 2023
But this whole thing is sorta weird. I mean I get the intent, but flying into this new relationship bullets flying may easily be off-putting and start things out on the wrong foot. It may spoil what could be an effective relationship. Both the doctor and the patient benefit if the relationship is a good one and both suffer is there are incompatibilities, but trying to suss that out in a 15 or 30 minute new patient visit is tough.
In what professional setting will the answer to "are you anti-sexist" going to be anything other than a stock response? In what professional setting is "you must not have gotten into any of the schools you wanted to since you ended up at St. George's. Want to talk about it?" going to be an appropriate conversation? You'll get more information about how much patience and poise they have for inappropriate questions more than actual answers to your questions. I guess in the age of Google and WebMD patience and poise for inappropriate questions is sort of a key skill for doctors...
Primary care doctors are board certified. If your doctor is board certified, you just need to assume they have the skills to be your doctor. Boards are the same regardless of what medical school you attend or residency you worked at. But it is still just a test and the individual person who is your doctor may have personal opinions, preferences, and biases that may not be compatible with you. Maybe it seems like a good idea to figure all of that out up front somehow, but socially I have no idea how you can accomplish that within the context of a new patient visit. It will realistically take years of visits and continuity of care and your responsibility through that is advocating for yourself; the doctor's responsibility is to give you the best care they can.
Think of it from the doctor's side. They probably have 12 patients in the half day, of which you are one. They have charting to go with each of those 12 patients. They may even have another 12 patients in the afternoon too. They probably have some of their patients in the hospital and might get paged out by hospitalists. And you're sitting in a room asking for their personal self reflection on their own gender bias. Maybe they like that topic and will gladly talk to you for a bit, but maybe they are thinking "why in the heck does the office keep adding patients to my panel when I only see patients 5 half days a week and already have 6000 on my panel. Why do they keep putting new patients into 15 minute slots when they take 30 minutes! I'm going to be behind now, have 2 other patients sitting in rooms already waiting for me, and am going to have to skip lunch just to get back on track this afternoon and I'm going to be charting all night. I need to pee."
posted by cmm at 10:20 AM on January 5, 2023 [9 favorites]
In what professional setting will the answer to "are you anti-sexist" going to be anything other than a stock response? In what professional setting is "you must not have gotten into any of the schools you wanted to since you ended up at St. George's. Want to talk about it?" going to be an appropriate conversation? You'll get more information about how much patience and poise they have for inappropriate questions more than actual answers to your questions. I guess in the age of Google and WebMD patience and poise for inappropriate questions is sort of a key skill for doctors...
Primary care doctors are board certified. If your doctor is board certified, you just need to assume they have the skills to be your doctor. Boards are the same regardless of what medical school you attend or residency you worked at. But it is still just a test and the individual person who is your doctor may have personal opinions, preferences, and biases that may not be compatible with you. Maybe it seems like a good idea to figure all of that out up front somehow, but socially I have no idea how you can accomplish that within the context of a new patient visit. It will realistically take years of visits and continuity of care and your responsibility through that is advocating for yourself; the doctor's responsibility is to give you the best care they can.
Think of it from the doctor's side. They probably have 12 patients in the half day, of which you are one. They have charting to go with each of those 12 patients. They may even have another 12 patients in the afternoon too. They probably have some of their patients in the hospital and might get paged out by hospitalists. And you're sitting in a room asking for their personal self reflection on their own gender bias. Maybe they like that topic and will gladly talk to you for a bit, but maybe they are thinking "why in the heck does the office keep adding patients to my panel when I only see patients 5 half days a week and already have 6000 on my panel. Why do they keep putting new patients into 15 minute slots when they take 30 minutes! I'm going to be behind now, have 2 other patients sitting in rooms already waiting for me, and am going to have to skip lunch just to get back on track this afternoon and I'm going to be charting all night. I need to pee."
posted by cmm at 10:20 AM on January 5, 2023 [9 favorites]
For a first patient appointment, you are likely going to get 15 minutes with the physician, at best. You need to spend your time discussing your health concerns and determining from his responses if you have confidence in him as a provider. If his clinical approach or personal style are not a fit, you look for someone else. The other topics you identified are inappropriate and in my opinion, likely to hinder a productive patient-provider relationship. You may also mark your self as a difficult patient and that can have ramifications beyond just this provider.
