The Empowered Patient: Finding Dr. Right

An except from The Empowered Patient.

by Elizabeth Cohen, MPH

Did you ever see the Seinfeld episode where Elaine gets into trouble at the doctor’s office? While she’s waiting in the examining room, she sneaks a peek at her chart and notices that it says she’s “difficult.” When the doctor comes in, he whips the chart out of her hands.

DOCTOR: You shouldn’t be reading that.

ELAINE: Well, it’s, you know, I noticed that somebody wrote in my chart that I was difficult in January of ’92, and I have to tell you that I remember that appointment exactly. You see, this nurse asked me to put a gown on, but it was a mole on my shoulder and I specifically wore a tank top so I wouldn’t have to put a gown on. You know, they’re made of . . . paper.

DOCTOR: Well, that was a long time ago. How about if I just erase it. Now, about that rash—

ELAINE: But it was pen. You fake-erased.

(Annoyed with Elaine, the doctor makes a beeline for the door.)

DOCTOR (on his way out the door): “This doesn’t look too serious. You’ll be fine.”

Screenwriter Jennifer Crittenden told me that she wrote this Seinfeld script because she’d had a “difficult patient” moment of her own in real life. One day she arrived for her dermatologist appointment on time but ended up sitting in the examining room, drumming her fingers, waiting for the doctor to show up. She looked up at the clock, realized she was about to be very late for work, took off the paper gown, got dressed, walked out of the examining room, and rescheduled with the receptionist. When she returned for the new appointment, she again had a long wait in the examining room. This time, like Elaine, Crittenden peeked at her chart. She found that the receptionist had written she’d been “very angry” at the last appointment. “I felt like it was an odd thing to put in a medical chart, not to mention an unfair characterization of the incident,” Crittenden told me. She fired the dermatologist and found herself a new one.

Go, Jennifer! We all deserve Dr. Right. Having Dr. Right might not seem very important if you’re healthy, but when you’re sick having Dr. Right could save your life. Dr. Right will call you back when you have a question about your medications. Dr. Right will act on a test result instead of letting it sit on his desk for weeks. If you’re in the emergency room and no one’s paying attention to you, Dr. Right will call the triage nurses and light a fire under them.  Dr. Right isn’t just chosen at random from your insurance company’s list of physicians. Dr. Right is someone who comes recommended by someone you know and trust. Dr. Right has experience dealing with your particular medical problem. Dr. Right hasn’t been blasted repeatedly on doctor-rating websites. Dr. Right is someone who hasn’t been censured by her state licensing board. And, perhaps above all, Dr. Right is someone you like and who likes you.

Fixing my mother up with Dr. Right

My mother has end- stage kidney failure, which means that she needs a new kidney. While she waits for one— and it could be years before she gets one, if ever— Mom will have to go on dialysis, where she’ll be tethered to a machine six days a week to clean out the toxins that her withering kidneys can no longer filter.

The worst part of all this is that it wasn’t inevitable. My mother might be healthy today if only she’d found Dr. Right.

Mom has always enjoyed pretty good health, but when she was sixty, she began to feel tired, achy, and dizzy. She went to the doctor, and he noticed that along with these symptoms her blood pressure was borderline high, despite the fact that she was on blood-pressure medication. Her internist tinkered with different medications and dosages, but the achiness didn’t go away, and her blood pressure wouldn’t budge. The internist then proceeded to tell my mother that her blood pressure would go down if she just stopped working so hard. “He told me the high blood pressure and the other problems came from being so busy. Slow down, he said, and you’ll be okay,” my mother recalls.

This response sounded strange to me. My mother had worked hard— and had done so happily— all her adult life, and until now she’d felt fine. Why all of a sudden would her long days (she’s a lawyer, social worker, and grandmother) cause her to feel ill?

My mother’s health continued to deteriorate. While visiting me in Atlanta, she felt especially weak, so I took her to my internist. He listened to her history, noting the tinkering with the medications, and sat and thought for a good long while. When you get back home, he told her, ask your doctor to check out your adrenal glands. Tiny things that sit atop your kidneys, adrenal glands play a major role in regulating blood pressure. When my mother returned home, she saw a new internist, who immediately sent her to a nephrologist, a doctor who specializes in the kidneys. He did several blood tests, which indicated that her kidneys were out of whack. Based on these test results, the nephrologist ordered more tests, confirming an adrenal abnormality.

If my mother’s original internist had caught her adrenal problem earlier, in all likelihood surgery could have corrected it. But at this stage, surgery wasn’t an option. Her nephrologist could treat her only with medicines and changes in her diet. This doctor did a great job, and my mother did exactly as she was told, but ten years after her diagnosis the day we all feared arrived. The doctor informed her that the medicines and the dietary changes were no longer working: she was in end-stage kidney failure. Only a kidney transplant or dialysis would keep her alive.

