Need new GP; GP too thick to take "Please refer me elsewhere" well
July 30, 2008 12:53 PM   Subscribe

I can't stand my doctor, and I don't think she likes me much, either. I need a prescription, though. How can I hint at her to refer me elsewhere? GPs are in short supply here.

I think my doctor is, personally and professionally, a moron. Confronted with a lump and told "It doesn't hurt," she scratches her head and says "Maybe it's a bruise?" She's ditzy and prone to making spelling errors. Stares at polka-dots and calls it striped. Ask "Do I need to take these on an empty stomach?" and get a blank look. Etcetera, etcetera. I never have a visit where she doesn't screw up at least once. My asthma is getting worse and I'm not getting anything done because her suggestions have been so bad it's clear she doesn't know what she's doing.

I am extremely polite, but I suspect my disgust is palpable, and I suspect she doesn't much care for me, either.

I'd love to curb my doctor visits for the moment, but. A flare-up of an ancient insomnia problem has me dependent on her for a prescription. She clearly hates to be dispensing this (non-benzodiazepine) medication; getting any prescription from her has always been an adventure; a miscarriage got me lectures on the addictive properties of painkillers rather than helpful medication. However, I've seen two specialists, and both backed my use of the sleeping pill -- and certainly she has no useful alternate ideas herself, so she's in a bit of a corner. But every visit for a prescription renewal is a nightmare; stupid questions from somebody who dislikes me and squirms over the renewal. My insomnia is getting worse from the anxiety over this.

The specialists were a psychiatrist, who wrote a nice letter about me and declined to see me again, citing lack of actual psychiatric problem, and a sleep specialist, who didn't really have anything new to offer and who doesn't follow patients, so I can't see them for the prescription instead.

She works in a practice with about ten other GPs. This is in Ontario where there's a doctor shortage; I have made it through in the past by always booking appointments on a flimsy pretense of urgency during the times when she's not there. The other doctors there are all great, strangely enough. I rang and asked if it was possible for me to see somebody else in the practice and got a curt "No, we don't do that." I have hinted at her that "maybe a few more sessions with a psychiatrist would be useful?" in hopes of her taking the hint and referring me elsewhere. No, [first psychiatrist] said you don't need that.

I'd just come out and say "Clearly this relationship isn't working for either of us; can you get me in with another GP?" but I'm pretty sure that wouldn't work with her, at least not immediately, and future appointments with her would be even less tolerable.

Is there a good way out? How can I even begin to explain this to another GP if I can actually find one? I have now asked three specialists for a referral to a GP and got nothing because I already have a GP; it seems I need her to want to hand me over to another GP...?
posted by anonymous to Health & Fitness (16 answers total) 1 user marked this as a favorite
I don't know much about Canadian healthcare, but being direct and adamant seems like the best recourse to me. Who runs the office? Tell them "Dr. Schlock and I don't get along well and I have lost confidence in her ability to treat me effectively. Please reassign me to Dr. Harmonious."
posted by Daddy-O at 1:14 PM on July 30, 2008

Have you actually been demonstrably harmed by anything that she's done? If so, I wonder if a malpractice lawsuit might just do the trick? You don't actually have to bring it to completion, you can just offer to drop the lawsuit if they'll allow you to see another doctor as your GP. There's no way that anyone in their right mind would say no if put in that position.

Maybe I'm thinking too much like an American?
posted by Citrus at 1:14 PM on July 30, 2008

I wish you could follow up -- I don't understand why you can't just go to another GP in a different practice as a new patient? If they ask at the new doc's office if you have a GP, the answer is no.
posted by desuetude at 1:14 PM on July 30, 2008

Subtlety is not going to work here. You're going to just have to say to her that you want to be seen by another GP. Period. I don't know how it works in Canada, but figure out what channels you have to go through up there to report negligent care if she doesn't send you to another doctor.