posted by fies at 10:34 AM on January 5, 2023 [4 favorites]
posted by fies at 10:34 AM on January 5, 2023 [4 favorites]
The Ask MetaFilter community is wonderful for almost always providing thoughtful and considerate answers to difficult questions, even when the poster has trouble with social conventions and communication (which the poster stated upfront they do). My reading of the poster's situation is more along the lines of amtho's. With that in mind, there are some really great ideas above about how to approach the questions in an indirect way, but it occurs to me that applying them may be a challenge for the OP if the approach conflicts with the OP's default communication style. So, I just want to suggest to the OP that practicing the questions (very few questions) ahead of time and, especially, anticipating your possible emotional reactions to the doctor's answers may be helpful in order to avoid getting derailed or blindsided during the meeting. It might even be worth writing it all down in a table or flowchart form. This can also help cope with the very limited amount of time the doctor will have for you – what people say above about lack of time for deep discussions is really true, so whatever you want to accomplish, you need to do it quickly.
In any case, good luck, OP! And hopefully other MeFites will continue with more good answers and avoid snarky dismissive one-liners like the one above that starts with "Nah ..."
posted by StrawberryPie at 10:40 AM on January 5, 2023 [6 favorites]
In any case, good luck, OP! And hopefully other MeFites will continue with more good answers and avoid snarky dismissive one-liners like the one above that starts with "Nah ..."
posted by StrawberryPie at 10:40 AM on January 5, 2023 [6 favorites]
My understanding is that new patient appointments, at least in the parts of the United States where I've lived, are usually a lot longer than most appointments. That is why, sometimes, you have to wait a long time to get a new patient appointment -- the doctors' schedule doesn't have many blocks of time that large.
posted by amtho at 10:42 AM on January 5, 2023 [2 favorites]
posted by amtho at 10:42 AM on January 5, 2023 [2 favorites]
It's generally wise to ask questions when hiring someone -- a therapist, a painter, an employee, and, yes, even a doctor.
They should be partners. There is at best no need for submission or hierarchy.
posted by NotLost at 10:45 AM on January 5, 2023 [8 favorites]
They should be partners. There is at best no need for submission or hierarchy.
posted by NotLost at 10:45 AM on January 5, 2023 [8 favorites]
My understanding is that new patient appointments, at least in the parts of the United States where I've lived, are usually a lot longer than most appointments. That is why, sometimes, you have to wait a long time to get a new patient appointment -- the doctors' schedule doesn't have many blocks of time that large.
I brought up appointment length to encourage the poster to really consider how they want to use what will likely be limited time.
It may vary, but my experience with the health systems that I have worked in and used is that new patient appointments are scheduled for 40 minutes, to include vitals, physical exam, and sometimes blood work. Only a portion of that time is with the actual physician, and that time is usually on the order of 15 minutes. Again it may vary, but my point is that there will not likely be time for free-wheeling conversation.
posted by fies at 10:50 AM on January 5, 2023 [1 favorite]
I brought up appointment length to encourage the poster to really consider how they want to use what will likely be limited time.
It may vary, but my experience with the health systems that I have worked in and used is that new patient appointments are scheduled for 40 minutes, to include vitals, physical exam, and sometimes blood work. Only a portion of that time is with the actual physician, and that time is usually on the order of 15 minutes. Again it may vary, but my point is that there will not likely be time for free-wheeling conversation.
posted by fies at 10:50 AM on January 5, 2023 [1 favorite]
These questions could make for a great conversation or job interview, and... you're not having a conversation or job interview. You're just trying to assess how to best work with the only PCP on offer.