If the original internist had ordered a simple blood test instead of blaming my mother’s symptoms on her work, she probably wouldn’t be in the situation she’s in now. So why hadn’t the doctor ordered a few simple blood tests when he saw that my mother’s blood pressure all of a sudden wasn’t responding to medication, and when, out of nowhere, she started to feel tired and achy? Why did he blame her for her rising blood pressure? I can’t help wondering: if she’d been a sixty-year-old male CEO, would he so glibly have dismissed her problem as one of simply “working too hard”? Would he have patted a man on the head and told him to relax? Or would he have done more tests to get at the root of the problem?

If there’s one thing you should take away from this book it’s that you must find a doctor who takes you and your health problems seriously. Dr. Right won’t attribute your problems to being “all in your head.” Dr. Right won’t tell you that if you “just relax” your symptoms will go away. If my mother had found Dr. Right from the very beginning, things probably would have turned out very differently. The lesson to learn from my mother’s experience is that a doctor who blames you for your illness is Dr. Wrong. Finding Dr. Right could have saved my mother’s kidneys.

Elizabeth Cohen is senior medical correspondent for CNN’s Health, Medical and Wellness unit and author of The Empowered Patient.

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  • jsmith

    A few years from now you might not be able to find Dr. Right, or even Dr. Anybody, in the outpatient clinic. You will be seeing a nurse or a PA. You will see a doctor who will spend the time to think seriously about your case only if you pay big bucks to a concierge doc, wind up in the hospital, or see the subspecialist that your nurse or PA refers you to. And maybe not even then.
    If you are lucky enough you see an outpatient doc, he or she will likely peek his head into the room to give the nurse or PA a quick second opinion.

    • maribel

      Why would it have to cost big bucks to see a primary care doctor? I would gladly pay my doctor $100-150.00 upfront for a standard office visit knowing most of it is going in his pocket. Then insurance would be for catastrophic events only. Most people can afford this. The definition of “poor” in this country is out of whack when necessities include cable TV, cell phones and a refridgerator full of beer.

      • jsmith

        It works for me, Maribel. Unfortunately, most pts have not been heretofore willing to do this. That might change if the only other option is the cattle call.

  • http://www.drmintz.com Matthew Mintz

    Saw your piece live on CNN and thought it was fairly good and balanced. Especially liked your advice to patients about not handing a stack of pages from the Internet to their physicians. I have not read you book, so the excerpt that Kevin posted may be a little out of context. However, it is really important, when talking about “Dr. Right” that the current state of the health care system makes it very difficult for even Dr. Right to always “do the right thing.” There are many Dr. Right’s out there struggling to do the best they possibly can. Many Dr. Right’s have recently felt that the only way they could stay Dr. Right is by dropping insurance altogether and/or going into concierge/retainer practices.
    The empowered patient recongizes this dilemma. The empowered patient tries to make the best use of their visit time. The empowered patient recognizes that office room waits and missed return phone calls are part of the system, and tries not to get too frustrated. The empowered patient does not place unreasonable expectations on the physician, such as trying to handle everything over the phone or email. The empowered patient asks questions and voices concerns, but in a respectful way.

    • http://www.twitter.com/alicearobertson Alice

      I agree with a lot of what has been shared, but surely “Dr. Right” will always be a relative term depending on the expectations of the patient. At least for me it’s been a bit like finding who fits the glass slipper, and thankfully, I think I found a few who I can rely on, and listen, and most of all really do seem to care. What a relief after the few ugly step-sisters I met before the right ones! Sorta like kissing frogs looking for your prince :)

    • http://www.medicalbilldog.com Dennis (Investigator/Negotiator) at Medical BillDog

      I don’t want to start a war with the medical establishment, but I’m getting tired of seeing some of these same strictures posted by doctors all over the Internet.

      Dr. Mintz, you say:

      Especially liked your advice to patients about not handing a stack of pages from the Internet to their physicians.

      I agree. That could be insulting if it were delivered impolitely–especially as an opening exchange. You could, I suppose, take it as an insult to your knowledge. Of course, the odds favoring you, or anyone, having read absolutely every bit of research in your field are astronomically small. That packet could be a huge favor, could be the data that offers a new high point in your career, but I see the point. Bad form for a starting point. Insulting.

      Let me tell you about something else that’s insulting. The first time a patient mentions researching something on the Internet, she get’s the lecture about how careful she has to be with what she trusts on the Internet. I have my graduate degree. I’m a good researcher. My wife’s a good researcher. All of my best friends are good researchers. We know to check the resources, the date, the methodology. We know that idiots post online whatever they feel or think. We get it. We all get it. We also get that it’s no excuse to dismiss, out of hand, everything that comes from an Internet source. Look at Trisha Torrey’s blog. She’s had patients actually thrown out of the doctor’s office for mentioning Internet research. Superior attitudes and patronizing treatment of our research efforts: that’s insulting.