But if that still doesn't work (and this is sketchy and should be a last resort), it might work to "admit" your deep sexual attraction to her, come on to her a bit, and then say that you don't feel comfortable seeing a doctor you want to sleep with. Make her feel icky enough that she wants to get rid of you.
posted by phunniemee at 1:16 PM on July 30, 2008

In Manitoba, I've had success contacting the College of Family Physicians to find GPs who are accepting new patients. Here's their Ontario website.
posted by Koko at 1:25 PM on July 30, 2008

Seconding desuetude - just go into another practice and tell them you have no GP. That's no lie, since you can break your relationship with your current GP by simply not returning to see her and not saying she's your doctor anymore. You don't have to do anything special or beg for a referral.
posted by pocams at 1:26 PM on July 30, 2008

Citrus, I don't know if you're a lawyer, but even starting a lawsuit is a huge headache and will cost money. Not to mention that if the poster's anxiety over this is causing worse insomnia, the stress of a lawsuit is going to drive them insane. Not to mention that the rest of the doctors would probably not be interested in treating someone who sued their collegue and would probably not want to develop a particularly good doctor-patient relationship with that person. Bad idea, American or Canadian.

Anonymous, I think you probably just have to be completely direct about it. Doctors are professionals, as much as yours might not seem to be, and should be able to accept it if a patient says something along the lines of "I think we just don't see eye to eye on my treatment, I appreciate what you've done for me, but I'd like to see Dr. _____ in the future." Whether or not your current doctor actually has the power to get to you transferred to one of the other doctors in the practice may be a whole other issue though. They may have full plates and not be willing to accept another patient.
posted by wuzandfuzz at 1:26 PM on July 30, 2008

I don't know how it works in Ontario, but in Manitoba you can change GPs if you can find one who is accepting new patients. If they ask you why you want a new GP, just tell them the old one wasn't helping you.
posted by Koko at 1:27 PM on July 30, 2008

What a bizarre situation. You have options but you're kind of taking the role of the victim. Talk to the office and tell them you don't feel comfortable with the doctor and ask to be switched to a different one. If that doesn't work then get a referral from a friend to her doctor. If that doesn't work then use the College of Family Physicians search engine to find someone. If that doesn't work and you're in Toronto then go to Toronto Western, second floor, west wing, Family Health Centre. No problem getting a doctor there within a day or two.
posted by loiseau at 1:33 PM on July 30, 2008

Looking at how the two specialists reacted, I'm asking 'HOW DID THIS WOMAN GET A MEDICAL DEGREE?' There's an old saying - what do you call the person who graduates last in his class from medical school? Doctor! And there are a whole lot of more competent folks of both sexes who have medical degrees who'd be happy to treat you.

Be direct and tell her things aren't working so well for you and you'd like to see another GP. If she asks what's wrong, tell her directly. She's a professional, she can handle it.
posted by kldickson at 1:33 PM on July 30, 2008

It seems like you should split this into two separate issues and deal with them one at a time.

1. You need the prescription for a sleeping pill. Given that the length of time to secure a new doc is uncertain, you should probably get this taken care of before moving on to #2. Make an appointment, go and see her, and continue to politely insist that you need some sort of resolution to your insomnia problem before you'll leave the office. Dealing with docs in the U.S., I've found it's helpful to adopt an attitude of being flexible about how a problem is solved--after all, she's the expert (even if you don't respect her much)--but inflexible in insisting it must be solved. If she hems and haws about giving you a prescription, ask her to refer you to a specialist. If she won't refer you to a specialist, insist that she must do something for your problem. Adopt the pleasant-but-unflappable attitude that you won't be moved until there's a resolution. Continue to ask, "So what is the plan for dealing with my insomnia?" every time it seems like you've come to an impasse. She's the doctor, and she needs to come up with a treatment plan.

