When Should You Fire Your Doctor?
By Tracy Morris
It’s a small worry, but it’s plagued you for weeks now, maybe years. Your primary care doctor has already brushed it off, told you to keep him posted about any changes, not to worry now. There’s been no change, but it still crops up regularly — not enough to sideline you at all, just enough to remind you again of your worry that something’s amiss.
Is it time to ask someone else? Get a second opinion? Maybe replace your doctor altogether?
Phyllis Hollenbeck, MD, is on a mission to open the eyes of both patients and physicians, to bring us all back to what healing and health care can and should be still. In her book, Sacred Trust, she illustrates what she calls The Ten Rules of Life, Death, and Medicine with unexpected compassionate warmth and poignant story-telling from her 30 years as a physician.
Perhaps the fact that I found her level of humanity and caring to be “unexpected” says something about my own experiences, professionally and personally, with doctors.
The Problem For Us All
If you’re like most women, you find a doctor — especially when it comes to your gynecologist — and stick with him or her for as long as you can. It’s a tactic that’s smart for several reasons. It’s good for what practitioners refer to as ‘continuity of care’, meaning essentially that the same set of eyeballs are reading your patient chart, theoretically tracking your health’s changes over time.
Of course, we all know that insurance coverage, if you’ve got it, and out-of-pocket affordability have bearing on who you see, too. Some of us may want to wander the health care practitioner terrain, but we simply can’t pay the bill that would be rendered.
There are other reasons why we don’t stray from the comfy confines of our (typically) assigned primary care doc’s realm.
For one thing, we’re loyal. As humans, that is, females are good about forming emotional bonds pretty quickly, especially with those we perceive as helping us, and then we’re even better about living the concepts of fair play. You take care of me, I’ll return the favor by remaining a patient in your medical practice.
Another reason women and men stand by their docs is our limited understanding of what physicians know and our related awe of their supposed skill set. Bluntly, we tend to think of them as deities, all-knowing and altruistic. Sure, we may be smart enough to know better, but the truth is that most patients really do expect more from their docs than most (any?) human can give.
Dr. Hollenbeck shines light on the realities of medical school and residency programs with apt and humorous description, and realistic dialogue.
Hollenbeck, the long-time single mom and care-giving daughter of elderly parents describes the state of being a patient: “The role of a patient means being infantilized, or worse, blown off by (usually) a guy wearing a white coat, whose training was essentially an enforced adolescence.”
I asked her about the idea that all docs start off with the inter-human skills of a typical teen.
“Adolescents have a lot of information thrown at them, just as doctors in training do. One day it seems easy, the next, you feel like an idiot. You’re also at the mercy of people who can either teach you and bring you up right, or people who aren’t very good at explaining ‘here’s how to become a grown-up’. You get yelled at a lot by people with your future in their hands. So whether it’s a question of getting the car keys or passing that course, you can be really stuck.”
Hollenbeck continues in detail about the medical educational process that is still a mystery to most Americans. “A lot of the trainers are people who worry you’ll surpass them in knowledge and skill — they actually want to keep you down because of their own insecurity. You’re in a rigid environment for many years, with a standardized curriculum — which has been a good thing in terms of the U.S.’ quality of medical advancements — but just like in high school, you’re in lock step. From medical school, you go into residency for anywhere from three to seven years of additional training depending on your specialty.”
“Depending on who’s teaching them, they can come out as a more mature person — with great empathy for people, a greater sense of humanity, of what life is about, its heartbreak and its beauty — or they can make no emotional progress from the person who was a premed student.”
So, I ask, worried that I know the answer already: how do we find a doctor like Phyllis Hollenbeck, MD? Or at least, what knowledge do we need, steps can we take to enlist the services of a physician who thinks and toils as much with her heart as her head and hands?
First, we might ask about their early years and undergraduate training.
Hollenbeck, a science-loving cheerleader who loved writing in her childhood, was turned on to the medical arena in Senior high school. She was fascinated by human stories and was able, thanks to Brown University, to combine majors in English and Premed in a program now called Liberal Medical Education.
Okay. Maybe we won’t be so lucky as to find a physician with that history.
Dr. Hollenbeck, who has managed to finesse her book and its message into a few medical schools’ reading lists, says she hears the question all the time.
“How do you screen through the jerks and find doctors who haven’t broken all the rules?” she posits. Her knowledge and experience give Hollenbeck an enviable position as a health care consumer. “I’m looking to give everyone the benefit of the doubt when I’m a patient, but I’m going to know within 60 seconds if you’re a jerk or not.”