      You say:

      The empowered patient tries to make the best use of their visit time. The empowered patient recognizes that office room waits and missed return phone calls are part of the system, and tries not to get too frustrated.

      I say, how the hell can I make the best use of my time when the doctor’s staff overbooks so that I don’t see the doctor until an hour after the agreed appointment time? A typical visit to the doctor wastes the majority of one half of a workday–either the morning is shot or the afternoon. You want us to make the best use of a seven minute block in the middle of a two hour fiasco. Yet most of the doctors I’ve seen ask me to repeat everything I’ve told his nurse (she recorded it; I saw her doing so). As for “missed return calls are part of the system,” I think you have a screwed up idea of a stable system. Missed return calls are a sign of bad communication skills.

      I say, I don’t want to handle “everything” over the phone, just the niggling crap that doesn’t require a ruined morning, $30 copay, and an actual face-to-face confab. Look at the current medical home models in which the fee-for-service system has been scrapped and the doctors are on salary. They’re handling 30% of their business via email and telephone, and they’re happy about it. The doctors know that they’re more likely to see patients who actually need to see a doctor.

      You say,

      The empowered patient asks questions and voices concerns, but in a respectful way.

      I want to say kiss my backside (or something much stronger), but for Elizabeth’s sake, I’ll forego that and try to stick to saying something productive.

      You, Dr. Mintz, don’t get to demand a respectful tone from me unless you’ve earned it. Patients become demanding, snappish, peevish, frustrated, and angry because doctors rob them of time, leave them sitting half-naked in a cold exam room for half an hour, forget that the co-pay is in addition to dumping a significant portion of their salaries into insurance and deductibles, insist that they repeat everything they’ve just told the nurse, and then want to talk to them like naughty children. You want a respectful tone from me, you’ll be on time for our appointment, you’ll speak respectfully, you’ll review your notes, and you’ll not withhold information that I need.

      • Maryrose

        I could not agree more. Many doctors think they are God and we as menials. It was not always this way. My father was a family physican and Mom an RN. I wish they were both alive as there would be a line to their door step. They showed true concern and kindness to the patient. Many tears were shed by them when a patient passed on and Dad often would attend funerals. Those kind of health care professionals have been long gone, sadly to say. I hate going to a doctor. I am just another number and come out with the feeling, “what’s the use of doing this injustice to myself”. A walk in Redy Clinic in a grocery store or a drug store treats a patient so much better. They do listen…..

  • ninguem

    Well, if you’re going to bring up Seinfeld, the best medical advice on choosing doctors was in this episode:

    http://www.youtube.com/watch?v=wXeV5cqb_3Y

    • jsmith

      “Doctors, a bunch of lackeys and yes-men all toeing the company line.”–Kramer

  • solo dr

    For the last 20 years patients are fixated on not wanting to pay more than the $20 copay for an office or hospital visit with the health insurance dictating how to practice medicine. If patients really were willing to pay $100 an office visit, insurance companies only would exist for CTs/MRIs/Caths/ER testing/Surgery etc. Doctors would spend more time with their patients if they did not have to prior authorize for free meds/MRIs/Stress Echos/CTs, etc. along with annually having to prior authorize medications that patients have been on for years. Even better is the patients who want mail order meds, are given a year’s supply of meds, but then call the office for a local refill as they forgot to respond to the autofill email for mail order meds and ran out of meds. A lot of medicine is wasted on paperwork and administrative work that detracts from the care of the patient and increases the waiting room times. The current system is not satisfactory for patients or physicians.

  • Susan

    to jsmith…..
    Why are you bashing other health care providers in this post? Ignorance? Lack of experience interacting with non-physicians providers? While most think about the physician as the only person capable of providing health care, there are many other licensed and credentialed providers out there. By your comments, you missed the point of this article.

  • Neil Hoyt

    For a “real world” example of finding “Dr. Right”, you may want to read a two-page excerpt from the recently released book, Faith-Based Caregiving in a Secular World, written by the son of a patient of Steven Reznick, M.D. To do so, click on http://www.bocaconciergedoc.com/ and then click on the excerpt’s link under the Announcements in the left-hand column. This excerpt is a testament to the level of care many physicians still provide in today’s uncertain health care environment.

  • http://www.neelysmiracle.com Christy Thompson

    We didn’t have Dr.Right and it almost coast us our daughter’s life. Thankfully we found him in time. Thank you for sharing this story. We have used Neely’s story through our website (www.neelysmiracle.com) to demonstrate the importance of being an Empowered Patient. We Believe!

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