2. You need a new doc. In this situation, I think you have no choice but to be direct with her, or with the head of the practice if there is one. However, again I'd try to approach it with the explicit attitude that you have a problem (you don't feel that you communicate well with her, and it's impeding your medical care) and you have a suggested solution (a referral to a new GP), but that you're flexible in how it's dealt with so long as it is dealt with. That way you're less likely to poison the relationship if she initially refuses (the response to that refusal would be, "Okay, if you won't refer me to a new doctor, how can we deal with the fact that my medical care is being impeded by our failure to communicate well?" -- uncomfortable, for sure, but keeping the outwardly-pleasant demeanor while insisting that a problem must be taken care of makes for surprisingly civil conversations in these matters, and you never know: things might actually improve with this doctor).

I'm not in the Canadian medical system, but I am in a closed-panel HMO and I think some of the dynamics of dealing with docs can be the same (needing referrals and the consent of your primary GP before you can get anything done). Good luck. The sooner you can deal with #1, the better equipped you'll probably feel to deal with #2. Don't try to do everything all at once--that's a recipe for anxiety!
posted by iminurmefi at 1:40 PM on July 30, 2008 [2 favorites]

I would politely ask to talk to the office manager and explain that you are having personal differences with your doctor but like going to the practice, like the convenience, etc. and that you would like to switch doctors and if you can't, you will have to find another office to go to, something neither of you would like.

We have this situation in my office (4 doctors). One of us (the senior person in the practice) is, um,... weak... in the interpersonal department and we get requests all the time to switch. It creates a tricky problem for us, we don't want to be accused of stealing patients but we also have to acknowledge the patient's right to see who they are comfortable with. Our official position is "we discourage switching because it's best medical practice for the patient to see the doctor who knows them best, but changing PCP is ok in some situations."

I suspect the office manager has had to deal with this situation before with other patients, so I would try and work it out with that person instead of creating a confrontational situation with the doctor. In most cases it really is personal style that leads to someone changing doctor but if you talk to the doctor about it she will read it as her not being a good enough doctor and that probably will lead to a really non-productive area of discussion.

Worst case scenario, you find a new office farther away.

Your concern about being seen to be "doctor-shopping" is valid but if you are totally honest with your new GP right from the beginning about the problems you had before, it shouldn't be an issue, at least with the kind of doctor you are interested in finding.
posted by Slarty Bartfast at 1:46 PM on July 30, 2008

Does Ontario not have walk-in clinics? In BC we have a ton, and you can get in to see a doc without any real problem. If you go at a busy time you may have to wait a couple hours, but if you bring a book and can tune out the screaming, sniffly kids, it's not completely horrible. That should get you your prescription.

If you still want a GP (and I don't blame you -- walk in clinics have their place, but sometimes it's nice to have an ongoing relationship with a doc, instead of just getting the next one available), then you simply need to pretend you don't have a GP and look for one accepting new patients. Pretend you just moved to the area. There are definitely a shortage of GPs accepting new patients country wide, but there has got to be somebody. Use the website linked above, or just go through the phone book, asking if they're accepting new patients.

You don't need to explain anything. If they ask who your old doc is, or they want the records, just tell them who she was. At most, all you need to explain is that you felt your previous doctor was no longer able to help you.
posted by cgg at 2:02 PM on July 30, 2008

cgg: Yes, Ontario does have walk-ins, at least in Ottawa.

Anyways, I'd avoid asking the doctor herself, and instead ask the administrative/office staff. Repeatedly. And insistently. In person. You might get better results in person than the curt answer you got when you called.
posted by flibbertigibbet at 3:33 PM on July 30, 2008

Here's the phrase that pays (in this situation): "I'm not sure we're a good match". Does not assign blame (on the surface, of course you're not really fooling anyone, but it's how to handle this situation).

As in:

"I really appreciate all you've done for me, but I'm not sure we're a good match. I know you're very busy with the number of patients you handle, so I hope you won't mind -- but would you please refer me to another doctor? Maybe another GP or internal medicine doctor?"
posted by amtho at 4:20 PM on July 30, 2008

Just go to a walk-in clinic.
posted by chunking express at 8:38 AM on August 1, 2008

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