With that in mind, I'd just jump straight into talking about actual medical stuff in order to get a sense of where his strengths are and how he does things. In particular, if you have any reproductive, transition-related, or disability-related health concerns, how he responds to those says a lot about how he is as a doctor. (I'm not trying to presume anything—I just have no idea what your actual health situation is.)
posted by spiderbeforesunset at 11:05 AM on January 5, 2023 [1 favorite]
With that in mind, I'd just jump straight into talking about actual medical stuff in order to get a sense of where his strengths are and how he does things. In particular, if you have any reproductive, transition-related, or disability-related health concerns, how he responds to those says a lot about how he is as a doctor. (I'm not trying to presume anything—I just have no idea what your actual health situation is.)
posted by spiderbeforesunset at 11:05 AM on January 5, 2023 [1 favorite]
Wow. I am a female physician. I trained at excellent places. I think medicine is biased against women and I implement idea that in my daily work. But if a patient came in the door with these questions, it would raise a million red flags and would indicate that they were likely not a good fit for my practice. PCPs are the most under-appreciated and overworked and valuable people in our medical system. You are entitled to excellent medical care by all physicians you see, but that doesn't mean you are entitled to come into their office with these intrusive and belittling questions. Doctors are humans (though I think this has been forgotten during COVID, when suddenly nurses and doctors became villains).
Also re the patient portal: PCPs get literally 100s of messages a day from patients that they are managing in between actually SEEING patients in person. The idea you would try to test this doctor on how they reply to a message in a patient portal is ... beyond words honestly.
posted by namemeansgazelle at 11:27 AM on January 5, 2023 [55 favorites]
Also re the patient portal: PCPs get literally 100s of messages a day from patients that they are managing in between actually SEEING patients in person. The idea you would try to test this doctor on how they reply to a message in a patient portal is ... beyond words honestly.
posted by namemeansgazelle at 11:27 AM on January 5, 2023 [55 favorites]
A data point in St. George's grads - a friend of mine, a grad from St George's is boarded in Anesthesiology, and has risen to Chief of Anesthesiology at a large hospital in New England. So as others have said, it's not so much where you went to school - there are multiple bars medical school grads must surmount after successfully graduating, including residency and establishing their practice - it's the internal drive, commitment, humanity, and willingness to continue to learn that are paramount. I know that anesthesiology is not the same as primary care, but believe me, primary care is very difficult with many competing responsibilities, and a St. George's (or other alternate medical school or foreign grad qualified here) education is not especially relevant. I would not mention it at all, as it will probably be perceived as a criticism and could easily steer your professional relationship in a direction it might be difficult to redirect.
posted by citygirl at 11:44 AM on January 5, 2023 [3 favorites]
posted by citygirl at 11:44 AM on January 5, 2023 [3 favorites]
I have interviewed PCPs on behalf of a relative who experienced abuse and forced sterilization at the hands of doctors. It's not an easy conversation to have. But I think there is a way for you to ask some things. (Agreed on the medical school thing.)
I'm in favour of owning why you're asking what you're asking. Try explaining a very little bit about you and then what worries you like this:
"I'm a really direct person! And I'm anxious about changing doctors, and I've only ever had female doctors. Could you tell me just very briefly a little bit about your background and approach to primary care? Could you also tell me about what you've learned about treating women of my age and general health status?"
Also, I would recognize that it takes time to build trust. And no doctor is perfect. If you can't choose, you can't choose (I'm Canadian, I recognize the issue), but if it is not working out later you can see what changes you can make at that time. In the meantime, trust your gut.
posted by warriorqueen at 11:49 AM on January 5, 2023 [25 favorites]
I'm in favour of owning why you're asking what you're asking. Try explaining a very little bit about you and then what worries you like this:
"I'm a really direct person! And I'm anxious about changing doctors, and I've only ever had female doctors. Could you tell me just very briefly a little bit about your background and approach to primary care? Could you also tell me about what you've learned about treating women of my age and general health status?"
Also, I would recognize that it takes time to build trust. And no doctor is perfect. If you can't choose, you can't choose (I'm Canadian, I recognize the issue), but if it is not working out later you can see what changes you can make at that time. In the meantime, trust your gut.
posted by warriorqueen at 11:49 AM on January 5, 2023 [25 favorites]
I went to graduate school at a university that my bonus daughter snubbed, saying they sent a letter of acceptance when she didn't even apply (implying it's not competitive and therefore a sub par education). I was almost kicked out of my grad program for issues that I now know were related to my undiagnosed autism involving not knowing the scripts to apply to my environment. My internship was a no man's land meant to discourage me from working in my field. They thought I would be a shit clinician (aside from the two professors that actually understood me, respected me, were not intellectually intimidated by me, and worked with me to get their contribution to the program to better fit my unique needs).
