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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