My Last Week’s Doctor’s Visit

I recently went to a new doctor for a minor problem and was asked a series of questions that made me feel like a criminal before I was locked away. You know that feeling you have when a policeman stops you and is even polite, but you’re still scared that somehow you broke a law and they will find out? I had the inkling that if I answered the doctor’s questions wrong, I would be placed in a sanatorium to be tested and treated until they felt I was safe to return to the public world.

After the exam I couldn’t pinpoint why I felt angry. The staff was professional and did their jobs. I was diagnosed properly and treated successfully, kind of, for my main concern. And then I realized that I was bothered that the doctor didn’t care about all of the other questions I had. She cared about the questions she had. The questions I had mattered to me because they impacted my quality of life, my experiences on a daily basis. The questions she had mattered to her because she was concerned about the ramifications of my health on the public. And there was a constant undertone that she was skeptical of my answers.

Why would a private doctor that I pay for out of my own pocket be concerned about public health more than my private health?

Public Health is Great, But not for Patient Exams

Public health is managing illness at the population level. The severity of the illness matters, its prevalence matters, its cost matters, and its transmission matters. Amazing information comes out of public health research. We all apply public health behaviors to better our own lives – washing your hands after going to the bathroom (I hope), not sharing drinks with friends (I apparently am the only one who is cold-hearted enough to do this), vaccines, wearing a condom to prevent some STDs, eating nutritious foods and regular exercise, etc.

While I expect any doctor I visit to have an understanding of public health, it’s usually not the reason why I am coming to see them. I am coming to see a doctor for very personal reasons that are a big enough deal that I have researched online for nearby doctors, called around to schedule an appointment, wasted time that day to visit them and for follow-up visits, and pay what often comes out to at least one to several hundred dollars to get taken care of. The difference is that I am your paying customer. If the government and taxpayers wanted to pay for my public health services, I’d totally be fine with that and manage my expectations likewise. Or if you are a Kaiser patient, you understand that in exchange for a really efficient and affordable healthcare system, you are a number and not a person. But this wasn’t my doctor.

5 Signs You Are Being Treated For Public Health

1. You are not at risk for a condition, but you get tested for it anyway because it is prevalent in your community

2. You are given recommendations that don’t apply to your lifestyle in any way, shape or form

3. You spend the majority of time answering your doctor’s standard line of questioning than they are answering yours

4. You are suffering from symptoms that your doctor calls “normal” and fails to help with treatment because they “aren’t that serious”

5. You are not allowed to get an expensive diagnostic test simply because it is expensive without working through if you may actually need it

 

5 Ways to Change, Really

I know doctors can be under a lot of pressure. There are really great doctors unhappy with their employers’ policies (hospitals); there are really great doctors restrained by insurance requirements; there are really great doctors who run expensive private practices; there is a really small number of really great doctors who are also innovative business leaders; and there are crap doctors who don’t care. It’s expensive and time-consuming as a patient to visit doctors by trial and error (I really feel for undiagnosed patients who do this). So I know it’s not that easy to just “change doctors”.

What I have proposed is changing the conversation with every doctor you visit. The idea is to assume that your doctor wants to help you. By changing the dynamic of the conversation, it may make it easier and more likely for you to work successfully with a variety of doctors.

1. Make sure you start the conversation.

If they ask you a question, interrupt your doctor, and re-start the conversation. It is possible to do this in a polite way and write out your needs before your visit if it helps you stay on track.

2. Make sure they answer all of your questions.

Again, you can write them out before your visit. To be fair, your doctor is limited in time depending on how much you have paid them (your insurance pays primary care doctors for 7-15 minutes of their time). If you have a list of questions, make sure to prioritize the important ones first. Ask your doctor how much time you have for your visit. See if you can e-mail them follow-up questions or schedule a longer appointment if possible to address all of them.

3. Confront them when their recommendations are insane.

I had one doctor in my early 20s tell me to quit my job. While there could have been an iota of truth in this idea – my job was kind of stressful – a more useful recommendation for a college grad with huge debt would have been going to someone to learn stress management techniques first. If a doctor gives you a recommendation and your first instinct is “impossible”, it really is impossible for you at that time. The likelihood of you actually following through is very, very low unless you face serious health side effects as a result. The doctor may not change the ultimate recommendation, but negotiate with them for middle ground before going to an extreme change in life.

4. Ask them why the diagnostic tests they recommend are important and how they work.

Some doctors do this automatically. I am an information fiend, so I often request this. And sometimes I find out that the tests they want to do really don’t make sense for me. So as a paying patient, I can say, NO. You can say no to getting tested for something that doesn’t make sense for you. In the reverse, if you’re one of those annoying patients who did research before visiting the doctor and you think you have a health condition that your doctor disagrees with and refuses testing for, ask them to work through the problem with you. If there are more affordable tests you could start with and haven’t tried yet, you can make stepping stones before launching yourself into an expensive test. I have met the people finally diagnosed with a brain tumor, with Lyme’s disease, and with appendicitis who had testing refused because they were considered expensive. If money is the only reason to not get testing, there may be a wiser path to take instead of simply not having it done.

5. Validate your own symptoms.

This one is often a struggle for me. I would love to ignore “not feeling right” because it’s easier. But if I’ve gotten to the point of going to see a doctor, I have already decided that my symptoms are seriously impacting my life. It is not the doctor’s decision to say that your symptoms are unimportant. They obviously are to you. Don’t leave an exam feeling ignored. It is possible to be polite and firmly re-state how they are important to you if your doctor dismisses them. I have become highly skeptical of the “it’s in your head” conclusion as we uncover the reality of more and more conditions that used to be “in our heads”. If the doctor simply doesn’t know how to treat your symptoms, instead of ignoring them, request who would be another doctor who could better help you.