I'm now working for an employer of clinical staff that is competitive to work for, on a very large scale. I also have a private practice where I routinely hear things like, "I wish I found you years ago," or "wow I've seen xyz number of therapists but you're the first one that caught that", and my drop out rate is very low even though I don't use any formal feedback mechanisms consistently. My former supervisors reach out whenever they have a new opening because they are so pleased with my performance in that role that they want to woo me back, after years away.
In other words, educational experience for a clinician may have very little to do with the quality of services they provide, and I would caution you to consider the biases that you are applying yourself here.
posted by crunchy potato at 12:02 PM on January 5, 2023 [4 favorites]
I'm now working for an employer of clinical staff that is competitive to work for, on a very large scale. I also have a private practice where I routinely hear things like, "I wish I found you years ago," or "wow I've seen xyz number of therapists but you're the first one that caught that", and my drop out rate is very low even though I don't use any formal feedback mechanisms consistently. My former supervisors reach out whenever they have a new opening because they are so pleased with my performance in that role that they want to woo me back, after years away.
In other words, educational experience for a clinician may have very little to do with the quality of services they provide, and I would caution you to consider the biases that you are applying yourself here.
posted by crunchy potato at 12:02 PM on January 5, 2023 [4 favorites]
I agree that these questions would be jarring for me and would feel confrontational and almost insulting on my first visit with a patient. At the first visit, I'm trying to understand my patient's concerns and needs, and I'm using both direct and indirect language to convey that I truly do care about their care. I would not ask these questions directly of anyone, let alone my own physician.
That said, your concerns are absolutely valid. I would just be honest with your physician. I think you'll get the most informative response that way because you're bringing your real concerns into the conversation.
"Doctor, I've never had a male primary care doctor before. I've had negative experiences in the past. Can you tell me about your approach to treating female patients?" If you have specific concerns, you might bring them up here.
"Doctor, being able to use the portal to ask questions is important to me, but again, I've had negative experiences before. Are you open to my asking questions on the portal?" (And tailor this to your specific experience.)
It might help to consider that your physician is a human who would respond to confrontational questioning the way a lot of humans might, but that doesn't necessarily indicate that you won't have a good relationship with them and have your needs met. The way you approach the situation is as important as their response.
(Also: The implication that patients are in a "submissive" role - ugh, I do not like this notion. Patients and physicians are partners in care. We work together. The patient's voice is the most important one in the room. Paternalism should not be a default in medical care.)
(Also: Personal pet peeve, but I detest the word "medical provider" and find it insulting as a physician. I do not use it in reference to physicians.)
posted by aquamvidam at 12:30 PM on January 5, 2023 [21 favorites]
That said, your concerns are absolutely valid. I would just be honest with your physician. I think you'll get the most informative response that way because you're bringing your real concerns into the conversation.
"Doctor, I've never had a male primary care doctor before. I've had negative experiences in the past. Can you tell me about your approach to treating female patients?" If you have specific concerns, you might bring them up here.
"Doctor, being able to use the portal to ask questions is important to me, but again, I've had negative experiences before. Are you open to my asking questions on the portal?" (And tailor this to your specific experience.)
It might help to consider that your physician is a human who would respond to confrontational questioning the way a lot of humans might, but that doesn't necessarily indicate that you won't have a good relationship with them and have your needs met. The way you approach the situation is as important as their response.
(Also: The implication that patients are in a "submissive" role - ugh, I do not like this notion. Patients and physicians are partners in care. We work together. The patient's voice is the most important one in the room. Paternalism should not be a default in medical care.)
(Also: Personal pet peeve, but I detest the word "medical provider" and find it insulting as a physician. I do not use it in reference to physicians.)
posted by aquamvidam at 12:30 PM on January 5, 2023 [21 favorites]
Re: your bonus comments OP, could be autism in needing things to be precise (a lot of autists I know can come across as very pedantic due to rigid application of rules and models, and frequently offend others with their bluntness) or basic anxiety and wanting information as a form of reassurance. Just for fun, you could read up on OCPD which isn't the same as OCD as there might be some resonance for you there. But my money's on female/AFAB with undiagnosed autism and the traumas that come with being autistic and female in a world that is only recently understanding how many women and AFAB individuals with autism actually exist.
I'm not your doctor or your clinician and I'm not diagnosing you with anything.
Re: your actual question, I agree that you won't get good info asking the PCP any form of these questions. But, asking other staff there is good. You can also ask the PCP something more general like, what do you think the older generation of doctors get wrong about treating patients in primary care? Give him a chance to talk about whatever soapbox he's got about that. The only younger providers I've met that don't have something for this question are those that are truly "servant leaders" who also tend to actually listen even if you're a woman. I suppose it's possible to ask this and get a smarmy, canned or corporate answer that sounds like servant leadership but lands political ... but you'll FEEL that probably, and that's still important data.
Also, I suspect most that choose primary care in the current cohort of recent grads are doing that because they love helping, and want to help as broadly as possible or perhaps enjoy the variety of primary care. It's not where the big money is. It's not the more prestigious specialty. It's where you can do the most good for the greatest number. And it's also a huge slog as others said - they are very overworked, underappreciated, underpaid probably, and have to know a lot about a lot.
They can also be held to unreasonable expectations. For instance, if my PCP pulled up Up to Date to research a condition or treatment for said condition during my appointment with them, rather than be worried they don't know what I need them to know, I would be RELIEVED to see that they realize they don't know everything, that important things might have changed since they last read up on that thing, that they are doing their due diligence and - perhaps most important for me personally - they are not so run by ego that they need to hide a lack of knowledge. That type of ego in a doctor can cause truly horrible outcomes, and interferes with effective collaboration with other specialties and staff. I'd much prefer a humble person that isn't afraid to be open about their understanding. And they CANNOT possibly have the depth of understanding needed for everything that they see as primary care providers. You want someone that is open to being wrong and learning more than a know-it-all, IMO, because the know-it-all PCP is probably full of shit.
posted by crunchy potato at 1:00 PM on January 5, 2023 [2 favorites]
I'm not your doctor or your clinician and I'm not diagnosing you with anything.
Re: your actual question, I agree that you won't get good info asking the PCP any form of these questions. But, asking other staff there is good. You can also ask the PCP something more general like, what do you think the older generation of doctors get wrong about treating patients in primary care? Give him a chance to talk about whatever soapbox he's got about that. The only younger providers I've met that don't have something for this question are those that are truly "servant leaders" who also tend to actually listen even if you're a woman. I suppose it's possible to ask this and get a smarmy, canned or corporate answer that sounds like servant leadership but lands political ... but you'll FEEL that probably, and that's still important data.
Also, I suspect most that choose primary care in the current cohort of recent grads are doing that because they love helping, and want to help as broadly as possible or perhaps enjoy the variety of primary care. It's not where the big money is. It's not the more prestigious specialty. It's where you can do the most good for the greatest number. And it's also a huge slog as others said - they are very overworked, underappreciated, underpaid probably, and have to know a lot about a lot.
They can also be held to unreasonable expectations. For instance, if my PCP pulled up Up to Date to research a condition or treatment for said condition during my appointment with them, rather than be worried they don't know what I need them to know, I would be RELIEVED to see that they realize they don't know everything, that important things might have changed since they last read up on that thing, that they are doing their due diligence and - perhaps most important for me personally - they are not so run by ego that they need to hide a lack of knowledge. That type of ego in a doctor can cause truly horrible outcomes, and interferes with effective collaboration with other specialties and staff. I'd much prefer a humble person that isn't afraid to be open about their understanding. And they CANNOT possibly have the depth of understanding needed for everything that they see as primary care providers. You want someone that is open to being wrong and learning more than a know-it-all, IMO, because the know-it-all PCP is probably full of shit.
posted by crunchy potato at 1:00 PM on January 5, 2023 [2 favorites]
If you are lucky, your doctor will gently inform you that questions about his educational choices and opportunities are not considered pertinent to patient care.
If you are not lucky, he may decline to onboard you as a patient. Yes, doctors can and will do that.
I will also remind you that words mean little compared to actions. Regardless of his answers (if any) you need to judge his fitness for your needs based on what he actually *does* as your doctor.
Focus on your health concerns. As you said, he is your only option at present.
posted by ananci at 1:23 PM on January 5, 2023 [4 favorites]
If you are not lucky, he may decline to onboard you as a patient. Yes, doctors can and will do that.
I will also remind you that words mean little compared to actions. Regardless of his answers (if any) you need to judge his fitness for your needs based on what he actually *does* as your doctor.
Focus on your health concerns. As you said, he is your only option at present.
posted by ananci at 1:23 PM on January 5, 2023 [4 favorites]
If I had to guess the "other factor" that this post suggests, you have an extreme distrust of professionals--at least in the medical field. Not only due to your assumptions about the man's education and the quality of his practice, but because you are requesting an amateur psychiatric diagnosis from a bunch of people on an advice board. Which, understandable, mental health care is expensive, but an actual real-deal diagnosis is probably going to require some interaction with a medical or therapeutic professional.
posted by kingdead at 1:50 PM on January 5, 2023 [1 favorite]
posted by kingdead at 1:50 PM on January 5, 2023 [1 favorite]
Response by poster: There are a lot of responses here, and a lot I want to respond to. Much of what's here is very useful information, and in many cases, it's also hurting kind of a lot. I'm taking it in anyway -- sometimes the same parts are both useful and painful.
Amtho, I'm very grateful to you for your understanding and kindness. It means a lot to me right here and now, and I'll also carry it with me far beyond this thread.
I'm going to process it and sit with it for a while before I respond more fully -- but I will. I am good at taking in what's presented, though, so if it's already been said, and you think you could just say it again or better, but it's a tough message, maybe figure I've got it instead. Thanks all.
posted by daisyace at 2:23 PM on January 5, 2023 [14 favorites]
Amtho, I'm very grateful to you for your understanding and kindness. It means a lot to me right here and now, and I'll also carry it with me far beyond this thread.
I'm going to process it and sit with it for a while before I respond more fully -- but I will. I am good at taking in what's presented, though, so if it's already been said, and you think you could just say it again or better, but it's a tough message, maybe figure I've got it instead. Thanks all.
posted by daisyace at 2:23 PM on January 5, 2023 [14 favorites]
I am not a physician but I am a licensed professional with a degree that ends in doctor. You will be easily able to Google if your doctor did a residence and if they are board-certified. If they are, I would try to put worries about skills out of your mind, and instead ask "I have diabetes, what's your treatment approach?" or another question relevant to a condition you have concerns about. I think you can be direct with a doctor without seeming to act as a medical board. The answers above from the poster who referenced Serena Williams were great.
Try to remember that this man dedicated years of his life to joining a helping profession that is now ridiculed by half of society. Being kind and direct will set you off on the right foot.
posted by notjustthefish at 2:25 PM on January 6, 2023 [1 favorite]
Try to remember that this man dedicated years of his life to joining a helping profession that is now ridiculed by half of society. Being kind and direct will set you off on the right foot.
posted by notjustthefish at 2:25 PM on January 6, 2023 [1 favorite]
Hey there, I just want to say I’m sorry if people’s responses put you on the defensive.
I’m sure you’re aware by now but medical school is very difficult to get into. I don’t know if this particular doctor did their residency in the US but getting into residency is also very difficult. I work with medical students who are exceptional and some of them don’t get into residency. Moreover, applying for residency from a medical school outside the US is often considered a strike against applicants. This article is about Caribbean medical students’ challenges getting into US residencies. This particular doctor might be inadequate for your needs but I thought that context might help you go into the appointment with an open mind.
In general, when I’m concerned about coming across as adversarial when talking with someone I don’t know, I try to think of us as a team working together to make something better. I also think being a little self-deprecating and curious about the other person are helpful.
For those reasons, I think questions like this would work well: “Sometimes with other doctors, I have had a problem with X. How would you deal with that?” “What is the best way to communicate with your office?” “What are your strengths as a health care provider?”
Good luck with this. I hope it works out.
posted by kat518 at 8:18 AM on January 7, 2023
I’m sure you’re aware by now but medical school is very difficult to get into. I don’t know if this particular doctor did their residency in the US but getting into residency is also very difficult. I work with medical students who are exceptional and some of them don’t get into residency. Moreover, applying for residency from a medical school outside the US is often considered a strike against applicants. This article is about Caribbean medical students’ challenges getting into US residencies. This particular doctor might be inadequate for your needs but I thought that context might help you go into the appointment with an open mind.
In general, when I’m concerned about coming across as adversarial when talking with someone I don’t know, I try to think of us as a team working together to make something better. I also think being a little self-deprecating and curious about the other person are helpful.
For those reasons, I think questions like this would work well: “Sometimes with other doctors, I have had a problem with X. How would you deal with that?” “What is the best way to communicate with your office?” “What are your strengths as a health care provider?”
Good luck with this. I hope it works out.
posted by kat518 at 8:18 AM on January 7, 2023
Response by poster: Thank you for all the help here. I understand now what I can and can’t ask and why, the role of med school in general and St. George’s in particular in (not) predicting doctors’ excellence, better determinants of excellence to consider instead, and better ways to figure it out than via direct questions in an intake -- and also some leads on my neuroatypicality or personality disorder or what have you. I appreciate it!
Many commenters offered that guidance while helping me feel understood. Many others, though, seemed to think I’m an oblivious dolt who planned to ask the sample questions in my post, even though the whole premise of my post was that I knew I couldn’t ask them. And some thought even worse of me than that – that I’m an entitled, rude jerk with ugly assumptions. That’s painful – to feel misunderstood and disliked by so many of you making and favoriting those comments (some deleted, I think?), including lots of names that I’ve recognized here for years and years.
So I hope I can be allowed to circle back to three of those topics.
First, “second chance.” I am sorry I referred to it that way. That’s how I’d seen these schools referred to in the press, and I didn’t think it meant anything beyond the literal meaning of the words – that they’re schools that provide a second chance for people whose first chance – often for relatable, blameless, and/or systemic reasons – didn’t work out. I was wrong, the connotation is much worse, and I won’t say it anymore.
Second, that I’m entitled. I can think of a few different reasons for that belief. It could be that I act entitled to a PCP with outstanding expertise. That one’s true. I am highly motivated to find one, if not now, then when healthcare isn’t so overburdened. Directly resulting from prior PCPs’ differing levels of expertise, I’ve enjoyed (in one case) and suffered (in another) big, specific consequences. Plus, I’m just the kind of person who combs through ratings, reviews, and characteristics before buying a darn spatula, so I’m not going to be happy-go-lucky about choosing a PCP. Those of you who prioritize factors like pragmatics and soft skills over sheer expertise, and even more so those of you who think any board-certified doctor is good enough, I’ll just have to agree to disagree. But I don’t think that’s a terrible thing in itself? So, another reason I could be perceived as entitled is because I was going to ask the rude questions, but again, I was never going to do that. Or, it could be because I was acting entitled to a certain kind of intake. This intake is an hour long, preceding my first physical, and has the explicit goal of getting to know one another – though it’s true that I didn’t know that no part of that should be akin to me interviewing him, which was foolish of me.
So that leaves the last reason for some of the harsher judgements of me: not because I was actually going to ask the entitled questions, but because they would even occur to me, with the ugly assumptions some commenters think underlie them. Those ugly assumptions are the final topic I want to respond to. I’m actually bewildered by this one. I have questions when I *don’t* know the answers, not when I assume I do. If I were assuming he was stupid or sexist, I wouldn’t be going to this intake, limited choices be damned. And, if I assumed the answers would be something like “he coudn’t hack it at a top-tier school,” then that wouldn’t serve my whole reason for wishing I could ask: to set aside my worries and feel confident in him. I’m a worrier, and I don’t know the guy, and PCPs have been high-stakes for me, and med school is the one piece of available information when I googled him (being that I didn’t know anything then about residences and certifications). So yes, I do wish he could dispel those worries with what most likely is his reassuring reason for his educational path. And yes, now I understand that I don’t get to find that out, and why it’s not relevant anyway, and what to do instead, and I truly do appreciate that. I just wish that I could have been offered that guidance without alienating and being alienated by so many of you.
posted by daisyace at 1:38 PM on January 7, 2023 [4 favorites]
Many commenters offered that guidance while helping me feel understood. Many others, though, seemed to think I’m an oblivious dolt who planned to ask the sample questions in my post, even though the whole premise of my post was that I knew I couldn’t ask them. And some thought even worse of me than that – that I’m an entitled, rude jerk with ugly assumptions. That’s painful – to feel misunderstood and disliked by so many of you making and favoriting those comments (some deleted, I think?), including lots of names that I’ve recognized here for years and years.
So I hope I can be allowed to circle back to three of those topics.
First, “second chance.” I am sorry I referred to it that way. That’s how I’d seen these schools referred to in the press, and I didn’t think it meant anything beyond the literal meaning of the words – that they’re schools that provide a second chance for people whose first chance – often for relatable, blameless, and/or systemic reasons – didn’t work out. I was wrong, the connotation is much worse, and I won’t say it anymore.
Second, that I’m entitled. I can think of a few different reasons for that belief. It could be that I act entitled to a PCP with outstanding expertise. That one’s true. I am highly motivated to find one, if not now, then when healthcare isn’t so overburdened. Directly resulting from prior PCPs’ differing levels of expertise, I’ve enjoyed (in one case) and suffered (in another) big, specific consequences. Plus, I’m just the kind of person who combs through ratings, reviews, and characteristics before buying a darn spatula, so I’m not going to be happy-go-lucky about choosing a PCP. Those of you who prioritize factors like pragmatics and soft skills over sheer expertise, and even more so those of you who think any board-certified doctor is good enough, I’ll just have to agree to disagree. But I don’t think that’s a terrible thing in itself? So, another reason I could be perceived as entitled is because I was going to ask the rude questions, but again, I was never going to do that. Or, it could be because I was acting entitled to a certain kind of intake. This intake is an hour long, preceding my first physical, and has the explicit goal of getting to know one another – though it’s true that I didn’t know that no part of that should be akin to me interviewing him, which was foolish of me.
So that leaves the last reason for some of the harsher judgements of me: not because I was actually going to ask the entitled questions, but because they would even occur to me, with the ugly assumptions some commenters think underlie them. Those ugly assumptions are the final topic I want to respond to. I’m actually bewildered by this one. I have questions when I *don’t* know the answers, not when I assume I do. If I were assuming he was stupid or sexist, I wouldn’t be going to this intake, limited choices be damned. And, if I assumed the answers would be something like “he coudn’t hack it at a top-tier school,” then that wouldn’t serve my whole reason for wishing I could ask: to set aside my worries and feel confident in him. I’m a worrier, and I don’t know the guy, and PCPs have been high-stakes for me, and med school is the one piece of available information when I googled him (being that I didn’t know anything then about residences and certifications). So yes, I do wish he could dispel those worries with what most likely is his reassuring reason for his educational path. And yes, now I understand that I don’t get to find that out, and why it’s not relevant anyway, and what to do instead, and I truly do appreciate that. I just wish that I could have been offered that guidance without alienating and being alienated by so many of you.
posted by daisyace at 1:38 PM on January 7, 2023 [4 favorites]
daisyace, thank you for patiently elucidating all that. The thing about emotional intelligence is that it's actually emotional skill, and has to be learned, and sometimes taught -- for example, to people listening to words and inferring one thing or another. I hope the world comes up with a better way than this very painful pattern.
I think it's possible to improve on it, but baby steps.
Congratulations on your new PCP! And your thoughtful approach.
posted by amtho at 5:02 PM on January 7, 2023 [2 favorites]
I think it's possible to improve on it, but baby steps.
Congratulations on your new PCP! And your thoughtful approach.
posted by amtho at 5:02 PM on January 7, 2023 [2 favorites]
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Caribbean grads arguably have a tougher road to success than any US-educated physician. St. George is one of the higher tiers of Caribbean Med schools and I have a number of friends who are excellent physicians that were educated there. They aren’t allowed to sit for their USMLE boards unless they are doing well and assured to pass. They have a much lower chance of matching to residency. Literally nothing is handed to them, so they really have to work for their degree and any other opportunity to succeed because of the stigma attached to Caribbean schools.
All of this to say, I guess, that this person really wanted to be a doctor and maybe don’t refer to it as a second chance med school.
posted by honeybee413 at 5:42 AM on January 5, 2023 [61 favorites]